Ensuring affordable healthcare for all
Dr Devi Prasad Shetty is called the ‘king of cardiac care’ and his network of Narayana Hrudayalaya hospitals is an epitome of affordable healthcare in the country. The group has 17 hospitals with around 5,700 beds. Cardiology, eye, trauma, orthopaedics, neurosciences, dental and cancer care are the specialities under NH hospital group which is planning 30,000 low cost beds by 2020
By Prashob K P
The Indian healthcare industry is moving on the affordability, quality and availability formula. It is the duty of the healthcare industry to address the needs of urban and rural poor alike.It was Dr Devi Shetty’s vision of affordable healthcare thatpersuaded him to start Narayana Hrudayalaya (NH) in Bengaluru in 2001. Withthis concept, he set up a network of healthcare institutes ina short period. The group has now 17 hospitals with around 5,700 beds. Cardiology, eye, trauma, orthopaedics, neurosciences, dental and cancer care are the specialities under the NH hospital group. The group is planning expansion with 30,000 low cost beds by 2020. A visionary leadership, technology driventreatments, strategic management and organisational culture help NH hospitals carve a niche in the healthcare industry of the country.
Henry Ford of cardiac care
What is common in Dr Shettyand Henry Ford? Henry Ford brought mass production to the world with the Model T Ford car at the beginning of the 20th century. Dr Devi Shetty is rewriting the history of cardiac surgeries through his venture NarayanaHrudayalaya. Being a healthcare entrepreneur, Devi Prasad Shetty, founder and Chairman of Narayana Hrudayalaya, is a philanthropist crusader with a missionary zeal.Influenced by the philosophy of Mother Teresa, he blends compassion and care.His vision is to provide quality healthcare for the masses worldwide.
Known for his unconventional ideas, Devi Shetty has innovative solution to most of the ills afflicting the Indian healthcare sector. He believes that if everyonereserves a small amount from their monthly mobile phone bills to a micro insurance health scheme, their healthcare needs will be taken care of. Narayana Hrudayalaya also plans to adopt 2,000 children every year from rural West Bengal and other states and mentor them to become doctors by offering soft loans. He also believes in the empowerment of paramedical staff involving them in the delivery of care. He proposes an equitable distribution of world class healthcare for the masses at an affordable cost.
Creating focused healthcare factories
Rather than being a multi purposed one, NarayanaHrudayalaya focused on specialised ventures with standard facilities. The core competencies, precisely defined by the organisation’s policy and its humanistic approach, are backed by its technological and economic strengths.The institute has adopted a unique formula for lowering healthcare costs and increasing accessibility. It has created ‘health cities’ with huge capacities in terms of infrastructure. Apart from NH Multispecialty Hospital, NH DevarajUrs Hospital, NH Hospital, Narayana Cayman University Medical Centre, SDM NH, and RTIICS (Rabindranath Tagore International Institute of Cardiac Sciences) NH, the group also runs Mazumdar Shaw Cancer Centre, one of the world’s largest cancer hospitals with 1,400 beds, in association with KiranMazumdar Shaw of Biocon.
It also has dental clinics and diagnostic centres, and the services include academic research, telemedicine, corporate health services, international medicine and stem cell research apart from healthcare, with a special focus on cardiology, oncology, medicine, surgery (general and specialised) and diagnostics. Performing a large number of cardiac surgeries, numerous dialysis at a modest cost, surgeries on children and the highest amount of bone marrow transplants at Mazumdar Shaw Cancer Centre in India, the NH group of hospitals is creating ripples in the healthcare industry.
By handling greater volumes, the organisation has been able to prepare its physicians towards greater proficiency levels.Since the super specialists at Narayana Hrudayalaya hospitals see large volumes of cases and perform no more than two to three types of procedures, they excel in their domain. Most of these hospitals attain clinical and quality outcomes that are among the best in the world.
Yeshaswini Insurance Scheme
For addressing the healthcare issues of the masses, Narayana Hrudayalaya had launched a micro health insurance scheme, Yeshaswini, in collaboration with the Karnataka state government. The scheme now has close to four million farmers as members contributing Rs 18 per month. It covers the expenses of 1,650 varieties of surgeries. In the first 20 months of the scheme, 85,000 farmers had free medical treatment, 22,000 had three surgeries, and another 1,400 had heart surgeries. Shetty also founded ArogyaRakshaYojana, a joint venture of NarayanaHrudayalayaPL, Biocon and ICICI, to provide free OPD consultation, cashless surgical facility and diagnostics at discounted rates. A distinctive rural healthcare service, Hrudaya Post was launched with the Karnataka postal circle to enable rural heart patients to scan and send their medical records to Narayana Hrudayalaya for consultation.
