‘There is need for low-cost hospitals having multi-specialty facilities’

“Surgeons are ‘technicians’ – the more number of surgeries they perform, the more they improve on their skill,” says Dr Devi Prasad Shetty, Chairman and Managing Director, Narayana Hrudayalaya. As a winner of India Healthcare Awards 2010, Dr Shetty recently won the Specialty Hospital – Cardiology (Narayana Hrudayalaya – Bangalore) award from ICICI Lombard General Insurance and CNBC-TV18. He also received an award for as a commendation for ‘driving affordable and quality healthcare for all.’ To top it all, this world renowned cardiologist has also been awarded the Padma Shri for Medicine in 2004. In a discussion with Shivani Mody, Dr Shetty talks about the need for quality healthcare services in the country, envisions the future and gives advice to budding surgeons.

While considering the world’s population, less than 10 per cent of people can actually afford surgery. Currently, the need is to provide surgery at an affordable cost and improve access to surgery for the poor as well. A radical change is needed in the mindset of healthcare professionals in the way we deliver such services. While bringing about innovation in medicines, the investment in Research and Development (R&D) drives up the cost of medicine. Seeing the recent trends, healthcare demands for process innovation rather than medicine innovation and healthcare solutions require to be customised as per local needs.

Leading medical councils in any country protect and support the growth of the industry. This thought process needs to change and attention should be paid to patient issues. The number of suffering patients in Asian and African countries is higher in comparison with that in developed nations. Globally, medical councils should work collaboratively and initiate training programmes for doctors and nurses in these regions to make healthcare effective, available and affordable.

People’s need to drastically change their attitude, and rather than accepting the services, they should demand better quality. 

Views on low-cost hospitals

Presently, there is need for low-cost hospitals having multi-specialty facilities. Today, a full fledged hospital with the latest equipment and complete services can be built for Rs 80-100 crore. But now these hospitals, having latest technology need to be constructed for Rs 20 crore, which is also possible. Most of the technology and equipment used in hospitals are imported, which adds to the overall cost. There is a need to develop low-cost, high-quality equipment domestically. The volumes will help drive down the cost of producing these equipment. Some of the major requirements are low-cost magnetic resonance imaging (MRI), electrocardiography (ECG) machines.

Moreover, the maximum life of imported machines is 5-7 years, after which the hospital needs to buy a new machine. Since this is not feasible in the long run, the industry needs machines that can work for 10 years, for example, Computed Tomography (CT) scan machines. Medical equipment need to become a commodity item for it to become affordable.  

While building a hospital, nearly 25 per cent tax is given to the government. Inviting a dramatic change, the policies need to be re-drafted. If a hospital is catering to the middle class and poor population, then the tax adds to the financial burden. There is a definite need to have one million hospital beds in India. Added to this, developing a health city can also help in reducing costs. The health city can be a platform for developing medical colleges as well. There is a requirement for at least 1,000 medical colleges.

What kind of help can the government extend?

Most hospitals are built near urban areas, and there is a strong need to develop tertiary healthcare. The government is slowly focussing on quality healthcare for inclusion of rural population as well. Rather than developing hospitals in far off locations, the government can set up hospitals having 1,000-2,000 beds in district headquarters. There can be smaller clinics in remote areas, which can be operated using telemedicine. People in remote areas can be referred to the district hospitals in case of critical illness.

One of our projects is to operate a low-cost hospital in Mysore. Starting this year, built at a cost of Rs 16 crore, the hospital will have all the latest facility and will also act as a remote centre. The cost of a heart surgery can be as low as Rs 50,000 instead of Rs two lakh in a city area. This remote hospital concept initiated in Mysore will be followed by another in Siliguri (West Bengal) and Bhubaneswar (Orissa). With government support, our plan is to set up 50 such hospitals in two years.   

Importance of technology adoption in healthcare services

The procedures and infrastructure are well developed and even technology adoption is up to date. In India, the cost of healthcare services is huge and people cannot afford quality services. One of the ways to provide quality healthcare services in an effective manner will be through technology such as mobile healthcare or telemedicine. We are already on the path of a revolution in this area. In this case, India will take the lead much ahead of other nations. Most medical problems will be treated using mobile phones. Mobile phones will be used to transfer and record data and even help in video conferencing.

Mobile phone devices have become even more intelligent and can be regularly used to monitor patients. These patients need not travel to the hospital and check ups can also be remotely managed. The data is collected in real-time or as per the requirement and any change in the pattern is easily noted. In case of an emergency, the mobile device can raise an alarm and treatment can be ensured at the right time.   

Using telemedicine becomes an innovative way to deliver healthcare, as in India, only one-third of households are in urban areas, and two-thirds in rural areas. With this technology, we have been able to provide specialist services to patients in remote locations. It has also helped us set up virtual classrooms and impart medical education between two locations. Narayana Hrudayalaya runs the world’s largest telemedicine centres networked with over 800 centres globally. Telemedicine is also used for imparting training services for nurses in Africa and other international locations. The technology is capable of revolutionising healthcare delivery to under-developed nations around the world. 

Healthcare scenario in next five years

India has enormous talent in the medical profession. The number of trained doctors and nurses will also increase in the coming years. With increased focus on medical tourism, India has the potential to become a hub in the coming 10 years. Already states such as Andhra Pradesh, Delhi, Karnataka and Gujarat have taken the lead in making the most of this potential.

We will see an increase in the number of medical colleges, as there is a need to train more doctors and add more number of beds.

The government is considering insurance in healthcare to include the vast majority. Each of the state governments will soon join the act. Most of the insurance schemes fund surgeries, as these are a major cost burden. Along with appropriate insurance schemes for surgery, diagnostics services should be provided free of cost. The diagnostics centres are being developed need to look at a proper model and collaborate with other services to reduce costs.   

An advice to budding surgeons

Medical students should consider a career in surgery, as it has immense opportunity and also there is dire need for talent in this field. There is a huge gap between the number of trained surgeons and patients needing surgery. For example, considering heart surgery, there are 25 lakh patients in need of surgery, but we have only 95,000 heart surgeons.

Further, not only looking at operating procedures, surgeons should consider patient issues as well. One of the hindrances in opting for surgery is the cost factor and procedures, which need funding. Professionals should be willing to help poor patients and consider alternative methods to fund surgery. At Narayana Hrudayalaya, 40 per cent of patients pay regular market price, while 60 per cent pay reduced price. We also avail government sponsored surgery. Further, surgeons should note that there is no alternative to hard work. They should remember that we are ‘technicians’ – the more number of surgeries they perform, the more they improve on their skill.

A glimpse of your personal life

I believe in rising early and exercising routinely. My work during the day revolves around seeing patients, doing video conferencing consultations and heart surgeries. On any usual day, I work for 15-16 hours. My family plays an important role in adjusting to my hectic work schedule.

My wife has been busy bringing up our three sons and a daughter. Fortunately, nowadays I get to spend some quality time teaching my daughter.