Part of the problem with doing this in the US is that cardiac surgery and cardiac care is a major revenue center for US hospitals. US hospitals are law bound to treat patients who come in their Emergency Rooms, regardless of ability to pay. So, they lose money on patients who are uninsured or under-insured and need expensive care, and then they make up the difference doing expensive cardiac procedures, OB, orthopedic surgery, etc...
There is a growing move to go to specialized hospitals like Heart Hospitals, Surgery Centers or stand alone OB centers in the US, because they are big revenue generators for the owners of those specialty hospitals. But, while I'm sure quality goes up at dedicated heart hospitals, it causes problems on the macro scale, because those specialized hospitals drain patients with private insurance that would otherwise be subsidizing patients without insurance at a general hospital.
If you read between the lines of the article, what they don't say is they are charging cash up front for many of those surgeries. Families with children needing heart surgery that don't have insurance are forced to either pay cash or their child likely dies an early death. It sounds like the are actually turning patients away that don't have the money to pay for their surgery. You can't do that in the US.
You've just made an excellent argument for why universal coverage (of some sort, public or private) is essential. This is part of why some starry-eyed supporters predict cost savings.
Hard to argue too much, it sounds like they do more for better and cheaper, which is a compelling combination.
I don't know that it's a great argument for universal coverage. At 2,000 dollars for open heart surgery it's still a lot but at least considerably more affordable. What will be interesting/exciting to see is how well they do at their facility in the Caymans and whether US insurers will cover the cost of treatments there. Ambulatory surgical centers have a record of greater outputs but also better outcomes than their generalist competitors. This is pretty compelling - (and at $2,000!):
"Dr. Shetty's success rates appear to be as good as those of many hospitals abroad. Narayana Hrudayalaya reports a 1.4% mortality rate within 30 days of coronary artery bypass graft surgery, one of the most common procedures, compared with an average of 1.9% in the U.S. in 2008, according to data gathered by the Chicago-based Society of Thoracic Surgeons [...] Dr. Lewin believes Dr. Shetty's success rates would look even better if he adjusted for risk, because his patients often lack access to even basic health care and suffer from more advanced cardiac disease when they finally come in for surgery."
> I didn't say the factory model was an argument for universal coverage.
Whatever.
> The argument however, that we couldn't take advantage of things like this in this country in part because we didn't have universal coverage, was.
Except that that's not true. As other folks have pointed out, we're starting to develop "heart surgery" factories and the like. Those folks also pointed out that some mandates that approximate universal coverage (a hospital has to take all comers) actually interfere with the development of factories because factories specialize.
Note that requiring that something be open to everyone is an obstacle.
His flagship heart hospital charges $2,000, on average, for open-heart surgery, compared with hospitals in the U.S. that are paid between $20,000 and $100,000, depending on the complexity of the surgery.
At only $2000 (or even $5000), and with better outcomes, I'm not sure why anyone who needs open-heart surgery isn't heading to this facility. Even factoring in transit costs, and paying out of one's own pocket, it's probably less than a 10% or 20% copay on a $50,000 open-heart surgury done locally.
It does sound as if real competition is finally coming to surgical medicine.
"Health care needs process innovation, not product innovation. You can't do one big thing and reduce the price, we have to do 1,000 small things." Dr. Devi Shetty
Jack Lewin, chief executive of the American College of Cardiology, who visited Dr. Shetty's hospital earlier this year as a guest lecturer, says Dr. Shetty has used high volumes to improve quality. For one thing, some studies show quality rises at hospitals that perform more surgeries for the simple reason that doctors are getting more experience. And at Narayana, says Dr. Lewin, the large number of patients allows individual doctors to focus on one or two specific types of cardiac surgeries.
The only question is how to replicate this model in the United States in the face of tremedeous political obstacles. (The AMA cartel, almost certainly lot of paperworks and complicated rules, the FDA, etc)
The idea has been developing. They call them ambulatory surgery centers in the US. Regina Herzlinger coined the phrase "focused factory" if memory serves. Of course they're nowhere near the cost of the Indian model but from what I understand there's something called the Texas Heart Institute that performs surgeries at costs dramatically lower than their more broad based peers (http://www.texasheartinstitute.org/)
Sorry, I should have clarified that Herzlinger was at least one of the first to use the term as it related to healthcare which was a bit controversial at the time when she published her book Market Based Healthcare.
There is a growing move to go to specialized hospitals like Heart Hospitals, Surgery Centers or stand alone OB centers in the US, because they are big revenue generators for the owners of those specialty hospitals. But, while I'm sure quality goes up at dedicated heart hospitals, it causes problems on the macro scale, because those specialized hospitals drain patients with private insurance that would otherwise be subsidizing patients without insurance at a general hospital.
If you read between the lines of the article, what they don't say is they are charging cash up front for many of those surgeries. Families with children needing heart surgery that don't have insurance are forced to either pay cash or their child likely dies an early death. It sounds like the are actually turning patients away that don't have the money to pay for their surgery. You can't do that in the US.