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17. Hart SE. Hospital ethical climates and registered nurses’ turnover 22. Hooman H. Design and standardization of job satisfaction scale. Tehran:
intentions. J Nurs Scholarsh. 2005;37(2):173–7. Governmental Management Educational Center; 2002. (Persian)
18. Elçi M, Alpkan L. The impact of perceived organizational ethical climate 23. Fayaz Bakhsh H. Teamwork [Internet]. Mihanblog. 2010 Dec [cited 2010
on work satisfaction. J Bus Ethics. 2009;84:297–311. Dec 2]. Available from: http://www.casemethod2.mihanblog.com/
19. Jaramillo F, Mulki JP, Solomon P.The role of ethical climate on salesperson’s post/4845 (Persian).
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2004;13(3):49–55. (Persian) journals.sbmu.ac.ir/me/search/titles?searchPage=5

“It all changed after Apollo”: healthcare myths and their making in
contemporary India

SARAH HODGES

Associate Professor, Department of History, University of Warwick, Coventry CV4 7AL, UNITED KINGDOM e-mail: [email protected]

Introduction Apollo and the invention of the “corporate hospital”

In the shadow of recent proposals for universal healthcare in in India
India, discussions regarding the impact of private medical care At the risk of stating the obvious, the rise and spread of the
on Indians’ health have taken on a greater urgency. However, Apollo Group of Hospitals from the 1980s matters because it is
our collective attempts to evaluate the effects of India’s widely seen to represent the beginning of a new chapter in the
growing private medical sector have been seriously hampered history of healthcare in India: the rise of the corporate hospital
due to a lack of reliable or comprehensive data regarding (i) alongside the unfolding of liberalisation in the country. Apollo’s
the size of the private healthcare sector, and (ii) its patterns story has been told and retold among physicians, journalists,
of growth, particularly since the 1980s. As we formulate and politicians, bureaucrats, and members of the general public. In
assess practical strategies for a sustainable healthcare future this story, the career of Apollo Hospitals appears to be nothing
for India in the absence of reliable statistical data, historians’ short of miraculous: Apollo, in particular, and India’s healthcare
tools for understanding the recent career of healthcare in the sector more generally, figure simultaneously both as the cause
country merit consideration. and effect of the country’s recent economic successes. Yet, as
this essay argues, this legendary status depends on accepting
To that end, in this article, I examine myths and myth-making a set of assertions that are at best, debatable and at worst,
as central to the rise and consolidation of Apollo Hospitals, mere myth. Not only are these stories debatable, they are also
first in Chennai and later as a key player in India’s recent dangerous, because they obscure a set of broader historical
healthcare history. Using face-to-face interviews with more processes that both precede and go beyond any results that
than 20 prominent Chennai physicians as well as published can be attributed to one man or one hospital. In the light of
sources, I investigate not only the myths surrounding Apollo this generally confused state of affairs, it would be useful to
and its founder, but also the manner in which these stories begin with a chronological account, both of the establishment
are regularly circulated within the wider medical community. and early history of Apollo (particularly in Chennai), as well as
The case of Apollo is instructive for two reasons: a) Apollo is of the broader context – in terms of the regional and national
seen widely as representing the new chapter in the history of provision of healthcare – in which Apollo emerged.
healthcare in India; and b) Apollo merits attention on its own, as In 1980, Dr Pratap Reddy, founder and chairman of Apollo
a case study, to illustrate how corporate hospitals established Hospitals Group, announced that he had acquired a plot of land
after it “manage” their own success story and thereby shape for the first Apollo hospital, Apollo Hospitals Chennai, on the
the perceptions of the common man and professionals alike. centrally located Greams Road. At the time, the Times of India
In short, I argue that the most important successes of Apollo reported that this was the first of a new chain of large hospitals
Hospitals have been in image management. Given that much of (1). This development was significant for three reasons. First,
Apollo’s “success story” is based on assumptions and assertions the Chennai hospital would be the first private limited hospital
that crumble under even the most basic historical scrutiny, we in India. Second, in order to move ahead with the financing,
would be wise to regard the corporates’ claims of economic Reddy had been given permission to build a private hospital
promise and therapeutic efficiency with some scepticism. of a capacity of over 30 beds. Until then, the law permitted

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only government or charitable trust hospitals to expand their private nursing homes which was [a] big difference.
