Dr. Devi Prasad Shetty (MS, FRCS-England)

Chairman Narayana Hrudayalaya Group Of Hospitals, India

Heart Surgery for $800

1

In a span of just 10 years, NH has expanded its operations to 11 cities comprising 14 hospitals with 5000 beds

Ahmedabad

Jaipur

Kolkata Jamshedpur

Hyderabad

Kolar

Bangalore

Dharwad

Mysore

Raipur

NH Cardiac MSCC Sparsh

Nethralaya

Shimoga

MSRNH CNH

Whitefield

2

Economy of the 21st century will be driven

by the health care industry.

3

•Jobs for extremely skilled, semi-skilled, and unskilled. •Healthcare and wellness industry is 4.5 Trillion dollars. •US health sector: $ 2.5 trillion. •IT> Health sector. •NHS: England's largest employer.

Job creation for economic growth and

social stability.

4

• 75% of the fortune, 50 companies are in health care, directly or indirectly.

5

India will become the first country in the

world to disassociate health care from

affluence.

6

• We produce the largest number of doctors in the world.

• We produce the largest number of nurses and med technicians in the world.

• Outside the USA we have the largest number of US FDA approved drug manufacturing units.

7

Of course by default!

8

• Indians are genetically 3 times more vulnerable for heart disease than Europeans.

• Younger age.

• We produce 28 million babies a year.

• We produce about 600 to 800 children a day with the heart disease.

• India need 2.5 million heart surgeries a year.

9

India does only about 90,000 a year

10

100 years after the first heart surgery

less than 10% of the world’s population

can afford it.

11

Global crisis in health care

• Tax payers’ money can't pay for it any more.

12

Yeshaswini Micro Health Insurance

1.7 million farmers, members of co-op societies

11 cents per month

Government as a reinsurer

Yeshaswini trust manages the scheme

Poor people in isolation are weak, but together are strong

13

How is it viable with 11 cents???

• Only 0.8% of the random population needs surgeries.

• No fraud - nobody wants surgery even if it is free.

• Pays only for the surgeries (1650 varieties).

• No administrative costs.

• 400 network hospitals with under-utilized OT.

• Medical treatment at discount. 14

Governments will become health

insurance providers • Rajeev Arogyasree of Andhrapradesh.

• Kalignar insurance of Tamilnadu.

• Vajapayee Arogyasree of Karnataka.

15

Politicians across the world do the right

things for the wrong reasons.

16

750 million Indians pay about Rs 150 / month just to speak on

the mobile phone.

17

• World doesn't need another magic pill, fastest scanner or new operation.

• World needs a mechanism to deliver what's already developed to 90% of the deprived population.

18

Narayana Hrudayalaya Health City

19

20

21

Why 5000 bed health cities

• More surgeries, better results, quick discharges.

• More you buy, less you pay.

• Number attracts the talent, and patients.

• Fixed costs get distributed.

• Academic activity builds the succession plan.

22

Telemedicine with ISRO

53000 patients have had tele-consultations free of cost

23

24

300 bed low cost heart hospital for $6 million,6 months by L&T

Only way to reach 30000 beds 25

Dialysis for $ 10

26

Daily P&L statement

27

Charity is not scalable.

28

Also largest employer of WOMEN.

29

30

We fly a 30 year old plane and

junk a 7 year old CT scanner.

31

Problem is not money, it's manpower

• India is short of at least 1 million doctors, 2 million nurses

• WHO estimates global shortage of 4 million health workers.

• Acute shortage of specialists. US>India

• Nephrologists.

32

Why India has high MMR, IMR

• We produce 28 million babies a year.

• India runs a MBBS DOCTOR centric health care.

33

Crisis in nursing • India is short of at least 2 million nurses.

• Admission to nursing schools have come down by 50% in India.

• Nursing is a dead end job with no opportunity for carrier progression in India.

• Nurses are not empowered even to give an injection.

