Indian Hospitals Need New Online Initiatives

Websites of Indian hospitals are hardly something to write home about. They are mostly poorly done, difficult to navigate and usually the information lies buried so deep that it tests ones patience to get the relevant information . The other day, it took me close to 20 minutes and numerous clicks to locate the address of a hospital from its website. I needed the address to send a Diwali card to a friend who works at the hospital and try as I might, I just did not seem to find the address of the hospital.

Almost all of the hospital websites that I am familiar with are largely static. Thus, they do not interact with patients or caregivers looking for specific information. They do not allow one to book appointments, download reports, interact with doctors taking care of ones loved ones, send good wishes or chat with the patients. They do not support e-commerce. Thus if I was an NRI living abroad and wanted to buy my parents an annual health check or if I wanted to pay their hospital bills on line, I just can not.

In the era of burgeoning medical travel and with Indian hospitals attracting a sizable chunk of patients from all over the world, this does seem strange. For some unfathomable reason, Indian hospitals have not invested too much on their websites or for that matter on online marketing per se. I believe it is high team someone woke up and used the net better.

It is indisputable that a certain kind of Indian consumer has fully embraced the e-revolution and their tribe is growing by leaps and bounds. With the broadband penetrating deeper, more and more Indian consumers will look at the internet for information, entertainment and commerce. They would seek information about doctors, medical facilities and would like to compare medical outcomes across hospitals. They would like to chat with doctors and customer experience executives in the hospital before making a choice. A hospital aspiring to attract these kind of patients must consider significant investments in their websites and in enhancing their online visibility.

The entire gamut of social media on the net can also be used by hospitals in interacting with their patients. At Artemis, we tried creating an online community of patients and caregivers, where members could post their hospital experiences, their recovery post discharge from the hospital, photographs showing their progress and interesting pieces of information on their disease and latest advancements in medicine. We also encouraged hospital doctors to interact with members of this community. Unfortunately the hospital discontinued this initiative once I left. The hospital was cutting costs and building an online community was considered too ‘long term’ for investments to continue.

The next level of online presence would require hospitals integrating their Hospital Information Systems (HIS) with their websites allowing patients and their relatives on line interactivity. This will facilitate hospitals inviting second opinions from experts anywhere in the world, keeping the patients family and relatives (who might be half way around the world) in the loop on the patient’s progress, interaction with their doctors and online payments. The big issue here is the online security of patient information. The hospitals will have to invest in a foolproof system, which guarantees authorised access to medical data. It would be a disaster if a hospital integrates its website with HIS and leaks confidential data.

With the current level of IT advancement, this and more is certainly possible. Indian hospitals have to look at these opportunities seriously and start investing. The returns would quickly follow.

The Apathy of Delhi Hospitals Towards the Poor

The Delhi High Court has been after private hospitals in Delhi to honour their commitments regarding the treatment of the poor, but sadly to no avail. The hospitals are just not willing to treat poor for free, a condition that they agreed to while accepting land from the government at hugely subsidised rates. In-spite of the Delhi high court directing the hospitals time and again to fill up the beds for the poor, the hospitals are dragging their feet by hiding behind every legal loophole that they can find.

For the uninitiated here is the story. As many as 38 private hospitals in the city managed to get land at subsidised rates from the government under the condition that they will treat certain number of poor patients free of cost. The list of these hospitals today read the whose who of the hospitals in the city. However, once these hospitals commenced operations, they never honoured their part of the bargain. Thus the poor continue to be unwelcome in these hospitals, while beds reserved for them either remain empty or are filled up with full paying patients. This needless to say is criminal.

The reasons for this, however are not too difficult to fathom.  The business of healthcare is a capital intensive business and the cost of real estate in Delhi is a prohibitively high expense.  Thus, getting land from the government at very cheap rates against a commitment of treating the poor once the hospital starts, seems to be a good way of grabbing land. I seriously doubt that any of these private hospitals had any intention of treating the poor to begin with. This was just a ploy to grab land to build the hospital.

Now with the hospital up and running they had to find excuses to wriggle out of the commitment made.  Here is a sample of what the hospitals have been saying. A large 600 bed hospital sitting on prime land in south Delhi and part of the largest hospital chain in the country claims that they are unable to treat the poor because they can not find them! As per them the government needs to refer poor patients to the hospital, and since there has hardly been any government referrals, they can not fill up the beds reserved for the poor. They further claim that ‘free’ to them means a free bed and the patient has to pay for all other expenses, thus making the hospital out of reach of the poor. (Mercifully, this claim has now been thrown out of the window by the high court). Other hospitals too advance similar claims. Strangely many do not offer any reason for not filling up these beds.

