Al Hammond

They are very similar. In India, people don’t have the money for health care, or any alternative health care system really. And the problem in the United States is that we can’t afford the healthcare system we have. In both cases, there is a very powerful economic driver to do something different.

367 days ago

Al Hammond

It’s incredibly promising. You have to remember that the primary problem that we face in the U.S. is that so many people don’t have access to care at all. Wal-Mart could provide a much more accessible way to get health care than finding a doctor.

Doctors often don’t take new patients, or they worry about insurance coverage and other issues. But the neighborhood drug store is there — you know how to find it, and it’s often the easiest place to get to by public transport.

Wal-Mart has a particularly strong presence in rural communities, which is where the majority of the uninsured population is. Having a low-cost provider is of course hugely important for someone without insurance.

367 days ago

Al Hammond

It’s quite widely accepted in public health systems that 80 to 90 percent of primary care could actually be performed by a nurse, perhaps assisted by a clinical decision support tool. A nurse is far less expensive than a doctor.

Known, common ailments — a flu, respiratory problem, a sore back — can be addressed perfectly well by somebody who’s well trained. With clinical decision support tools, the algorithms are good enough that we know exactly what questions to ask, and we know what to prescribe based on the answers.

Here’s the analogy that doctors don’t like to hear: take McDonalds. The fries always taste the same, because the workers are following a well-defined procedure that is well controlled and monitored. Primary health care can be like that. At least, that’s what we’re doing in India.

The key is to have the ability to recognize something that is not in the realm of primary care. You want to detect more serious ailments and refer them to a hospital or appropriate facility. That sometimes takes experience and intuition. And that’s where a real doctor can make a difference — but you could employ a remote doctor with the right tools.

The data shows that if you have point-of-care diagnostics and a remote doctor doing evidence-based medicine, the result is actually likely to be better than if you walked in and saw a doctor in person.

367 days ago

Al Hammond

Our health care system is certainly too fragmented, but having a large provider with consistent standards and low costs is one way of unfragmenting it. You get such widely varying practices among doctors in the United States. Outcomes vary enormously for the same condition, from group to group and state to state. That shows that the quality control is lousy.

With a big company like Wal-Mart, and its reputation on the line, they’re going to worry a lot about standardization and quality control, and detecting those things that are not simple and getting those to a real doctor. And in my opinion that would significantly improve the quality control. This is not to say that Wal-Mart is automatically going to do a good job or that there won’t be issues. But if there aren’t Wal-Marts trying to invade the space, then we need to invent them.

Incremental change is not going to solve our problem. We have to get out of the medieval guild model of health care and into an industrial age model of health care, because otherwise, we simply can’t afford it.

367 days ago

Al Hammond

Wal-Mart could go a lot further than the basics. If Wal-Mart were to learn about our experience in India, they might add point of care diagnostics, telemedicine, and good referrals. It could be the entire package.

367 days ago

Al Hammond

Right now, many people fall through the cracks, because the health system’s not integrated. There’s potential to form innovative partnerships with specialists, large hospital chains, insurance providers, diagnostic companies — you name it. In the spirit of social entrepreneurship, we should welcome any experimentation aimed at improving the system.

367 days ago