The Life Saver

By Sheryl Flatow. Photograph by Eric Levin

Staying healthy in India isn’t easy: the country is ranked 167th in the world for health care expenditure and 163rd for life expectancy. A grim diagnosis. Like many things in the world’s fourth-largest economy, that’s changing—and fast. And much of it has to do with Analjit Singh (BSBA’77, MBA’79). In the 1980s, he built a company worth millions, then broke it up to do something that many others (the US government included, some would argue) have failed to do: deliver quality, affordable health care that treats all patients like VIPs. The hospitals he built don’t even smell like medical institutions: he put coffee shops, wafting a clean scent of roasted beans, in the lobbies. In doing so, Singh created a demand that no one knew existed.

The chairman of Max India Limited, Analjit Singh (BSBA’77, MBA’79), recalls that one of the first lessons he learned in Economics 101 was “demand creates supply.” But Singh, who has transformed health care services in his native India, believes that John Maynard Keynes got it wrong. “My view is that supply creates demand,” he says. “If you come up with a unique product or service and there’s a market for it, you’ve got a demand.”

In other words, if you build it, they will come.

Singh founded Max India in the 1980s, and for roughly 15 years the company was a mini-conglomerate with diversified businesses ranging from pharmaceuticals to telecoms to packaging to electronics. It helped make him staggeringly wealthy—today, his net worth is $725 million, according to Forbes—but by 1999, he had lost interest in the company’s various endeavors. “I kind of had it,” he says. “The things we were doing didn’t mean that much to me from an inner perspective. I began to think about what I really wanted to do with my life, what would excite me, motivate me, engage me, inspire me.”

He realized that he wanted to make a difference in his community. So in 2000, Max India was reinvented as a service-oriented company. “I had this deep, personal desire to get involved in something where business meant more than business, where we were doing something for the social good,” says Singh, who divested 14 of his businesses, freeing up management time and capital. “The new business would be commercial only in order to do things that touch people’s lives and create an impact. I didn’t want to get into an overcrowded space; I wanted to get into something where I could show the way.”

In a country where private health insurance is a new phenomenon and the vast majority of the population is uninsured, the new Max India brand embraces what Singh calls “the business of life.” The group, which has a presence in areas as diverse as clinical research services and food packaging, includes one of India’s largest life insurance companies, a health insurance joint venture, and the hospital network Max Healthcare (MHC). Max India’s total annual revenue is INR 10, 624 crore—about $2 billion—while its foundation backs initiatives such as rural immunization programs and palliative care for people with cancer. Although the hospital network isn’t the biggest part of the group—that honor goes, by some distance, to the life insurance unit, Max Life—it exemplifies the social impact that Singh aims for.

He says his choices were both spiritual in nature and strategic. “It was well known in India that if you got sick and went to a hospital, you were relegated to go to a hole in the wall,” he says. “Even the best private sector hospital was pretty shabby.” The exceptions were the high-end Apollo Hospitals, founded in 1983 and credited with bringing world-class health care to India—albeit at a price. But Singh recognized a systemic problem throughout India: even when medical care was of the finest quality, the patient experience pre- and post-op was not.

“That’s another way of saying that our technical capability was great, but our care capability was zero,” he says. “So I saw an opportunity. If care is what is lacking in terms of total patient experience, which includes everything from medical outcomes to managing infection, to good nursing with good training, to creating a cheerful environment, to hospitality, then there has to be a market for it. And if the private sector will pay for it, there’s got to be a reasonable business. I’ve always said that in the health care sector one should aim to be reasonably profitable, never profiteer.”

India underwent significant deregulation beginning in 1991, creating a variety of opportunities for the private sector. Over the next decade, Singh says, “Indians were enjoying a new world of better packaged products and state-of-the-art telecom, airline, and banking services.” Why, he asked, should health care get left behind?

Although government employees are covered by a government health care plan in India, there’s no national health insurance available to the private sector. “Either a company covers your health needs as a part of your employment deal, or a sponsor covers you, or you’re on your own,” says Singh. That’s why hole-in-the-wall facilities were overcrowded; they offered treatment for a dollar. “We felt that if we came up with a very good quality product and service, there was a market waiting to happen.”

