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.
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. Why women? If I have the job of cleaning the floor in the hospital, I can give the job to the man and give him 6,000 rupees salary and he will spend 3,000 rupees on himself.
And 3,000 rupees goes to the family’s welfare. Instead, I give the job to his wife and give her 6,000 rupees salary, she will spend the entire 6,000 rupees on the family’s welfare. A woman who comes from a low socio-economic status, once she is employed, she becomes an empowered woman and these empowered women will discipline the children. And when these children grow up, they build a great nation. This is the power of job creation for women.
The Future of Healthcare in India
The next big thing in healthcare is going to happen in India. The next big thing in healthcare is not going to be a magic pill or a faster scanner or a new operation. It is going to be utilizing IT to make hospitals safer for the patients. Believe me, hospitals are not safe for the patients.
Getting admitted to an American hospital, which is one of the safest hospitals on earth, getting admitted to an American hospital today is ten times riskier than skydiving. We need to make it safer. To make it safer, we have to use IT.
So we are investing heavily in iPad-based solutions, replacing the chart with the iPad, which will follow the patients. And we are investing heavily in developing simulators to train critical care nurses to be better critical care nurses. If we can train a pilot to fly an F-16 fighter plane with a simulator, we can easily use the simulator to train critical care nurses, and this is what we are trying to do.
For all this to happen, the cost has to come down. The cost of healthcare has to go down. If a solution is not affordable, it is not a solution. So we invested heavily in technology to get the information.
We have an advanced Oracle ERP solution on a cloud. We have hospitals in 22 locations. Every day, by 12 o’clock in the afternoon, all the doctors, all the senior administrators get an SMS on their mobile phone with yesterday’s revenue, yesterday’s expense, and the EBITDA margin. For us, looking at the profit and loss account at the end of the month of a hospital is like reading a post-mortem report.
Whereas having the profit and loss account on a daily basis is a diagnostic tool that will help you to reduce the cost. This is why our organization was profiled at the Harvard Business School as one of the case studies and occupied the front page of Wall Street Journal four years ago.
Conclusion
We believe that India will become the first country in the world to dissociate healthcare from affluence. India will prove to the world that the wealth of the nation has nothing to do with the quality of healthcare its citizens can enjoy.
Why can we do it when other developed countries can’t do it? It’s mainly because we produce the largest number of doctors, nurses, and medical technicians in the world. Outside the US, we have one of the largest numbers of US FDA-approved drug manufacturing units. We have everything going for phenomenal healthcare delivery. But never give the credit to the policymakers who you think made it happen.
Everything good in this country happens by default, and if there is one country which is directly managed by God, that is my country. Thank you very much.
