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INDIAN HEALTH CARE INDUSTRY

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					             INDIAN HEALTH CARE INDUSTRY


DEFINITION:

Companies that develop, manufacture, market, and/or distribute
health-related products or provide health care services, such as
hospitals, nursing homes, HMOs, medical product suppliers, medical
equipment and medical device makers and medical laboratories.

The industry is divided into following divisions:

Anesthesia,                             Radiology                   ·
Critical and Respiratory Care ·         Surgery ·
Cardiology ·                            Surgical       Supplies   &
Diagnostics ·                           Disposables ·
Facilities Management ·                 Technology & Communication ·
Hospital Information Systems ·          Telemedicine ·
Laboratory Equipment ·                  Wound Management ·
Medical Products/Equipment ·            Miscellaneous
Oncology ·                              Medical tourism·

HISTORY AND GENESIS:

India’s private health care services industry in the shape of corporate
hospitals started in the 1980s with the establishment of Apollo
hospital as the first corporate hospital in Chennai. It is growing at a
rapid pace ever since. Health care is the world’s largest industry and
with India’s high population and dismal public health care system is
going to be an important player in the country.

Only 10% of the market potential has been tapped till date in the last
few years. Middle class with its huge purchasing power has risen in
India. Unhealthy and stressful urban life style brings health care to
the top of everyone’s list. World-class health care facilities have
become available to Indian middle class thanks to the private sector.

India’s expenditure on health as a percentage of GDP is highest for
developing countries. 85% of Indian health care cost is met from
private funds as per UN study.

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INDUSTRY STATUS FOR HEALTHCARE:

The Indian healthcare market is worth Rs 83,000 crore today and is
expected to grow. Indian govt expects the Indian health care industry,
which currently accounts for 4% of country’s GDP to grow at a rate of
13% annually for the next five years. It is projected as the next boom
in the country after the IT euphoria.
Sangita Reddy - Director, Apollo Hospitals Enterprise Ltd.; Md,
Apollo Health Street
The government to grant infrastructure status to healthcare because
there is no reason why it should not, considering the yeoman service
the players in the private sector is doling out to the people in this
country. We do not demand any kind of subsidy from the government
Vishal Bali; General Manager; Wockhardt Hospital & Heart Institute;
Bangalore
Healthcare should necessarily be given an industry status; the
industry can become more organized.
Today the sector is growing but there is no structure in the industry.
Sops should be given to this industry because worldwide healthcare
is the biggest employer.
This is an industry, which has quality norms that are recognized
worldwide today. We have the ability to create world-class
infrastructure.
 Ram Nath Prasad; Hospital Administrator; Sankalp Hospitals Private
Limited; Jamnagar, Gujarat
1 We lack in infrastructural facility, which demands investment on
huge scale, and the mobilization of the fund becomes a problem.
2. The industry status will encourage the private sector/corporate
houses/entrepreneurs to invest in this sector.
3. According industry status will encourage competition, which will
result in distinctive shift in quality of treatment. The ultimate
beneficiary will be common people.


                                                                      2
4. It will help in globalising the healthcare sector. The foreign
institutions will be encouraged to take interest/invest in India.
5. With industry status resulting in improvement in quality of services,
the insurance company will be encouraged to join the healthcare
services.
6. Government, from time to time, announces various incentive
measures for industries and healthcare sector will not remain
unaffected. The incentive schemes will definitely add favourably to
their growth.
7. The industry status will force hospital to be more transparent in
their dealings. The various laws applicable to industry will apply to
health sector, too.


SIZE MARKETS:

Size of Indian health care industry is worth $20 billion. 12% of
national annual expenditure is on health care. 82% of total health
expenditure comes from self-paid category.

Employee’s account for 9%. And insurance covers only 5%. The GOI
national health policy 2002 envisages an overall increase in the
health spending to 6% of GDP by 2010. Of which, 1/3 would be
committed to public health programs.

The rest 2/3 is earmarked for private sector with a growing role in
urban primary care and tertiary care sectors with growth of private
health insurance.

Indian diagnostics is riding an outsourcing wave with 70-80% cost
advantage over similar facilities in UK and US. SKP cross border
consulting expects $864 Mio diagnostic business to grow CAGR of
20%. We provide high-end tests under molecular diagnostics cyto
genetics cancer HIV tumor hepatitis and invitro diagnostics.

