Comments on: Real Medical Innovation, and Closed Systems

By: ElamBend

ElamBend — Mon, 23 Nov 2009 00:23:28 +0000

I can see the Carib islands becoming destinations for complicated treatments and cruise ships for less complicated. Why pay a tax for botox when you can take a one-day cruise and get it discount.
This monstrous bill will only hurt the poor and unresourceful, supposedly those it is meant to help.

By: Jonathan

Jonathan — Sun, 22 Nov 2009 04:41:15 +0000

Great post. While I agree with many conservatives that the current medical legislation will be terrible if passed, I suspect that the outcome will not be as bad as many people fear, because as you point out the USA is no longer a closed system. I hope that this is true in finance as well. The difference in medicine is that, unlike in finance, countries aren’t trying to create an international regulatory cartel (not that a regulatory cartel will necessarily work in finance, but the regulators have a good chance of making it much harder to do business). And of course the people who are most hurt by any top-down medical “reform” will be the people who are too poor to buy their own services — the very group that the medical scheme is supposedly designed to help.

By: Marty

Marty — Sun, 22 Nov 2009 00:55:45 +0000

Great post and comments. There is already quite a traffic to India for cosmetic surgery not coverred by most insurance, in the patient’s interest of saving $$.

Two thoughts:

1. Procedures not normally covered by insurance have seen much lower price rises than othe rmedical care—the difference being price sensitivity by the patients/customers. So, of course, the health care bills in Congress do away with HSAs. Mustn’t let the inmates have any options.

2. The idea that standardization might degrade rather than enhance quality suggests a person viewing medicine as art rather than science. This may flatter some egos but is inconsistent with trying to provide high quality and affordable care to a large market. There is room for some artists at the cutting edge, where genius should count in developing new things, but the vast majority of care is properly doing things that have been done millions of times before, and that’s not art, that’s production.

By: Nicholas

Nicholas — Sat, 21 Nov 2009 23:15:48 +0000

Fascinating, thanks for this post. If only we in developed countries could have a free enough financial/medical system to promote innovation like this.

By: Michael Kennedy

Michael Kennedy — Sat, 21 Nov 2009 22:56:32 +0000

I don’t know how many people will go to India for high tech treatment but I can see them going to Cayman Islands or Mexico, Many years ago, a friend of mine decided to give up his ENT practice and move to Palm Springs to do facial plastic surgery. He wasn’t all that well trained and there was some doubt about how well it would work. Well, he worked a deal with the resort hotels there to give cheap rates to his post-op patients in the off season. The whole thing took off and women would go there to have plastic surgery and then recuperate in the luxury hotel where their friends wouldn’t see them. It was one of the first of the resort medical travel concepts.

Heart surgery is a bit different than facelifts but I can see total hip replacements and other elective procedures as part of a package deal. The busiest hip replacement surgeon in Orange County, CA, I understand, has dropped Medicare and does his work for cash. There are other orthopedists who have done the same thing. Some entrepreneur will set up a rehab program in a resort area outside the country and do quite well. The heart hospital concept is already an active alternative. Moving it if necessary won’t be that hard with the Obamacare alternative to stimulate referrals.

By: david foster

david foster — Sat, 21 Nov 2009 21:13:00 +0000

HA…what do you mean by “soaring percentage?” Do you actually think India’s malnutrition rate is *higher* than it was 10 or 20 or 30 years ago?

Links?

By: Harry Angstrom

Harry Angstrom — Sat, 21 Nov 2009 21:10:35 +0000

[Sock puppetry deleted by Jonathan.]

By: Carl from Chicago

Carl from Chicago — Sat, 21 Nov 2009 20:45:32 +0000

Your comment means a lot considering that you are a respected doctor and I am just a businessman who likes to write about general topics. I appreciate it.

By: Michael Kennedy

Michael Kennedy — Sat, 21 Nov 2009 19:39:30 +0000

I agree with this completely. A current book that would be worth reading is The Innovator’s Prescription which discusses similar ideas. In 1995, when I was at Dartmouth, there was great interest in the methodology of improving quality of care in cardiac surgery (And other areas). They had done a study in which a group of hospitals in New England had agreed to study their own processes, including having staff members from other hospitals observe each other. They analyzed process and, as a result, were able to reduce morbidity by a factor of three.

I returned to California with the intention of working on quality improvement projects with hospitals, insurers and HMOs. I found no interest. Most assumed that improved quality meant higher cost, ignoring the example of Toyota.

The current health reform legislation is written by tax lawyers and has no possible benefit to quality or improved efficiency. It is more in the line of “Floggings will continue until morale improves.”

I do think, if this passes, we will see the evolution described above. A flight to quality will occur, both local in the form of cash only practices, and in technology with off-shore specialty surgery clinics. Some years ago, an Egyptian anesthesiologist friend of mine wanted to start a hernia clinic on Ibiza for Arabs. He would talk to the patients and I would do the surgery. I probably should have done it.