GLOBAL HEALTH PROBLEMS
REVOLUTIONARY HEALTH CARE
In reading an American magazine called "The Futurist" there is an article by Rick Docksai, a deputy editor who writes concerning "Local Solutions for Global Health Problems". It is apparent to me that health solutions are an absolute necessity in all societies, rich and poor, East or West, since debilitating diseases associated with old age find their way into all strata of life. Whether you live in the underdeveloped world or in the West, people are living longer and are subject to diseases more common to the aged. The advances in technology are nothing short of amazing, but surgeons like all human beings, want to keep their remuneration as high as possible and do not pass on the savings in time and effort, to the public. In my lifetime health care costs just keep rising and the doctors just keep asking the public, the insurance companies and the government to keep paying more. Spending more money on health problems is not necessarily the answer. Some countries that spend, relatively speaking, paltry sums on health care, do better than the big spenders. Cancer studies which get a disproportionate amount of research money show the poorest results. It is in the surgical field, on all parts of the body, where the greatest advances have occurred and where the most savings can be realized.
In 1976 Indian eye surgeon Govindappa Venkataswamy resolved to make eye surgery affordable for even the poorest Indian. Anybody could get eye surgery whether they could pay or not, and the clinic was called Aravind. Since 1976 Venkaraswamy has expanded his one clinic into 5, and has 3200 clinicians and nurses working for him. Aravind has added a manufacturing factory to produce transplant lens at a cost of $10.00, much cheaper than the $150.00 that a typical lens would cost. The Aravind hospitals make money and are constantly looking for ways to cut costs. All procedures of the doctors are reviewed constantly, the doctors receive fixed salaries, with no bonuses for seeing more patients. An Aravind surgeon conducts 2000 surgeries a year, far above the 400 of other Indian surgeons and the 200 of the typical U.S. doctor. Many other eye surgeons are trying to emulate the Aravind method. Health care delivery in much of the world is driven by the notion of "limitation" an underlying assumption that there is simply not enough resources for everyone's needs. This is not the model at the Aravind hospitals.
Another area of interest to Canadians is cardiac treatment. Devi Shetty founded a hospital in Bangalore India called Narayana Hrudayalaya hospital. This hospital has 1000 beds, the average U.S. hospital 160 beds, its team of 42 surgeons completed in 2008, 3174 cardiac bypass surgeries, more than twice the 1367 completed at the Cleveland Clinic the same year. The cardiac surgeons at the Indian hospital work longer and harder than comparable U.S. surgeons. The mortality rate after the first 30 days at the Indian hospital, following coronary surgery was 1.4% compared to 1.9% in the U.S. Jack Lewin, the chief executive of the American College of Cardiology, was impressed since the patients in India arrive in a worse condition. A cardiac bypass operation costs $2000.00 at Shetty's facility compared to $5000.00 at another Indian hospital and between $20,000. - $40,000. at a U.S. hospital. Shetty has expanded his hospital into a network of 12 hospitals throughout India and has plans for 5 more, including one in the Cayman Islands, which will attract U.S. patients. An article in the Wall Street Journal called Shetty "the Henry Ford of heart surgery". The article offered insights for all countries, including the U.S., looking for ways to cut costs. Hip and knee operations which are not mentioned in the article will, I am sure, draw the attention of surgeons who are interested in saving money for governments and patients, with the new technology.
There is another cost-saving medical trend on the way which can be of help to areas that do not warrant the expense of a large hospital. Shetty's hospitals are reaching out to volumes of patients beyond India to Malaysia, Pakistan and 24 other countries. Narayana sets another first by providing telemedicine courtesy of its array of 800 satellite centres. With video conference facilities he interfaces with residents of remote villages. Mobile teams can travel to patients who need work done in person, and then relay the results, both electrocardiagrams and angiograms, over fiber-optic and satellite links. The hospital has conducted more than 30,000 tele-consultations thus far.
Medicine in North America is not practiced with competition in mind. Practitioners charge what their associations recommend but with the number of people entering old age, and with the government paying their medical expenses, it is only a matter of time until government health plans call for an end to the system of payment that increases costs every year.