From the look of things, hardly a week passes nowadays without someone going to India for heart surgery, a bone marrow transplant or some other life-saving medical procedure.
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We only get to hear about those who need public fundraising support, but there are many who easily afford the cost, hence quietly slip out of the country and come back without anyone noticing. While many know that accessing healthcare in India is generally much cheaper than doing so locally, few understand why this is the case and therein lies the danger.
If we keep trekking to India, focusing only on taking advantage of the affordability of its health services, the lessons on how India achieved its famous low-cost model might be lost on us and with it an opportunity to reform our own health delivery system.
At a time when Parliament is debating the appropriate model for healthcare funding, a look at India’s secret of achieving a low-cost model may be instructive for Zimbabwean lawmakers. Ultimately, improving our health delivery system while making it more affordable for the majority of patients means we can stem the tide of money currently being exported by health tourists to the likes of India and South Africa and this can go a long way in helping to fix our current account deficit.
According to Vijay Govindarajan and Ravi Ramamurti in an article titled India’s Secret to Low-Cost Health Care, Indian doctors and hospitals are treating medical problems for much less than can be achieved elsewhere, leveraging on practices commonly associated with mass production and lean production.
Admittedly, our challenges in Zimbabwe are much more complicated because it’s often not about not knowing how to do more with less, but it’s mostly about not having adequate resources in the first place. Govindarajan and Ramartmuti cite three major practices that have allowed Indian hospitals to cut costs while still improving their quality of care.
A hub-and-spoke design
In order to reach the masses of people in need of care, Indian hospitals create hubs in major metro-areas and open smaller clinics in more rural areas which feed patients to the main hospital, similar to the way that regional air routes feed passengers into major airline hubs.
Costs are cut by concentrating the most expensive equipment and expertise in the hub, rather than duplicating it in every village.
This system also creates specialists at the hubs who, while performing high volumes of focused procedures, develop the skills that will improve quality. From this description, it does seem that we have a hub-and-spoke design in place in Zimbabwe though a network of district, provincial and major referral hospitals, but it perhaps needs to be better capacitated though manning with adequate specialist doctors and upgrading outdated equipment in order for it to become more effective. Also, while we have several hubs, we probably don’t have enough spokes.
Indian hospitals transfer responsibility for routine tasks to lower-skilled workers, leaving expert doctors to handle only the most complicated procedures. India is dealing with a chronic shortage of highly skilled doctors so hospitals have to ensure that doctors perform only mission-critical duties.
For example, by focusing only on the most technical part of an operation, doctors at these hospitals have become incredibly productive — performing up to five or six surgeries per hour instead of the one or two surgeries common in other parts of the world.
After shifting tasks from doctors to nurses, several hospitals have even created a lower tier of paramedic workers with two years’ training after high school to perform the most routine medical jobs.
All this leads to a reduction in costs.
Good, old-fashioned frugality
There is a lot of waste in some hospitals to the extent that when you walk into them, they look like five-star holiday resorts, with most of the buildings having no relation to medical outcomes. In such hospitals, doctors are either blissfully unaware of costs of are keenly aware of them, in which case they happily pass them on to patients.
By contrast, Indian hospitals are said to be fanatical about wisely shepherding resources and do some things that would be frowned upon in this part of the world; such as, for example, sterilising and safely reusing many surgical products that are routinely discarded elsewhere after a single use. The Indians have also developed local devices such as stents or intraocular lenses that cost one-tenth the price of imported devices.
The hospitals have also innovated on compensation for doctors.
Instead of the fee-for-service model which is common in Zimbabwe and infamously creates an incentive to perform unnecessary procedures and tests, doctors at some Indian hospitals are paid fixed salaries, regardless of how many tests they order.
Other hospitals employ team-based compensation, which generates peer pressure to avoid unnecessary tests and procedures.
We can get there too
Health care is now often viewed as a craft and each patient as unique, but by applying principles of mass production and lean production to health care delivery, Indian doctors and hospitals appear to have discovered the best way to cut costs while still delivering high quality health care. Over time, I believe we can achieve the same success in Zimbabwe by plucking a leaf or two from India’s book of healthcare reform and meshing it with the strengths that used to make Zimbabwe’s healthcare system one of the best in Africa at independence in 1980 and in the early 1990s. Howard and Karanda Mission Hospitals have already proved that Zimbabweans can flock to good local health institutions just as they do now to Indian and South African hospitals.