BACKGROUND Multiple modern Indian hospitals operate at very low cost while meeting US-equivalent quality accreditation standards. Though US hospitals face intensifying pressure to lower their cost, including proposals to extend Medicare payment rates to all admissions, the transferability of Indian hospitals' cost advantages to US peers remains unclear. METHODS Using time-driven activity-based costing methods, we estimate the average cost of personnel and space for an elective coronary artery bypass graft (CABG) surgery at two American hospitals and one Indian hospital (NH). All three hospitals are Joint Commission accredited and have reputations for use of modern performance management methods. Our case study applies several analytic steps to distinguish transferable from non-transferable sources of NH's cost savings. RESULTS After removing non-transferable sources of efficiency, NH's residual cost advantage primarily rests on shifting tasks to less-credentialed and/or less-experienced personnel who are supervised by highly-skilled personnel when perceived risk of complications is low. NH's high annual CABG volume facilitates such supervised work "downshifting." The study is subject to limitations inherent in case studies, does not account for the younger age of NH's patients, or capture savings attributable to NH's negligible frequency of re-admission or post-acute care facility placement. CONCLUSIONS Most transferable bases for a modern Indian hospital's cost advantage would require more flexible American states' hospital and health professional licensing regulations, greater family participation in inpatient care, and stronger support by hospital executives and clinicians for substantially lowering the cost of care via regionalization of complex surgeries and weekend use of costly operating rooms.

中文翻译：

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现代印度医院的成本优势是否可以转移到美国？

背景技术在满足美国同等质量认证标准的同时，多家现代印度医院的运营成本非常低。尽管美国医院面临降低成本的更大压力，包括提议将医疗保险支付率扩大到所有入院费用，但印度医院成本优势向美国同行的可转移性仍不清楚。方法采用时间驱动的基于活动的成本核算方法，我们估算了两家美国医院和一家印度医院（NH）进行选择性冠状动脉搭桥术（CABG）的平均人员和空间费用。这三所医院均获得联合委员会的认可，并因采用现代绩效管理方法而享有声誉。我们的案例研究采用了几种分析步骤，以区分可转让和不可转让的NH成本节省来源。结果在消除了不可转移的效率来源之后，NH的剩余成本优势主要在于将任务转移到具有较低知识和/或经验较少的人员，这些人员在感觉到的并发症风险较低时，由高技能人员进行监督。NH的年度CABG量很高，从而促进了此类受监督的工作“降档”。该研究受到案例研究固有的局限性，没有考虑到NH患者的年龄偏小，或者由于NH的重新入院或急诊后护理设施安置的频率可忽略不计而节省了费用。结论现代印度医院具有成本优势的大多数可转让基地都需要更灵活的美国各州医院和卫生专业许可规定，更多的家庭参与住院治疗，