HealthCare Market The Indian Perspective

INDEX
TOPICS
1. Introduction To Hospitals 2. Health Care Sector - Analysis 3. Medical & Health Care Service 4. SWOT Analysis Strength Weakness Opportunities Threats 5. Product 6. Respondents feedbacks : Government Vs Private Hospitals Factors responsible for choice of Hospital After effects of the AMRI incident 7.Future Prediction & Analysis 19 7. 8. 9. 10. 11. 16- 18

Pg. Nos.
3. 5. 6.

INTRODUCTION TO HOSPITALS
Until the early 1980s, Government-run hospitals and those operated by charitable organizations were the main providers of subsidized healthcare. However, the last two decades have seen the mushrooming of corporate and privately run hospitals. The corporate hospital sector is most evolved in the south while charitable/trust hospitals proliferate in the west. However, the north and east are also showing a growing trend in private hospital expansion. Previously hospitals were set up as charitable institutions to take care of the sick and the poor. Today its a place of diagnosis and treatment of human ills, for the training research, promoting health care activities and to some extent a center helping biosocial research. World Health Organization (WHO) states that hospitals are socio-medical organization whose functions are:

Curative, Preventive, Patient services and Training of health workers in biosocial research.

Indias healthcare sector has made impressive strides in recent years. With time the classes and quality of hospitals have changed a lot today. Most hospitals today are trying to provide all ultra facilities and are in the process of making state of the art hospitals. Hospitals provide the infrastructure facility to healthcare. Earlier hospitals were thinking inline of prolonging the duration of patients stay. higher patient turnover ratio. Nowadays they are going for a

A hospital offers considerable advantages to both patient and society. A number of health problems require intensive medical treatment and personal care, which normally cant be available in a patients home or in the clinic of the doctor. This is possible only in a hospital where a large number of professionally and technically skilled people apply their knowledge and skill with the help of world-class expertise, advanced sophisticated equipment and appliances. The excellence of hospital services depends on how well the human and material resources are utilized to promote patient care. The hospital is not an entity in itself. Today, the hospital is a place for the diagnosis and treatment of human ills and restoration of health and well being of temporarily deprived patients. The first and the foremost function of a hospital is to give proper care to the sick and injured without having social, economic and racial discrimination. However, the hospitals must perform many more things in addition to the patient care. The education and training of doctors and nurses, support to medical research and assistance to all activities carried out by public health and voluntary agencies to prevent diseases and further to promote health attitude are some of the important services of modern hospitals. The essential function of the hospital in the Indian context is to cater to very large masses of people by providing comfortable conditions for various users. This necessitates creation of a system which encompasses patients, doctors and nurses in a synergetic totality. The applications of marketing strategies insist on the development of product or services of the hospitals against the background of changing environmental conditions. Hospital planning in the Indian condition reflects requirements and comforts of Indian masses. The marketing management of hospitals diverts ones attention on the planning and development of the product in the Indian environment.

THE HEALTHCARE SECTOR: AN ANALYSIS

Healthcare is one of the most essential services in any growing society. Propelled by an affluent and health conscious growing middle-class, the healthcare industry in India grew by more than 13 per cent per annum in the last decade. Indias healthcare industry is estimated at Rs 1,500 billion or US$ 34 billion. This works out to US$ 34 per capita which is 6 per cent of GDP. Healthcare statistics state that India has: 5,03,900 doctors 7,37,000 nurses 162 medical colleges 143 pharmacy colleges 3,50,000 chemists 15,097 hospitals accounting for 8,70,161 hospital beds There is an extensive three-tiered government healthcare infrastructure comprising of: 23,000 Primary Health Centres(PHC) 1,37,000 sub-centres (serving the semi-urban and rural areas) 3000 Community Health Centres(CHC)

