An Indian Heart Surgeon’s Quest to Change the World’s Health Care
January 28th, 2009
Submitted by: Josh Hickman
For those of you who have not chosen Khanna’s Billions of Entrepreneurs for your read this quarter, I would like to bring to your attention a segment in the book in which I felt could break new ground in the practice of medicine in developing countries, as well as our own fifty states. The chapter titled “Barefoot Doctors and Medical Tourists” discusses what both China and India have going for their hospital system as well as where they fall short. China, whose hospitals are described as “clean, free of crowds, and well run” which is a stark contrast to a hospital in Mumbai which is filled with “hundreds of people demanding surgical attention with paint flaking off the walls and unsanitary conditions” (Khanna, 213). The story of Dr. Devi Shetty touched me, an entrepreneurial heart surgeon who once cared for Mother Teresa in his career, has provided affordable and reliable health care for people even in the poorest of India’s slums. Dr. Shetty runs a private hospital in Bangalore (Narayana Hrudayalaya) that can provide medical services for the equivalent of a few cents to people, and will not turn away anyone who cannot pay for service (some government subsidies help make this possible). Shetty won the entrepreneur of the year award at the 2006 World Economic Forum for building “Healh City”, a network of different hospitals and medical departments to house five thousand hospital beds and maximize the use of their medical equipment to cut down costs even more.
Seeing this success with privatization of health care, why do we still see medical costs in the U.S. for thousands of dollar per day? And what happens if someone does not have medical insurance? Some catastrophic illness could also mean the end of your financial future which would be devoted to paying off these medical costs. I have a very close friend whose mother had an unexpected brain tumor last year and was near death (thankfully she is alive now and rehabilitating), and her hospital bills were well over a million dollars for a two month stay. If the family had not had any insurance, they would be in a very scary financial situation right now.
So would privatization of health care and hospitals in the U.S. be an answer to our problems? Shetty has plans to expand to Mexico (see here for a short article about the project) as well as other cities in India including Hyderabad. This brings up an issue of whether it is fair to be providing free health care from our tax dollars to people who maybe are unemployed, or not contributing their part to federal or state taxes. However, by utilizing medical equipment and personnel more efficiently and effectively, driving the overall cost down for everyone could help the issue without having to resort to heavily subsidized programs. Dr. Shetty is an example of someone who thinks outside the box, not only to benefit him, but in order to revolutionize the model of hospitals and make changes in how a country operates.
Entry Filed under: Bangalore, Hyderabad, India, Mumbai, New Delhi, Pre-Departure
16 Comments Add your own
1. Oscar Merlin | February 5th, 2009 at 2:54 pm
Unfortunately, for every person doing a good deed you have ten people just doing the opposite. Check this link out about illegal organ transactions http://www.youtube.com/watch?v=GGIPhCpHqhs&feature=related . I think that the things that Dr. Devi Shetty does should be even more popularized to inspire more people and at least counter balance all of the bad things done out there.
2. Emily Schaapveld | December 15th, 2009 at 8:25 am
The biggest problem with US health care system right now is the waste. Money is wasted everyday on unnecessary testing, medication, and visits to the doctor. Our insurance system is such that you can go to the doctor for a check-up and only make a co-pay. Insurance is supposed to cover the cost of a catastrophic event, not a head cold. This overuse of the health care system has caused wasteful spending, driving up the costs.
Dr. Shetty’s system takes the right approach by focusing on controlling costs, which keeps the price of health care low. Without the use of insurance, Shetty eliminates a moral hazard problem, forcing people to make smart decisions and therefore keeping the costs low. However, there are always a few bad apples, so the question is how to keep that number low too.
3. Alex Thornton | December 19th, 2009 at 2:09 pm
To elaborate on Emily’s comment, American’s health care problem is a cultural one. American’s believe that more health care, more treatments, are the solution to illness.
I heard a great example of this on This American Life on National Public Radio. A young girl got into an accident and may have fractured her spine potentially leading to paralysis. Her doctor preformed a noninvasive physical examination and determined that there was no sign of damage to her spine. Her father barged in and demanded a CAT scan, thinking a physical examination was insufficient. The doctor explained to the father that a CAT scan would be risky as it exposes the patient to up to 440 times the radiation of a chest X-ray. The doctor also pointed out that he would get paid for the CAT scan, but ethically, he was obligated to recommend the best procedure for his patients. The father withdrew his demand and the daughter did not get the medically unnecessary CAT scan.
