INTRODUCTION TO HEALH CARE Health care means a wide and intensive form of services, which will be related to well being of human beings. Health Care is a social sector. Health Care services are provided at state level with the help of central government. Health care is a wide and intensive industry, which covers Hospitals, Health Insurances, Medical software, Health- equipments and Pharmacy in it. Major inputs of health care industry The major inputs of health care industries are as listed below: I. Hospitals II Medical insurance III. Medical software IV. Health equipments Overview of health care sector in India: India’s 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. The healthcare industry in India expected to grow in size to Rs 270,000 core by 2012. The SERVICE SECTOR MANAGEMENT 1
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INTRODUCTION TO HEALH CARE
Health care means a wide and intensive form of services, which will be related to well
being of human beings. Health Care is a social sector. Health Care services are
provided at state level with the help of central government.
Health care is a wide and intensive industry, which covers Hospitals, Health
Insurances, Medical software, Health- equipments and Pharmacy in it.
Major inputs of health care industry
The major inputs of health care industries are as listed below:
I. Hospitals
II Medical insurance
III. Medical software
IV. Health equipments
Overview of health care sector in India:
India’s 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. The healthcare industry in India expected to grow in size to Rs
270,000 core by 2012. The healthcare industry employs over four million people,
which makes it one of the largest service sectors in the economy of our country.
Healthcare is dependent on the people served; India’s huge population of a billion
people represents a big opportunity. People are spending more on healthcare. The rise
in literacy rate; the higher levels of income; and an increased awareness through the
deep penetration of media, has constituted to greater attention being paid to health.
India has a very low density of doctors. Infant mortality is amongst the highest in
India.
SERVICE SECTOR MANAGEMENT 1
Hospitals in India are running at 80-90% occupancy. Major corporations like the
Tatas, Apollo Group, Fortis, Max, Wockhardt, Piramal, Duncan, Ispat, Escorts
have made significant investments in setting up state-of–the-art private hospitals in
cities like Mumbai, New Delhi, Chennai and Hyderabad.
Good Healthcare in India is in extreme short supply and it is this gap that Corporate
are looking to plug. Most users of healthcare prefer private services to government
ones. The private Healthcare segment has grown into a formidable industry estimated
to be Rs.8,00,000 crores. Using the latest technical equipment and the services of
highly skilled medical personnel these hospitals are in a position to provide a variety
of general as well as specialists’ services.
“India is well positioned to tap the top end of the $3 trillion global healthcare
industry because of the facilities and services it offers, and by leveraging the brand
equity of Indian healthcare professionals across the globe”, said Vinod Khanna,
Union Minister of State for External Affairs.
The Government of India places top priority to healthcare in the national agenda. It
is very serious about encouraging indigenous R&D and creation of human capital.
This would improve the quality of life of our people, leading to greater socio-
economic progress of the country.
As medical costs sky rocket in the developed world, countries like India have
immense potential for what is called "Medical Tourism", highlighted Harpal Singh,
Conference Chairman, in his theme address. “India, with outstanding human resource
talent and the setting up of world class medical facilities, was now poised to take
leadership in the fast emerging arena of healthcare management which is witnessing
the first signs of globalization”.
SERVICE SECTOR MANAGEMENT 2
MARKET ANALYSIS
Market Overview
India has a fairly comprehensive healthcare system comprising of government and
private service providers. However, the system reaches barely fifty percent of the
population – mainly on account of general infrastructure bottlenecks. The country
lags behind international standards on basic healthcare infrastructure and facilities.
India has 94 beds per 100,000 population as compared to the WHO norm of 333
beds per 100,000. The density of doctors is also low. There are only 43 doctors
for a population of 10,000.
Size of Market
India's healthcare industry is estimated at Rs 1000 billion. Of this, pharmaceuticals
account for Rs 200 billion. As per some estimates, Rs 185 billion is spent on
healthcare annually. On average, Indian families spend 600 per month on healthcare
which is 11% of the household income, showing that they are willing to spend
provided the service they get is of high standard. According to The World Health
Report 2000, India's health expenditure is 5.2% of its GDP. Public and private
health expenditure is 13% and 87% respectively.
CII-McKinsey Study
A joint study "Healthcare in India: The Road Ahead" done by the Confederation of
Indian Industry and McKinsey & Company in 2002 mentions that India has 1.5 beds
per 1000 people while China, Brazil & Thailand have an average of 4.3 beds. The
study projects that changing demographic and disease profiles and rising
treatment costs will result in healthcare spending more than doubling over the
next 10 years. Private healthcare will be the largest component of this spending
in 2012, rising to Rs 1560 billion from the current level of Rs 690 billion. In
addition, public spending could double from Rs 170 billion if the Government
reaches its target spending level of 2% of the GDP, up from 0.9% today.