MEDICAL & HEALTHCARE SERVICE

There are four types of health-care facilities: primary health centers and rural hospitals, government hospitals, private hospitals, and teaching institutions. The central and the state governments are major players in this sector, running hospitals, nursing homes, medical/nursing/paramedical colleges and medical insurance. A large majority of the population, particularly in rural and semi urban areas, receives free or highly subsidized treatment in such hospitals and health care centres. Private sector investment in the sector was opened up in 1983, to bridge the huge gap between demand and government-owned healthcare services. Since then, the private sector has grown significantly and presently accounts for Rs 690 billion, nearly 80% of healthcare expenditure. There are almost 9500 private hospitals and nursing homes in India, majority of them located in major cities, some of them equipped for providing the most modern stateof-the-art technology and equipment. However, more than 30% of the national bed strength is concentrated in 150-odd corporate hospitals. Important names in the private sector are Escorts, Apollo Hospitals, Max Health Centre, Fortis, and Wockhardt; several foreign healthcare chains have technical/financial tie-ups with Indian private healthcare chains. The health care services (excluding pharmaceuticals) market is estimated to be growing at the rate of around 16 percent annually. There are certain industries that directly affect and are directly affected the status of healthcare in the region. They may include: 1. 2. 3. 4. Technology and Equipment Drugs and Pharmaceuticals Diagnostic laboratories Medical Insurance

SWOT ANALYSIS
STRENGTHS

Indias healthcare sector has made impressive strides in recent years. It has transformed to a US$ 17 billion industry and is surging ahead with an annual growth rate of 13% a year. In the last five years, the number of patients visiting India for medical treatment has risen from 10,000 to about 100,000. With an annual growth rate of 30 percent, India is already inching closer to Singapore, an established Medicare hub that attracts 150,000 medical tourists a year. Hospitals in India boast of conducting the latest surgeries at a very low cost. The healthcare industry employs over four million people, which makes it one of the largest service sectors in the economy. Indian specialists have performed over 500,000 major surgeries and over a million other surgical procedures including cardio-thoracic, neurological and cancer surgeries, with success rates at par with international standards. The quality of healthcare has improved considerably with the availability of world class high-tech medical equipment and information technology.

WEAKNESSES
India has poor social sector indices, given the high population of the poor, acute lack of medical facilities in the lesser-developed parts of the country, and a lack of public funds to provide adequate medical care and attention to the entire population. Indias health expenditure is 5.6 per cent of GDP, whereas most established market economies spend 7-10 per cent of GDP on health. USA spends over 14 per cent. Low doctor-patient ratio: US has 2,340 doctors as compared to Indias 143 doctors for very 10,000 people. Life Expectancy in India is amongst the lowest at 55.5 years compared to US at 75.5 years and 66.5 years for Thailand. On an average, 80 out of every 1,000 children die. This figure is just 9 in the US and 30 for every 1,000 in Thailand. High deposit fees and high costs of medical services limits itself to high income level group or is out of reach for common man. The I dont care attitude by the government hospital. For e.g. Cooper Hospital. Medicine and drugs fraud by the menials. Even organ selling by doctors to make more money. Complex and long admission procedure for admission, which can sometimes be fatal.

 The common men and poor men are completely at the mercy of the
overcrowded government hospitals and dispensaries.

OPPORTUNITIES

At the current pace of growth, healthcare tourism alone can rake in over $2 billion as additional revenue by 2013. From less than 10,000 patients visiting India for medical treatment five years ago, the medical tourism market in India is worth US$ 333 million, with about 100,000 foreign patients coming in every year. Trade in medical equipment and products, including warehousing, selling and servicing the latest medical electronics equipment, diagnostic kits, reagents and consumables. Telemedicine systems, for treating patients in remote areas through a satellite connection. Corporate health care clinics for providing high quality basic services in consultation, diagnostics, minor surgeries etc. Business Process Outsourcing of medical transcriptions and other hospital management administration tasks. R&D base for new molecule development, clinical trials, etc., utilizing the high quality scientific manpower and low costs.

THREATS
The government is reducing the grants given to hospitals, thus making it impossible to cater to the poor people. The unions of the menials and even doctors: they can go on a strike, disrupting the functioning of the entire health care unit. Competition from other international hospital chains, which are more, advanced in technology and better financial support. The public spending on health in India is a mere 0.9% of GDP and the private spending on health is 4.2%. India ranks 171st out of 175 countries in terms of public spending on health. Government pays more attention on age-old programmes like tuberculosis, leprosy etc. and less attention on killer diseases cardio vascular, diabetes, obesity and hypertension. Unplanned urbanization and neglect of the public health system as whole has led to the resurgence of water-borne diseases like hepatitis and cholera every year. More virulent forms of tuberculosis are being seen in those infected with HIV, which appears to have spread widely in India. The number of people in India infected with the HIV/AIDS virus has risen sharply. According to India's National AIDS Control Organisation (NACO), more than 4.5 million Indians are infected. HIV/AIDS in India is not only confined to high-risk groups and in cities, but is gradually spreading into rural areas and the general population.