Unless America’s cultural belief that more health care is better is changed, then health care cost will continue to rise.
4. Erika Bylund | January 20th, 2010 at 3:39 pm
There is no question about the wastefulness of American health care. What really puts our nation to shame is how much more some developing nations are able to achieve and offer in medical care for pennies on the dollar. I was without health insurance for the first time about a year ago. I never had any major health issues, but just in case of some traumatic injury, I wanted to be covered. After three months of battling through faxes, phone calls, and emails with Blue Cross, they finally decided to cover me. I have emergency insurance, but for my everyday doctor bills, I simply ask my doctor if he will discount my bill (by up to 50%) if I pay cash. He usually says yes because what they collect from me now is a lot more that what they collect from a lot of their patients who do have (substandard) health insurance coverage. I recommend that option to anyone without insurance facing a large medical bill.
The beauty of it is that many doctors are private practice and have the authority to negotiate their bills. Good ol’ fashioned American negotiating. However, when I can pay full price, I do because I know that my doctor typically only keeps a fraction of what he charges. It is very very expensive to be a medical practitioner.
The article suggests that if doctors and patients can interact on a need-based, ability-to-pay interaction, then both sides of the coin stand to have a greater net-gain. However, it is especially apparent in Josh’s article, that a government subsidy might be necessary in some cases.
One of the major difficulties for a lot of doctors is how hospitals, pharmaceutical companies, and insurance companies operate like/as publicly traded companies. The minute you start worrying about returns and shareholders (even in the case of non-profits), the wrong corners get cut and quality of health care (and compensation for doctors) drops.
When I embarked for my work in Suriname, I was offered international traveler’s health insurance. I laughed- why would I pay for insurance that would cost me as much as the actual treatment in the host-country? What a joke. It would cost me about $20 bucks to see the doctor in Suriname. Besides, the insurance company can’t even reimburse you unless you have the “right codes.” Last time I checked, doctors in Suriname weren’t using American codes to itemize their use of a bandaid!
5. Michael Harroch | February 5th, 2010 at 4:29 pm
It is very tricky to compare how the public and private sectors affect the health care system in different countries. I often find myself at the center of discussions that aim to compare the French and the American healthcare systems. The truth is, there are many things that make the French system inconceivable in the US and vice-versa. I still absolutely believe that countries and societies can learn from each other, but copy/paste does not work for health care. What Dr. Shetty has accomplished in India should not be seen as an answer to the public vs. private sector debate. Rather, the take-aways here are the little things Dr. Shetty has implemented that have significantly lowered the costs of running a medical practice.
This post reminds me of a very interesting interview I saw about an American Doctor who has created a new checklist (out of all things) that is lowering deaths in surgery by one third! Dr Atul Gawande, associate professor at Harvard Medical School was inspired by pre-flight checklists that were first implemented by the US Air Force during WWII. For more information, checkout: http://gawande.com/
6. Jay Ponto | February 19th, 2010 at 2:20 pm
In reference to wasting funds on health care, many additional expenses resulting from unnecessary testing are commonly the result of doctors protecting themselves. Often, doctors will order expensive tests that patients do not need, but the doctors order the tests because they are protecting themselves against a potential malpractice lawsuit in the event one occurs.
This fear of malpractice lawsuits prompts unneeded tests, unnecessary procedures, and more patients being sent to specialists, further increasing costs. The most prominent reason that patients sue doctors is because doctors failed to diagnose a disease. If the doctors do everything in their power to diagnose a disease, patients will be less likely to seek legal action.
As an example, a patient could walk into a doctor’s office because the patient is experiencing a hearing loss. This COULD be due to an acoustic neuroma (slowly growing tumor), but there is a VERY small chance that this is the case. A logical course of action would be to wait a few months and see if he hearing loss continues, which might suggest the rare tumor. Nonetheless, many doctors will order an MRI to every patient who complains about hearing loss, just in case. Hypothetically speaking, if the doctor did not order an MRI, the patient could go to another doctor, that second doctor could do an MRI that finds a tumor, and the patient could turn around to sue the first doctor for misdiagnosing the patient.
http://www.aarpmagazine.org/health/health_care_costs.html
7. Danielle Steussy | February 20th, 2010 at 10:11 am
This is an incredibly interesting topic, particularly given the state of the health care system right now and the President Obama’s reformation project. Emily makes a great point about the amount of waste of health care in the United States. In fact, it even reminds me of every single episode of House where the crew searches for causes of illness by running an incredible amount of tests and procedures on patients until the patient has lost a couple of limbs, some organs, and have gone through enough unnecessary rounds of chemotherapy to last them a lifetime. Although an extreme situation, it’s always emphasized in the show by Dr. Cuddy that there are problems with insurance and generally how quickly everything adds up. Sounds similar to the current system, right?
