I am a cancer surgeon currently working in India’s top medical tourism centre. Future US strategy for American and global healthcare should be three pronged.

Control cost of consumables. Shift main focus to strategic planning. Evidence based treatment.

Huge cost of disposables has somehow not received any critical analysis in the whole healthcare reforms debate. It might appear a small issue. It is not. Consider this; a coronary bypass in US costs a whopping $ 20,000 to $ 50,000. A bypass done in India in the best equipped centre costs not more than $ 6000. A large amount is saved by minimizing the use of disposables. Let me utter the words forbidden in western healthcare world- ‘reuse the instruments’. It is not something unethical or scary. Any way the conventional metal instruments like forceps are being reused after autoclaving. In India we ethically resterilize many costly instruments which are labeled ‘disposable’ by their western manufactures.

For example, a hand gun of Harmonic Scalpel (Ethicon) costs $1500. We safely reuse it 5-15 times, properly sterilizing it with Ethylene TriOxide (ETO) gas while our more privileged western counterparts throw it away after every surgery. Numerous check cultures from these instruments confirm sterility. If the US takes an initiative in recycling the instruments the trend will be followed by the rest of the world. At a policy level US can encourage manufactures to develop reusable instruments. (Think Obama’s encouragement to develop fuel efficient cars here.) America is a major exporter of medical devices. This initiative would have a lasting impact on healthcare costs world over. The ‘disposable culture’ has to be tamed. The list of potentially reusable existing instruments is long. The present opportunity to save is large & future potential of this concept to save funds is huge. It will have a permanent and positive impact on affordability of healthcare technology.

I volunteered for six months in a remote tribal health centre Palsan in Nashik District. Two things which were conspicuous by their absence were scarcity of funds and strategic planning. I still remember the tragic day when I had to mutely refer a critically ill trauma victim to a district hospital 8 hours away because my centre lacked even basic resuscitation facilities. Collaborating with the sole medical officer I established trauma management protocols based on the local patterns. We used the funds earmarked for expensive and unnecessary antibiotics to buy basic life saving instruments and drugs. Vitamin supplements were replaced by anti-snake venoms. Costly antibiotics and vitamin supplements both don’t have any proven role in primary healthcare. The moral of the story- funds are available but are poorly managed. A sustained solution lies not in individual efforts in a remote corner but at broader policy making levels. Here comes America’s role. The niche expertise US has in strategic planning should be involved at a policy making level of governments of developing countries. The US should shift its focus to prevention of diseases rather than giving free funds to developing nations to buy specific drugs. Once the drug stockpiles are exhausted disease prevalence returns to original levels. A few countries even divert the US aid funds to buy weapons! Let the US expertise play a more central role such as designing national health programs. Change US focus from material support to prevention strategies and planning.

Evidence based treatment is a distant reality in most developing countries. For example resource poor government hospitals here waste large sums on periodic Serum PSA tests. Enough data is available in US that these tests are insensitive and non-specific. These funds can instead be diverted to tackle other dire diseases. The US has a huge database on evidence based treatment. In fact developing strict evidence based treatment guidelines can save millions of dollars even in US healthcare system. For example, why should insurance or governments pay for the expensive Ixabepilone ( BMS) which, at best, improves survival in metastatic breast cancer by mere 3 months? The US can develop evidence based guidelines which the developing countries can follow. It will save them from the traps laid by multinational pharmaceutical companies. The saved resources can save hundreds of lives.

My suggestions are applicable to the healthcare reality in both developed and developing nations. All these three seemingly separate strategies in fact work towards one common principle- only a healthcare which is affordable can save lives. Consumables add a huge chunk to the cost of care and new innovative thinking can control this expenditure. The US involvement in designing national health programs will ensure better planning and implementation. Developing preventive strategies would prepare developing nations for current and future challenges. Evidence based treatment is another avenue to make healthcare affordable and effective.

Frugality should be the essence of future of healthcare reforms.