32 highlights
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Shubhra said that, in a conversation with her, Trehan threatened to reveal that the distinguished jurist had liver cirrhosis and hepatitis B. Both diseases carry a certain social stigma: cirrhosis is commonly attributed to excessive alcohol consumption, and hepatitis B can be acquired through unprotected sex.
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The country’s health sector is among its least transparent and worst regulated.
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And over the years, the private sector has acquired an unsavoury reputation for greed and mismanagement, with experiences of rampant breaches of confidentiality, a lack of informed consent during treatment, and questionable decision-making by doctors common in hospitals throughout India.
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He founded one of India’s top single-specialty hospitals—the Escorts Heart Institute, now Fortis Escorts Heart Institute.
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A competitor of his pointed out to me that Trehan has only one hospital to his name—unlike Apollo or Fortis, Medanta is not a chain. Yet the power he wields in the private sector is disproportionate to the size of his business
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In the three decades since the Indian government permitted the operation of bank-funded private hospitals in the country, there have been only two doctors who have seen such enormous success as entrepreneurs. Prathap Reddy, who convinced Indira Gandhi to allow banks to fund hospitals in the country, and founded the Apollo group of hospitals, was the first. After him comes Trehan
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Cardiac surgeons and cardiologists have been disproportionately influential in health policy formation in India, thanks to the vast majority of Indian politicians belonging to an age group for which heart disease is a pressing concern.
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As the Bharatiya Janata Party-led government seeks to make real headway in solving India’s health crises, it is confronted with two broad challenges. The first is to combat the health sector’s severe shortage of human resources. The second is to calibrate the role of insurance in public health care, which has grown in importance, and will play a vital role in shaping future health policy.
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For years, entrepreneurs have been lobbying the government to implement expensive solutions, by way of public-private partnerships, at both the state and central levels. These solutions include the state purchasing care from private hospitals; increasing cover on government insurance schemes; providing subsidies for infrastructure, including land, power and water; and offering tax rebates to entrepreneurs willing to set up hospitals in underserved areas.
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Many critics point out the government’s current penchant for pro-industry policy is proving ruinous to public health facilities, already long-neglected, and falling behind in the race to capture talent.
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The private sector has spare capacity to offer the government. But the government has to appreciate that the private player “has a cost of delivery, and a 10 to 15 percent margin,” he said.
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“Isn’t it shocking that an industry lobby is the secretariat for setting up curriculum and standard operating protocol for all health-care professionals? Have you heard of such a thing in any other sector?”
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The only photograph in the room was of Frank Spencer, a legendary cardiothoracic surgeon at New York University, who taught Trehan his skill.
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Then, at age sixteen, Naresh met and fell in love with Madhu Purie, daughter of Vidya Vilas Purie, the wealthy film financier and owner of Thompson Press. Both sets of parents were displeased.
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I had said to Trehan, earlier in the conversation, that his critics considered him brilliant and arrogant in equal measure. “I have lived three lifetimes worth of work,” he said in response.
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THE PRIVATE SECTOR WAS PRACTICALLY non-existent in Indian health care a generation ago. Through 1979 and early 1980, the Chennai-based doctor Prathap Reddy did the rounds of the prime minister’s office to get Charan Singh to sign off on his pet project, a hospital in his home city that he would call Apollo.
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The 1980s were also a defining decade for Indian health policy. In 1978, India signed the Alma Ata Declaration at the World Health Assembly, promising “Health for All” by 2000. To follow up, India unveiled its first ever formal health policy in 1983.
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Since the birth of modern India, the government’s outlook on public health had been limited more or less to damage control—containing epidemics of diseases such as leprosy and tuberculosis.
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Public health researchers, as well as historians, have said that since India’s politicians were focused on industrial growth during the country’s early years, crucial social sectors such as health and education were deprived of attention.
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It was only in the sixth five-year plan, which ran from 1980 to 1985, that policymakers ruefully acknowledged that there was “a serious dissatisfaction with the existing model of medical and health services
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Like almost every essential service, the building and operation of hospitals in India was effectively monopolised by governments, which had done little to meet overwhelming demand.
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Today’s swanky new hospitals owe their existence to the sixth and seventh five-year plans. The sixth plan document admitted that the private sector would have to be engaged to meet India’s growing requirements.
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Crucially, Ahmed also wanted the same thing as Trehan: to set up a hospital dedicated to cardiac care in Delhi. He happened to be the son of a former president of India, Fakhruddin Ali Ahmed—a political connection that proved to be vital as the two of them set about bringing the dream to life.
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When Trehan got up to speak at the CII conference in December, his message to the audience was clear: he wanted the private sector to provide health care to people, and be reimbursed by the government.
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At least thrice in his speech, he asserted that the government contracted private-sector health-care providers at “unreasonable” rates. “The current government rates do not cover the cost of tertiary care per international standards,” he said.
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Trehan’s argument overlooked the fact that the government has always offered heavy subsidies to private hospitals when leasing out land, providing infrastructural services such as water and electricity, and other major incentives, such as tax rebates.
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The Indraprastha Apollo Hospital was famously given fifteen acres of land in Delhi’s Sarita Vihar for a grand total of Rs 1, in exchange for the hospital providing a generous amount of free care to poorer patients—but the conditions of the lease, it turned out, were subsequently repeatedly violated.
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“There is ample evidence to show that whenever a health sector is heavily dependent on insurance, private hospitals deny services for many categories of illnesses, and there is oversupply of some services,” Amit Sengupta, an activist with the India chapter of the People’s Health Movement,
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Many of Trehan’s views on India’s looming health care crises are at odds with the opinions and experiences of others in the field.
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Sengupta, the public health activist, pointed out that the stability of medical costs in private hospitals did not necessarily indicate their concern for the public interest. As the volume of patients seeking medical attention from private hospitals increases, there is no need to raise rates in order to maintain profits.
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The government currently invests 1.3 percent of the GDP into health care—paltry by global standards, where many of the world’s most industrialised nations allocate well over ten percent of their GDPs to health care, and even some significantly poorer countries, including Bangladesh, often spend more of their GDP on health than India does.
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If medical visas were made more readily available, and if the government reached out a little more to private entrepreneurs, he said, they would all be ready in short order to conquer the next waiting markets—the SAARC and African countries.