RAVI’S BLOG-CARDIOLOGY AND CARDIAC SURGERY IN INDIA
Introduction. By Pierantonio Russo, MD, FAAP, Cardiology and Cardiac Surgery-July 2010
Medical standards have advanced very rapidly in India over the past 25 years, particularly in cardiology and cardiac surgery. The rising middle class, the solid economic growth (9% GDP/year), the nearly universal coverage provided through government insurance, growing access to private insurance and the presence in India of employees from US and other western companies, particularly in Chennai, have triggered an explosive demand of modern health care services and hospital beds. Currently, an estimated 6 million patients need cardiac surgery in India and the number of total cardiac operations has increased to 70-80 thousands per year. In my several visits to India on behalf of GOLI, I found that there are about 1,000 cardiac surgeons in India, practicing at about 175 centers. However, the number of well equipped hospitals to meet current needs of patients requiring cardiac surgery need to grow. In selected private, “corporate”, hospitals, cardiology and cardiac surgery procedures are practiced with excellent results. Some of these selected Centers, are accredited by the international branch of the JCAHO (JCI). The JCAHO is a branch of the agency that reviews hospital standards in the US and certify that the hospitals meet quality standards. JCI accredited hospitals in India, now treat international patients, including American citizens, under the banner of “international tourism”. Some USA health care plans, (for example, Well Point) have included some of these hospitals within their extended network.
Surgery for complex congenital heart surgery in children are performed in ten Centers in India with good results, but the number of operations is insufficient to meet the national need, estimated at about 1,5million.
In the first article of his new blog, Ravi’s blog, Dr Ravi Kumar, one of the leading cardiologists in Chennai, and GOLI’s partner physician, gives us his perspective on the current status of cardiology in India. I am sure that you will enjoy reading it
By Ravi Kumar, MD-Chennai India-July 2010
The following patients’ stories showcase the mix of highs and lows and the realities of cardiac services in India – a land of stunning contrasts. Highly complex and modern surgery is now practiced in selected hospitals by specialists who do a lot of high volume work at low fees.
KS REDDY (KS) had led a fairly uneventful 58 yrs of his otherwise humdrum life in Bangalore, South India. He had been underplaying his occasional giddiness and shortness of breath which he had experienced on his rare walks up the 10 steps to the shopping mall. Otherwise, “KS “had had a comfortable life with his lucrative textile business. It was on a visit to the nearby city of Chennai for a wedding that he fainted and was admitted to one of the superspeciality hospitals there. The cardiologist told him that he had a 5 cm large cancer blocking one of the valves of his heart, along with an irregular heart beat, and that he would need a detailed heart evaluation. This would include a coronary angiogram (picture of his coronary arteries) and an electrophysiological study (test the electric function of the heart) . For KS the cost was not a factor. Also he had 10,000 USD worth of health insurance. However, he was from Bangalore, so he chose to find a hospital there. Not a big problem since that city had 6 large hospitals offering the services that he needed. He checked into one of the private hospitals and chose a deluxe suite, where his relatives could attend on him .The next day he had a coronary angiogram and the cardiologists were able to fix his irregular heart beat with a procedure called ablation. Then, the cardiac surgeon removed the cancer from his heart valve and performed several bypasses (CABG) on his blocked coronary arteries. KS was back home in a week. The total hospital cost was 10,000 US dollars, fully covered by his health insurance for which he had been paying a premium of about 300 US dollars a year for last 5 years. The same multiple procedures in the US cost above $100,000.
Chami was a manual laborer in the remote district of Theni, in the State of Tamil Nadu, India. Aged 60, he had been ill for years. He was diagnosed with severe block of one major heart valve and an aneurysm (enlargement and weakness) of his aorta, the major artery of the body. He also had a narrowing of two coronary arteries, and a narrowing of his carotid, the artery supplying blood to the brain. He needed a fairly complex mix (hybrid) of surgical and catheter based interventions (endovascular procedures). In more details, he needed replacement of the heart valve, coronary artery bypass, and replacement of a major portion of the aorta, including the aortic root and the aortic arch, from which the arteries to the brain take off. Finally, he needed the placement of a stent graft to the aorta, via the groin. This was a huge technical and clinical challenge by any International standards, requiring a team of highly trained cardiac surgeons, interventional cardiologists, anesthesiologists and intensivists (for the postoperative management). Only problem, Chami‘s family lived on $ 2 a day in a hut and had no assets. However, since he lived in the “relatively” progressive state of Tamil Nadu that recently had introduced universal health coverage for cardiovascular services, he underwent the complex surgery in a hospital in Chennai. The waiting time to be scheduled for surgery was only 14 days. The State paid the hospital $3,000 US that covered all the procedures that Chami needed and for his postoperative care. The doctors performed the procedures for free. Chami left the hospital in a week. A similar procedure in the US cost not less than $ 150,000.
Specialized Cardiac Services in India – a short history:
The first open heart operations in India were done in Delhi and Chennai in 1969, relatively “early” by third world standards. After achieving independence in 1947, India could count on a large number of Medical Colleges started by the British from 1870 onwards. These were concentrated in large cities, like Calcutta, Chennai (Madras), Delhi and Bombay. In the 70’s three major Indian hospitals started offering a formal training program for cardiologists and cardiac surgeons: All India Institute of Medical Sciences Delhi, Southern Railway HQ Hospital Chennai and Christian Medical College Hospital Vellore. These Hospitals trained scores of specialists who also received advanced training in USA, Australia, and UK, especially with Dr Albert Starr in Oregon, Dr Cooley at the Texas Heart Institute, Texas, the Cleveland Clinic Ohio, the Royal Adelaide Hospital Australia and HSC Great Ormond Street, London.
In the 1980’s the Indian Government in its “Centres of Excellence Programs “ started the three years Doctorate of Medicine ( DM) for Cardiologists and Master in Surgery ( Mch) for cardiac surgeons. The trainees were trained by the first generation of foreign trained specialists. The development of large corporate multispecialty hospitals followed in the 1990’s with big names like Apollo, Fortis and others. Nowadays, selected private hospitals, with an average 300 beds, perform 1000 heart operations a year and about of 2000-3000 catheterizations and cardiology interventions.
QUALITATIVE FEATURES OF THE CURRENT ADULT CARDIOLOGY SERVICES IN INDIA
- Availability of large number of specialists in the major Cities, providing improved access to services in private hospitals at low costs.
- Consumer’s choice of “hotel hospital facilities” in private hospitals. Different “package rates “for different procedures reflect different hospitality services (room accommodation): single room, double, deluxe rooms. However, the standard of medical care is the same across the various package rates.
- Use of “concierge access” for all patients, via physician cell phones and e-medicine (email)
- Personalized care. Very close patient-physician relation. This also accounts for a very low medical litigation rates in a large Country of 1.2 billion population.
- Increasing availability of modern technology in private hospitals. The increasing strong and liberalized economy has allowed access to modern equipment. The limiting factors to widespread adoption of modern technology are cost and the training necessary to operate new equipment.
- JCI accredited hospitals. Increasing number of hospitals in India is opting for JCI accreditation offering proof that outcomes and operational processes meet US and international standards.
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