A place to rant about politics, the media, and especially the electorate. Much like alcohol, the electorate is both the cause of, and the solution to, all of America's problems.

Location: Seattle, Washington

Tuesday, February 01, 2005

American medicine outsourced to India?

A study by the Confederation of Indian Industry (CII), and McKinsey consultants estimated "medical tourism" could be worth 100bn rupees (£1.21bn) by 2012. Last year some 150,000 foreigners visited India for treatment, with the number rising by 15% a year, says Zakariah Ahmed, an analyst who helped compile the report,

With a large pool of highly trained doctors and low treatment prices, healthcare aims to replicate the Indian software sector's success. Built on acres of land, often gifted to companies at peppercorn rents from Indian local authorities eager to promote business, the new, sleek medical centres of excellence offer developed world treatment at developing world prices.

While I'm generally against the outsourcing skilled labor (I think it leads to a stupider, less skilled workforce), I don't feel so bad about it in the case of medicine - doctors in particular. Of course outsourcing affects a lot of people: nurses, administrators, and so forth. But the newspapers have been chock full of CPN and administrator positions for as long as I've seen newspapers, so I'm not all that worried about their job prospects.

Doctors on the other hand, have always enjoyed a de facto monopoly. One consequence of this is a lack of responsibility and accountability for their own preventable medical errors. And preventable medical errors are the *true* root of rising malpractice costs ("runaway jury awards" are as nonexistent as "frivolous lawsuits".) - see the Public Citizen report for the full details. A significant rise in "medical tourism" constitutes a direct frontal assault on that monopoly.

Outsourced medicine will, I suspect, put competitive pressure on American doctors. Hopefully, this will manifest in two ways (1) higher quality care, i.e., a decrease in the rate of preventable medical errors (currently on the order of several hundred thousand per year), and (2) cheaper care. The two are of course deeply and intricately connected - one path of interest is: (medical errors) -> (malpractice suits) -> (high malpractice premiums) -> (high medical costs). There are other interesting connections as well.

One thing I have no feel for is how the strong push doctors are making for Freedom From Medical Responsibility (also called "tort reform" by idiots and republicans) meshes with (what doctors must see as) the upcoming outsourcing threat. It seems that the manner of their interplay would depend partly on just how accountable Indian doctors are for *their* preventable medical errors. If they mandate strong patient protection rules, then this poses serious problems for American doctors, as I suspect they'll get their republican-driven Freedom From Medical Responsibility legislation shoved through one way or another - maybe while everybody is throwing fits about Social Security.

Indians get called a lot of things by my enlightened American brethren, but I've never heard "stupid" on their playlist. Since they don't have neo-con ideologue blinders on, Indians can see as clearly as anybody that American medicine suffers from two major defects: cost and quality. The Guardian article plays up the "cost" side of the issue. With FFMR in the offing in America, which will only drive down the quality of American medicine even further, I suspect India will also look to address the "quality" side of the equation as well.

The current cost of outsourcing your medical difficulties to India is still relatively high - only the financially secure can seriously hope to avail themselves of indian services. Possibly, however, this cost will decrease over time, rather like in the case of cd and dvd players, to the point where the the most expensive component to indian treatment is the plane ride over there (ok, maybe that's going a bit far). But you can bet that Indian business developers will be doing all they can to make it *very* attractive for Joe America to spend his money in India.

Indian medical outsourcing also ties into the Indian/Chinese view of the world: America is pretty irrelevant now, and becoming more so as time passes. To do top-tier work in the areas of education, scientific research, and software/IT, American hands are no required - it's really too bad that our republican leaders don't care about this. In essence, the intellectual barycenter of the world has shifted dramatically in the last few decades, and is now moving at an alarming rate across the Pacific Ocean towards China and the Indian subcontinent.

All of this is purely speculative, and years away at the least. But it also seems to be something worth keeping track of.


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