Artificial Legs in Thailand

Responding to Harvard Business Review blogs, wherein it is stated, "Doctors in India and Rwanda do not know anything more about the science of eye care or cardiac surgery or treating HIV/AIDS patients. But they do know how to deliver quality care at lower cost. By comparison, there is something highly inefficient about the health care delivery in the U.S. — and much to learn from poor countries."

If I want my house cleaned in Canada, it will cost me $100. The same work in Thailand will cost $10. It's not because house-cleaning is so much more efficient in Thailand, it's because we pay them one tenth of the wage. That - though unacknowledged - also applies in the present case.

And even more so. This is particularly troubling: "He hired amputees as technicians to do the fitting and help with rehabilitation and training with new patients. This approach had several benefits. First, it dramatically reduced costs..." It may cost more for professionals in developed countries, but that is because they are qualified to do the work.

In Thailand, Jivacate won't need to worry about this. His clients will not be able to afford legal representation if the inferior material breaks, wears, is fitted poorly, or causes additional harm. Indeed, he probably has few insurance costs of any kind to worry about. Or professional costs of any kind, beyond his own expertise.

This article fosters the impression that health care can be just as good if performed by amateurs at poverty-level wages using waste materials. It is misleading not only because it represents the two types of service as equivalent, it is misleading because it represents the high cost of health care in the United States as being caused by materials and professional salaries.

Compared to Thailand, such a proposition may carry a ring of truth. But compared to other technologically advanced nations, where equal-quality health care is offered using the best materials and highly-trained professionals, it does not. The equivalent care costs twice as much in the United States as, say, Canada, not because of the quality of the cause, but because of the high overhead created by a private system.

In the United States, where there are commercial temptations aplenty to cut corners on staff and skimp on materials, insurance and litigation costs are disproportionately high. Additionally, there is the overhead that must cover profit for private investors. There is the expensive allocation and billing system to maintain, and a system of private insurance coverage that is completely unnecessary in, say, Canada.

Jivacate's methods are merely stopgap methods in a nation that cannot afford professional service for all. But the way forward for Thailand will not be best served through private specialists offering plastic legs and amateur staff. A national program providing basic essential care will do more for Thailand than all the yogurt containers in China.