:00:10. > :00:16.Those are the headlines on BBC News. It is time for HARDtalk.
:00:16. > :00:20.My guest today is a brilliant heart surgeon, a veteran of more than
:00:20. > :00:25.30,000 operations. His growing international reputation rests less
:00:25. > :00:28.on his medical skills and more on his business brain. He wants to do
:00:28. > :00:36.for major surgery what Henry Ford did for the motor car. Make it
:00:36. > :00:46.affordable for the masses by mass production. He is building medical
:00:46. > :00:50.
:00:50. > :01:00.he is vision really change healthcare around the world? -- his
:01:00. > :01:13.
:01:13. > :01:20.vision. Devi Shetty, welcome to HARDtalk.
:01:20. > :01:26.Thank you. Delighted to be here. you see yourself first and foremost
:01:26. > :01:31.as a doctor or a businessman? Always a doctor. Always a heart
:01:31. > :01:37.surgeon. Never a businessman. spend a huge amount of your time
:01:37. > :01:46.doing deals, travelling the world, negotiating contracts. Not actually
:01:46. > :01:55.in the operating theatre. I see about 60-At Heart patients a day. I
:01:55. > :01:59.do 2-3 heart surgery is a day. -- 60-80. Because of your business and
:01:59. > :02:05.desire to expand, how much time do you spend away from your day job in
:02:05. > :02:11.the operating theatre? I guess I travel once or twice a month. Most
:02:11. > :02:16.of the time I am in the hospital. I do see patients in other parts of
:02:16. > :02:26.the country with a video conferences. At the disobeyed in
:02:26. > :02:30.
:02:30. > :02:34.various lectures... -- participate. I want to take you back how you got
:02:34. > :02:39.into the business of healthcare. When did you first decide, you know
:02:39. > :02:48.what, I am not entirely satisfied by the surgery I am doing, I want
:02:48. > :02:55.to go further? I used to work at a hospital in London as a heart
:02:55. > :03:03.surgeon. I started my career in Calcutta. I used to see 60-100
:03:03. > :03:07.patients predate. At the end of the day, no patient could come for the
:03:07. > :03:12.surgery because they could not afford it. That is not a solution.
:03:12. > :03:17.That was the time we decided we had to do something to reduce the cost.
:03:17. > :03:21.You could not deliver enough of a public good, you could not do what
:03:21. > :03:29.you wanted to do because not enough people could afford the service?
:03:29. > :03:37.Exactly. Less than 10% of the world's population can afford heart
:03:37. > :03:47.surgery. Less than 10% of the world's population can afford it.
:03:47. > :03:52.90% of the world's population are silent bystanders. For a time, you
:03:53. > :03:58.were giving treatment and acting as a physician to Mother Teresa. Did
:03:59. > :04:04.that have any impact on new and what a health system should look
:04:04. > :04:10.like? It had a major impact. Six years with Mother Teresa left
:04:10. > :04:15.behind a very major impact on everything that we did. She gave us
:04:15. > :04:20.a simple solution to complex problems. A woman who influenced
:04:20. > :04:25.you a great deal, a spiritual woman, a woman who devoted her life to the
:04:25. > :04:30.poor. When you decided to launch you are a business venture in the
:04:30. > :04:40.healthcare system, it has to be said, the profit motive underpinned
:04:40. > :04:41.
:04:41. > :04:45.everything you did? Not exactly. First of all, charity... If you are
:04:45. > :04:49.going to offer free healthcare, there is a limit to watch you can
:04:49. > :04:53.offer. If you use your business skills and reduce the cost, then
:04:53. > :05:01.you can offer healthcare to the whole world. When I started my
:05:01. > :05:09.career in India, heart surgery was costing 150,000 rupees. 20 years
:05:09. > :05:13.later we brought it down to 60,000 rupees. This transformation did not
:05:13. > :05:22.happen on its iron. It is a carefully calibrated model that you
:05:22. > :05:29.use. You have to pour in enough full fee-paying patients to allow
:05:29. > :05:38.you the economic freedom to give treatment to those who cannot
:05:38. > :05:44.afford to pay. Yes, we need 40% of the patients to pay regularly. Then
:05:45. > :05:53.60% can pay less, and some people can do nothing. Does that mean
:05:53. > :05:59.you're overcharged the people who have the ability to pay? -- you
:05:59. > :06:04.overcharge. The rich have to pay for the poor. I wonder whether your
:06:04. > :06:09.clients, the rich, in India today there are a lot of them, are they
:06:09. > :06:16.satisfied by this? They never pay the premium. They pay the same as
:06:16. > :06:22.in other hospitals. That is good enough to subsidise the care. It is
:06:22. > :06:32.about containing the cost. We have a profit and loss account in a
:06:32. > :06:41.hospital on a daily basis. All of the doctors, every day, we get a
:06:41. > :06:45.SMS with a profit and loss account. Hang on. This is extraordinary.
