What India Has to Teach About Running Hospitals
Ask a Westerner for her perception of hospitals in India and she’ll probably think of the nation’s status as a “developing country” and assume that hospitals provide a mediocre standard of care without access to state of the art medical technologies.
In fact, nothing could be further from the truth: India’s medical system is incredibly varied, and includes several very high-quality facilities. The way some private hospitals in particular are run provides a number of fascinating lessons in health policy that the United States might want to consider signing up for.
As the United States struggles to reform its broken health care system, one of the biggest issues involved is controlling costs. Indian hospitals manage to provide a superb quality of care at a fraction of the cost spent in the United States, explain Professors Vijay Govindarajan and Ravi Ramamurti in the Washington Post, so how do they do it? And how can we look to India for a model to reduce hospital costs while still maintaining high patient care standards?
The two men identified three different areas in which Indian hospitals had found a way to slash costs while keeping up patient care.
The hub and spoke model
In the United States, hospital care tends to be very scattered. Numerous hospital facilities dot the landscape, while patients may bounce between facilities for various needs. In India, the hospitals the men looked at utilized a hub and spoke model: one centralized large facility for complex care needs, and numerous “spoke” hospitals to handle day to day clinical issues. This system allows for easy provision of preventative care and minor medical issues, allowing doctors at the hub hospital to focus on more demanding clinical cases.
Furthermore, the hub specialists can use telemedicine to offer remote treatment at rural spoke hospitals. Thus, all patients get the benefit of the practice, skill and experience provided in hub locations, even those in areas that couldn’t sustain a high-quality hospital facility on their own.
More and more, the United States is starting to look to this model, but India has taken it further. By providing a number of layers of medical training and skill sets, hospitals move simple tasks away from skilled medical personnel so they can focus on treating patients. For example, paramedic workers can handle routine medical care in India, thus freeing up physicians and cutting costs for medical procedures.
A similar level of task shifting can be seen in the widespread uses of physician assistants and nurses in the United States; more and more, they’re being tasked with more complex medical care, giving doctors more time to treat the challenging patients who need a doctor’s attention. It’s common for women to see a PA or RN for annual exams, for example, freeing up a gynecologist and cutting costs (the doctor’s time costs much more, and thus results in higher fees for patients).
Indian hospitals also run their operations very frugally, with a focus on no-frills care. The resort-like environs of private hospitals in the United States aren’t present, while doctors receive fixed salaries instead of pay-per-procedure compensation. Equipment is sourced through inexpensive means, when possible, and hospitals focus on generic sources for medications rather than brand names. While hospitals do not cut corners or endanger patients, their primary goal is as medical facilities, and they manage their budgets as such.
That means that hospitals can sometimes be a bit bleak, and lack the amenities American patients may expect, but that lean operating mentality results in much, much lower costs: an acceptable tradeoff, some might argue, for good quality care at a price that patients, private insurers and government-supported health services can afford.
Photo credit: Dinuraj K.