Indian heart surgeon's bypass surgery just $1,500 in effort to expand care
MUMBAI -- Devi Shetty is obsessed with making heart surgery affordable for millions of Indians. On his office desk are photographs of two of his heroes: Mother Teresa and Mahatma Gandhi.
Shetty is not a public health official motivated by charity. He's a heart surgeon turned businessman who has started a chain of 21 medical centers in India. By trimming costs with such measures as buying cheaper scrubs and spurning air- conditioning, he has cut the price of artery-clearing coronary bypass surgery to 95,000 rupees ($1,583), half of what it was 20 years ago, and he wants to get the price down to $800 within a decade. The same procedure costs $106,385 at Ohio's Cleveland Clinic, according to data from the U.S. Centers for Medicare & Medicaid Services.
“It shows that costs can be substantially contained,” said Srinath Reddy, president of the Geneva-based World Heart Federation, of Shetty's approach. “It's possible to deliver very high quality cardiac care at a relatively low cost.”
Medical experts like Reddy are watching closely, eager to see whether Shetty's driven cost-cutting can point the way for hospitals to boost revenue on a wider scale by making life- saving heart operations more accessible to potentially millions of people in India and other developing countries.
“The current price of everything that you see in health care is predominantly opportunistic pricing and the outcome of inefficiency,” Shetty, 60, said.
Cutting costs is especially vital in India, where more than two-thirds of the population lives on less than $2 a day, and 86 percent of health care is paid out of pocket by individuals. A recent study by the Public Health Foundation of India and the London School of Hygiene & Tropical Medicine found that in India non-communicable ailments such as heart disease are now more common among the poor than the rich.
One in four people there die of a heart attack and per- capita health spending is less than $60 a year. Yet the country performs only 100,000 to 120,000 heart surgeries each year, well short of the 2 million Shetty estimates are needed. The mortality rate from coronary artery disease among South Asians is two to three times higher than that of Caucasians, according to a study published in 2008 in the journal Vascular Health and Risk Management.
“There has been fast urbanization in India that's brought with it a change in dietary patterns and lifestyle,” said Usha Shrivastava, head of public health at the National Diabetes, Obesity and Cholesterol Foundation. “It's leading to this huge jump in cardiovascular disease.”
The average age for a first heart attack in India, Pakistan and other South Asian nations was 53 years, compared with 58.8 years in countries outside the region, according to a study published in 2007 in the Journal of the American Medical Association.
The biggest impediment for heart surgery in India is accessibility. Shetty aims to bridge that by building hospitals outside India's main cities. He said he plans to add 30,000 beds over the next decade to the 6,000 the hospital chain has currently, and has identified 100 towns with populations of 500,000 to 1 million that have no heart hospital.
A 300-bed, pre-fabricated, single-story hospital in the city of Mysore cost $6 million and took six months for construction company Larsen & Toubro Ltd. to build, Shetty said. Only the hospital's operating theaters and intensive-care units are air-conditioned, to reduce energy costs.
One of the ways in which Shetty is able to keep his prices low is by cutting out unnecessary pre-op testing, he said.
Urine samples that were once routine before surgery were eliminated when it was found that only a handful of cases tested positive for harmful bacteria. The chain uses web-based computer software to run logistics, rather than licensing or building expensive new systems for each hospital.
When Shetty couldn't convince a European manufacturer to bring down the price of its disposable surgical gowns and drapes to a level affordable for his hospitals, he convinced a group of young entrepreneurs in Bangalore to make them so he could buy them 60 percent cheaper.
In the future, Shetty sees costs coming down further as more Asian electronics companies enter the market for CT scanners, MRIs and catheterization labs -- bringing down prices. As India trains more diploma holders in specialties such as anesthesiology, gynecology, ophthalmology and radiology, Narayana will be able to hire from a larger, less expensive talent pool.
One positive unforeseen outcome may be that many of the cost-saving approaches could be duplicated in developed economies, especially in the U.S. under health reform.
“Global health-care costs are rising rapidly and as countries move toward universal health coverage, they will have to face the challenge of providing health care at a fairly affordable cost,” said the World Heart Federation's Reddy, a New Delhi-based cardiologist who is also president of the Public Health Foundation of India.
Show commenting policy
TribLive commenting policy
You are solely responsible for your comments and by using TribLive.com you agree to our Terms of Service.
We moderate comments. Our goal is to provide substantive commentary for a general readership. By screening submissions, we provide a space where readers can share intelligent and informed commentary that enhances the quality of our news and information.
While most comments will be posted if they are on-topic and not abusive, moderating decisions are subjective. We will make them as carefully and consistently as we can. Because of the volume of reader comments, we cannot review individual moderation decisions with readers.
We value thoughtful comments representing a range of views that make their point quickly and politely. We make an effort to protect discussions from repeated comments either by the same reader or different readers.
We follow the same standards for taste as the daily newspaper. A few things we won't tolerate: personal attacks, obscenity, vulgarity, profanity (including expletives and letters followed by dashes), commercial promotion, impersonations, incoherence, proselytizing and SHOUTING. Don't include URLs to Web sites.
We do not edit comments. They are either approved or deleted. We reserve the right to edit a comment that is quoted or excerpted in an article. In this case, we may fix spelling and punctuation.
We welcome strong opinions and criticism of our work, but we don't want comments to become bogged down with discussions of our policies and we will moderate accordingly.
We appreciate it when readers and people quoted in articles or blog posts point out errors of fact or emphasis and will investigate all assertions. But these suggestions should be sent via e-mail. To avoid distracting other readers, we won't publish comments that suggest a correction. Instead, corrections will be made in a blog post or in an article.
- Kennametal profits drop more than half in fiscal fourth quarter
- Post-Gazette offers voluntary buyouts in bid to avoid layoffs
- Range Resources cuts workforce 11%
- GNC sales, profits slip in second quarter
- U.S. Steel CEO expects rebound
- Plastics propel Bayer’s 2Q earnings
- PPG puts brand 1st in strategy to reach commercial paint market
- Muni bond funds stressed
- EPA ordered to ease limits on cross-border air pollution that involves Pennsylvania
- Voice-assisted technology raises privacy concerns
- United Airlines hack coincided with incursion into government employee data