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PEST ANALYSIS
Political factors
Most of the healthy nations are also wealthy nations. In India even after 53 years of
independence we all have to accept that government has failed to provide basic
healthcare. Healthcare is the neglected field, only meant for slogans by our
politicians.
To improve healthcare facilities we have to provide special assistance to private
healthcare sector. The reality in private healthcare sector is that as an industry it has
long gestation period and so most of the bigger projects fail.
Government has to give certain concessions to private health sector. It can be in the
form of free land for small hospitals at district levels or concession in power tariff.
Government later on gets back revenue in the form of tax when these institutions start
making profits. Concessions can be limited to first five years or so.
Maharashtra government is playing an important role in the development of the
hospital sector.
Economic factors
The Indian healthcare is the next boom in the country after the IT euphoria.
Setting up hospitals is not an easy task.
The amount of hospitals in India is very less when compared to the other developed
countries. Even the urban areas do not have enough medical facilities. In the rural
areas one village has only one doctor, who may not be very well qualified.
The other governments of other states should take up a cue from the Maharashtra
government, in setting up similar Joint ventures all over the state with the assistance
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of World Bank. The World Bank can make available funds of around Rs 700
crore for state health systems and development projects.
The people in India do not avail of the hospital facilities very soon. This is because of
the high cost related to it. However this may all change because of the increasing
deployment of third party payment either in the form of Medical and Allied
Insurance, or in the form of reimbursements from the State. This in turn will increase
the employment opportunities to many people.
Social Factors
1. Certain percentages of beds have to be kept for poor people. E.g. in Bombay
20% of beds has to be kept reserved for poor people.
2. Look after the needs of local poor people.
3. Open counseling and relief centers.
4. Teach hygiene, sanitation among the poor masses.
5. Safe disposal of hospitals wastes like used injection needles, waste blood etc.
and taking due care of environment.
6. Spreading awareness about various diseases through campaigns and free
medical check ups.
7. In brief the social aspect of hospitals industry is to see that latest treatment and
medicines are available to people at large at concessional rates or free of cost
and that its activities are not only restricted to rich people.
Technological Factors
We are witnessing Information technologies transforming the way health care shall be
delivered. Innovations such as computer based hospital information systems, medical
records; decision support systems, health information networks, telemedicine, real
time image transfers and newer ways of distributing health information to consumers
are beginning to affect the cost, quality, and accessibility of health care.
The technologies today can support vast databases, network communications, quick
distribution and reliable image transfers.
SERVICE SECTOR MANAGEMENT 5
INTRODUCTION TO HOSPITALS
Until the early 1980s, Government-run hospitals and those operated by charitable
organizations. The last two decades have seen the mushrooming of corporate and
privately run hospitals. Most large trust and corporate hospitals have invested in
modern equipment and focus on super-specialties.
The private sector accounts for 70% of primary medical care and 40% of all
hospital care in India. They employ 80% of the country’s medical personnel.
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. Key therapeutic areas are cardiology,
nephrology, oncology, orthopaedics, geriatrics, maternity and trauma/critical care.
Hospitals are not for profit making, they are social institution to make available to
society the required Medicare services. However this may not be true for private
hospitals. Today hospitals are 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. WHO states that hospitals are socio-medical organization whose
functions are: Curative, preventive, patient services and training of health workers in
biosocial research.
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.
SERVICE SECTOR MANAGEMENT 6
CLASSIFICATION OF HOSPITALS
The classification of Hospitals on the basis of objective, ownership, path and size.
1. On the basis of the OBJECTIVE there are three types:
Teaching cum research for developing medicines and promoting research to
improve the quality of medical aid.
General hospital for treating general ailments.
Special hospitals for specialized services in one or few selected areas.
2. On the basis of the OWNERSHIP , there are four types:
Government hospital, which is owned, managed and controlled by
government
Semi-government hospital, which is partially shared by the government.
Voluntary organisations also run hospitals.
Charitable trusts also runs hospitals.
3. On the basis of PATH OF TREATMENT , there are:
Allopath which is the system promoted under the English system.
Ayurved, which is based on the Indian system where herbals are used for
preparing medicines.
Unani
Homeopath
Others
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4. On the basis of the SIZE, there are:
Teaching hospitals – generally have 500 beds, which can be adjusted in tune
with number of students.
District hospital – generally have 200 beds, which can be raised to 300 in
contingencies.
Taluka hospital – generally have 50 beds that can be raised to 100 depending
on the requirement.