bed strength beyond 30 (Chennai doctor 2). Third, this hospital Because nursing homes wouldn’t take acutely ill patients.
raised funds through overseas borrowing and was also the first They would only take elective surgical procedures; very
to issue public shares to finance its establishment (2,3). It was mild illnesses. Anything serious was referred to the
observed at that time that this was “the first [public offering] of government teaching hospitals. Obviously the three:
its kind in India for financing a multispeciality medical centre to Kilpauk Medical College, Stanley Medical College, and
be run on corporate lines”(4). the biggest, Government General Hospital. If you had
a serious illness, [in] those days it was considered that
The Chennai hospital was inaugurated amidst much fanfare the place to go to was Government General Hospital.
in September 1983 by Zail Singh, President of India. It was It all changed after Apollo (Chennai Doctor 1).
only in February 1984 that it started admitting patients (5). It
consolidated its reputation as the hospital of choice for the city’s Yet the claim that “Apollo changed everything” fails to bear the
powerful a few months later, when MG Ramachandran, the then weight of scrutiny. It would be useful to disaggregate the “It all
chief minister of Tamil Nadu, was admitted there (6). By 1988, changed after Apollo” myth into its five key elements:
Apollo Hospitals expanded to Hyderabad, as Reddy had initially
•• Apollo came up at a time that healthcare for “ordinary
planned. In 1996, Apollo Indraprastha was opened in New Delhi.
Indians” was flagging.
By 1993, Apollo Hospitals had begun to issue large •• Apollo provided a new model of healthcare delivery in
advertisements in the national press to congratulate India.
themselves on serving the nation (see Figure 2 in appendix). At
•• At its heart, Apollo is a patriotic project.
the time of writing this article in 2013, Apollo has undertaken
the task of continued expansion in India and beyond. The •• In order to establish Apollo, its chairman, Prathap Reddy,
year 2013 also marks three decades of the existence of Apollo, single-handedly changed government policy.
and the occasion is to be celebrated by the Group with •• Apollo was an immediate success.
commemorative volumes by and about Reddy. One of the In light of this descriptive convergence among both admirers
recent promotional pieces summed up Apollo’s achievements and critics, the rest of this section attempts to describe and
as follows: assess these five elements of the “It all changed after Apollo”
myth.
From one multispeciality facility that he founded in
Chennai 30 years ago to 54 hospitals, 1600 pharmacies, 1. Apollo came up at a time when healthcare for “ordinary
60 diagnostic clinics and 11 nursing colleges in 2013, Indians” was flagging
Dr Reddy’s medical system attracts more than 100,000
Talking about Reddy, a doctor whom I interviewed claimed,
footfalls daily across India. Cumulatively, more than
“When he set up Apollo Hospitals in Chennai in 1983,
32 million people have been treated at various Apollo
private healthcare institutions were virtually unknown to
hospitals (7).
the country”(8). This aspect of the myth of Apollo is often
articulated through three sub-claims: 1a) that there was
Apollo: myths and myth-making no reasonable healthcare available in Chennai, 1b) that the
Despite a wide range of opinions regarding the rise of the government, in particular, had either abdicated or was simply
corporate hospital, there are many similarities in the manner unable to fulfil its responsibility to provide healthcare for
in which its significance is described both by supporters and ordinary Indians, and that, therefore, 1c) only the very rich
critics. An admirer recently wrote: had access to high-quality healthcare, for which they travelled
abroad.
In 1983, at a time when the government’s commitment
to investing in public healthcare appeared to be flagging, Let us consider these in turn.
