{
 "schema": 1,
 "id": "is-it-cheaper",
 "type": "story",
 "names": {
  "name": "Is it cheaper",
  "aliases": [
   "the price comparison, worked",
   "one knee, two prices"
  ],
  "said": "The trade answers with a percentage. This page answers with two published numbers and a list of what neither of them contains."
 },
 "region": [
  "global"
 ],
 "facets": {
  "kind": "essay"
 },
 "text": {
  "what": "One operation, two published prices, worked to the end. A Bangkok hospital's knee package set against an English provider's self-pay list price for the same operation, with the implant, the nights past the package, the two flights and the follow-up at home added back in one line at a time. Every figure is read off a seller's own page with its own date and put through one dated exchange-rate table. The point of the exercise is not the ratio it produces. It is the count of lines nobody publishes.",
  "story": "Bumrungrad International Hospital in Bangkok prices package JOINT04, a unilateral total knee replacement, at 356,500 baht, and states the price valid until 31 December 2026. Practice Plus Group in England lists knee replacement surgery at £13,799, under the line \"Prices correct as at April 2026\", with the initial consultation priced separately at £145. Put both through this site's single rate table, dated 16 September 2026, and they come to 10,707 and 18,596 US dollars. The English number is 1.74 times the Thai one. The difference between them is 7,889 dollars.\n\nThat ratio is the last defensible thing on this page, and it is already wrong, because the two numbers are not descriptions of the same object.\n\nThe English list says what it buys: a pre-operative nurse review, prescriptions, dressings and equipment, the anaesthetic, \"any overnight stay required\", physiotherapy, \"pathology and histology needed whilst admitted\", \"any post operative appointments required\", and a named consultant from start to finish. The Bangkok package buys three hours of theatre, the nursing and surgical team fees inside those three hours, three nights on the surgical ward, equipment and supplies, medications related to the procedure, the surgeon, an assistant surgeon if needed, and the anaesthesiologist. It then names nine things it does not buy: the implant, the first consultation and the follow-up visits, specialist consultations, nights beyond three and any intensive care, blood transfusion, laboratory and imaging before or after surgery, take-home medication, outpatient charges before admission, and complex or emergency cases. Seven of those nine sit inside the English price.\n\nThe first missing line is the largest. The Bangkok package excludes the implant, and says so in its own title. The English list does not name the implant on either side — neither as an inclusion nor as an exclusion — which is a different silence rather than a smaller one. No page read for this record, in any country, publishes what a knee implant costs. *Inference —* the 7,889-dollar difference is therefore headroom measured against an unpriced item. If the device and its fitting run to more than that at the Bangkok end, the trip is dearer before anybody boards an aircraft, and nothing published by either seller settles the question either way.\n\nThe second line is the nights. Three are named in Bangkok and the fourth is billed; in England the phrase is \"any overnight stay required\". The side of the comparison with a capped stay is the side that can overrun, and the overrun is priced by the party the patient is already committed to.\n\nThe third line is the flights, and this site's own price table is the evidence about them. Of 214 published price rows on disk, twelve name flights among their exclusions and none names them among the inclusions. There is no fare anywhere in the table, because a fare is not a published price with an inclusion list. What can be got is a scale: the International Air Transport Association's fact sheet, updated June 2026, forecasts 839 billion US dollars of passenger revenue in 2026 against 4,343 million origin-and-destination passengers. *Inference —* that is about 193 dollars a journey, it is this project's division rather than any figure the association publishes, and it is the average of every seat sold on earth including domestic hops, so it is the wrong number for London to Bangkok. It is the right number for the shape of the argument: against a 7,889-dollar gap, two long-haul fares move the answer without deciding it. Against a dental crown at a few hundred dollars, the fares are the entire transaction.