Health Systems Around the World

Devi Prasad Shetty trained in cardiac surgery at Guy's Hospital in London, returned to India in 1989 and joined a heart hospital in Kolkata, where he became known as one of the doctors who treated Mother Teresa after her heart attack. Kolkata taught him that most Indians who needed heart surgery could not pay for it, and that the constraint was price, not skill. The cost of a heart operation is mostly fixed: theatres, intensive-care beds, equipment, salaries and the building. In 2000 in Bengaluru he founded Narayana Hrudayalaya to push volume through those fixed assets: more theatres running more hours, more patients per intensive-care bed, standard processes, task-sharing and daily cost reports by noon. Bypass operations were reported at roughly ₹1.5–2 lakh, about $2,000–3,000, against US prices commonly above $100,000. The Wall Street Journal called him "the Henry Ford of heart surgery" in 2009.

Narayana Health became a listed chain of about 5,554 operational beds across 18 hospitals in India (reported, late 2025), with consolidated FY25 revenue of ₹5,483 crore, about $650 million, at an EBITDA margin of about 25% (reported). Its hospital in the Cayman Islands sells to Caribbean and North American patients at about a 43% EBITDA margin. In November 2025 it bought Practice Plus Group's hospitals in England, which treat mostly NHS-funded elective patients, for about £188.78 million. A model built to make surgery affordable for Indian cash patients was now selling to the world's most famous tax-funded health system. This chapter explains how health systems differ, and what those differences mean for the companies that sell into them.