In diagnostic kit manufacturing 25 companies are involved. The in-
vitro diagnostic market has a CAGR of 25% for the last three years.
The rise in literacy rates, higher income increased awareness led to

                                                                       3
higher health expenses in India and preference increased for private
service providers.

Private health care consists of GPs and private practitioners, 5-100
bed nursing homes, large hospitals, corporate hospitals, trust
hospitals. 52nd national sample survey indicated that 81% of
outpatient care and 56% of inpatient care is provided by private
sector.
Medical tourism is the next big wave app.125000 medical tourists
from UK US Middle East PAKISTAN have come to India last year and
CII Mckinsey report suggest that medical tourism would be a $2
billion industry by 2012. South Asia is witnessing a boom in medical
tourism.
As many as 150,000 medical tourists visited India's hospitals last
year. Number of arrivals is growing by at least 15 per cent per
annum. Medical tourism in India is slated to become a $2.3 billion
industry by 2012, according to market estimates.

NO OF PLAYERS:

Three major corporate hospital groups viz FORTIS health care;
WOCKHARDT and Apollo hospitals and 26 best hospitals in the
subcontinent were forming partnerships with international insurance
and tourism companies that will send both insured and uninsured
patients for low cost treatment.

In the CII Mckinsey reports places earnings at Rs.10000 crore by
2012.Maharashtra Karnataka kerala and Delhi are foremost in
tapping this potential escorts Delhi has setup a 1500 bed medicity in
Delhi with 20 super specialties and Apollo indraprastha has obtained
JCI accreditation.

Private hospital in Hyderabad which get 10% of their patients from
abroad are opening separate words for foreigners eg: global
hospitals, Apollo hospitals, Asian institute of gastroenterology. JCI
joint commission international has benchmarked and accredited
indraprastha Apollo Delhi and wock hardt Mumbai. Wockhardt
Bangalore has got Harvard medical international tie up. MIOT


                                                                    4
hospital Chennai is trying to match US hospital documentation
standards.
TOP 10 players in 2005
   1. AIIMS Delhi                 Top five private hospital groups
   2. Apollo hospital Chennai     are:
   3. PGIMER, Chandigarh.         1 Apollo
   4. CMC vellore                 2 FORTIS
   5. Shankara         netralaya  3 MAX
      Chennai                     4 WOCKHARDT
   6. Bombay hospital Mumbai      5 ESCORTS
   7. NIMHANS MYSORE
   8. JASLOK         HOSPITAL
      MUMBAI                         Top five hospitals for
   9. SGPGIMS, Lucknow               prosthetics:
   10.      JIPGMER,                 1. AIIMS Delhi
      Pondicherry                    2. Haji ali hospital Mumbai
   11.      Tata       memorial      3. SMS medical college
      hospital, Mumbai                  Jaipur
                                     4. AIIPHRC Delhi
                                     5. Apollo hospital Chennai




PRODUCT – RANGE, PRICE:

Price Compare Overview

COST COMPARISON – INDIA VS UNITED STATES OF AMERICA
(USA)

Significant cost differences exist between U.K. and India when it
comes to medical treatment. India is not only cheaper but the waiting
time is almost nil.



                                                                    5
This is due to the outburst of the private sector, which comprises of
hospitals and clinics with the latest technology and best practitioners.
The comparative table is given in pricing chapter later on in the
report.

Medical tourists have good cause to seek out care beyond the United
States for many reasons. In some regions of the world, state-of-the-
art medical facilities are hard to come by, if they exist at all; in other
countries, the public health-care system is so overburdened that it
can take years to get needed care.

In Britain and Canada, for instance, the waiting period for a hip
replacement can be a year or more, while in Bangkok or Bangalore, a
patient can be in the operating room the morning after getting off a
plane.


