As Apollo Hospitals celebrates the 35th anniversary of its founding, the group’s chairman, Prathap C. Reddy, is looking ahead to make the most of the global advances in medical technology rather than choosing to rest on past laurels. In this conversation, Dr. Reddy speaks on the need for increased government spending on health, the right pricing strategies for the soon-to-be-launched Central scheme of Ayushmaan Bharat, and the scope for medical tourism in India.
On the private health-care model
Thirty-five years ago, it [private health care] was never considered as a doable model. It was just the charitable and government sectors that were providing health care. However, India, which did have medical institutions on a par with the best in the world, fell back because of lack of upgradation of infrastructure for over 30 years.
In November 1979, I lost a patient who was only 38 years old. I had referred him to Houston for cardiac surgery and he died because he could not raise $50,000 to go abroad for the procedure. That shattered me. I wondered, how can we bring those facilities to our people, so that they don’t have to pay that price, or keep dying.
At that point, hospitals were not allowed funding from banks. However, after a lot of lobbying, the then Finance Minister, R. Venkataraman, on instructions from Prime Minister Indira Gandhi, gave us an order that allowed us to borrow to set up one hospital — 50% from banks, 50% as a foreign exchange loan. It was later, under Rajiv Gandhi’s premiership, that relaxations came in for hospitals to be funded like any other trade. He also granted tax allowances for health insurance. All this helped us and the industry.
Simultaneously, we need to recognise that the doctor is important, continuous training on the job is essential, in order that he gives the highest calibre of skills to the patient. We have parameters and protocols for patient safety, reduction of morbidity and mortality in place.
Apollo was the first to bring to India international hospital accreditation and certification with Joint Commission International (JCI), and we also helped create the Indian version — the National Accreditation Board for Hospitals and Healthcare Providers. Today, there are 32 hospitals in India with JCI accreditation and 480 NABH-accredited hospitals.
In 2017, the size of the Indian health-care sector was estimated at $160 billion, and is projected to grow to $372 billion by 2023. The hospital sector alone was worth $62 billion in 2017, and is expected to grow to $133 billion by 2023, with the private sector accounting for about 74%. There are around 40-45 million admissions per year in private hospitals in India.
As far as the Apollo group is concerned, we are expanding to Tier 2 cities, and we are now in education, training of doctors, nurses and technicians, the pharma industry, and healthcare insurance too.
On non-communicable diseases
The biggest challenge for India is going to be the imminent explosion of non-communicable diseases (NCDs) — they are going to kill. By 2020, diabetes will raise its ugly head; as of now, China has the highest number of diabetics in the world, but at the rate at which we are going, we are bound to catch up in a few years. We are the cancer capital of the world, the stroke capital, heart disease capital of the world... We don’t need these medals. Young people are collapsing and dying of myocardial infarctions, and the protection that we believed young women had against heart disease seems to be eroding too. Data show that by 2020, NCDs will have disastrous implications, and by 2030, it will be just catastrophic.
There is a World Economic Forum study that says the world will spend $30 trillion by that time  and India’s share of that would be $4.8 trillion. Here, we are battling to raise the health allocation to at least 3% of the GDP from about 1.5%.
But the solution to all of this is early detection and prevention. Cancer, for instance, is no longer a death sentence. I wrote to Prime Minister Narendra Modi, suggesting that in four years it is possible to treat all cases of cervical cancer. Use the Accredited Social Health Activists appointed at each village level to do simple identification [to see] if a woman has cervical cancer and refer her to the Primary Health Centres for therapy.
We are also planning to launch a massive prevention effort, which we will roll out soon.
On the Ayushmaan Bharat scheme which envisages providing government-sponsored health coverage for families across the country based on income criteria
It is a wonderful thing to say the government is giving some protection for you. It is the first attempt by the government to get into a public-private partnership, and we see it as that.
However, what they have promised will require more money than what we are told will be sanctioned. We don’t know, they may allot much more money during the launch and we may be happily surprised.
My concern here is the possibility that standards may go down. There is a particular price point below which whatever interventions you provide, the possibility of losing lives is high.