PRODUCT

Kotler says a product is anything that can be offered to a market to satisfy a want or a need. Products that are marketed include physical goods, services, experiences, events, persons, places, properties, organisations, information and ideas. In the case of hospitals, different types of hospitals offer different services to their users. Some of the hospitals give priority to medical education, training and research while some others concentrate on medical treatment. The product of a hospital can be any of the following:

PRODUCT

MEDICAL SERVICES

MEDICAL TRAINING

MEDICAL EDUCATION

MEDICAL RESEARCH

PRODUCT LINE WIDTH, DEPTH & LENGTH Medical services Cardiac Dental Dermatology Neuroscience The following is the product width, depth & length of Fortis Hospital: Surgery Operation Medical training Medical education Dentistry Ophthalmology Neurology Medical research Heart diseases Cancer Aids

FORTIS

MEDICAL SERVICES

SURGICAL

DIAGNOSTIC

ALLIED

DENTAL

CARDIOLOGY

ANDROLOGY

NUCLEAR MEDICINE

PHYSIOTHERAPY

CLINICAL CARE

OPTHALMOLOGY

PATHOLOGY

DERMATOLOGY

ORTHOPAEDICS

RADIOLOGY & IMAGING

RESPIRATORY

GENERAL SURGERY

ONCOLOGY

ENT

SERVICE QUALITY DIMENSION

RELIABILITY The ability of the service provider to meet the promises made by them accurately. The customer must develop a feeling that they can depend on that particular service provider for their problem. 1. The staff of the hospital has to be very accurate while performing their job. Only than the customers would rely on them. For e.g. during surgery the amount of anesthesia to be given to the particular patient has to be accurate.

2. The service provided should be such that the customers develop a feeling of loyalty so that the hospitals get the repeat customers as well as new customers. e.g. if Mr. X goes to Lilavati hospital for the bypass surgery and the surgery is conducted successfully and he recovers soon, he would not only become loyal to the hospital but also he will narrate the whole incident to many others thereby giving Lilavati more customers. ASSURANCE The service provider and the employees must be capable of winning the trust and confidence of the customers. 1. The customers can be assured by informing them that the doctors, nurses, ward boys and the other related staff is competent enough in providing them their expected level of service. 2. The frontline staffs have to be very polite and friendly to the patient and the relatives. 3. The patient must develop the feel that he is safe in that particular hospital. For e.g. when a patient is brought to the hospital in emergency he and the relatives must be attended with courtesy and also the doctors and the nurses must politely tell them, that nothing will happen to the patient, we will try our level best and not react with abrupt and angry statements. His words should sound empathetic and at the same time consoling. TANGIBLES This includes the ambience, the technologies used, the facilities used to communicate things etc. 1. The ambience of the hospitals must be gentle and clean. The technologies used in the hospitals have to be latest or updated

regularly. Because now a days people do not buy the product but benefits. 2. The environment of the hospital has to be peaceful. The corridors outside the rooms should not be crowded. Even in the visiting hours too many people should not be allowed at a time. 3. The seating arrangements for the patient who have just come for some tests and the person accompanying him have to be comfortable. 4. The signboards must be the perfect indicators so that there is no difficulty for the customer to locate the place, he wants to go to. For eg., in Asian Heart Hospital, the technologies used are latest, the visitors are given two passes so only two people can go and see the patient in the visiting hours. EMPATHY The attitude of the service provider should be caring and if possible individual attention to each customer should be given 1. The attitude of the doctors and nurses should be concerned. They should be approachable as and when required. 2. The doctors and nurses must have the ability to understand the problem of the patient and give the solution accordingly. 3. The doctors must communicate well to the patient and the relatives about the disease the patient is suffering from. 4. The nurse and the ward boy should be assigned to look after the patient.

