PPP health care model in Uttarakhand: Healing heart with a human touch

Till as recently as 2005, if you developed any kind of heart ailment in the state of Uttarakhand, you had to take a trip down to Delhi to get any kind of treatment. There was no set up of testing or treating any heart problems in the entire state.

In 2011, when the Uttarakhand government signed a memorandum of understanding for a public private partnership (PPP) with Fortis Escorts (Escorts hospital in Delhi had been bought by Fortis), things changed. Under the agreement, the government owned Coronation hospital provided the space for the heart centre and Fortis had to invest in the equipment, doctors and specialists. The partnership would treat several below-the-poverty-line patients for free and be reimbursed by the state for it. Within a year of signing, things were set up and by April 2012, the 55-bed heart centre started functioning.

Initially, the centre handled 30-40 out patients in a day, did 30 angioplasties in a month and performed around 10 open-heart surgeries in a month. Now, OPD consultations have doubled to between 80 and 90 a day; approximately 60 angioplasties a month (between 500 and 600 in a year) are performed; and around 200 open-heart surgeries are done every year including on children. It is the only centre in the state handling paediatric cases. 

The other government hospitals in the area — many of whom lack the equipment, the operating facilities and the expertise — refer the more complicated cases to Coronation. Once a year, a team from Japan comes and performs CTO Angioplasty, a complex procedure for those with close to 100 per cent blockages. 

From 8 am to 2 pm, anyone can come in for a free cardiac consultation — a consultation at one of the private hospitals would cost anywhere between Rs  800 and Rs 2000, depending on the hospital and the seniority of the consultant. Almost all tests — like a simple ECG — is 30-40 per cent lower in price than private options. 

For more complex tests like an echocardiograph, the difference can be quite stark, with Coronation rates almost half of what others charge. An ICU bed costs Rs 2,000 a day — far lower than the average rate of Rs 4,000 to Rs 5,000 at most other options. Coronation rates for surgery are far lower than at most private facilities. “Charges have been fixed and kept lower by the government so that tests and treatment remain affordable” explains Yogendra Singh, a heart specialist who heads the centre. 

While the free care can be a life saver for the hundreds of patients who are below the poverty line, the efficient and inexpensive treatment can be an eye opener — and quite a faith reaffirming experience — for anyone coming from the metros.

Pushpa Ahuja, 81, who currently resides in Bengaluru, was recently on a visit to Dehradun when she felt breathless while taking a leisurely walk in the Forest Research Institute — a stunning, sprawling 1,111 acres heaven in the heart of the city where your chances of meeting a leopard are almost as high as that of meeting a human.

Ahuja had two options. She could comfortably afford any private facility — be it the Max hospital (well known in the city) or any other smaller clinic offering good facilities (many have come up since 2005). Or armed with her CGHS card, she could also show up at a government hospital. 

Call it good luck or providence, but she found herself at the Fortis centre at Coronation. The hospital didn’t look or feel like a government facility. Doctors looked at her quite promptly (age in smaller towns still begets respect and deference), performed a series of tests and even offered her a cup of tea. At no point did she feel she couldn’t trust what the doctor was advising. Two hours later, she was sent home with a clean chit. 

For Ahuja, the excitement was many-fold. She had been treated like a human being. The doctors assured her that her heart was like that of a 35-year old. The money charged for her treatment didn’t, for a change, feel like extortion. Her bill for a battery of tests and consultation: Rs 1,600.