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.]
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.
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.
Insurance is a big nightmare here, which I fear might just catch on in places like India as a lot of practices are just adopted from the west without much thought on the basis of being "innovative". I had an absolute torrid time when I was hospitalized here as a student and the insurance provided by the school didn't even cover 50% of the cost because they found ways to deny basic items of coverage. You're right in saying that the laws and the lobbying pretty much lets the insurance companies get away with murder.
For those who haven't read this, there's a brilliant piece by Atul Gawande in the New Yorker about the system needs to change for the better:
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_...
Hope I wasn't too tangential ranting off but calling it a dangerous fluff piece is just being ignorant. Cost can be brought down by not compromising on quality.
>>>In 1995, the famous Aravind Eye Hospital in Madurai, India, developed a course that would give lay people basic skills needed for maintenance of ophthalmic instruments. One of us (V. Srinivasan) — a retired professor of physics with rich experience in laboratory work — helped to develop that course. The methodology used was "learning by doing." It wasn't so different from how kids learn to ride a bicycle or to swim. As a result of this hands-on approach, people with very different educational backgrounds, who spoke a variety of languages, could participate. Soon, we were able to care for equipment at a fraction of the cost it would have taken to create a separate, specialized service staff.<<<
Over here this is called hacking. Training people in situ to do minor repairs like this isn't exactly a ground breaking achievement. It is certainly an excellent example of efficient and lean management, but to call it an "innovation" is to jump the shark.
Real innovation is when someone comes up with a tele-medicine app for the iPhone which offers early diagnosis and treatment of retinopathy of prematurity to remote areas. (see: http://www.technologyreview.in/biomedicine/24311/) That is innovation.
The irony over here is that such people are hardly ever respected in this piece of land, and people instead of working with them offer hassles to them. Do you think it was easy for them to sell such a concept to a technophobic country? (there is a reason why startups are rare in India. Moreover, when people start them they face stuff like; "what you're starting a company? You're insane. You'll ruin your life." )
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."
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)
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.
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.
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.
