When
my father had a toothache, he saw a dentist in Boston who recommended a root
canal and dental crown costing about $2,000. He decided to wait until he was in
India, his native land, for holidays and had the procedure done there for $200.
Extremely satisfied with the service and the
price, my mother decided to have her two front teeth replaced, eliminating a
wide gap that tarnished her smile, and estimated she had saved $3,000.
According to Deloitte consulting services,
875,000 Americans like my parents were medical tourists in 2010, traveling
outside U.S. borders to receive health care, dental work, elective hip
replacements, even bypass surgery.
I hadn't given medical tourism or outsourcing
much thought until some months ago, when I was in Bangalore, India, with Devi
Shetty, a pediatric cardiothoracic surgeon and founder of a large medical
complex.
Shetty told me bypass surgeries cost his
patients $2,000 to $5,000, one-tenth of what it would cost in the United
States. As a U.S.-educated doctor, I wasn't sure whether I should feel
threatened by or marvel at Shetty's setup. But I was curious, so I asked him
how he was able to realize such savings.
His formula was simple: Focus on the process
and on volume. "If you are investing heavily in the process, the product
naturally will be good," he told me. Just as Wal-Mart capitalizes on the
power of bulk purchasing, Shetty has applied process and volume principles to
his hospitals, using innovation and well-tested surgical techniques developed
in the United States.
Experts have identified other factors that
make foreign hospitals less expensive: lower labor costs certainly, but also
fewer third-party payments, price transparency, limited malpractice liability
and fewer regulations.
American health care dollars are bound to be a
prime target for providers overseas. But I was worried about the quality of
health care in a developing country, where the tap water is unsafe for
drinking.
Shetty, 54, wearing a surgical cap and
sea-blue scrubs, had me drape on a cotton gown and surgical shoe covers for a
tour of his ICU. He told me that the Joint Commission International -- a
U.S.-based organization that establishes standards for and inspects health care
providers -- was coming for a review in two weeks.
I asked him a litmus-test question about
quality of care delivered to critically ill patients: "What is your ICU
nurse-to-patient ratio?"
Without hesitating he said, "One to
one." The same as ours in the United States, I told him. He sent me a note
a month after our meeting: "We got JCI with flying colors." More than
220 medical sites outside the United States are JCI-certified.
I realized that Shetty was providing
"value-based care," not just "quality care." Value has
become the new buzzword in today's health-care-quality movement. Value is
defined as quality divided by cost. Shetty had maintained U.S.-standard quality
in his hospital services at a lower cost, thereby delivering better value than
American hospitals do.
Though we may be resistant, we need to shift
our focus from quality to value. Medicare has already done this by initiating a
value-based purchasing program. This means there will be financial incentive
for hospitals to provide higher-quality care at lower total cost.
Starting in July, Medicare is computing
performance scores that will lead to monetary rewards in October 2012 for
hospitals that provide high-quality care. There will also be penalties.
Medicare will also be measuring efficiency measures, which is Medicare spending
per beneficiary, and again reward high performers.
Unlike software and manufacturing, health care
is highly regulated. And it is largely locally based, hence many patients are
unlikely to go overseas for their care.
Regardless, medical tourism has gotten my
attention, and from it I have learned about the difference between
"value" and "quality." And in the end, it motivates me to
provide value-based care that is high-quality health care at the lowest cost.
Dr. Manoj Jain
The Commercial Appeal – Menphis,Tennessee
Manoj Jain is an infectious disease doctor in
Memphis and also writes for The Washington Post. Archived articles are at
MJainMD.com.
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