Al Hammond

Notes From the Field: The Future of Healthcare Part II

I wrote before about standing in a room with dozens of MDs sitting at terminals in the world’s largest medical call center. Together with an even larger group of lay health workers, they advise thousands of patients per hour. Costs per patient are so low that I described medical call centers and telemedicine approaches as the future of medicine. But that’s only part of the story.

Last week I stood in another room in India where perhaps 15 women in clean-room garb were assembling point-of-use rapid diagnostic kits-these were pregnancy tests, but the company makes similar diagnostic kits for malaria, dengue, hepatitis, HIV, glucose levels, etc., more than 30 in all. Two women dip sheets of special paper into an antibody solution; two more ran a specialized paper cutter to slice the medium into thin strips; still others assembled the strips into plastic housings, sealed them into foil envelopes, inspected the product carefully, and packed them into cartons.

These few workers turn out about 50,000 “strip test” kits a day. These could be used by consumers directly-most require putting 2 drops of urine or blood or plasma on the strip test and watching a few minutes until it give as “yes” or “no” signal-but are more accurately handled by a lay technician. And here is the key point: Most of these kits sell for less than $.10 each in India (including supplies, labor, packaging, shipping, and profit). The kits have a built-in error check, are stable for 2 years at room temperature and below, and the company has data to back up a claim of high reliability. And this is not the only company in India making these kinds of diagnostic kits.

But that’s today. Next door to the diagnostic assembly building is the company’s newer facility, where automated production machinery is being installed that will lower production costs significantly, to mere pennies a test. So imagine that you could walk into an “instant clinic”, get tested in 5 minutes for an insignificant cost, talk to a doctor in a medical call-center about the results if you desired, pick up the medicine you need, and leave-within 20 minutes. Of course, in an industrial country, the price will be higher; the labor for the technician (30 seconds to perform the test, 30 seconds to tell you the result) probably will cost more than the test itself, not to mention shipping, customs duty, FDA approvals, etc. But the result is still a radical shift in the cost paradigm for healthcare delivery.

Within a few years, more sophisticated diagnostic devices will be available too-a “lab-on-a-chip” that analyzes the DNA in the sample and gives a digital readout, at a cost of perhaps $1-$2 a test. We are tracking a pipeline of a dozen such diagnostic devices now in development covering a wide range of diseases and health problems. But it is hard to escape the feeling that the women I visited last week are the pioneers, already shaping the future of healthcare in a fundamental way. We will be using their products and tele-medicine in the remote rural part of India (6 hours by train from the nearest airport, plus another hour by car) where we are launching a novel approach to healthcare services.

We may not care in the U.S. whether a test costs a dollar or a dime or a penny-any of those would constitute a revolution of the type the Obama Administration is looking for-but there are 4 billion people in the world for whom low-cost diagnostic kits can be truly transformative, and for whom the difference between a dollar and a few pennies may just determine whether they seek medical care for themselves or their children.