Dr. Rajiv Chaundry looked proud as he stood in the gleaming lobby of his newest building. The press huddled around, waiting to hear the latest from the world’s wealthiest man.
“My family is not Christian,” he began, “But I still remember Christmas, 2009 as the best day of my life.”
Everybody already knew what he was referring to, it was a story he’d told many times, but they waited nonetheless. Rajiv spoke in a perfect American accent – according to legend, it had been honed in one of India’s many call centers.
“On that day, America passed Healthcare Reform.
“On that day my father cried and spoke the most prophetic words of his life. ‘India’s day has arrived.’
“It can be hard to remember those days. India’s was an economy just beginning to flower. Our GDP was just over 1 trillion US dollars. American healthcare spending only was over 2 trillion dollars. It represented a tremendous opportunity.
“The Republicans in those days were worried about the death of innovation – about massive costs – about twisted incentives. But we had other ideas. Indian hospitals had competed with American hospitals for international patients. The rich went to America. The middle class of the UK, Canada and a few other countries – well, they came here.
“When American stepped down the road of an even more unnatural and stilted health care economy, we knew our day was here. Healthcare is a massive industry – today larger than any other. And with reform, what little remained of the power of ownership and profits to drive quality in the United States was eliminated.
“We’d seen it a dozen times before. India was no stranger to the phenomenon: In what are essentially state-controlled industries, quality declines. Services become apathetic, buildings derelict, equipment shabby. And in healthcare, that means death.
“But we were already moving in the other direction. Thrust into international competition for middle-class patients, we applied the lessons of industry to healthcare. We were specializing our facilities and delivering cheaper, higher-quality services than anybody else on the planet. Even in those days, some Indian hospitals could deliver the world’s best open heart surgery outcomes for an average of only $2,000 per operation. Today, India has grown into the world’s largest economy on the back of healthcare. We provide fully 30% of all the world’s health services – public or private. Our industry employs tens of millions. We’ve studied, we’ve learned and we’ve built.
“What you see today is a culmination of that effort.”
Rajiv turned and the horizontal escalator we were on began to move. The facility was a gleaming, massive, machine of life. We were in what appeared to be a lobby.
As we moved, Rajiv continued to speak, “Folks, this hospital has 50,000 beds – by far the largest in the world. It is a medical city. We don’t have a traditional admissions area. Instead, incoming patients are immediately assessed and sent to the area of the hospital most appropriate to them. We find that eliminating waiting times results in not only happier, but healthier, customers. Once in the appropriate area, patients are assessed by a doctor before we even begin to collect their paperwork. Past patients have radio ID cards that enable us to check them in without any paperwork at all.
He gestured out the window and towards a runway outside. “As many of you know, many of our efforts are geared towards enabling people around the world to take advantage of our fantastic care. That is why we started MediAir in 2014. With dedicated medical transports, including long-haul A380s, MediAir provided a huge number of innovations – FAA approved hospital beds, tracked loading to enable patients to get on and off the aircraft without even sitting up, a full suite of life support and medical systems, a fully trained medical staff, including an emergency OR on the A-380s. And last, but not least, onboard passport control, to enable patients to get from aircraft to hospital without delays. But we never had direct access to one of our hospitals – we always had to fight Indian traffic and Indian roads. Now, that has been changed. Aircraft can land on that runway right there. The aircraft pull into hangers and discharge patients directly into the hospital. The process is incredibly smooth – and admissions complications have been dramatically cut.”
The escalator continued moving.
“We’ve built the best into every aspect of this hospital. The escalator system use RFid tags on patients to direct them to any portion of the hospital quickly and safely. Despite having a top speed of almost 15 miles per hour, the escalators are gentle. When they stop and go, they do so gently. This single innovation has enabled us to build a hospital on a scale never before seen.”
The escalator whisked us into a large and darkened room. In all directions, on several floors, were individual workstations, encased in sound-proofing plastic.
