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Medical outsourcing not such a foreign concept
Some may have traveled abroad for health services without knowing
By KARIN BASARABA
It’s midnight in Bangor, Maine. An ambulance delivers a patient who has just been in an accident. She needs an emergency brain scan. Her scan is interpreted by a team of radiologists just starting their day in Bangalore, India and the results are faxed back within 30 minutes.
Sounds like the possible future of health care, right?
Actually, according to a recent article published in the New England Journal of Medicine, several hundred American hospitals are currently using overseas teleradiology services, designed to capitalize on time differences between North America and abroad.
And while these services may seem like a flash-in-the-pan trend, the shortage of radiologists in the US, coupled with their desire to sleep at night rather than the day, points to a form of medical outsourcing which may be here to stay.
Initially, medical outsourcing began when physicians were not available in rural or less populated areas to interpret medical tests or x-ray results.
However, as health care becomes digitized, many activities, from MRIs to the manipulation of laparoscopic instruments, are deemed borderless.
"You can’t reach over and slap [the radiologist] on the back, but every other aspect of the interaction is preserved," said Dr. Arjun Kalyanpur, a Yale-trained radiologist who runs Teleradiology Solutions, a "nighthawk" company based in Bangalore.
Kalyanpur started his operations in 2002 when there was an acute shortage of radiologists in the US. And, he said, due to the aging population, more radiologic imaging scans are being performed in the US, requiring more radiologists which the US simply does not have.
"Training programs in the US have not kept the pace with these changes," he said.
"The number of training positions has remained relatively constant, while the number of scans has exponentially increased. We stepped in to fill that void."
Filling a void is exactly what medical tourism hopes to do. With the price of surgery in the US getting exponentially higher and wait lists in Canada and the UK longer, traveling overseas for surgery is becoming a necessity for some.
MedSolution.com offers surgery in both India and France, where prices are substantially cheaper and waits are non-existent.
And while some may worry that the quality of care they will receive overseas will not be the same as at home, just as with the overseas teleradiologists, most of the doctors are US-trained and licensed.
Outsourcing, however, is not an entirely new practice. A call to the Dell Computers 1-800 number instantly connects you with a customer service agent – in India.
And although outsourcing is often motivated by cost reduction, health care's version may offer substantial advantages for patients. For example, many hospitals now purchase interpretation services from outside companies, whose interpreters often speak a range of languages that individual hospitals cannot match.
Whereas medical tourism requires the patient to travel abroad for surgery, it is simply the patient’s scans that are sent abroad with overseas teleradiology. However, both aim to improve the quality and efficiency of health care.
"Outsourcing focuses on improved quality or access to specialized care – allowing patients to obtain services from the best provider, not just the best in town," said Dr. Robert Wachter, professor of medicine and chief of the medical service at UCSF Medical Center.
"Provided that quality is not compromised, outsourcing that is focused on the bottom line may also have virtue, particularly for patients who must pay a portion of their bill, for payers, and for fiscally challenged hospitals."
"Even domestic providers may celebrate outsourcing that frees them from off-hours duties or permits round-the-clock services," said Wachter, who was recently named one of the 50 most influential physician-executives in the US by Modern Physician magazine.
And like medical tourism, the use of overseas teleradiology has certainly been controversial. But when those opposed have gone up against the demand of consumers for decent products at low prices, outsourcing has usually prevailed.
With files from Rediff, Metro West Daily News and
the New England Journal of Medicine.
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