Developing countries are catching up to the rest of the world — and in this case it isn't good news. Higher rates of non-communicable diseases are increasing demand for services to treat cancer, diabetes, and cardiovascular disease. Taking care of these patients, whether rich or poor, will require a massive expansion of services — from detection through complicated tertiary care. Both public and private sector providers will need to find affordable ways to close the gap between what's available and the treatment that's needed.
Without proper planning, efforts to expand health services can come with a big price tag for health systems in countries still struggling to provide basic health services. High costs can limit access to health services widely available in the developed world, and delay goals for implementing universal health coverage in developing countries.
The Promise Of Specialization
Expanding services doesn't have to be cost prohibitive. Examples of specialty service providers are emerging from developing countries and demonstrating that it is possible to reduce costs and deliver quality care in a financially sustainable way. High volume is central to the success of these hospital and clinic networks, so it isn't surprising that pioneering companies are coming out of India and China — countries that are each home to over 1 billion people.
With a relatively higher share of out-of-pocket payments for patients in most developing countries, there is constant pressure to reduce cost. Specialization enables these companies to be more innovative and to find efficiencies that reduce costs without sacrificing high quality and good outcomes. In fact, quality is critical for the overall success of the enterprise, since these providers want to attract more selective, wealthier patients, as well as those with lower incomes.
Cardiac Care In India
Dr. Devi Shetty, the famous cardiac surgeon and founder of Narayana Hospitals, has shown that sophisticated health care can be affordable. Since founding his first hospital in Bangalore, India in 2001, Dr. Shetty has built a chain of multi-specialty hospitals. This chain includes the world's largest heart hospital, which has over 1,000 beds and is the site of as many as 35 major heart surgeries each day. Narayana's size means it can negotiate the best prices with medical suppliers. Every cost is scrutinized — from sutures to medical gowns to lighting. Surgeons perform more operations, so they become more skilled.
The result: the cost of open heart surgery at Narayana is now about $1,200. This compares with over $100,000 in the U.S. and Naryana reports high success rates that appear to put them on par with global averages.
Eye Care In Mexico And China
Eye care is another area where costs have been significantly reduced, making life-changing health services available to even the poorest people in developing countries. Cataracts are completely treatable but still cause over half the cases of blindness around the world.
Doctors in developing countries are advancing new surgical techniques that have brought the cost of cataract removal to as little as $25, putting it within reach of millions more people. For example, salauno, a specialty eye clinic in Mexico, adapted best practices from India's renowned Aravind Eye Care System and is rapidly expanding throughout Mexico. Doctors focus exclusively on patient treatment. Prices follow a sliding scale based on income. So far, salauno has examined over 100,000 patients and performed 12,000 surgeries — with just under half free of charge to the patient.
The model has proven so successful that eye hospital chains, such as Eye-Q Vision, are expanding rapidly in cities across India.
In China, home to one-fifth of the world's blind people, Aier Eye Hospital has grown from a single hospital in 2002, to a network of 100 hospitals in 26 provinces responsible for treating nearly 20 million patients. Aier adapted the idea of a multi-tier network of hospitals to ophthalmology and introduced it to China. The network model lowers costs through efficiency, as lower tier hospitals in smaller cities are a gateway, referring patients with more complicated ailments to larger, more sophisticated hospitals with expensive, advanced equipment and specialized doctors. Preventive and primary care is provided through outpatient services offered in retail stores, community eye clinics, and through partnerships with public schools.
Doctors and equipment are shared across the network. A published schedule of tiered pricing reduces corrupt or wasteful practices by doctors — like collecting side payments or prescribing unneeded drugs. A strong reputation for quality enables Aier to subsidize prices for lower income patients with higher prices for discretionary procedures like LASIK surgery, which is paid out-of-pocket by more affluent patients. As a result, Aier accepts patients regardless of income level.
Even very expensive services like kidney dialysis can become more affordable when performed in a specialty clinic. Nephroplus, India's leading provider of dialysis services, uses standardized operational, clinical, and financial processes and protocols to ensure consistent quality and maximize the use of dialysis equipment leading to lower treatment costs and more patients served.
Reaching the ideal—that every person can get the health care they need without suffering undo financial hardship—will require us to challenge our assumptions about health care. It will require investments in innovative new models for health care delivery and it will require diligent attention to cutting cost. Fortunately, there are many inspiring examples that show this can be done without sacrificing quality outcomes.
Lessons from these examples could also benefit patients in developed countries. This can only happen if providers and regulators are open to innovations from the emerging markets, where there are even greater pressures to reduce cost and provide care in more efficient and affordable ways.
from Health Affairs Blog http://ift.tt/1OxwhnF
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