For many medical tourists, though, the real attraction is price. The
cost of surgery in India, Thailand or South Africa can be one-tenth of
what it is in the United States or Western Europe, and sometimes
even less. A heart-valve replacement that would cost $200,000 or
more in the U.S., for example, goes for $10,000 in India--and that
includes round-trip airfare and a brief vacation package.
Similarly, a metal-free dental bridge worth $5,500 in the U.S. costs
$500 in India, a knee replacement in Thailand with six days of
physical therapy costs about one-fifth of what it would in the States,
and Lasik eye surgery worth $3,700 in the U.S. is available in many
other countries for only $730. Cosmetic surgery savings are even
greater: A full facelift that would cost $20,000 in the U.S. runs about
$1,250 in South Africa.
Bangkok’s Bumrundgrad hospital has more than 200 surgeons who
are board-certified in the United States, and one of Singapore’s major
hospitals is a branch of the prestigious Johns Hopkins University in
Baltimore. Escorts Heart Institute and Research Center in Delhi and
Faridabad, India, performs nearly 15,000 heart operations every year,
and the failure rate is 0.8 percent-- half of same in United States.
India and South Korea are pushing ahead with stem cell research at
a level approached only in Britain. The doctors are supported by


                                                                         6
more registered nurses per patient than in any Western facility, and
single-patient rooms resemble four-star hotels, with a dedicated
nurse with a personal assistant for the post hospital recovery period
plus vacation incentive.

Asian airlines offer frequent-flyer miles to ease the cost of returning
for follow-up visits.
Ten years ago it was negligible and now more than 250,000 patients
per year visit Singapore alone. This year, half a million to India up
from 150,000 in 2002. Medical tourism brings India as much as $2.2
billion per year by 2012. Argentina, Costa Rica, Cuba, Jamaica,
South Africa, Jordan, Malaysia, Hungary, Latvia and Estonia are
joining the trend. By 2015, 220 million baby Boomers in the United
States, Canada, Europe, Australia and New Zealand, represents a
significant market for inexpensive, high-quality medical care.
In US 43 million people are without health insurance and 120 million
without dental coverage. Patients in Britain, Canada have long
waiting lists for major surgery. Major centers for medical tourism are
Bangkok and Phuket, with eye surgery, kidney dialysis and organ
transplantation most common in Thailand. Phuket Hospital is for sex-
change surgery. India is a newcomer to medical tourism growing @
30 percent each year.
India has top-notch centers for open-heart surgery, pediatric heart
surgery, hip and knee replacement, cosmetic surgery, dentistry, bone
marrow transplants and cancer therapy, and virtually all of India’s
clinics are equipped with the latest electronic and medical diagnostic
equipment.
Unlike many of its competitors in medical tourism, India also has the
technological sophistication and infrastructure to maintain its market
niche, and Indian pharmaceuticals meet the stringent requirements of
the U.S. Food and Drug Administration.
 Additionally, India’s quality of care is up to American standards, and
some Indian medical centers even provide services that are
uncommon elsewhere. For example, hip surgery patients in India can
opt for a hip-resurfacing procedure, in which damaged bone is
scraped away and replaced with chrome alloy--an operation that
costs less and causes less post-operative trauma than the traditional

                                                                      7
replacement procedure performed in the U.S. Costa Rica is for
inexpensive, high-quality plastic surgery medical care without a trans-
Pacific flight.
South Africa draws many cosmetic surgery patients, especially from
Europe, and many South African clinics offer packages of personal
assistants, trained therapists, beauty salons, post-operative care in
luxury hotels and safaris with low ‘Rand’ in exchange value i.e.
perpetual bargains.
Argentina ranks high for plastic surgery, and Hungary for high-quality
cosmetic and dental procedures costing half as in Germany and
America.
Dubai--a luxury vacation paradise--opens the Dubai Healthcare City
by 2010 to include a new branch of the Harvard Medical School. [By
Becca Hutchinson Photos by Kathy F. Atkinson and Jack Buxbaum]


WHY CONSIDER INDIA FOR SURGERY?

  1. best medical treatment in the world
  2. excellent reputation in its private hospitals
  3. a global health destination.
  4. forefront of medical technology and equipped with modern
     state-of-the-art technology and highly skilled medical
     personnel.
  5. Indian doctors are among the best in the world and their high
     level of surgical expertise as they train and work in the UK, and
     become members of the BMC.
  6. Hygiene is excellent
  7. surgical patients are screened for HIV and Hbs Ag antibodies
  8. operation theatres have laminar air flow installed and gaining
     ISO9001 standardisation.
  9. Low cost treatment = most cost-effective in the world.
  10.       knee replacement costs £9,000 in the UK £2,150 in
     Chennai
  11.       a full set of teeth capped costs just £400, vs £45 for one
     in UK in Manipal Hospital, Bangalore.
  12.       Patients / medical tourists can book package deals of
     flights, transfers, hotels, treatment and a post-operative


