Dr Devi Shetty - Indian heart surgeon HARDtalk

Those are the headlines on BBC News. It is time for HARDtalk.

My guest today is a brilliant heart surgeon, a veteran of more than

30,000 operations. His growing international reputation rests less

on his medical skills and more on his business brain. He wants to do

for major surgery what Henry Ford did for the motor car. Make it

affordable for the masses by mass production. He is building medical

he is vision really change healthcare around the world? -- his

vision. Devi Shetty, welcome to HARDtalk.

Thank you. Delighted to be here. you see yourself first and foremost

as a doctor or a businessman? Always a doctor. Always a heart

surgeon. Never a businessman. spend a huge amount of your time

doing deals, travelling the world, negotiating contracts. Not actually

in the operating theatre. I see about 60-At Heart patients a day. I

do 2-3 heart surgery is a day. -- 60-80. Because of your business and

desire to expand, how much time do you spend away from your day job in

the operating theatre? I guess I travel once or twice a month. Most

of the time I am in the hospital. I do see patients in other parts of

the country with a video conferences. At the disobeyed in

various lectures... -- participate. I want to take you back how you got

into the business of healthcare. When did you first decide, you know

what, I am not entirely satisfied by the surgery I am doing, I want

to go further? I used to work at a hospital in London as a heart

surgeon. I started my career in Calcutta. I used to see 60-100

patients predate. At the end of the day, no patient could come for the

surgery because they could not afford it. That is not a solution.

That was the time we decided we had to do something to reduce the cost.

You could not deliver enough of a public good, you could not do what

you wanted to do because not enough people could afford the service?

Exactly. Less than 10% of the world's population can afford heart

surgery. Less than 10% of the world's population can afford it.

90% of the world's population are silent bystanders. For a time, you

were giving treatment and acting as a physician to Mother Teresa. Did

that have any impact on new and what a health system should look

like? It had a major impact. Six years with Mother Teresa left

behind a very major impact on everything that we did. She gave us

a simple solution to complex problems. A woman who influenced

you a great deal, a spiritual woman, a woman who devoted her life to the

poor. When you decided to launch you are a business venture in the

healthcare system, it has to be said, the profit motive underpinned

everything you did? Not exactly. First of all, charity... If you are

going to offer free healthcare, there is a limit to watch you can

offer. If you use your business skills and reduce the cost, then

you can offer healthcare to the whole world. When I started my

career in India, heart surgery was costing 150,000 rupees. 20 years

later we brought it down to 60,000 rupees. This transformation did not

happen on its iron. It is a carefully calibrated model that you

use. You have to pour in enough full fee-paying patients to allow

you the economic freedom to give treatment to those who cannot

afford to pay. Yes, we need 40% of the patients to pay regularly. Then

60% can pay less, and some people can do nothing. Does that mean

you're overcharged the people who have the ability to pay? -- you

overcharge. The rich have to pay for the poor. I wonder whether your

clients, the rich, in India today there are a lot of them, are they

satisfied by this? They never pay the premium. They pay the same as

in other hospitals. That is good enough to subsidise the care. It is

about containing the cost. We have a profit and loss account in a

hospital on a daily basis. All of the doctors, every day, we get a

SMS with a profit and loss account. Hang on. This is extraordinary.

Whatever a doctor is doing, he is going to be interrupted at midday

with a financial report on the last 24 hours of activity inside the

business? It seems an extraordinary way of treating your doctors.

the doctors are not given the financial information, there is no

way you can reduce the cost of healthcare. They are the ones,

there are many different ways of treating the problem. The outcomes

are more or less the same. The doctor has the choice to decide

which is the best way. If you do not educate the doctors to

understand the financial implications you can forget about

reducing the cost. It is a fascinating model you are

discussing. In healthcare systems there is a profound debate about

whether doctors themselves should be the ones to make the key

financial decisions. We have it with the NHS at the moment, the

present government arguing doctors should take key financial decisions.