RESPONSIVENESS The service delivery should be prompt and up to the mark. 1. The patient should be attended as soon as he comes to the hospital and registers himself. In case of emergency he should be attended immediately. 2. The nurse should be able to locate the doctor soon if he is needed. For e.g. a patient suddenly starts sinking or breathing at a faster rate the nurse should be able to call the doctor immediately. For this, a good intercom facility is required.

RESPONDENT FEEDBACKS

Have you ever been admitted to a Hospital?

Yes No

41

87

Would you prefer a Government or Private Hospital?

Government Private 9

119

Rate the following factors on the basis of their importance leading to choice of a
Very High 90 80 70 57 59 58 60 50 40 32 29 30 21 14 17 20 10 0 Previous Experience Location Doctor assosciation State of art infrastructure Hygene and Comfort Expense 11 68 High Somewhat Negligible Not at all

49

90

44

43 41 27 4 9 31

10

13

23 5

Do you feel safe in a hospital after the AMRI incident?

Yes No Maybe

Security and Maintenance in Indian Hospitals:

45 40 35 30 25 20 15 10 5 0

36

39

42

11 0

Very Negligent

Negligent

Average

Strict

Very Strict

FUTURE PREDICTIONS AND ANALYSIS

THE HEALTH BUSINESS Health is a common concern of almost every individual on this planet. It is also well known to us that we cannot ignore taking care of our health to gain or achieve other goals like financial success. In fact a healthy person is a much more competent person in any sphere of life. Thus, we must have some knowledge about our body, how it works, what does it need etc. As we proudly say that our country is developing fast, we have also been noticing the drawbacks of this development. The levels of stress and Pollution are rising at unbelievably high rates. This is resulting in increasing numbers of heart attacks and cancer and many other such diseases. Headaches and Viral infections are nothing unusual to any body. Researchers all over the world have been recognizing the potential damage of this kind of a life and the damage is bigger than what our minds can yet conceive.

All this is excellent for the Health industry. More the number of people falling sick, more the industry grows. Doctors and lawyers are some of the richest people in America. We will not comment on the lawyers but doctors sure seem to have a very prosperous future in India too. But is it going to continue the way it has always been? We know how constant the variable change is. Is the Health Industry going to witness changes too? What possible changes could there be? Science has developed so much that medicines act like magic. Fall sick, go to the doctor, take some pills, and start working again.

The major changes that I feel are going to be implemented in the hospitals would be in their services. Hospitals are becoming business organizations. They make huge money for the services they render. The rooms and operations in a private hospital cost a lot more compared to Government hospitals. It is like the ratio of rates charged by Government banks to the rates charged by the private banks. Hospitals are also competing and thus they form strategies like: 1. Market Segmentation 2. Distinguishing their product/service 3. Promotional techniques etc SOME OF THE SERVICES THAT MAY BE INTRODUCED IN THE NEAR FUTURE CAN INCLUDE: Mobile Hospitals: This includes Helicopters being used by the hospitals to airlift the patient to save the time it takes to reach the hospital. It is a fact that there are a lot of incidents where the doctors failed because the time taken for the patient to reach the hospital was too long. This will be a great break through and could save a lot of lives. The practice is already followed by some of the developed countries. The helicopter itself can have some life saving equipment so that the doctors can immediately start their work on the patient. However, This service will most probably be accessible by the richer class, as it may be quite expensive.

We observe the following strategies here: 1. 2. Market Segmentation: As only the richer class will be able to access it. Distinguished Product/Service: Not all hospitals will introduce it simultaneously. Thus, whoever does it first can get an edge over the market. 3. Promotional Technique: Can be advertised to lure the potential customers. Medical Tourism: This Is a concept which has already been introduced by some hospitals. Apolo hospitals was the one to introduce it. It aims at promoting India as a great destination for medical treatment. Medical services in USA and Europe are much more expensive compared to India. Thus if India matches the International Standards in this industry, it would get millions of people to get their treatment done here. The hospitals have collaborated with the tourism industry to make the package even more interesting. Since the foreigners have already come to India to get the treatment, they might as well travel around India a little bit. Services of an expert no matter what your location: With the growth of technology, computers and Internet, the world today has become very small or much better connected. In the near future it may be possible that the patient is in America but he wants to be treated by the doctor he trusts the most but that doctor is in India. Technology makes it possible for the doctor he wants to be able to observe perfectly, the body of the patient through cameras and internet etc.