Prathap Chandra Reddy did something unthinkable: he
launched the country’s first corporate medical system. 1a. There was no good healthcare available in Chennai for
Three decades on, the argument over the pros and cons of “ordinary” Indians
privatised healthcare in a poor country remains unsettled Although this claim is oft-repeated (that before the
but there is one thing Dr Reddy’s admirers and critics establishment of Apollo and other corporate hospitals in
both agree on: the emergence and rise of his company, Chennai, there was no good quality healthcare in the city for
Apollo Hospitals Enterprises, has altered the health-care so-called ordinary Indians), it is difficult to find evidence to
landscape of India (7). support this claim. For the sake of simplicity, let us leave aside
Compare this with the sentiment of a critic of Apollo: the vexed question of who an “ordinary Indian” is (as well as the
even more vexed question of whether or not she is well served
I would say that what I noticed during the past thirty by corporate medical institutions in Chennai today). Whilst
years, which is the time I have been practising medicine, historians have yet to fully document the city’s medical past,
the big change is that when we were undergraduates, physicians from Chennai have described in interviews how the
there were no private hospitals in Chennai. There were city has been the long-standing home of high-quality medical

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care and medical education in India. Chennai’s reputation as a Apart from the extensive medical infrastructure in and around
“healthcare hub” far precedes the opening of Apollo Hospitals Chennai in terms of medical education and large government
in 1983-1984. One of the doctors whom I interviewed, and hospitals, over the 20th century, the city also became
who was closely associated with the Tamil Nadu branch of the famous for its large number of private nursing homes, run by
Indian Medical Association, estimated that the city was home prominent physicians. These private nursing homes included
to approximately 400 hospitals and 10,000 beds. the Pandalai Nursing Home, Sundaravadanam Nursing Home
and Kumaran Nursing Home. Nearly every doctor I interviewed
The phrase repeatedly used both by physicians in interviews and
mentioned that, particularly from the 1960s onwards, Chennai’s
newspaper journalists to describe the cluster of medical facilities
Poonamallee High Road came to be India’s “Harley Street”
in Chennai is “medical mecca.”The use of this term is based on
among doctors and patients across India. Nevertheless, none
a detailed consideration of the various aspects of excellence
of this is apparent in the awestruck assessment of Reddy and
in the medical sphere, including: medical education and large Apollo Hospitals cited below (an assessment which is very
government hospitals; a cluster of private nursing homes run common).
by prominent physicians (particularly along Poonamallee High
Road); excellent connections to national transport infrastructure; [Reddy’s] plan for the creation of a nationwide hospital
nodes of specialist expertise; and a reputation for the provision system in the corporate sector may not seem extraordinary
of ethical treatment at reasonable fees. today when private medicine has made major inroads
across the country but it was dramatic 30 years ago…
That the medical education provided in and around Chennai is When he set up Apollo Hospitals in Chennai in 1983,
of a high quality is common knowledge. Three medical colleges private healthcare institutions were virtually unknown in
in the region are consistently ranked in the top ten nationally. the country (7).
These are the Christian Medical College in Vellore (established
in 1902 and affiliated to Madras University in 1942), Jawaharlal Yet, rather than being “virtually unknown”, Chennai’s private
Institute of Postgraduate Medical Education and Research in hospitals and nursing homes were part of a larger regional
Pondicherry (established in 1823 and re-developed in 1956), and national trend of an expanding private medical sector, a
and Madras Medical College in Chennai (established in 1850). trend which emerged around 1960. As Bhat observes, “Private
The students graduating from these institutions not only staff healthcare expenditure in India has grown at 12.5% per annum
large teaching hospitals, but also go onto to staff and manage since 1960–70” (10). In rural India, the number of small private
the small, medium and large hospitals across Chennai. treatment facilities increased threefold between 1984 and 1992
(11). Similarly, in the small city of Mangalore in south-west India,
Further, Chennai is famous for the high quality of treatment the number of moderate-sized nursing homes jumped from six
and research carried out in a number of its government in 1986 to 20 in 1994, and to 32 in 1998 (12). Further, as Nicher
hospitals. Special mention may be made of the Government and Van Sickle point out, “In the 1980s, small private labs began
General Hospital (established in 1664), and Stanley Hospital springing up in towns and cities...”(12).
(established in1792). Other hospitals of note included the
Southern Railway Headquarters Hospital in Perambur (date As home to a good number of highly-trained physicians,
whether practising privately or in government institutions,
of establishment not available),Vijaya Hospital (established
Chennai became well known as a centre of excellence in
in 1972), KJ Hospital and MV Diabetes Hospital (9). The same
particular specialist areas. One doctor summed up what many
high standards of quality are maintained by several high-
others noted:
profile voluntary and charitable trust hospitals as well. These
include the Voluntary Health Society (established in 1958), the Historically, Chennai is the healthcare capital of India…
Cancer Institute (established in1954), and Sankara Nethralaya for whatever reason the primary centre is always started
(established in 1978). Speaking of the high standards of in and around Chennai. Cardiac units, neurosurgical
government hospitals, one physician said: units, orthopaedic units; anything that starts in India and
healthcare first seems to be able to kick off in Chennai
When I went to medical school [1970s], MMC was still
and then to somewhere else. Dr B Ramamurthy was the
the place you went to if you had complicated illnesses.
legend of his time –a first world-class neurosurgical centre
Even private doctors would do hernias and gall bladders
that he put up in the seventies (Incomplete)... Like that, the
outside. But if you needed cancer surgery… they’d say:
Cancer Institute in Adyar still has a reputation for being
“Hey, listen come to the government hospitals. They
a good oncology centre… In ophthalmology, [Sankara]
are better equipped to do all those. We are academic
Nethralaya is a world-class centre (Chennai doctor 2).
centres”(Chennai doctor 2).
