The heart surgery assembly line… that saves lives

In India, ideas accredited to Henry Ford some hundred years ago, are now being used to optimize the process of open heart surgeries; a specialized or “assembly line” approach. Instead of the a senior surgeon performing the entire surgery from beginning to end, the surgery is divided into stages. Surgically opening the chest and cutting the breastbone can safely be done by a junior surgeon. This means that senior surgeons have more time to perform the most complex part of a surgery. Not only does this practice save on cost, it also maximizes expertise. Rather than performing 1 surgery per day, a surgeon may perform 3 or more.

Medical tourism on the rise

India’s Ministry of Tourism published figures showing over 150,000 inbound medical tourists travelled to India in 2010. Today, it could easily be over 200,000. A lot of these come to India from countries like Nigeria, Bangladesh, and Afghanistan, where accessing healthcare is difficult or prohibitively expensive. However, patients from the world’s most developed nations, such as the US, are also seeking treatment in India to avoid high costs and long waiting lists.

Is heart surgery in India safe?

India’s low costs are not because of inferior surgeons or equipment. Indian cardiologists are some of the most experienced surgeons in the world, with surgeons performing many more surgeries than their counterparts in the US and Europe. As more high-tech hospitals are built in India, surgeons are returning home from abroad too, sharing experiences and best practice from around the globe.

27 hospitals in India currently have JCI accreditation, meaning they meet the high standards laid out by the US Joint Commission, and many others are working towards it.

Economies of scale

India’s densely populated cities call for very large hospitals, which are often part of a nationally recognized hospital chain, such as Fortis and Apollo. These hospital chains are able to buy in bulk and negotiate on cost, and get better per-unit prices from suppliers than a small hospital.

This applies to surgical tools, gowns, implants, imaging devices, and all other equipment required to run a hospital. The savings from this economy of scale is passed on to their patients.

Devi Shetty and Narayana Health

One of the leaders in the mission to provide affordable care is Devi Shetty who, with over 20 hospitals across India, has helped to lower the costs of surgery. His chain of hospitals, Narayana Health, went public in 2016, being valued at over 1bn dollars. Devi Shetty has spent many years working on the optimization of surgeries, to reduce costs without cutting back on patient safety. By charging more to those who can pay, he helps to cover the costs for those who can’t afford treatment. A heart surgeon by trade, and Mother Teresa’s personal physician, Shetty has earned international recognition for his work.

According to Forbes writer John C Goodman, “An American surgeon typically does three or four surgeries a week. At Shetty’s hospitals, they typically do two or three surgeries a day — six days a week.” The price for a heart bypass surgery at Narayana starts at just $5,700. Valve repair surgeries start from $7,000, and ventricular septal defect (VSD) closure starts at $2,500 (including the device).

What India’s hospitals can teach the world

An estimated 200,000 patients travel to India each year for medical care, but this isn’t the only reason India is developing cost-effective treatments. The country’s 1-billion-plus population has above average rates of cardiovascular disease, and the majority of people are without health insurance. Most health care, over 80%, is paid for out of pocket. In order to make life-changing surgeries a viable option for more and more people, cost effectiveness is paramount.

Advocates of equal access to healthcare hope that lessons from India can be used to improve healthcare around the globe, particularly in the US where costs are often prohibitive to those who don’t have insurance, and copayments can bankrupt even those who do. The Indian hospital chain Narayana Health is already treating patients from the US and Canada at its new hospital, Health City, located on the Cayman Islands, just a 1.5 hr flight from Florida.

For decades, you could find India’s yoga centers and ashrams full of international people, turning to India for its healing powers. Today, you can find tourists from around the globe in its multi-storey, super-specialty hospitals as well — people who are turning to India for what some would call “western medicine” at an affordable cost.

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