‘India’s challenge will be fighting non-communicable diseases’

The Apollo Hospitals chairman on the growth of private health care, Jayalalithaa’s illness, and expectations from the Modi government
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. Excerpts:
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. 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.
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.
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.
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.
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.
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.

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