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how to measure in financial terms gift economies, NGOs, services, and altruistic behavior.
Even tourism is not separately calculated for a countries GDP. Currently USA healthcare
accounts for about $2.3 trillion dollars out of a GDP of some $15 trillion and is predicted to
reach $4.6 trillion in 2020, or 20%. To put this in perspective, if USA healthcare was a
countries' GDP as an economy, then that country would be the fourth largest economy in the
world. How much more of the economy can it take up before it becomes a problem? I asked
two well-known healthcare economists, one who is a member of Med Pac, this question and
both said maybe 45% to 50%. If a family were to spend half of its income on healthcare it
would be a disaster but is the USA economy different? Furthermore, if you have a huge
defrayed expense like kids going to college that is not on your budget, like Medicare and
Social Security, should you not include it in your household balance sheet? It is not part of the
US Government's balance sheet and the deficit reduction process. I do not know enough to
answer this question, but it would seem that if less money is being obtained from
manufacturing, for example, can you continue to spend more money on services. At some time
this imbalance will end in a major problem just like the housing crisis. Neither, can one impute
that there are altruistic ways for ensuring “survival of offspring” or other theories of reducing
behavior to purely species greedy motives in a Darwinian world of survival of the fittest. Or,
for that matter, driven by genes, including specific altruistic genes, that has been argued by
some.
I am sometimes asked how rural NGO run hospitals in Africa compare with Americas best
run and top hospitals, including economics. As stated earlier, a good question rarely has a
good simple answer. If one breaks the question down in terms of patient 1) access, 2) quality
of care, 3) costs, and 4) system of payments, this structures the complex answer into a matrix.
Access: Looking at Shongwe with regard to patient access historically, it was essentially
free to anybody that showed up the emergency/casualty/admission area. In a morning some 200
patients might show up, over half kids with malnourishment and fevers due to some infectious
agent such as malaria (fever, semi comatosed), salmonella (fever, obtunded, rigid acute
abdomen type picture, history of diarrhea long gone), meningococcal meningitis (comatosed,
neck stiffness), pneumonia (fever, runny nose, coughing), TB (listless and wasted, low grade
fever, dry cough), or some other rare infection. In five minutes one had one had to make a
presumptive diagnosis, start treatment to save a life, and later confirm the diagnosis with blood
or sputum smears, chest X-ray etc. Human suffering, particularly of the kids, was sometimes
overwhelming. The medications were simple and effective at that time because bacterial and
protozoal resistance was not an issue. By the next morning, recovery could be dramatic and
very gratifying. If more complex issues were present, like congenital heart disease or issues
requiring more advanced specialist care, patients were sent by ambulance to Barberton or if
more severe, to Pretoria for care at a University Hospital, irrespective of cost. Noninfectious
cardiovascular disease was not an issue although cancers were sometimes seen that needed
referral. Costs were covered by philanthropy from NGOs and government subsidy.
What is often not recognized in the USA is that essentially the same situation exists, namely,
every patient that shows up at an emergency room has to be treated and only when stabilized
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