You have been very passionate towards becoming a doctor since you were a child. Tell us about early life and how did it all started?
When I was in fifth standard in 1962, Dr. Christan Bernard did the first heart transplant surgery in Capetown and our teacher came and announced that today somebody took out the heart of a dead body and put it in someone who had a problem and that man then walked out of the hospital, and so it was all very dramatic. That’s the day when I thought I’d become a heart surgeon even before deciding to become a doctor. In fact, I didn’t know then that I had to be a doctor first in order to become a surgeon!
You did your higher studies in London but generally what happens is a lot of people who go abroad and they tend to practice there it self; what prompted you to come back to India?
It’s a tradition in my family that, my brother, my brothers in law, all went to England for training. And, actually a lot of people go there and work to get experience and comeback, my idea was never to stay there. At the same time, my wife was really unhappy and if she would’ve been ok, I would have managed it for some time more. At least, for a few more years. But she didn’t want our children to be brought up there.
How did you conceptualise Narayana Hrudayalaya? What was its starting point?
Everyone thinks that people who achieve something in life have a very grand master plan. But actually, there is no master plan, and we are all wandering around trying to make a difference. It is very difficult to see the horizon, to see the future. So, I came back to India like any other Indian doctor with the great desire. The British have a great system which is very fair, where a millionaire and a chauffeur get’s to be treated in the same hospital in the same ward, close to each other. There is no concept of a semi private or a deluxe room. You feel that healthcare is a birthright and everyone should have access to it. Then, all of a sudden, from Heathrow to Howrah was a big change for me and then the grass root reality that people have to buy rice, kerosene as well as healthcare. It’s very sad. Then you realise that if one can’t change the policy at least one can make it affordable. You have no control over the price structure and you start asking people to sponsor the money to be used for treatments. I operate on kids and I don’t charge them any fee if they are from a poor family. But, when these kids come from a wealthy family, I ask them parents to sponsor another poor child’s operation. So, this way we had a lot of donors. Then, I realized that donor’s money is the best money to sponsor poor people. The rich people have a desire to help the poor but they don’t know who genuinely needs it. Similarly, the poor man also needs money for treatments but if he goes directly to these people asking for the money, they won’t write the cheque. Here, I come in as the person who connects the two.
Whatever you have been doing, it’s something that everybody appreciates not only in India but across the globe. How do you feel that after almost like sixty nine years of independence, more than sixty percent of population cannot afford health care facility in India?
India is a typical example of lack of proper policies and we’re punished because of it. First thing we did was to dissociate medical education from rural health care. Like in Karnataka state, there is a Minister for Medical Education and there is a Minister for Healthcare. So, the intention of the medical education minister is not making sure that the poor people in Karnataka have access to healthcare. Medical Education unfortunately is a curse for this country. It has become a very lucrative business. If you ask me one reason for why in this country every 10 minutes, a pregnant lady dies during childbirth, 3 lakh children die post delivery, two million children die before celebrating the first birthday, it’s all because of the lucrative medical education. Look at the data, twenty six million babies are born in this country, conservatively, twenty percent of them will require caesarean section during child birth which means we need to do five point six billion caesarean sections per year, to do that we need at least two lakh gynaecologists, anaesthesiologist, paediatrician and radiologist but we don’t have more than 30000-40000 each one of them. So no matter whether, you increase the budgetary allocation from one per cent to five per cent, you simply cannot reduce the rate of mortality. So, if the policies were revolving around offering adequate medical facility to rural India, in order to achieve it, you need to increase the manpower. Unless there is an excess of manpower in the cities, the doctors won’t go to small towns and villages. Government is talking about universal healthcare but that will not change anything. It is just that by covering universal healthcare people who were already paying, government will pay. But the lack of healthcare coverage is not going to increase. So, it is a typical example of lack of clear policy. USA has19k under-graduate seats and 40k post-graduate seats to train gynaecologists and radiologists and we have 56k undergraduate seats and 14.5k post-graduate seats. There is no way you can meet the demand. Think about, we are not even replacing the people who are retiring and dying. The gap is huge and that’s why value of post-graduate medical seats goes up to 5 to 7 cores.
Have you ever tried talking to government about this scenario?
