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Heart in the right place

About 25 per cent of India’s billion-plus population does not seek medical care because they cannot afford it. Hospital bills are also the second most common cause of rural indebtedness. In Bangalore, one man is showing how to make the best health services in the world accessible to all, reports Neelesh Misra.Also see Dr Devi Shetty's interview

india Updated: Aug 11, 2009 01:06 IST
Neelesh Misra

As he dialled the call centre of the cellphone service provider, all Umesh Narayanappa wanted was a good tariff plan.

Destiny had a different plan, though.

The 25-year-old house painter from Vijaypura village, 60 kilometres north of Bangalore, realised he liked the voice of the female executive, Ashvini. He kept calling her over the following weeks; they met outside her Bangalore office, fell in love and got married in six months.

Their parents didn’t approve and cut all ties with them. She gave up her urban life, moved to his village. They had a son.

Destiny still had a different plan. http://www.hindustantimes.com/news/images/Untitled-drshetty.jpg

A mild pain in the back that he had been ignoring for two years suddenly worsened into excruciating agony in June.

He and his wife shuttled between 12 hospitals — and were told he was about to die from a bubble-type enlargement in an artery connecting the heart to the kidney. Surgery would cost Rs 4.5 lakh, more money than Narayanappa ever hoped to see.

“I was devastated — even God hadn’t supported us,” he says in Kannada, speaking hoarsely through an interpreter as he sits on a wooden bed at his single-room home, days after his surgery. His wife looks on, leaning against the doorless kitchen entrance in a black nightie.

Someone guided the painter to Narayana Hrudayalaya, a hospital outside the city that is taking inexpensive, world-class healthcare to hundreds of thousands of Indians — and creating a template for the world.

The doctors there opened up his heart and kidney and saved his life. The bill: A mere Rs 60,000, for the implants.

Even that was paid by Yeshaswini, a government-run micro-health insurance scheme. Narayanappa is one of 30 lakh members. He pays a premium of Rs 450 a year. Many others pay just five or ten rupees a month.

It is a model that could revolutionise healthcare across India: Micro-health insurance, functioning through a network of large hospitals (with up to 5,000 beds each).

How do they afford the minimal costs? With economies of scale. Because they are so large and can accommodate so many, the notional cost of each procedure drops drastically — a benefit they can pass on to those who really need it.

So here’s what we suggest: State governments across the country must tie up with large private hospitals, much as the Karnataka government has done, example to use economies of scale and offer state-of-the-art procedures at rock-bottom prices.

For government hospitals like sprawling AIIMS in New Delhi and the JJ Group in Mumbai — which already have large facilities — existing norms could be modified and subsidised rates lowered further, to make optimum use of the equipment paid for by the taxpayer and open the doors to many more.

Dr Devi Shetty, chairman of the Bangalore hospital and the man behind the Yeshaswini model, is already planning to take similar projects to several Indian cities. His hospital has become one of the global hubs of cutting-edge cardiac care, drawing people from 56 countries — and faraway villages in India. The success rate: 95 per cent.

“It was a dream. I never thought it could happen — my husband getting getting treated at such a good hospital,” said Ashvini, as she lifts her husband’s shirt to show the post-operation bandages.

“All the other hospitals said I was in the last stage. Then Dr Shetty came in… like God. What else can I say?” says her husband.

Of over 6,100 surgeries at Narayana Hrudayalaya last year, only 1,200 were fully paid for. “My idea of a patient is not a man stepping out of a BMW,” he says, as he walks around the hospital in white coat and blue crocs, greetings patients along the way. “It’s the poor chap sleeping on the floor in a government hospital. That is a typical Indian patient.”

But he still makes profits. And the world’s top business schools are now studying how. A Harvard Medical School study found Narayana Hrudayalaya superior on some parameters to nine New York state hospitals.

The secret is in the huge numbers – and in seeking profits but giving up unbridled corporate greed.

The Bangalore hospital and a sister concern in Kolkata together do 15 per cent of all the heart surgeries in India. At 30 operations a day, that’s also the highest for any hospital chain in the world.

Here is how it works: A brain scan at 2 pm would cost Rs 5,000 but at 2 a.m. only Rs 500 — because the equipment is a one-time cost and, since the numbers are overwhelming, pricing can be staggered. “For this to happen, you need to accommodate around 5,000 families all across the hospital,” says Dr Shetty. “Then you tell them ‘OK, you have no money — you come at 2 o’clock at night’. And they come and do the MRI or CT or whatever.”

Now, the hospital is getting into cancer care, which promises to be even cheaper. “[With cancer], there is no recurring cost [of materials],” he says. “We feel we can reduce the cost of cancer care by 75 per cent.”

A blood test that would cost an ICU patient up to Rs 400 elsewhere costs Rs 8 here. A session with a gamma knife — used to treat brain tumours — costs up to Rs 4 lakh in private hospitals and Rs 1 lakh in government hospitals. Dr Shetty’s hospital will charge Rs 85,000.

But at the end of the day, Dr Shetty says, it is not about the money.

“First thing you ask yourself, why are you in this business? Right? If you are in this business to make a difference, then you constantly ask yourself, ‘How can I replace the cost’?”

(With inputs from Vanshika Sahni and Sumegha Gulati)

Idea nation

Universal healthcare

The Problem

About 25 per cent of India’s billion-plus population does not seek medical care because they cannot afford it. And hospital bills are the second most common cause of rural indebtedness. Meanwhile, in private — and even government-run — hospitals, state-of-the-art machines lie idle because the cost of each procedure is so high that not many can afford it. If those costs were lowered, more people would have access to better healthcare, and the hospitals might even end up making more per machine.

HT’s Fix

n Have all states tie up with large private hospitals that will offer rock-bottom prices to members of the government micro-health insurance scheme. This model has worked in Karnataka, where 30 lakh people, most of them farmers, pay between Rs 5 and Rs 40 a month for cover.

n The hospitals, each with up to 5,000 beds, have so many thousands of patients coming in each day that the notional cost per procedure slides — especially since equipment is a one-time cost.

n As they pass on this benefit to those who really need it, they can afford to perform up to 80 per cent of all procedures at minimal rates and still make a profit.

n The cost of the discounted procedure is paid by the government, from the lakhs it collects each month in the many (if minuscule) premiums.

n In rural areas in Karnataka, the premiums are collected through farmers’ and other cooperatives. In urban areas, it could be collected by adding the nominal charge to electricity bills, using a mechanism that is already in place to offer healthcare of disadvantaged families.

n For government hospitals like sprawling AIIMS in New Delhi and the JJ Group in Mumbai, subsidised rates could be slashed further as more patients were accommodated, making better use of the machines bought with taxpayer money, and making quality healthcare available to millions more.

Government Speak: V Venkatachalam



Idea nation