Outsourcing elective surgery to the Developing World

Troubling article in Time Magazine. In America, the wealthiest country in the world, most citizens can’t afford life-saving surgeries due to out-of-control prices. Where are they turning? India, Thailand and other Developing countries. Something is very wrong with this picture that US-trained surgeons are performing the same surgeries, such as heart transplants, in state-of-the-art hospitals abroad for a fraction of the cost it would be here.

Of course, conservatives will blame trial lawyers for the spiraling costs and cry this highlights the need for “tort reform”. But there’s no question that insurance companies are jacking up prices way beyond what they need to protect themselves and ensure a health bottom line.

Lack of competition and inefficient operations at hospitals is a culprit as well:

U.S. hospitals could certainly do with a little global competition. For years, their share of the national heath-care bill has grown at a rate far faster than inflation, and today they gobble up a third of all medical expenditures. At current rates, the U.S. will be spending $1 of every $5 of its GDP on health care by 2015, yet more than 1 in 4 workers will be uninsured. The ingrained inefficiency of most hospitals doesn’t help. “A lot of them still don’t know how to schedule their operating rooms efficiently,” says Reinhardt. “They’ve never had to. They always get paid, no matter how sloppy they are.”

It’s a disgrace that in the wealthiest and most powerful country in the history of the world, patients are having to fly half way around the world to have a lifesaving procedure done. It’s great we have “universal” coverage for education, but something absolutely must be done to address this troubling trend.

“This has the potential of doing to the U.S. health-care system what the Japanese auto industry did to American carmakers,” says Reinhardt.

Unfortunately, human beings are not automobiles, and this article points to a troubling trend that looks like it will only get worse unless the powers-that-be begin to address it.

As I mentioned in an earlier post, David Sirota’s new book “Hostile Takeover” has a great chapter on health care, an excerpt of which can be read here.

Update: My father, a pulmonologist in the suburbs of Philadelphia, has taken issue with this post as he thinks it singles out hospital administrators and physicians for this troubling trend. While I believe there are still a lot of inefficiencies at hospitals, just from my personal experience, my father notes that about 30% of Medicare costs go toward providing care for patients at the end stages of their life-terminally ill with very poor quality of life.

Of course, this raises an important biomedical ethics issue: given the fixed budget for healthcare provision in the US, should we as a society spend such high amounts of money keeping seriously ill patients alive, as opposed to treating patients who have breast cancer and have a good chance of living a long, productive life post-surgery?

My father correctly notes that politicians, journalists and pundits (and bloggers!) tend not to address this issue, probably because it is such a sensitive and difficult thing to discuss.

I’m happy to say that he does support universal health care, although he does have some hesitations about the downsides (e.g.: not being able to get the state-of-the-art medicine you might want when the government deems a cheaper generic drug is an acceptable substitute). I guess it all comes down to “you get what you pay for”.

Update 2: This New Yorker article by Malcolm Gladwell helps explain some of the poor economic reasoning that is perpetuating the health care crisis.