MELISSA BLOCK, HOST:
Cardiac surgery in the U.S. can run hundreds of thousands of dollars. A state-of-the-art medical center in Bangalore, India, performs open heart surgery for a fraction of that. The majority of operations there are steeply discounted or free of charge. NPR's Julie McCarthy introduces us to a surgeon who is rewriting the rules of affordable, high-tech cardiac care.
JULIE MCCARTHY, BYLINE: We scrub up and step into a world where Dr. Devi Shetty says he never gets tired...
(SOUNDBITE OF MEDICAL DEVICE BEEPING)
MCCARTHY: The operating room. Shetty joins a team of doctors performing surgery on 6-year-old Nitha Nisar, magnifying lenses perched on his nose. Shetty says the child has a leaking heart valve.
DEVI SHETTY: Repairing the child's heart valve - it requires lot of expertise. It is done in very few centers across the world. And we have done thousands of them.
MCCARTHY: Shetty is Buddha-like calm. Nothing of the nail-biting tension of TV hospital dramas here, Narayana Health, the center he founded. The gurgling heart-lung machine does the work of Nitha's stopped heart. Monitors keep a metronome-like rhythm, and music infuses the air.
(SOUNDBITE OF MUSIC IN OPERATING ROOM)
SHETTY: Music is very soothing because the operation lasts six hours, eight hours, 10 hours. You need to create that environment.
(SOUNDBITE OF MUSIC IN OPERATING ROOM)
MCCARTHY: Shetty also insists that young surgeons at this teaching hospital attend painting classes to learn to treat instruments like paint brushes. Ultimately, we are all artists, he says.
SHETTY: Because of the huge volume - because the number of operations we perform on a daily basis, we have developed phenomenal skills.
MCCARTHY: Shetty says it's why they have good outcomes. He speaks huddling over the spliced open chest of the child.
SHETTY: Now I'm trying to close the opening we created to repair the valve. These are the fine sutures made up of a material called Prolene.
MCCARTHY: To cut costs, Shetty assessed the price of the sutures supplied by a multinational company.
SHETTY: Every year, the product price goes up by 5 percent, 10 percent. And the revenue of people doesn't go up by 5 percent, 10 percent.
MCCARTHY: Shetty switched to a cheaper Indian brand, spurred competition and made savings.
SHETTY: Huge saving - huge, huge saving.
MCCARTHY: Some doctors complained that the cost-cutting compromises quality but say they use their skills to overcome any shortcomings. Shetty has slashed costs on everything from the operating table to the lighting, all from American or European companies.
I understand you're a very tough bargainer.
SHETTY: I'm not negotiating on my behalf. I'm negotiating for the man who's selling his house to sleep on the hospital bed.
MCCARTHY: Selling a home, a cow to pay for a hospital stay is not uncommon. While health care in India is universal, coverage and quality are spotty. And most Indians still don't have insurance.
SHETTY: So it's my duty to give him at the best price.
(SOUNDBITE OF MUSIC IN OPERATING ROOM)
MCCARTHY: A flutter of excitement ripples through the OR as Nitha's heart begins to pump on its own again.
SHETTY: Show them, yeah. You can see the heart. It looks like a happy heart now.
MCCARTHY: Success.
SHETTY: God's grace.
MCCARTHY: Shetty deflects compliments the way one of his former patients, the late Mother Teresa, might have. He calls the tiny nun a Nobel laureate, a towering influence on his life. From Shetty's glass-walled OR, I peer into a row of active operating theaters. Fifty-eight surgeons work six days a week here, stitching back life into broken hearts for a fraction of what they might earn at a premier private hospital in India or in the U.S.
NARAYANA RAJAGOPALAN: You know, there are certain things that in life, you know, you just do only once.
MCCARTHY: Pulmonary critical care specialist Dr. N. Rajagopalan came home to treat his fellow Indians, quitting a $350,000-a-year practice in Miami.
RAJAGOPALAN: It's precipitous fall from that year (laughter). But as I said, I think health care is a mess everywhere. I think whatever Dr. Shetty has been doing is remarkable.
MCCARTHY: Devi Shetty says Narayana's profits are poured back into the enterprise, which now has 29 hospitals in India and one in Grand Cayman. The volume of surgeries - 14,000 last year - have drawn comparisons to the assembly lines of Henry Ford.
SHETTY: It's pointless building boutique hospitals where one surgery or two heart surgeries are done in a day. We need to have few hospitals, but these hospitals should do very large number. Then your quality improves, cost goes down.
MCCARTHY: So Henry Ford's not a bad model.
SHETTY: Oh, not at all. This is the way forward for the world.
MCCARTHY: Shetty contends people are entitled to cardiac care, regardless of how little they earn.
SHETTY: We have never refused a single patient because they have no money.
MCCARTHY: The fees from the rich offset the costs for the poor. Patients with money pay several thousand dollars for open heart surgery. But patients with little money - and little hope of raising any - pay very little. They are 60 percent of the cases. The head of the charitable trust wing, Lakshmi Mani, says there's no complicated means test to determine who's eligible for free surgery.
LAKSHMI MANI: One look at them, we can make out they are poor. They don't have the money. And once we start doubting their credential, there's no end to it.
MCCARTHY: But the hospital is tougher on a male child who needs surgery. Shetty figures in a culture that puts a premium on sons, families of boys will somehow raise the money. A girl child in India, however, is far more likely to die before the age of five for lack of adequate food and medical care.
SHETTY: They will never raise the money for a girl child. So if it is a girl child, we talk to them very politely. And the moment they start asking tough questions, we tell them don't bother. You don't pay anything. We'll take care of the child.
MCCARTHY: Cardiac disease is on the rise in India. The chief's office is a revolving door of stricken breadwinners and babies.
SHETTY: More than 90 percent of the heart problems in children are correctable. Six-hundred to 800 children are born every day with a heart problem.
MCCARTHY: Baby Aswin was fortunate to get treatment. Ninety-five percent don't.
(SOUNDBITE OF CHICKENS CLUCKING)
MCCARTHY: Amid the clamor of chickens and children, the wide-eyed infant recovers at his uncle's house. Anjali Subramaniam cradles her son in her sari and talks the ordeal that left a scar the length of his tiny chest.
ANJALI SUBRAMANIAM: (Speaking foreign language).
MCCARTHY: The father's meager $5-a-day wage meant that the infant's surgery was done for free. But expensive incidentals were not covered. Anjali's brother scraped together $1,000 for those, saying, Dr. Shetty cares for the poor like us. Anjali says her son has been given a second birth.
SUBRAMANIAM: (Speaking foreign language).
MCCARTHY: We see the doctor as a god, the young mother says. And that hospital for us is a temple. Shetty is overturning how cardiac care gets apportioned in India, whether it's addressing gender bias or redistributing care to the poor. The hospital's break-even point for surgery is $1,200. Shetty wants to cut that in half.
SHETTY: Like we get oxygen, air and water, health care should become available to everyone on this planet, naturally.
MCCARTHY: Devi Shetty predicts that in India will become the first country to disassociate health care from affluence. Julie McCarthy, NPR News.