Serious students of the US healthcare system understand that costs are high and quality is uneven. While there are some incredible components of our system, it’s clear to me that we should look elsewhere for best practices that we could apply in the US. That outlook led to my interest in “medical tourism,” which I spent some time focusing on just before the Obamacare era.
A Harvard Magazine article (Global Health at Home) starts with the same premise, and cites a statement from the World Bank president that “situations of scarcity lead to innovation.” This gets right to the heart of the matter, because in the US high and rising costs are taken for granted, and budgets are not really a constraint. As a result we are not forced to think differently and creatively.
I was a bit surprised that the authors then jump to the conclusion that the solution is global health, which is “premised on taking responsibility for all people in a given location.. and at all levels of income. Philosophically, global health is guided by the words of… Paul Farmer, co-founder of Partners in Health: ‘The idea that some lives matter less is the root of all that is wrong with the world.’ Equity is the soul of global health.”
The authors use the term “Global Health at Home,” to describe their concept of bringing this global health approach, developed for poor countries, back to the US. Their solutions are pretty sensible: a holistic approach to chronic diseases, attention to identifying and addressing the social determinants of health, deployment of community workers, and an emphasis on care at home. These are good ideas but we don’t have to go abroad to learn them and frankly I don’t see that equity is the key lever for cost containment in the US or elsewhere.
I’m thinking about how scarcity has led to innovation in other fields: like how farmers in Israel innovated in irrigation to compensate for the lack of water or how earlier computer programmers developed elegant programming approaches when memory was a scarce resource (unlike the typical bloatware we see today).
What are the equivalent opportunities in healthcare, from both a process and product standpoint? What clever and efficient approaches are being taken for diagnosis and treatment in resource constrained settings? Can we apply them to the US? If we do, are there trade-offs that we need to consider?
What barriers are in place and can or should they be lowered? These may include regulatory requirements, malpractice risks, and payment methodologies.
It’s a topic worthy of systematic inquiry. I assume people are working on it, so if you’re aware please let me know on Twitter @HealthBizBlog
As a sidenote, it’s inspiring that the lead author of the Harvard article is in his 90s and still going strong!