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   vacation with Ayurvedic stream of medicines and alternative
   rejuvenating retreats of yoga, meditation or naturopathy.
13.       Main centres are Bangalore, New Delhi, Kolkata
   (Calcutta), Ludhiana, Chennai and Hyderabad with air fares of
   £300 return. Flying time from London to Delhi is nine hours.
14.       India has a tropical climate with high temperatures and
   dry winters and the best time to visit is between October and
   March as the monsoon is apparent throughout the country
   between May to September.
15.       So, with private facilities equal to European counterparts,
   efficient, multilingual doctors and dentists, coupled with
   massive savings on surgery, India is a sensible choice for
   treatment abroad.




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PATIENT STORIES:

Cosmetic surgery in India
From the moment Catherine Kerr arrived in Mumbai, the treatment
that she received from Wockhardt Hospital has been outstanding.
She...

Breast reduction surgery in India
Marie Gordon-Russell has been trying for six years to undergo breast
reduction in the United Kingdom. Initially she was told there was an
NHS waiting...

Knee arthroscopy surgery in India
Ms Karen Holman needed knee surgery but the private quote she
had been given in the UK was far too expensive. She heard that the
Apollo...

Artificial Disc Replacement in India
The Taj Medical Group arranged for Heidi Rogers to spend a week in
Delhi to undergo clinical investigations for the relief of Lower Back...

Cardiac by-pass surgery in India
Mavis Childs, 67, took drastic action after waiting more than two
years to have a heart by-pass operation on the National Health
Service. She...

Total Hip Replacement in India
Barry Peters from Surrey, UK had a total hip replacement followed by
some cosmetic dental work. He was one of four Taj patients
prominently...

Shoulder surgery in India
Mr. Mark Carr, a paraglider pilot from the UK had been experiencing
severe shoulder pain for several years but his x-rays kept coming
back as...

Heart bypass surgery in India
It was one of the most critical decisions George Marshall had to take
in his life. The 73-year-old violin repairer from Bradford, UK, was
suffering...

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Knee replacement in India
Mr. Brian Troughton, from Stafford, had been experiencing severe
pain in his left leg for quite some time but had been told by his doctor
that the...

Birmingham Hip Resurfacing operation in India
Mr. Henry Stevens is a professional polo umpire, horse trainer and
polo manager who live south of London. He had been suffering from
severe...

Face-lift surgery in India
Ms S, aged 54 from Manchester had wanted a face-lift for several
years but could never afford to have surgery in the UK. She then
read a very...

Male face-lift surgery in India
Mr. Arthur Wedderburn, 64, from Newcastle went to Manipal Hospital,
Bangalore for a full-face lift and decided to have some dentistry
treatment done...

It can take up to 11 months on the NHS to get a hip replacement and
privately this would cost between £9,000 and £13,000 vs £3,600*in
india (*Quotes from Indraprastha Apollo Hospitals, New Delhi, India).
Rhinoplasty (a nose reshape) costs between £3,500 to £5,000 in the
UK compared to £1,100 up to £1,500* in India. (*Quote from
Indraprastha Apollo Hospitals, New Delhi, India).


HEALTH INSURANCE:
The country's total spend on healthcare is 6% of the GDP - of which
the private healthcare expenditure accounts for 4.25% of the GDP.
Though the private healthcare expenditure is growing at the rate of
12.8% per annum, the contribution of insurance cover is almost
negligible.
Health insurance companies can play a major role in bringing down
the occurrences of acute care by offering incentives for the health
insurance customers to maintain health. There is the need to evolve
innovative and targeted insurance schemes that covers, for instance,
the mother during her pregnancy and also protects the newborn,

                                                                      11
which is unfortunate enough to be born with congenital heart disease
that requires surgery. The hospitals have to utilize the bandwidth
availability at district level to launch telemedicine programmers for
primary diagnosis, educating the paramedical staff; Apollo is pioneer
in telemedicine in India.
The existing insurance healthcare system caters almost exclusively to
the urban population. Even for the urban insured, most of them are
delivered through an employer-generated system that terminates with
employment. 80% of the healthcare facilities are clustered in urban
areas, while only 2% of the specialists are available for over 75% of
the population that live in rural India.
There are over 60 Neuro-surgeons in Chennai alone whereas the
whole of North Eastern States have just 3 neurosurgeons. There is
need for health insurance for children as they are unprotected and
expensive healthcare remain inaccessible to them.
Presently the prepayment mechanisms that exist in the country
include private health insurance, social insurance such as ESI,
employers-based insurance and community insurance that are
floated on a not-for profit model.

