"Treatment Outside Hospital - Future of Healthcare": Dr Prathap C Reddy, Chairman, Apollo Hospitals Group

Sep 01, 2020

NEW DELHI, 01 September 2020: Dr Prathap C Reddy, a cardiologist and an entrepreneur who founded the first corporate chain of hospitals in India, the Apollo Hospitals, is rightfully called the architect of modern Indian healthcare. He recently took time off his busy schedule to talk to Ms Naina Lal Kidwai, Past President, FICCI, for the FICCI Fast Forward series. Excerpts:

Ms Naina Lal Kidwai: Let me start by thanking Dr Reddy. We are so fortunate to have someone with his vision joining us in this important series of FICCI Fast Forward where we look at the future and, in this case, we are looking at the future of healthcare. The FICCI Fast Forward approach is one that gives us insights into many industries. Dr Reddy is one of the brightest minds, the greatest visionaries, an entrepreneur, also a doctor- cardiologist.

Dr Prathap C Reddy: Thank you, Naina, it is wonderful talking with you. I think what you said is true. Today we are all in panic because of this new virus. I must admire India for the various steps that it took early enough. From bringing back our people to implementing the lockdown that helped in curbing the transmission of the disease to a very large extent, and most importantly, treating patients that needed a lot of intensive care equipment. My heartfelt admiration for the entire healthcare teams that have worked so hard. While people were scared at home, the healthcare professionals were treating Corona patients.

Ms Naina Lal Kidwai: Dr Reddy, have we invested enough in terms of healthcare facilities or did COVID-19 bring very starkly to light the fact that maybe we haven't gotten enough hospitals, equipment, doctors, enough of anything- not just for a pandemic but for all the annual diseases we often see, whether it is malaria or tuberculosis or any of the illnesses, which we see in large numbers in the country? So, do we need to invest more and if so, how would you suggest we look at that? 

Dr Prathap C Reddy: I think I have always been talking about this. I always say we need to 'double our doctors, triple our nurses, quadruple our paramedics' to meet the health staff requirement in the country. The world needs several hundreds of them and if you train more doctors, more nurses, more paramedics today, we could supply to the world. Also, it is one industry that will continuously keep giving more jobs to fulfil the healthcare needs of our nation and that of the world.

Ms Naina Lal Kidwai: And what needs to be done to do this? We have enough people; we have enough colleges, then why are we running short of talent and not being able to export more? Why do we not have more hospitals? What does the government need to do to create this equal environment? 

Dr Prathap C Reddy: There are two things -- first, as far as the people training is concerned, I think we are very conservative. Organisations don't get permission for more training centres to be established, whether it is for doctors or nurses or technology. Currently, I think they have doubled/ ramped this up but what they are doing for nurses is still not enough. If they can train 250 doctors, they should be able to train 250 or more nurses. Med skills are there, but adequate training programmes are needed.

Secondly, do we have enough hospitals and healthcare needs for the country? The answer is no because the funding available for healthcare from the government is very low. We are lowest in healthcare even in comparison to our neighbouring countries. We need to step up funding.

I'll give you a small example -- when I got the permission for a medical college in my district headquarters -- Chittoor, I requested for the district hospital to be transformed into a medical college hospital. Originally what was a 300 - bedded hospital, with probably 30-40 in-patients and a 100-140 out-patients when we took over, is now a 750 bedded hospital, completely online and treats around 2000 out-patients per day. We are also treating around 200 COVID patients in the district hospital. Also, complains like people in the metros have too much healthcare facilities but there isn't enough healthcare for the people living in small towns and in the villages, that could get sorted.

We also started this new scheme called the Apollo Kavach. Not everyone who has the Corona virus needs to go to a hospital and get ICU bed. We took the number of hotels across the country and put it up there on the app to launch isolation rooms in the vicinity of Apollo Hospitals with medical supervision for quarantine (this was done to address the situation where over 50 per cent of cases would need only isolation and medication).

Ms Naina Lal Kidwai: But isn't this a fabulous model going forward, not just for COVID but to have the local society, residential complex based clinics, maybe, even specialty clinics across the cities, even in rural India, that does not require us to go into these bigger hospitals all the time? It is a fabulous model that you have started in India. The future looks good for that.

Dr Prathap C Reddy: You are really pushing us to talk on what future of health will be in the world. The future of the world is not going to be in the hospitals all the time. Yes, the hospitals are needed for bigger emergencies, to treat heart attacks, to do major surgeries. But everything else should move to the clinics and homes -- that is the future of healthcare. We are ourselves moving on to see not on how we keep on increasing hospital beds but to increase more healthcare facilities using technology.

So, I think the whole vector of healthcare delivery needs to change and it will change. Artificial Intelligence, automation, and robotics are making a significant impact in helping us in very smoothly transforming the healthcare system in our country. Greatly, we are here for the patient.

