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Tech industries still suck at estimating costs.
CI/CD = Continuous Impediment/Continuous Despair
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Sure, but at least they give you some sorta number or a ballpark. I've worked with clients myself in larger companies and a few of my bosses for smaller companies would be happy to tell me the ropes. I never met one vendor that says, nah just sign this to agree to pay a mystery amount we'll figure out later.
Also, the larger the firms, the monies exchanged are contracted. So, you know what your spending.
Jeremy Falcon
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That's pretty much how it works in the US. Medical tourism has become a thing with Americans because of insane prices and is becoming a thing with Canadians because of insane wait times. Mexico, Panama, Thailand, and India have excellent, affordable private clinics, often staffed by doctors who trained in the US.
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Real talk, if I ever needed a serious procedure... time to plan a vacation. 
Jeremy Falcon
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There are some downsides for medical tourism. I recall reading about some woman who went to Mexico for a procedure that was completely botched. Oh wait, that happens in the US as well  .
At 65, I'm reaping the consequences of chewing ice from when I was 15 to about 25. At 25, the dentist read the riot act at me, so I stopped. I've split two teeth vertical now (means no saving them). I was looking at going to Costa Rica, but their prices seem to have gone way up over the past decade.
Charlie Gilley
“They who can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety.” BF, 1759
Has never been more appropriate.
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I was treated for COVID in the US in 2022.
I didn’t pay for hospitalization as:
A) I am eligible for Medicare
B) I think the US government mandated free treatment as they didn’t want untreated patients wandering through the country spreading the infection.
I did pay for tests and certain fees for the doctors, amounting to about $5,000.
As I had mentioned earlier, I had a cardiac arrest when I reached the hospital and they resuscitated me after some 4 minutes of heart stoppage. I guess the pumping of my chest supplied enough blood to my brain so I don’t have brain damage (I think).
The doctors were very good. But they were quite surprised that the two stents in my LAD artery stayed put despite vigorous pounding of my chest and possibly using electric shock to restart my heart. The doctor’s comment (he had trained at Harvard Medical School) was: any hospital in the US can put in stents but this level of quality is possible only in the top ten hospitals in this country. My stents were put in at a hospital in Kolkata, India.
The nursing care was good M-F but around 3 pm Friday, the nurses would start going home and then till Monday morning, nursing care was abysmal. I got myself evacuated to India for further treatment.
Last year, I returned to the US and caught COVID again. Ran back to India. COVID subsided but left me with kidney failure. I guess I could return to the US for free dialysis but I found I can easily pay $60 ( I could price shop and get a lower price but saving $20 is not worth it) for each dialysis session three times a week out of pocket rather than go through the US medical system.
I get excellent care, the doctor visits me during the dialysis session to find out how I am doing, any minor infections are treated at once with antibiotics (antibiotics cost me $2 for my current UTI). If necessary, the technician comes to my home for drawing blood or collecting urine/stool samples.
In short, I am treated with great care and kindness. The equipment is the same as you would find in Europe or the US. The hospital will ensure my safety as I am a cash cow for them (kidding).
Most of the doctors have undergone training in the US or UK after their basic medical degree from India and so are conversant with the most current medical treatments.
The number of patients the doctors see in India is huge. They see every disease in every stage of progression so that their practical knowledge is very very high.
I can’t ask for or get better medical care.
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There have been a few politicians advocating for legislation to require medical providers to publish their prices for everything they do, but I haven't heard of anything helpful resulting from those efforts.
Will Rogers never met me.
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Hopefully it just won't end up being one of those promises that only exist to win a vote.
Jeremy Falcon
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I've never heard of anything helpful coming from any politician's brilliant ideas for legislation.
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Couple of points:
1. Medical Industry deals with living patients, and each of us has a (slightly/largely?) different response to the same treatment (because of a variety of factors - genetics, lifestyle, habits, stage of ailment, etc.)
2. Because of this different response (complications in extreme cases), the type and duration of treatment are likely to be different for each patient.
Therefore, a fixed-price model may not always work.
Can we compare this with a bug-fixing type of software project, where the type and criticality of bugs is unknown; where a Time & Material pricing model is more suitable? (comparing an ailment to a bug/set-of-bugs).
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Amarnath S wrote: Therefore, a fixed-price model may not always work.
That's a load of nonsense. Software development also deals with unknowns and yet they still price better than that.
