Little Manushi and healthcare

Earlier in January, there was an article in the Daily Star (UK) about a one-pound baby (Little Manushi) born prematurely at 28 weeks in India. The mother, age 48, delivered Manushi at 28 weeks due to dangerously high maternal blood pressure and reduced blood flow to Manushi.

According to the article, the cost of Manushi’s care was one million Rupees or, converted into American dollars, $15,738. According to the Mirror, she was hospitalized for 6 months.

What does this story mean to us?

In the January 1, 2010 issue of Managed Care, the average daily cost of treating a premature infant was $3,000 with children born at 26 weeks quickly exceeding $250,000 or more. Finding an average cost of care for a very low birthweight/premature infant is very difficult. In 2018 we find that Nationwide Children’s Hospital in Columbus, Ohio charges between $4,800 and $6,984 per day for neonatal intensive care unit (NICU) services. University Hospitals in Cleveland charges $8,935 per day for their NICU unit -- $7,250 per day for neonatal step-down unit. Suffice to say, everyone agrees neonatal care (and healthcare in general) in the U.S. is very expensive.

If Manushi was born at Nationwide Hospital and because our care is more efficient, we assume 150 days of Manushi’s care was in a neonatal intensive care unit and use Nationwide Hospitals’ average cost of $5,892 per day, the cost of the hospital component would be $883,800. If we had matched the 180 days that Manushi was confined, the number would have been $1,060,560. This overlooks the cost of care provided by a neonatologist.

How is it that India can treat Manushi for 1.8% of what the cost of the treatment is here (yes, physicians and nurses are paid 20+ times more in the USA than India)? What were the techniques employed in India that could be incorporated here? What techniques can be incorporated in other aspects of healthcare such as pharmaceuticals (for example, a Harvoni course of treatment in the U.S. is $96,000 while it is $1,500 in India) that will allow us to drive down the cost of healthcare and preserve positive outcomes?

According to the World Health Organization, in 2014 India spent $267 per capita on healthcare which represented 4.7% of GDP. Life expectancy in 2014 is age 67 for males, 70 for females. According to the Commonwealth Fund, the 2014 private sector funds 69.1% of Indian healthcare expenditures directly out of pocket. 20% of the Indian population is insured.

For comparison purposes, the United States spent $9,403 per capita for healthcare, which represented 17.1% of GDP. Life expectancy is age 77 for males, 82 for females. According to the Commonwealth Fund, 67.2% of our population is insured via private voluntary health insurance.

Amazon, Berkshire Hathaway, and JP Morgan are looking to form a company with the end goal of getting healthcare costs under control. Can they incorporate the lessons of Manushi and help drive down the cost of healthcare?

While healthcare was barely mentioned in the SOTU address, the cost of healthcare is an issue that must be addressed in order to make sure the United States continues to be the world beacon for prosperity and freedom. The alternative is to have the cost of healthcare suck the life out of our economy like a vampire in the night.

 Let’s learn from Little Manushi.