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at a major New York hospital, believes there are day-to-day consequences if the medical infrastructure is hollowed out through outsourcing. "The further away you take these basic procedures [analyzing MRIs, CAT scans, etc.], the less control you have on quality, and the greater probability you have for mistakes," says Todd, an RN, speaking on behalf of Physicians for a National Health Program. "We have already seen a lot of the regular infrastructure trimmed and that creates problems," she continues. "The fewer clerks we have, the worse communication is, and communication is essential to basic healthcare. This is where I think the quality issue comes into the picture. If you begin to cut down on all the things that surround basic healthcare, you are going to eventual- ly compromise that care." Sidney Wolfe, MD, sees a correlation between outsourcing to cut costs and the deskilling of the nursing profession. "In this country, a hospital might hire someone for patient care who is not an RN, and the hospital may be getting a financial ad- vantage," says Wolfe, director of Public Citizen's Health Research Group. "But it's not an advantage to the patient. The RN can pick up a turn in the patient's condition that an [unlicensed] person would overlook. Downgrading is fraught with potential problems. Outsourcing health services, like diagnostic services, has the same potential for problems." A surgeon sits at a state-of-the art computer station in Ban- galore, India, analyzing a three-dimensional image of a U.S. patient's kidney. He notes some potential trouble spots and sends his findings off by email. The transaction by Wipro Health Sciences, an India-based company, saves a U.S. hospital 45 per- cent on the procedure. A German drug firm, Mucos Pharma GmbH, contracts out the testing of a new treatment for neck and head cancer to Siro Clin- pharm of Mombai, India. Siro finds volunteers to test the drug in half the time and expense the German company would encounter in Europe—and without having to first test the drug for safety. A North Carolina man without health insurance had a life- threatening heart condition that required a new valve, which would cost him $200,000 in the United States. He flew to New Delhi, where doctors replaced his heart valve with one from a pig for a total cost of $10,000, including roundtrip airfare. For nearly a decade, the U.S. medical industry has been out- sourcing records and financial transactions to places like India, Hong Kong, Singapore, Pakistan, and the Philippines. But recent- ly, outsourcing has spread beyond number crunching and word processing to basic medical services. From biopsy analysis to car- diac surgery, the healthcare industry has discovered there is gold in going foreign. Health professionals eye these developments with concern, see- ing a potential impact on the quality of care that patients receive, the privacy of their medical information and, quite possibly, U.S. jobs. Betsy Todd, an epidemiology nurse with 30 years experience U.S. Healthcare Industry Turns to Outsourcing Medical Services By Conn Hallinan OUT OF OUR HANDS Feature Story 14 J A N U A R Y / F E B R U A R Y 2 0 0 6 C A L I F O R N I A N U R S E