\n\nThe fourth line is the follow-up at home, and the only published figures for it are failure figures. Gold Coast University Hospital in Queensland costed twelve patients presenting in 2012–13 with complications of cosmetic surgery done in Thailand at AUD$151,172.52 to that hospital in one year, averaging AUD$12,597.71 each. An NHS Scotland series of 81 patients over five years came to £755,559.68, \"an average of over £9,327.90 per patient\". Surgeons at the University of California San Diego reviewed 91 patients who had bariatric surgery in Mexico and then presented to them between 2014 and 2024, and put mean total hospital charges at $193,445.08 each. *Inference —* none of those is a term to add to a quotation. Each is conditional on something having gone wrong, and none has a denominator. What they establish is the size of the tail, not its likelihood.\n\nSo what the 1.74 covers is this: one hospital's package against one provider's list price, on their own stated dates, at one day's exchange rate, for the lines both sellers name. What it does not cover is the implant at either end, the consultation at either end, the nights past the third, the two fares, the hotel, the companion's bed, the physiotherapy after discharge, the six-week review, the revision if there is one, and the movement of the baht and the pound between the day the price was published and the day it is paid. A facilitator routing knees to Thai hospitals advertises 10,000 to 16,000 dollars for the operation; the top of that advertised range is 86 per cent of the English list price, and for hips the same facilitator's range tops out within 800 dollars of the English one.",
  "how": "Every price on this site keeps the currency it was published in. The dollar figure beside it is that currency put through one table of mid-market rates dated 16 September 2026, printed on the page, and a price published in 2019 converted at that table is not what its patient paid — both dates sit on the row so the gap is visible. The rate table carries no card spread, no foreign-transaction fee and no cash-advance charge. The price page, the exclusion list and the validity date are read off the seller's own page rather than taken from a comparison site, and the arithmetic in this record is division, stated so it can be checked.",
  "today": "As of 17 September 2026 this site holds 214 published price rows across 21 countries and twelve currencies: 69 packages, 62 list prices, 44 advertised ranges, 17 published estimates, 14 state tariffs, seven survey figures and one reimbursement. Thirty-six of them carry no exclusion list at all. Of those that carry both lists, 68 have more exclusions than inclusions. No regulator in any jurisdiction read for this project requires a seller to publish a common inclusion list, which is the reason two prices for the same operation cannot be subtracted from one another."
 },
 "kin": [
  {
   "to": "knee-replacement",
   "as": "The operation worked end to end on this page.",
   "rel": "procedure"
  },
  {
   "to": "bumrungrad",
   "as": "Publishes the Bangkok package that forms one half of the comparison.",
   "rel": "facility"
  },
  {
   "to": "hip-replacement",
   "as": "The same arithmetic on the other joint, where the facilitator's advertised range nearly meets the English list price.",
   "rel": "procedure"
  },
  {
   "to": "implant-excluded",
   "as": "The unpriced line the whole comparison turns on.",
   "rel": "risk"
  },
  {
   "to": "the-price-that-isnt",
   "as": "The companion piece: the exclusion lists themselves, across every procedure on this site.",
   "rel": "story"
  },
  {
   "to": "package-price",
   "as": "The form of price this comparison is made of, and why two of them cannot be subtracted.",
   "rel": "term"
  },
  {
   "to": "reading-the-exclusions",
   "as": "The step in the journey where the nine excluded lines are found, when they are found.",
   "rel": "step"
  },
  {
   "to": "exchange-rate-table",
   "as": "The one dated rate table every dollar figure here passes through.",
   "rel": "dataset"
  },
  {
   "to": "the-follow-up-nobody-books",
   "as": "The longer piece on the last line of the sum, and who ends up paying it.",
   "rel": "story"
  },
  {
   "to": "united-kingdom",
   "as": "Where the self-pay list price on this page is published.",
   "rel": "place"
  },
  {
   "to": "thailand",
   "as": "Where the package price on this page is sold.",
   "rel": "place"
  },
  {
   "to": "getting-a-quote",
   "as": "The step where a headline number arrives and the device price does not.",
   "rel": "step"
  }
 ],
 "links": [
  {
   "label": "Bumrungrad package JOINT04",
   "url": "https://www.bumrungrad.com/en/packages/total-knee-replacement-surgery"
  },
  {
   "label": "Practice Plus Group — knee surgery self-pay prices",
