Medical Tourism: The factory model of Heart Surgery

There is an article in the weekend edition of Wall Street journal that makes for an interesting read that features The Henry Ford of Heart Surgery, Devi Shetty. Tarticle touches on multiple themes:

• Cost cutting: How Dr. Devi Shetty is cutting costs (and not quality): The process provided an example of how he slashes costs. Four years ago, the sutures would have been bought from a Johnson & Johnson subsidiary. Today they are made by a Mumbai company, Centennial Surgical Suture Ltd. . . . Four years ago, Dr. Shetty scrutinized his annual bill for sutures -- then $100,000 and rising by about 5% each year. He made the switch to cheaper sutures by Centennial, cutting his expenditures in half to $50,000. "In health care you can't do one big thing and reduce the price," Dr. Shetty says. "We have to do 1,000 small things."
• Cost cutting without impacting quality: Dr. Shetty's success rates appear to be as good as those of many hospitals abroad. Narayana Hrudayalaya reports a 1.4% mortality rate within 30 days of coronary artery bypass graft surgery, one of the most common procedures, compared with an average of 1.9% in the U.S. in 2008, according to data gathered by the Chicago-based Society of Thoracic Surgeons.
• Expansion of Medical Tourism: His flagship heart hospital charges $2,000, on average, for open-heart surgery, compared with hospitals in the U.S. that are paid between $20,000 and $100,000, depending on the complexity of the surgery. . . . By next year, six million Americans are expected to travel to other countries in search of affordable medical care, up from the 750,000 who did so in 2007, according to a report by Deloitte LLP. A handful of U.S. insurance plans now give people the choice to be treated in other countries.

With the healthcare debate in the U.S reaching a crescendo, one is sure to see more articles of these genera. If nothing else, it will help Americans get a better understanding of the healthcare best-practices elsewhere in the world.

Links of interest

• Wikipedia on Medical Tourism
• Articles on Medical Tourism
• Need Extensive Medical/Dental Work? Consider Outsourcing

Some Indians Americans go Boa(t/d)ing but how many go to Udah?

The topic of accents, pronunciation and mastery of language is frequent among Indian Americans and immigrants and is a definite icebreaker; sometimes leading to passionate debates about the right or wrongs of aping accents. A hint to you: the surest way to hit an Indian immigrant below the belt? Remark about his use of English attributable to the fact he is not native born. ;-) The converse also works great: want to brownnose your Desi boss? Complement her on her clear unaccented Indian English.

A few days ago we were at a friend’s place for dinner when the topic of Indians and accents came up (surprise?), and we began sharing our anecdotes. I remarked about a colleague of ours, Raj, who seemed to have the most Americanized accent among the few Indians in the team. Ms R, a colleague from Georgia was slightly amused. She mentioned a recent conversation with Raj who had talked to her about his recent family vacation to Udah. It is only after Raj completed his story that Ms R realized that he wasn’t talking about a trip to an exotic foreign land but to the state of Utah. Turns out Raj took his lessons on pronouncing his Indian American "T" and "D"s to an extreme. Hearing this, I was reminded of Bollywood movies depicting scenes of the British Raj where the Gora Sahib would make attempts to bond with natives, speaking thoda thoda hindi in his thick British accent

What about me? Having spent years in the west – England, Europe, Canada and the US –I guess I still haven’t made a conscious attempt to acquire a native accent. I retain a typical Indian accent with what some have remarked, a tinge of the South Indian accent.

Thanks to globalization and the Business Process Outsourcing (BPO) boom, one can probably find scores of young Indians in Bangalore, Gurgaon or Hyderabad who speak much ‘better’ accented American English than most first-generation immigrants in Boston or Bay area. And between every Mohan who continues to retain a plain accent and Raj who work on his T’s and D's there are stripes in between.

A few interesting posts and blogs on the topic:

• Can That Damn Accent!
• The Venture Capitalist from Kanpur: Rekhi is a large and rumpled man with a heavy accent and a rapid-fire delivery. "I'm not smooth," he says, stating the obvious. The edges may be rough, but the sum is impressive
• Are Indians the Model Immigrants? They have funny accents, occasionally dress in strange outfits, and some wear turbans and grow beards, yet Indians have been able to overcome stereotypes to become the U.S.'s most successful immigrant group

Butterfly effect of American Healthcare Reform

The fact that American Healthcare industry is going through a massive transformation is being closely being watched by most Americans. Last night’s “historic vote” on healthcare by the US House of representatives is just one step in the transformation sweeping across healthcare. More important is the impact of this on the global healthcare industry and the butterfly effect on the global economy. Just a few interesting s snippets why the debate on healthcare is so closely watched

