about a dozen a week. And because they
work on a fixed salary instead of per oper-
ation, the cost to the hospital drops when
the number of procedures increases.
“More than 100 years after the first heart
surgery, less than 10% of the world’s popu-
lation can afford it,” says Shetty. “That’s
why we concentrate on the mechanics of
delivery. It’s the Walmart approach.”
In addition to cost-cutting, Narayana
Hrudayalaya finds creative ways to make
the economics work. The company started
a micro-insurance program backed by
the government that enables 3 million
farmers to have coverage for as little
6
as 22 cents a month in premiums.
Patients who pay discounted rates are
in effect compensated by those who pay
full price or opt for extra perks. Typically,
the latter group includes foreigners for
whom a $7,000 heart operation, access
to an experienced specialist, and a
deluxe private room is a relative bargain.
The balance of patients is, in fact, crucial.
Every day, Narayana Hrudayalaya’s
surgeons receive a P&L statement of the
previous day that describes their opera-
tions and the various levels of reimburse-
ment. The data allow them to add more
full payers, if necessary (unless urgent
health issues dictate otherwise). “When
you look at financials at the end of the
month, you’re doing a postmortem,” says
Dr. Ashutosh Raghuvanshi, Narayana
Hrudayalaya’s CEO. “When you look at
it daily, you can do something.”
And doing something—doing more,
actually—is the point. By 2017, Shetty,
58, envisions expanding from 5,000
hospital beds throughout India to 30,000.
He could barely have imagined such an
empire 15 years ago. Before becoming
one of India’s best-known health-care
entrepreneurs, Shetty was its best-known
heart surgeon. He was interrupted in
