Frugal innovation: Challenging sleepy "practice as usual"

Apr 19, 2010 14:45 EDT


In its recent special report on innovation in emerging markets, the Economist argues that emerging economies are the engines of innovation that could leave the rest of the world priced out of the market. With soaring healthcare costs, tightened budgets, and a dramatic rise in "medical tourism," what can we learn from frugal innovation?

See:

The new masters of management. The Economist. April 15, 2010.

The world turned upside down. The Economist. April 15, 2010.

Mobile pocket echo device: Revolutionizing medicine. Topolog. February 5, 2010.

New wireless sensors and technologies for CV medicine. Topolog. May 7, 2009.





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Your comments
Frugal innovation: Challenging sleepy "practice as usual"
# 1 of 2
April 21, 2010 10:36 (EDT)
vijay nambi
Dear Dr Topol: Nice post! I think, though, that with every frugal innovation there are bound to be many more additional ones that increases the cost to the system....but i agree that this is surely one way to drive down costs
As somebody who trained in India and then subsequently in the US the differences I found in the "systems" (which I think have a big impact on costs) between the US and India when i started here were fascinating. Let me start with the caveat that I am clearly generalizing and these are based on my experiences with both the systems which may be a bit different now and may be different for others.
1. In India, most patients pay for their care out of pocket (concept of health insurance has just started recently: will be interesting to see how this affects healthcare); therefore, patients would, for the larger part, not want testing unless absolutely essential. Hence keeping test costs low is essential/crucial for the test to be used.
2. Another big difference is the medical records or the lack thereof especially in the out patient setting. Physicians in India generally provided patients with a sheet of paper with the diagnosis and prescriptions and it was the patients responsibility to keep these and bring them for subsequent visits...if not the next physician will have to repeat the test:). As a result of not needing to document "x" number of review of systems etc for each patient, we could handle a huge patient load.....most physicians could see ~40 patients in an evening. Also the clinics for most physicians start early/ mid afternoon and go on till almost 9/ 10p at night...this makes it very friendly to the patient who does not have to miss work. For most physicians "walk ins" are the norm although this may be different in a hospital setting. Clearly, higher volumes is one of the ways physicians compensate for their lower consultation fees etc  
3. I think another key is that physician over heads are miniscule compared to here (labor is cheaper and far lesser demands/regulations on having a clinic as well). Also the cost of living is far more cheaper which therefore allows the physician to charge lesser for his/her time
4. Since there are very few insured individuals, the consultation fee is what the doctor sets it at; however, it is important to note that there is a wide spectrum of fees that are charged such that most people can find a doctor in their "price range" and sometimes even a hospital although the latter I suspect is a lot more difficult
5. Finally, of course, limited to non-existent malpractice suits.

I think each of these systems have several advantages and disadvantages and personally (and am sure many others would agree) I like a bit of both together. For example, i love having my patient records for the next visit but don't really care for the level of documentation (of things that are not pertinent) that is demanded here which is a drag on time. All that being said, I don't think we will ever be able to drive down healthcare costs here to the same levels we see in countries like India, but these "frugal" innovations will certainly help bridge the gap.
# 2 of 2
April 28, 2010 02:24 (EDT)
Tilak Jain

Dear Dr. Topol,

 I agree with Vijay on the points he made in his comment. Would like to add also that perhaps it is true that frugal innovations will lower costs - but who bears the risk? In the other countries, nearly all the time the patient bears the risk. Out here in the US risk seems to be distributed amongst all the healthcare provider (can get sued), patient or other insurers. So costs will remain higher, even for the same exact treatment. Given the economic growth in the 'emerging countries', costs might actually increase as systems get better regulated. 

What are the tradeoffs for frugal innovation then, as you ask? Lets assume for an instance there exists on the market a usb enabled device, costing around $250, that interfaces to your laptop and scans your eyes for vision correction parameters. A supporting module uses an electrochemical/polymer kit to fabricate soft disposable lenses right there at home. Another add-on module fills your cavities while you read a magazine. Do you think people will buy these items? I believe when it comes to the consumer, the answer is yes!  Now, would I trust a MAC operated software to drill a hole in my skull and implant a DBS while a physician monitors it on skype. No way!

 So I think one of the main tradeoffs for frugal innovations is going to be increased risk (though risk is never zero). However, it will definitely help if we can select treatments/diagnostics/procedures that are not inherently too risky and become extremely frugal by providing intelligent low-cost solutions on those fronts. The technologies are all mature enough to make this happen today, but somebody has to tell the innovators what will fly!

 Tilak


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Who's talking
Photo
Eric J Topol MD
Director, Scripps Translational Science Institute
The Gary and Mary West Chair of Innovative Medicine
Chief Academic Officer, Scripps Health
La Jolla, CA