Ms Naina Lal Kidwai: So, let me ask you, say, as a patient in your vision of healthcare delivery going forward, whether it is a neighbourhood clinic or a clinic that is smaller or that is ideally near home, how big would this clinic be? Does it provide overnight facilities, will it be speciality based? How would you envisage this going forward? And specifically for respiratory issues, given that COVID has very dire respiratory consequences, and of course, in India, because of pollution, we have a very large share of respiratory disease, how could someone, who is a patient of asthma or respiratory disorders, use one of these new order clinics or the smaller hospitals that you are describing?

Dr Prathap C Reddy: Typically, clinics don't have any in-patient beds. But you are asking what if they have respiratory problems, can COVID patients get treatment there? No, I think that was very clearly classified as Stay I/ Stay II in a hotel or a safe place where the monitoring will be done through the nurses and the doctor. On an average a day, we are doing a couple of thousand daily consults. All our consultants are participating in this. 

Ms Naina Lal Kidwai: Certainly, it would sound like people would be a lot happier dealing with this new structure of not having to go into a big hospital that is COVID designated if you don't have a COVID disease. It would be great to see other hospitals do the same. But is this what you see happening in other hospitals as well?

Dr Prathap C Reddy: I think it is happening, it is not just Apollo. But I think the system itself has caught up. Less than 40-50 per cent of the patients are in the hospital. Even the government has opened up large halls, putting thousands of patients in quarantine. It is a very helpful thing and it eases the pressure on the hospital beds, because we did not have enough beds.

But my one advice to all of them is, instead of panicking on COVID, focus on building your immunity by getting the NCDs (Non-Communicable Diseases) tested and monitoring them well. If NCDs are under control, they won't have the severity.

Indian Healthcare is not only great with technology, but with the people too. And that is what Indians are capable of -- being able to give care and compassion is so much better. And we are not charging through the roof for the treatment. 

Ms Naina Lal Kidwai: What we often missed, I think, was the technologies and the investment in the institutional framework. And if that is happening now where we have world-class equipment as you have described, I think that is what we have lacked historically, and we need more of. And it will attract better doctors and of course, global patients and a huge amount of money for the country to earn, in terms of medical tourism as well.

Dr Prathap C Reddy: Medical tourism -- my thing is Indian doctors, Indian nurses, are second to none. They have proven this around the world and if we have enough technology to back them up, they can give the same or better care than the best centres anywhere in the world at one-fifth or one-fourth of the cost than what they'll charge anywhere in the world. India must become the global healthcare destination. In the longer run, we will not only earn enough profit but will be enabled to export our doctors, nurses and more importantly build lot of employment. With medical tourism, we will also be able to build more hospitals.

Ms Naina Lal Kidwai: Before we end here, it would be real miss if we didn't discuss the whole telemedicine space. I know that you have done much in the CRS (Cardiorenal syndrome) as well, but mainstreaming delivery of medicine and through tele-medicine into rural and lesser developed areas of the country -- how do you see that playing out and is being able to deliver proper healthcare into the remote parts of the county?

Dr Prathap C Reddy: Back in 2002, the first satellite telemedicine in the world, apart from NASA, was from my village to the Hyderabad hospital.

So, we've been doing a lot since that time because the technology wasn't available for us. On an average day, we give around 2000 plus telemedicine.

I admire the government for their vision of the Atmanirbhar Bharat mission. They have already laid the network to various villages.

The Government of India announced creation of a health identification card where all medical history can be uploaded. The card will be available for every citizen and this will have a very significant impact. With 3G and 4G, this will totally revolutionise the way we examine people, the way we use our medical tools to make a diagnosis. So, telemedicine, tele-consults and tele-lectures, I think all this equipment will be a part of a healthcare system. 

Ms Naina Lal Kidwai: Let me just end by asking you, if you had a wide open slate, what are the three things that you are going to focus on or ask the giver to focus on, in terms of the next three years to improve healthcare and health related jobs in India? 

Dr Prathap C Reddy: I think you always ask the right things which really are the concerns of the people. We want our people to be happy, the nation to be healthy and happy, only then can we achieve the goals of being among the top three in the world and I think we can do it. Second, of course, is to make us behave ourselves -- use and adaptation of digitalisation, I think, is an attitudinal change that should happen.

Also, insurance should play a greater role. I also must add that they are now paying out of hospital expenses in these COVID times. This is where they are adapting to the situation and giving ultimate care.

My last advice for all citizens of India is look out for your health yourself. You must know the state of your health. The only way to go ahead is to do what we have done now -- being pro-health. Pro-health will tell you the state of your health. And as we said for everything, we have the means to completely bring it under control so you can enjoy a normal life, normal health. Don't deny yourself this. 

Ms Naina Lal Kidwai: So, we should know how to monitor ourselves and build our immunity and pay attention to that. I think that's a wonderful way to end and you rightly brought up the area of insurance. I know from your daughter, our FICCI president, Dr Sangita, that a lot of work is happening from your group to get insurance to cover outpatients as well. And I think that will change the way healthcare is delivered and it won't require us to always check into a hospital to avail of medical insurance.

Dr Prathap C Reddy: I get help from my daughters and another 80,000 people who are my fellow family for all the good work that you are seeing.