Saturday, March 26, 2016

A Healthcare System We Can No Longer Afford

Obamacare, catering to pharmaceutical companies to win their support for the legislation in 2010, made sure that Americans were (1) unable to buy prescription drugs from overseas (under the rubric that we could not assure sufficient quality standards from foreign sources in such untrustworthy places like Canada, the U.K., France or Switzerland… countries which, by the way, actually manufacture drugs sold in the U.S.) and (2) the healthcare exchanges here were not allowed to do what every other nation with state-controlled healthcare systems can do: use the bargaining power of their masses of consumers to negotiate lower prescription drug prices.
We spend 60% more for healthcare in this country than the next highest country, Switzerland, because of so many reasons, yet millions of Americans are still without coverage. We seem to have a proclivity to protect the big institutions in this country at the expense of consumers, and the medical/healthcare profession is far from innocent in this battle.
You can see above why we have to pay so much for pharmaceuticals, but a normal trip to a doctor’s office or a hospital emergency room is often nothing more than an emergency trauma center and/or a triage-designed referral system. All-too-frequently, it takes way too long, with way too many levels of filtration, to reach some of the most basic diagnoses.
Increasingly, countries with a chronic shortage of doctors and really stringent budget shortages – a fact of life staring the United States in the face as we open up the medical system to more Americans – have had to redesign their screening and diagnostic systems to increase accuracy and decrease the time to diagnosis and treatment. Automation with a built-in testing procedure, which includes a reasonably thorough diagnosis of blood and urine leaving only the critical summary analysis by a physician, can reduce the time for such an entire diagnostic “office visit” to 15 minutes, from soup to nuts. All medical records are recorded electronically, available instantly to any authorized physician through a centralized cloud-based repository.
We’ve always pictured India as massively dysfunctional society with problems heaped on problems multiplied by just too many people to handle. But India is also a nation with a tradition of technological excellence, home of the academically stellar Indian Institutes of Technology, a country where so many American medical facilities and doctors outsource their medical record-keeping, billings and even complex diagnostics (overnight when India is awake and America is sleeping). Whether local medical facilities use technology developed locally or systems designed in the United States, the obvious need for the highest levels of efficiency to cope with the volume of patients have force Indian medical practitioners to adopt processes that could teach their American counterparts a thing or two.
Perpetually running for office, Congress men and women spend a significant amount of their time raising campaign money. For those in the House, estimates suggest that well over half their professional efforts are focused on fundraising. So it’s no small wonder that there are many groups stroking the palms of legislators in exchange for assurances that anything that would make them more competitive (hence driving the price of services down) will die in flames even before such an “offensive effort” makes it to a floor vote.
And so it was when India-born Kanav Kahol, a biomedical engineer and researcher at Arizona State University’s department of biomedical informatics, developed a sophisticated automated diagnostic system known as the Swasthya Slate… “[A $600 medical] device, the size of a cake tin, performs 33 common medical tests including blood pressure, blood sugar, heart rate, blood haemoglobin, urine protein and glucose. And it tests for diseases such as malaria, dengue, hepatitis, HIV, and typhoid. [See the above test grid summary from their Website.] Each test only takes a minute or two and the device uploads its data to a cloud-based medical-record management system that can be accessed by the patient…
“[Kahol] became frustrated at the lack of interest by the [U.S.] medical establishment in reducing the cost of diagnostic testing. He worried that billions of people were getting no medical care or substandard care because of the medical industry’s motivation in keeping prices high. In 2011, he returned home to New Delhi to develop a solution…
“Kahol had noted that despite the similarities between medical devices in their computer displays and circuits, their packaging made them unduly complex and difficult for anyone but highly skilled practitioners to use. They were also incredibly expensive — usually costing tens of thousands of dollars each. He believed he could take the same sensors and microfluidics technologies that the expensive medical devices used and integrate them into an open medical platform. And with off-the-shelf computer tablets, cloud computing, and artificial intelligence software, he could simplify the data analysis in a way that minimally-trained front-line workers could understand.
“By Jan. 2013, Kahol had built the Swasthya Slate and persuaded the [Indian] state of Jammu and Kashmir, in Northern India, to allow its use in six underserved districts with a population of 2.1 million people. The device is now in use at 498 clinics there. Focusing on reproductive maternal and child health, the system has been used to provide antenatal care to more than 22,000 mothers. Of these, 277 mothers were diagnosed as high risk and provided timely care. Mothers are getting care in their villages now instead of having to travel to clinics in cities.
“A newer version of the Slate, called HealthCube, was tested last month by nine teams of physicians and technology, operations, and marketing experts at Peru’s leading hospital, Clinica Internacional. They tested its accuracy against the western equipment that they use, its durability in emergency room and clinical settings, the ability of minimally trained clinicians to use it in rural settings, and its acceptability to patients. Clinica’s general manager, Alvaro Chavez Tori, told me in an email that the tests were highly successful and ‘acceptance of the technology was amazingly high.’ He sees this technology as a way of helping the millions of people in Peru and Latin America who lack access to quality diagnostics.” Washington Post, March 11th.
We may believe in shortened terms towards getting an M.D. or relegating an increasing amount of screening, diagnosing and even prescriptions to nurse practitioners, but we need to deploy any and all viable methods and technologies to increase medical efficiencies. We need to purge unjustified protectionism accorded our medical elites from every nook and cranny of our healthcare system. We need this clear and obvious focus a whole heck of a lot more than we need to throw out Obamacare and think that somehow, we can replace it with a new system that will solve all our medical ills. Let’s address the obvious fixes… now.
I’m Peter Dekom, and it is fascinating that so many of the bastions of capitalism are the first ones in line to make sure that they face no competition.

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