PREVENTIVE HEALTHCARE:

Preventive care – That’s the new mantra of today.
More professionalism:
The concept of managed care is coming up in a big way, which will
provide a comprehensive range of services from preventive primary
care to long-term care. And that’s not all. Healthcare is getting more
professional and commercial too. Perhaps it’s the rising
consumerism, growing need for better healthcare facilities or the
discerning middle class getting more demanding, it’s the dawn of a
new era for the healthcare industry.
For economically weaker sections:
With the recent spate of insurers coming in, healthcare seems to
have come of age. While hospitals such as Apollo did dole out



                                                                    12
healthcare packages, these were by and large limited to the higher
echelons of society, the privileged few.
Healthcare companies:
Considering the potential the healthcare industry holds, a number of
companies are busy working out strategies. Also a new breed of third
party administrators (TPAs) will play their role and help administer
these strategies to reach out to the consumer. Max India, Fortis
Healthcare, Paramount Healthcare, BUPA Piramal, a joint venture
between the Piramal group and the UK-based healthcare major
BUPA are few, which have ventured into this arena.
Speciality hospitals:
Max India is setting up a network of about 35 to 40 primary care
clinics, four diagnostic (with ambulatory surgery facilities), two
medium-sized hospitals, and a large state-of-the-art tertiary care
hospital by 2005.
While, Apollo plans to set up Speciality hospitals here as also abroad
and Apollo Lifestyle Clinics too, of which 200 will begin their
operations by end of 2002 some companies believe in going via the
primary route as they feel this could help them tap the market better
since patients approach the nearby primary clinic first.
Third party administrators:
The Insurance Regulatory Development Authority (IRDA) is yet to
come out with the final guidelines on third party administrators. While
the draft regulations are already out a number of changes are
required in the norms set, in order to encourage the newcomers set
up shop here. Also the sale of healthcare products has not been
permitted by the regulator, which has proved to be a major setback to
them considering the large amount of investment that has already
been made.


MARKETING OF HOSPITALS IN INDIA:
Marketing department
With the realisation of importance of hospital marketing, the presence
of a full-fledged marketing department has also been acknowledged.

                                                                     13
“The marketing department is said to be the voice of hospital where
the brand is fashioned and communicated, internally as well as to the
community at large,” says Anne Marie Moncure, managing director,
Indraprastha Apollo, New Delhi.
The role of the marketing department in our hospital is of paramount
importance. Apart from helping to create a brand image for the
healthcare institution, the department acts as an interface between
the doctor and the public.
Agrees Urmila Nabar, marketing manager, Nanavati Hospital,
Mumbai, “We provide the liaison between the doctors and the public.”
The marketing department has assumed more importance after the
boost in medical tourism, opines Colonel B S Khimani, director,
administration, Jaslok Hospital.
The marketing department liaisons with the medical officers of the
foreign consulates to bring patients from abroad. “FICCI is helping
hospitals to utilise the potential of medical tourism. Jaslok hospital
has recently tied-up with FICCI to utilise the potential of this
upcoming sector,” informed an official from Jaslok Hospital.
The success of the marketing department depends on its association
with various other departments. “Organisational excellence is very
important than the departmental excellence. The front end cannot
perform its duties without the backing of the quality of back end
operations,” says Anantram.


MARKETING STRATEGIES:
Though there are no specific strategies for hospital marketing, a
systematic approach to marketing has evolved over the past few
years. “Unlike earlier, now the corporates prefer a long-term
association with the healthcare institution by signing a memorandum
of understanding (MoU),” says Deepika Gupta, marketing executive,
S L Raheja Hospital, Mumbai. Marketing experts believe that a sound
Client Relationship Management (CRM) forms the basis for soliciting
corporate tie-ups, today.




