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'I don't see any positive steps this time too'

It was Dr Pratap Reddy who first initiated Indians into world-class healthcare through Apollo Hospitals. Reddy has been talking about the need to privatise healthcare for a long time now. Unfortunately though, substantial improvements are still to be seen.

"I have listened to 30 budget speeches. I don't expect any positive steps this time too," Reddy says.

Every year, he would give representations to the finance minister, health minister and the Prime Minister. But this time round, he tells Shobha Warrier that he will do no such thing.

What should be the roles of the government and the private sector in imparting healthcare to people?

They coined the slogan, "Health for all by 2000 AD". But you see, it failed because we did not use all the resources that were available.

That is why I have coined another slogan, "Health for all with the help of all". This would require the government, the private sector and other voluntary organisations to work together.

We can arrive at a solution only this way. Probably we may be able to give a solution to two thirds of the world too. I think we can own the responsibility of tackling major problems of the developing and underdeveloped world in providing adequate healthcare to its entire population.

What kind of roles do you define for these three so that all the three work together?

You can't draw any iron curtain between the government, the private sector and voluntary agencies. Broadly, we can say that the government can play a very significant role in improving public awareness, hygiene etc.

If the government can provide clean drinking water, a major part of the problem can be solved. Leave alone drinking water, if the government can even make people aware of the importance of drinking boiled water, we can save 250 million people suffering from gastro-intestinal problems.

They can bring legislation to ward off environmental pollution. They can make people aware of the problems connected with tobacco smoking and can also provide primary healthcare to people.

When you come to the broader aspect of healthcare, I don't think the government should shoulder the responsibility of tertiary healthcare which is capital intensive. You may ask, what happens to the poor people then? By giving cost effective treatment and not cutting corners, like what we are doing at Apollo, we can give quality service to people. I think, we can give this model to other developing nations and underdeveloped countries.

Take Singapore for example. The cost of medical treatment is two-thirds more than the cost of what we have here. That is because they ape the western model.

It is a misnomer to say that in India, healthcare is cheap because of our workforce. That is wrong. You cannot call India's workforce cheap. You should call them as skilled manpower.

We have reduced the cost of a heart surgery from $50,000 to $3000 not because of the cost of labour alone, but because we put in the chips right.

There are not many private players in the field of healthcare. What should the government do to attract more players?

This is where I feel very sad. The mind set of the bureaucrat and the government, be it the finance minister, the health minister or the Prime Minister; all of them unfortunately still believe that it is sacred to keep health out of the private sector.

If only they understand the reality. Very often the finance minister says, 'I am against subsidies. Please don't come to me for subsidies.' I have openly told him that I don't want subsidies to improve healthcare in our country.

I don't have to actually give the government a new formula. They say they can't build roads, ports and bridges. They encourage private participation in those fields. All this they declare as infrastructure.

Why can't they declare health as infrastructure? Or, even call it an urgent sector.

For example, if they give tax benefits, it will attract investors from both inside and outside the country. What do they lose? Apollo probably pays about Rs 200 million as income tax.

All others in the country, according to me, are probably contributing another Rs 150-200 million to this. Is Rs 300 million not important for a nation? By waiving the tax for 'x' number of years, they are going to get an investment of Rs 4-5 billion each year for the next 8-10 years.

I will give you the typical example of Ford. Ford was given sales tax exemption and if you ask Karunanidhi whether he was sorry for that, he will say he is not and never was. He once said that by giving tax exemption, I am giving them an opportunity to come to Tamil Nadu so that there will be employment potential. There will be other spin off benefits too.

The spin-off effects in healthcare development are something that people have not realised. Number one, it has still not got into their head. I am sore with CII because they are supposed to be representing industry. The single largest industry in the world is healthcare. Second, it is the single largest employment provider. This is what the government should look at.

I will give you another example of my village, Aragonda where I have started a charity Hospital. When we started the hospital, the entire village was grateful to me, but not for starting the hospital. They said, you have provided employment to 150 families. That is the first benefit that the village got. What we need is 80,000-100, 000 hospital beds per year at a cost of Rs 250-300 billion.

When the construction activities of the hospitals start, the government is going to get money. Let's say from this Rs 250 billion, 30 per cent goes into construction. The state government gets its sales tax and the central government gets TDS. So, the government is going to get much more than the imaginary loss of Rs 25-30 crores as income tax by encouraging private participation.

But the mindset is totally closed. They are not listening.

Don't they understand what you say?

I don't know. Whenever I tell them, they think it is Apollo talking. Year after year, I used to make representations to the health minister, the finance minister and the prime minister. That is why this time I didn't do that. I felt it was useless. Let me not even try it.

They think it is for my personal gain that I am asking all this. They forget that when I try to bring in more players in the field, I am bringing competition for myself and I believe I am justified in doing so because there is so much to be done in the field of healthcare.

Apollo alone cannot do it. We need 200-500 players to come in and they all will come in because what does the businessman first do? He does a feasibility study. He will see whether there is a demand for the product. And here, there definitely is tremendous demand.

With the opening up of insurance sector, do you expect many players entering the field of healthcare and health insurance?