He can then instruct the doctors in America to do exactly what he feels should be done. Thus to a great extent, the patient is actually enjoying the service of the doctor in India while he is in America. These were some of the additional service I visualize that the hospitals will introduce in the coming future. There is one significant movement that has started. The Health industry is observing a path different from the traditional path. Nobody generally has a deficiency of vitamins or minerals. If we had we would suffer from specific diseases. Deficiency of vitamins and minerals cause specific diseases. Scurvy is a disease where your tissues break down and you bleed into your tissues. In the old days when they use have long sea voyages they use to not carry fresh fruits and vegetables because they would decay anyhow. A man went out for a voyage and after 2 weeks he had scurvy. His son followed his Dads footsteps and did the voyage and even he developed Scurvy. So Scurvy is a genetic disease. We know now that Scurvy is not a genetic disease and is caused by deficiency of vitamin C. We do not suffer from such diseases any more. No one gets Berry Berry, which is a deficiency of Vitamin B3. We are dying of Heart Diseases, Cancer, and Diabetes. These are diseases caused by free radicals and not by Vitamin deficiencies. Free Radicals can only be combated by Anti Oxidants. One of the free radical caused disease is: AGING 1. No one can avoid 2. Effect of Free radicals in our cells and DNA 3. Everyday, these free radicals that we introduce in our body are attacking our DNA and we get older.

4. More the free radicals quicker we get age. There was a person who looked like he was in his 60s. Looked like a healthy 60 years old. He drives his car himself to the mechanic. One day when he took his car, he was looking tired. The mechanic asked him what was wrong. He replied that he is coming straight from Nashik by road. He had just opened a new manufacturing plant there. It is expected to generate profits after 5 years and he is looking forward to it. His actual age was 92. Passion is what drives him. Aging is a free radical disease. Other Free radical diseases are: Heart Diseases Cancer Diabetes 95% of modern day diseases are caused by free radicals FREE RADICALS: They are generated by over use of oxygen Oxygen is very essential. We have to breathe to live. But we do not need to go overboard. The body is taking more and more oxygen because: 1. SYENTHETIC CHEMICALS When we introduce synthetic chemicals, the body takes a lot more Oxygen and energy to get rid of it. The waste product is Oxygen based Free Radicals

Oxygen based free radicals are unstable chemicals that lack an electron. It needs an electron from somewhere to stabilize. So it goes around the body to get the electron and attacks the blood cells and the DNA and rips the electron out disturbing the natural, normal functioning of the body. 2. STRESS Stress again burns more oxygen. Therefore, Free Radicals are caused by excessive Synthetic Chemicals and Stress (Modern Society) The city life today is very unhealthy. We dont breathe fresh air; neither do we eat pure food. The food, the water, everything we consume is generally not as clean as it should be. Its even got remains of pesticides and insecticides, which are poisonous. Doctors, scientists, and those concerned are realizing the severity of the damage done by modern city life and are trying to device ways of regaining a pure healthy life. A balanced diet is only a term that we are unaware of. There are very few people who know what makes a balanced diet. Books have been written on the advantages it has. There was an observation that an average man spends his entire life trying to save money and loses his health in the process. The rest of his retired life, he spends all that money to regain the lost health. This situation can be changed. A persons body is compared to a machine. It requires good food in the head and the stomach and needs regular maintenance to function smoothly for a long time. When the food is not sufficient or is not of good quality, and if regular maintenance is not taking place, this machine like body will start malfunctioning and may even die.

WE CANNOT CHANGE THE CURRENT PROBLEMS WITH THE SAME THINKING WE USED TO CREATE THEM --------------------------------------------------These concepts do not go in harmony with the concepts of the illness industry. In the whole 5 years course of MBBS, there is only one chapter on Nutrition. The doctors in the hospitals complain that if people will not fall sick, their business will go down. However, there are some very dedicated doctors in the illness industry also whose efforts are helping to save the lives of many people. Also the wellness industry came out of the illness industry and will take a lot of years still to outgrow the illness industry. We will have to wait and see what predictions come true. --------------------------------------------------