Asia India

Healthcare for All: Narayana

Hrudayalaya, Bangalore
Prepared by Prabakar Kothandaraman & Sunita Mookerjee
(India)
Sector: Health
Enterprise Class: Local SME
Summary
In a nation of over one billion, healthcare is yet to be recognized as a fundamental right for
Indias citizens. Large sections of Indian society are unable to meet healthcare costs and are
denied even the most basic of healthcare. Health insurance, especially for the poor, is non-
existent and healthcare quality is sub-standard. Public health expenditures amount to only
0.9% of the GDP, while private healthcare expenditures add up to 4.2%. A doctor with a
mission who believed that a countrys poor needs to become healthy if the nation is to
become wealthy managed to light a fire in the minds of those that wanted to serve the market
for products and services for the lowest sections of the society. Dr. Devi Shetty, FRCS
(London)1 founded Narayana Hrudayalaya (NH), a cardiac hospital on the outskirts of the
southern Indian city of Bangalore in 2001 with a mission that focused fundamentally on
delivering state-of-the-art cardiac care to poor people. NH achieved its mission through a
series of innovations that involved technology, care-giving process, financial instruments and
human resource policies.

Challenges
The incidence of cardiac disease in India is very high. Indians have a particularly higher
genetic risk of heart disease than people of other ethnicities. The Indian sub-continent
accounts for nearly 45% of the worlds rate of coronary heart diseases.
Despite these indicators, only very few can afford the price of a heart operation that could
range from US$1,500 to $6,000 given that close to 34% of the population in India survive
on less than US$1 per day. Therefore, NH focused on solving the problem of making
cardiac care affordable for the poor.
Other challenges include the accessibility and quality of healthcare. In detecting heart
ailments, the first line of diagnosis involving primary healthcare givers is crucial.
However, several of the Indian primary care centers were short on either staff or
equipments or both. Access to diagnostics was extremely limited. Costs of pursuing
secondary diagnostics away from home villages were very expensive. This restricted
quality of healthcare available to the patient as proper operating room (OR) facilities and
qualified medical professionals necessary to deliver quality cardiac care were not
available for the poor. Finally, poor people could not afford to pay top dollar for cardiac
care.

Innovations
The chief innovation behind the NH solution to the poor was what Dr. Shetty termed the
wal-martization of healthcare.2 It was based on the simple premise that, just like retailing
products, retailing healthcare in India can use population as a strength to drive down costs
and establish unimaginable scale.

1
Fellow of the Royal College of Surgery (London)
2
Viswanathan, Vidya (2005), Heart Care for Everyone, Civil Society, Vol. 3, No.3, December.

Case Study Healthcare for All: Narayana Hrudayalaya, Bangalore 2

 A combination of empowered satellite rural healthcare centers and state-of-the-art
communication and software technologies were used in multiple ways to improve access.
The remote healthcare centers did the initial screening and counseling, while satellite
communication technology provided access to consultants located several thousand miles
away.
NHs innovation in providing healthcare insurance at US$11 cents per month empowered
its poor patients and enhanced their ability to pay. NH also offered low-cost insurance
schemes, in partnership with government and foundations. Also, NH focused on upstream
innovation for producing technical staff to control its service quality.
Dr. Shetty managed to put together a team of highly motivated surgeons that focused only
on giving care and serving NHs mission. People want to be like Mother Teresa; they
just need to be channeled into the right environment, observed Dr. Shetty.

Positive Outcomes for the Poor

Between 2001 and May 2007, NH performed over 23,000 surgeries and 34,000
catheterization procedures. The hospital subsidized poor patients to the tune of US$2.5
million that benefited close to half of all the patients that came to NH for treatment
because they could not afford to pay their full cost.
The hospitals focus on children was highlighted by the fact that over 40% of its cases
were in the pediatric category and that enabled it to claim to be the largest cardiac care
facility for children in the world.

Challenges for the Future & Replication

Dr. Shetty was worried about the availability of qualified people to expand the facilities
beyond his current health city project that, when completed in 2008, would have 5,000 beds
serving specialties such as orthopedics, oncology, and eye care along with the core cardiac
care. The success of the health insurance scheme that NH developed for the poor had
prompted several other state governments that want to replicate it in their states. Some of
them also want NH to build cardiac hospitals in their states, as well. The telemedicine
coverage was expanding further, and more locations were likely to be added, which may put
more pressure on NHs resources.

Case Study Healthcare for All: Narayana Hrudayalaya, Bangalore 3