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Sunday, November 3rd 2013

There’s Something To Indian Healthcare

Don’t get me wrong, I’ve written previously with some admiration for Devi Shetty. But an op/ed in the Washington Post calling on U.S. hospitals to be more like those in India sugarcoats the major obstacles to such and I think ignores coming changes in rising economies.

[T]he transfer of responsibility for routine tasks to lower-skilled workers. This leaves doctors free to focus on complicated medical procedures. Several hospitals have created a tier of paramedic workers with two years of training after high school to perform routine medical jobs. As a result, surgeons, for example, are able to perform two to three times as many surgeries as their U.S. counterparts. Compare that with the United States, where hospitals reduce costs by laying off support staff and shifting mundane tasks such as billing and transcription to doctors, who are overqualified for those duties.

That task shifting includes things like families of patients performing basic nursing tasks and a stoicism amongst patients that simply is not part of American culture.

At least one true thing,

U.S. hospitals are constrained by regulations and norms unlike those in India.

But they end with this,

The Indian experience shows that costs can be dramatically reduced and access can be expanded even as quality is improved.

Which is silly.

India’s costs are low somewhat because India’s costs of living are low, they have little to no R&D costs, they have far fewer regulations and, most importantly, expectations are currently far less than those in the United States. The U.S. spends at the periphery of healthcare. That spinal fusion of questionable indication or that proton beam for your cancer or that lengthy ICU stay when the prognosis is terrible are not things that contribute really to population based metrics, and they’re not things that Indian patients are currently seeking but they’re major contributors to costs.

I want to see the private forces Vijay Govindarajan and Ravi Ramamurti cite in their op/ed keep control on health care costs eighty or ninety or one hundred years from now when the growth of Indian wealth helps lead to social expectations of health care are on par with what we have here in the U.S. And India is moving that way; we shouldn’t kid ourselves about any notion that current social values and ideas on end of life and health care in Indian culture are immutable. Eventually this “quality of death” is not going to be acceptable.

In such a sense India’s current efforts aren’t some “new” health care. And the Indian health care consumer is slowly moving to be more like the U.S., not the other way around. Only top down/government forces will keep the costs of Indian health care down under such a situation. India’s going to have to learn from Europe. Not America learning from India.