Hundreds of hospitals across the country are now outsourcing certain medical services overseas -- to countries such as India, Switzerland and Australia -- and the growing trend has profound implications for health care policy and practice, according to a UCSF expert in the field of patient safety.
Robert Wachter, MD, professor of medicine and chief of the medical service at UCSF Medical Center, explores the growing "dis-location" of medicine in the United States in the February 16 issue of The New England Journal of Medicine. Wachter is the author of a "perspective" piece on this topic.
Medicine has traditionally been a local enterprise, he says, but as health care enters the digital age, many services no longer need to be housed within the confines of a hospital or clinic, but can be anywhere, including overseas. Diagnostic imaging and intensive care unit monitoring are just two examples of services that can now be outsourced, both domestically and potentially offshore, he adds.
Outsourcing might hold tremendous advantages for patients, if it is focused on improving quality or increasing patient access to specialized care, writes Wachter. However, he cautions that medical outsourcing may also cause harm, especially if the driving force is saving money.
The outsourcing of medicine raises obvious concern regarding how to ensure quality, as well as patient confidentiality, when providers are thousands of miles away, according to Wachter. Another concern relates to the viability of those services that are not outsourced. "Outsourcing could potentially erode the economic underpinnings of local health care," he says, "causing consequences not only for displaced providers, but for patients themselves when they seek out local doctors and hospitals."
Although resistance from doctors and professional societies is inevitable, Wachter suggests the medical community begin to consider how outsourcing can serve the interests of patients and hospitals, along with ways that local providers and hospitals can improve their own quality and efficiency to compete effectively. Given the quality and cost challenges besetting the American healthcare system, if outsourcing can allow some care to be delivered at comparable quality but at much lower cost, its growth seems all but inevitable, he says.
"For now, outsourcing is focused on reading x-rays or monitoring ICU patients from afar, but as our technology improves, expect to see laparoscopic surgery and many other procedures performed by a doctor who isn't in the same room -- or country -- as the patient," says Wachter, who recently was named one of the 50 most influential physician-executives in the U.S. by Modern Physician magazine.
"Think about the battles over globalization and protectionism surrounding manufacturing computers or automobiles. The debate over the 'dis-location' of medicine will make those discussions look like a calm discussion over afternoon tea," Wachter says.
An interview with Wachter on the implications of medical outsourcing also can be heard at www.nejm.org.
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