”  ………In my neighbourhood, there is a speciality hospital which aspires to give every woman who can afford it the Liz Hurley moment while delivering her baby. Apart from state-of-the-art operating theatres, medical equipment, highly qualified doctors, a neo-natal emergency transport service, an all in one labour-delivery-recovery room (called a birthing suite), and a 24-hour pharmacy, it also boasts of retail outlets within its premises where one can shop for maternity clothing, baby care accessories and assorted baby thingummies like personalised name tiles mounted on a wooden base, which you can put in your baby’s room. Other attractions include a coffee shop with a multi-cuisine menu and customised artisan chocolates to celebrate the “Baby Shower”. If this sounds like the big, fat, Indian birthing fantasy, the effect is wholly intended  ………………….”

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One thought on “The big, fat, Indian birthing fantasy

  1. Dear Ms Chatterjee,

    I read your piece The Harsh Truth about Healthcare (7th April 2010) with interest. You’re absolutely right in mentioning that “very few are seeking to tap the bottom of the pyramid.” Dr. Devi Shetty is an honourable exception. In fact, Dr. Shetty has created a healthcare model that is worthy of emulation the world over, including the advanced west. I have studied his hospital model in fair detail and thought I could share my observations with you.

    Nararaya Hrudayalaya (NH) model is fairly simple as a concept based on commonsense economics that often eludes star ivory tower economists. It leverages number that sets off a chain reaction: lower input costs of consumables (40% of cost) through volume discount; optimal utilization of equipment and facilities thereby pushing cost down; more number granting greater expertise to doctors/technicians/para-medics/nurses making cost head south. Quality healthcare is therefore no more a mirage and a chimera for the poor. Result: Dr. Shetty has rewritten the healthcare grammar; he is the creator of a new “healthy” paradigm – he is, in short, an altruist multiplier.

    “India will become the first country in the world to dissociate healthcare from affluence,” Dr. Shetty says. Healthcare, unlike other goods and services, is a high-octane beast. Drugs and disposables take up 40% of the revenue that’s generated. The other fixed costs are salary and overheads. The break-even point is fairly high. However, volume equips one with power to source disposables. Wal-Mart model is the one to follow in terms of scalability and philosophy: to drive cost down on a day-to-day basis. India’s population – both of patients and skilled human potential – provides a unique competitive advantage. The vast untapped pool of patients hitherto not in the treatment window can be leveraged for achieving economy of scale. This is where the government can step in – not as healthcare service provider, but as health insurance provider.

    All that the government needs to do is encourage creation of large private hospitals that can leverage numbers and provide quality healthcare delivery system aided by government-sponsored health insurance cover. The mass insurance will drive the insurance premium down. More-less duality is the mantra. More people insured means less insurance premium; more patients mean more honing of skills; more skills mean less time spent on procedures; less time spent means less labour cost/overhead; more patients mean more exploitation of available facilities; more patients mean more use of disposables and volume discount aiding less cost of consumables; less labour/material and more exploitation of fixed assets mean less overall expenses; less overall expenses mean less insurance payment; less insurance payment means less premium charged; less premium charged mean less governmental liability. The syllogistic cycle of medical cost heads only one way – south.

    I will seek your indulgence to go personal here to buttress the viability of this model based on my personal experience of having spent 34 days in that hospital for treatment when I had to undergo two back-to-back surgeries. During the period of my convalescence, one day, out of curiosity, I was glancing at my 23-page hospital bill, all expenses quoted to the minutest detail. The IV Cannula used copiously on me during and after my surgeries was charged Rs 29.06 – at one-third the retail price of Rs 90.

    I stumbled upon an item called Bair Hugger (Adult) Blanket quoted twice. I couldn’t understand its import. On my next visit, I asked Dr. Vikram Belliappa, my Gastro-surgeon, about it. He explained that in top-flight hospitals world over these blankets are used to wrap the patients with during the course of surgery to ward off hypothermia caused when the body is cut open for the procedures.

    “Do you use it for all patients – including the ones who’re treated for free?” I asked facetiously, curious to know if there were any differences in service standards.

    “Oh yes,” he said, so casually as though I had blasphemed, “our SOP can’t be breached in the case of any patients, paid or free.”

    For the patient, Narayana Hrudayalaya is a hospital like no other. The obvious differentiator is the patient care and unfailing courtesies of doctors, para-medics, nurses and almost everyone the patient and his relatives came in contact with; the not-so-obvious is the cost and the discount on consumables passed on to the patient. These differentiators grant the hospital (even the model) a competitive advantage over all others; everything is taken care of in a kind of cookbook algorithm.

    The answer lies in what Dr. Shetty calls the “Wal-Mart approach to healthcare” where size is king and he who has the size calls the tune! This indeed is socialized medicine on capitalist model.

    With regards,

    Yours sincerely,

    Sudhansu Mohanty

    280-A Lower Agram Road,

    Agram Post,

    Bangalore 560 007

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