:06:45. > :06:49.Whatever a doctor is doing, he is going to be interrupted at midday
:06:49. > :06:57.with a financial report on the last 24 hours of activity inside the
:06:57. > :07:01.business? It seems an extraordinary way of treating your doctors.
:07:01. > :07:08.the doctors are not given the financial information, there is no
:07:08. > :07:12.way you can reduce the cost of healthcare. They are the ones,
:07:12. > :07:16.there are many different ways of treating the problem. The outcomes
:07:16. > :07:22.are more or less the same. The doctor has the choice to decide
:07:22. > :07:24.which is the best way. If you do not educate the doctors to
:07:24. > :07:29.understand the financial implications you can forget about
:07:29. > :07:32.reducing the cost. It is a fascinating model you are
:07:32. > :07:36.discussing. In healthcare systems there is a profound debate about
:07:36. > :07:41.whether doctors themselves should be the ones to make the key
:07:41. > :07:51.financial decisions. We have it with the NHS at the moment, the
:07:51. > :07:51.
:07:51. > :07:55.present government arguing doctors should take key financial decisions.
:07:55. > :08:02.You are saying, the doctors have to be at the centre of financial
:08:02. > :08:10.management? Exactly. If you have to teach a finance man about medicine,
:08:10. > :08:19.it may take his whole life. You can take a doctor in a few days.
:08:19. > :08:24.are compromising the doctor's focus on the care for the patience.
:08:24. > :08:34.doctor has dual responsibilities. When you asked me what is my doctor,
:08:34. > :08:34.
:08:34. > :08:39.I describe myself, I put a price tag on human life. Every day I
:08:39. > :08:47.see... I tell the mother, this charter requires an operation. The
:08:47. > :08:51.mother asks me, how much is it going to cost? 60,000 rupees. That
:08:51. > :09:01.is the price tag I put on the child's life. The mother does not
:09:01. > :09:02.
:09:02. > :09:12.have that money. That is the situation every doctor has to date.
:09:12. > :09:15.
:09:15. > :09:21.-- take. Here are some downsides to your approach. You have talked
:09:21. > :09:26.about an economy of scale, industrialisation, the Henry Ford
:09:26. > :09:31.model, I can understand what you're saying, but I can see major
:09:31. > :09:37.problems... You treat your surgeon's like shop floor workers.
:09:38. > :09:47.You want them to do 2-3 operations carried gave. Is that in the best
:09:48. > :09:52.
:09:52. > :09:57.interests of the doctor or the patient? -- -- per day. We have a
:09:58. > :10:07.0% attrition among our doctors. We can employ any doctor. That is
:10:07. > :10:11.because they enjoy working with us. Doctors would like to be in the
:10:11. > :10:15.operating room from morning to night. They do not want to do
:10:15. > :10:20.anything else. This is the environment you create. You give
:10:20. > :10:25.the doctor the freedom to do whatever they want. What about the
:10:25. > :10:35.notion, those aspects of medicine which clearly offer you opportunity
:10:35. > :10:39.for scaling up and for profits? Cardiac surgery is an obvious one.
:10:39. > :10:49.Cancer would be another. It is so prevalent in the modern world.
:10:49. > :10:51.
:10:51. > :10:58.There must be other rare diseases which cannot be scaled back. We are
:10:58. > :11:03.in the entire sphere of healthcare. We run healthcare in some very
:11:03. > :11:10.important regions of our state. you afford to specialise in these
:11:10. > :11:17.much less profitable aspects of modern medicine? We are not
:11:17. > :11:22.concerned about... We have one particular state where we have very
:11:22. > :11:27.poor primary healthcare. We see 40,000-60,000 patients entirely
:11:27. > :11:35.free. We do not look at making money at every level. All we are
:11:35. > :11:40.trying to do is keep our nose above water. You have acute hospitals.
:11:40. > :11:47.You are a pioneering hospital in by -- Bangalore, 1,000 beds to the
:11:47. > :11:51.cardiac unit. In America the average number of beds would be 160.