In addition, many physicians noted that the practice of
Another physician echoed these sentiments:
medicine in Chennai was marked by a high level of professional
“…I think more and more people joined medical college in ethics, combined with relatively low costs. One doctor observed:
Madras. It was considered to be, you know, the place to go “A kind of good temperament is there in most of the senior
to. So it had that reputation of being something, even right doctors in Chennai, they want to be helpful not necessarily just
from the first days…” (Chennai doctor 7). make money” (Chennai doctor 3) Another doctor elaborated

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on this theme: “Medicine really exploded during the post-war served as a catalyst for them. Many of the doctors interviewed
years. And Madras had the reputation that it tended to be pointed out that it was, in fact, the long-standing healthcare
a little bit more conservative. The Bombay person is always infrastructure in and around Chennai that created a client
a little bit more of an entrepreneur”(Chennai doctor 12). base for private medicine. Several doctors drew attention to
In this conversation, the doctor equated a broader cultural the fact that, particularly by the 1980s, the region’s population
conservatism with a higher level of professional probity. had been sensitised to the importance of good healthcare
“habits”, such as visiting doctors to address their health
1b. Apollo came up at a time when government support for
concerns. It is also to be noted that the relatively higher levels
healthcare for ordinary Indians was flagging
of development in Chennai and across Tamil Nadu over a long
Just as with the claim that good-quality healthcare was virtually period meant that even before liberalisation, the state was
unavailable for ordinary Indians before Apollo, the claim home to a comparatively large middle class population which
that Apollo “filled a gap” in the provision of healthcare due to could afford specialist care in Chennai.
the lack of government support is difficult to sustain. This is
particularly the case when one considers the overwhelming 1c. Apollo triumphed because it provided what was up till then
evidence to the contrary. There was a substantial government unavailable in India or for Indians
health infrastructure in Tamil Nadu before the establishment of This aspect of the Apollo myth claims that good-quality
either Apollo or any other corporate hospital in Chennai. healthcare was out of the reach of Indians, except those who
As part of a larger project of widening and strengthening the were very, very rich. The corollary claim is that those who could
health infrastructure in India, primary health centres and sub- afford international travel went either to the UK or to the USA
centres were introduced as the “rural health” component of the for specialist, life-saving treatment. The following is an excerpt
Minimum Needs Programme during the Fifth Five-Year Plan from an interview with a doctor from Chennai, and what he
(1974–1978). As Duggal explains: “During the 1980s, the public says is typical of what many physicians reported:
health spending peaked and this was reflected in major health
Chennai doctor7… I mean, they were doing excellent work. But
infrastructure expansion in rural India via the Minimum Needs
Programme” (13). Tamil Nadu was particularly successful in its there was always this thing that if you were a VIP you got good
attempts to implement the programme for building health treatment,whereas if you were a common man you didn’t get such
infrastructure. As Muraleedharan et al narrate: “Tamil Nadu good treatment. And the hospital could have been a lot cleaner.
embraced the concept whole-heartedly and built the facilities So that was one thing that did put people off. Now suddenly here
much faster than almost all other states” (14). was a place where everybody could go to. I mean not everybody
– people who could afford it, and who did not want to go to a GH
However, there is also a possibility that Tamil Nadu was able [General Hospital] could come here.
to capitalise on the rural health agenda of the Minimum
Needs Programme, at least in part, because it had already SH (author): Instead of going abroad.
launched a robust programme of health planning prior to
Chennai doctor 7: Yes. Now let’s talk about the heart. Everybody
the implementation of the Minimum Needs Programme. KS
who needed a bypass would go to the US. Now suddenly here was
Sanjivi (doyen of Chennai’s voluntary health sector, b. 1903–d.
a place that one could go to. You didn’t have to go there.
