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February 6, 1998


Issues '98/Dr Pratap Reddy

'The government must realise that healthcare is as important as roads and ports'

We must all realise that there is a lot to be done in India the area of healthcare, especially since India is making efforts to become a global player in every other field. We are succeeding in some areas and progressing in others but in healthcare, we are far, far behind in terms of quality and numbers.

We have only one hospital for 1,300 people as against 250 in the West and 90 in Japan. The healthcare delivery system in the West has undergone a tremendous change in the last 20 years. Some Indian institutions such as Apollo has brought this technology to India and demonstrated that we can do what everybody else can do. Apollo's goal is to give proper healthcare to all Indians.

The government must realise that healthcare is as important as roads and ports. The World Health Organisation recommends that the government should triple its GDP allocation for healthcare, from two per cent to six per cent. But that alone will not solve the problem. I think they should use the money for providing clean water, improving the environment, and establishing primary healthcare centres. The rest should be left to the private sector, to make healthcare efficient and cost-effective.

For this, the government should create an enabling environment. Then you will have a lot of people who will look with interest and say, 'Hey, if there is a chance, why shouldn't I also participate?' The government provides a number of incentives in many areas; they should also give such benefits to those who invest in healthcare. Such measures need to be brought in.

Last year, healthcare got some attention from the higher-ups in the health ministry. They responded to our request. I am very happy that both the Federation of Indian Chambers of Commerce and Industry and the Confederation of Indian Industry have also joined our efforts to bring in changes.

Those who can afford it should pay for themselves. Those who can buy their own houses and cars should not depend on the government to provide healthcare. Nearly 50 to 60 per cent of our population can subscribe to some sort of a health insurance programme. I call it "health maintenance organisation membership" in which the organisation will stress upon your well being. Medical insurance will treat you when you are sick, but that is not the answer for us. What we need is a mechanism to keep us healthy. To remain healthy, we must improve health awareness and detect diseases early.

It is very sad that while in the United States, the incidence of cervical cancer among women has been eradicated, in India it is one of the most common cancer. It shouldn't be that way as there is no difference between the women, except that in the US, it is detected early. Every woman who is above 35 regularly goes to a health centre and gets a pap smear done. This has reduced the incidence of cervical cancer to almost zero. And what is the cost of doing a pap smear? Only Rs 150. Moreover, if a tumour is detected early, the cure costs only Rs 500.

Now look at the damage if it becomes cervical cancer: great suffering; uncertainty about life; and huge expenses, which runs into thousand or hundreds of thousands of rupees. That is why our stress should be on detection and prevention. It is much more important in our country because we don't have free rupees.

Health insurance is very important, as it serves a twin purpose. One, it will take care of you when you are sick. More important, it will circulate a lot of money because of the premia you pay to the health insurance organisations. It is predicted that in five years time, the money in health insurance will go up to Rs 200 billion as against the 20 billion on today. And in 10 years time, it is expected to reach Rs 720 billion or so. Even if the organisation cuts 10 per cent as profit, the rest will be recycled into the healthcare system. This can only mean more healthcare networks, more hospitals, and more clinics. Health insurance is one area the government should act on quickly.

Another area concerns investing in hospitals. Today, if an industrialist has Rs 100 million, he would rather invest in industries that give good returns. Investing in healthcare gets him brickbats and no benefits? It is not that Indians lack skills. In fact, our skills are the same or better compared with anyone else worldwide.

Do you know how Sri Lanka woos industrialists into healthcare? When I wanted to establish a hospital there, the president said, 'There will be no customs duty for you, not only for the medical equipment but for the building materials also. I am given you a ten-year tax holiday and the investment is also exempt from tax.'

The Sri Lankan president takes such measures because she wants to quickly reduce the gap that exists in healthcare. I am sure the results are going to come. Apollo and many others from different countries are all going to Sri Lanka.

India also can attract foreign investors. I have talked to many people in Washington DC; I have addressed them in Singapore. All of them have expressed interest but also felt there were so many disincentives in the medical industry. For instance, I pay twice as much for power as does a liquor factory, and four times more for the water. These types of disincentives must go. You need some sort of a patting on the back.

The government should ask itself what went wrong. Somewhere in the Constitution, it is written that health is going to be guarded by the government, which is impossible. Even advanced countries cannot afford to do so. Nearly 30 per cent of the British have private insurance and they are charging from everyone. I feel, for a very long time the government felt embarrassed to admit that it was unable to reach its goal of health for all by 2000. Now the government has become helpless. What I would suggest is to wipe the old board clean and start afresh.

I have some plans for the rural areas too. First, you must understand that doctors are human beings. You have no funds to establish hospitals in the rural areas. If you have funds and set up primary health centres, you have no doctors or nurses there. This is because the doctors lack minimal comforts; their children cannot get decent education in such areas, and therefore avoid it.

This is where telemedicine can play a significant role. The centres in rural areas, semi-urban, and a metropolis can be connected. The health workers in the rural area can get help from the semi-urban areas, and if it is beyond them, they can ask the bigger centre. It is time to establish telemedicine and it should be the country's first priority. You give incentives to industries if they establish in rural areas; similar incentives should be given to those who start a hospital too.

I give full credit to the social workers who educate people on family planning. India's medical personnel, 400,000 doctors, should also be induced by telling them that "it is your duty to make one or two persons accept family planning advice every day'. We doctors take the Hippocratic Oath, but in India, I think this is the second oath that the medical community must take.

In India, bureaucrats frame healthcare policies. It does not happen in the US. The first time, when Bill Clinton made plans for healthcare, it failed horribly. This time he talked to the doctors. His whole speech on healthcare was for the betterment of doctors so that they can deliver better healthcare. Interaction must take place between the medical community and policy-makers in healthcare. At present, the interaction is zero. Some bureaucrat decides on policy and some politician announces it; doctors are nowhere in the healthcare picture.

Dr Pratap Reddy, head of Apollo Hospitals, spoke to Shobha Warrier.

'We can earn $30 bn through healthcare'

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