In MHC’s early days, it built a clinic that was open from eight in the morning until eight at night and charged patients a fee of about $20. Singh visited one day, and noticed low-income workers sitting in the lobby. “I wanted to find out what was driving these people here, when they could get treatment elsewhere for a dollar,” he says. “The answer was, ‘When we go into those shabby kinds of places, we need to wait for three or four hours in the heat. We don’t know when our turn will come. We don’t know if we can go back if things go wrong. When we come here, we sit in an air-conditioned environment, we are seen within 10 minutes of the appointed time, we get a registration number, and if we have a problem we can call back or we can come back.’ So we discovered that there was, indeed, a market.”

As MHC opened its hospitals, a commitment was made not just to providing the finest medical care, but excellent service. “We had to raise the game by offering what I call a total patient experience, a total customer experience,” says Singh, a 2013 BU Distinguished Alumni Award winner. “That goes from keeping the floors scrubbed and the loos clean to the smell of coffee as you enter the lobby. We have little cafés installed in every lobby, because I want patients to get a smell of coffee when they walk in, not the smell of a hospital. . . . Our patients are greeted as they come in, and ushered to their room. There is multidisciplinary care by doctors, and high-quality nursing. Someone is there to attend to the patients at all times and answer questions. We installed IT, so that we could create health records for patients.”

MHC runs 12 hospitals with a total of 2,200 beds at 9 sites in northern India, with more on the way. There are two general hospitals, and the rest are what Singh calls “super specialty” hospitals, with centers devoted to fields like cardiology, oncology, and neurology. “We stay focused in the north, rather than have a presence all over India, because we feel that’s how we can control quality,” he says.

Singh’s vision has dramatically altered the health care landscape in his country. “Upping the ante on medical outcomes, clinical excellence, and service excellence was a game changer,” he says. “It led to a whole new sector developing, and a lot of people followed through and jumped into the fray. It’s fair to say we were responsible for that.”

His impact has also caught the attention of business leaders outside of India, according to former CEO of Quest Diagnostics Kenneth W. Freeman, Allen Questrom Professor and Dean.

“Through the powerful combination of identifying major growth opportunities, selecting the right CEOs and corporate partners for the various lines of business, and gaining access to financial capital, Max India has become widely recognized inside and outside India for excellence in health services,” says Freeman, a director of medical device specialists Accellent and a former member of the Healthcare Leadership Council. “Analjit’s focus on delighting the customer represents a transformational change in India, to the point that Max India is widely respected and benchmarked by other companies.”

The number of hole-in-the-wall facilities has been diminishing, which is due in part to the financial gains to be made by selling off these properties. But there is another, more important reason contributing to their decline. “Skill is taking over, brand is taking over, quality is becoming more relevant,” says Singh. “At Max, 80 percent of our patients are middle class or above, but we also treat lower-income people. And that’s because their employers and sponsors are sending them to us and Apollo and Fortis, a third high-quality chain, rather than to the places they used to send them for care.”

Investment in health care from the private sector continues to grow, and Singh says the government “has embraced and accepted” that health care is going to be increasingly privatized. “Our funds come from capital markets, private equity players, and private capital, and people are looking for a reasonable return,” he says. “We can’t give it away. But we have a strong sense of corporate responsibility, and we have certain obligations of free treatment, both outpatient and inpatient, which we try to fulfill as responsible citizens of society.”

Singh has since expanded the company into the hospitality field with a wellness resort; the company’s next venture is a senior community that will embrace both independent and assisted living. “It’s become part of the life of the company to think about spin-offs to our health care business that offer unique opportunities and choices,” he says.

Singh says his approach to Max India can apply to all businesses. “It’s about commitment, about focus, about a sense of place . . . about not taking anything for granted, about a raison d’etre. It’s not about skimming the cream. I also believe that people do better when they’re passionate about something. So if people do better, it stands to reason that their business must do better as well.” It’s a conviction that Singh can back up—his businesses are successful. The life insurance company he chairs has 287 offices in 216 cities and has been named an Indian “superbrand.” Most Indian—even global—companies would take just one of those achievements. And yet underpinning Max Life is a mission that wouldn’t be out of place on the website of a nonprofit—the first line is about being honest; the last about contributing “to society by supporting causes in health and well-being.”

“The central theme of what you want to do, the central idea must resonate with you, or it’s not going to work,” says Singh. “The connection is very important: you’ve got to do what is right, and do it right.”