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With over 15,000 hospitals (the second-highest number in the world) and nearly 600,000 physicians (the fourth-highest number in the world), it appeared that India’s health-care system was well equipped. However, the actual number of physicians per 1,000 population was only 0.5 (compared with 2.7 in the U.S.), and since approximately 70% of doctors were located in urban areas while the same proportion of the population still lived in rural areas, actual access to health care was limited by inconvenient and expensive travel.

While public health care was mostly free, the high incidence of corruption at government hospitals lowered the cost differential between public and private health care (stories were told of having to bribe the security guards at hospitals even to visit a patient). In addition, public hospitals and clinics were notoriously understaffed and underequipped. In an article on the public health system in India, Dr. Atul Gawande, a surgeon at Boston’s Brigham and Women’s Hospital, described a hospital in Nanded (about 400 miles from Mumbai) that had just 500 beds and nine general surgeons to service a population of 2.3 million people: “. . . the faucets don’t work . . . examinations take place behind a thin rag curtain with gaping holes in it,” he wrote. Everyone he asked said they would borrow money or sell their possessions to access private health care, and according to Dr. Gawande, “even the Prime Minister does not go to his government’s hospitals.” [3]

Given that less than 14% of the population was supported by health insurance, treatment was an option only for the rich or those able to borrow to pay the bill. A report by McKinsey & Co. estimated that the richest 7% in the country accounted for 30% of spending in private health care and over 40% of inpatient spending, reflecting the skewed access to private health care. [4]

Ironically, India’s private health-care industry, while closed off to the country’s majority, was gaining popularity among foreigners. With improving quality and technology at Indian private hospitals, the concept of medical tourism was spreading, with an estimated 150,000 foreign patients receiving treatment at Indian hospitals in 2003. The low cost of treatment at Indian private hospitals (relative to developed countries) was an attraction—for instance, OHS could cost up to US$70,000 in the United Kingdom and US$150,000 in the U.S. but was just US$3,000–$10,000 at the best Indian hospitals. Dr. Shetty related the story of a friend who operated on a British patient in India: “He [the patient] said there’s every chance an Indian would operate on him in the United Kingdom, so why not get operated on by an Indian in India?”

The Demand for Cardiac Care in India

Heart disease was one of the most common illnesses in India—approximately 2.4 million people needed heart surgery every year, although due to lack of affordable treatment, only 60,000 surgeries were performed. The prevalence of the disease had significant implications on its workforce—it was estimated that 28% of the 5 million Indians who died of cardiovascular disease every year were under 65 years old, and almost 25% of heart attacks occurred among the under-40 population. Congenital heart disease was a particular concern—around 224,000 newborns in India were affected by heart disease every year, and the rural population was particularly susceptible due to poverty and unhygienic conditions that worsened the risk.

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