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The Rediff Business Interview/Dr Pratap Reddy

'Health insurance is a necessity in India'

You said some of your patients come here after selling their property. Was it the case when you started the hospital also or the attitude of people to health care has changed over the years?

When I first started, the attitude of the people was like suddenly finding water in a desert. People from all over India who could not afford to go abroad started rushed to Madras. Slowly, those who did not have personal funds also began coming here, either pledging or selling their properties.

Don't you think there is something deficient in our health care system and policy itself? All these poor people shouldn't be rushing to a hospital where the treatment is unaffordable to them.

It is not deficient. It is very easy to criticise the government saying the government hospitals are ill equipped, they are not giving medicines, etc. You must realise that they also have their priorities. The governments says it is spending two per cent of the GDP on health care. If it is increased to 6 per cent or 10 per cent, it will deprive people of something else, probably their allocation for education will come down.

I feel the only way of overcoming this is by self propelling. If private investors and insurance come into health care, it will propel the engine of health care development. Subscription money will come in and it will get into the health care system which, in turn, will develop to build more hospitals. Then people will start asking for quality.

You talked about government priorities. Kerala has always given top priority to health and education and the state has good quality medical colleges in the cities and primary health centres with doctors and medicines in the the rural areas. Doesn't that mean government-run machinery also can do something if they have set their priorities right?

Definitely they can do a role. Kerala is an excellent example. Yes, this is where the government should have their priorities. They should concentrate their resources on giving primary health care, immunisation, pollution-free environment and safe water. I call health care the help of all. So, there should be no distinction between the government, the private health provider and the charitable provider. All should have the same goal, to fill the large vacuum that exists today.

When medical insurance comes to India, half our population will not be able to afford it.

I believe so. You see, overnight you can't become an America. I have done 22,000 heart surgeries in India. I have not solved the country's problems but at least I have helped those 22,000. Many others followed later. But we have brought in the standards. In the first year, even if you were to get seven and a half per cent of Indians to take medical insurance, it is 75 million people. Next year, it can increase to 100 million. It will grow that way. So, after 10 or 20 years, we could cover 60 to 70 per cent by insurance, and the government can take care of the rest more effectively.

You have been talking about health care export. What exactly is that?

We have proven that in health care, we can be the single largest foreign exchange earner in the country. Today, in India nobody needs to go abroad for treatment. So many VIPs who otherwise would have gone abroad are treated in our hospitals with the same results, thereby saving valuable foreign exchange. People from other country have stared coming in now. We get patients from Sri Lanka, Middle East, Pakistan regularly.

We started bone marrow transplant here and have done 40 cases now. More than 60 per cent are from other countries. I will tell you an incident. A family from Pakistan came here. Their one-and-a-half-year-old child had donated his bone marrow to his three-year-old brother and everything went off smoothly. The father of the children was very happy not only because the operation was successful but because he had saved a lot of money too. On enquiry, he found that in London and the US, the cost is around $ 200,000 and here we did it for $ 30,000!

Mark my words, if we proceed along the same line in a chartered manner, India would become the major health care destination in the world. Most importantly for the Afro-Asian countries. Do you know what you are going to earn? Tremendous amount of goodwill besides foreign exchange.

Recently, when I went to Sri Lanka, the president was so thankful to Apollo for the type of facilities offered that that when I wanted to start a hospital in Lanka, it was almost a blanket permission. This is the kind of respect, the kind of love, the kind of friendship that we are going to get from our neighbouring countries.

I have read in the papers that by exporting leather shoes, we earn $ 1 billion which is one per cent point of the global leather trade. Exporting textiles earns $ 2.5 billion, which again is one one per cent point of the global textile trade. If you apply the same yardstick to health care, it is almost $ 3 trillion industry. Hospitals will earn a direct income of $ 30 billion. What about your travel and hotel industry by this way? I told a finance minister, 'Sir, please do all this and then you will earn so much of foreign exchange that you will not know what to do with it'. Thirty billion dollars can equal all the other foreign exchange income.

What about the the controversies that have arisen. For example, the case of former national table tennis champion Chandrasekhar and the one concerning actress and dancer Viji? [Chandrasekhar was admitted to the Apollo Hospital for a minor knee injury in 1984. Due to complications, he lost the use of his leg then and the Supreme Court ordered a compensation of Rs 1.9 million in 1995. He has recovered now and is coaching youngsters. Viji also went in with a knee problem and suffered temporary paralysis in September last year. She sued Apollo and later had an out-of-court settlement. She has recovered and has resumed dancing.]

