00:00:03
this podcast is brought to you by Indian
00:00:05
knowledge at Warton please visit
00:00:06
knowledge. won. up.edu India for more
00:00:14
information India imagine was the theme
00:00:17
of the 2008 Wharton India economic Forum
00:00:20
that was held in Philadelphia recently
00:00:22
the dayong event attracted several
00:00:24
leaders including apj Abdul Kalam former
00:00:27
president of India as well as CE EOS of
00:00:30
Indian companies nonprofit groups
00:00:32
Consulting and private Equity firms
00:00:35
Indian knowledge at Wharton brings you
00:00:36
one-on-one conversations with these
00:00:38
leaders today we are speaking with
00:00:40
Sunita ready who is Executive Director
00:00:42
of Finance at Apollo Hospital
00:00:44
Enterprises and she's also on the board
00:00:46
of focused health insurance company
00:00:48
Apollo
00:00:49
dkv uh sonita thanks very much for
00:00:51
joining us today my pleasure uh how has
00:00:55
medical tourism grown over the
00:00:57
years it has grown
00:01:00
uh I wouldn't say substantially but it's
00:01:02
grown by
00:01:03
10% um
00:01:05
initially 10 years ago you know AP poloo
00:01:08
started uh focusing on patients outside
00:01:11
of India and um it didn't happen with
00:01:15
marketing it was more of a pull of
00:01:18
customers towards good quality medicine
00:01:21
rather than marketing and pushing them
00:01:23
through advertising and marketing the
00:01:26
reason that it happened was that around
00:01:28
southeast Asia people people began to
00:01:30
see a value proposition which was high
00:01:33
value in terms of clinical outcomes high
00:01:36
quality Care at one/ Tenth of the cost
00:01:38
of what they would pay in the unit
00:01:40
traditionally pay in the United States
00:01:42
and 1 fifth of what they would pay in
00:01:45
the US and probably onethird of what
00:01:47
they would pay in a country like
00:01:48
Singapore so we started attracting to
00:01:52
patients from all over southeast Asia as
00:01:55
it progressed you know people began to
00:01:57
realize that the India story where
00:01:59
Healthcare was concerned was improving
00:02:02
dramatically just 2 years ago we got the
00:02:04
jci accreditation which is which puts us
00:02:07
on par with
00:02:09
hospitals in the rest of the world you
00:02:11
know shoulder-to-shoulder with the Mayo
00:02:13
Clinic and Cleveland Clinic and with
00:02:16
that we started getting patients from
00:02:17
the West as well um most of them use you
00:02:20
know the internet as a medium through
00:02:22
which you know they fix this uh their
00:02:25
appointments and arrange Consultants
00:02:27
with doctors but again it's it's this
00:02:30
value proposition that is really driving
00:02:32
consumers and I would say that currently
00:02:36
10% of our total revenues come from
00:02:38
medical tourism now that's not really a
00:02:40
large amount and it's grown by 2 to
00:02:44
3% um they are obstacles in the way of
00:02:47
this happening one is that you know our
00:02:50
airport facilities I mean if you look at
00:02:52
the hospitals that are really doing well
00:02:54
they're connected to international
00:02:57
airports and you know they're about
00:02:59
maybe 50 to 60 flights compare us with
00:03:01
Thailand there 260 flights international
00:03:04
flights flying into Bangkok every day
00:03:07
and that makes it really easy for
00:03:09
patients to go to Bangkok for medical
00:03:11
tourism whereas if you compare that with
00:03:14
the Chennai where our largest hospital
00:03:16
is there are about 15 flights and I
00:03:19
think one is you have to look at the
00:03:20
airport infrastructure the second thing
00:03:23
that you really have to look at is most
00:03:25
of the work that comes to India is of a
00:03:27
you know the case mix is is Ser care and
00:03:30
acute care it's not the plastic
00:03:32
surgeries that you see in in a in
00:03:35
Bangkok it's the high-end Orthopedic
00:03:38
work it's Cardiology some of it is
00:03:40
oncology so they come for the really
00:03:43
high-end work and to do that because
