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Good article that raises some very good questions. I had a few specific takeaways out of it. >“Everyone does as much as they can,” Ashwinikumar Kudari, a senior gastrointestinal surgeon, says toward the end of a busy day at the Bangalore hospital. He’s just removed two malignant tumors the size of golf balls from a middle-aged woman’s intestines—the seventh surgery he’s performed or supervised since morning. A compact man with a trim mustache and a wry smile, Kudari is soon on the move again, checking in briefly on a gallstone removal next door before dashing up a spiral staircase to another operating theater. There, he takes over from a colleague who’s struggling to locate a particularly tricky fistula. “Our margins are low on one surgery, but because we do so many in a day, we can make enough,” he remarks after the elusive fistula—the longest he’s ever seen—is found, running from the man’s anus to above his groin. By working at this pace, the average Narayana surgeon performs as many as six times more procedures annually than an American counterpart. I'm wondering how overworked doctors are in these conditions, or how long a senior doctor lasts in a hospital like this. It might be a good place to gain experience, but how feasible it is to work there for 10 years? >It’s all a far cry from the high-touch treatment Westerners expect, but Shetty is adamant that none of the practices compromise safety. Sterilizing and reusing clamps and tubing is permitted under the standards of the Joint Commission, a U.S.-based body that vets and accredits hospitals worldwide, including Narayana’s cardiac hub. Involving properly instructed family members in the simplest care tasks isn’t unheard of in Europe and North America, and some studies suggest it may improve patients’ prospects. (Unlike busy nurses, relatives have just one person to focus on.) I growing up in the soviet block I remember family members taking care of relatives in the hospital, and I never really questioned this at that time. Now looking at the western medical system, it seems like nurses are doing work that there not supposed to be doing and there aren't enough of them all the time. > Yet even for bypasses—Narayana’s bread-and-butter procedure, with greater economies of scale than any other—Shetty needs to cut costs further, because Modicare will reimburse only about $1,300 for each surgery. For other treatments, the difference between current price tags and Modicare payment schedules is much wider. “They are paying less than what it costs,” Shetty says. It seems that politicians have established a system that covers everyone. Not always effective, that underpays a lot, but it's there, now as society gradually accepts that the system is their and it is fair, it may be possible to expand in in the next 5-10 years either with the amount of coverage it provides or with the amount of money it pays per procedure. |