The Government’s Apathy to Healthcare in India

The Union budegt presented last month by the finance minister, Pranab Mukherjee, is hugely disappointing for the healthcare sector in the country. For many years now people associated with healthcare in the country have been waiting for big-ticket reforms in the sector, but the government has been turning a deaf ear. This year too, the story is no different.

The healthcare services in the country are not only woefully inadequate but also unevenly distributed. The healthcare industry, which is hugely dependent on private enterprise is just not attracting enough investments. Setting up and managing a hospital till it breaks even and makes money requires huge upfront investments. Presently, India has 860 beds for a million people, way below the WHO’s norm of  3960 beds for a million people. Studies by E&Y and KPMG have indicated that India needs to add 100000 beds per year for the next 20 years to reach close to this figure. This alone entails a spend of Rs. 50000 Cr. per annum. Compare this with what the government proposes to spend on healthcare in the next financial year, Rs. 22300 Cr. While this is 14% more than what the government spent last year, this amount is clearly insufficient.

The National Rural Health Mission, the flagship government programme for providing healthcare services in rural areas is riddled with inefficiencies. The government-run Primary Healthcare Centres are usually understaffed, ill-equipped and provide the most basic level of healthcare. Rural and semi urban India also needs good professionally managed secondary and tertiary care hospitals, which provide reasonably good quality healthcare at affordable rates. It seems that the government does not have the will power or the resources to usher in healthcare reforms.

Amazingly, the private sector entrepreneurs are willing to step in and bridge the gap.  All they need is a little help from the government in the form of tax holidays, duty reduction or abolition of duties on medical devices, easy availability of funding from government institutions at soft rates, longer payback periods and land at concessional rates. The government should also set up a regulatory body, a watchdog, which will keep an eye on hospitals being set up through this mechanism. The watchdog is critical as it will establish guidelines for setting up the hospitals, monitor progress, ensure quality through regular audits, lay down a fair pricing mechanism and in general ensure that the private sector, while availing of government policy benefits delivers on the promise of efficient, good quality and easily accessible care.

This is really not too difficult to achieve. Look at how private participation has revolutionized telecommunications in our country. Today India has more than half a billion mobile phone connections, the tariffs are the lowest in the world and even remote, far-flung and fairly inaccessible areas are connected (I had my phone working in the Nubra valley in Laddakh). The phones generally work, the services are efficient and the private sector companies, who had the foresight to start early are making profits. Some are even planning to go global and compete with the best in the world. The TRAI, which is the government watchdog is seen as an impartial and fairly efficient body, doing its job of advising the government on policy matters and ensuring compliance and a level playing field amongst all the operators.

No country can progress and aspire to be an economic superpower unless its citizens have access to good quality healthcare services. Considering India’s size and a population of over a billion people, (the majority living in rural areas), it is imperative that the government kick-start  reforms in this critical area sooner than later. If no significant policy initiatives have been announced this year, can the healthcare industry bodies (like those associated with CII and FICCI) lobby with the government, initiate debate and fuel informed discussion amongst all stake holders so that public opinion can be rallied in favour of these reforms.

Healthcare services impact the health of the nation. It is time all the healthcare stakeholders including the government sat together to prepare the blueprint for the next generation healthcare services for the country. This is very important because, unless we have robust, universally accessible, reasonably priced healthcare services for our citizens, all our claims about being an economic superpower will remain hollow and truly meaningless.

The Silly Question of RoI in Healthcare Marketing

The other day I was with Dr. Jadhav who heads the Marketing function at the well known Narayan Hrudayalaya in Bangalore. Dr. Jadhav was keen to use radio for his hospital’s communication needs and I was hoping to persuade him to advertise with Fever 104, the radio station owned by The Hindustan Times, my current employers. Narayan Hrudayalaya, which is a well-known cardiac hospital thanks to the famous Dr. Devi Shetty and his pioneering initiatives, has recently started a Cancer Centre as well as a Multi Speciality hospital and wanted to promote these. The aim of the communication was to tell the citizens of Bangalore about these services available at Narayan Hrudayalaya and to drive ‘footfalls’.

While I discussed the plans with Dr. Jadhav, I could not help but notice his concern about the RoI on his marketing spends. Dr. Jadhav was very clear that if he spent Rs. 100, he needed 3 times the  sum in revenue, which could be directly attributed to this activity. I could easily relate to this because this is exactly the kind of  expectations the management teams had of me, when I headed the Marketing function at Max Healthcare and Artemis Health Institute.

I wish calculating RoI on healthcare spends was this easy. While there are many websites, which help one calculate RoI on marketing spends using complex formulae and spreadsheets involving the lifetime value of a customer, the cost of capital and what have you, I believe quite often the best way forward is a subjective gut feel and patience.

Measuring the success of a healthcare marketing campaign by merely counting the number of queries/walk ins generated in the hospital OPD is a great folly. The hospital business is unlike any other business and one must remember that exciting marketing communication alone will not lead to people walking in to check out the services of the hospital. This can happen for a new restaurant or a movie theatre,  but for someone to visit a hospital he must have a pressing need.

