Intended for healthcare professionals


Delivering cost effective healthcare through reverse innovation

BMJ 2019; 367 doi: (Published 14 November 2019) Cite this as: BMJ 2019;367:l6205
  1. Mark Skopec, research assistant1,
  2. Hamdi Issa, doctoral student2,
  3. Matthew Harris, clinical senior lecturer in public health1
  1. 1Department of Primary Care and Public Health, Imperial College London
  2. 2Institute of Global Health Innovation, Imperial College London
  3. Correspondence to: M Harris

High income countries have much to learn from lower resource settings about cost effective healthcare innovations, argue Mark Skopec and colleagues

The process of reverse innovation, where ideas originating in low resource settings are adopted by higher income countries, challenges the notion of developed countries as the instigators of healthcare transformation.1 Between 1985 and 2009, the annual growth rate of patent applications in low and middle income countries was 19%, leading them to double their share of global patent applications (from roughly 4% to 8%).2 As healthcare services increasingly seek to optimise their cost effectiveness, the efficient and scalable solutions used in lower resource environments provide an opportunity for wider learning.

Reverse innovation is a broad term, encompassing innovations that have been ideated, trialled, tested, and adopted in low and middle income countries, before being used by healthcare providers in high income countries.234 The term itself has problems, arguably perpetuating the view that innovation normally flows from high to low income settings, thereby undermining the shift in knowledge translation that it seeks to promote.5 Nevertheless, reverse innovation presents a broad range of opportunities and challenges in healthcare. Several reverse innovations have the potential to provide considerable efficiency benefits and cost savings to the NHS.

Examples and opportunities

In 2009, General Electric developed the GE Mac 400, a handheld portable electrocardiogram (ECG) device, originally designed for use in rural India.3 It costs $1000 (£775; €900), a fraction of the cost of similar devices sold in high income countries (GE Healthcare lists the price of hospital class units as between $2000 and $10 000). The engineers who developed the Mac 400 recognised which features of the hospital class units were most essential and which could be sacrificed to decrease costs. The Mac 400 is battery powered, has a simplified …

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