Primary health centres – generally have 6 beds, which can be raised to 10.
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I’S OF HOSPITAL INDUSTRY
Intangibility
Intangibility indicates that the service has no physical attributes and as a result,
impossible for customer to taste, hears, feel or smell before they actually use it.
Hospital industry is where the customers (patients) get treated for physical problems
they have. The customers can’t really realize the service provided until they get well.
For this they have to provide good supplementary services.The only way they can
provide tangible clues to make the service provided a success. For e.g. the hospitals
provide extra facilities like television, or then friendly personnel’s can make a
difference.
Inconsistency
It’s also referred to as heterogeneity or variability. The inconsistency occurs largely
because of
Different service providers perform differently on different occasions.
Interaction between customer and provider may vary from customer to
customer.
Standardization is hard to maintain. Every doctor is not the same and may not give
the same diagnosis. Also a patient may not each diagnosis in a different way. Also
since the quality of work done can be determined only after the service is performed
the providers have to be well trained in case of performing the service process.
Inseparability
Inseparability means that the service can not be separated from the creator-seller of
the service. Infact there are many services which are created, delivered and consumed
simultaneously through interaction between customer and service producers.
Here too the customer, i.e. the patient has to come upto the hospital to get the
treatment. The customer has to be present when the service is performed. Infact in
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case of hospitals the service is created and delivered simultaneously. The type of
service to be provided depends on the customer.
Inventory
Services can not be easily saved, stored or inventoried. This is all due to the
perishable nature of the services. Also there’s cost also associated with the carrying of
inventory. Here the costs are more subjective and are related to capacity utilisation for
e.g. if a doctor is available but there’s no patient during that period, the fixed cost of
the idle physicians salary is a high inventory carrying cost.
Also due to demand fluctuations the services can not be stored. E.g. there’s a lot of
rush at the dentists clinic in December and January as that’s the time when there are
lots of tourist visiting India.
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INTRODUCTION TO DIABETES
"Diabetes" is a Greek word meaning "a passer through; a siphon". "Mellitus" comes
from the Greek word "sweet". Apparently, the Greeks named it thus because the
excessive amounts of urine diabetics produce (when blood glucose is too high)
attracted flies and bees because of the glucose content. Diabetes is the common term
for several metabolic disorders in which the body no longer produces insulin or uses
the insulin it produces effectively.
In 2004, according to the World Health Organization, more than 150 million
people worldwide suffer from diabetes. Its incidence is increasing rapidly, and it
is estimated that by the year 2025 this number will double. Diabetes is in the top
5, of the most significant diseases in the developed world, and is gaining in
significance. It’s almost hit the world like an epidemic.
What is diabetes?
It is a common condition and is characterized by abnormally high blood sugar levels.
Diabetes is a number of diseases that involve problems with the hormone insulin.
Normally, the pancreas (an organ behind the stomach) releases insulin to help the body
store and use the sugar and fat from the food we eat.
Diabetes occurs:
When the pancreas does not produce any insulin, or
When the pancreas produces very little insulin, or
When the body does not respond appropriately to insulin, a condition called "insulin
From the triangle we see that three kinds of marketing activities take place in a hospital.
EXTERNAL MARKETING
The hospital undertakes external marketing as to promote the service i.e. treatments and
facilities to the patients. This has been explained in detail under the promotion mix and
the hospital marketing.
INTERACTIVE MARKETING
Secondly interactive marketing takes place between the employees and the patients.
Interactive marketing describes the employees’ skill in serving the client/patient. We
know the customer of the hospital is the patient who is in some degree of discomfort or
suffering when he is admitted/comes in.
From the time he enters to the time of discharge, the patient has to continuously interact
with the hospital’s employees by way of talking to the nurses, attendants.
Thus in his vulnerable state of suffering or sickness the patient expects quality care along
with empathy and consideration of his every need by the hospital staff.
Thus the selection, motivation, training of the hospital staff makes huge difference in the
well-being and recovery of the patient.
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INTERNAL MARKETING
Good and effective interactive marketing is made possible only through efficient internal
marketing. Hospitals undertake internal marketing to train employees and motivate them
to serve customers well. Such training will help improve employee competence and
improve employee responsiveness, problem solving ability as well as their attitude,
goodwill towards patients, all of which in turn will result on patient well being and
recovery or customer satisfaction.
Thus internal marketing ensures that the employees are at their best behavior with the
patients and well informed about the various activities of the hospital. An important way
of internal marketing is analyzing feedback from regular customers satisfaction surveys
and improving service delivery so that the way of service delivery itself becomes the
marketing of the service
INTERNAL MARKETING AT EMERALD
Continuous medical education programs are held periodically so as to make
doctors aware of how new/rare diseases, latest technology etc.
