Would You Go To This Doctor?

Healthcare, like government, is something that we could do better in America. American car companies learned to innovate after Japanese car companies surpassed them in cost and quality. Sweden has an aging population, just like the US (indeed like every other country), but it has reformed its state pension system, from projected insolvency (Social Security) to solvency. The overall labor productivity in America has increased by 1.6% per year over the last two decades, while the productivity for health care in America has gone down by 0.6% per year over the same period. One place the AMA could look is India, but would they buy it? Would you?

Devi Shetty is an Indian heart surgeon, trained at Guy's Hospital in London (quite prestigious). He performed the first neonatal heart procedure in India, and took care of Mother Teresa. He has taken the assembly line to health care. His flagship Narayana Hrudayalaya Hospital in Bangalore has 1,000 cardiac beds, compared to an average of 160 in American cardiac hospitals. He and his team of 40 cardiologists perform about 600 procedures a week in truly assembly line style. The sheer number of procedures allow his surgeons to acquire world-class expertise and specialize, and the hospital has true economies of scale in purchasing power. Individual surgeons perform 4-6 times as many procedures as American cardiologists. Richer patients pay more so that poor patients get free, but because of the economies of scale, the hospital can perform open heart surgery for about $2,000 versus about $100,00 in the US (cost; never mind the insurance issues here). Their success rate is as good as the best American cardiac hospitals. He has established a health-insurance program with local self-help groups that covers 2.5 million people for a premium of $0.11 (yes, 11 cents!) a month that provides one-third of his patients.

His group has built three other hospitals adjacent to his cardiac hospital in Bangalore; a trauma center, a 1,400 bed cancer center and a 300 bed eye hospital. They share common labs, blood banks, radiology centers, etc. and save from a common economy of scale. Shetty plans on increasing the number of beds in his practice to 30,000 over the next five years, which would make his the largest practice in the world. His hospitals have video and internet links with hospitals in India, Africa and Malaysia, so his staff can practice tele-medicine.

Finally, he is building a 2,000 bed hospital in the Cayman Islands that will offer Americans heart operations for less than half of what they pay in the US. Would you go to this Doctor?

Lest you worry over assembly line surgery, there was (I am not sure if he is still in practice now) a plastic surgeon that did breast implants in Houston, who had an operating room that featured four beds in a cross-shape that rotated. As soon as he finished with a patient, the next would rotate into position, while at stations 3 and 4, patients were loaded and unloaded.