   "url": "https://practiceplusgroup.com/treatments/knee-surgery/"
  },
  {
   "label": "IATA Industry Statistics fact sheet",
   "url": "https://www.iata.org/en/iata-repository/pressroom/fact-sheets/industry-statistics/"
  }
 ],
 "sources": [
  "s:bumrungrad-joint04",
  "s:practiceplus-knee",
  "s:practiceplus-hip",
  "s:bumrungrad-joint08",
  "s:defiant-prices",
  "s:er-api",
  "s:iata-industry-statistics",
  "s:eplasty-cosmetic-tourism-cost",
  "s:wounds-uk-cosmetic-tourism",
  "s:spurzem-bariatric-tourism-2025",
  "s:mbs-49318",
  "s:cdc-yellowbook-travel-insurance",
  "s:nordorthopaedics-prices"
 ],
 "provenance": {
  "default": {
   "tier": "cited"
  },
  "fields": {
   "text.story": {
    "tier": "cited",
    "note": "every price is read off the seller's own page and cited; the four stretches of arithmetic and reasoning are marked Inference inline"
   },
   "text.how": {
    "tier": "harvested",
    "source": "s:er-api",
    "note": "the conversion method is this repository's, and the rate table is the harvested one"
   },
   "text.today": {
    "tier": "inference",
    "note": "counts computed over the price rows on disk on 17 September 2026"
   }
  }
 },
 "confidence": "high",
 "updated": "2026-09-17",
 "blurb": "One operation, two published prices, worked to the end. A Bangkok hospital's knee package set against an English provider's self-pay list price for the same operation, with the implant, the nights past the package, the…",
 "region_terms": [
  {
   "key": "global",
   "name": "Everywhere",
   "note": "use for a node that belongs to no one country — a standard, a word, a risk"
  }
 ],
 "kin_out": [
  {
   "to": "knee-replacement",
   "type": "procedure",
   "name": "Total knee replacement",
   "as": "The operation worked end to end on this page.",
   "rel": "procedure"
  },
  {
   "to": "bumrungrad",
   "type": "facility",
   "name": "Bumrungrad International Hospital",
   "as": "Publishes the Bangkok package that forms one half of the comparison.",
   "rel": "facility"
  },
  {
   "to": "hip-replacement",
   "type": "procedure",
   "name": "Total hip replacement",
   "as": "The same arithmetic on the other joint, where the facilitator's advertised range nearly meets the English list price.",
   "rel": "procedure"
  },
  {
   "to": "implant-excluded",
   "type": "risk",
   "name": "The implant is excluded",
   "as": "The unpriced line the whole comparison turns on.",
   "rel": "risk"
  },
  {
   "to": "the-price-that-isnt",
   "type": "story",
   "name": "The price that isn't",
   "as": "The companion piece: the exclusion lists themselves, across every procedure on this site.",
   "rel": "story"
  },
  {
   "to": "package-price",
   "type": "term",
   "name": "Package price",
   "as": "The form of price this comparison is made of, and why two of them cannot be subtracted.",
   "rel": "term"
  },
  {
   "to": "reading-the-exclusions",
   "type": "pathway",
   "name": "Reading the exclusions",
   "as": "The step in the journey where the nine excluded lines are found, when they are found.",
   "rel": "step"
  },
  {
   "to": "exchange-rate-table",
   "type": "dataset",
   "name": "The dated exchange rate table",
   "as": "The one dated rate table every dollar figure here passes through.",
   "rel": "dataset"
  },
  {
   "to": "the-follow-up-nobody-books",
   "type": "story",
   "name": "The follow-up nobody books",
   "as": "The longer piece on the last line of the sum, and who ends up paying it.",
   "rel": "story"
  },
  {
   "to": "united-kingdom",
   "type": "destination",
   "name": "United Kingdom",
   "as": "Where the self-pay list price on this page is published.",
   "rel": "place"
  },
  {
   "to": "thailand",
   "type": "destination",
   "name": "Thailand",
   "as": "Where the package price on this page is sold.",
   "rel": "place"
  },
  {
   "to": "getting-a-quote",
   "type": "pathway",
   "name": "Getting a quote",
   "as": "The step where a headline number arrives and the device price does not.",
   "rel": "step"
  }
 ],
 "source_list": [
  {
   "id": "s:bumrungrad-joint04",
   "kind": "web",
   "title": "Total Knee Replacement Surgery (Exclude implant) — package JOINT04",
   "publisher": "Bumrungrad International Hospital",
   "url": "https://www.bumrungrad.com/en/packages/total-knee-replacement-surgery",
   "accessed": "2026-09-16",
   "note": "read off the hospital's own package page; price stated valid until 31 December 2026"
  },
  {
   "id": "s:practiceplus-knee",
   "kind": "web",
   "title": "Private knee surgery and treatment — self-pay price list",
   "publisher": "Practice Plus Group",
   "url": "https://practiceplusgroup.com/treatments/knee-surgery/",