Training programmes are held every fifteen days for nurses who come into most
direst and frequent contact with patients, so as to educate them on how to handle
various temperaments/patients.
They also collect feedback from customers which will help them continuously in
improving the service delivery.
SERVICE SECTOR MANAGEMENT 57
CRITICAL INCIDENTS
Here, critical incidents are the period prior and during the procedure, discharge and
billing. During and prior the procedure, the relatives of the patients are likely to be most
vulnerable. That is, they are worried about the well-being of the patient and as a result are
likely to be less tolerant of mishaps.
EMERALD handles this by ensuring that the relatives receive a host of conveniences at
the time. For instance,
A counselor gives frequent updates to relatives during the procedure. In the case
of ICU patients, the counselor also arranges meetings between the ICU doctor and
the relatives once a day.
Relatives are provided with comfortable cubicles with communication facilities in
the waiting lounge.
Prayer rooms are also provided for the relatives. This is where they can pray
while the patient is in surgery or ICU.
Sometimes there may be more than one consent form for a procedure. This may
prove a complication that the patient/relatives don’t need at the time. Thus, the
hospital ensures that the patient’s consultant or his assistant explain the details of
the procedure to the patient/relatives.
All measures are also taken by the hospital to ensure that the patient receives the best
care, a number of formalities have to be completed by the patient at the time of discharge.
As this may prove confusing to the patients, the ward sister gives the patient a discharge
summary at the time of discharge.
After the procedure and recovery the patients are usually eager to get home. Therefore,
they will not appreciate lengthy or complicated billing procedures. The hospital has a
separate business centre for the efficient and quick processing and payment of bills. So as
SERVICE SECTOR MANAGEMENT 58
to avoid any inconvenience to the patient, the final refund is made by cheque, and sent to
the patient by courier
COMPLAINT MANAGEMENT/SERVICE
RECOVERY
Service recovery is an aspect of the total customer service strategy that is often
overlooked by hospitals and health care workers. Service recovery provides the tools
employees need to help customers “recover” from negative perceptions, thus becoming
satisfied patients.
EMERALD has a distinct Customer Care department. It is the duty of this
department to sort out problems associated with customer satisfaction, complaints
etc.
The department takes a round of the hospital everyday between 9-12 every
morning, collecting feedback and checking on the service that the patients and
visitors receive.
Feedback forms are provided by the ward sister to the patient at the time of
discharge. The patient is asked to fill it and put it in the suggestion boxes before
leaving. The patient is assured of his/her identity being kept secret from the
hospital staff.
Suggestion boxes are placed at the nurse’s station in each wing.
The department acts any problems discovered on. For example, if a patient
complains that a particular doctor doesn’t arrive on time etc., the doctor is made
aware of the situation/ discomfort caused due to his late arrival and asked to
correct his behavior.
In the event that the patient leaves the hospital with a bad impression, a letter is
seen to the patient, apologizing for the inconvenience and an assurance that it will
be looked into and prevented from happening again.
The use of web technology for virtual hospital visit is said to be the first of its kind in the
world. The claim may be true considering that family bonds in the country are very
strong and even extends to close relatives. It may also be one of the reasons why such a
SERVICE SECTOR MANAGEMENT 59
facility had not been thought of in other parts of the world. Besides, scaled – down joint
families are still prevalent where this technology would come in handy. The success of
this facility is revealed by the fact that there were as many as 8,000 hits within two
months after its introduction.
MEDIA PLAN
All media promotions will begin six months before the commencement of the hospital in
order to create some awareness before be become completely functional. The Ad spend
will be maximum in the first year, as this will be when we are creating awareness about
diabetes and also building a name in society among our target audience.
Our plan will consist of the following activities along the various lines,
Personal Selling:
It involves sending personnel out to schools, pharmacist, doctors and other hospitals etc.
to talk to prospective customers (patients), especially parents of these children. So that
nobody is ignorant about the seriousness of the disease. We will also have walk in
seminars to achieve the same end.
Public Relation:
Direct contact program:
Nurse’s day celebration on 12th may every year.
Children’s day celebration on 14th November every year.
Celebration of Independence and Republic day in order to shape the young minds
as they will be molding the future.
Education/Awareness:
Magazines newsletter where children will share their experience.
Sponsorship incase of school sports day.
Pharmacist and doctors.
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Corporate Social Responsibility:
Free check-ups done at school and other places.
Diabetic week
Beautification of the surrounding
Out reach camps incase of epidemics, communicable diseases
Provide medicines to orphanages and old age homes.
