July 2, 2009
The Wall Street Journal examines how some U.S.-based health care programs are improving their treatment capabilities by learning from strategies used in developing countries. "When doctors running the AIDS clinic at the University of Alabama at Birmingham wanted to increase the number of patients who showed up for treatment, they turned to an unusual place for help: southern Africa," Wall Street Journal writes. By using an AIDS clinic in Zambia as a model, the Alabama clinic was able to decrease its no-show rate "from 31% in 2007 to 18% through June 2009."
The Journal reports that "with health-care costs soaring in the U.S. and more than 50,000 new HIV infections every year, many are starting to ask: If it can be done over there, why can't we do it here? The obstacles range from the complexities of insurance reimbursement to regulations designed to protect patients. Another hurdle is cultural: There is a deep-seated reluctance to accept that simpler and less expensive treatments like those used abroad might be good enough." Others worry that "imported practices -- and possibly lower standards -- would be adopted only for disadvantaged patients in the U.S."
Mark Dybul, former U.S. Global AIDS Coordinator under President George W. Bush, says "we learned from Africa that in a very resource-limited setting, you can do very effective chronic care delivery that doesn't have to be overmedicalized. ... These are models we can learn a lot from."
The Prevention and Access to Care and Treatment Project (PACT) in Boston was able to decrease by 40 percent total medical expenses for a group of 20 patients by using a program from rural Haiti as a model. PACT aims to increase treatment adherence among HIV/AIDS patients by training community health workers, and the strategy "appears to work," writes the newspaper. "But PACT, which is expanding to sites in New York, still pays for the program out of private donations and fund raising, since insurers don't cover it."
Low-cost technologies, which are sometimes "faster and cheaper than the more sophisticated version of the test performed in the U.S.," are also sometimes easier to launch in the developing world, the Wall Street Journal writes. William Rodriguez, former chief medical officer for the William J. Clinton Foundation, said, "In the developing world, people are willing to make the tradeoff in accuracy for simplicity and low cost. In the U.S., that kind of trade-off is a hard sell" (Marcus, 7/2).