A global perspective

There is no question that as the global population becomes increasingly industrialized the incidence of spine related complaints will increase and with this there will be an elevated demand for medical services. Currently there remains significant disparity between both the amount and the quality of spine related medical services with the majority of the global population either unable to afford or unable to access the appropriate care. The economic importance of treating spine injuries and their pain related complaints has been well documented but what has not been stressed is the fragile relationship these injuries have with economic viability particularly in impoverished countries. The disability system established in most western countries which provides for some monetary support when its citizens are injured has no equivalent in those parts of the world where the average daily income is less than ten dollars. The tragic consequences of this lack of a safety net mean that if the main income generating individual of any family is injured and unable to work then the rest of the family will be unable to eat or satisfy their most basic needs. This is an incomprehensible scenario for most people in the west and while it is without doubt very disturbing it also presents an immense economic opportunity that if legitimately coordinated will help solve what can only be described as a humanitarian crisis.

Over the last five years several companies have started to analyze these emerging markets with a clear view to the bottom line of their financial spreadsheets. The majority of these companies are from India and China, two countries that have already made significant in roads into Sub-Saharan Africa, and their ability to provide high quality medical care at a fraction of the cost of that in the US is one of the critical keys to their success. The Indian entities in particular have a demonstrated track record in their own country in which they have developed these models of healthcare delivery. One of the most relevant factors is the marked lack of medical litigation that continues to plague the US healthcare system and drive up costs as physicians practice defensive medicine and order a disproportionately high number of unnecessary tests to simply protect themselves against frivolous lawsuits. If this problem is not seriously tackled it will ultimately lead to the US losing its competitive edge in the global healthcare market. Patients will simply choose to go to countries that provide the most competitively priced service. This trend known otherwise as global tourism is predicted to grow annually by 15% for the next decade and will lead to more US citizens seeking healthcare oversees.

The advances in medical technology and communication tools are increasingly enabling physicians from the aforementioned impoverished countries to acquire the necessary skills and knowledge to provide high quality healthcare to both their native citizens and patients from the US. The somewhat archaic system of medical licensing will have a very limited ability to prevent patients and physicians from locating to parts of the world where their services can be provided and it is almost certain that the medical landscape of 2025 will bear little resemblance to that of 2014.

The digital age and a knowledge based economy have been two of the most relevant forces in the social revolutions that commenced in earnest in the 1990s and it is these same forces that will change and shape the medical landscape of the future. The introduction of robotic surgery, although still in its nascent stages, will allow the performance of complex surgeries in remote areas of the globe. The monetization of advanced medical technologies lies partly in the securing of intellectual property rights although these battles if fought in the Chinese or Indian courts generally have poor outcomes for the holders of the patents. The message from this is that the speed at which a company can get its product or service to market will dictate to an extent and for a very limited time period the success it experiences. The concept of intellectual property is primarily an American one that is not replicated to the same extent in countries such as India or China. The order of events has changed and ideas are increasingly seen as belonging to all of humanity. The key therefore is to focus initial resources more intensely on the manufacturing and selling of the product hoping to get to market first.

One of the most important considerations in the development of advanced technologies is their energy consumption and portability. There has been significant progress in the manufacturing of lighter materials with the introduction of 3-D printers allowing the rapid and cost effective production of devices that could very recently only be produced in large expensive factories. These tools would theoretically allow the provision of state of the art devices and surgical instruments in remote regions of the planet.

The portability of self sustaining surgical suites will allow the performance of complex procedures and when combined with the fact that minimally invasive technologies are now the standard of care the requirement for blood replacement and post operative intensive care will significantly decrease. The combination of these technologies and their application in countries whose bureaucratic and administrative hurdles are sensibly proportional will shift the global healthcare balance of power and thus the economic distribution. It is into these nuanced situations that smart healthcare money is being invested.