• In the US alone, about 580000 establishments make up the health care industry. As per the US Bureau of labor, “As the largest industry in 2006, health care provided 14 million jobs—13.6 million jobs for wage and salary workers and about 438,000 jobs for the self-employed. . . . Health care will generate 3 million new wage and salary jobs between 2006 and 2016, more than any other industry.”
• Implication: Healthcare reform = impact on jobs
• Per themedica.comThe United States of America has one of the largest medical and healthcare industries in the world, followed by Switzerland and Germany. The USA's medical industry comprises of more than 750,000 physicians and 5,200 hospitals. USA witnesses approximately 3.8 million inpatient visits and 20 million outpatients visit on a daily basis. Furthermore, the United States of America has the largest workforce i.e. one in every 11 US residents employed in the health care business.
• Implication: Healthcare reform = Large lobbying interest. Some want change that can help them, some don't want to change the status quo.
• The sheer size of the reform is mind boggling: House health bill totals $1.2 trillion
• Implication: Imagine the proverbial 700 pound gorilla charging ahead and you want to change course!
• The Global prescription drug market was $550 billion in the year 2006. Also, the total health care expenditures across the world were $4.5 trillion last year. Of which, US solely account for $ 2.2 trillion, $ 2 trillion in OECD countries and remaining $ 0.3 in other countries of the world. Indian drugmakers including Dr. Reddy’s, Ranbaxy etc have made inroads into the global generic drug industry and are also watching the reform closely.
• Implication: Healthcare reform = Impact on globalization!

I like the way BioPharma Today blogs about this "The legislation wending its way through Congress is the center of the political process, but regardless of the outcome for Obamacare 2009, change is inevitable. The scale and timing will depend heavily on the legislation—and, whatever is enacted, the implications (intended or otherwise) will take years to untangle."

As a technologist, I am fascinated by the Technology Lead changes coming down the pipe, especially the opportunities for automation, integration and system changes.

Implication: Healthcare reform (or not!) = Impact on software industry is not hard to fathom. However, seeing the forest for trees and translating them into opportunities that can impact me? I guess, there is a million dollar question hidden here.

With Global Mobility of its people, Tata Consultancy to Expand Footprint in Emerging Markets

The recent article and interview with TCS’s new chief N. Chandrasekaranmade for interesting reading. [Software Exporter to Expand Footprint in Emerging Markets]

With revenues of $6 Billion, the largest Indian software services firm is certainly a global player. Mr. Chandrasekaran's comments to WSJ were measured, and to some extent upbeat. However, one question stood out. When asked, "What are the challenges to ramping up hiring in the U.S.?"
he replied:

"Mobility is an issue. If I hire someone in California, and the next project is in North Carolina, I can't really move them. If I send someone from India, they can go to California, and when that's done I'll send them to North Carolina. Also, we want to train people in our methodology. In India, we recruit people and train them. It isn't just about having the correct software coding skills..—I'm sure we could find enough skilled programmers in the U.S."

I addressed the same issue of mobility in my book (Offshoring IT Services) while examining the cultural aspects of Indian software developers and how their ability to be mobile made them attractive in the global marketplace. Mobility of people is a big factor in Globalization of businesses, but wasn’t the flattening of the world supposed to mitigate the need for mobility? I guess it is true to some extent. Case in point the H1-B visa quota for this year, annually capped at 65,000 is not yet exhausted even half-year after the gates were opened. During the last few years, the quota was exhausted in just a few days after the April deadline.

As they embark on expanding the footprint in global markets, I guess the question that. Chandrasekaran and team must be asking themselves: how to motivate their Indian employees to pack up and head to Timbuktu, Mongolia or Siberia when even H1 visas are going begging?

Airline Pilots: rare heroes, few great, most good and deligent, and some well . . . just plain human

For young kids growing up, few professions exude as much glamour as that of Pilots. Earlier this year, this view was reinforced by the heroics of Airline Pilot 'Sully' Sullenberger, who successfully carried out the emergency ditching of US Airways Flight 1549 in the Hudson River, offshore from Manhattan, New York City, saving the lives of all 155 people on the aircraft. Media, and most of us just went ga ga heroics. And kids of this generation had yet another role model.

Bloggers and writers continue to eulogize Sullenberger and the story. (Sweating the Small Stuff: Lessons from “Sully” Sullenberger. American Mustache Institute Honors David Axelrod, Chesley "Sully" Sullenberger)

Fast forward to end of October and comes news of Pilots of a commercial aircraft that let their jet go “wayward,” prompting an intense media scrutiny, leading to FAA convening an emergency session to revoke their license. The airline has indicated that they will be fired. There way too many intricacies to the story including role of laptops in aircraft and role of technology in aviation itself (e.g, can we really trust pilots who totally trust auto-pilots?, Pilots missed Twin Cities by 150 miles - but how?) and so on.