Fortunately the current government is aware and they are taking some steps. I hope we find the solution. I am optimistic that the current government will be able to do it as medical education is controlled by the state. Irrespective of that we keep saying that health care is a state subject, the state government only conducts the exam, and they don’t have control on their own manpower.
What is the support that private healthcare players get from the government?
We just need open medical education. Just open equalized under-graduate and post-graduate seats and in 2 years, all the dynamics will change.
In rural areas, hospitals don’t even have proper techniques/facilities. Please tell us.
I will give you an example. We have 5k community health centres across the county which was designed by the policy makers for 60% of the child births in the country. Each centre is supposed to have gynaecologists, paediatrician and radiologists. Health ministry data shows 80% posts are vacant. Facilities are there but nobody is there to treat people. Medical service is a regulated industry. I am a trained heart surgeon, but if I do inspection I’ll lose my license. So, essentially unless you have that many certified people no point producing more doctors. Today, unfortunately regulation restricts the doctor from doing so many things.
You have treated Heath Insurance policy, why can’t policy go across country. In fact, the state of Karnataka has cheapest policy of RS. 10 making it so affordable, why are other states behind or hospitals not applying it?
The recognition for this should be given to the Karnataka state government. There are people like me in every state who come up with these things but it is the government which has the political will and wisdom to understand. Fortunately we have a very understanding government and they are very supportive and they took the challenge. When I tell people that a farmer can pay Rs.5 and get a heart treatment done people will think that I am crazy, however, the government understood it and they thought if INR 5 doesn’t work then INR 10 will work and if INR 10 will not work then INR 15 will work as it is the government’s job and they agreed to become the re-insurer. But then we didn’t even required re-insurer. They had the political will to do it. No matter what private sector you talk about, whatever unless there is a good government which is innovative in trying to change things, things are not going to change on their own. Private enterprises, whatever they do, like mobile phones companies, are touching millions of people’s lives. But who would you give the credit to, the mobile company? No, it is actually the government who makes the policy to ensure that these companies can run it successfully. Ultimately, the credit of growth of a nation must be given to the policy makers. They are the ones who make it happen.
What are the opportunity areas of Healthcare in India right now?
3 million beds are required just for 1 disease called heart surgery. We need to do 2 million heart operations every year. All the hospitals in India put together are able to do just 120,000 heart surgeries. We do a significant share of those surgeries. We have 23 hospitals and 7 heart centres across the country. So, the disparity between what we need and what is available is huge. There is no comparison. People keep talking about competition, but there is no competition. Ofcourse, if we are going to charge a premium, then there is competition. But if you offer affordable healthcare then there is absolutely no competition.
How have you overcome the challenges?
When you look at young entrepreneurs coming together trying to create something, the first question they ask is what shall we do, whether it will be an app, Software Company or a restaurant? Then they ask, how shall we do it but never the question why? The point is just like that, so no negotiation. We know why we have to do it, so people working with you know why we are doing it and they are convinced that if you don’t provide healthcare, someone is going to die, someone is going to lose a loved one. We get help from all experts coming from various areas together and they all know the why. Till the time it’s not your personal agenda and you are clear why you are doing it, it will happen. If it’s your personal agenda, then you will face obstacles.
Why private hospitals are not coming forward to do community services?
It takes a lot of effort and there is a market of people who can afford to write a cheque. So, why bother going down the strata. For us to earn the revenue, the kind of work we have to do is 10 times more than what others have to do. You can imagine the load and stress on the team. So, when there are enough people to write a cheque, why you want to reduce cost and make it affordable so that more people will come. I see 60-100 people in OPD every day and I do at least 1-2 heart surgeries a day. So, lot of effort goes into this when you can earn that kind of money just by seeing 4-5 rich people.
But people are happily donating you, covering your cost, as they believe in cause, so why still there is this thinking process?
Ideology for people who want to is very simple. When people started hospitals they made policies and made it clear to all their employees that this is a hospital for rich people which also takes care of the poor. But when we build our hospitals and talk to our employees, we tell them that this is a hospital for the poor people but we also take care of the rich. So, it’s all about the why. If you are pushed in an ideal environment, given a choice, I would prefer working for working class and poor but the economic reality is I can’t do that.