4 ms·

Could an Indian Hospital Help the U.S. Cut Health Care Costs?

10 points by sankara 16y ago

yummyfajitas 16y ago
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 16y ago
  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)
hugh3 16y ago
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 16y ago
  >> 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.
lkozma 16y ago
I find "reverse innovation" a bit condescending, why not call it just innovation.
rdl 16y ago
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.
todayiamme 16y ago
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 16y ago
  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.
hsuresh 16y ago
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_care_can_be_world_class.html http://www.ted.com/talks/thulasiraj_ravilla_how_low_cost_eye....

10 points by sankara 16y ago

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 16y ago
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)

hugh3 16y ago

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 16y ago
>> 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.

lkozma 16y ago

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

rdl 16y ago

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.

todayiamme 16y ago

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 16y ago
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.

hsuresh 16y ago

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_care_can_be_world_class.html http://www.ted.com/talks/thulasiraj_ravilla_how_low_cost_eye....