34

Global Trends in Supply and Demand

1 31-1011 Home health aides

2 15-1081 Network systems and data communications analysts

3 31-9092 Medical assistants

4 29-1071 Physician assistants

5 15-1031 Computer software engineers, applications

6 31-2021 Physical therapist assistants

7 29-2021 Dental hygienists

8 15-1032 Computer software engineers, systems software

9 31-9091 Dental assistants

10 39-9021 Personal and home care aides

11 15-1071 Network and computer systems administrators

12 15-1061 Database administrators

13 29-1123 Physical therapists

14 19-4092 Forensic science technicians

15 29-2056 Veterinary technologists and technicians

16 29-2032 Diagnostic medical sonographers

17 31-2022 Physical therapist aides

18 31-2011 Occupational therapist assistants

19 19-1042 Medical scientists, except epidemiologists

20 29-1122 Occupational therapists

U.S. DEPARTMENT OF LABOR BUREAU OF LABOR STATISTICS TABLE 2. FASTEST GROWING OCCUPATIONS, 2004-14

15 of the 20 fastest growing occupations in the USA are in Health Care 35

It's the insecurities of professional bodies which perpetuates shortages

36

37

India needs 500 new medical schools

• If India adds 100 new medical schools a year for the next 5 yrs we will adequate number of doctors by 2025.

• It costs about $40 million to build one medical school.

• Medical education is very expensive.

38

Why is it so expensive to build a medical school in India ?

• Existing large hospitals cannot become teaching institutes.

• A new campus to be created on 25 acres of land with hospital, academic block, hostel, auditorium, playground built according to specifications.

• Only not-for-profits can run educational institutions.

• Teacher retirement age of 60, no part-time teachers recognised.

• Archaic curricula requires 250 teachers for 100 students while GMC requires 40 teachers.

39

Global university for medical, nursing and

paramedical education • Global university to conduct training program across Asia, Africa, middle

east and Latin America.

• Best syllabus from leading universities of USA and Europe.

• Conducts entrance and exit tests.

• Accredits best hospitals across the world for training and periodically monitors the standards.

• Degree recognised globally.

40

Cost of health care will not get reduced

in US and Europe unless Asia and

Africa become a health care market.

41

Why are mobile phones so cheap in USA and Europe?

42

750 million Indians keep buying mobile

phones

43

Intent and policy mismatch • Government spends 1% of GDP on Healthcare. • 80% of the national expenditure on health is borne out of pocket. • 47% of the rural, 37% of the urban population borrow money or sell assets to pay for health care. • Health care costs are the most common cause of rural indebtedness. • Shortage of 3 million beds. •No standard PPP.

44

45

Harvard Business School

“Cardiac Care for the Poor”

46

THE WALL STREET JOURNAL - THE HENRY FORD OF HEART SURGERY

47

Knowledge @ Wharton

“Narayana Hrudayalaya: A Model for

Accessible, Affordable Health Care?”

“Patients at his hospital get cardiac care at a cost lower than any other

hospital in the country and at a fraction of what it would cost elsewhere in the world, a feat

accomplished through what Shetty refers to as "process innovation."”

http://knowledge.wharton.upenn.edu/india/article.cfm?a

rticleid=4493#

48

Forbes

“The World’s Largest Heart Factory”

“Devi Shetty's doctors perform the most heart surgeries in India. He is using that

scale to cut the cost of treatment.”

http://business.in.com/article/beyond-business/the-worlds-largest-heart-factory/1442/1

49

The Guardian, U.K.

“Indian heart surgeon and public health activist Dr Devi Shetty's

Bangalore-based Narayana Hrudayalaya hospital performs

more heart operations a day than Singapore and Malaysia together.

http://www.guardian.co.uk/world/2010/mar/31/india-

health

50

BBC News

“Production Line Heart Surgery”

“A simple business plan, but potentially quite revolutionary.

Could this be a vision of the future for health care, in Britain and around

the world?”

http://www.bbc.co.uk/news/health-10837726

51

NH: Selected recognition

Television media

The Discovery channel & the Australian Broadcasting Corporation have made documentaries on Narayana Hrudayalaya, which have been broadcasted all over the world http://www.youtube.com/watch?v=4r9R8B-p1Ok - Discovery Channel

http://www.youtube.com/watch?v=xsPic6PRCf4 - Australian Broadcasting Corporation

Articles, Case Studies & Books

Forbes Asia Harvard Business School

Reader’s Digest

News Scientist 52

NCUMC

Thank you

Artist’s impression

53

By 2020 India becomes a Superpower

But this will still be our customer 54