I want to enable every man, woman and child to have access to high-tech healthcare within the next 15 to 20 years, including in the poorest regions of the world. Today, most healthcare interventions are not accessible to nearly 90% of the world’s population. The way forward is not a new medicine or a new scanner or a new operation – it is a process innovation to bring healthcare to everyone.

Most countries suffer from a simple mismatch: the demand for health care is rising faster than the supply of doctors. One approach to making doctors more effective is to focus what they do. This is something that we in India have been dedicated to.

At Narayana Health our focus has been on offering as many operations as possible using the core resource without compromising on quality. Surgeons do the most complex procedures and other medical staff do everything else. In addition, by using the latest technologies such as tablets in the ICU instead of patient charts, simulations to train critical care nurses and telemedicine to access those patients in remote parts of the country, a far higher quality of healthcare is delivered than the global norm.

Alongside our process innovation priority, this means that surgeries in the organisation’s 18 hospitals across 14 Indian cities typically cost between $1600 and $2000 each – less than half that of other Indian hospitals and about one-fiftieth as much as a similar procedure in the US: Two per cent of the cost with outcomes that rival the best in the US.

Equally in other areas of Indian healthcare, similar efficiencies are also being achieved. LifeSpring hospitals have reduced the price of childbirth by augmenting doctors with less expensive midwives: Their costs are about 20% of those in a private clinic. In addition, Aravind Eyecare provides cataract surgery to about 350,000 patients each year for around $50 each: Operating rooms have at least two beds so that surgeons can quickly move from one patient to the next and, for every surgeon, there are six ‘eye-care technicians’ specifically trained by Aravind to perform many of the other tasks in the operating theatre that, in other countries, require a surgeons training.

Japanese companies reinvented the process of making cars. That’s what we are doing in healthcare: What healthcare needs is process innovation, not product innovation. It’s all about numbers. Because we do a large number of operations, our overheads are distributed over a larger number of patients. Equally, because we implant the largest number of heart valves in the world we get heart valves at a lesser price.

Looking ahead, I see that the efficiencies we have achieved through the approaches that we have taken in India can be applied globally. With an aging society and escalating costs, the 20th century model of healthcare still practiced in many countries today is unsustainable and we need to shift the model forward.

In addition, I also see a need to change the world of health insurance. There has to be an alternative way of funding healthcare. 10 years ago we convinced our local government to launch a health insurance programme and convinced 1.7m farmers to contribute 5 INR (8c) per month and the government became the reinsurer. Today the premium has risen to 18 INR (US$0.27) per month. In 10 years, 450,000 famers have had treatment and 60,000 of them have had a heart operation all because of the power of 5 rupees per month. Today we are covering high technology healthcare for nearly 3 million farmers.

Now we are trying to convince policy makers that micro-health insurance is the best model for the whole of society. In India we have 850 mobile phone subscribers who are spending 150 rupees per month just to speak on the phone. So if we can collect 20 rupees from each mobile phone subscriber, we can cover the healthcare of another 850 million people. The Indian government will soon become a health insurance provider. Not only a healthcare provider.

  • Future Agenda

    Some of the IDE RCA/LSE students who attended a
    Future Agenda workshop at the Shard recently focussed on the future of health. They were particularly concerned about the way mental health care is lagging behind physical health and how it carries a social stigma, which makes it difficult for sufferers to ask for help. This was considered particularly ironic given that the millennial generation is more stressed than any other, living as it does in a 24/7, culturally diverse, increasingly urban world. The team wanted to increase awareness of the issue and suggested that the health professionals should learn about how to address and communicate difficult issues from other campaigns including those around climate change. In addition they argued that there was a risk of individuals mis-diagnosing their conditions owing to the vast amount of health information now available and suggested that communication technology would be a good way to support those in need by
    providing an independent but more personalised, informed service, letting individuals know that they are not alone and that others experience similar challenges. They suggested an initiative called “Behind Me, the community based service to release and share difficult feelings such as depression anxiety and stress” which would act as focus for patient need by helping to identify the problem, introducing the patient to others with similar conditions and providing helpful anonymous support and counselling.

    A second team looked at how best to make the most of the vast amount of personal health information that is going to become available over the next 10 years. Despite concerns around privacy and ownership it was generally agreed that the sharing of health information between citizens would be beneficial and would challenge the existing business model which is broadly based on a price and volume which in turn produces solutions for stereotypical conditions rather than a personalised diagnosis.