One Step Closer: Narayana Health

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The “One Step Closer” series features high-impact non-governmental organizations and individuals, and innovative solutions bringing the world one step closer to cardiac surgery for all. Today’s post features the Narayana Hrudayalaya hospitals group in India, known for its low-cost cardiac surgical procedures, available for India’s poorest.

Dr. Devi Shetty, Indian cardiac surgeon (medically schooled in Mangalore, India, and surgically trained in Guy’s Hospital London, United Kingdom) and healthcare entrepreneur, founded Narayana Hrudayalaya/Health (NH) in 2001 in Bommasandra, Bangalore, India.Today, NH is the largest cardiac hospital in the world, with over 1,000 beds and performing over 40 cardiac surgeries per day, including 16 paediatric heart surgeries. As a whole, the so-called NH Health City, the hospital and its campus’ services, intends to treat 15,000 outpatient visits per day. Through an agreement with Ascension Health’s TriMedx in 2012, NH has expanded to create a network of hospitals across India, providing low-cost cardiac care, in addition to expansion to services as neurosurgery, paediatric surgery, haematology, transplant, and nephrology, among others. Accordingly, the NH network has expanded to 26 hospitals with 6,900 beds across India, employing 13,000 people (of which 1,500 doctors) and treating over 2.5 million people every year.

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NH’s success in reducing costs of cardiac surgery builds on the use of economies of scale and innovative solutions (e.g., using reusable scrubs and natural cross-ventilation instead of airconditioning), which has allowed the price per procedure to drop by 50% (coronary artery bypass grafts (CABGs) dropped 50% to 95,000 rupees or US$1,583 in India, compared to US$106,385 in the United States, $27,000 in Mexico, and $14,800 in Colombia). Other interventions include limiting redundant pre-operative testing and training patients’ family members to take over part of the post-operative care. The mass production of surgical interventions and purchasing has given Dr. Shetty the reputation of the Henry Ford for cardiac surgery.

And yet, the low cost does not come at the expense of quality reduction, as mortality rates (1.27%) and infection rates (1%) after CABG parallel those in the United States. Bed sores, normally present in 8 to 40% of post-CABG patients globally, are close to 0. Data registries, integrated on the Cloud rather than in high-cost data hubs, form a critical part of NH’s model, aiming to continuously improve both the quality of care delivered and the efficiency of use of resources to do so.

The wealth of a nation has little to do with quality of health care its citizens can enjoy.
– Dr. Devi Shetty

NH sets itself even more apart by delivering free surgeries for India’s poorest and poor children, also earning Dr. Shetty the nickname of Bypasswale Baba in India, the Saint who Grants Bypasses. In parallel, a model of micro health insurance (yeshasvini) was set up in collaboration with the government of Karnataka, providing an innovative insurance model for 4 million Indians, severely reducing out-of-pocket expenses and financial catastrophy.

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In the future, Dr. Shetty and NH aim to expand to a network of over 30,000 beds across India and bring costs per CABG down to US$500. “I believe we can dissociate the wealth of a nation from the quality of its healthcare”, he says.

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