1994) claimed in 1973 that Tamil Nadu was one of the few
states which had the requisite number of primary health This claim, however, fails to take into account some basic
centres, complete with the medical and paramedical personnel developments in India’s economic history. In the mid-1980s, the
needed(15). In 1973, Sanjivi explained: cost of international travel rose astronomically for Indians. This
The government of Tamil Nadu was the first to constitute a was because of changes in the exchange rate and, in particular,
state planning commission with a task force on health … radical devaluing of the rupee, particularly by the late 1980s.
presided over by Malcolm Adiseshiah… [It] divided itself It was at precisely the same time as overseas medical travel
into working parties to consider in depth the problems became prohibitively expensive that Apollo began to
of health services, medical education, family planning, announce dividends via newspaper articles. In other words, it
nutrition, sanitation, the role of voluntary organisations is worth considering that Apollo did not create a market, but
and indigenous medicines, including homeopathy. It stumbled into one.
handed over its report to the Chief Minister of Tamil Nadu,
2. The emergence and rise of Apollo was a catalyst for a new
M Karunanidhi, in 1972 (15).
model of healthcare delivery in India
Taken together, the pre-existing government health
This claim is predicated on the corollary claim that Apollo was
infrastructure and the policies prioritising planning for the
quickly emulated by many others in the private healthcare
provision of primary and tertiary healthcare did much to
sector. Certainly, the story of Apollo can be described as that of
contribute to the growth of all healthcare in Chennai, well in
the emergence and rise of one corporate hospital chain in India.
advance of the establishment of Apollo.
To be fair, from the very beginning, Apollo’s promoters planned
Whereas the role of Apollo may constitute a part of these Apollo not as a single institution, but as a chain of large private
larger trends, it would be erroneous to claim that it could have hospitals (16). This was, indeed, a new concept in India in terms

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of the scale, organisation and delivery of private healthcare. the Kanchi math took over the hospital through its deemed
What is less clear, however, is the degree to which Apollo served university at Kancheepuram. The hospital was rechristened the
as a catalyst for the successful emergence of other large private Sri Kanchi Kamakoti Sankara Medical Hospital (20). However,
hospitals and hospital chains across India. in 2006, Sankara Hospital admitted defeat in being able to
make the venture profitable and applied to sell the hospital,
In claiming that Apollo served as a catalyst for other private
explaining that in its expansion to 450 beds on the 46 acre
hospitals and chains to emerge, many assume that Apollo
site, it had become untenable financially. In 2007 in an all-cash
was an immediate success. However, Apollo took at least
deal worth Rs 257crore, Sankara Hospital was bought by Global
five years (and most likely, many more) before it made any
Hospitals and was renamed Global Health City, which is what it
dividends. Further, there was a substantial gap (at least 15
is known as today as well (21).
years) between the inauguration of Apollo in 1983 and the
establishment of other large, successful Indian hospital chains In short, whilst Apollo was the first, it is far from clear whether
that continue to be in existence today. Nevertheless, Apollo did it paved the way for other large, private hospitals in Chennai, or
make waves in the early years. As early as 1991, Chennai was whether other large, private hospitals found it easy to succeed.
hailed as the“corporate healthcare” city of India, though it had If anything, time has shown that the largest organisations tend
only a total of four large private hospitals (compared to the to survive, given that they can do business (and spread losses)
approximately 20 that we have today). In 1995, one journalist across economies of scale.
celebrated Chennai’s achievement thus:
3. At its heart, Apollo is a patriotic project
Madras is the new “mecca of medicine”… In the last five
The assertion that Apollo is a symbol and an institution
years the hospital services sector has boomed in this city,
though “for profit” hospitals exist elsewhere in the country, representative of the greatness of the Indian nation is a
Madras is the only city with four corporate hospitals (17). truism. Statements on this aspect of the Apollo myth are often
repeated and it is this angle that the Apollo Hospitals Group
Indeed the 1990s was a time of relative early growth, and, soon promotes the most vigorously in its publicity material and
after this article was published, Chennai had six corporate media appearances. As Prathap Reddy regularly emphasises
hospitals: Tamilnad Hospital, Devaki Hospital, Malar Hospital, in his many interviews to the media, “…bringing the best
Dr Agarwal’s Eye Hospital (which went public in 1994), and healthcare within the reach of every patient is our mission and
Chennai Kaliappa Hospital, in addition to Apollo. One of the [at Apollo] we are determined to make it a reality” (22). However,
obvious factors to reckon with was, and still is, that starting a this claim addresses an implicit criticism. That is, one often
corporate hospital requires immense funds. One of the doctors hears worried murmurings, even among physicians employed
interviewed observed that “the gestation period for a hospital by Apollo, of how for-profit medicine may be profit-driven. The
is five to seven years, minimum, before it can make a profit,” anxiety is that profits in medicine make for bad medicine and a
(Chennai doctor 6). As one physician explained: deterioration in morals, which would be particularly deleterious
to patients in India, a nation still wracked by dire poverty. In
When you borrow money [for a hospital], you’re asked to
framing the business of Apollo as a service to the nation, this
repay like an industry in like five years. [But] you cannot pay
criticism is neutralised.
