Ashraf Shehata, Partner, KPMG in the US
- Changing the interaction with the patient. The phone is vitally important as many interactions as possible should start with a call
- Use technology to help patients manage their own care and interact with the system – creating a virtual platform to do this will be a critical component of future models
- Careful choice – avoiding over specification, paying for features that are not needed
- Clever financing – buy-back schemes, leasing and other financing methods can be effective in controlling costs
- Improving workflow – automating routine processes, including capture of data used to improve workflows, gives rapid diagnoses and supports continuous improvement
- Miniaturization and portability – reducing the need to replicate equipment in different locations.
Beyond the capital cost of equipment, including imaging and laboratories – maintenance, consumables and energy use contribute to high costs and limiting their supply is important.
- Strict criteria for ordering tests and investigations, backed up by data systems monitoring any decisions that vary from the guideline to allow improvement and performance monitoring
- Using high-cost scanners continuously by programming inpatient investigations for evenings and nights and operating seven
- days a week or even 24 hours a day for routine work. If staff are available, patients can be offered a co-pay option or price reduction for accepting appointment times late at night
- The use of point of care testing or hot laboratories supported by central reference laboratories. There is much more to do in labs, physiological measurement and imaging to bring low-cost, high-quality diagnostic technology to emerging markets.
An important source of advantage in low-cost systems is the way they deploy information. As noted in many of our case study examples, several low-cost providers have moved remarkably quickly and cheaply to introduce electronic health records, paperless systems, decision support, inventory management and other IT elements to support business processes. Using technology to support education and staff development is another important application.
We expect low-cost systems will continue to innovate to stay ahead and the next generation of innovators will use mobile devices, automated data collection, collaboration tools and systems to enhance engagement with patients and professionals. The growth of smartphones and other mobile devices over the next ten years will be exponential, with costs falling enough to put them in common use almost everywhere. This offers new ways to engage with patients and new cost saving opportunities for data capture and recording, for example by removing the need for devices to be manufactured with screens and printers.
- Low-cost markets require medical technology with fewer features at much lower costs; current suppliers to high-cost markets will need to adapt quickly to respond to these emerging needs
- More must be done to ensure that technology is appropriate to its environment and that it can be serviced locally
- Telemedicine connects remote communities, reduces the need for travel and creates new ways of providing low-cost care. Using software on smartphones rather than special equipment has great potential
- Low-cost mobile clinics or using facilities on a time share basis offer opportunities to greatly reduce fixed costs
- Centralize scarce resources and use transport or telemedicine solutions rather than following Western approaches to highly distributed specialist care
- Collaboration between systems on standardization and shared purchasing is important, although flexible local procurement is also needed
- More can be done to support local production
- As with workforce, regulations and regulators can be a barrier to progress