Want to Lower Healthcare Costs? Serve the Poorest.
My work takes me from affluent cities to rural areas where the poorest of the poor live. From the United States to India, South Africa and across the Middle East, I’ve observed that there are basically four reasons why people get sick (and others don’t).
- Genetic: you are born with certain predispositions
- Environmental: where you were born and choose to live matters…if you don’t have clean drinking water, you will have a very difficult time staying healthy
- Physical: your fitness, habits and hygiene play large roles
- Psychological: the amount of stress you carry can make you ill
All of these elements operate from the patient’s standpoint. They basically have the same impact whether you live in Tokyo or a remote part of India. But the types of diseases vary by region and by levels of affluence. I have been to parts of the Middle East where the attitude is almost that if you don’t have diabetes, you are not fully participating in life.
Given these commonalities, if you can fix healthcare problems at the bottom of the pyramid, you can learn how to lower the costs of providing healthcare solutions in developed nations too.
In both poor and affluent communities, healthcare costs swell because people don’t seek care early enough. Whether you ignore chest pains or an infection for too long, either way the cost of treatment will be exponentially higher than if you intervened early.
From a health information system standpoint, we need to think differently about how we identify, solve and treat healthcare problems. Most software systems in the healthcare world largely deal with transactions. They store medical records, lab results, and the like. This is very basic stuff, and not nearly the end goal.
In the future, the success of medical software anywhere in the world will hinge on its ability to proactively manage three things:
For example, long before many diseases become critical (i.e., expensive to treat), there are changes within a person’s body and sometimes behavior. These changes are data. In fact, our bodies generate huge amounts of data, the vast majority of which our information systems ignore, until a disease reaches an expensive/critical stage. But the technology now exists to gather much of this data remotely - from lab-on-a-chip devices to medical tricorders. All we need is our systems to utilize this data properly.
To put this in simple terms, your physician should be able to alert you - not the other way around - when your body starts producing data of concern.
Now think back to the challenges of the poor. The greater our ability to remotely - and cost efficiently - monitor and treat a patient, the better our ability to lower healthcare costs worldwide. A physician in Manhattan or Mumbai should be able to help a patient in the middle of a poor, remote village…without ever leaving his or her office. This would greatly improve what we can do locally.
Medicine will always be about compassion and humans caring for humans, but we can’t deny that medicine has already also become a data science. We shouldn’t think about this in terms of one approach for the poor and another for the wealthy. We need to recognize that caring for the poor may benefit the wealthy more than they can possibly imagine today.