Heart Surgery for Everyone

In a children's ward in Bengaluru, a mother sits beside a cot. Her baby was born with a hole in the heart. The child tires quickly, feeds badly and breathes too fast. An operation could mend it.

For millions of families in India, the cost of such an operation has been more than they could ever hope to pay. That is the problem a heart surgeon named Devi Shetty decided to take on.

A schoolboy's decision

Devi Prasad Shetty was born in 1953 in Kinnigoli, a small town in coastal Karnataka, one of nine children. When he was at school, news came of the world's first human heart transplant, carried out by Christiaan Barnard in South Africa in 1967. Shetty has often said that this was when he decided to become a heart surgeon.

He studied medicine at Kasturba Medical College in Mangalore, and then trained in heart surgery in Britain, at Guy's Hospital in London. He could have stayed there. In 1989 he came home.

Kolkata

He joined a heart hospital in Kolkata, the B. M. Birla Heart Research Centre. In 1992 he operated on a baby only days old, in what was reported as the first such operation on a newborn in India. He also cared for Mother Teresa, who was treated there for heart trouble.

What troubled him most was the waiting. Every day he met families who could not pay. Children whose hearts could be mended went home without being mended.

Why so expensive?

Shetty began to ask a question that sounds simple: why does heart surgery cost so much?

Part of the answer, he believed, was that each hospital did only a few operations, so the cost of costly machines, buildings and skilled staff was spread over too few patients. If a hospital did a great many operations, it could charge each patient much less. And surgeons who did the same operation many times would become very good at it.

In 2001 he opened Narayana Hrudayalaya, a large heart hospital on the edge of Bengaluru. Its name is often translated as "temple of the heart". It was built to carry out a very large number of heart operations, many of them on children.

The hospital looked hard at every cost. It bought supplies in bulk and bargained firmly. It kept its expensive machines working long hours rather than letting them stand idle. Managers tracked the costs of each day closely, so that everyone knew what each operation really cost. Reporters began to compare Shetty's methods with Henry Ford's assembly line.

Patients who could pay more helped to support those who could not, and charities and donors helped too.

Five rupees a month

Many of the people who most needed care were farmers, and farmers rarely had savings or health insurance. Shetty worked with the Karnataka government's cooperative department on an answer. In 2003 a scheme called Yeshasvini was launched for farmers who belonged to rural cooperatives.

Members paid a very small sum, reported at first as five rupees a month, and in return were covered for many kinds of operation at hospitals across the state. Large numbers of farmers joined, and many received operations they could never otherwise have afforded.

A bigger hospital family

Narayana Hrudayalaya grew into Narayana Health, a group of hospitals in many Indian cities. It trained nurses and doctors, used phone and video links so that specialists could advise doctors in distant towns, and kept looking for ways to bring prices down.

Not everyone agrees on how far such ideas can go, and good hospital care in India is still out of reach for many families. Shetty himself has spoken often of how much remains to be done, and of how many more heart surgeons and nurses the country needs.

The Government of India awarded him the Padma Shri in 2004 and the Padma Bhushan in 2012.

For the mother beside the cot, none of this is about awards or business. It is about one question: can her child be mended, and can her family afford it? Devi Shetty has spent his working life trying to make the answer yes.

Want to read more?

A Harvard Business School case study by Tarun Khanna, V. Kasturi Rangan and Merlina Manocaran describes how the hospital kept its costs low. Geeta Anand's 2009 article in The Wall Street Journal, "The Henry Ford of Heart Surgery", follows a day in the hospital's life, and the Padma Awards records list Shetty's honours.