Health insurance is going to give access to a large number of people. Around 250-300 million people fall in the middle class category. According to me, 70 million families can purchase good health coverage for themselves if they are informed that it is necessary for them to protect themselves against any unplanned event.

When you are talking about 250-300 million people, it is bigger than the United States. 74 per cent of the 250 million are the number of people insured there. Here, we are going to have a much larger figure. But what do we have? We do not even have one per cent of the facilities that USA has.

They have privatised health insurance but they have not taken one of my suggestions. Health insurance is now an appendix to life and general insurance. So, they are not going to give innovative policies to encourage insurance policies in healthcare. Even in case of the appendage, I had pleaded with the IRDA and the government to make it compulsory to have health insurance like the rural crop insurance, cattle insurance, etc.

They should have gone one step further. When the birth certificate is given to a child, they should ask the parents to take insurance for one year for the child. Again, when the child goes to school, it should continue.

What happens now is, when a young man goes to a western country, the first thing they ask is, where is your health insurance card? They are forced to take insurance when they go there. Why can't we have such a system here too?

Now that the economy is not growing as expected and Indian agriculture is slowing down, everybody is talking about the need to invest in primary education and healthcare. Do you expect the finance minister to announce any positive measures in his budget?

I have listened to 30 budgets and in all the budgets, what they have said was, we are increasing the customs duty of something and reducing the excise duty of something. That is not healthcare of the nation. So, I don't see any positive steps this time too.

There is no indication at all. Nobody is talking about healthcare. Even CII did not talk about it. I expressed my anguish after I saw the CII memorandum. Do you know what they recommended? They wanted the government to levy service tax on doctors and hospitals. I am not saying they should not do that.

But what we urgently need is to bridge the healthcare deficiency. That should have been the primary concern of a major organisation like the CII, FICCI or ASSOCHAM. They are supposed to be representing the industry and the government listens only to them. The government has not been listening to medical bodies.

According to me, leave alone 100 times, we should grow at least 10 times in healthcare to meet the demands of our people. The government has no money to invest Rs 250-300 billion and even if they do, they shouldn't be doing this. Instead they must invest in primary healthcare, educating people on hygiene and eradicating diseases like AIDS and malaria.

If I were the finance minister or the Prime Minister, I would have made the President announce that this year, we are going to give top priority to health of all people.

They should remember that you can't build healthcare facilities in one day. They should stop tinkering and take some bold initiatives which do not hurt them. They should immediately declare that we invite as many people to facilitate healthcare from inside and outside the country, and that they can have 100 per cent FDI in healthcare. Now it is 74 per cent, but they should make it 100 per cent.

I have addressed conferences all over the country. They tell me that there is a big game that venture capitalists can play by investing in healthcare in the country. But only if the government defines its role of how it is going to promote healthcare and attract investors. They need not invest at all.

Even otherwise also, government spending has consistently gone down over the years and now it has dropped from above 6 per cent to less than 2 per cent. They can even further reduce it and use the money for some other better purposes. I hope they will use it for education.

Rural India is poor. When the private sector set up hospitals there, will people be able to afford the treatment?

Why do we have health insurance? I feel the rural Indian is more knowledgeable and aware about insurance than the urban Indian, as he has cattle insurance, crop insurance etc. I am collecting Re 1 a day as insurance money in my Aragonda village. Re 1 may be too less an amount but they can do something of that sort.

You just come to my village and you will see a landlord and his coolie side by side in the post-operative ward. This can happen and this will happen but why not speed up the process?

You once said that private investors hesitate to come to the medical field because they get only brickbats and not bouquets.

The situation is worse now. Nobody makes an attempt to change this. Just take the Kumaramanaglam case. Can you imagine the health minister of a country trying to order an enquiry into the illness of a minister who went back normal from the hospital four months ago?

The enquiry was not on the entire illness and what the cause of his death was, but on the illness that he had four months ago. This attitude to throw daggers at the medical community and doctors must go and we should act as co-players in a major national game where there is a tremendous need.

Three years ago, you said that bureaucrats who did not know anything about healthcare framed the health policies here and that the interaction between policy makers and the medical community is zero. Is there any change in that now?

Even now it is the same. It seems the health minister is going to come out with a broad health policy. Why can't the broad health policy be discussed with the medical community?

I have said it before and I am saying it again. Our family health plan did not achieve its target because health professionals were not involved in it. You should have involved them emotionally. When the doctor says, you have had your second child now and I want you or your husband to be sterilised, they will do it.

If they can accept our suggestions to have a bypass surgery, they will definitely listen to a doctor's advice on family planning too. But the government has not taken the doctor with them.

Unfortunately, the government has taken the doctor as being on the opposite side of the road, only trying to shoot at him. I don't think the bureaucrats and the politicians will be like this forever. I am sure they are going to see reason.

For every other thing, you need government funds. But in this case, you don't. In fact, the government is going to get money from TDS, excise duties, sales tax, etc. apart from creating employment and bringing in foreign exchange.

I hope the government realises all this as early as possible. I don't think this will go unheard forever. Now they are only hearing Dr Reddy cry. But soon, in five or ten years, they are will hear the cry of the crisis.

Interviews
Budget 2001

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