As seen in: Financial Times
By Muhammad Yunus
June 4, 2013
A system designed for low-income patients is testing the upmarket model, writes Muhammad Yunus.
Across the west, the cost of healthcare is rising. That is because the systems are focused on the most expensive resources: specialist doctors, tests and treatments in pricey hospitals. This “Cadillac” model has created a lucrative industry where costs and prices increase continually. But look beyond the west and you will find innovative, affordable models for healthcare delivery. Even more surprising, this “Tata” approach often delivers better results. Having worked as a banker to the poor, I began working on healthcare in 1995 because I saw borrowers could be financially crippled by health problems. I soon learnt that medical bankruptcy and rising health costs were a growing problem worldwide. Meanwhile, many poor people have no access at all to care. Too few highly trained health professionals are willing to work in low-income communities.
As with banking, we need health systems designed with the specific needs of the poorest people in mind. In Bangladesh, for example, we set up clinics for families making $2,000 a year or less. They are staffed largely by nurses and community health workers, who consult remotely with doctors when necessary. Our Grameen Kalyan (“wellbeing” in Bengali) clinics, run on a not-for-profit business model, are reaching the point where they are fully funded by members’ subscriptions – $3 a year for access to steeply discounted basic care, diagnostics and mainly generic drugs.
My friend, Dr Devi Shetty, operates a hospital in Bangalore, India, that performs even complex heart procedures for about $2,000 apiece. He sees results as good as, or better than, most western hospitals, which may charge $100,000 or more.
In Mexico, the poor can pay about $5 a month for access to a phone-in medical service that helps them decide when emergencies are real and directs them to an affordable caregiver when necessary. Even in poor countries, almost everyone has access to mobile phones but they are underused for healthcare.
What magic formula allows such low prices? Are these grimy facilities, entered by patients at risk of their lives? Not at all. They are clean, modern and staffed by qualified professionals. The difference is that they were designed with very poor customers in mind. Everyone works at the peak of their training. Doctors, who draw the biggest salaries, take on only tasks no one else can do. Nurses and technicians are trained to do everything else. By specializing in specific surgeries, hospitals can perform more cases daily. And when supplies such as sutures are too expensive, they work out how to make or procure them for much less.
I understand that there are hurdles to reforming entrenched healthcare systems. But we see many great solutions. We plan to found an enhanced primary health clinic for Grameen America borrowers in New York this year. We will provide women with access to a team that will include doctors but also rely on lower-cost personnel, such as health coaches to combat chronic diseases. Our borrowers will have around-the-clock access to medical advice. With this innovative combination of smart staffing and use of phones, email, internet and other services, we hope to cut the cost of their care dramatically while improving their health. Data from earlier versions of such clinics suggest we can.
Many believe the poor should receive unlimited free care but we are fast realizing this costs more than most governments can afford, and outcomes and quality can be low. In my experience, the poor are happy to pay affordable prices. They like being customers, able to demand high-quality services and dignified treatment rather than beggars who must accept whatever is on offer.
If we consider new models, using technology to rethink and redesign healthcare, costs need not continue to rise. In fact, they could drop, becoming affordable to even the poorest. We need to do for healthcare what microlending is doing for banking: revolutionize an industry stuck in old ways.
The writer is the founder of the Grameen Bank, with which he shared the 2006 Nobel Peace Prize.