00:03:45
we're recognized for that sort of work
00:03:48
to do that it's it is quite
00:03:50
uncomfortable for patients to make this
00:03:52
journey and we need to smoothen out that
00:03:55
process you know the 12 hours and 14
00:03:57
hours and the immigration and Custom and
00:03:59
we're working at that when we now have
00:04:02
people at uh you know to facilitate and
00:04:05
assist these patients as they come
00:04:07
across uh finally I'd like to say that
00:04:10
that there is a huge opportunity here
00:04:13
because if you look at the us alone they
00:04:15
40 million us who are who are not
00:04:18
insured if you look at the UK there are
00:04:20
about 250,000 Asians who are not who who
00:04:25
are in the waiting line with NHS so this
00:04:27
is a huge market and I believe that the
00:04:29
way to address this Market is to create
00:04:32
a package that will enable them to use
00:04:35
Indian facilities we tried talking to
00:04:37
governments and saying you know why
00:04:39
don't you send patients who don't have
00:04:41
treatment who have no options to
00:04:45
India but then again uh we've spoken to
00:04:48
benefits companies Etc I think the only
00:04:50
single hurdle facing the US and foreign
00:04:53
patients coming here is a legal
00:04:55
liability and the fact that they cannot
00:04:58
address uh their concerns through a
00:05:01
legal Forum in the United States whereas
00:05:04
they could use the Indian legal system
00:05:07
but um it's become a way of life that
00:05:10
people want want to have that uh the
00:05:13
legal system to back them up in case
00:05:15
there is a problem now the incidence of
00:05:18
problems is is not even 0 1% so far
00:05:21
because a successfully it's a very good
00:05:23
clinical outcomes are so good and we are
00:05:26
jci accredited and patients have the
00:05:28
same rights that they would in the U
00:05:31
that they would in the US they would
00:05:33
have in India so they are protected but
00:05:36
I think it's it's just a hurdle that we
00:05:37
need to overcome and once we've done
00:05:40
that I think you know we will be tying
00:05:41
up with insurance companies we will tie
00:05:43
up with Benefits companies and to see
00:05:47
how we can we can really assist people
00:05:51
who need that type of healthare have you
00:05:54
seen a discernable increase in in your
00:05:56
Western clientele over the past few
00:05:58
years I know the story story has been
00:05:59
out for a little while now I was just
00:06:02
curious to know if you've seen yes yes
00:06:04
we have seen you know there has been a
00:06:06
rise of about 5% and what do you
00:06:08
attribute that to then if it's difficult
00:06:10
say to to access uh these people through
00:06:14
Insurance programs or through the
00:06:15
government is it direct advertising you
00:06:17
mentioned advertising earlier it's not
00:06:19
at all advertising it's the fact that
00:06:21
you know people are so confident that
00:06:23
their clinical outcomes will be good and
00:06:26
uh it's testimony from patients whove
00:06:29
who've went through the whole process
00:06:31
that is actually like I said it's it's
00:06:32
pulling patience to the system because
00:06:35
uh we don't Market I mean you don't see
00:06:38
advertisements but we are now working
00:06:41
with CI and CIA is a confederation of
00:06:45
Indian industry which is doing the brand
00:06:48
India you know there is a brand India
00:06:50
foundation and they have a come they
00:06:52
have a campaign called incredible India
00:06:55
so I work with them and we are now doing
00:06:58
experience Indian Health care and it's
00:07:01
just launched you know we just launched
00:07:02
that campaign and hopefully we'll see a
00:07:05
lot of results happening from that great
00:07:08
uh your program uh combines uh elements
00:07:12
of both Western care and also Eastern
00:07:14
medicine I no this in a lot of your
00:07:15
materials you advertise the point that
00:07:17
there's centuries of Eastern Medical
00:07:19
Practice that you rely on as well can
00:07:21
