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What India Has to Teach About Running Hospitals

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.

Task shifting

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).

Economy mode

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.

 

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Photo credit: Dinuraj K.

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60 comments

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8:57PM PST on Nov 10, 2013

rather be in an Indian Hospital than an merrycan$$$$

12:16AM PST on Nov 10, 2013

we can all learn from each other

6:39PM PST on Nov 9, 2013

I'm not so sure about India's hospitals. There was a Frontline program on PBS where an American was in India. Somehow he got injured by a train. At the hospital where they took him a Dr. cut off his leg with some kind of ax. There was no sanitation and the mans leg became infected with some kind of unknown bacteria. He went through many months of agony , and almost died several times.. Theres much more to the story than I can relate here.
But I don't think I would want to get treated in India.

10:15AM PST on Nov 9, 2013

Faint hope of instituting something like that here - too many fingers in the till....

9:31AM PST on Nov 9, 2013

TYFS

8:01AM PST on Nov 9, 2013

WE can learn much from all cultures.

We need to get bankers to stop running hospitals in USA.

3:53AM PST on Nov 9, 2013

ty

11:08PM PST on Nov 8, 2013

Well,if this is the case in India,how come consortia of Indian doctors are buying up nursing homes and residential care facilities and then running them for profit and not a decent standard of care???Staff to patient ratio is a disgrace with night shifts seeing one registered nurse to 90+ patients!Not only that,some of these consortia bring in their own staff from overseas,undercut the legal wages and conditions,ie:grossly underpay the staff,and also bring in their own supplies from India because it's cheaper than buying locally?!There are still many elderly nursing home patients who do not want to be tended to by Asian staff,because they remember WW2!They should not be distressed like this in their final years of life!

10:36PM PST on Nov 8, 2013

Hmmm...guess I could have used this level of care when I got food poisoning after eating at an Indian restaurant here in the US once. Ironic.

8:12PM PST on Nov 8, 2013

Informative, thank you.

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