Sunday, June 29, 2008

Globalization of healthcare-for-the-rich

"There is a revolution afoot in international healthcare." So begins a piece in the May-June issue of Harvard Magazine, which notes that changes in U.S. visa policy since 9/11, making trips to the U.S. for certain purposes more difficult, have prompted wealthy non-Americans to seek "world-class" healthcare outside the U.S. Hospitals for the wealthy (or relatively wealthy) have been springing up around the world, and various U.S. universities have sought to capitalize on this.

Something called Harvard Medical International (HMI), which was set up in 1994 to make money for Harvard Medical School (HMS) and which has projects in 20 countries and an operating budget (for '07) of $21 million, is being transferred by the university to Partners Healthcare, "the parent organization for two of the largest Harvard-affiliated teaching hospitals." The rationale for the transfer is that HMI is a consulting company that should never have been a formal part of the university in the first place. But the new organization will be allowed to use the Harvard name, when entering into new contracts, for the next five years, and the university will continue to be involved in some aspects of HMI-connected projects. HMS will continue to operate, for example, its Dubai Center (for postgraduate and continuing medical education), which is linked to the projected 4-million-square-foot Dubai Healthcare City.

A pertinent issue, broached but not really tackled by the article, is whether this whole trend benefits anyone other than the wealthy. If so, very indirectly, would be my admittedly ignorant guess. On the other hand, an interesting coda to the article, which may relate to this issue, questions "the model that says medical advances develop in the United States and ripple out to the rest of the world." It relates the story of an HMS student, Eric Twerdahl, who spent a summer researching "the impact of HMI projects in Dubai and India on healthcare in their respective regions." It goes on:
Twerdahl met a vascular surgeon in Bangalore who has revised operating room practice -- for example, sterilizing and reusing equipment, instead of using disposable items -- to cut the cost per procedure. He met a cardiac surgeon in Mumbai who has pioneered open-heart surgery without general anaesthesia, using instead an epidural administered above the level of the heart. These innovations sharply increase access to care, but were unlikely to develop in the United States, where the healthcare system is much less responsive to cost. In this sense, says Twerdahl, "the days of U.S. medicine thinking that it's at the top of the pile are numbered."
But at the same time, of course, that organizations like HMI are engaged in projects that may encourage such innovations, it is safe to assume that a number of health systems in various parts of the world are not at all in good shape: see, for instance, this report on the situation in what used to be Soviet central Asia.

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