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Monday, April 22nd 2013

The Two Thousand Dollar CABG

I remember reading a profil of Devi Shetty and dismissing his dream of cheap surgery as unreproducible in the West. His Narayana Hrudayalaya hospital in Bangalore India supposedly does the most heart operations in the world. He contracts with fabric companies to make his own low cost suture, trains families to perform the duties of western nurses (although such is the way in much of the world), is aided by India’s lax recognition of pharmaceutical patents and uses his huge volume to drive a bargain on medical equipment he cannot replicate in cheaper form. All of such is done on the cheap for patients with a tiered progressive pricing system that has the truly poor pay nothing and those that can afford it pay on a scale and for more comfortable accommodations.

He continues to push boundaries by opening facilities across India and one in the Cayman Islands. In a new profile, he compares his ambitions to health care in the western world,

“Near Stanford (in the US), they are building a 200-300 bed hospital. They are likely to spend over 600 million dollars,” [Devi Shetty] said.

“There is a hospital coming up in London. They are likely to spend over a billion pounds,” added the father of four, who has a large print of mother Teresa on his wall — one of his most famous patients.

“Our target is to build and equip a hospital for six million dollars and build it in six months.”

There may indeed be things to take away from Dr. Shetty’s work. Ideas about continuous operations and large volumes and standardization of processes. Here is his talk on such things to an NHS trust. But it is not wholly replicable. And isn’t merely a matter of entrenched interests or unnecessary regulation. Certainly such are major obstacles. The biggest obstacle and a foolish obstacle.

But even if such didn’t exist in western health care there are other more inherent considerations. At least one of which is that I think much of what Dr. Shetty has done has benefited from costs borne by western health care.

India and Africa and the Cayman Islands didn’t bear the development costs of those dialysis machines or heart valves that Dr. Shetty’s company is now buying in bulk. And they can’t. The technology in fifty years or a hundred years that is going to make all of Dr. Shetty’s valve replacement operations obsolete isn’t going to come from the still developing world.

That’s not to completely justify the massive difference in costs between what Dr. Shetty is doing and America. Like I said, there is much to learn from him. I agree in the specialization of physicians as technicians, of tertiarization of specialized care, of volume and of operating closer to capacity and with greater efficiency. There is probably amazing savings for western health care there. But the idea of the two thousand dollar CABG in England or France or Canada is infeasible and, to be honest, I’m not sure desirable.