A recent report in The Times of India indicates that 16 of these 38 hospitals have not even bothered to submit details of the status of their free beds to the government. Hospitals like Dharmshila Cancer Hospital and the Jaipur Golden Hospital have submitted that all their free beds are empty. The Times of India report also alludes to a nexus between the health officials of the government and these hospitals. The health officials refer their kith and kin or their political masters to these hospitals and they are treated free against the beds meant for the poor.

While all this has been going on for many years, some public spirited Non Governmental Organisations have moved the courts. The high court has made all the right noises but justice is yet to be done. While the cases against these hospitals meander in our courts, the poor, as always continue to suffer silently.

Pic courtesy http://www.flickr.com/photos/9019392@N08/552358084/

Should Healthcare be free in India?

Yesterday morning I was billeted in a training session on Edward de Bono’s Six Thinking Hats and the power of parallel thinking. Out of the blue the trainer  asked the group to discuss the topic ‘Should Healthcare be free in India? The group that discussed this had well educated professional managers and senior executives. However none of them had a background in healthcare services per se.

Many people in this group felt that healthcare services should indeed be free in the country, pretty much like roads. Those with a a legal view supported this argument by pointing out that our constitution guarantees the right to life as a fundamental right and healthcare services can not be divorced from the right to life. A gentleman in the group gave the example of NHS in the UK and said that inspite of problems, it works. Many felt that in the face abject poverty in many parts of the country, it is only right that people have access to good quality healthcare at the expense of the government.    

The Healthcare Opportunity in India

Everybody acknowledges that the healthcare industry in India has a lot going for it. Patients from across the world are looking at state of the art Indian hospitals for cheap and quality care. The doctors and the nurses are considered to be one of the best in the world, their is abundant supply of good quality medical talent, health insurance is penetrating deeper and the market is predicted to grow substantially.

A quick look at the numbers tell the story. Healthcare is presently a USD 35 bn industry and is expected to grow to USD 75 bn by 2012. A Confederation of Indian Industry report says that investments worth USD 50bn are required annually for the next 20 years to meet the growing demand. India will need 3.1 mn additional beds (presently 1.1 mn) by 2018    

Pricing Healthcare Services

The pricing of services in a hospital is perhaps one of the most complex and difficult exercise undertaken by the hospital managers. Pricing is  usually a Marketing function in most industries and the final call would usually rest with the Marketing chief. However, in hospitals this seldom happens. Pricing issues are generally discussed and debated in the executive committees and the leadership teams, views are sought from senior medical leaders and usually a consensus is arrived at. l,

Many hospitals follow a ‘market based’ pricing model, which simply means they comb through the pricing policies of their competitors, get pricing data from various labs and other diagnostic centres through their referral sales teams and establish their pricing either basis a premium or a discount from their chosen competitors.

Very few hospitals have a ‘cost plus’ pricing system. Developing an accurate costing of all medical procedures is next to impossible. This is simply because the medical consumables used vary from doctor to doctor and also depend on the complexity, age and general condition of the patient. The cost is also invariably a function of the training and competence of the concerned doctors and medical staff attending on the patient. Thus the cost of a bypass surgery may vary dramatically depending on the condition of the patient, the competence of the surgeon and his team and co-morbidities like diabetes.

The calculation of a price is usually based on a ’surgeon’s fee’. On top of this is added the cost of anaesthetic gases, the anesthetist’s fee, an OT fee and OT consumables. The surgeon’s fee is usually checked with the hospital’s surgeons and if it is Rs. X, the fee for surgery inclusive of gases, anaesthetist’s fee and the OT charges usually adds up to Rs. 2X. 

The patient on top of this is charged room rent depending on his choice of the hospital room, the cost of medicines and room/ward consumables and all diagnostics. The hospital also charges exorbitant consultant’s visiting fee every time he/she visits a patient in the hospital. (Some hospitals like Artemis cap this to a maximum of two chargeable visits). Strangely all hospitals charge a premium on all services if a patient chooses a single or higher category rooms. This simply means that if one opts for a single room one pays higher for everything, the surgeons fee, the cost of surgery and diagnostic tests. Most people do not know this and believe that the hospitals charge a premium only on room rent. Many would consider this a pernicious practice simply because a surgeon’s skill and time, which are the determinants of his fee has nothing to do with the room category a patient is in.  

