1. Heart Surgery for $800
Dr. Devi Prasad Shetty (MS, FRCS-England)
Chairman
Narayana Hrudayalaya Group Of Hospitals, India
1

2. In a span of just 10 years, NH has expanded its operations to 11 cities comprising 14 hospitals
with 5000 beds
Jaipur
Ahmedabad
Kolkata
Jamshedpur
Raipur
Hyderabad
Dharwad
Kolar
Shimoga
NH Cardiac
MSRNH
Bangalore MSCC
CNH
Sparsh
Whitefield
Nethralaya
Mysore
2

3. Economy of the 21st
century will be driven
by the health care
industry.
3

4. Job creation for economic growth and
social stability.
•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.
4

5. • 75% of the fortune, 50 companies are in
health care, directly or indirectly.
5

6. India will become the
first country in the
world to disassociate
health care from
affluence.
6

7. • 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

8. Of course by default!
8

9. • 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

10. India does only about 90,000
a year
10

11. 100 years after the first heart surgery
less than 10% of the world’s population
can afford it.
11

12. Global crisis in health
care
• Tax payers’ money can't pay for it any more.
12

13. Yeshaswini Micro Health Insurance
Poor people in isolation are weak, but together are
strong
1.7 million farmers, members of co-op societies
11 cents per month
Government as a reinsurer
Yeshaswini trust manages the scheme
13

14. 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

15. Governments will
become health
insurance providers
• Rajeev Arogyasree of Andhrapradesh.
• Kalignar insurance of Tamilnadu.
• Vajapayee Arogyasree of Karnataka.
15

16. Politicians across the
world do the right
things for the wrong
reasons.
16

17. 750 million Indians pay about
Rs 150 / month just to speak on
the mobile phone.
17

18. • 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

19. Narayana Hrudayalaya Health City
19

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21. 21

22. 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

23. Telemedicine with ISRO
53000 patients have
had tele-consultations
free of cost
23

24. 24

25. 300 bed low cost heart hospital for $6 million,6 months by L&T
Only way to reach 30000 beds
25

26. Dialysis for $ 10
26

27. Daily P&L statement
27

28. Charity is not scalable.
28

29. Also largest employer of WOMEN.
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30. 30

31. We fly a 30 year old plane and
junk a 7 year old CT scanner.
31

32. 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

33. Why India has high
MMR, IMR
• We produce 28 million babies a year.
• India runs a MBBS DOCTOR centric health
care.
33

34. 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

35. Global Trends in Supply and Demand
U.S. DEPARTMENT OF LABOR
BUREAU OF LABOR STATISTICS
TABLE 2. FASTEST GROWING OCCUPATIONS, 2004-14
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
15 of the 20 fastest growing occupations in the USA are in Health Care
35

36. It's the insecurities of professional bodies
which perpetuates shortages
36

37. 37

38. 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

39. 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

40. 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

41. Cost of health care will not get reduced
in US and Europe unless Asia and
Africa become a health care market.
41

42. Why are mobile phones so cheap in
USA and Europe?
42

43. 750 million Indians keep buying mobile
phones
43

44. 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

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46. Harvard Business
School
“Cardiac Care for the Poor”
46

47. THE WALL STREET JOURNAL - THE HENRY FORD OF HEART SURGERY
47

48. 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

49. 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

50. 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

51. 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

52. 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

53. NCUMC
Artist’s impression
Thank you
53

54. By 2020 India becomes a Superpower
But this will still 54 our customer
be