

Could an Indian Hospital Help the U.S. Cut Health Care Costs? - sankara
http://blogs.hbr.org/cs/2010/07/could_an_indian_hospital_help.html

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yummyfajitas
Useless in the US. Suppose a mistake is made, or even just a bad outcome
occurs.

Lawyer: "Big Medicine, as a cost saving measure, employed uneducated people
like yourself to maintain equipment so they could pay unsympathetic
shareholders more money. As a result, a sympathetic young child has died."

~~~
rdl
Biomedical maintenance is definitely expensive, but there are a lot of things
which can be done technologically which improve quality AND lower costs: 1)
Better remote diagnostics on equipment 2) Designing equipment to be maintained
by operators, or shifting to disposable or "use once, return to depot"
equipment 3) Generally, looking at life cycle costs for equipment vs. just the
purchase price.

For a lot of equipment, the operator is actually highly skilled and trained,
and in some cases, is cross-trained to maintain the equipment as well (more
true in rural health centers).

Another innovation is moving the equipment around -- the MRI trucks get higher
utilization in rural communities than a single MRI center would.

(I only really know the radiology side, although the military biomed shops
usually maintain everything)

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hsuresh
There is a TED talk by one of the people behind Arvind Eye Hospital mentioned
in the article ->
[http://www.ted.com/talks/thulasiraj_ravilla_how_low_cost_eye...](http://www.ted.com/talks/thulasiraj_ravilla_how_low_cost_eye_care_can_be_world_class.html).

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lkozma
I find "reverse innovation" a bit condescending, why not call it just
innovation.

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todayiamme
This is perhaps the most dangerous fluff piece I have ever seen.

Most government hospitals in India reek of urine (people go on the walls), and
have so poor hygiene standards that a slaughterhouse would be better. This
"innovation" isn't something really ground changing people do this all the
time around the world, but it doesn't happen in the US due to fear of lawsuits
and other hassles.

I doubt that there is anything to teach to the US healthcare system. The truth
is that almost all good medical professionals have answers and solutions to
the problems that plague it, but the political climate doesn't allow it to
happen. Those laws that straitjacket such cheap and sweet solutions while
letting insurance companies get away with institutional murder.

On the other hand, in India such pieces create bursts of irrational pride and
are oft quoted when people need a good cop out. According to most indians
(citizens as well as politicians) silicon valley is powered by indianpride
(tm), NASA runs on the backs of it's 60% indian workforce and so on. I truly
wish that they would take a look around.

[edit: I am truly sorry if this sounds like an over-generalization. Beautiful
examples of innovation exist in India as they do in every land on Earth, but
the truth remains. Too many people live a life of suffering and die needlessly
due to this system. India's HIV epidemic is comparable to that of Africa.

I exist in a place with excellent healthcare at an exceptionally cheap cost as
compared to the US. Unfortunately the majority of people don't. There is a
selection bias in operation over here. It is true that medical tourism is off
the charts, but how many hospitals cater to them? What institutions do so?
Also, there is almost no data available on the dearth of reliable doctors.
This is a huge problem in rural areas where facilities exist only on paper.

I think that each one of us should experience the brutal poverty that most
people face in this country before leaping on to such things. There are people
working to change this. Let us respect them not write fluff pieces that
encourage the divide between myth and reality.

I admit that I am not patriotic and I rebel against the concept of nations
states, but those statistics are real live people and they matter. The only
way to help them is to swallow the bitter pill and work on this.]

~~~
train_robber
Think you are generalizing a bit. I admit government hospitals here in India
are not exactly world class, but 'reek of urine' is not there in every
hospital. Atleast the hospitals in my part of the country (Kerala) are way
better than you describe it to be. Whether they are the answer to US customers
is a different thing.

