Will a doctor ever want to be in the insurance business? After all, doesn’t every new operation, add to a surgeon’s income and every denied procedure an addition in the profits of an insurance company? But then, Dr Devi Shetty, founder chairman of Narayana Health and one of India’s leading cardiac surgeons says, “in all my 33 years back in India the whole discussion was around affordable healthcare and cost reduction. But today, any further lowering of costs in medical procedures will be at the cost of quality and since we cannot compromise on the quality but do still need to make healthcare affordable, the only option available is affordable health insurance.” The hope for the country now, the doctor reminds, “is not universal healthcare but universal health insurance.”
Explaining the confluence of factors – ranging from the changing cost dynamics, increased patient awareness and a proactive regulator – that led to his renewed interest in medical insurance yet again after 17 years, he says, “about two months back (around July) we applied for a licence to set up ‘Narayana One Health’ as a 100 per cent subsidiary of Narayana Health and we do hope that we get the regulatory approval and license in a few months.”
Ask him about what difference it will make and there is a palpable sense of excitement. He says, “we will unfold a new model of integrated care with presence across primary, secondary and tertiary care.” For this, he says, “we are setting up a chain of primary clinics and have already set up around 10 in Bengaluru and adding more.” For not only do people typically not like going to a hospital and are more comfortable in a clinic, many do not necessarily need to visit a hospital also. This model, he explains, is about managed care that covers people right from the primary care level. Given the medical expertise within the group, the emphasis would be on ensuring prevention but would also involve taking care in cases where medical intervention and tertiary care is required. Add to it all, the emphasis on affordable health insurance, will ensure making suitable product offerings and options. What also needs a mention is the leadership that Dr Devi Shetty is putting in place. He already has an insurance industry expert Ravi Vishwanath leading Narayana’s foray into insurance. Many in the insurance arena know Vishwanath by his earlier role at HDFC Ergo.
The aim in insurance, says Dr Devi Shetty, is not to go for an aggressive launch nationally but to stay more sure -footed and grow gradually. “We will start off in Bengaluru and gradually expand to other states,” he says.
To Dr Devi Shetty, the interest of Narayana in insurance was triggered by a proactive regulator and the trust deficit that prevails among the three crucial stakeholders in healthcare – hospitals, insurance companies and patients. “Hospitals and insurance companies do not trust each other and the patient does not trust both the hospital and the insurance company,” he says.
Seeing a new reason for hope in an engaged and proactive insurance regulatory authority – the Insurance Regulatory and Development Authority of India (IRDAI) – he sees a regulator keen on seeing an increase in the depth of insurance penetration in the country (today at just around 4 per cent) and to have all covered by 2047. It is perhaps with good reason for the doctor is enthused enough to say: “In five years, India will become the first country in the world to disassociate healthcare from affluence with family wealth having little connect with the quality of healthcare and a large number of insurance players offering a range of products.”
As for his integrated model and its rollout, one may have to wait and see how it pans out. But then, there is no denying that over the years, Dr Devi Shetty has tended to attempt newer approaches to existing problems. One example of this emanates from conversations with Dr K Kasturirangan. In the late 1990s when telemedicine was not known as widely as it is today, Dr Devi Shetty along with Dr Kasturirangan, the then chairman of ISRO (Indian Space Research Organisation), tried looking at using satellites to provide telemedicine. This was even before adequate satellite bandwidth was available.
But then, today Dr Devi Shetty seems confident about the difference newer models backed by a regulator keen on increased insurance penetration can being about. Many would be hoping he is proved right.