You are saying, the doctors have to be at the centre of financial

management? Exactly. If you have to teach a finance man about medicine,

it may take his whole life. You can take a doctor in a few days.

are compromising the doctor's focus on the care for the patience.

doctor has dual responsibilities. When you asked me what is my doctor,

I describe myself, I put a price tag on human life. Every day I

see... I tell the mother, this charter requires an operation. The

mother asks me, how much is it going to cost? 60,000 rupees. That

is the price tag I put on the child's life. The mother does not

have that money. That is the situation every doctor has to date.

-- take. Here are some downsides to your approach. You have talked

about an economy of scale, industrialisation, the Henry Ford

model, I can understand what you're saying, but I can see major

problems... You treat your surgeon's like shop floor workers.

You want them to do 2-3 operations carried gave. Is that in the best

interests of the doctor or the patient? -- -- per day. We have a

0% attrition among our doctors. We can employ any doctor. That is

because they enjoy working with us. Doctors would like to be in the

operating room from morning to night. They do not want to do

anything else. This is the environment you create. You give

the doctor the freedom to do whatever they want. What about the

notion, those aspects of medicine which clearly offer you opportunity

for scaling up and for profits? Cardiac surgery is an obvious one.

Cancer would be another. It is so prevalent in the modern world.

There must be other rare diseases which cannot be scaled back. We are

in the entire sphere of healthcare. We run healthcare in some very

important regions of our state. you afford to specialise in these

much less profitable aspects of modern medicine? We are not

concerned about... We have one particular state where we have very

poor primary healthcare. We see 40,000-60,000 patients entirely

free. We do not look at making money at every level. All we are

trying to do is keep our nose above water. You have acute hospitals.

You are a pioneering hospital in by -- Bangalore, 1,000 beds to the

cardiac unit. In America the average number of beds would be 160.

Is it really in the patient's interest to have these vast medical

factories? We need to do 2.5 million hard surgeries every year

in my country. All of the heart hospitals in the world put together

account for no less than 90,000 surgeries. If you build large

hospitals you can reduce the cost significantly. The outcomes are

always better than doing less number of operations. Statistically

it has been proved that a large hospital doing a large number of

procedures has much better outcomes then going small numbers of

procedures. A few weeks ago we saw a horrible incident in Calcutta. A

private hospital with a terrible place, 90 people killed. It raised

serious questions about the standards of some privately run

hospitals, as you get larger, we talk about Europe ambitious

expansion plans, are you sure you can maintain the standards you say

you believe in? As we get bigger, it becomes relatively easier to

maintain standards. I will give an example... It is harder to know

what is going on in every single hospital that you control. We have

an information system. Any employee or patient, anyone who has an

unpleasant experience, they press a speed dial number and it goes to

the patient's complaint system. When you have large numbers you can

put in investigative systems. talk about how far your ambition

can go. You have implied to me that you believe what you have developed

here is a model which has application across India and

perhaps across the developing and developed world as well. I just

wonder, whether you're ambition is rarely matched by reality? You have

talked about the challenges in India. Poverty is still a huge

phenomenon across the country. Hundreds of millions of people

living on $2 a day or less. One- fifth of all the children in the

world who died under five years-old die in India. Isn't that a much

larger problem than developing sophisticated heart and cancer

It is a relatively easy problem to be solved. We produce the largest

number of doctors, nurses and medical technicians in the world.

We started of with about 1.7 million families on health

insurance. Today we have 4 million families. They pay just 22 per

month. We gradually increase the premium. 4 million farmers just pay

22 per month and they can have a heart operation, brain operation,

cancer operation. In some ways for you as an articulate and

influential voice within Indian healthcare you might want to focus

more of your efforts on conquering the basic problem of poverty and

malnutrition rather than sophisticated hospitals with

amazing surgical ability. I would like you to understand that the

economy of the 21st century could be driven by the healthcare

industry. It is 4.5 trillion dollars. US healthcare alone is 2.5

trillion dollars. This will drive the world economy. If you invest in

healthcare you will make countries healthy and wealthy. You speak as a

private operator. I come back to this word, profit. We do not be

better if the Indian state were delivering? At the moment the

Indian state is not doing it. Maybe you should be pressuring it.