                                                                    14
Events, both indoor and out-reach programmes, play a significant role
in marketing of healthcare institutions.
Continuous medical education, awareness sessions for general
public, check-up camps for public, organising events on various
health days, conducting interviews of specialists on visual media,
informative and interactive website, printing and making readily
available various emergency or appointment numbers are the
commonest marketing tools.
According to Dr K S Bhimwal, medical director, Rockland hospital,
with the surge in concern in health check ups, hospitals have
fashioned various types of special health check up packages catering
to executives, pregnant women, servants, shop keepers to slum
dwellers.“Recently, we celebrated Liver Day at Apollo, which was
aimed at educating and creating awareness amongst children and
parents, so we organised a fashion show and health quiz, which
generated a lot of interest,” says Moncure.
Though hospitals are publicising through advertisements, according
to Dr Saumitra Bharadwaj, marketing manager at Fortis hospital,
NOIDA, hospitals should create goodwill for themselves and should
not completely rely on advertisements.
“As patients are the best ambassadors, it is important to take care of
their needs and provide them with best possible care. Their
apprehensions should be addressed so that they have the courage to
come back to the same facility,” he adds. Agrees Anantram, “In this
business, every satisfied customer brings thousand new customers.”
Future:
Would hospital marketing become more aggressive in the future?
“We can no longer rely on word of mouth for getting patients.
Hospitals, mainly the corporates ones, would definitely get more
aggressive to survive the intense competition,” avers Juhi Bhandari,
marketing manager, Hinduja Hospital.
However, Nabar disagrees, saying, “Aggressive marketing is not
necessary in healthcare sector as it would not fetch more patients.
Patients’s decision to choose a hospital is based on three factors:
facilities available in the hospital, expertise of doctors and vicinity.”


                                                                       15
Will new marketing mantras emerge in the future? The answer lies in
the thought process of the new faces in this sector. According to
Manish Sharma, management trainee, Hinduja Hospital, “As in the
West, in future, tertiary care Indian hospitals need to conduct
research so as to segmentise the market and tap that area from
which patients are not turning up.”
For instance, if research shows that a hospital is not attracting
enough patients from a particular age group or a disease profile, it
needs to strategise to get those patients.”
Case studies of marketing strategies of few hospitals
Fortis, Noida
Fortis was the first hospital to organise an exhibition in the National
Capital Region, wherein the general public could visit all departments
of the hospital and get answers from experts.
Secondly, Fortis launched a dialysis technician programme for
women from the weaker section of society in which they were given
free training by the hospital and they will be assimilated in the
hospital itself.
Apart from organsing CMEs almost every week, camps, there’s a
special OPD where consultants charge Rs 100 only. Internally, we
have patient co-ordinators, counsellors, ward in-charge etc to take
care of all need of patients. There’s also a system of taking feedback
from patients and visitors.
Dr Saumitra Bharadwaj, marketing manager, Fortis hospital, Noida
Jaslok Hospital, Mumbai
The marketing strategy of Jaslok Hospital involves tying up with
corporates, some of them being Oil and Natural Gas Commission
(ONGC), Mumbai Port Trust (MBT), Bhabha Atomic Research Centre
(BARC) and Air India. One of the most effective marketing tool is a
web site (www.jaslokhospital.net), which is constantly updated by our
technical staff.
Other marketing strategies involve that the hospital conducts free
health check-ups like diabetes and cardiac check ups for the general
public, inviting foreign faculty and holding joint symposiums with the
foreign delegates to share their skills, knowledge and experience.

                                                                     16
The hospital has a tie up with Stanford University Medical Centre, US
and we hold video conferencing every month with the doctors of the
centre, who interact with the faculty of our hospital.
Dr J P Sharma, medical superindentent, Jaslok Hospital
Apollo Hospital, Chennai
All marketing endeavours at Apollo are based on strict ethics, code of
conduct and corporate social responsibility.
We understand that the consumer is the best judge of the quality of
our products and to that extent we have to be humble when we talk
about our excellence in healthcare.
I cannot advertise that we have the best doctors. It will be against the
code of conduct. Though we have a marketing budget and
programmes, they do not appear same as that of the one that
traditional product or service sectors have.
When the consumer wants a medical product or service, referring
doctors and the circle of friends and relatives influence the
consumer’s decision.
To reach our message to each of these two divisions, we take
different approaches. We interact with doctors on one on one basis.
We regularly conduct seminars and continual education programmes
to explain to doctors the advances in the medical sciences and the
infrastructure that our hospital has.
To reach the consumers, we rely mostly on public relations.
Whenever our doctors perform pioneering surgeries or winning
awards for their achievements, we talk to the media and when people
come to know about our achievements they get confidence to go for
our services.
We regularly present various health programmes to the corporates
who form a significant chunk of our customer base. Being a hospital
chain, we have the advantage of leveraging our brand.