   "accessed": "2026-09-16"
  },
  {
   "id": "s:practiceplus-hip",
   "kind": "web",
   "title": "Hip surgery: costs and care plans — self-pay price list",
   "publisher": "Practice Plus Group",
   "url": "https://practiceplusgroup.com/treatments/hip-surgery/",
   "accessed": "2026-09-16"
  },
  {
   "id": "s:bumrungrad-joint08",
   "kind": "web",
   "title": "Total Hip Replacement Surgery (Exclude implant) — package JOINT08",
   "publisher": "Bumrungrad International Hospital",
   "url": "https://www.bumrungrad.com/en/packages/total-hip-replacement-surgery",
   "accessed": "2026-09-16",
   "note": "425,200 THB, four nights, implant excluded; price stated valid until 31 December 2026"
  },
  {
   "id": "s:defiant-prices",
   "kind": "web",
   "title": "Defiant — posted prices index",
   "publisher": "Defiant (defiant.to)",
   "url": "https://defiant.to/procedures/",
   "accessed": "2026-09-16"
  },
  {
   "id": "s:er-api",
   "kind": "dataset",
   "title": "Open Exchange Rates API (open.er-api.com)",
   "publisher": "ExchangeRate-API",
   "url": "https://open.er-api.com/v6/latest/USD",
   "accessed": "2026-09-16",
   "note": "one dated rate table; every converted price on the site names the date"
  },
  {
   "id": "s:iata-industry-statistics",
   "kind": "org",
   "title": "Industry Statistics — fact sheet, table \"Global airline industry\", updated 6/2026",
   "publisher": "International Air Transport Association, Sustainability and Economics",
   "url": "https://www.iata.org/en/iata-repository/pressroom/fact-sheets/industry-statistics/",
   "accessed": "2026-09-17",
   "note": "read as a PDF and extracted with pdftotext. The rows used here are O-D passengers, million (4,343 forecast for 2026) and Passenger, USD billion (839 forecast for 2026). The fact sheet publishes no average-fare line; the figure derived from those two rows is marked as this project's arithmetic wherever it appears."
  },
  {
   "id": "s:eplasty-cosmetic-tourism-cost",
   "kind": "paper",
   "title": "The real cost of cosmetic tourism: cost analysis study of cosmetic tourism complications presenting to a public hospital",
   "publisher": "Livingston R, Berlund P, Eccles-Smith J, Sawhney R. Eplasty 2015;15:e34",
   "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC4522144/",
   "accessed": "2026-09-16",
   "note": "Gold Coast University Hospital, Queensland, financial year 2012–13, 12 patients"
  },
  {
   "id": "s:wounds-uk-cosmetic-tourism",
   "kind": "paper",
   "title": "Cosmetic tourism: the cost of going 'under the knife' abroad for cosmetic surgery",
   "publisher": "Hatch J. Wounds UK 2025;21(4):44–49",
   "url": "https://wounds-uk.com/journal-articles/cosmetic-tourism-the-cost-of-going-under-the-knife-abroad-for-cosmetic-surgery/",
   "accessed": "2026-09-16",
   "note": "carries the BAAPS national audit figures and the NHS Scotland series"
  },
  {
   "id": "s:spurzem-bariatric-tourism-2025",
   "kind": "journal",
   "title": "Getting more than what you pay for? Managing complications of bariatric tourism at an academic center near the US-Mexico border",
   "publisher": "Spurzem GJ et al., Surgical Endoscopy, 2025, doi:10.1007/s00464-025-11850-x",
   "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12222374/",
   "accessed": "2026-09-16"
  },
  {
   "id": "s:mbs-49318",
   "kind": "gov",
   "title": "MBS item 49318 — total arthroplasty of hip",
   "publisher": "Australian Government Department of Health, Disability and Ageing",
   "url": "https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=49318&qt=item",
   "accessed": "2026-09-16",
   "note": "schedule fee $1,577.30, fee last updated 01-Jul-2026"
  },
  {
   "id": "s:cdc-yellowbook-travel-insurance",
   "kind": "org",
   "title": "Travel Insurance, Travel Health Insurance, and Medical Evacuation Insurance — CDC Yellow Book 2026, chapter by Rhett J. Stoney",
   "publisher": "US Centers for Disease Control and Prevention",
   "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/travel-insurance.html",
   "accessed": "2026-09-16",
   "note": "carries the USD 25,000 to over USD 250,000 medevac range, the Medicare and Medigap limits, and the finding that insurers fully paid two-thirds of travel health claims"
  },
  {
   "id": "s:nordorthopaedics-prices",
   "kind": "web",
   "title": "Orthopaedic Surgery Prices",
   "publisher": "Nordorthopaedics Clinic, Kaunas",
   "url": "https://www.nordorthopaedics.com/hip-knee-wrist-hand-ankle-foot-shoulder-surgery-prices/",
   "accessed": "2026-09-16",
   "note": "every figure is written as a 'from' price in euro and sterling; the page carries no inclusion list"
  }
 ],
 "tiers": {
  "text.what": {