Compulsory Rural Postings after MBBS

The Hindustan Times reported on Friday that the Union Health Minister Dr. Anbumani Ramdoss has announced that young medical graduates, fresh out of medical schools will now have to mandatorily serve one year in rural and semi-urban centres in India.

Dr. Ramdoss believes that this will help in augmenting healthcare services in these parts of the country. It is well known that in the Indian hinterlands the availabilty of healthcare services is pathetic.  In villages, where more than 66% of India lives, it is rare to find a qualified doctor. In semi-urban centres too modern, good quality and reliable healthcare is largely unavailable.    

Healthcare Advertising on Radio

Now that I work for a radio station I have been applying some time figuring out the feasibility of healthcare advertisements on Radio Stations.  In India the private FM radio stations are only allowed to play music and things like News, Sports, General Entertainment are not allowed. Most stations thus offer a mix of music interspersed with Jock Talk, audience bites, station sweepers, contest promos and of course advertising.    

Healthcare Loyalty Programs

 I must confess that without making any serious effort I have become  a member of various loyalty programs and I bet this will be the case  with most of you. I earn reward points whenever I use my credit  cards, shop at my favourite store, fly my preferred airline or buy  books at the corner bookstore chain. I was recently offered    membership of another ‘club’, when I opted to purchase medicines for my mother at the local pharmacy, which seems to have suddenly gone a little high tech and dare I suggest become more customer friendly. Loyalty programs are suddenly everywhere.

I believe time has come for healthcare services to embrace the concept of rewarding loyal ‘customers’.

What is a loyalty program?

A loyalty program involves identifying and rewarding ‘loyal’ customers, who keep coming back. Now I know this sounds a little weird in the context of a hospital, where at one level the objective is to ensure that the patient never comes back again. While no hospital wants to see patients coming back, the fact of life is that everyone needs care at different points in our lives.    

The High Tech Story

 I recently came across an intriguing piece of news on  the online WSJ about the efficacy of the 64 Slice CT  Scanner. I am familiar with this piece of high tech  gadgetry because I was tasked with marketing the  benefits of CT Angiograms, when Max Hospital had installed it at the Max Devki Devi Heart and Vascular Institute. I recall we were in a race with Apollo Hospitals, who had also bought  a similar machine and both of us wanted to claim that we were the first to offer CT Angios in the city of Delhi.

The WSJ piece titled ‘Doubts grow over High Tech CT Scans of the Heart’ refers to a study published in the Journal of American College of Cardiology and concludes that ‘in more than 50% of the subjects, CT angiography ‘detected’ coronary obstructions that simply were not there’. The study was  funded by the Dutch government and used CT scanners made by Siemens, Philips and Toshiba.  

Patient Centric Healthcare

Patient Centric Healthcare is fast becoming a much abused term . Most hospitals that I know here in Delhi prefer to call themselves Patient Centric, but none really is. Many, I suspect do not know what it means to be truly ‘Patient Centric’.

Patient Centric to me would imply a hospital, which has systems, processes and people oriented towards patients. The people including the medical folks are trained to understand that the Patient and his needs must come first. The hospital processes and workflows  are designed around patients and their needs. And most importantly their are systems in place, which monitor the efficacy of these processes, capture patient feedback and cycle them back as implementable inputs. A truly patient centric hospital would be the one, where the responsibility of patient care lies not only with medical folks, but with each and every individual working in the hospital.

Will you call a hospital patient centric if it refuses patients for elective surgery on Sundays? I recall the great fuss I had had to encounter, when I asked that a surgery be posted on a Sunday because the patient wanted it that way. All hell immediately broke loose. How dare I do something like this? Docs and OT staff need rest on Sundays and if it is not an emergency there is no reason for the surgery on a Sunday. How dare I call surgeons and anaesthetists on their day off? What about the incremental costs?  My plea that a patient is a customer and if he wants his surgery on a Sunday, than we may as well do it, did not work. Even the CEO, who also happened to be a surgeon (and his wife the anaesthetist) rapped me on the knuckles and instructed that I dare not do something like this again.