Internal assessment:
Seminars held on a monthly basis for doctors in the auditorium.
Get together and informal meetings for staff.
Continuous training provided to staff on different issues such as behavior,
personality, etc.
CMEs (continuous Medical educational Programmes)
Committees for grievances and accepting constructive criticism.
.
Advertising:
Television commercial media plan
Channels Program Days Total Budget
Mon, Tue, Wed, Thur Fri, Sat,Sun ####(Rs.) week
Star plus Kaun Banega Crorepati 2 1 1 1 1 3 39,00,000Kyunki saas bhi kabhi bahu thi 1 1 2 17,00,000Kasautii zindagii kay 1 1 2 12,00,000
Sony C.I.D. 1 1 12,00,000
Aaj Tak News around the clock 1 1 2 39,000
CNBC Health and Fitness 1 1 12,000
History Biography 1 1 9,000
Star world Opra Winfrey Show 1 1 25,000
Zee Café Full House 1 1 5,000
Total 2 2 2 2 2 2 2 14 80,90,000
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The total budget for the TVC for the week is Rs. 80,90,000 and hence for the month Rs. 32,360,000 and the difference in the rate is due to the various categories.
News paper media plan
Name Of The Paper No. Of times in a week Weekly Budget (Rs.)
Times of India + Wellness 3 6,00,000
Hindu 2 1,00,000
Economic Times 3 3,00,000
Dainik Bhaskar(Regional paper) 2 2,50,000
Gujrat Samachar(Regional paper) 1 50,000
TOTAL 11 13,00,000
Magazine:
Name of the magazine Weekly Budget
Health and Nutrition 67,500
Health Screen 55,000
Reader’s Digest 2,50,000
India Today 4,00,000
TOTAL 7,72,500
The print budget for the month is Rs.82,90,000
Outdoor:
Place Weekly Budget
Worli 3,50,000
Mahim (Bombay Scottish) 1,00,000
Juhu ( Maneckji cooper school) 1,00,000
Bandra ( A.V.M. school) 3,00,000
TOTAL 8,50,000
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The monthly budget for outdoor advertisements is 34, 00,000
Direct Marketing:
As for direct marketing, we will be sending out brochures/pamphlets on a selective basis
to doctors, hospitals and schools. They can even visit our website for the same. We also
have customer service departments, which will be entertaining all the calls and queries of
the customers.
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THE ROAD AHEAD…
It is very important to have a clear cut vision of what the organization wants to achieve in
the following years as competition gets intense and delighting customers gets difficult.
Hence we at EDH have set a benchmark for ourselves regarding the future perspective
and we will achieve this within five years from now.
The list on our agenda includes:
We plan to open a medical institution (diabetes education) in our campus which
would help the young minds get first hand information with practical exposure.
We would have our own Research and Development facilities.
Continuous improvement in Human Resource.
We plan to expand ourselves into a multi-specialized hospital.
Open branches in metropolitans.
Emerging as one of the main market players in the field of health care.
Finding new ways to delight our patients and help them to stay fit for a better
tomorrow.
Air ambulance facility will be provided in near future.
‘The diet store’ which is one of a kind now, will have franchising given to
different places and cities.
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AIR AMBULANCE CONCEPT
Transfer from military evacuation to today’s sophisticated EMS (Emergency Medical
Services) programs for all concerned did not occur overnight. Australia, a land of vast
distances and scattered population, probably deserves the credit for being the leader in
integrating the airplane into the health care delivery system. “Get the patient to the best
medical care available as rapidly and as safely as possible, a rewarding goal with proven
medicalbenefits.”
In India this service was only available in the military, but none in civil due to lack of
finances and non-availability of suitable aircrafts. With the onset of liberalisation in our
country during the early years of the last decade, it became possible to commence a
dedicated Air Ambulance Service, leading to reduced morbidity and mortality during
evacuation.
An air ambulance is specifically designed to accommodate the aero medical needs of
person’s who are ill, wounded, injured or otherwise mentally or physically incapacitated
or helpless, who may require emergency medical care in-flight, and who, in a physician’s
opinion, cannot be safely transported on a standard commercial flight.
SERVICE SECTOR MANAGEMENT 65
BIBILOGRAPHY
1) S. L. Raheja Hospital Name of fellow
A) Books
Philip kotler……..Marketing Management
Christopher Lovelock…….Service sector Management
Understanding diabetes
(Simple guide for patients)….Anil Kapur, Kamla Kapur
B) Magazines / Brochures
Health screen….. Volume 2, No.7, July 2005(diabetes clinical management ……cover story pg 10 – 17)