“NEVER DOUBT that a small group of committed people can change the world. Indeed, it’s the only thing that has,” says Dr Devi Shetty, Chairman and Consultant Cardiac Surgeon, Narayana Hrudayalaya Institute of Cardiac Sciences, Bangalore. His hospital is a proof of this.

It is a place where the poor and the destitute throng, for no patient is denied treatment for want of money.

It is also the haven where the rich come, willing to pay for the world-class infrastructure and treatment offered.

The hospital complex is run both like a business empire and a charitable institution. No wonder then that Dr Shetty’s business model is the subject of a case study at the Harvard Business School and a documentary by Discovery Channel. He speaks about his “Robin Hood Philosophy” and the urgent need of healthcare for the poor.

No patient with a heart ailment is denied treatment in your hospital. Why did you think of this model? And how does it work?

First of all, some facts and figures. India requires 2.5 million heart surgeries every year. But at the moment only 70,000 heart surgeries are being performed. What happens to the rest? They all perish gradually over a period of time.

All over the world, less than eight per cent of heart patients get an opportunity to be treated. For 92 per cent of the people living on this planet, heart surgery is a dream. Think of that — 92 per cent!

The first heart surgery was done 100 years ago. Hundred years later, less than eight per cent of the world can afford heart operation. All over the world, 650,000  heart surgeries are done. Out of which 450,000 are done in the US alone. And in the rest of the world only around 200,000 operations are being performed.

So essentially, right now, heart care is reaching a very, very small percentage of the people, that too in the affluent part of the world.

Our desire is to make sure that everyone who requires a heart operation gets it because most of the heart operations give very good long-time results. People can have a meaningful life after the operation.

India produces about 300 to 500 children every day with heart diseases. And children’s operations are very expensive and children cannot wait.

Because of all these reasons, we thought we should bring down the cost of the operation and make it affordable. And we are able to do that because we are able to perform about 30 heart surgeries a day. We have the infrastructure to do about that much.

The largest heart hospital is in Brazil and they are able to do about 32 to 35. When we handle that many numbers, the cost goes down significantly. Because of the large turnover, the economy of the scale works for us. And as you do more operations your results get better.

Institutions like the Harvard Business School and other organisations have conducted a survey on our results. And they feel that what we have achieved is as good as anywhere else in the world.

Does it mean the hospital remains solvent because of the large turnover?

Yes. Also, we have state-of-the-art equipment and infrastructure that attracts those who can pay for it.

It is an unwritten convention that the rich pay for the poor. Usually a poor patient is not denied treatment, but the costs are recovered from those who can pay. So In what way is your model different?

We just need about 25 to 30 per cent of patients who can pay the actual cost. If that happens and about 10 per cent pay the premium, for the remaining 60 to 70 per cent of patients, surgery can be performed at cost price or even less or for free. That is the difference. It is simple economics that drives the philosophy of the organisation rather than a one-off case that might be practised elsewhere.

Today we get patients from about 25 countries. A large number of people who can afford to pay as well. That is the one reason we are able to offset the losses in other areas.

Isn’t your business model — rob-the-rich-to-pay-the-poor — in a way exploitation of the rich?

It depends upon how you look at it. The rich pay because they get the service. And that extra service doesn’t really cost extra money because whether they are rich or poor, they get operated in the same operating room. The intensive care unit is the same. But when the rich occupy a single room. They get all the comforts … extra comforts. So they pay for it. It’s not that they pay for something they don’t get. In fact, they do get much more than they pay for. But a part of what they pay gets utilised for treating the poor.

The Harvard Business School has used the way the hospital is run as a case study. How do you feel about it?

Their interest in us as a case study reinforced our belief in what we are doing and we are convinced that this is the only model that works.

They studied us about three years ago. At the time we were very small. Now we have become three to four times larger. Today the number of people who can afford to pay even in developed countries like the US for all the high-tech heart operations is very small. In the US alone, there are about 40 million people who are not covered by health insurance.

We believe that globally, the cost of heart operation and healthcare has to come down.

Your avowed ambition is to cure the poor of the world for just a dollar a day. Is this an achievable ambition?

Yes, it is an achievable ambition. We run a health insurance scheme with the Government of Karnataka. It is called Yashasvini. It is the fourth year we are running it. The first two years the farmers paid just 11 cents per month. And two years ago we revised it to 22 cents per month.

If three million people contribute that amount each, you can get a heart operation done, a brain operation done, kidney operation, the gall bladder or whatever operation done entirely free. As I said, it is the economy of the scale and the numbers.

Poor people in isolation are weak. But together they are very strong. So we go through cooperative societies which have a very large network and utilise their infrastructure to collect the premium from the farmers and run the scheme.

You are particularly interested in heart problems of the children. Why?

I’m particularly compassionate about problems of children primarily because I have four children. I know what it is for parents to see their children suffering.

Also, I spent a significant amount of my time in learning Paediatric Cardiac Surgery. I had the opportunity to work in the field when I was working in England. It is much more complicated than adult cardiac surgery. It is like the difference between making a wristwatch and a wall clock.

It’s relatively easy to fix a wall clock when it’s damaged, but when you try to fix a wristwatch, it is a delicate operation. You need to be very, very careful.

