A healthcare business model that most could follow (but don’t)

A few resources-rich individuals have offered him carte blanche to replicate LVPEI in other parts of India. Like this entrepreneur from Mumbai, one of India’s wealthiest persons, who wanted to donate a replica of the Hyderabad centre to his city, which would have cost him nearly Rs 250 crore in an outright donation. Or this young political leader from Delhi who led a ‘diffused group’ of people who wanted an LVPEI in the North. The Board at LVPEI left it to Rao. And Rao said, “Thanks, but no thanks. We can help you but not set it up ourselves because it’ll take away the focus from the care of the neglected population.” To various private equity investors, he says, “We only take one kind of money: donation.”

Enhancing the business

Expansion on the tech side is, though, welcome. In December 2016, it became one of the partners in Microsoft Intelligent Network for Eyecare (MINE) along with eye care centres in the US, Brazil, Australia and Kenya to use artificial intelligence for eliminating avoidable blindness. A new threat is emerging from modern lifestyle, and doctors believe the world is staring at a myopia epidemic.

I went to Rao, who is 71, arguably India’s most celebrated ophthalmologist today, with some simple questions: Why is eye care concentrated among the nonprofits and why hasn’t this model extended to other therapeutic areas like cardiac, cancer, general medicine…? Moreover, even within nonprofits, no new healthcare provider of a reasonable scale has emerged in recent times. Is that era over?

Below is a mildly edited version of our conversation:

The Ken: Why is it that nearly 60% of eye care in India is in the nonprofit sector?

Rao: Other than eye care centres, the only other significant nonprofit quality care provider is Christian Medical College in Vellore. There’s hardly anybody else who is providing in other specialities. Why it did not happen in other areas is because it has revolved around individuals even in eye care. That has something to do with the individuals. But I strongly believe every speciality can have this model if somebody wants it. The question is: Does someone want to do it? In eye care, in some peculiar way, philanthropy is built into the training of ophthalmologists in this country, through the eye camps over five-six decades. As postgraduate students, we all went to work in eye camps, and postgraduates continue to do it even today. That has brought to the minds of doctors that free eye care has to be provided. How much the practitioners do I don’t know but a large percentage of them seem to do something or the other. That’s because of what is ingrained in them. At the All India Institute of Medical Sciences [in Delhi] we started the first eye camp in Modinagar then that translated into an eye hospital as our professor convinced the Modi family to start an eye hospital. We were a precursor to the Modinagar Eye Hospital. In the South, Dr Venkataswamy [of Aravind Eye Hospital] did camps on a massive scale in Tamil Nadu. In Andhra Pradesh, it was Dr Siva Reddy. Like that in many parts of the country, different people were champions of cataract treatment and blindness prevention.

The Results

The focus was on cataract. But it had its consequences, which people did not realise until we did an outcome study in the late 1990s. We found out there was a significant percent of complications. It did the good it could do but now the time has come to look at the limitations of eye camps. Camps have come down significantly for sure. If I want to be brutally honest, while surgery [today] is not done in a school building or under a tree, the same culture is brought inside the hospitals. When you do massive surgeries in a single day by a single surgeon, whether it is inside or outside a hospital, something breaks. Enough attention to detail and asepsis is not given. So, the problem is still there. Both from government—and NGOs—side, a lot of camps are still being done, but inside the hospital.

The culture is that the operation theatre is not used [regularly] but once a week or once a month it is used for these camps. Just imagine, you don’t do anything for a week and suddenly you do a huge volume. That is why every now and then, you hear stories of a large number of people losing their eyesight. Because the system hasn’t set in.

 

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