Indian Healthcare Firms learn the lesson from US Debacle

There’s a lesson in here for the Indian government—both the seemingly crippled government in power today and future ones being planned, especially in BJP war rooms. And perhaps there’s a job opportunity for Nandan Nilekani too if he’s looking to get out of a tough election fight where the Congress seems headed for trouble. While India’s Food Security Bill has received much criticism for poor processes to correctly identify recipients of aid, considering India’s Public Distribution System (PDS), which was supposed to be a similar delivery mechanism is in a mess, some have suggested technology as the answer, especially considering Chhattisgarh and Orissa’s success. However, a few thousand miles away, the world’s only superpower has put on an embarrassing show that proves that a huge technology spend without a razor sharp focus on quality and without proper project management oversight is a recipe for disaster. So, despite a massive $363 million spent on building the healthcare.gov website, the citizen-facing Hub of President Barack Obama’s Affordable Healthcare Act, what Obama hoped would be his greatest legacy may now turn into a millstone around his neck, unless his Administration deals with building user problems, and quickly. And here’s how much of a disaster healthcare.gov is turning out to be: The Verge reports how US Health and Human Services secretary Kathleen Sebelius was in the middle of testifying before US Congress on the subject when the website crashed. And the list goes on and on. The Verge in one page captures all those embarrassing stories for those interested. A busy screen on healthcare.gov site. Reuters And now, comes the news that there are security concerns too. A US government memo pointing to security worries, written shortly before the site’s October 1 launch has emerged. The memo, obtained by The Associated Press, said incomplete testing created uncertainties that posed a potentially high security risk for the website. It called for a six-month “mitigation” programme, including ongoing monitoring and testing. It further revealed that the troubled website was granted a temporary security certificate on Sept. 27, just four days before it went live. And US Republicans, who have tried to corner Obama over the Affordable Healthcare Act are literally rubbing their hands in glee, as they argue that troubled website’s glitches are proof the government is incapable of managing the complex health care programme. “You accepted a risk on behalf of every user … that put their personal financial information at risk,” Rep. Mike Rogers told Sebelius, citing the memo. “Amazon would never do this. … This is completely an unacceptable level of security.” It’s interesting that Rep. Rogers brings up Amazon, because clearly, Republicans who believe in lesser government involvement would rather not have the government getting into this space. And incidentally, the US Administration might have managed to build a whole new Amazon with the kind of money they blew on healthcare.gov. Andrew Couts, writing in Digital Trends, points out that Facebook, which received its first investment in June 2004, operated for a full six years before surpassing the $500 million mark in June 2010. Twitter, created in 2006, managed to get by with only $360.17 million in total funding until a $400 million boost in 2011. So, how did the US Administration get to this precipice and what’s the way forward? To start with, an incredible 55 contractors worked on the website. You don’t need Sherlock Holmes to tell you that there’s where the problem started. Steven Bellovin, professor of computer science at Columbia University, in an insightful guest article on CNN.com explains that the overall failure appears to have been one of project management on the part of the US government. Software code has to be perfect, and Bellovin recollects that one of the first American space probes to Venus was lost in part because of a single missing hyphen character in a program. In addition to perfect code, testing has to be rigorous and project management is key to doing a good job with resourcing a project, setting deadlines and handling change mid-project change management. Department of Better Technology, a private company that builds software for the US governments dug even deeper. In a blog, on the Healthcare.gov fiasco, the company states that the code that runs the site is riddled with “Lorem Ipsum Dolor” — the placeholder text that web designers and developers use to demonstrate designs before copy has been written. And to give you an idea of just how bloated the healthcare.gov site is, here’s an infographic from Information Is Beautiful, which explains that Healthcare.gov has nearly 85 percent more code than Facebook, one of the largest websites in the world. Forget websites, the healthcare.gov website has nearly 95 percent more lines of code than what powers an F-35, the super high-tech, complex, fifth-generation multirole fighter that is the ultimate combat aircraft and will join the US Air Force in December 2015. The Department of Better Technology blog goes on to find holes in architecture and more but finally zeroes in on the most important issue—procurement—how the US government selects contractors to do its work. The blog explains that officers who decide on awarding these contracts are afraid of their buys being contested by people who didn’t get selected or of being blamed when things go wrong because they chose an innovative player. So officers choose contractors with lots of government work experience and over time a select few end up being the only ones allowed to compete for bids. Alex Howard, a fellow at the Harvard Ash Center for Democratic Governance and Innovation, told The Verge, “the firms that typically get contracts are the firms that are good at getting contracts, not typically good at executing on them.” Rings a bell, doesn’t it, because this is what happens in so many sectors in India too. Infrastructure being the worst. In Mumbai, India’s financial capital, everything from sea links to metro projects are stuck because of the government’s criteria set by officers eager to protect their backsides and hence resulting in too few vendors being pre-qualified for such projects. Mumbai Metropolitan Region Development Authority (MMRDA) said in January that the much talked about Mumbai Trans Harbour Link, a key infrastructure project to decongest Mumbai would see bids finalised by the end of May 2013 and construction would begin by October. Current situation? Same as in January, since a sum total of zero companies bid for the project. But let’s not get sidelined into Mumbai’s infrastructure woes that may never see a solution. There’s at least a chance that Healthcare.gov can be salvaged. Using a word coined by the Bush administration in 2007 to increase the number of American troops in order to provide security to Baghdad and Al Anbar Province and bring in a semblance of governance, President Obama’s administration promised a “tech surge” that will involved outside consultants joining the existing team to fix problems. History is divided on whether the surge in Iraq actually worked. But war is gory business and the truth is often tough to find with bullets flying all around–US public opinion could be swayed by reports that focused on the bright side while leaving the ugly parts for the footnotes. The war over Healthcare.gov is being fought on the screens of US citizens though, and the more the visible problems with Healthcare.gov, the greater the chances of President Obama’s legacy being worse off than erstwhile President George Bush. And before anyone in the Indian government offers to send Nandan Nilekani to help thanks to his UIDAI creds, they might want to remember this . Clearly, the world largest democracies have more red-tape and bureaucratic ineptitude in common than is widely accepted

A few innovative Indian hospitals could show the United States healthcare how to outgrow the challenges of reducing costs while improving quality of care and access for patients, researchers claimed.

Professor of international business at Tuck School of Business, Vijay Govindarajan, and his co-author Ravi Ramamurti, who is a professor at Northeastern University have taken out an article in the current issue of Harvard Business Review.

The article “Delivering World-Class Healthcare Affordably,” revealed nine private Indian hospitals provides quality health care at a fraction of U.S. prices, the Washington Post reports.

Most of these hospitals are accredited by the U.S.-based Joint Commission International or its Indian equivalent, the National Accreditation Board for Hospitals and Healthcare Providers, the authors said.

Health services in India have to be affordable because their patients are poor and typically pay 60 percent of their medical costs out of pocket, the report added.

They have innovated in three areas which are as follows:

1. Using a hub-and-spoke design, with hub hospitals located in major cities and spoke hospitals in rural areas.

2. Transfer of responsibility for routine tasks to lower-skilled workers.

3. Old-fashioned frugality. Indian hospitals shepherd resources by building hospitals at a fraction of the cost spent in the United States, replacing imported devices with local equivalents costing a fraction of the price. (ANI)