BIOEN 404 Team Design I
Winter 2014
DesignforHigh‐andLow‐ResourceSettings
DefinitionofLRS.Low‐resourcesettingsaretypicallycharacterizedbyalackoffundstocover
healthcarecosts,onindividualorsocietalbasis,whichleadstooneorallofthefollowing:
o Limitedaccesstomedication,equipment,supplies,devices.
o Less‐developedinfrastructure(electricalpower,transportation,controlled
environment/buildings)
o Fewerorless‐trainedpersonnel
o Limitedaccesstomaintenanceandparts
o Limitedavailabilityofequipment,supplies,&medication.
o Notethatthereare“Tier‐I”and“Tier‐II”categoriesforanygivencountry/setting.
Othercharacteristics/implications
o Cannotcountonelectricgrid,batteries,ordedicateddevices;however,oftencan
piggybackoncellphones.
o OfteninfrastructureprovidesthegreatesthealthimprovementsoCivilEngineershave
medicalimpact.
o Equipmentisrelativelyhigh‐costcomparedtopersonnel,soequipmentisless
frequentlyreplaced.
o Properdisposalfacilities(e.g.incineration)notalwaysavailable.
o Levelofregulationvariesbycountry;enforcementvariesbyregion.
o Generallyfarfromdesignfacilitiessodesigniterationisdifficult.
o Patientssometimesfar(intermsoftraveltime)fromcarefacility,sofollow‐upshould
beavoided.
o Lesseducationabouthealthingeneral,butoftenalotaboutspecificrisks.
o Insurance?
Differentdiseases
2005WHOdata,fromKortum’sGlobalHealthbook,p57.Under‐5deaths,per1000U5
population.
Injuries
Neonatal
Malaria
Measles
Diarrhea
USA+Canada .2
1.3
~0
~0
~0
Africa
.7
10.4
7.2
2
6.3
Low‐resourcedesignandsustainabledesignarenotequivalent.Sustainabilityappliestoboth
highandlowresourcesettingsandmeansthatouractivitiesdonotpermanentlydeplete
energyormaterialresources.Indevelopedcountriesthismeansdecreasingenergy
consumption,mineralextraction,chemicalagriculturalpracticesormonoculturingthat
depletesoilnutrients.
Inunderdevelopedcountries,sustainabilityoftenmeansavoidingsoildepletionanderosion,
deforestation(e.g.Haitivs.DR).Wecanaffordnottodestroyforestsforfirebecausewe
haveoil,coalandnuclear,whicharebuiltonnon‐sustainablematerials.
print date: 2/26/2014
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BIOEN Bioengineering Team Design I
Winter 2014
We(high‐resourcecommunities)canaddressthedeficitsinmanyways;herearethree:
Donations(givemoney,material,assistancee.g.MSF/DWB)
Increaseeconomicself‐sufficiency
Reducemedicalsystemcostswherebioengineersareneeded
Oftenissueisdeliverymorethaninvention.
BioengineersWithoutBordersismodeledafterEngineersWithoutBorders,whichprovides
expertisetoimproveinfrastructure.BWBisdifferentbecausebioengineeringistypically
doneindoorsinhigh‐costfacilities.Humansarealmostthesameworld‐wide,so
technologycanbedevelopedathome;theneedcouldbeestablishedonlocation.
Ideally,medicalandothertechnologywouldbesustainablewithineachcountry/region.They
couldbuildtheirowninfrastructure:clinics,roads,electricalpower;purchasetheirown
supplies,andsupporttheirowndoctors,wherevertheyaretrained.
Wecouldmakedesignsthataresimpletouse,morereliable/robust,easytoassemble.Note
thatareallgoalsforHRSalso,butmorecriticalinLRS.Don’tbuymoreaccuracythanyou
need:Goalcanbetohelpthemostlivesratherthaneachlifewithperfection.E.g.labina
backpackw/simpledevicesincludingmicroscopethathaslowresolutionbutallthatis
neededistoobservebacteriaasdots.
Intheshortterm:itisbeneficialtoprovidedonationsthatsupporteducationalprogramsand
allowtheregionstoestablishtheirowneconomyandinfrastructure.Goodexample:
microloans.Caveat:manyloansusedfordailylife.
COSTREDUCTION
1)Pharmaceuticalanddeviceindustriesreducetheircostsforpurchaseinforeigncountries.
Marginalcostislowanddoesn’thurtanyoneinthiscountry;otherwisewouldhaveno
salesoverseas.Differentialcostmodelisalsousedforinsurancecompaniesand
government‐sponsoredmedicationprograms(e.g.Canada),andevenU.S.hospitals.
2)Designproductsthatrequiresimplerinfrastructure:Lessspace,lesstraining,less
refrigeration.
3)Designproductsthatarethemselveslessexpensive:smaller,lessmaterial,looser
tolerances,designedbylow‐costengineersoverseasorbycollegestudents
print date: 2/26/2014
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BIOEN Bioengineering Team Design I
Winter 2014
PROFITABILITYANDMARKETING
IamnotanexpertineithersoIwillprovidemostlyphilosophy
 Reasonsthatpeoplewillgiveyoumoney
 Satisfyanactualneed
 Satisfyaperceivedoremotionalneed
 Alleviatemisfortune(medicine?)
 Trickery/force
 Allowincreasedprofitability
 Anothertakeonwaystomakemoney
 Arrangeforworkerstoprovideaproductorserviceforcustomers
 Reduceworry,specificallytoseparatethecustomerfromtheunpleasantnessassociated
withtheproductionordisposalofgoods.
 Agriculture
 Mining
 Low‐costproduction
 Trashdisposal
 Designforprofitability
 Avoidgettingsued
 Buildabettermousetrap
 Makeadisposableproduct
 Provideserviceonproductwithlongservicelife
 Makeyourproductappealing
 Marketingtargets
 Customer/patient:improvehealth,reducecost
 Physicians:increaseprofitability,increasepatientthroughput,improveoutcomes
 Insurancecompanies:increaseprofitability
 Funding device development
Generally large private funding base for profitable devices. Contrast to large public funding
base for lower-profit LRS devices.
Fundingsourcesforstartupcompanies(vs.newproductsw/inexistingcompanies)
Loans
Stock/interestsales
Collaborationsw/establishedpartners,largeorsmall
print date: 2/26/2014
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BIOEN Bioengineering Team Design I
Winter 2014
How HRS features affect NEED. Want product that…
o Increases patient throughput and/or decreases cost / patient
o Increases appeal for physicians or patients (e.g. open MRI; laparoscopic surgery is better for
patient but not surgeon)
o Provides new capabilities, i.e. draws in new patients or gives advertising benefit
o Combined devices are good; already a lot of equipment in hospital suite.
How HRS affects Specifications:
o Can make more precise and less robust, due to presence of maintenance
Design process:
o Regulatory affairs mean it is best to design for new twist on fundamentally proven design.
o Can outsource entire design process, but that doesn’t really matter who the end user is.
o Testing implications?
As of 2011, US spends more per capita and as % of GDP than any other country.
http://healthreform.mckinsey.com/insights/latest_thinking/accounting_for_the_cost_of_us_health_care
From Altarum Institute, Center for Sustainable Health Spending
http://www.altarum.org/files/imce/CSHS-Spending-Brief_Feb%202013.pdf
Reported as $2.87 trillion annually as of Dec 2012, ~18% of GDP.
print date: 2/26/2014
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