Ultimately, as everyone has mentioned already, the most important steps to take to help drive down the costs of health care is to decrease waste and abuse of our current system. I think that what Americans need to do is really observe what works and what doesn’t work in other countries and what other doctors, like Dr. Shetty, are doing to help fix this problem. I agree with Michael on this that the copy/paste method doesn’t really work but at the very least, we can learn from countries and tailor their ideas to the culture of the United States.
The bottom line is, however, that insurance needs to be affordable to all so that everyone can get the health care they need in times when they simply aren’t able to afford it by themselves. So many of us have had the privilege of having health insurance that we overlook the fact that good hard-working are not as fortunate as us and don’t get the care that they deserve.
8. William Ary | February 21st, 2010 at 6:48 pm
My issue with health care is that there are two different philosophies: a minimalist approach (where people are turned away as part of triage unless the benefits of medical care will probably mean the difference between life and death or lifetime crippling injury) and an expansive approach where people are free to come in to the doctor even for small things like the cold Emily mentioned. I think this is a result of the way healthcare is provided- either an out of pocket pay as you go industry or a completely subsidized, bureaucratic behemoth where everyone is equal and entitled to care but at the cost of a low standard of quality or a crippling tax burden that stifles the government economy. My own perspective is purely minimalist. I think no one should be guaranteed more than a small level of disaster prevention healthcare as part of a national blanket coverage program. Rather, people should be free to allocate a portion of their income to savings or insurance to cover their health. If they want better care, they can individually pay more to access it. People who make more money have contributed more economically to the society, so they have earned the right to receive more in return.
Another way to minimize costs is to ensure that competition drives costs down. Making sure that the costs of equipment, facilities and services are very close to their production costs will force the overall cost of healthcare down. Further, we need to evaluate what aspects of healthcare are really important. What is more important, giving antibiotics to sick people or making sure that each bed in a hospital has new sheets?
9. John Barry | February 26th, 2010 at 10:51 pm
The story of Dr. Devi Shetty is a real inspiration. Why is it sometimes that the people who have the least to give are the most generous? According to a 2007 Harvard study 62.1 percent of personal bankruptcies in the United States were caused by illness or medical bills. This number is up considerably from 1981 when only eight percent of families filing for bankruptcy did so in the aftermath of a serious medical problem. How is it that the citizens of mankind’s wealthiest nation can’t afford to pay their healthcare bills and people living in India, a place where 45 out of 100 people make less than $1 per day can pay their bills?? I’ve heard a lot of speculation on the matter but I don’t claim to be an expert in the the economic realities of medicine so I won’t go any further into it.
While I don’t feel that my tax dollars should go to pay for someone unemployed in a healthy economic climate who doesn’t pay their fair share, I think that all children should get the best healthcare available regardless of whether their parents were ivy league educated or city college drop outs. My feelings are that healthcare should not be reserved for the wealthy and priviledged but available for all who need it, and I hope that congress eventually agrees with the President and I.
10. Tim Lynds | March 3rd, 2010 at 10:39 pm
To touch on some of what has been mentioned above, Americans need a pill to fix any health problem and everything is a health problem. There are quite a few systematic reasons why our health care is so outrageously expensive including insurance company pressures, over testing, and out of control medical supply and equipment costs. But people need to realize that part of the blame lies with the health care consumers themselves. Many Americans go to the doctor for anything and everything. People get a cold, they go to the doctor. People scrape their arm, they go to the doctor. People see a new freckle on their leg, well you get the point. In general we are over consuming health care in this country which is contributing to higher prices as well as lower service quality.
Dr. Shetty is awesome for making health care affordable for the masses in India. He made health care available to people who really needed it. Now that this health care is available, I cannot believe that poverty stricken Indians are running to the doctor every time they sneeze. They are probably not abusing and over consuming these newly available health services. If they did, Dr. Shetty’s system would probably suffer and prices would rise. The Indian consumers would essentially force themselves out of the market. Just a thought.
