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In pursuit of the $800 heart surgery

By Mallika Kapur, CNN and Catriona Davies for CNN
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Revolutionizing health care in India
  • Dr. Devi Shetty wants to reduce cost of surgery with economies of scale
  • At his 1,000-bed hospital in Bangalore, 35 heart surgeries are performed a day
  • 40% of Shetty's patients pay premium prices to subsidize treatment for poor
  • To make a real difference, health cities would have to be repeated on much larger scale, skeptics say

Bangalore, India (CNN) -- Dr. Devi Shetty is a prominent heart surgeon with big plans to revolutionize Indian health care.

In a country of nearly 1.2 billion, where only a tiny minority have access to top-quality hospitals, Shetty wants to bring down the cost of surgery through economies of scale.

Shetty, who was Mother Teresa's physician, has opened a 1,000-bed hospital in Bangalore, one of several "health cities" made up of specialist clinics in India's major cities.

By driving up numbers of patients, he has reduced the cost of heart surgery to $2,000 on average, a fraction of the cost in other countries; a complicated procedure in the United States can cost as much as $100,000.

It's nothing but economies of scale.
--Dr. Devi Shetty, heart surgeon

Shetty says he charges premium prices to 40% of his patients who can afford it, in order to subsidize the same treatment for those who can't.

Shetty said: "One hundred years after the first heart surgery, less than 8% of the world's population can afford heart surgery. This is ridiculous. Something has to be done."

He added: "It's nothing but economies of scale. Traditionally, hospitals all over the world do two or three heart surgeries in a day. We do 35 heart surgeries in a day. As you keep doing more operations, your results get better."

Shetty said his aim is to reduce the cost of heart surgery to $800 per person. "It will happen. It will happen in a very short duration of time," he said.

However, the numbers currently being treated in specialist clinics are just a "drop in the ocean," given the millions of Indians with little or no access to health care, according to Gulrez Shah Azhar, a senior lecturer at the Indian Institute of Public Health in Gandhinagar.

He said health cities were in the most part "ivory towers," treating only the wealthiest Indians and foreign medical tourists.

Azhar said: "Even someone like me couldn't imagine getting treatment in a health city because I don't have that kind of money."

He added that 80% of Indian health care is in the private sector, but less than 1% of the population could afford to pay for a stay in a private hospital.

Azhar said: "The cost of health care is one of the biggest reasons people fall into poverty. If they need access to a hospital, people will mortgage their property and take a taxi 150 kilometers to the nearest hospital. One night in hospital might cost a month's salary."

He added: "Expenditure by the Indian government is one of the lowest in the world, less than 1% of GDP. The government says it has a target to increase spending to 3% but it has yet to be fulfilled.

It's a very good idea, but it's not mainstream considering the size of the country.
--Gulrez Shah Azhar, Indian Institute of Public Health
  • India
  • Healthcare Issues
  • Surgery

"We are at a crucial stage where we have to decide whether to establish a health insurance system like the United States or invest heavily in a public system like the UK."

The UK spends more than 7% of GDP on its public health care system, according to its government.

Azhar praised Shetty's approach to keeping costs low, but said it would have to be repeated on a "grand scale" to make a significant difference.

"It's a very good idea, but it's not mainstream considering the size of the country," he said.

One of Shetty's patients is 2-year-old Shyla, the daughter of a poor farmer who brought her 500 kilometers by bus to Bangalore for open heart surgery.

Her father said: "I earn $40 a month. There's no way I could have paid for this myself."

Shetty finds an analogy in economics to support his philosophy.

He said: "Today Americans buy a cell phone without paying for it. How did it happen?

"Because 750 million Indians bought the mobile phone and use it. Every Indian, Asian and African should become a consumer for health care. Then when an American pharmaceutical company comes up with a pill to extend life to 100 years, there are enough buyers."

Anwar Zafar Jilani, an Indian doctor working in the UK who studied health care policy at the London School of Economics and the London School of Hygiene and Tropical Medicine, is skeptical about the ability of health cities to widen access to affordable health care.

He said: "The best thing you can say about health cities is they are bringing state-of-the-art healthcare to India for those who can afford it, but they are not increasing access for the poor.

"India's healthcare system remains very divided and unequal."

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