Green helps hospitals that serve poor people reverse the "for charity" mentality that limits them to offering low-cost services, often at low levels of quality and efficiency. Because these hospitals rely on charity to pay their bills, their staff often lacks the motivation and management skills needed to make the hospitals financially self-sustaining.
Along the way, Green has developed two rules of thumb for pricing: patients can generally afford to pay their monthly family income for cataract surgery, and hospitals can afford to cut the cost of cataract surgery to the equivalent of the average monthly family income of approximately the bottom 60 percent of the population (in terms of income).
While most health care programs are funded either by government and non-profit organizations that target the poor, or by businesses that target the most affluent consumers, multi-tier pricing relies on lower- and middle-class customers as the "financial backbone of these programs," Green said. For this reason, it's important to offer affordable prices and attractive services to these consumers.
"This market-driven approach will work best in countries that don't have social security, health insurance or government services that cover the lower-middle and middle-class," he says. "You orient the quality of your service and pricing to that group."
Green introduces management reforms that empower and motivate a hospital's staff so they collaborate to assume ownership of the hospital's management and work to recover costs through more efficient operations. He urges hospitals to employ a ratio of five paramedics to one doctor "because that is how you free up the surgeons' time to do high-volume surgery," he said.
"You develop a team approach that breaks down each aspect of the pre-operative, operative, post-operative and sterilization inpatient care so that there is a well-managed team approach" using the optimum five-to-one ratio of paramedicals to doctors, he said. This dramatically increases both the overall number of surgeries, and the number of surgeries performed by each doctor, thus reducing the average cost of each surgery through better teamwork, organization and surgical and clinical training.
"For instance, the average surgeon in our programs will do 2,000 to 3,000 cataract surgeries per year," Green said. "They will do 20 in a morning – while the average volume in some countries like China is 14 cataract surgeries for the entire year. So we help tweak the production model by increasing productivity."
Green urges hospitals to boost salaries and pay bonuses in order to motivate doctors to do high-volume, high-quality work and to improve their morale and loyalty. This proves to be a cost-effective strategy because it increases productivity and the quality of services and reduces turnover of the most highly skilled staff.
Green boosts hospitals' accountability by getting them to rely on patient fees rather than charitable contributions. This approach compels hospitals to earn loyalty and establish a good reputation in the marketplace by satisfying their customers' expectations, thus forcing them to improve their efficiency, quality and value to remain competitive.
By recruiting existing community groups to operate diagnostic screening camps, Green cuts the cost of hospitals' outreach and marketing efforts. "These groups do the outreach and publicity," he said. "It's a very strong community-based approach that is cost effective because you have community involvement, and you are spending their resources and time to help you get patients."
Green also shaves expenses by getting hospitals to carefully scrutinize the cost of medical supplies. "We bring down the cost of consumables through intelligent purchasing on the international market," he said. "For instance, in Egypt we reduced [the cost of medical supplies] from $90 per patient to around $20 through intelligent purchasing."