Technology For The Poor
Vijaybhasker is an industry veteran at strategic and operational levels, and has demonstrated expertise in the use of a wide variety of management tools & levers in the context of development project and social businesses.
Technology in healthcare can broadly be divided into those that help service providers provide services:
• Proactively to the customers. Examples: advance alerts using IoT, reminder services, health record analytics to identify the risk factors, etc.
• At scale. Example: teleradiology, etc.
• With reduced errors. Examples: laboratories systems, AI assisted diagnosis, prescriptions checked for drug-drug interactions, EHR for continuity of care across service providers, etc.
• That were hitherto not possible. Examples: laparoscopic surgeries, etc.
• With lesser training. Examples: point-of-care diagnostic kits that can be run by health workers; telemedicine, etc.
Another broad division of technology helps service providers manage the healthcare enterprise.
While the above technologies are important and are developing at a faster pace, simple economic analysis can help provide guidance to the technology developers in prioritising the technologies for development and also suggest further actions. I try to capture the insights provided by using the simple tools of cost, price, benefit and its perceived value.
Technology comes at a cost to the service provider. The costs could relate to development of new products (technology) including the clinical trials, disseminating the technology, training of service providers on the new technology, promoting adoption of technology by service providers, cost of manufacturing the product, cost of using the product (including costs related to installation and consumables, if any). The ultimate consumer pays the price for the technology. Analysis becomes complex based on the portions of the above costs
that the ultimate consumer is asked to pay for. This could be at the root of several moral debates. The analysis becomes more complex if person benefiting from the technology is different from the person paying for that. (I am not referring to the son or family member paying for the services here.)
Take the example of cannula. Nurse trainees who have newly joined the hospital are unable to cannulate the patient properly. This results in wasting two cannulas before finally inserting one cannula. The patient is billed for all the three cannulas. The benefit is for the nurses who got trained and the hospital that got the nurses trained. But the patient is paying the price. Will the patient pay if we transparently tell her that the hospital is charging for the extra two cannulas as the nurses are getting trained? Is hospital morally right in camouflaging this? Moreover, this also raises the question of who should pay for the practical learning of nurses –nurses themselves, patients, hospitals, or government (society at large).
The ultimate consumer pays the price for the technology
Another example; a radiologist installs new generation ultrasound machine. This costs about 1.5 times of the ordinary ultrasound machines installed in other diagnostic centres. Most of the prescriptions will be for scans that can be done using the ordinary ultrasound machines and hence the radiologist will have to charge only the prevailing market price for doing these scans. There may not be adequate volume if the radiologist only wants to do certain advanced scans as he has latest technology. But, sure the patients benefit from a better scan because of the technology that the radiologist has deployed. In this case, the radiologist is paying the price but the benefit is for the patients.
The complexity in analysis increases as a result of different people imputing different value to the results of technology. The basic healthcare technology of washing hands with soap after using toilet is yet to be considered valuable by many poor households. Achieving the goal of universal individual sanitary latrine is a distant dream. In some cases, a certain technology becomes fashionable and attains a lot of value. In certain parts of India, for example, the doctor is held in high esteem only if he prescribes an injection.
Given that almost all the technologies developed help service providers, the development of technologies is viewed from the angle of either the service providers or the developers of the technologies. There is no concerted effort to sensitize the community in appreciating and wanting the benefits of the technology. It is possible that the current media efforts do not reach the poor and are unable to affect a change in their behaviour. Without the people valuing the results of the technology, they may not be willing to pay for the technology or they may not even adopt it. If people are not willing to pay for the technology, then the service provider will have to compromise transparency in billing. The costs of technology may have to be included in some other head and passed on to the patient. On the other hand, social disparities in health outcomes can increase if poor people are unwilling to adopt the technology. This can have adverse public health outcomes, social outcomes and impact government budgets.
Further debate is also needed on the portions of the costs that should be publicly funded, and those that should be recovered from the ultimate user - the patient.