Read here the full transcript of renowned cardiac surgeon Dr. Devi Prasad Shetty’s talk titled “It’s Not A Solution If It’s Not Affordable” at TEDxGateway 2013 conference.
Listen to the audio version here:
TRANSCRIPT:
The Price Tag on Human Life
I would like to talk about the need for cardiac surgery for $800, the need and how it can be done. I’m a cardiac surgeon by profession, but I have a very interesting job. My job is putting a price tag on human life. Now, you must be wondering what kind of job it is.
Every day, I see about sixty to eighty patients in my clinic, most of them are little kids, sitting on their mother’s lap. I examine the kid and I tell the mother that her baby has a hole in the heart, he needs an operation. She has only one question. You know what that question is? “How much is it going to cost?” I tell her it is going to cost eighty thousand rupees, which she doesn’t have, and that is a price tag on the kid’s life.
If she comes up with eighty thousand rupees, I can save the child. If she doesn’t have eighty thousand rupees, she’s going to lose the kid. This is what we doctors do from morning till evening, putting a price tag on human life. How long will we accept this to go on?
The Heart Health Crisis in India
Indians are genetically three times more vulnerable to heart attacks. We develop heart attacks at a younger age. The average age of my patients in England was sixty-five; in India, it is forty-five. In my practice, it is not the young son bringing his old father for a heart operation, it is the old father bringing his young son for a bypass grafting.
We need to do two million heart operations a year. Can anybody guess how many heart surgeries are done? It’s only about one hundred and twenty thousand heart surgeries a year. What happens to the remaining 1.9 million people? They perish gradually over a period of time. In the process, we perhaps produce the largest number of young widows in the world. How long will we accept this to carry on? Why this mess?
The Healthcare Funding Problem
This mess is because our government spends about 1.1% of the GDP on healthcare, slightly more than sub-Saharan African countries. We thought we have to look at an alternative way of funding healthcare. So, around ten years ago, we convinced our state government, the government of Karnataka, to launch a health insurance called Yeshasvini. We convinced 1.7 million farmers to contribute five rupees per month, eleven cents per month.
And the government agreed to become the reinsurer. In ten years, over four-and-a-half lakh farmers had various surgeries and 60,000 farmers had a heart operation, all because of the power of five rupees per month. Now we are trying to convince our policymakers. We have 850 million mobile phone subscribers who are spending 150 rupees per month just to speak on the mobile phone.
So, if we can collect 20 rupees from each mobile phone subscriber, we can cover the healthcare of 850 million people. This is the power of collective action. Poor people in isolation are very weak, but together they are very, very strong.
Transforming Healthcare Infrastructure
When this kind of massive transformation happens, when everyone has healthcare, you need to change the way hospitals are built.
So, twelve years ago, we started a concept of Health City in Bangalore, and this is a picture of our Bangalore Health City. The plan was to have 5000 beds in one campus with the infrastructure to see about 10 to 12,000 outpatients per day. The first building is a heart hospital which has the infrastructure to do 60 heart operations in a single day. But we have 100 towns in India with a population of half a million to one million.
They can’t afford to have this big health city. They need a small super-specialty heart hospital. So, we worked with L&T to build a 300-bed super-specialty heart hospital and equip it, build and equip for six million dollars. This is about 20% of what it costs otherwise.
And we wanted L&T to build it in six months and sure enough, they built the hospital. This hospital has come up in Mysore. In this hospital, after the heart surgery is done, when the patient is in the ward, the patient is not taken care of by the nurses alone, the patient is cared for by the spouse.
Empowering Families in Patient Care
Traditionally, the spouse or family member has no role to play in patient care. A typical heart patient on the fifth day is ready to go home. The family was not involved with the care. On the fifth day, we call the wife, give her one plastic bag filled with medicines, and tell her to take care of the husband. She is lost.
She doesn’t know what to do with him. Whereas if she is involved with the entire process of caring in the hospital, there will be continuity of care when the patient goes home. So we worked with Stanford University and developed an audio-video based curriculum to train the spouse to be the caregiver so that there will be continuity of care when the patient goes home.
Healthcare as an Economic Driver
The economy of the 21st century will be driven by the health sector because the health sector is one industry that can create millions of jobs. Look at the IT industry which gets a lot of support from the government.
For one quarter of a million dollar turnover in the IT industry, they create about seven to ten jobs. In the healthcare industry, to get a quarter of a million dollar turnover, we need to hire 250 people. And the majority of the people in the health sector are unskilled people. We hire a very small number of extremely skilled, semi-skilled people.
If you want a stable society, if you want a better future, we need to create jobs for rural women. As an organization, we have over 13,000 employees across the country and at one point in time, over 90% of our employees were women.