As a frequent (business) traveler, I have learnt to trust the system, and the men and women behind the system - from ground staff to the air-crew who do a tremendous job of ensuring we travel safe. This said, a few incidents do stand etched in one’s memory.

The bottomline: Pilots and crew are just like us: rare heroes, few great, most good and deligent, and some well . . . just plain human

Globalization of England: British Jobs for British, < Polish, Asian, Indian, Immigrant> Workers

I was talking to my friend who lives London over the weekend who was describing his plan for move. His family was moving across town from Southall to a new place in Wembly. He remarked that the movers he had contracted were no polish, adding that he selected movers who advertised they hired only British blokes for the jobs. His remark also triggered an intense debate with him on the impact of Polish and East European immigrants in London and UK in general. Knowing my friend, I realized that his remark was not racist but certainly nationalist.
I recall the years I spent in London and Manchester in the mid-nineties when a similar debate over the influx of South-Asians, Indians, Pakistanis and Sri Lankans, in England. After moving from UK, I have sporadically kept track of events there, especially as it pertains to Britain’s role in global economy, immigration and similar aspects. The growing strength of European Union, Eurozone,, European Economic Area and the council of Europe has also meant freer movement of goods and services, and more importantly people across Europe.

The visible aspect of globalization and EU, especially the influx of East Europeans in UK is perhaps the most jarring to the media and average Joe Bloke (ref articles below). The non-visible part, movement of billions of Euros, Pounds and Dollars in contracts for European giants, say Airbus, that translates to real economic value and jobs in Western Europe is downplayed by digerati and the media. For instance, Airbus employs around 57,000 people at sixteen sites in four European Union ountries: Germany, France, the United Kingdom, and Spain. Airbus also sells to Poland as it does to other countries around the globe. If Airbus were to setup the next plant in Poland, perhaps fewer Poles would find the need to immigrate across Europe.

For those living across the pond, the story perhaps sounds familiar: replace EU with NAFTA and Polish with Mexican (or Latin American). Steve Hamm, author and journalist for Business Week stirs similar conversation in his blog while talking of Indians in America.

Bottomline: The global downturn is certainly making politicians in the west reassess their views on Globalization, especially the visible aspects of globalization that impacts man on the street: jobs; which in turn translates to sentiments and most importantly Votes.

Interesting articles/blogs:

• Why are polish people disliked in the United Kingdom?
• Polish workers: Help or Hindrance? (BBC) More than half a million Poles have entered the UK since joining the EU in 2004. Some people in Kent say they are taking 'our' jobs while others believe they are a vital ingrediant to a strong local economy.
• Tide of migration turns as Polish workers return
• Polish workers desert London as downturn bites

Wag the dog: Playing the global media

This week the American media went wild over the saga of a young boy thought to have taken off on a helium balloon in Colorado. Now comes news that the Sheriff will file Charges on suspicions of a hoax (Sheriff: Charges will be filed in balloon saga). It also turns out Richard and Mayumi Heene had inside hooks into the media (Huffington Post: Balloon Boy, Wife Swap Son).

Flashback to about six months ago: Media went similarly wild over the saga of Nadia Sulaiman who gave birth to Octuplets and dropped the story like hot potatoes the moment they realized she was a single mom on welfare already struggling to support her other kids. The public was outraged over the fact that a single mom on welfare went on to get fertility treatment and give birth to eight more children. Needless to say, before the story died down, Sulaiman’s "supporters"created a website asking people to donate, publicizing the URL, again thanks to the media frenzy over the story. (I couldnt google the URL when I searched recently).

And before that there was the saga of the British girl lost in Portugal. How did the story end? Parents were suspects : A British couple who turned their young daughter’s disappearance from a Portuguese resort into an international cause célèbre — raising millions of dollars and recruiting celebrities from J. K. Rowling to the pope to their campaign — were formally named suspects by the Portuguese police on Friday, a representative of the family said. Of course, this was not the last word. Two years hence, the saga continues and the media continues to follow the story: Satellite clue to Maddie kidnap

Wag the Dog is a Hollywood classic about a Washington spin doctor who, mere days before a presidential election, distracts the electorate from a sex scandal by hiring a Hollywood film producer to construct a fake war with Albania. The scheme enlists the aid of a country music singer, who creates several theme songs for the war; a "fad king"; and a costume designer, who helps create a fictional special forces unit to fight the war's supposed battles.

Of course, not all of us are as media savvy, at least not savvy enough to get over the money-and-muscle of large corporate in India. I remember how Jet Airways ensured almost a total media blackout when little Aditya died on board an international flight. The mainstream media India approached and interviewed us for stories that never got aired or published. The parents decided to bury the grief in solitude and move on.

I guess for every Nadia Sulaiman or Heene family that manages to Wag the Dog, there are a hundreds of others with a story waiting to be told.