of the biggest problems facing the U.S. health care system is money. Services
cost a lot, and many people don't have the money or insurance to pay for the
health care they need. Rose Hoban looks at the latest approach to solving that
academics have spent years looking for ideas about how to make health care
affordable. Some professors from Duke University in North Carolina have turned
their gaze outside the U.S. They think they've found some examples that work –
Schulman is a physician. He's also a professor of business at Duke. He went to
India to study their health care system and says the health care market there
is fiercely competitive.
describes a new class of hospital that's emerged in the past two decades to
serve the rapidly expanding middle class. "Most of the hospitals that we
looked at had very, very high volume, so their surgeons are really very
technically excellent," he reports.
shows that surgeons that do more surgeries are more skilled. "The
arguments are that some of their surgeons are even better than most of our
surgeons here [in the US]," Schulman adds. "The care provided in the
Indian hospitals was of consistently high quality."
says maintaining that quality was the focus of hospital managers, and doctors
were paid incentives to do good work.
they need to make investments to make the operating rooms the best that they
could be, they made the investment," he says. "But where they needed
to make investments to make the rooms look a little nicer, they saved money in
order to save the patient money."
argues this shows that you can offer quality clinical services, and not worry
about the amenities as much. That's different from the situation in the US,
where the assumption is that a fancy hospital with lots of amenities gives
people in India have health insurance. Most medical care is paid for out of
pocket. Schulman says this means patients need to know what they'll have to pay – unlike the U.S. system, where insurance companies negotiate prices directly
with hospitals. This is also unlike the system in many European countries,
where the government pays the bill. Patients in neither the United States nor
Europe know what their care costs.
Schulman says in India, patients are conscious of cost… and of getting a good
value. "If the hospital tells you your service is going to be a certain
dollar amount, then complications that arise as a result of surgery, in some
cases, are even [covered] by the hospital, financially. So, there's a financial
incentive for the hospitals to deliver high-quality service," he says.
"There is moreover a custodial reason that they feel that when they make a
contract with someone to offer a service, they're bound to deliver that service
at that price."
also says Indian doctors and nurses are extremely proud of their health care
system – and of how sophisticated it's become.
paper is published in the journal Health Affairs.