Innovative thinking in India can bring health care to the uninsured billions

Innovative thinking can bring health care to the uninsured billions, argues Devi Shetty, founder and chairman, Narayana Hrudayalaya Hospitals

More than 100 years after the first heart surgery, less than 10% of the world’s population can afford it. India requires over 2m heart surgeries a year, but all its heart hospitals put together perform operations on fewer than 110,000 people; the rest suffer or perish gradually. It is thought that less than 10% of the world’s population can afford any major intervention on the heart, brain, kidney or joints.

The reason for this calamitous situation? Simply a lack of innovation. Innovation in health care has focused on developing a magic pill, a new vaccine or a faster scanner rather than delivering what is already available.
A different form of innovation is needed in 2013 and beyond. In India my team envisaged a heart hospital with 300 beds in Mysore, and then built it in nine months for just $7m. We are now adding 30,000 beds across the country under the low-cost model.

Innovation in funding is needed too. In the rich world taxpayers’ money could pay for health care when people retired at 60 and died at 65. Today, people retire at 60 and celebrate their 95th birthday. With the rise in life expectancy in emerging economies as well as developed ones (thanks to better living conditions, technology and social-support systems), taxpayers’ money will no longer be enough.

Poor people are weak in isolation but very strong when bound together. They do not mind paying a tiny amount of money every month for health care. Unfortunately, a vehicle does not currently exist for them to do so. The time is ripe for governments across the world to create such a vehicle.

About ten years ago our group came up with the concept of micro-health insurance named Yeshasvini, collecting a premium of 11 cents from 1.7m farmers through a co-operative network. The government of Karnataka state agreed to pay five cents a month as its contribution towards each farmer’s health-insurance premium and offered to be the reinsurer. Yeshasvini was designed to pay only for surgical procedures. Today more than 3m farmers are contributing 22 cents a month and enjoying coverage for surgeries in 400 hospitals across Karnataka. Based on the success of this model, the states of Andhra Pradesh and Tamil Nadu have launched similar schemes.

We will become the first country in the world to dissociate health care from affluence

India’s formal economy employs over 28.7m people. Health insurance covers the employees and their families, a total of more than 50m people: Employees’ State Insurance takes care of all their health-care expenses.

Unfortunately, the informal sector, which employs over 450m people, does not have such coverage. We are in the process of trying to convince policymakers to launch a similar organisation to Yeshasvini which will cover the health-care cost of construction workers, farm labourers, pushcart vendors, housemaids and the rest.

How might this work? India has over 925m mobile-phone subscribers, who spend about 150 rupees ($2.80) a month just to speak on the mobile phone. If every mobile-phone subscriber had to pay 20 rupees a month towards health insurance, the money collected would be two-thirds of the government’s total budget for health care. No additional expense would be incurred to collect the premium because the mechanism for collecting money from subscribers already exists.

Health-insurance premiums from the citizens of every town and city could also be collected through electricity or water bills. The bills reflect the number of residents living in each house and are collected by the government agencies very promptly.

All governments should promote not-for-profit health-insurance agencies. The agencies should have a clear mandate requiring that all the premium they collect be spent on health-care benefits for citizens.

And the poor shall also have health care

When I was a young medical student, our policymakers convinced us that health care was expensive and that it would remain so, but they promised that one day India would become a rich country and everyone would be able to afford it. However, when we grew up we realised that the rich countries are also struggling to offer health care to their citizens. So, India becoming a rich country will not translate into affordable health care for everyone—which means that we have to change the way health care is delivered.

India can make this happen very quickly because we produce the largest number of doctors, nurses and medical technicians in the world. Outside the United States, we have the largest number of US Food and Drug Administration-approved drug-manufacturing units. We have everything going for a phenomenal delivery of health care. The missing link is that our citizens do not have money to pay for it. Once this is addressed by government-sponsored micro-health-insurance schemes, we will become the first country in the world to dissociate health care from affluence.