The other way I look at it is, most of the people who develop blockages … the reason is either because they smoke, drink and have unhealthy lifestyles. But children with congenital heart disease suffer for no fault of theirs. If we can fix their hearts, they will be able to lead normal lives. They have a life ahead of them, whereas if you fix the heart of a 75-year-old man, he has already lived his life.

Isn’t it ironic that today we have become more aware of health issues, but have no time to take care of our health?

Yes, that’s true. You see, when you buy a new car, you don’t have to worry about its maintenance or the engine. But after two years you need to look after it. It’s the same thing with our body.

Another irony of our times is that our life expectancy has increased, but we suffer from so many lifestyle-related ailments that the purpose of a long life is defeated.

That is true. In the near future, celebrating 90th or the 100th birthday will  become the norm with all the available medical facilities, early diagnosis and treatment and all kinds of medical intervention. In this kind of scenario, it is left to us how we want to live. Since we are going to live long, we must learn to live well, without too many aches and pains. That is in our hands.

What criterion do you use to hire doctors?

For senior level jobs, we normally don’t advertise. We do the headhunting ourselves because we feel that if we advertise we may not get the most talented people. We find out who are the best people in the field and make an offer they cannot refuse.

Isn’t dedication a very big criterion?

Yes, it’s a very, very big part. Unless they are passionate about what they are doing, they won’t fit in. They should be able to differentiate between need and greed. We service their need, but we cannot service their greed. Here the take home salary maybe very good, but they work three to four times harder than elsewhere.

Tell us something about the training programme you have launched in rural areas.

The greatest problem in the future is not going to be money for healthcare, but lack of technically skilled manpower. There will be an acute shortage of doctors, nurses and technicians in this world because people are going to live longer. But someone has to look after them. And you cannot produce specialists overnight. It takes 15 to 20 years. And as the world grows more and more affluent, healthcare jobs will become more and more unattractive.

When you come from a wealthy family, you don’t want to become a doctor and work 18 hours a day. But someone will have to look after the ailing. So we have launched a programme in West Bengal where we identify children studying in Class 7 in government schools in the rural areas. They should commit to us that they want to become doctors. Then we give a debit card from ICICI Bank so they can draw Rs500 a month. Rs200 goes to the family so that the child is not taken off the roll and forced to work in the fields. And Rs300 is spent on the child’s education and other expenses.

When the student reaches +2 level, we organise an educational loan and we stand as guarantors.

We started with 200 students. Our aim is to have 2,000 students from the villages of West Bengal become doctors.

Now the Gujarat and Rajasthan governments have asked us to launch the same programme,

We want to follow the same model in Africa. We are also trying to set up a few nursing schools there.

Why Africa?

Everyone says that Africa’s problem is money. Their problem is not money. Even if you give them money, they cannot build hospitals there because they don’t have nurses, doctors and technicians.

We also train surgeons from all over. We have a tie-up with the University of Minnesota. We train heart surgeons and nurses for the University of Oregon, China, Pakistan, Bangladesh, apart from Africa.

What are the future plans for Narayana Hrudayalaya?

We believe that future hospitals are going to be health cities. So here, within two years, we are planning to have facilities for 5,000 beds. We are in the process of building a 1,000-bed cancer hospital that is a joint venture with Kiran Mazumdar of Biocon. We want to reduce the cost of cancer treatment by 50 per cent. Once it is done, we want to scale it up in other parts of the country.

Our eye hospital is ready. It has the infrastructure to perform about 300 to 500 cataract surgeries everyday. We have an orthopedic hospital where joint replacements are done. We are building similar health cities in Kolkata, Ahmedabad and Jaipur.

We want to build a charitable hospital for children’s heart diseases in Pakistan for poor families because a large number of children from Pakistan come to us for treatment.

We also have a tie-up with the Dubai Higher Colleges of Technology for a Health City Project. They are setting up a 50-acre campus, which is a joint venture between HCT and us. The idea is to train doctors, nurses and medical technicians mainly for Gulf countries.

You have been awarded by the World Economic Forum for Social Entrepreneurship, which is unusual for a doctor. You obviously have a head for making money.

Naturally, yes. You see most of the great ventures in the world have been successful because of people with a head for business. If Mahatma Gandhi had run a business enterprise, he would have been very successful.

Now coming to the aspect of medical skills, there could be many doctors with the skill to operate on the heart. But if the patient cannot pay for it, the skill is wasted.

We strongly believe that skilled doctors have to spend at least part of their time in building infrastructure so that people without money can be treated. Money is the greatest problem with many patients. If we don’t address this issue, no one else will. If we expect others to take interest in it, the interest will be purely monetary. Then the very purpose is defeated.

You are concerned about infanticide, particularly female infanticide. What is your message to those who indulge in it?

It’s a result of poverty and lack of education. It’s very difficult to address it without addressing other larger issues of society.

Today we get carried away by all the development around us. But we fail to see that it benefits only a very small percentage of people. Unless it reaches down to the level of the common man, many other problems will mushroom. Infanticide is only one problem in the larger set of problems.

Your mantra for success? 

I believe in strong family values and being spiritual and compassionate. I am not talking about the religious aspect of spiritualism. I have a strong belief in God guiding me in whatever I do.