:11:51. > :11:58.Is it really in the patient's interest to have these vast medical
:11:58. > :12:03.factories? We need to do 2.5 million hard surgeries every year
:12:03. > :12:08.in my country. All of the heart hospitals in the world put together
:12:08. > :12:13.account for no less than 90,000 surgeries. If you build large
:12:13. > :12:17.hospitals you can reduce the cost significantly. The outcomes are
:12:17. > :12:21.always better than doing less number of operations. Statistically
:12:21. > :12:26.it has been proved that a large hospital doing a large number of
:12:26. > :12:33.procedures has much better outcomes then going small numbers of
:12:33. > :12:38.procedures. A few weeks ago we saw a horrible incident in Calcutta. A
:12:38. > :12:41.private hospital with a terrible place, 90 people killed. It raised
:12:41. > :12:46.serious questions about the standards of some privately run
:12:46. > :12:50.hospitals, as you get larger, we talk about Europe ambitious
:12:50. > :12:56.expansion plans, are you sure you can maintain the standards you say
:12:56. > :13:01.you believe in? As we get bigger, it becomes relatively easier to
:13:01. > :13:06.maintain standards. I will give an example... It is harder to know
:13:06. > :13:12.what is going on in every single hospital that you control. We have
:13:12. > :13:19.an information system. Any employee or patient, anyone who has an
:13:19. > :13:25.unpleasant experience, they press a speed dial number and it goes to
:13:25. > :13:30.the patient's complaint system. When you have large numbers you can
:13:30. > :13:34.put in investigative systems. talk about how far your ambition
:13:34. > :13:40.can go. You have implied to me that you believe what you have developed
:13:40. > :13:45.here is a model which has application across India and
:13:45. > :13:50.perhaps across the developing and developed world as well. I just
:13:50. > :13:58.wonder, whether you're ambition is rarely matched by reality? You have
:13:58. > :14:01.talked about the challenges in India. Poverty is still a huge
:14:01. > :14:07.phenomenon across the country. Hundreds of millions of people
:14:07. > :14:11.living on $2 a day or less. One- fifth of all the children in the
:14:11. > :14:14.world who died under five years-old die in India. Isn't that a much
:14:14. > :14:24.larger problem than developing sophisticated heart and cancer
:14:24. > :14:29.It is a relatively easy problem to be solved. We produce the largest
:14:29. > :14:36.number of doctors, nurses and medical technicians in the world.
:14:36. > :14:42.We started of with about 1.7 million families on health
:14:42. > :14:52.insurance. Today we have 4 million families. They pay just 22 per
:14:52. > :14:52.
:14:52. > :14:57.month. We gradually increase the premium. 4 million farmers just pay
:14:57. > :15:03.22 per month and they can have a heart operation, brain operation,
:15:03. > :15:09.cancer operation. In some ways for you as an articulate and
:15:09. > :15:15.influential voice within Indian healthcare you might want to focus
:15:15. > :15:20.more of your efforts on conquering the basic problem of poverty and
:15:20. > :15:28.malnutrition rather than sophisticated hospitals with
:15:28. > :15:36.amazing surgical ability. I would like you to understand that the
:15:36. > :15:45.economy of the 21st century could be driven by the healthcare
:15:46. > :15:51.industry. It is 4.5 trillion dollars. US healthcare alone is 2.5
:15:51. > :15:57.trillion dollars. This will drive the world economy. If you invest in
:15:57. > :16:02.healthcare you will make countries healthy and wealthy. You speak as a
:16:02. > :16:10.private operator. I come back to this word, profit. We do not be
:16:10. > :16:16.better if the Indian state were delivering? At the moment the
:16:16. > :16:21.Indian state is not doing it. Maybe you should be pressuring it.
:16:21. > :16:28.state can provide healthcare with the taxpayer's money. Taxpayer's
:16:28. > :16:36.money cannot offer healthcare in every part of the world. Forget
:16:36. > :16:44.about the developing world. When people retire at the age of 60 and
:16:45. > :16:48.they die at the age of 65, that was the 20th century. This is an
:16:48. > :16:52.ideology for you. You do not believe in state delivered
:16:52. > :16:57.healthcare, whether in the United Kingdom or India. You do not
:16:57. > :17:07.believe the model can work. cannot. The cost of healthcare is
:17:07. > :17:07.
:17:07. > :17:17.to hire. -- too high. We are trying to convince the government...
:17:17. > :17:20.
:17:20. > :17:30.not a tiny amount of money. For a farmer, 22 per month could be a lot.
:17:30. > :17:33.
:17:33. > :17:41.Millions cannot afford it. For many it costs more than 22 cents to
:17:42. > :17:48.smoke. There are 750 million Indians speaking on the mobile
:17:48. > :17:53.phone. If we spend that on the healthcare system, we would have
:17:53. > :17:57.the best in the world. Why is it, that if his private model works so
:17:57. > :18:02.well, in the United States you see if millions of citizens who cannot
:18:02. > :18:05.afford private health insurance? Many Americans listening to you
:18:05. > :18:10.extolling the virtues of private healthcare are scratching their
:18:10. > :18:14.heads and say it does not work in the richest country on earth.