Cutting cost from top to bottom
Narayana Hrudayalaya scans their each step from the beginning to get the best value for money. The institute critically examines its entire supply chain and process -from the cost of land, the technologies used and the manpower. Narayana Hrudayalaya partners with the governments and real estate owners to get land at subsidised rates and procure medical technology on lease or convince the vendors to park their machines in the hospital instead of outright purchase and buy consumables from them, thus saving on expenditure.
Thus, Narayana Hrudayalaya is able to commission large-scale projects and scale them up across the country. To attract and retain the best manpower, Narayana Hrudayalaya pays compensation at par with the best. Bulk purchases all medical stores and consumables, at discounts, directly from the manufacturers and manages all inventory efficiently by forecasting demands and eliminating wastage. Within the Health City, various specialties share expensive imaging equipment and other facilities like laser, cyber knife and blood bank etc. run round the clock instead of 7-8 hours daily, thus increasing asset utilisation.
At Narayana Hrudayalaya, approximately 40 per cent of patients pay a reasonable price for their treatment, a small percentage - those who want the comforts of private rooms - pay a premium, the majority pays less than the market rate and 10 to 20 per cent pay virtually nothing. For the needy patients, the hospital's charitable trust raises money to help compensate for the material costs of their treatment, thus, dissociating healthcare from affluence. At Narayana Hrudayalaya in Bengaluru, 40-60 per cent of paediatric heart surgeries are partly funded by charity and donations.
Blending technology,medical care
Through telemedicine and other ICT applications, Narayana Hrudayalaya automates processes and shares medical expertise with remote parts of India and other countries. It has migrated to digital radiology for better throughput and image quality, while working in a filmless and paper light environment. Without IT backing, service industries cannot survive. IT cannot cure, but it can make healthcare safer for the patient.
Thus, by providing healthcare for masses with affordable manner, NarayanaHrudayalaya hospitals and Devi Shetty are creating a hallmark in the Indian healthcare industry. Looking to the global healthcare scenario, Shetty’s vision is much more different than the rest. His innovational thoughts and ideas create a new path and also inspire other players in the private healthcare space.Why are weaffordable?
We believe that low-cost healthcare is the way forward in India and outside. Ten years ago, cost was not an issue for the US hospitals. Today, the US and Europe are struggling to offer healthcare to their citizens. The only way cost can come down is by economies of scale, wherein hospitals would be doing a large number of procedures utilising the infrastructure for at least 14-16 hours a day.The tax payers’ money could pay for healthcare 20 years ago, when people retired at the age of 60 and lived for a few more years. Today, people retire at the age of 60, but live on to celebrate their 95th birthday. In such a scenario, we have to look at an alternative methodology to fund healthcare.
Healthcare costs cannot be borne out of pocket. It is like somebody availing of an insurance cover for his car. Put it simply, you can’t afford it.We need a mechanism wherein every citizen of our country can contribute a tiny amount of money every month towards healthcare. When everyone pays a small amount of money, it becomes a huge pile of money which can take care of about 5-7 per cent of the people who need healthcare.
Narayana Hrudayalaya has a different philosophy altogether. Today, when a new hospital comes up, the promoters would tell the employees that this hospital is built for the rich people, but we also care for the poor. Whereas, when we start a hospital, we tell the employees that our hospital is built for the poor, but we also care for the rich. This is the fundamental difference. As long as we look at the poor people as the main customer of the organisation, the entire concept of low-cost healthcare cannot become viable. We perform the largest number of heart surgeries in the world today. We attract patients from 76 countries. We train heart surgeons from the United Kingdom, the United States and many other Asian and African countries. This is happening because of the numbers. Unless we build large size projects reducing costs, the cost of healthcare will not come down, and quality will not improve.
Excerpts from the interview with Dr Devi Shetty published in Future Medicine 2012 August issue:‘We cut cost wherever we can’
For maintaining affordable healthcare, we cut expenses wherever we can. Lots of challenges are there. It depends on the way how we tackle it. Right from design and construction, we sought new ways to be frugal. It has kept the design compact, reduced empty spaces and used prefabricated structures. Also, instead of marbles and expensive furniture, the hospital has used simple tiles and low-cost seating, reducing the cost per bed to Rs 12-18 lakh. The high cost of infrastructure is a major limiting factor for healthcare providers. To bring down costs, Narayana Hrudayalaya is running the Mysore facility like a startup. Though 2.5 million heart surgeries are required in India every year, only 90,000 are performed. The country needs 2 million additional beds to serve the current needs of the population. Our aim is to add 30,000 beds in small-to-medium towns in the next five years.
All our innovations are based on affordability theory. Shortage of healthcare manpower in India has impacted the cost of human resources, which is increasing. And hence, every institution of Narayana Hrudayalaya will double up as an academic institution conducting training programmes for a range of medical professionals from cardiac surgeons to sterilisation technicians. People simply do not have the money to pay for the expensive healthcare intervention. So, we should constantly try to juggle to offer services to the poor and make it affordable for people who can pay some money.Viren Shetty, Senior Vice President, Strategy & Planning
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