back in healthcare in the five years. Absolutely impossible.
So what then happens is that people take the massive Apollo Hospital not only neutralises the criticism of for-profit
amount of money. [But] modern medical technology medicine, but also often presents Prathap Reddy’s very pursuit
depreciates in four years. At the end of the fifth year, you of profit (whether in healthcare or other ventures) as patriotic.
have junk, it’s scrap… (Chennai doctor 2). Mostly, this claim of patriotism is paired with praise for the
service Apollo Hospital provides to middle-class consumers.
The following tale of Tamilnad Hospital illustrates how, while
One of Reddy’s recent interviewers wrote, “[Reddy’s] is the
it was one thing to open a corporate hospital, it was quite
story of one man who set out to revolutionise the unaddressed
another to keep it going or to turn a profit.
healthcare needs of a section of India’s growing middle class.
From Tamilnad to Global It is a tale of manoeuvring through difficult bureaucratic and
complex medical systems”(7).
Tamilnad Hospital was incorporated in 1984 by a US-based
non-resident Indian, Dr CP Velusamy. In 1985, it became a public Indeed, much of the retrospective publicity concerning Reddy
limited company. In 1991, Tamilnad Hospital issued public and the establishment of the first Apollo highlights a series of
shares in order to finance the cost of setting up what was at meetings he had with Indira Gandhi, and later, Rajiv Gandhi.
that time described as “the first phase” –a 250-bed hospital in The accounts of these meetings portray Reddy as one who
Perumbakkam, which was in south suburban Chennai and quite aimed to help save the nation from what was seen as stifling
remote in those days (18). In 2000, after a protracted labour regulation and bureaucracy. These accounts regularly include a
dispute, Tamilnad Hospital faced a mass walk-out of physicians version of the following story: “I told Mrs Gandhi only the rich
(19). Following the labour unrest, as well as a lengthy delay in and powerful get access to healthcare and she really gave the
the hospital’s plans to start a medical college jointly with the first impetus by telling everybody, ‘Here’s a man who wants to
Kanchi math nearby, Tamilnad Hospitals folded up. In 2003, reverse the brain drain’”(8). However, no one mentions the fact

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that Indira Gandhi, who is regularly credited with evaluating during the 1980s with the sheer persuasiveness of his
the overall effect of the first Apollo, died within the first year argument that his was a national/populist project.
of its establishment. Of Mrs Gandhi’s endorsement of Apollo
Indira Gandhi and Rajiv Gandhi figure prominently in these
Hospitals, another of Reddy’s interviewers wrote:
accounts. One newspaper reported: “Banks were not willing
The new hospital attracted the best medical talent, to fund hospitals. Apollo approached the Centre and found a
including eminent non-resident Indian doctors who patient listener in the then Prime Minister, Indira Gandhi. The
returned to India from hospitals in the US and UK. This healthcare sector gained industry status, and access to financial
prompted then Prime Minister Indira Gandhi to remark, markets” (26). Referring to 1989 when Rajiv Gandhi was the
“Dr Reddy you have brought talent back to India and Prime Minister, another interviewer made the following claims:
reversed the brain drain” (23).
