Reducing the costs of surgical correction of congenitally malformed hearts in developing countries

Abstract

A large number of patients in developing countries require surgical correction of congenitally malformed hearts. Unfortunately, only a limited number of centres offer these patients surgery at an affordable cost. In this review, we discuss the problems in managing these patients, with an emphasis on reduction of costs, so that the maximum number of patients can benefit. It is apparent that containing costs requires a multipronged approach, which begins with timely referral, and continues with early surgical correction and adequate postoperative care carried out in a scientific manner. Indigenization, innovation, training of manpower, and building a team, are essential to cut the costs, and to improve the quality of care.

Future of pediatric cardiac care in India

“…Attempts at indigenization in surgical fields are increasingly seen. [19] Indigenous industrial products in cardiology fields are also beginning to emerge. The convergence of PCC professionals to make the Pediatric Cardiac Society of India in 1999 and their journal (Annals of Pediatric Cardiology) since 2008 augurs well for the future.…”

Establishing a pediatric cardiac intensive care unit - Special considerations in a limited resources environment

“…In most developing nations, the cost for the ICU care constitutes one-tenth to one-sixth of the total costs of congenital heart surgery. [29] The goal of a successful intensive care team should be to reduce expenditures without compromising quality. Unless a conscious attempt is made toward this end, patient bills frequently get out of control and the program will acquire the reputation of being very expensive with the attendant risk of premature collapse.…”

“…Early extubation strategy can be adopted in uncomplicated cases by judicious selection of anesthetic agents without compromising safety. [29] To some extent, early extubation is dependent on surgical strategies and surgical support times (bypass and cross-clamp times). For example, delayed sternal closure will typically add an additional day or two to the duration of mechanical ventilation.…”

Pediatric cardiac care for the economically disadvantaged in India: Problems and prospects

“…[12] It is clichéd but important that we should “think globally but act locally.” We should be sensitive to local dynamics, local realities and should engage ourselves in research, innovations and advocacy accordingly. Opportunities for garnering local resources are lost in the absence of an active advocacy group.…”