Wealth is not Health

Healthcare, and not only for the rich, is going to be the one area where India will have to make huge investments in the coming years

Devi Shetty

If there is one country which can dissociate healthcare from affluence, it is India.  The other day my wife was walking near a shopping mall and she saw a beggar on the pavement, lying with his face covered, an arm stretched out for help. When she peeped under the blanket to know why he had covered up his face, she could see the beggar talking on his mobile phone. This is India. Ten years ago, a mobile phone was linked with affluence.

Today, it is dissociated from affluence. I strongly believe that the same thing is going to happen in healthcare. People continue to live in slums, they continue to have problems finding decent accommodation, transport, well-paying jobs, but when they are unwell, they are going to have access to high-tech healthcare with dignity.

This will happen, because the government will become a health insurance provider rather than a healthcare provider.

Four years ago the Karnataka government launched a programme called Yesheswini Micro Health Insurance Scheme, which proved to the world that with Rs 5 a month, you can get a heart, brain, kidney or any operation done.  Over a period of four years, Yesheswini has emerged as one of the world's largest micro health insurance programme, covering the lives of more than 2 million farmers. Now many similar programmes have been launched in different parts of the country.

All we need to do is to create a vehicle to which poor people, whenever they have money, can contribute in small amounts. This will be the premium that will look after them when they are unwell. There may not be many hospitals that offer quality healthcare, however, as soon as some type of health insurance becomes available to cover people, hospitals will come up in no time.

However, once finance becomes available, the one thing that could hold us back is lack of technically skilled manpower. India currently has about 30,000 medical seats whereas the requirement is over 100,000.

India also requires a few thousand more nursing schools spread out all over the country. Though we currently produce the largest number of doctors, medical technicians, and nurses in the world, it is much less than what is required for our own requirement. We believe that in the future, healthcare services of the whole world, especially in the developed world, will be taken over by Indian professionals.

This is because, as countries become wealthy, healthcare jobs become unattractive, since nobody wants to be woken up at 2 o' clock in the morning to examine somebody with a stomach ache. Therefore, some of the general practitioners and the super-specialists of USA and Europe are going to be Indians. 

The cardiac surgical services of a general hospital in Geneva had not a single local surgeon coming for training in the last five years. This means that within the next few years, when the senior surgeon retires, that post will be occupied probably by an Indian.

Therefore, on the occasion of the 60th anniversary of our Independence, our recommendation to the government is: Create an infrastructure of health insurance, where working class families can contribute money through whenever they have some. Also, encourage private entrepreneurship to build as many hospitals as possible.

Besides, the government should invite overseas medical institutions to set up medical colleges, nursing colleges, and paramedical colleges in India.  We are probably not aware that a well-qualified doctor or a nurse with a degree from India draws less salary than a doctor or a nurse from the Philippines with an American degree, who may have never stepped on American soil. It is nice to be proud of our heritage and education, but what matters is the value is of your degree when you go out of the country.

The training our people receive should be such that their degrees are recognised and fetch them good remuneration.

The healthcare industry, if it blossoms, can create more number of jobs than any other industry. The IT industry, with so much support from the government, has so far created just a million jobs, and these are taken over by people from the middle and upper-middle class. Healthcare industry, on the other hand, creates jobs primarily for women from lower socio-economic strata.

For a turnover of, say, Rs1 crore, an IT company can perhaps manage with five to seven people, but a healthcare enterprise would need at least 250 personnel. When we are talking about building the nation, we should invest in that industry which can create maximum employment. It is sad that the healthcare industry as of now has not received any encouragement for large-scale investment.

Unless sizeable investment comes up in this sector, India's healthcare scenario is not going to change, since right now it is managed by thousands of small, skilled players who don't have the economy of scale to drive down costs. We strongly believe that the cost of an operation can be brought down by 75 per cent provided sufficient incentives are given to build up the volume.

India requires 2.5 million heart operations a year and all the heart hospitals put together are doing only about 70,000 surgeries. It is pointless for us to be talking about all the developments in healthcare if most of our people cannot afford it. For us, unless a solution is affordable, it is not a solution. 

Devi Shetty is Chairman of Narayana Hrudayalaya in Bangalore.