you talk specifically about how some of
00:07:23
those things what some of those elements
00:07:25
are yes now we do believe in an
00:07:28
Integrated Health care uh package in
00:07:31
that sense we talk about allopathy in
00:07:35
you know for the actual treatment in
00:07:37
terms of surgery um diagnosis Etc but
00:07:41
where rehab is concerned and where
00:07:43
well-being in is concerned we you know
00:07:46
we've tried to integrate the systems of
00:07:48
ayurva and yoga and uh it has helped
00:07:52
because when patients go back they need
00:07:55
to readjust to a lifestyle that talks
00:07:57
about continuous well-being
00:08:00
being and um and really I think the key
00:08:04
here is um I believe there is a lot of
00:08:07
value that we will get from ayura and
00:08:10
and yoga certainly a big Market in the
00:08:13
US too now or at least a growing Market
00:08:15
it is it is uh it's it's strange but
00:08:19
when panjali discovered yoga thousands
00:08:21
of years ago there were very few Indians
00:08:23
practicing it and now that it's such a r
00:08:26
6% of the world today practices yoga
00:08:29
and a lot and it's become famous because
00:08:32
it's you know the movie stars in the
00:08:35
west and uh people all over America are
00:08:38
doing it and now it's come back to India
00:08:40
and people are now saying okay it should
00:08:42
become a way of life Aura is the science
00:08:46
of life right so you're you are one of
00:08:49
the largest Health Care Systems in in
00:08:51
India correct yes we largest and so I
00:08:56
guess one question would be uh about
00:08:58
your community ini do and how you're
00:09:00
reaching out to poor populations can you
00:09:03
tell us a little bit about sat which
00:09:06
which the acronym stands for save a
00:09:08
child's heart and maybe some of your
00:09:10
other community initiatives as well yeah
00:09:13
uh I'll start with such uh such is save
00:09:16
a child's heart it also means the truth
00:09:20
in Hindi um the reason that we started
00:09:24
such is that you know we came across so
00:09:26
many children who had heart disease and
00:09:29
we believe that if an intervention at
00:09:32
that stage you know when the child is
00:09:34
Young will give them a more productive
00:09:36
future so we said let's do something for
00:09:39
children and make them productive adults
00:09:41
because that's what India really needs
00:09:44
and um we started this Foundation where
00:09:46
the hospital does everything free of
00:09:48
cost the consumables act the money for
00:09:51
the consumables come from
00:09:53
donations and uh people have really done
00:09:57
you know have donated in a large way
00:09:59
so far we've completed 500 free
00:10:02
surgeries and our Target this year is to
00:10:04
do 1,000 every year and the surgeon does
00:10:07
not charge and the hospital does not
00:10:09
it's just 50,000 Rupees for the
00:10:11
consumables which come as a donation so
00:10:14
people find it not so difficult to give
00:10:17
a check for 50,000 especially when you
00:10:19
know you're saving a child's life and
00:10:21
you're assuring him of a good future
00:10:24
ahead sure the second thing that we do
00:10:26
is this Outreach to at a village level
00:10:29
you know where Healthcare is not
00:10:30
available we really wanted to create a
00:10:33
sustainable model not really to do it as
00:10:36
Charity but create something that was
00:10:38
sustainable for the future so we uh in a
00:10:42
small village in chur in fact your
00:10:45
President Bill Clinton inaugurated this
00:10:48
initiative out of aragonda we set up a
00:10:50
small Hospital which was a primary care
00:10:53
facility we connected it through tele
00:10:55
medicine through our T to our tery Care
00:10:58
Facility
00:10:59
so and then we created an insurance
00:11:02
product which was one 1 rupee a day
00:11:04
which allowed people access into the
00:11:07
primary facility so what would happen is
00:11:09
if they fell sick they would be treated
00:11:11
here they wouldn't have to pay anything
00:11:13