Ashok Anantram, president-business development, Apollo Hospitals,
Chennai


                                                                      17
SWOT Analysis
Strengths                        Weaknesses
                                 Inadequate         work     culture
Sufficient money and qualified environment
manpower.                        Apprehension of Job withdrawal
 Located in an industrial town   Unwillingness shown by some of
Dynamic leadership               the employees.
Skilled accredited staff doctors Internal conflicts between people
Personalized care                Low morale of many staff
Efficiency and honesty           members and
Interior Design And Graphics In Doctors
Hospitals                        Adverse drug reaction programme
Logo of hospital and brand
building expenditure

Opportunities                      Threats
Hospital has started enough        Likely    resistance   and    non
activities and generates enough    cooperation of the employees in
income.                            future
Autonomy to operate and            Problems of maintenance and
develop                            backup services Advanced HIS
 Attract patients from other       software
countries                          Insurance
the country's unmet demand for     Negligence claims
healthcare facilities,             Competition from other corporate
increasing spending in private     Hospitals
healthcare,                        A low ROI of 15 to 20%,
Growing        population    and
economy,
Increase in life expectancy,
Lack of entry barriers and
Intellectual pool


.




                                                                  18
FUTURE REQUIREMENTS AND TRENDS:
MEDICATION ERROR REPORTING THROUGH PRESCRIPTION
AUDITING:
Dr M C Joshi
Bringing information on patterns of existing practice together with
information on appropriate practice is an essential component of
efforts to improve healthcare.
This is possible only when each and every prescription in the hospital
is audited by a prescription auditing team. The process of prescription
auditing in its broad sense include prescription monitoring, drug
utilisation studies, prescription pattern studies, study of prescription
habits of doctors, adverse drug reaction monitoring, drug interaction
monitoring, criteria based prescription auditing and many other
activities.
But the grassroot activities include checking the prescription for drug
name (brand name or generic), strength, formulation, dose, route of
administration, frequency, duration of treatment and drug allergies.
Adverse Drug Reaction (ADR) reporting could also be confirmed by a
search for prescriptions containing tracer drugs e.g. Avil injection and
Effcorlin injection
Why Is Prescription Auditing Needed?
According to studies cited in the Institute of Medicine report, To Err Is
Human: Building a Safer Health System, 44,000 to 98,000 Americans
die each year as a result of medical errors.
This statistic is associated with a cost of USD 17 to USD 29 billion
and ranks medical error the eighth-leading cause of death in the US.
The Joint Commission on Accreditation of Healthcare Organisations
(JCAHO) states that some of the most common medical errors are
related to medication delivery.
A medication error is defined by the National Coordinating Council for
Medication Error Reporting and Prevention (NCC MERP), as “any
preventable event that may cause or lead to inappropriate medication
use or patient harm while the medication is in the control of the health
care professional, patient, or consumer”.


                                                                       19
In Indian scenario, a proper reporting of medication errors in the
hospital is not available, but out of all visits to the medical emergency
department- six per cent are drug-related.
ADRs accounted for 45 per cent of all ADEs. Of all ADE-related visits,
52 per cent and of all ADE-related admissions, 55 per cent were
considered preventable.
Voluntary Consumer Action Network, in a recent survey of 200
prescriptions, confirmed irrational drug use and has warned that
doctors found to be mis-prescribing would be sued in consumer
courts for medical negligence.
The fast growing rates of medication errors all over the world decides
the need for starting a routine prescription auditing in all the
multispeciality and tertiaty healthcare centres in India.
Standard Operative Procedure
1.Doctor prescribes medicines on the prescription order sheet.
2. Indents made by the nursing staff (drug order to pharmacy through
an online transcription).
3. The indents contain – drug name, strength, formulation, doses
route of administration, frequency & duration of treatment.
4. Indents checked by the clinical pharmacist (using softwares).
Pharmacist should read it carefully and check the drug name (generic
/ brand), strength, formulation, doses, route of administration,
frequency and duration of intake.
5. The clinical pharmacologist specifically screens the indents made
from the ICUs, since these patients are more prone for requiring
doses adjustments, drug interactions and adverse effects (cases of
altered pharmacokinetics and pharmacodynamics) using the online
lab module. If the pharmacist is unsure about any drug, he should get
it verified with the clinical pharmacologist.
Note: In case any correction / suggestions / recommendation/need for
an alternate therapy is felt by the clinical pharmacologist, a
verification call is given to the doctor- prescriber.



