February 12, 2011
What's Missing from Healthcare in Rwanda?By Deane Waldman
A recent online article posted on NY Times Live tells a great medical success story in Rwanda. The author describes the opening of a "Harvard quality" hospital in Butaro, Rwanda where they had previously had no medical facilities at all.
The 150-bed Butaro hospital was built in only two years at a cost of R40-million. (The cost of a comparable hospital in the U.S. would be 225-300 million USD). The physical structure itself is designed to scrub the air twelve times per hour to reduce risk of airborne infection. Here, that requires multi-million dollar machines. The Butaro hospital has advanced laboratory facilities, telemedicine capability, and a fully functional, user-friendly electronic records system.
In a country where the annual per capita income was $510 in 2009, patients get as high quality medical care as we get here in the richest nation on earth. But wait - their care is better! Why? Because it cost a tiny fraction of what health care costs us here.
What is missing from the new hospital in Butaro? Answer: things that waste money, such as unnecessary duplication and the #1 dollar waster in U.S. healthcare: a massively bloated bureaucracy needed to support a costly and harmful regulatory machine.
Before 2010, the U.S. healthcare bureaucracy consumed almost 40% of healthcare expenditures. That is right: 40% of all U.S. healthcare dollars never touch a patient. With passage of PPAHCA (disingenuously named Patient Protection and Affordable Health Care Act), that number could approach 50%. Even Everett Dirksen would consider throwing away one trillion dollars a year wasting "real money."
You really need to experience healthcare from the inside to appreciate fully how and how much the U.S. healthcare ‘system' wastes dollars and frustrates providers. Most of that daily waste is missing from Rwanda.
Doctors in Rwanda can communicate with each other without fear that HIPAA looking over their shoulders hoping to find them "out of compliance" and pull their licenses.
Hospitals in Rwanda do not waste time and money preparing for a Review by the Joint Commission (JC). They do not have to hide their doorstops on take down the books on top shelves. If the JC reviewers find doorstops or anything within 18 inches on the ceiling tiles in doctors' offices, they can close the hospital because those infractions will place them "out of compliance."
Nurses in Rwanda can spend time with patients, time that American nurses must waste in repeated annual training modules about security upgrades, ethics infractions, theoretical biohazards, and the next set of regulations that must be followed to the letter.
Nurses in Rwanda can use the infection prevention checklist without filing a research protocol with the FDA.
In Rwanda, restocking hospital supplies does not require multiple committee meetings, forms in quadruplicate, and pre-approval by legal counsel.
In Rwanda, research to find better ways to treat patients does not require 87 different steps*, each involving multiple committee meetings, thousands of man-hours and billions of red tape dollars.
*The number 87 was not picked at random. Dr. David Dilts at Vanderbilt reported in a 2006 article that number of different steps are mandated when going from an idea to actually starting a clinical research project.
One more thing that is missing in Rwanda: Federal organizational charts. Go online and look at the organizational charts for the NIH or the FDA. Then recognize that every box represents a whole agency with its own organizational chart, and each box in a box represents hundreds of bureaucrats, thousands of regulations to oversee, billions of dollars to consume, and thousands of providers to hound right out of health care.
To your right is displayed an organizational chart for the Healthcare ‘Reform' Act (PPAHCA). Are you surprised that it will cost only a trillion or so dollars? This too is missing from Rwandan healthcare.
For some inexplicable reason, the U.S. Public thinks that healthcare regulations are free or at least that they do not have to pay for them. In fact, the Federal healthcare bureaucracy is the leading cause of dollar wastage in the U.S. Those are dollars they do not need to waste in Rwanda.
If patients in Rwanda can get high quality care without regulations ‘protecting' them, why are we throwing away trillions of dollars a year on healthcare regulations and bureaucracy, money that we do not have?