India Healthcare- IXP

Feb-22-2011 by
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This past January 33 HBS students traveled to India as part of the Healthcare Immersion Experience Program with faculty leader Richard Hamermesh. During this 10 day program, students traveled to Delhi, Bangalore, and Mumbai to learn first-hand how healthcare is delivered in India.

From meetings with government officials, entrepreneurs, local hospitals and clinics, consulting firms, venture capitalists and NGOs, students developed a comprehensive understanding of the strengths and challenges of India’s health system.

The program began in Delhi. Upon our arrival at Delhi’s newly constructed airport, we were immediately struck by the beauty of the classical hand gestures, or “Mudras” which have various meanings including blessing, joy, charity and service. Sculptures of gestures were on the wall above customs bestowing blessings on travelers while they waited in line. After traveling through customs rather quickly, we were able to easily find a taxi and begin navigating the traffic heavy streets of India’s capital.

In India where road lanes are mere suggestions and car horns are modes of frequent communication among drivers, countless activities flooded the streets. We drove by pedestrians, rickshaws, motor bikes, government cars, dogs, camels, and cows; the streets of India were consumed with activity.

The 45 minute drive to the hotel from the airport allowed us time to take in all the surroundings. We passed by barren lands, greenery districts, homes on the side of the roads made out of rubbish, beautiful modern hotels, families sleeping on sidewalks, and large amounts of discarded waste which covered parts of the city. The air was filled with various substances and a thick foam of fog engulfed the city.

During our travels we saw people from all walks of life and a unique blend of traditionally Indian and western culture. Some women were dressed in beautifully beaded saris with only their belly or eyes uncovered, while men were dressed in jeans and sweaters and covered their heads and mouths with turbans or scarves. The population appeared very diverse.

Charged to develop an early stage business idea for healthcare delivery in India, the program began with presentations from two government officials in Delhi’s most famous business hotel, The Taj Palace. [The Dalai Llama just happened to be staying there with us!] The presenters laid out the framework for India’s healthcare infrastructure and identified major gaps in how Indian healthcare is delivered. Patient beds, technological resources, educational health facilities, and healthcare professionals were some of the pronounced deficiencies in the system.

To round out the research presented, we were then broken up into groups to focus on the needs of three distinct populations within India: base of the pyramid, middle class, and in-bound medical tourist. Graciously hosted by some of the most reputable hospitals and clinics in India, including Amar Jyoti, Sir Ganga Ram, Apollo, Fortis, Nova Medical Center, St. Johns Hospital, the Asian Heart Institute, and Narayana Hrudayalaya, among others, we had the opportunity to interact with and learn from founders, CEOs, leading physicians, and patients.

Prior to the program we were assigned HBS cases about the companies we visited. When we arrived the discussion circled around the companies’ mission verses profitability, economic and personnel structure, physical layout and areas for improvement and expansion. Presentations and discussions were then followed by a tour of the facility, which afforded us a snapshot of the many flavors of healthcare in India.

As the 10 day program progressed, we traveled from Delhi to Bangalore and then Mumbai. We conducted field-based research by interviewing people on the street in addition to company visits. The goal was to solidify our understanding and gain further perspectives on the care needs of a specific population segment. To consolidate the data received from both company visits and field based exercises, we presented our observations to the larger group during the afternoon learning focus meetings.

One of the most striking hospital visits was to the Narayana Hrudayalaya health city where we met with Narayana’s visionary, Dr. Devi Shetty. This health city has 5,000 beds on one campus and is comprised of several super-specialty hospitals that focus on areas such as cardiac surgery and oncology. By comparison, MGH has 870 beds. Economies of scale, along with lower physician salaries, malpractice and CapEx costs, allow the Narayana hospitals to deliver high quality care at a fraction of the cost of hospitals in the US. For example, whereas heart surgery costs approximately $130,000 in the U.S., the same procedure costs $5000 in India. Dr. Shetty described his vision for continuing to drive the costs down for these procedures to dissociate access to healthcare from affluence. We concluded the visit with a tour of the pediatric cardiac surgery ward. This ward housed 50 small children recovering from cardiac surgeries, making it the largest pediatric cardiac surgery ward in the world by its volume.

Our company visits included a meeting with the Co-Founder and CEO of the award-winning social venture, Healthpoint Services, Amit Jain. As Mr. Jain explained Healthpoint seeks to profitably address the needs of customers at the base of the pyramid by providing quality access to licensed doctors, state-of-the-art diagnostics, approved drugs and clean water. The company builds profitable telemedicine clinics for primary care in rural areas where patients can be video linked for less than $1 per visit. The clinics generate foot traffic by serving as the much-needed centers for clean water distribution.

Perhaps most touching was a final visit to the Dharavi slums, profiled in the movie Slumdog Millionaire, and home of an estimated 9 million Mumbai residents, making them the largest slum in Asia. Our host Dr. Khembavi, a native of Dharavi, afforded us a unique insight into the inner workings of this vibrant, vital neighborhood in Mumbai. After learning about Dr. Khembavi’s inspirational path from slum-dweller to physician, we toured local homes, schools, and hospitals. The hopeful, hard working residents explained to us how they save money from each meager paycheck for anticipated healthcare expenses. We were shocked to learn that the small 100 square foot residence we visited could sell for $60,000 USD. As a result, many of the city’s middle class inhabitants, such as teachers and accountants, live in the slums.

Our conclusions about Indian healthcare presented many contrasts. Despite its rapidly growing middle class and vibrant economy, India retains very few doctors and lacks the resources needed to provide quality healthcare to the majority of its population. However despite this contrast, India leads in cutting edge research, maintains a predominately consumer-driven healthcare system and generates among the highest success rates for surgery in the world.

Ultimately the trip gave us the opportunity to explore the realities of India’s healthcare system and apply our findings to deliver a business idea that could offer solutions to India’s far-ranging healthcare needs.

While our principal goal was learning focused, we also had the opportunity to explore India through a variety of activities and group meals along the way. “This program provided us with a once-in-a-lifetime chance for some personal development and renewal for us all as we immersed ourselves in India’s exciting culture and examined real life situations. It was truly a fantastic experience to see India’s healthcare system first hand and from multiple perspectives.”  – Professor Richard Hamermesh.

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