Does God bless everyone? In a hospital too, we do our very best. After all, medicines do not have a 100 per cent success rate. We cannot cure all. With the best of care that we are taking, the success rate of a heart surgery is only 99 per cent. It is the same all over the world too. It is very unfortunate that people call it negligence.

Generally people feel that doctors used to be more dedicated earlier. Now many doctors look at this as just another profession, that they are more interested in making money even though they are dealing with human beings like themselves. Do you feel there is a deterioration in the outlook of today's doctors?

I don't think so. Earlier a doctor had only a stethoscope and he used to talk to the patient all the time. Today, there are many modalities available to him. So somehow people feel doctors are not concerned. I don't think there is any letdown by doctors or medical community as such. People criticise only doctors and hospitals, nobody talks about the pharmaceutical industry.

That is the unfortunate reason why in India, no one, not even a doctor, wants to open a hospital even if he possess 100 million rupees. Because all he gets from the press and the public is criticism. He would rather invest his money in something else and earn profits. If he makes money through business, he is portrayed as a successful businessman, but if he starts a hospital, he gets only brickbats.

But are the doctors not scrutinised by the press and people as they deal with human beings who live only once and their lives depend on the doctors?

That is why you must respect and worship the man and the hospital. Because they are the ones who are providing you with all these facilities. If they stop doing it, if they divert themselves to some other business because you are throwing brickbats at them, then what will happen? I too need not have done this. I could have remained in the US and become a multimillionaire. But the small number of people who criticise me do not hurt me, do not stop me from doing my mission.

I am not talking about any particular hospital or doctor. But it is true that there are many, many doctors and many, many hospitals which look at this profession as a way to make money. Is it not a different profession where dedication is very essential?

Please tell me where there is no black sheep. In every sphere, there is one black sheep. For that you should not smear the entire medical profession. On the whole, you must understand that medical practice and medical facilities are turning a new face now.

Today, many factors have come to deliver health care. So if any of these do not function well, you can't put the blame squarely on the hospital and the doctor. Tell me, which doctor goes home at four or five o'clock? All my doctors come at seven in the morning and leave only by seven in the evening. Is that no dedication? I too work 365 days. I take leave only on Sunday afternoons to spend some time with my grandchildren. It is very difficult to define the word dedication.

So, unlike the general public, you feel that the attitude of doctors has not deteriorated at all.

I am not justifying anyone or anything. There are some doctors who have not fallen into the general pattern of medical ethics. Because of them you should not criticise the entire profession. That's what I want to say.

Last time we had to cancel our appointment because you rushed to Hyderabad after the bomb blast. Did you go there to personally supervise the rescue work?

You asked me about our responsibility. See, I considered it my moral responsibility to be there. What more can you ask of anybody else? Here was a blast. It was aimed at killing the MLA and the minister. But who died? Ordinary people. Who went to their rescue? Apollo ambulances. Six ambulances went and picked them up. We did not ask whether they could pay or not.

From 1145 hours in the morning till 1630 hours the next day, all our nine theatres were busy operating on these people. All of us knew those were the people who were picked up by paying hundred rupees and brought in a lorry. So we knew they could not pay. But did any of us shirk our responsibilities? No doctor, no theatre technician, no anaesthetist left the theatres that day. They continuously worked for almost 26 to 30 hours. There was no financial motive. I am glad you asked me this. What more can you ask of a doctor? What more can you ask of a human being? As a citizen, will you or any other person put them in your car and drive them to a nearby hospital?

When the earthquake took place in Maharashtra [September 30, 1993], our team went unasked for. Nobody requested us. Two of our ambulances and doctors went and did service there for two weeks or so. We even gave them chits so that they could come to our hospital if they needed surgery. During the floods [Andhra Pradesh, 1997], both our Hyderabad team and this team went there to serve the affected. Nobody highlights this. We don't get anything. No publicity, no money, nothing. When dengue fever broke out in Delhi [1996], we treated 1,650 people but neither the press nor television ever mentioned a word about this. But we are not bothered. We do everything silently.

Please remember that doctors are also human beings. They do bad things, they do good things also, like anybody else.

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