I had the privilege of listening to Dr. Naresh Trehan at the HT Leadership Summit organised by the Hindustan Times in New Delhi on Oct 30th and 31st 2009. The Leadership Summit has over the years become the marquee event in the city’s calendar and leaders like the Prime Minister, the Finance Minister and a former US President (George W Bush) addressed the gathering, which was composed of the who’s who of the Delhi elite. Dr. Trehan, who is widely regarded as one of the most accomplished cardiac surgeons in the country, was invited to speak on the challenges that the healthcare industry faces and how he saw things working out by 2020.
Dr. Trehan spoke with great passion and expressed anguish at the huge gap that exists in the supply of healthcare to the haves and ‘have nots’ in our country. “While Delhi draws thousands of patients from across the globe, 50 kms outside the city, one would struggle to find a qualified physician. India has some of the finest healthcare facilities, comparable to the very best anywhere in the world, which offer services at a fraction of the cost in the west, yet most Indians can hardly access these. The real challenge is how do we bridge this huge divide”, pointed out Dr. Trehan.
The prescription that he had for the malaise was simple enough.
Dr. Trehan, suggested a healthcare model based on Preventive, Primary, Secondary and Tertiary Healthcare centres connected with each other through a hub and spokes system. Indian villages are filthy, people do not have any sense of public hygiene and children, who are most vulnerable die of infections, which can easily be prevented if only one could improve sanitary conditions in our villages. Dr. Trehan demonstrated, how by just improving village sanitation and building a proper school in a village in North India, he and his team has been able to cut down disease and infection in the village. This he said was accomplished with financial support from a few large business houses who generously donated for this cause. One would reckon that this can just as easily be done with funds from the government. After all this is an investment in healthcare and education of the future citizens of the country and is bound to pay healthy (no pun intended) dividends.
Dr. Trehan acknowledged that no self-respecting doctor wishes to practice medicine in the hinterlands of the country. The quality of life that he expects for himself and for his family, just does not exist in Indian villages as yet. Thus, it makes no sense to have Primary Healthcare Centres in every village simply because it would be impossible to have qualified doctors functioning at these centres. Dr. Trehan instead suggested mobile clinics located in district headquarters and small towns, which can visit nearby villages on fixed schedules and offer Primary Health Care services in remote villages.
The government has a fairly vast healthcare infrastructure at the district level. The district hospitals can easily serve as good secondary care hospitals, provided they are managed efficiently and are held accountable for the quality of care they deliver. Dr. Trehan mooted a model based on a Private Public Partnership (PPP), which would allow efficient utilization of these resources and also generate a decent profit, which can be used to further strengthen these hospitals.
As far as the Tertiary Healthcare is concerned Dr. Trehan indicated access and pricing as the big issues. He felt that low-cost universal health insurance as a possible answer. Dr. Trehan also believes that tertiary healthcare costs can be significantly brought down if a hospital has a high throughput of patients. Thus, a tertiary hospital can amortize its fixed costs over a large number of patients, bringing the overall costs down. In this context he mentioned his own efforts at establishing ‘Medanta – The Medicity’ a large 1200 bed facility that he has built in Gurgaon.
Medanta, set to commence operations in a few months is a large tertiary care facility located hopes to attract patients not only from big cities but also from smaller towns and cities. Dr. Trehan believes that more such large institutes will help bring the costs down and will allow more Indians to access world-class healthcare.
Dr. Trehan also mooted setting up a National Task Force, consisting of healthcare experts and government officials to try and put together a national level plan to rejuvenate Indian healthcare. “I had met the Prime Minister of India in the early 1990’s, with ideas on revamping our healthcare system. He agreed with most of what I had to say and promised that in a few months, things will move. Twenty years hence I am still waiting for a cohesive healthcare policy” lamented Dr. Trehan.
One hopes that with Dr. Manmohan Singh, the Prime Minister of India, talking about huge investments in healthcare to drive ‘inclusive growth’, things are finally set to move.