Narayana Hrudayalaya : Annual Report 2021-22

Contents

02-39

CORPORATE OVERVIEW

1. Chairman's Message

1. CEO's Insight

1. Profile of Board of Directors

1. FY22 Operational Highlights
2. FY22 Clinical Highlights

1. Clinical Overview

40-105

STATUTORY REPORTS

40 Management Discussion & Analysis Report

1. Board's Report

1. CSR Report

1. Corporate Governance Report

1. Business Responsibility Report

106-262

FINANCIAL STATEMENTS

107 Standalone Financial Statements

185 Consolidated Financial Statements

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Narayana Hrudayalaya Limited

Chairman's

Message

In India, with a diverse population of 1.3 billion people, one size fit all solution will

not work. We need health insurance at premiums starting from few hundred rupees to few lakh rupees.

Annual Report 2021-22

Dear friends,

My entire professional life as a heart surgeon and as an entrepreneur was spent in trying to reduce the cost of healthcare. After spending years on cost reduction, we made massive difference to the common man of our country and set an example for the rest of the world to follow. I left England way back in 1989 and started a new inning at Calcutta as a heart surgeon. 31 years ago, my first patient paid one and half lakh rupees for a bypass grafting. Today, we are doing bypass for poor patients at the same price. Tell me, what was costing H1.5 lakhs 31 years ago that costs the same today? This was possible because of the dedication, passion, and sacrifice of lakhs of doctors, nurses, medical technicians, and hospital administrators of this blessed country.

However, we have reached the inflection point in reducing costs. We can't reduce the cost further without compromising on the quality of surgery. This is something we all want to avoid for obvious reasons. But what is the way forward for half of our country's population who cannot afford to pay for healthcare out of pocket?

Low-cost health insurance

Out of pocket payment for healthcare is a third world phenomena. We are no longer a third world country and we need to build new avenues to pay for healthcare. A financial intermediary pays for the healthcare in most parts of the world. The cell phone revolution taught us a very interesting lesson - Indians are willing to pay a small amount of money in instalments for essential services. We believe that the future of healthcare services in India is closely linked to innovation in low cost health insurance. There are a lot of exciting companies developing satchet-sized insurance as well as integrated healthcare plans. Some of these initiatives will fail, some will succeed, but all are worth exploring.

In India, with a diverse population of 1.3 billion people, one size fit all solution will not work. We need health insurance at premiums starting from few hundred rupees to few lakh rupees. That will only happen if risk takers are encouraged and eventually few good ideas will succeed and then the world will never be the same again. Once India cracks the code of affordable health insurance, we will prove to the world that it is possible to dissociate healthcare access from affluence. I would like to thank our government for Ayushman Bharat and starting discussions on affordable health insurance and I have no doubt that it will become a reality soon.

Electronic Medical Records

Mass adoption of EMR happened in USA because of $24 billion in grants given by the government to all hospitals. To improve the safety of healthcare in India, EMR adoption is critical. Today, small hospitals and nursing homes are reluctant to adopt EMR because of the time spent on learning a new system. If a small amount of money is paid per patient, nursing homes and clinics across the country will be incentivized to adopt electronic medical records. India is perhaps the only country which can do it at scale because of the extremely talented pool of software engineers who can develop most advanced electronic medical records and make it available at an affordable price.

Rapid expansion of Nursing and Medical Colleges

There are 2,600 nursing colleges offering nursing degree programs in USA. With less than a quarter of Indian population, USA graduates over 1,55,000 registered nurses per year. India has 2,500 colleges teaching General Nursing and Midwifery (GNM) and 1,900 colleges offering BSc Nursing. About 90,000 GNM and 100,000 BSc Nurses graduate each year. For 10,000 people, India has 21 nurses while USA has 116 nurses. Please keep this data

in mind when you criticise Indian hospitals and compare them to western standards. Hospitals today have no control over the number of nurses and doctors getting trained or how well they are trained. Today, our hospitals have been reduced to a training school for nursing graduates to get experience certificate and migrate to the middle eastern or west.

There is nothing wrong in our doctors and nurses migrating abroad for better opportunities. Our doctors and nurses have generated tremendous goodwill for our country across the world. But we also have to recognize our position as the number 1 training ground for medical professionals, not just for India, but for the whole world. Shortage of nurses is the greatest stumbling block for delivering healthcare across the world. Indian hospitals struggle with nurse attrition rate of 50% to 75%. No service industry with this level of attrition can function without compromising on quality and patient safety.

Our government has adopted the bold strategy of "Make In India". I believe this should not be limited to manufacturing but extended to the services sector as well. India produces the largest number of skilled professionals in the world, and we have the opportunity to "Make Professionals in India for the World". Our policies should permit all hospitals with over 100 beds to start nursing colleges to train GNM and BSc nurses. Nursing colleges managed by hospitals will train highly skilled nurses because they have practical experience working as nurse assistants while studying. Since nursing students are also working, hospitals will be able to reduce the tuition fees, thus helping students from poor families to become nurses and build a better life.

Once India cracks the code of affordable health insurance, we will prove to the world that it is possible to dissociate healthcare access from affluence.

Creating Cadre of Hospitalists

In 2020, about 1.6 lakh doctors appeared for NEET-PG and less than quarter of them were able to get a post graduate seat in clinical subjects. What would rest of the MBBS doctors do? Most of them will continue studying for a PG seat, attending coaching classes in Kerala or Kota, mugging MCQs, and not touching patients for 3-4 years. It is a colossal waste of talent and resources of the country. Due to the big gap between UG and PG seats, most of them will never get a PG seat. It is very important to create well-paid training programs for all graduating doctors inside hospitals either as specialists with postgraduate degree