Tactical communication involving discounts, freebies and the like should be handled with care. I am not sure I would prefer to go to hospital for cardiac surgery because there is a discount being offered on the surgery, or I would like to go under the knife at a particular time just because the hospital is offering a deal. Come to think of it, I would be downright suspicious of the hospital if it tries to hustle me into a medical procedure by making a commercial offer.

Marketing spends in a hospital must be looked upon as an investment in the hospital brand and the values it stands for. The customers should be informed about the services of the hospital, the experience and training of its doctors, the robustness of its systems and processes and above all the promise of the experience the hospital hopes to deliver to its customers. It can highlight its ease of access, competitive pricing vis-a-vis other hospitals and superior services.  The hospital must showcase medical excellence, send out stories of success against great odds and constantly remind its customers what it truly stands for. It needs to communicate all or some of these over time before it should even attempt to measure the RoI.

A hospital’s brand equity is built over many years and much as hospital marketers would like to hurry this up, there are just no shortcuts. A hospital must set aside a small sum of money (7% of sales in the first years tapering to 2-3% in later years) year on year to spend on connecting with its patients and the local communities it hopes to serve. It should diligently spend this money informing, educating and reinforcing its brand values.

A few years later, the hospital will find itself buzzing with patients and no one would really be interested in the RoI on marketing spends.

Indian Healthcare 2010

Here is a list of 10 things one would like to see happen in healthcare services arena in India in the New Year.

1. Healthcare Service providers should move faster towards recognising the patient as a customer and focusing on delivering ‘Total Patient Care’. This would include better medical care as well as much superior levels of hospital services. Hospitals need to invest heavily in people and process improvements to achieve the goal of ‘Total Patient Care’.

2. Investment in the hospital brand. Most hospitals in India are chary of investing in the brand and whatever little marketing communication that happens is purely tactical, meant to drive traffic or communicate the commencement of a new service or the addition of another doctor. This must change. Hospitals must find a credible and differentiated positioning in the consumer’s mind and move quickly to occupy it.

3. Develop an information resource pool that allows patients and caregivers to check out the hospital services, compare doctor’s qualifications, training, specialisation and years of experience.

4. Focus on wellness rather than illnesses. Indian hospitals are mostly about sickness and ordinary folks dread visiting hospitals. It would be a lot better if our hospitals also incorporated wellness services and promoted them aggressively. Prevention and community medicine should become critical areas of focus.

5. Develop sustainable and high quality outreach programs by seeking local community participation. I live next doors to Indraprastha Apollo Hospitals in New Delhi and I often wonder, wouldn’t it be great if this hospital ran a community health program in our area. The local community can offer space for the hospital to run and manage a small clinic with a round the clock nursing coverage and doctors (family physicians and specialists) visiting for a couple of hours everyday. Imagine, all major hospitals running maybe 5 such clinics in areas abutting them. The hospitals will not only get more patients, they will earn tremendous goodwill of the local community.

6. Use social media to create patient communities and facilitate constant exchange of thoughts and ideas. Let medical experts join in to provide guidance and keep the community interactions at an even keel. We had tried something like this at Artemis Health Institute in Gurgaon. Unfortunately it fizzled out once I moved on. More hospitals need to remain connected with their patients in a meaningful manner, even when they do not need the hospital. It is an investment in a relationship, which will pay dividends in the long term.

7. Improve Emergency services. I recall calling Apollo Hospitals once to rush an ambulance to my residence to pick up my wife who had accidently hurt herself and was bleeding profusely. I explained that I was at work and was on my way as well. I reached home before the ambulance and brought my wife to the Emergency in my car. The ambulance never reached my place because the Emergency services at the hospital kept calling my wife at our home landline phone to confirm whether she was really hurt!!!

8. Government run hospitals treating the poor are models of sloth, inefficiency and corruption. It would be great if private enterprise forges some kind of a win-win partnership with these hospitals and improves services. I am sure the savings from reducing crippling systemic inefficiencies will itself ensure decent profits for the private healthcare enterprises. The government must take initiatives in inviting a few carefully selected private healthcare organisations to participate in this experiment.

9. Health Insurance must penetrate deeper and wider. The claims processing should become less cumbersome. In this age of instant communication, hospitals and insurance companies manually fax documents, seek patient histories and look for loop holes to wriggle out of paying claims. This must end. Insurance companies and hospitals must connect with each other seamlessly and exchange information that helps patients get better service.

10. Rural and semi urban India must get its due share in the development of healthcare infrastructure. The government must encourage investments in primary and secondary care  in these areas. Unless we have more and more people accessing reasonably good quality healthcare services close to where they live, the India growth story will remain a big sham.

Here is wishing everyone a happy and healthy 2010.

Pic courtesy http://www.muhealth.org

Indian Hospitals Need New Online Initiatives

HIS_boxWebsites 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.   Continue reading

The Apathy of Delhi Hospitals Towards the Poor

Poor PatientsThe 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.   Continue reading

Should Healthcare be free in India?

AIIMSYesterday 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.     Continue reading

The Healthcare Opportunity in India

Wockhardt HospitalEverybody 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     Continue reading