First and foremost, the government should become a health insurance provider than a healthcare provider. Can the government run a software company or a hotel? They can’t: these are complicated businesses. Believe me, healthcare is a hundred times more complicated than these businesses. When we suggest that the government should become a health insurance provider, we are not talking about Mediclaim type of insurances with Rs. 2,000/- premium. We are talking about health insurance where the premium is 5-10 rupees per month. Six years ago when we launched a now well-known programme, called Yeshaswini micro-health insurance, with a premium of five rupees per month, everyone laughed at us. Today we have 3 million farmers subscribing to the scheme by paying five rupees per month, and the scheme has been adopted all across the state. Andhra Pradesh changed the model slightly with the government paying the entire premium for the BPL cardholders. We are opposed to the idea of poor people not paying anything. We want them to contribute a tiny amount of money in installments. But for this to happen, the government should create a vehicle for people to pay a small amount whenever they can.

The government should not try to make money at the cost of people’s health. Today when you pop a pill or you get a heart operation done, nearly 20-25 per cent of the money goes to the government. Technically speaking, when more people fall sick in India, the government earns more money. For the next ten years if the government comes up with a policy so that it doesn’t earn money from the miseries of people who are hospitalised or unwell, healthcare costs can go down significantly.

Without large investment in the healthcare industry, it will remain a mom and pop operation. The largest corporate chain of hospitals in India has a revenue of just 800 crores — in fact, some Maruti spare parts dealers have higher revenues. If the economy of scale is to reduce healthcare costs, the industry has to grow hugely. For this, the government must give the healthcare industry infrastructure status so that, like others, it can borrow at low rates and repay over a 10-20 years period. Tax holidays, which are given for hospitals in non-metros and outskirts of the city should be extended to every new hospital all across the country.

There are many international agencies which fund large healthcare projects provided these projects are backed by sovereign guarantees. The government could guarantee this programme, since in case of default, they have the large assets created by these hospitals. Sovereign guarantee loans come with a very low interest and the repayment period is over 10 years. Currently only government hospitals enjoy this line of credit. This should be extended to large-scale projects with over 2000 beds. Major reforms are required in medical education. Currently, our medical education system allows less than 10 per cent of the graduating doctors to become specialists. Even though we produce one of the largest number of doctors in the world, a very small fraction of them become medical specialists, which is going to be a major problem in the near future. We need to create thousands of training positions for surgeons, physicians, diabetologists, nephrologists etc. Major tax incentives should be given to industrial houses to set up large-scale hospitals in the Northeast, where the political situation makes it difficult for investment to change the healthcare dynamics in the region.

If the last century was driven by machines which address human toil, the healthcare industry will drive the economy in our time. Today healthcare is the rare industry that generates employment in America. For a turnover of a quarter of million dollars they barely require five to seven people, whereas for the same quantum of revenue in our industry, we need to hire 250 people. Our workers are semi-skilled and unskilled people; most of them are nursing staff. They have no options but to work in India, given their skill levels. In terms of job creation, our policymakers must look at healthcare as an industry which is going to contribute significantly in the area of equitable growth by creating millions and millions of jobs.

The writer is a cardiac surgeon and has designed Karnataka’s low-cost health insurance scheme, ‘Yeshaswini’.