“If you rethink processes, you can have as much or better outcomes.” ~Mani, after our visit with Dr. Shetty
I want to tell you about the best visit of the trip. It was a life changing visit, to Narayana Hrudayalaya, where we met with the hospital’s founder, Dr. Devi Shetty. Dr. Shetty is an amazing man, a true philanthropist, idealistic, innovative, and with a strong global mindset. Smart is an understatement. Big picture, long term thinker is spot on.
He started by asking us what we think is the #1 industry in the world - guesses? Food/Agriculture. How about #2? It’s healthcare. The world’s healthcare industry is $4.5 trillion, and $2.5 of that - over half - is from the U.S. That’s more than double the entire Indian economy ($1.2 trillion)!! Why is it so expensive??
Dr. Shetty has an analogy, that in the U.S. we have developed the Rolex of healthcare. What do we need to tell time? A Timex would do just fine. Instead of being realistic about quality, cost, and accessibility to all, we have required everyone to buy a Rolex when they really just need a Timex. Healthcare is the same - and it’s out of control. How would we downgrade everyone to a Timex so healthcare is accessible for all? He talked about it being a human rights issue, to deny people the procedures they need to save their lives. So the surgery costs $8,000. Do they only get life if they can afford the $8,000? 40 million people in the U.S. have no access to healthcare, but it doesn’t have to be this way. He explained that the U.S. has one of the poorest values for healthcare, meaning the quality you get for the cost you pay.
Dr. Shetty looks at it in this way - we have quality healthcare, but we need a mechanism to deliver it to all. We don’t need R&D to develop new things if we don’t have a way of distributing what’s already available. The broken link is the delivery process. He used the mobile phone as an example - mobile phone bills used to be expensive! Now 750 million Indians have mobile phones - the process of distributing them has allowed for economies of scale to drive the cost down. So what if we look at the entire world as a healthcare market? What if - in his example - we added a 10 rupee (23 cents) tax to everyone’s cell phone bill, which was used as an insurance premium and access to healthcare? Now we’ve hit 750 million Indians. This will help drive costs down.
Eight years ago, Dr. Shetty started an insurance program at 11 cents per month for Indians. Now Indians have access to healthcare, and he doesn’t even turn those away who can’t afford the cost. He said those who can’t pay still help the cause by increasing the order volume. His surgeons are not paid per surgery, they’re paid a decent salary. He estimates that surgeons in the U.S. perform 2-3,000 surgeries, while in India surgeons perform that by age 35. They’re truly technicians, they get in, perform the surgery, and other specialists look after the patients pre and post-op.
Dr. Shetty’s hospital is for profit - they’re not losing money. But they’ve managed to find a way to drive down costs and increase accessibility. In fact, his goal is to have 30,000 beds by 2015! (He has more than 5,000 right now.) His way of thinking was profound: “The future is different from the past, not an extension of the past. Choose a path that will help the essentialities, not the accessories, of life.” He said that in the U.S. we don’t push hard enough for lower costs, but that while 20th century growth was driven by machines, 21st century growth will be driven by healthcare. If less than 10% of the world can afford a kidney, heart, or brain transplant, things will change. We can’t rely on the past to predict the future. Methods will change; process will change. Luckily there are guys out there like Dr. Shetty fighting for it - for the health of all people.
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