…On Reddy’s representation, the former (Rajiv Gandhi)
Reddy regularly remarked that “…the man who really changed amended in three days in the Parliament and removed all
the face of healthcare in this country with his vision and clarity hardships leading to liberal funding And so the costliest
was none other than Rajiv Gandhi – by opening up hospitals to medical equipments made inroads[sic] into Indian
funding and other opportunities” (8). hospitals and were equipped on par with the western. Rajiv
Gandhi also gave a tax exemption of Rs 10,000 [on medical
However, when Reddy was preparing to open Apollo in 1982, equipment] (27).
his statements regarding the national role that the hospital was
expected to play were substantially different from the stories Finally, another interviewer risks over-egging the pudding,
we hear today. In 1982, a newspaper reported that Apollo was exceeding even Reddy’s and Apollo’s own claims: “Often
an institution primarily intended to serve foreigners travelling referred to as the father of modern healthcare in India – after
to India from the Gulf for medical treatment: all, he revolutionised healthcare in India when the country was
mired in babudom” (8). Reddy himself was quoted as having
A hospital being built under the corporate sector here said the following of the first Apollo:
expects a steady flow of rich Arab clients and a huge inflow
of foreign exchange, since the Arabs are not satisfied with …securing licences to import 370-odd medical equipment
for the hospital itself took two years. Meanwhile, lowering
the facilities offered in the Bombay hospitals. Dr Prathap
of import duty on life-saving medical equipment also
Reddy, chairman of the company behind the venture, told
helped private healthcare during the pre-reform era. The
newsmen here yesterday that many rich Arabs had told
duties came down from 100% to 5–6% over the years (26).
him that they wanted to be picked up from the airport to
the hospital and all investigations and treatment should The claims regarding the transformation brought about
be done under one roof, regardless of cost (24). by Reddy ignore and obscure the fact that the pre-existing
economic climate had already been in the process of changing.
In this early iteration, Apollo would serve the Indian nation
Reddy takes credit for these changes, in particular, liberalisation,
– not by ministering to Indians –but by ministering to India’s first under Indira Gandhi in the early 1980s and then under
foreign exchange reserves. The avowal of such objectives Rajiv Gandhi in the late 1980s. This aspect of the myth also
echoed a statement Reddy had made slightly earlier, in underplays the increasingly active role of associations such as
which he had disclosed that the government recognised the the Federation of Indian Chambers of Commerce and Industry
Apollo venture as a “core economic activity” because it (the (FICCI) and the Confederation of Indian Industry (CII).
government) was aware of the potential of healthcare to attract
foreign exchange(25). It should be evident that this quote is at 5. Apollo was an immediate success
odds with the avowed aim of Reddy and Apollo that has been The popular perception is that upon its establishment in 1983,
commemorated subsequently. Reddy and Apollo Hospitals Apollo was an immediate success in terms of therapeutic
have been honoured with the highest accolades that the Indian outcomes and profit margins. The publicity circulated by Apollo
nation can bestow. Reddy received a Padma Bhushan in 1991 Hospitals gives one to believe the same. As one of the doctors
(India’s third highest civilian honour) and a Padma Vibhushan who was interviewed emphasised, “[Apollo] was a place where
in 2010 (India’s second highest civilian honour).The Indian you could be confident you get every kind of treatment under
Postal Service issued a commemorative stamp in honour of one roof. And it was available for a price, but it was there. The
Apollo Hospitals in 2009. quality was there. That was right from the beginning. It was
a foregone thing. It just took off” (Chennai doctor 7). Many
4. In order to establish Apollo, Reddy changed state practices
single-handedly attribute the success to Reddy’s visionary nature. Another
doctor declared, “Apollo succeeded because Reddy could see
Many go on from the assertion that Apollo was a trailblazer, what was coming”(Chennai doctor 8). However, this was not
that too the only one, in crafting a new future for medicine in the case, as is clear both from Apollo’s own attempts to secure
India, to claim that Reddy effected these changes by dint of funding through further public share issues to underwrite
his personal charisma. According to these accounts, Reddy further expansion, as well as the struggle of other hospitals to
charmed the “Delhi Durbar” under successive prime ministers thrive within the same market (Chennai).