There's nothing preventing them from doing flat rates or rates by procedure even if it's more then one procedure. And there's certainly nothing preventing them from knowing how much a procedure would cost regardless if it needed to happen to or not. There's no honest or transparent billing schedule and it's on purpose.
Amarnath S wrote: Can we compare this with a bug-fixing type of software project, where the type and criticality of bugs is unknown; where a Time & Material pricing model is more suitable? (comparing an ailment to a bug/set-of-bugs).
Clearly, you've never hired anymore or a vendor. You may want to think a bit more about what you're saying.
To this point though, time and material is at least comparable to a fee schedule for unplanned procedures, if you're trying to quantify the unknown. And that can be priced by procedure. The vast, vast majority of procedures and ancillary procedures are known however. Which means, you have at least two options for upfront billing models.
Also, side note, time is what rookies do, but that's irrelevant.
There is zero reason why people cannot give an estimation or fee schedule upfront. Regardless of whether or not that fee schedule includes time or not. Zero. No real vendor does that. One that's actually in business instead of just spouting theory online.
Jeremy Falcon
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Fair enough.
I can only write from my experience, and that too, in India; cannot tell about other places.
- I was hospitalized in 2021, and they initially said 3 days of hospital stay. And we paid the appropriate amount (i don't have medical insurance). But the stay extended for 6 days, and the amount doubled. This is what I meant by non Fixed Cost.
- While working, the neighbouring office was an Offshore Development Centre, in India. There were about 100 people working of fixing OS bugs, some of them kernel type of bugs, for a Unix flavour. The centre ran for about 8 or 9 years, and was run on a T&M basis.
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There's nothing preventing anyone from having a fixed cost per day for a hospital stay. Doesn't matter if you stay 3 days or 30 days it's simple addition. Hotels do it all the time. There's also nothing from knowing the price of a primary or secondary procedure before it's performed. The time simple fact is they don't want to tell you upfront so you can't shop around.
Jeremy Falcon
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In India, the prices of primary and secondary procedures (both diagnostic like CT, MR, Ultrasound, etc. and treatment like surgeries, etc.) are told upfront, in most big hospitals (of course exceptions are there where hospitals lose their human touch and become crassly commercial, but they are exceptional cases).
And further, there are a number of Government run hospitals and charitable ones (professionally run), where even angioplasty and bypass surgeries are done at highly concessional rates.
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That just gives more credence to my point... it's completely possible. Over here in the US, they don't even give us that info. It's a just sign here and we'll charge whatever we want later on.
Jeremy Falcon
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Perhaps the lesser prevalence of medical insurance in India makes hospitals to state upfront the diagnostic / treatment expenses, to the patient. Because a significant percentage of people use personal funds for healthcare, and need ball park estimates.
However medical insurance is gradually increasing, and maybe after 50 years, the situation in India may become like US.
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They do it because they can. No one does comparison shopping or gets multiple quotes before going in for emergency surgery. The best anyone does is to ensure that the hospital & surgeon are in their insurer's network.
Freedom is the freedom to say that two plus two make four. If that is granted, all else follows.
-- 6079 Smith W.
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Thanks for the intelligent reply, Daniel. Some peeps can't see outside the box they live in, ya know. 
Jeremy Falcon
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US Medical Industry.
GCS/GE d--(d) s-/+ a C+++ U+++ P-- L+@ E-- W+++ N+ o+ K- w+++ O? M-- V? PS+ PE Y+ PGP t+ 5? X R+++ tv-- b+(+++) DI+++ D++ G e++ h--- r+++ y+++* Weapons extension: ma- k++ F+2 X
The shortest horror story: On Error Resume Next
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Doctors, lawyers and consultants are all similar.
You pay regardless of if they fail or succeed.
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Questions
Is it Maintained?
Do you look for it or just explore the code?
What do you do if it is not there?
Is the code documenting itself good enough?
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(nervous laugh) Hahahahaha deep breath Hahahahaha!!!
When I'm going through undocumented legacy code, I write code comments worthy of a 1st year college student.
If there are function comments, I'll check them, add missing parameters comments and stuff like that.
We lost many, many years of expertise (retirements) in a short amount of time; so there is a lot of documentation going on.
CI/CD = Continuous Impediment/Continuous Despair
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similar boat to you with retirements and a vast change in staff
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Never trust documentation. There is no guarantee the last developer updated it when they changed the code. You can read it as a guide. So trust, but verify.
Hogan
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