:18:14. > :18:20.cost of healthcare and doing anything on the human body is the
:18:21. > :18:29.highest in the United States. You just cross the border and go to
:18:29. > :18:39.Canada. The Canadian government pays a huge amount of money to
:18:39. > :18:43.maintain its healthcare system. I am trying to say is that across
:18:43. > :18:49.the world there is a serious problem with delivering healthcare.
:18:49. > :18:54.This is the only industry where 70% of the cost goes to the salaries.
:18:54. > :19:00.Ask any businessmen at, or any other industry, where 75% of funds
:19:00. > :19:09.Goto salaries, no business would be sustained. There is something
:19:09. > :19:13.seriously wrong. In England, the US and Asia. We need to take control
:19:13. > :19:18.of the situation. This is a disaster waiting to happen. Nobody
:19:18. > :19:25.questions it because people have no money. To answer the problem, you
:19:25. > :19:30.have to realise that there is a shortage of manpower. Let us
:19:30. > :19:34.discuss how far you think you can take to model of healthcare. You
:19:34. > :19:39.want to build a medical cities, as you call them, in different parts
:19:39. > :19:46.of your own nation. You have an ambition to take that model
:19:46. > :19:52.overseas. How far can this go? intention is to build hospitals in
:19:52. > :19:57.India, Asia and Africa. I would like to spend a lot of my time in
:19:57. > :20:03.Africa. That is one area of which is very close to our heart. We
:20:03. > :20:08.believe that Africans do not need money, but institutions, trained
:20:08. > :20:13.doctors and nurses. Then they can take care of themselves. Our
:20:13. > :20:18.intention is to build a large number of hospitals. I find that
:20:18. > :20:23.fascinating. Many will find it admirable. If that is your
:20:23. > :20:33.commitment, Wyatt is so much of your time and effort going into
:20:33. > :20:34.
:20:34. > :20:39.building a massive hospital complex in the island's? We would like to
:20:39. > :20:42.show to America that just outside their waters in the Cayman Islands
:20:42. > :20:48.you can build a hospital and offer healthcare at less than half of
:20:48. > :20:52.what they haven't the U S. That is explicitly about what people call
:20:52. > :20:59.medical tourism. You are going to put a hospital offshore from the
:20:59. > :21:07.United States and are going to appeal to Americans to come to you
:21:07. > :21:11.for cheaper healthcare than they can get in the US hospital. Exactly.
:21:11. > :21:18.We are primarily looking at the Caribbean region because in that
:21:18. > :21:21.region there are no large hospitals. It brings me back to the first
:21:21. > :21:31.question I asked about whether you are first and foremost a
:21:31. > :21:31.
:21:32. > :21:35.businessman or a doctor. If you want to push a model into Africa,
:21:35. > :21:44.why on earth are you spending so much time and money on a project in
:21:44. > :21:51.the Cayman Islands? We have a large number of willing partners in the
:21:51. > :21:55.West. They see money to be made. US healthcare is August the profit.
:21:55. > :22:01.You say you are not about the profit. Why are you mixing with
:22:01. > :22:09.these people? The people pride Noren with us are running a
:22:09. > :22:15.prestigious, not for private hospital. -- partnering with us.
:22:15. > :22:21.Our intention is that we want to stir the first project their and
:22:21. > :22:27.convince everyone it works. If everything works out find it then
:22:27. > :22:33.the larger hospital chains in Africa. People watching this will
:22:33. > :22:38.wonder how quickly you can deliver. You need to train or see a system
:22:38. > :22:44.which trains a vast number of new doctors. India needs hundreds of
:22:44. > :22:52.thousands of new doctors. Africa would need them as well. Hill is
:22:52. > :22:59.going to train them? When I decided to come here today I had meetings
:22:59. > :23:04.with several policy makers. We desperately require a global system
:23:04. > :23:11.which would train doctors, nurses and technicians in India, Africa
:23:11. > :23:18.and Latin American countries. The traditional university system can
:23:18. > :23:25.never produce a sufficient number of doctors. The UK is one country
:23:25. > :23:31.which can think about this major transformation because UK
:23:31. > :23:35.universities are respected all over the world. The government is still
:23:35. > :23:41.heavily involved in universities. There would have to the Government
:23:41. > :23:51.that trains the doctors. Exactly. All we need is the curriculum and
:23:51. > :23:57.the examination system. Everything else can be taken care of in India.
:23:57. > :24:02.We need a reputation. You are confident thnfident thand kids will
:24:02. > :24:06.live in India where everyone has access to decent healthcare? Yes.