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The World’s Cheapest Hospital Has to Get Even Cheaper

Cancer surgery for $700, a heart bypass for $2,000. Pretty good, but under India’s new health-care system, it’s not good enough.
An operating theater at Bangalore’s Narayana Institute of Cardiac Sciences.

An operating theater at Bangalore’s Narayana Institute of Cardiac Sciences.

Photographer: Anshika Varma for Bloomberg Businessweek

It was only after a junior surgeon opened the patient’s chest, splitting his sternum with a quick buzz from a handsaw and cranking a savage-looking retractor to pin open his rib cage, that the rare and lethal disease became visible.

A normal heart has the rough dimensions of an apple, but the beige and purple mass beating between the man’s ribs had inflated to the size of a cantaloupe—the result of clots in his pulmonary artery that were blocking the flow of blood to his lungs. With his own circulatory system effectively strangling him from the inside, his heart had swollen from the effort of keeping him alive. In the West, the condition would almost never be allowed to progress this far. But the patient, an outwardly healthy 31-year-old, lives in a remote city in western India, where doctors had no idea how sick he was. At such a late stage, the only way to save his life was this difficult and dangerous operation at Narayana Health City in Bangalore.