The Healthcare Debate…and what we could learn from a Hospital in rural India

Watching the anguish and fury in Britain at changes to the National Health Service this week, I couldnt help but think of a hospital I visited in south India once.

When it comes to healthcare, you don’t tend to think of India as a model. Government hospitals are notoriously poor. A friend of mine nearly died recently because the doctors failed to diagnose appendicitis — until it burst.

But Aravind Eye Care is different. With just eight hospitals, it performs more than half as many cataract operations as the entire British NHS each year. In 2011, it handled 2.6 million outpatients and carried out 300,000 operations, two-thirds of them free or heavily subsidised.

And yet it receives no government or taxpayer funding, no money from NGOs or donors. It is entirely self-funding.

The system is simple: patients choose between free healthcare, which comes with no frills, or paying for luxuries, such as a private room. The hospital uses the profit it makes from the paying patients to fund its free operations.

All the patients get the same healthcare: the same doctors, same nurses, same operating theatres and diagnostic tests. What you get for paying is better accomodation and food, and to shorten the waiting time. There is no means-testing or assessment. Patients choose whether they want to pay or not.

Dr V (Photo credit: Wikipedia)

Aravind was built up from nothing by Govindappa Venkataswamy — known to everyone as Dr V — a retired doctor who mortgaged his family home to start it. He began with an 11-bed clinic. He told a team of visiting foreign doctors that one day he would have a 100-bed hospital like theirs. They laughed.

Today Aravind has eight hospitals. The largest has 1,380 beds.

Whenever the healthcare debate comes up, the British and the Americans seem to have trouble getting past demonising each other’s systems. Each holds the other up as an example of the nightmare that will ensue if changes are made.

To the British left, private health companies and the profit motive are evils that will reduce healthcare to a privilege of the rich, bleed people dry financially and leave the poor to die.

To the American right, state-funded healthcare will result in filthy, inefficient hospitals where money is wasted while people die for want of proper care.

The British in particular talk as if there were  only two systems conceivable, and any change to the NHS would amount to ushering in an American system.

In India, Dr V found a way to make the profit motive serve the principle of free healthcare. He saw that India’s goverment healthcare was unable to tackle the problem of curable blindness. Indians are genetically prone to cataracts. In the villages, Dr V said, blindness was a terminal disease: if you couldn’t see, you couldn’t work, and if you couldn’t work, your life, and the lives of all those who depended on you, were in danger. Ignoring the ideological debate between left and right, he set out to solve the problem by whatever means necessary.

He wasn’t interested in profit for himself or for shareholders. He wanted profit because it funded his work. From the start, he hired a business manager from the private sector and told him he wanted the efficiency of a private company.

He took the virtues of the private sector — efficiency and high productivity — and married them to the principle of free healthcare.

But then Dr V was a remarkable man. I had the privilege of meeting him once. As a young man he was struck with rheumatoid arthritis, a crippling disease that left his hands permanently disfigured. He was told he’d never work as a surgeon again. He retrained himself to hold the instruments with his twisted hands, and carried out over 100,000 delicate eye operations.

I’m not saying we could transplant his model from India to Britain, or other Western societies. But we might be able to learn something from it.

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