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Outcomes of Prescription Auditing:
Medication Errors
Medication errors reported through prescription auditing could be
because of the mistake done by a doctor, nurse or the pharmacist.
Medication errors are basically of two types: intercepted errors and
actual errors, on the basis whether they reach the patient or not.
Both the types of errors are further divided into four categories-
      Prescription error
      Administration error
      Transcription error
      Dispensing errors
Except administration error, rest all types of errors could be rectified
by prescription auditing. The administration error could only be
rectified by hospital rounds, which are also essential for adverse drug
reaction monitoring. Prescription errors which are corrected and
prevented by prescription auditing team are called as intercepted
error.

NEW TECHNOLOGY ABSORPTION WILL BE THE IN-THING OF
HEALTHCARE INDUSTRY IN THE COUNTRY

Various applications can be embedded on to the healthcare smart
cards. There are an increasing number of information technology
companies now looking at developing either software or hardware for
the healthcare segment in the company.
The healthcare segment is actually making these companies look at
the segment in a big way.
 Any new technology takes its own time to get acceptance. But if one
looks at the healthcare segment industry in the country, the time
taken for a new technology to be accepted has been short as
compared to in the west.




                                                                      21
Corporate hospitals need customer relationship management (CRM)
Technologies.
There is a wide gap between the usage of information technology in
corporate hospitals and other medium and small hospitals in the
private sector.
Given this difference it is very difficult to assume that this technology
would penetrate or find acceptance with small and medium hospitals.
Another factor that will prohibit hospitals from taking to such
technology is the price. Price will be of importance here.
With Indian IT companies looking at the domestic healthcare segment
in a big way there is every possibility that dearth of good software
may become history.
The hospitals going in for newer technologies have good
maintenance partners in these software companies some of which
have proved themselves in the international arena.
With already few companies working in tandem with hospitals to
develop specific software modules, there is air of confidence that
these companies can deliver the goods when it comes to new
technologies.
This very fact should drive some of the hospitals to implement new
technologies such as the healthcare smart cards looking at benefits in
the longer run if not immediately.

ENTERPRISE MANAGEMENT                  AND     SUPPORT        IN    THE
HEALTHCARE INDUSTRY:

SAP AG Enterprise Management and Support in the Healthcare
Industry 2

The Healthcare Industry:

Healthcare facilities worldwide are struggling to adapt to a new
market environment that demands intense focus on measuring and
managing costs.



                                                                       22
Hospitals also face a myriad of regulations and legal requirements
Information technology solution adopted by the hospitals should
ideally cover the following areas on real time basis:

     Financial Analytics and Management
     Budgeting.
     Financial and management accounting.
     Financial supply chain management.

   Cost and profitability management.
   Procurement and Supplier Relationship Management
   Patient Management

   Application and Data Integration
   Easily integrates data and applications. Including SAP, non-
    SAP, and legacy systems.

   And is interoperable with key technology standards, including
    Java 2 Platform, Enterprise Edition (J2EE) and Microsoft .NET.
   ELECTRONIC DATA TRANSFER across multiple application
    components within and beyond enterprise boundaries.

   MASTER DATA MANAGEMENT at vastly reduced data
    maintenance costs. This in turn facilitates successful
    collaboration across diverse business processes and with
    external organizations, reduces IT integration costs, and
    improves decision-making.

   DATA ANALYSIS AND REPORTING to detect and analyze
    deviations early.
   Regulatory Compliance and Corporate Governance

   These include online controls for internal and external auditors
    and the ability to export data to auditing software, enabling
    detailed insight into various audit functions and supporting
    faster, more accurate reporting.




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 Human Capital Management to increases efficiency, reduces
  costs, and boosts employee satisfaction with Employee life-
  cycle
 Management functions.

 Environment, Health, and Safety
 New and Enhanced Capabilities for the Healthcare Industry
 Self-Services and Role-Based Access

 Employee self-services.
 Manager self-services.
 Purchasing agent role.

 HR executive role.
 Consolidated Financial Reporting




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