   "tier": "cited"
  },
  "text.story": {
   "tier": "cited",
   "note": "every price is read off the seller's own page and cited; the four stretches of arithmetic and reasoning are marked Inference inline"
  },
  "text.how": {
   "tier": "harvested",
   "source": "s:er-api",
   "note": "the conversion method is this repository's, and the rate table is the harvested one"
  },
  "text.today": {
   "tier": "inference",
   "note": "counts computed over the price rows on disk on 17 September 2026"
  }
 },
 "primary_image": null,
 "tag_facts": [],
 "recognition_facts": [],
 "acclaim": 0,
 "kin_in": [
  {
   "from": "australia",
   "type": "destination",
   "name": "Australia",
   "as": "The question a returned patient's second operation reopens.",
   "rel": "story"
  },
  {
   "from": "nepal",
   "type": "destination",
   "name": "Nepal",
   "as": "The question this survey's respondents did not answer the way the field expects.",
   "rel": "story"
  },
  {
   "from": "switzerland",
   "type": "destination",
   "name": "Switzerland",
   "as": "The country that answers the question by refusing the premise.",
   "rel": "story"
  },
  {
   "from": "united-kingdom",
   "type": "destination",
   "name": "United Kingdom",
   "as": "The question a 12-week median wait answers differently for each patient.",
   "rel": "story"
  },
  {
   "from": "singapore-city",
   "type": "hub",
   "name": "Singapore",
   "as": "The destination that answers no, and sells on something else.",
   "rel": "story"
  },
  {
   "from": "knee-arthroscopy",
   "type": "procedure",
   "name": "Knee arthroscopy",
   "as": "The question a day case answers worst, once the flight is counted.",
   "rel": "story"
  },
  {
   "from": "heidelberg-university-hospital",
   "type": "facility",
   "name": "Heidelberg University Hospital",
   "as": "A Bangkok package and a Heidelberg estimate are two different contracts, and comparing their numbers compares nothing.",
   "rel": "story"
  },
  {
   "from": "narayana-health",
   "type": "facility",
   "name": "Narayana Health",
   "as": "The 95,000-rupee figure against the Cleveland Clinic's 106,385 dollars is the comparison that essay exists to take apart.",
   "rel": "story"
  },
  {
   "from": "deciding-whether",
   "type": "pathway",
   "name": "Deciding whether to go",
   "as": "The comparison this step is built on, taken apart.",
   "rel": "story"
  },
  {
   "from": "uk-nhs-treatment-abroad",
   "type": "rule",
   "name": "NHS funding for treatment abroad",
   "as": "The arithmetic that looks different once the home system is paying for the revision.",
   "rel": "story"
  },
  {
   "from": "oecd",
   "type": "org",
   "name": "Organisation for Economic Co-operation and Development",
   "as": "Where the 0.0 to 1.0 per cent finding is set against the market-size claims.",
   "rel": "story"
  },
  {
   "from": "devi-shetty",
   "type": "person",
   "name": "Devi Prasad Shetty",
   "as": "Volume against price, which is his claim and this site's question.",
   "rel": "story"
  },
  {
   "from": "directive-2011-24-adopted",
   "type": "event",
   "name": "Directive 2011/24/EU adopted, 9 March 2011",
   "as": "A reimbursement at the home tariff changes the arithmetic that every other page here does out of pocket.",
   "rel": "story"
  },
  {
   "from": "exchange-rate-table",
   "type": "dataset",
   "name": "The dated exchange rate table",
   "as": "Every comparison on that page passes through this table and inherits its date.",
   "rel": "story"
  },
  {
   "from": "oecd-waiting-times",
   "type": "dataset",
   "name": "OECD waiting times for elective surgery",
   "as": "The other half of the comparison: the wait at home against the fee abroad.",
   "rel": "story"
  },
  {
   "from": "world-bank-out-of-pocket",
   "type": "dataset",
   "name": "Out-of-pocket share of health spending",
   "as": "The share a household already pays at home is where the comparison starts.",
   "rel": "story"
  },
  {
   "from": "how-this-was-built",
   "type": "story",
   "name": "How this was built",
   "as": "The price rule applied end to end to one operation.",
   "rel": "story"
  },
  {
   "from": "the-follow-up-nobody-books",
   "type": "story",
   "name": "The follow-up nobody books",
   "as": "The comparison this is the missing last term of.",
   "rel": "story"
  },
  {
   "from": "the-price-that-isnt",
   "type": "story",
   "name": "The price that isn't",
   "as": "The same exclusions carried through one comparison to a ratio.",
   "rel": "story"
  },
  {
   "from": "waiting-lists",
   "type": "story",
   "name": "The queue is the product",
   "as": "The money question this one sits behind.",
   "rel": "story"
  }
 ]
}