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Conclusion: the trouble with myths for writing policy of recognition of the fact that, over the past three decades, this
Alongside biotechnology and information technology, form of the delivery of healthcare has succeeded only due to its
corporate healthcare is given pride of place within India’s selectiveness. Indeed, even some ofthe doctors who praised the
current “sunshine story.” These industries are taken to be hospital’s supposedly “innovative” model of care simultaneously
examples of the country’s capacity to deliver and are given recognised that most multispeciality hospitals succeeded both
much of the credit for the nation’s recent economic successes. financially as well as in healthcare delivery, because they made
Indeed, according to a recent KPMG report, rising income levels, very selective and strategic choices about their investments
changing demographics and shifts in disease profile were in specialisations. These specialisations allowed for very high
expected to double the size of spending on healthcare by 2012 success rates for very specific procedures, which could facilitate
(28). The industrial barons leading these fields both drive new a high patient throughput and a corollary income stream.
economic policies and profit from these new policies. In this context, we could consider the example of the Railways
Looking ahead at the role that corporates are poised to play, Hospital in Chennai. Railways offered excellent services for
one final point regarding the form and meaning of medicine, patients with heart-related ailments. However, because of the
as well as myths in this sphere in the era of liberalisation, wide cross-section of the population that this hospital was
requires critical scrutiny, particularly in the light of the current built to serve, the heart specialists there were able to develop
government’s pursuit of universal health care. That is the claim expertise not only in coronary bypass surgery, for example, but
that corporate “multi-speciality” and “super-speciality” hospitals also in the much riskier areas of paediatric cardiac surgery and
both constitute an innovation in the delivery of healthcare, the heart ailments suffered disproportionately by the poor (eg
and the corollary of this, ie that corporate hospitals provide an rheumatic heart diseases that do not necessitate open heart
surgery).
extremely broad range of high-quality medical services and, as
such, a template for healthcare delivery to the nation. Mistaking the “comprehensive care” that the corporate
hospitals claim to deliver for a genuinely comprehensive
I found that there was widespread agreement, particularly
care is a dangerous mistake. It is evident that there is a big
among the doctors I interviewed, with the view that multi-
difference between the comprehensive care of universal health
speciality corporate hospitals represent an innovation in the
care proposals and that that large government hospitals have
delivery of healthcare. One doctor explained the significance of
historically provided. This is particularly clear if one considers
multi-speciality large private hospitals thus:
what corporate hospitals are being asked to, and poising
Suppose a specialist – I am talking about 20 years back themselves to, deliver to the general population of India under
– suppose you are an eye specialist. You will have an eye the universal health care proposals. Neither these hospitals,
hospital. Or you are a surgeon. You will have a surgical nor the Government of India has suggested that corporate
hospital. But the corporates changed that. Apollo Hospital hospitals should become involved in public (or “preventative”)
changed that concept. They said, “All departments under healthcare. But why not? One profile of Reddy says, “…As Dr
one roof” That was the concept (Chennai doctor 10). Reddy himself acknowledges, primary healthcare should be the
responsibility of the government, which has both the resources
Another doctor echoed this view: and manpower to reach all parts of the country” (8).Yet how can
[Apollo] was a place where you could be confident healthcare be either universal or comprehensive in the absence
you could get every kind of treatment under one roof... of primary health care? Corporate health care has a proven
Suddenly people found that here was a place that, you track record of offering quality care, but only in highly specific
know, they had all kinds of specialities. That was the first –and highly revenue-generating—procedures, such as heart
hospital that actually even had specialists coming in bypass surgery. The costly business of primary healthcare is to
(Chennai doctor 7). be left entirely to a system that many consider already over-
burdened and under-funded. Nevertheless, Reddy’s confidence
Listening to these accounts, I failed to see what was so that corporates should not shoulder more comprehensive care
innovative. Surely, I thought to myself, the concept that one has been accepted by many of today’s leaders (28). Reddy
hospital could treat an entire range of ailments was the describes his goal thus: “My vision for the Apollo Hospitals
foundational idea of hospital medicine, as it emerged in the Group is to touch a billion lives, and I am sure we will fulfil the
late eighteenth and early nineteenth centuries. Many claim dream” (22).Yet, it is hard to imagine that he wants to touch all
that the multispeciality hospital provided something new, but parts of these lives’ bodies; it is just the revenue-generating
surely this was simply a shinier imitation of the government parts that interest him.
and charitable institutions which were already in existence
and which, too, were based on a long-standing model of List of doctors interviewed by author and cited in article
comprehensive clinical investigation and treatment. Chennai doctor 1: Interviewed 21 July 2010
Chennai doctor 2: Interviewed 11 May 2010
But the problem with this misconception is beyond a basic
amnesia for medical history. The problem with the celebration Chennai doctor 3: Interviewed 5 July 2010
of the corporate multispeciality version of hospital care is a lack Chennai doctor 4: Interviewed 19 July 2010

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publication/236888943_Tracing_Privatisation_of_Healthcare_in_India aspx

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