11. Jordan Wente | March 8th, 2010 at 7:03 pm
Dr. Shetty’s idea reminds me a lot of a video we watched in marketing this quarter. The video was about franchising health care in Africa and how this changed the way health care was being distributed to the population. Since the government in Kenya was not able to sufficiently provide health care to the communities, Chris Hillstrom stepped in an implemented HealthStores. The idea was to provide treatment for preventable illnesses and increase access. Interestingly enough these Health Stores were based on the business concept of franchising. Franchising the stores enabled the costs of products to be much lower because of higher volume and distribution. These are just a few of the many benefits the Health Stores brought to the country. Maybe a concept like this could be useful in India for those patients who do not need surgical attention but rather just basic medical attention. It might help reduce the problem of overcrowded hospitals. I know India is far better off medically than Kenya but just the basic concept is interesting.
12. Michael Minasian | March 10th, 2010 at 10:15 am
The reason that healthcare and insurance costs are so high is because of these extremely high cost “critical” procedures. When you have a collective, which is how American insurance companies operate, a relatively healthy person is paying premiums to cover the person who has to have triple bypass surgery at a moments notice. A doctor who covers basic health needs at a cheap rate regardless of circumstance should be praised, but it is by no means a solution to any problem that we have. Certainly something can be learned from the efficiencies which he has uncovered.
13. Frederick Peemoeller | March 12th, 2010 at 5:58 pm
Yes, the health care system is extremely inefficient, but is that really the only problem? i think the bigger issue is that when you go to the hospital and only are seen for 10 minutes to take three x-rays, the bill is over 400 dollars. Some of that money goes to the greed of medical suppliers, hospitals, doctors, and nurses, but a lot of that money is to pay against malpractice insurance. If Dr Shetty was in the states performing the same line of work, he would be bankrupt within the first six months because of all the people trying to sue him. The legal ramifications of a misdiagnoses in America are extreme, and, with the help of inefficiencies and greed, our healthcare system is self destructing.
14. Chase Janvrin | March 15th, 2010 at 4:25 pm
I think Michael Harroch makes an excellent point. Something as complex as a country’s health care system doesn’t simply have a plug and play solution. Not to suggest that we don’t need health care reform in the U.S., it’s just that taking a model that works in a different country won’t necessarily work in this one. While personally I’m for a national health care OPTION, I’m not for fully socialized health care. And as Michael pointed out, I don’t think it would work here anyway. That said, I think that one of the great benefits of living in a developed country is access to health care when needed. I applaud Dr. Shetty’s work, and think that U.S. doctors could probably learn a lot from his efforts. I think there are a great many doctors around the world and in the States that do significant amounts of pro-bono work, and it’s a shame they don’t all get the recognition they deserve.
15. Chris Phippen | March 19th, 2010 at 1:02 pm
I think Fred is right on. This is obviously a very complex situation with so many issues to discuss, but I would focus on the cost. There is no logical way, in my mind, that 10 minutes can cost $400 or a month long stay in the hospital can actually cost anywhere close to a million dollars. Or at least it shouldn’t be so. I agree that the price of malpractice insurance is probably immense, due to the sue-happy mentality of the American public. There should be some legislation in place to protect physicians from lawsuits for outrageously large sums of money for things like “emotional distress”.
I think Dr. Shetty’s efforts and those of doctors like him should be applauded and made more public. The American health care system could definitely benefit from taking a look at that of other countries.
16. Yuxiang Gao | March 19th, 2010 at 8:08 pm
I agree with Emily’s points. Speaking of the health care in the USA , I really had very bad experience of it. I had some blister on my face, I went to see a doctor, waited in the room for half an hour, after many tests, the doctor give me $200 bill and $480 prescription. Instead of buying the medicine, I called my mother tell her the situation ( my mother is a doctor), she asked me to drink more water and that’s all. 2 days later, i turned to fine.
The main issue for US health care system right now is the waste. Money is wasted everyday on unnecessary testing,But I also agree with Michael Harroch, It is very tricky to compare how the public and private sectors affect the health care system in different countries. medication, and visits to the doctor. So it is interesting to see what the developing countries can learn from the lessons the developed countries took.
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