state can provide healthcare with the taxpayer's money. Taxpayer's

money cannot offer healthcare in every part of the world. Forget

about the developing world. When people retire at the age of 60 and

they die at the age of 65, that was the 20th century. This is an

ideology for you. You do not believe in state delivered

healthcare, whether in the United Kingdom or India. You do not

believe the model can work. cannot. The cost of healthcare is

to hire. -- too high. We are trying to convince the government...

not a tiny amount of money. For a farmer, 22 per month could be a lot.

Millions cannot afford it. For many it costs more than 22 cents to

smoke. There are 750 million Indians speaking on the mobile

phone. If we spend that on the healthcare system, we would have

the best in the world. Why is it, that if his private model works so

well, in the United States you see if millions of citizens who cannot

afford private health insurance? Many Americans listening to you

extolling the virtues of private healthcare are scratching their

heads and say it does not work in the richest country on earth.

cost of healthcare and doing anything on the human body is the

highest in the United States. You just cross the border and go to

Canada. The Canadian government pays a huge amount of money to

maintain its healthcare system. I am trying to say is that across

the world there is a serious problem with delivering healthcare.

This is the only industry where 70% of the cost goes to the salaries.

Ask any businessmen at, or any other industry, where 75% of funds

Goto salaries, no business would be sustained. There is something

seriously wrong. In England, the US and Asia. We need to take control

of the situation. This is a disaster waiting to happen. Nobody

questions it because people have no money. To answer the problem, you

have to realise that there is a shortage of manpower. Let us

discuss how far you think you can take to model of healthcare. You

want to build a medical cities, as you call them, in different parts

of your own nation. You have an ambition to take that model

overseas. How far can this go? intention is to build hospitals in

India, Asia and Africa. I would like to spend a lot of my time in

Africa. That is one area of which is very close to our heart. We

believe that Africans do not need money, but institutions, trained

doctors and nurses. Then they can take care of themselves. Our

intention is to build a large number of hospitals. I find that

fascinating. Many will find it admirable. If that is your

commitment, Wyatt is so much of your time and effort going into

building a massive hospital complex in the island's? We would like to

show to America that just outside their waters in the Cayman Islands

you can build a hospital and offer healthcare at less than half of

what they haven't the U S. That is explicitly about what people call

medical tourism. You are going to put a hospital offshore from the

United States and are going to appeal to Americans to come to you

for cheaper healthcare than they can get in the US hospital. Exactly.

We are primarily looking at the Caribbean region because in that

region there are no large hospitals. It brings me back to the first

question I asked about whether you are first and foremost a

businessman or a doctor. If you want to push a model into Africa,

why on earth are you spending so much time and money on a project in

the Cayman Islands? We have a large number of willing partners in the

West. They see money to be made. US healthcare is August the profit.

You say you are not about the profit. Why are you mixing with

these people? The people pride Noren with us are running a

prestigious, not for private hospital. -- partnering with us.

Our intention is that we want to stir the first project their and

convince everyone it works. If everything works out find it then

the larger hospital chains in Africa. People watching this will

wonder how quickly you can deliver. You need to train or see a system

which trains a vast number of new doctors. India needs hundreds of

thousands of new doctors. Africa would need them as well. Hill is

going to train them? When I decided to come here today I had meetings

with several policy makers. We desperately require a global system

which would train doctors, nurses and technicians in India, Africa

and Latin American countries. The traditional university system can

never produce a sufficient number of doctors. The UK is one country

which can think about this major transformation because UK

universities are respected all over the world. The government is still

heavily involved in universities. There would have to the Government

that trains the doctors. Exactly. All we need is the curriculum and

the examination system. Everything else can be taken care of in India.

We need a reputation. You are confident thnfident thand kids will

live in India where everyone has access to decent healthcare? Yes.