Are cost advantages from a modern Indian hospital transferable to the United States?
| Autor: | Kevin A. Schulman, Bipin Mistry, Robert S. Kaplan, Brent C. James, Arnold Milstein, M.C. Mazza, M. Kalani, R. Mann, V.G. Narayanan, J. Xue, Terry Platchek, C. Pinnock, J. Punnen, G. Poulsen, Christine Nguyen, Feryal Erhun, Michael J. Mack, D. Shetty, D. Ballard, K. Brayton, Dhruv S. Kazi |
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| Přispěvatelé: | Apollo - University of Cambridge Repository |
| Rok vydání: | 2020 |
| Předmět: |
Male
Patient Transfer Performance management media_common.quotation_subject India Commission Coronary Artery Disease 030204 cardiovascular system & hematology Medicare 03 medical and health sciences 0302 clinical medicine Medicine Humans Operations management Quality (business) 030212 general & internal medicine Coronary Artery Bypass Hospital Costs Activity-based costing Average cost health care economics and organizations Accreditation media_common Inpatient care business.industry United States Risk perception Elective Surgical Procedures Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | American Heart Journal |
| DOI: | 10.17863/cam.52600 |
| Popis: | Background Multiple modern Indian hospitals operate at very low cost while meeting US-equivalent quality accreditation standards. Though US hospitals face intensifying pressure to lower their cost, including proposals to extend Medicare payment rates to all admissions, the transferability of Indian hospitals’ cost advantages to US peers remains unclear. Methods Using time-driven activity-based costing methods, we estimate the average cost of personnel and space for an elective coronary artery bypass graft (CABG) surgery at two American hospitals and one Indian hospital (NH). All three hospitals are Joint Commission accredited and have reputations for use of modern performance management methods. Our case study applies several analytic steps to distinguish transferable from non-transferable sources of NH’s cost savings. Results After removing non-transferable sources of efficiency, NH’s residual cost advantage primarily rests on shifting tasks to less-credentialed and/or less-experienced personnel who are supervised by highly-skilled personnel when perceived risk of complications is low. NH’s high annual CABG volume facilitates such supervised work “downshifting.” The study is subject to limitations inherent in case studies, does not account for the younger age of NH’s patients, or capture savings attributable to NH’s negligible frequency of re-admission or post-acute care facility placement. Conclusions Most transferable bases for a modern Indian hospital’s cost advantage would require more flexible American states’ hospital and health professional licensing regulations, greater family participation in inpatient care, and stronger support by hospital executives and clinicians for substantially lowering the cost of care via regionalization of complex surgeries and weekend use of costly operating rooms. |
| Databáze: | OpenAIRE |
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