In the U.S., it used to cost $50,000 for a cardiac surgery. We have now brought it down to $4,000, and Narayana Hrudayalaya [Bengaluru] has brought it down to $3,000. One reason for this is that we do a large number of beating heart surgeries (about 98%) which cost less, and where the recovery is much faster for the patient.
I don’t think we can look at the business side of it if they pay only, say, ₹90,000 for a cardiac surgery. Where do I cut costs? Our results [for cardiac surgery] are on a par with the Cleveland Clinic in the U.S. In fact, for two years running, our Hyderabad hospital had a 100% success rate for coronary bypass surgeries.
We will do some of these surgeries, of course [under Ayushmaan Bharat]. We have an obligation to do some in Delhi. Even here, we’ll do a certain percentage for genuinely poor people.
On price control for coronary stents
Last year the government slashed the rates of coronary stents by a huge percentage. This year, it revised marginally the cap rates for some types of stents.
The government should have given patients some options, even as they reduced the price of stents to give more patients access to them. This has removed the choice that the patient and the doctor used to have, in picking what they think is best, particularly when affordability is not a factor. If a patient has a block and wants us to put in the best stent available in the world, then we should give him that choice. Beyond that, with the depreciation of the rupee, importing stents is hardly viable, with this policy.
On medical tourism
Apollo brought the first medical value traveller to India. Today, over 3.5 lakh persons from over 150 countries visit India every year for treatment. [Data presented in the Lok Sabha earlier this year indicated that the Ministry of Tourism’s estimate was 4.27 lakh people in 2017.] People now know that in India they can get the best quality of care at a mere fraction of the cost they have to pay abroad.
But just as things were going wonderfully well, the government hiked the medical visa fee for patients and attenders. Also, while patients could come in on a tourist visa earlier, they need a valid medical visa to seek treatment in India now. On the other hand, countries such as Singapore, Thailand and Malaysia, more recently even Korea, are trying to woo patients with easy entry formalities.
On the Arumugasamy Commission constituted to conduct an inquiry into former Tamil Nadu Chief Minister Jayalalithaa’s death
It is very clear that we did the very best for the person, not only because she was the Chief Minister, but also because she was very sick. Frankly, during the first 48 hours, we thought her chances were zero. But then she improved and we were able to control the infection. However, she developed a simultaneous heart valve issue, along with respiratory distress. She was not in a position to have surgeries and had several co-morbidities, including diabetes and hypertension.
She had a cardiac arrest in front of the doctor, who did everything immediately to bring her back. Even on the ECMO [to support the heart and lungs], she did not come back. We are competent, and every kind of expert was there at hand to assist in treatment.
On technology in healthcare
Technology has done a lot for healthcare; it has a significant role in the advancements in treating patients. We are currently working on a product that will provide an artificial intelligence-driven clinical protocol to bring out the best outcomes in a patient and make predictions based on clinical inputs fed into it.
As a hospital we have also striven to get the latest technology, sometimes as pioneers. We order products that will be state-of-the-art not when we sign the contract but will be the latest in the market on the day of installation. We are fortunate to have been able to stay with the best in the trade for so long. Our Proton Centre, that will be inaugurated in Chennai at the end of the year, will be one such modern station for treatment of cancers.
Top three requests for Prime Minister Modi
Primarily, take action before the huge tsunami of non-communicable diseases destroys our families and our youth. Look at both prevention and treatment options for all NCDs.
Secondly, provide adequate protection for doctors. Doctors want to do the best for the patient, but sometimes they are in the position of making crucial decisions when the patient is critically ill. If the patient does not make it, then people rampage through hospitals. Protect doctors, and hospitals — treat destruction of hospital property as a non-bailable offence.
Finally, the demand-supply gap in healthcare is still huge; the government should encourage people to establish new infrastructure. We need new hospital beds; now, for instance, we have 1.1 beds per 1,000 people, while the global average is 2.7 and the WHO recommendation is 3.5. We need to work towards increasing that, and increasing the doctor-patient ratio as well.