I Was Told: You Can’t Get A Packet Of Bidis For Rs 5, And You Want Heart Surgery?

[kds1980]

When he first proposed his model for micro-health insurance, people laughed in his face. Today, it’s being studied by the world’s top business schools. Dr Devi Shetty, chairperson of Narayana Hrudayalaya, Bangalore, talks to Neelesh Misra about his dream of inclusive healthcare...
As a doctor, what are your feelings about the existing system?

When you work in a government hospital as a young doctor, you have a perfect knowledge of what Indian healthcare is all about.
When was it that you worked at a government hospital?
Say, 28 years ago. But nothing has changed. Today, there are cures and medicines... but a solution is not a solution if it is not affordable.
You also worked in the UK as a young man. What was that like?

When you work with the UK’s National Health Services, you see a totally different side of healthcare. In the UK, whether you’re a millionaire or a millionaire’s driver, you share the same floor, same ward, same OT.
Is that where you got the idea for the Narayana Hrudayalaya model?
I left England in 1989 [and] started in Calcutta. [There], if I saw 100 patients a day, 99 of them couldn’t afford heart surgery. I realised that to really solve the problem, we had to look at how to reduce the cost and make it affordable.
So how does your model work?
Traditionally, when a hospital is built, they plan three or four operating rooms. Here, we have 24 operating rooms. Every floor has an operating room. Every floor has an ICU. 100-bed or 200-bed hospitals are not available to the common man because the scale is small. They are like Rolex watches. Instead, if you buy 30 acres of land and build a 5,000-bed hospital, then your cost is borne by that many more beds.
How many beds do you have?
Right now, there are 3,000 beds. We aim to soon have 15,000 outpatients everyday. With that many people coming in, you can have a difference in charges. Say at 2 am, you can charge 500 rupees for a CT scan or MRI, instead of Rs 5,000. So, for patients who don’t have the money, we tell them: “Ok, come at 2 am”.
So is the aim universal healthcare?
Essentially... what we are really trying to do is make India the first country in the world to dissociate healthcare from bank balance. My aim is to have, in my lifetime, a situation where millions of people may still be living in slums with no running water and no toilets, but when they are unwell, they can access state-of-the-art healthcare with dignity.



And such a scheme is working in Karnataka? It is. We started Yeshaswini (meaning Victor) five years ago. We now cover 30 lakh farmers in the state.
And they have access to…?
They have access to 300 hospitals across the state. Taking from this model, the Andhra government launched an insurance scheme called Arogyasri and today the chief minister proudly says he won by a thumping majority because of it. Eighty per cent of the state’s population is covered.
Is it hard getting support for such a scheme?
When I first began talking about Yeshaswini, people laughed at me. ‘You can’t get a packet of bidis for five rupees,’ they said, ‘and you want to do heart surgery?’
What is the role of the government?
Essentially, the government will not continue as a healthcare provider. It will become a health-insurance provider. And that is the best thing that could happen.
You really see this happening, government as insurance provider?
It has happened in Karnataka, Andhra, Tamil Nadu. It’s all set to happen in West Bengal. Today, the best gift a politician can give his votebank is a school. In a few years, that ultimate dream gift will be a micro-insurance policy.
The feedback column ‘Your Voice’ has not been published today due to space constraints. It will be back on Wednesday.

 

[kds1980]

Re: I was told: You can’t get a packet of bidis for Rs 5, and you want to do heart su

Heart in the right place

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.

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 ho{censored}ly 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’?”

Enlarge
Hindustan Times

Umesh Narayanappa and his wife Ashvini were devastated when doctors told them he needed heart surgery. But with some help from a micro-health insurance scheme that costs him Rs 450 a year, he got the Rs 4 lakh surgery done at Narayana Hrudayalaya for just Rs 60,000.

 

[spnadmin]

Re: I was told: You can’t get a packet of bidis for Rs 5, and you want to do heart su

God bless him!

 

[kds1980]

Dr.shetty has shown the world that true benefit of medical science could only reach the people if it is affordable.I hope other states in India as well other countries should adopt his model rather than allowing private hospitals exploiting people.

 

[spnadmin]

I agree. This is a ray of hope, rays of hope in fact.

 

[harbansj24]

This is another example of Humility, perseverance and tenacity of South Indians which I have written about in another thread.

Dr. Shetty does By Pass surgeries for just $ 1,200 in Narayana Hurdyalaya whereas the cost in US is $ 1,00,000!

 

[spnadmin]

harbhansj24 ji

I for one deeply appreciate your writing about southern Indians. There is a big gap in my knowledge on this and you are providing insights and information in a very powerful way, as have these two articles by Kanwardeep Singh ji.

 

[Archived_Member_19]

there is another foundation in Madurai and Pondicherry

Welcome to Aravind Eye Hospital

they manufacture Ophthalmic medical devices and give the big multinationals a run for their money as they sell the same class of products at one tenth of the price.

They also do free Eye transplants and cataract operations.