Also about the part that 'most' Indians think of indianpride(tm) is
unacceptable to me. I agree I used to get forwards during my college days
about this, but as I grew older, I am smart enough to realize this is not the
case. I guess most of my fellow citizens do too.

~~~
todayiamme
I am sorry if it sounds like that, but Kerela is better off because of its
massive investment in infrastructure as compared to other parts of India, but
the truth is that most clinics in rural areas exist only on paper. I am sure
that you know the story pretty well.

I have access to a pretty good healthcare facilities in my city, but that
doesn't mean that every case is like that. The overwhelming majority points in
the opposite direction and it is important to accept that the problem exists
before correcting it.

I see fluff pieces everyday in newspapers. If a researcher is somehow related
to India then the newspapers give headlines like; "NRI Discovers XYZ". Or,
"Indian Led Team Discovered XYZ" and so on. There are specific patterns in the
almost all of the leading dailies except for The Mint
(<http://www.livemint.com/>) and a few other business newspapers. There is
hardly any news of any significance whatsoever. The world is reduced to 2
pages along with vivid bikini shots of celebrities. In fact, a lot of global
news is about how Britney Spears baked her baby in the oven. The myopia used
to shock me, but I now know that the newspapers are not at fault they are
simply catering to the audience.

>>>I agree I used to get forwards during my college days about this, but as I
grew older, I am smart enough to realize this is not the case. I guess most of
my fellow citizens do too.<<<

Of course, they're smart enough to realize this, but people tend to believe
things often because they believe that they ought to believe them. Further,
the circles in which we exist are not varied enough to make a conclusion like
this. There is a selection bias in our peers. If you go out of the way and
talk to people then you will be shocked and amazed with the replies you get.

At the end it doesn't matter much to me. I don't like the concepts of
demarcating plots of land and building elaborate belief systems based on that
concept. To me it's a lie and a sham. What matters more are the people who
live a life of suffering with no escape and die everyday in inhumane
conditions that somehow never make the headlines. The AIDS epidemic in India
is comparable to that of Africa. _Africa_.

There's a lot to solve over here and creating fluffy pieces simply won't do
it.

I am really sorry if this appears rude to you. That is not my intention, but I
am afraid this is the truth and we ought to do something about it.

~~~
train_robber
That is a better clarification. I guess I took it in a different angle. I
agree about the part that the mainstream media is not helping with its shock-
jock journalism.

PS: Nothing about 'rudeness' at all. Response was not triggered by that.

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rdl
Probably the only way to genuinely reduce costs by an order of magnitude would
be to create a "cash and carry, no recourse except gross/criminal negligence"
parallel system. Given US society, the only legal way to do this would be a
public health system directly operated by the government.

I am a libertarian and aesthetically opposed to this idea, but I think
realistically the least bad option would be universal coverage by a "designed
to a price" public health system, maybe on par with the UK NHS, with better
quality private care and private insurance for those who can afford it. Allow
the government to provide scholarships (similar to ROTC) to promising studies
to become doctors in the service, with MD salaries on the 80-150k range, and a
focus on providing cost-effective routine and emergency care, and on cost
effectively managing any expensive treatment. Roll Medicare into this. You
could cut expenditures 50-80% while only reducing outcomes slightly, and cover
everyone.

The AMA, industry, etc. would all be against this, but I think the total
number of people employed in the medical industry is still low enough that
"see, universal coverage" AND "50-80% cost savings" would win out politically
over the libertarian arguments and the "death panels" arguments. By
establishing that private health care can still exist, and be best in the
world (unlike the Canadian system), reasonably wealthy people shouldn't be too
opposed.

The risk is that a system of initially limited scope and budget would expand
-- any given case where the public system didn't cover an illness might get up
to a thousand constituents writing to their representatives. 1000 people
highly motivated by an issue would trump 250 million people paying less than a
cent each for the increase in cost in that one case. Eventually we would end
up with a gold plated system like we have now. The only way I can think of
preventing that would be for the US government to be starved of revenue (which
it is working on!), or a constitutional amendment setting a certain standard
of public care which cannot be legally exceeded.

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hugh3
Look, there are many ways that US hospitals could cut costs by reducing the
standard of care in one way or another. Some of them would be safe, some of
them would be dangerous, and some of them probably look safe but would turn
out to be way more dangerous than you'd think.

Sure, it's a great idea to save money when money is being wasted, but I'm
really skeptical of this new fashion of claiming that the US's worst problem
is that our standards of healthcare are _too damn high_.

~~~
thejo
>> I'm really skeptical of this new fashion of claiming that the US's worst
problem is that our standards of healthcare are too damn high.

I don't think anyone is advocating lowering of standards. The Aravind Eye Care
and similar success stories are all about innovation in the model of
delivering healthcare. They excel in lowering costs through scale while
ensuring high standards. The founder of Aravind was inspired by the process
standardization of McDonald's and succeeded in replicating that in healthcare.
The doctors at Aravind are actually considered to be among the best in the
world simply because they perform far more surgeries than doctors elsewhere.
Others like Narayana Hrudayalaya are replicating the model in areas like
treatment of heart disease in India with great success. So, there's definitely
room for process innovation which can improve the standards while reducing
costs at the same time.