“This is the hub of our virtual clinic system. Naturally, we want to reach our customers in their home countries. Not everything requires a long flight, and not everybody is willing to wait for the shoddy care their local health utilities can provide. So we built 30,000 small-scale clinics globally – but staffed here. We essentially built medical vending machines. In a private area of a shopping center, for example, a patient can walk into the kiosk, slide their credit card, and work with a doctor – no appointment required. Our doctors interact with patients and using advanced robotic technology can physically interact with patients. It takes a little practice, but our doctors acquire amazing tactile abilities using these devices. They can actually ‘zoom in’ on a small area and feel it in more detail than a human hand could possible provide. In addition, because of the number of doctors available, we have further cut waiting times. Of course, for an additional fee, you can be seen by ‘your’ doctor.”
A hand went up.
“Do you plan to provide surgery’s using this equipment.”
“No,” said Dr. Ragiv, “We can’t provide sufficient control of the environment through our virtual clinics. However, the clinics can be used to book MediAir flights. And we expect to deploy our first medical ships for more involved and emergency outpatient procedures. We will be parking the first ship in international waters off of the New Jersey coast. Future ships will serve other major population centers.”
The reporter nodded and our escalator continued.
“I’d love to show you are R&D; facility, but it is top-secret. We are in constant competition with other facilities in India and our secrets are, how shall I put it, sacrosanct. Needless to say, we have a full-scale research facility pushing the barriers of medicine to offer our patients more than any other hospital chain in the world. We have 200,000 beds throughout the chain, there is ample opportunity to profit from the best in medicine. Of course, we submit to the Indian Review Protocols for efficacy review on every innovation we deploy. The IRP has enabled India’s healthcare system to provide unparalleled levels of patient safety even as it cut out the waste and red tape associated with the FDA. This is a competitive field, but it is also critical to India’s future. The IRP has ensured we have the processes in place to both grow it and protect it.”
We passed over a large artificial lake.
“Our innovations has slashed costs for a wide range of care. But they have also improved outcomes. I will admit that IndiaCare offers better gastric outcomes – particularly in diagnosis – but we are at or near the top of every other specialty. Specialist facilities do crop up now and then, offering innovations in specific areas and it is our guarantee that if they provide something you need, we’ll hire them to do the job. We have sub-contracted no fewer than 150,000 procedures this year alone.”
We were whisked onwards. The escalator shifted upwards. The opaque ceiling was replaced by a massive glass skylight. We were rising towards a gleaming tower.
“Health is a wonderful industry. Our employees change lives every day. It is amazing to consider, but only a decade ago, India was exporting doctors. Today, we import the best from all over the world. Fully half of our medical staff is from the US – doctors and nurses fed up with the hassles of providing care in the US, and the costs of doing so. Here, they just need to do their jobs. They work hard, they are paid very well and they never see an insurance form. We compensate them based on performance and, if they’d like, they can reside in our own on-site luxury condominiums. The housing complex has every conceivable facility – including synagogues and Kosher restaurants for our many Jewish doctors.”
The escalator veered to the left and we reentered the hospital proper.
“Before this tour ends, I want to show you our next generation patient rooms.”
The escalator came to a stop outside a cut-out room.
“We find that costs are far lower when patients are housed in wards. Of course, our patients also value privacy. So we offer compact, high-density beds. Where traditional hospitals had sliding sheets or drapes separating patients, we offer room separators that can be electrostatically tinted to be either opaque or clear. This approach cuts the risks of infection while providing a truly low-cost high solution.”
And then, unexpectedly, each of the walls suddenly lit up with images.
“Of course,” Rajiv continued, “We didn’t stop at making them opaque. Each of these walls is a low-cost O-LED monitor. Nobody wants to be cut off from the outside world. These monitors can allow a patient, sitting down, standing up or laying on their backs, to immerse themselves in almost any environment. They can put themselves in their own living rooms or at a cafe and interact with relatives or friends. Or they can just hang out on the beach and forget their troubles. And when it comes time to medical care, any portion of the wall can be used to display medical data, including X-rays, MRIs, test results, medical probe views and, of course, vital signs.”
Rajiv paused and smiled his famous grin. “Folks,” he said, “Welcome to the future.”
He paused again.