except for the one rupe a day 325 rupees
00:11:17
um and they would be if they needed some
00:11:19
tertiary care work they would be
00:11:21
connected via Tel tele medicine to our
00:11:24
specialist in the main hospital and they
00:11:27
would only have to travel or come come
00:11:29
to the city when they needed acute care
00:11:33
and I think it was it's an excellent
00:11:35
model currently we have 64 tele medicine
00:11:39
centers that connect us to you know to
00:11:41
many centers in India and we are going
00:11:45
to work on this model and set up more of
00:11:47
these Primary Care initiatives the third
00:11:50
thing of course that we do are these
00:11:52
camps where we go into the villages and
00:11:54
Screen them for cancer and you know
00:11:57
India is the only country where cical
00:11:58
can cancer still exists and oh cancer is
00:12:02
a big it it the numbers are just growing
00:12:05
exponentially and we believe that early
00:12:08
intervention and screening is one of the
00:12:10
ways to check the growth and you know
00:12:13
mortality from cancer so there are many
00:12:16
camps that we do out you know from each
00:12:19
of our hospitals that have to do with
00:12:21
cancer screening the fourth of course is
00:12:23
to do with Wellness because preventive
00:12:26
Healthcare is a big as aspect of
00:12:29
healthcare you know it will be a$1
00:12:32
trillion industry in the next 5 years
00:12:35
and without looking at it from the
00:12:37
industry Viewpoint I think healthcare
00:12:39
education is important and AP poloo
00:12:42
tries to do that through its preventive
00:12:44
healthare schemes and our uh Outreach
00:12:47
programs where we do these checkups in
00:12:50
villages right now what would you
00:12:53
identify as the biggest challenges
00:12:54
facing the industry looking forward I
00:12:57
think you know two challenges is the
00:12:59
main of course is skilled Manpower the
00:13:01
fact that the government has not allowed
00:13:04
for the corporate
00:13:06
corporatization of of you know colleges
00:13:10
they still function at a trust level
00:13:13
which means that you know people either
00:13:15
pay capitation fees and the number of
00:13:17
seats are so limited by state
00:13:20
governments health is a State subject so
00:13:23
there's a dichotomy there whereas it
00:13:25
should be something that you know
00:13:27
there's a central policy on on it's not
00:13:29
a fundamental right that people get
00:13:32
healthare you know it's it it is very
00:13:35
much so in each state there's a separate
00:13:37
policy and I believe that the need for
00:13:40
healthcare education is tremendous one
00:13:42
is for for people to learn about
00:13:44
healthare the second is of course is to
00:13:47
get skilled manp part and I think that's
00:13:49
a huge challenge because now our nurses
00:13:51
are going to the us our doctors are
00:13:53
migrating to the US they're going they
00:13:55
have been going to the UK in the us
00:13:57
alone you have 40 ,000 of the doctors
00:13:59
trained in India at a subsidized rate
00:14:02
because these hospitals are trust
00:14:04
hospitals and they they really don't pay
00:14:07
that much but um we we really need to
00:14:10
double the capacity in terms of training
00:14:13
colleges because if we going to create
00:14:15
the 880,000 beds that are required for
00:14:17
us to meet the wh Norms then we need to
00:14:20
staff those 880,000 beds I think the
00:14:23
second issue has to do with uh with the
00:14:26
high cost of real estate because set up
00:14:29
a hospital um you need real estate you
00:14:31
know you need land and uh the way the
00:14:35
prices have almost doubled traditionally
00:14:37
it was 40% of project cost and now it's
00:14:39
moved to 65 and I think we need to set
00:14:42
up a healthcare reat like you have in
00:14:45
the US to overcome this hurdle right
00:14:48
well thank you very much for speaking
00:14:49
with us today you're most
00:14:53
welcome for more information please
00:14:55
visit knowledge. won. up.edu
00:14:59
SL
00:15:03
[Music]
00:15:05
India
