HEALTH CARE SECTOR

INTRODUCTION
“A customer is the most important visitor on our premises. He is not
an interruption in our work. He is the purpose of it. He is not the
outsider on our business. He is a part of it. We are not doing him a
favor by serving him. He is doing us a favor by giving us an
opportunity to do so.”

-------------------------------------------------- Mahatma Gandhi

In regard to hospitals, we may change the word “customer” with

“patient”. Since the doctor’s very existence is related to the patients,
hospital becomes an integral part of medical care.

Health is an integral part of the socioeconomic development of India. The

healthcare industry in India is one of the fastest growing industries. The
healthcare industry is expanding at a rapid rate of about 13% per annum.
All sectors in India are undergoing a change from unorganized to an
organized structure and so are also seen in healthcare. Till few years ago
healthcare delivery was sole responsibility of Private practitioners and
Doctor owned and run hospitals.

However the Indian health care industry has came of age and has become
quite competitive in recent times. Clinical developments, such as infection
control, less invasive surgical techniques, advances in reproductive
technology and gene therapy for cancer treatment, continue to increase
the longevity and improve the quality of life of many people.

Cost containment is also shaping the health care industry, as shown by the
growing emphasis on providing services on an outpatient, ambulatory
basis; limiting unnecessary or low priority services, and stressing
preventive care, which reduces the potential cost of undiagnosed,
untreated medical conditions.
Health Care Sector before Independence

Since ancient times traditional practitioners of health care have contributed

to the medicinal needs of society. Acute knowledge in the medicinal
properties of plants and herbs were passed on from one generation to
another to be used for treatment. The colonial rule and the dominance of the
Britishers changed the scenario. Hospitals managed by Christian
missionaries took centre stage.

Health Care Sector after Independence

Prior to independence the healthcare in India was in shambles with large

number of deaths and spread of infectious diseases. After independence the
Government of India laid stress on Primary Health Care and India has put in
sustained efforts to better the health care system across the country. The
government initiative was not enough to meet the demands from a growing
population be it in primary, secondary or tertiary health care. Alternate
sources of finance were critical for the sustainability of the health sector.

Entry of Private Sector

Till about 20 years back, the private sectors venture in the health care sector
consisted of only solo practitioners, small hospitals and nursing homes. In
1980's realizing that the government on its own would not be able to provide
for health care, the government allowed the entry of private sector to reduce
the gap between supply and demand for healthcare. The private hospitals are
managed by corporate, non-profit or charitable organizations. The
establishment of private sector has resulted in the emergence of opportunities
in terms of medical equipment, information technology in health services,
BPO, Telemedicine and medical tourism.

The private sector has made tremendous progress, but on the flip side it is
also responsible for increasing inequality in healthcare sector. The private
sector should be more socially relevant and efforts must be made to make
private sector accessible to the weaker section of society.
SEGMENTS
The healthcare industry has two segments –

 Public healthcare – The public healthcare system consists of

healthcare facilities run by central and state government which provides
services free of cost or at a subsidized rates to low income group in rural
and urban areas. This segment is looked after by 3 departments –
 Department of Health
 Department of Family Welfare
 Department of AYUSH (an acronym for Ayurveda, Yunani, Siddha
& Homeopathy)

 Private healthcare – The private healthcare on the contrary are

privately owned hospitals and medical practitioners which provide
valuable services but relatively at a high service rates. Private healthcare
segment Private healthcare accounts for 80% of the healthcare market,
while public expenditure accounts for the rest 20%. Some popular private
healthcare agencies are Apollo Hospitals, EHIRC, Fortis Healthcare,
Wockhardt, Max Healthcare and Aditya Birla Group.

MARKETING SEGMENTATION:
The INDIAN health care sector constitutes:
1. Medical care providers: physicians, specialist clinics, private
corporate hospital, non govt. charity trust hospitals and govt.
hospital.

2. Diagnostic service centers and pathology laboratories.

3. Medical equipment manufacturers, ambulances.

4. Contract research organization, pharmaceutical manufacturers.

5. Third party support service providers (catering, laundry).

Characteristics of Health-Care Industry:-
A service industry like hospital has to offer the best of services to the
patient. A hospital has the following service characteristics:-
1. Intangibility:-
Health services are highly intangible which cannot be tested or
examined before consumption. The intangibility factor can be
compensated by physical evidence like place, people, price,
equipment and communication material that the patient can see.
For an example, at Lilavati Hospital the aesthetics, interior
decoration, the cleanliness, the hospitality and the attention paid
by employees to patient, the quality of doctors etc, pay an
important role to reduce uncertainties with an effort to add
tangible to intangibles.

2. Inseparability:-
Generally, health services are characterized by inseparability.
Health services are produced and consumed at the same time and
cannot be separated from their providers, whether the provider
are people or medicine. Hospital-patient interaction becomes a
special feature of hospital services marketing as the patient is also
present when the services is produced. Therefore such a service
needs careful handling.
 3. Variability:-
Service variability tries to reduce the variability factor in order to
standardize the quality of services. Health services are subject to
a great degree of variability. There is variation in service
performance offered by the providers, employees depending on
skills, moods etc, as the services offered by the hospitals are highly
judgmental as and individualized. The various diagnostic
procedures are also not standardized. The variation in services
also depends on the affordability of the affordability of the patient
and reputation of the hospital.

4. Health service quality:-

Word of mouth is the best form of publicity and it also plays an
important role in setting the platform for ascertaining service
quality. Therefore the satisfied past patient of a hospital can bring
more number of patient to that hospital than advertising.

The following are the principle dimensions which customers

use to judge a firm quality of service.

i. Tangibles: The physical facilities, equipments, personnel &

communication facilities.
ii. Reliability: It is the ability to perform the promised service
dependably and accurately.
iii. Responsiveness: The willingness to help patients and to provide
prompt services.
iv. Assurance: The knowledge & courtesy of the employees & their
abilities to convey trust & confidence.
v. Empathy: The provision of caring, individualized attention to
patient.
  Positive Approach of IT on the Health Sector
Introduction
The technological improvement & development affected to the well
being of the health sector in a significant way. The new inventions on
medically related sections made a huge development on the unrevealed
areas in the medical world with a new approach. The development of
new related devices, equipments made health sector rich & the systems
are developed to make things easier, also the education & awareness on
health areas are vastly increased with the aid of the technology. The
knowledge on health becomes more common & available almost all the
places in the world with the development of communication method via
the technological development. The significant areas which made
medical sector enrich with knowledge, power, equipments are discussed
below.

1. Learning & Researching Advancement through the Technology

Education is one of the crucial events for a developing country. The
standard of the country is depending on the educational advancements
& achievements at most of the cases. Therefore learning & researching
activities involved a major consideration on development of a country.
On behalf of health, education regarding health factors is very
important. The knowledge of a society on the medical science decides
the well-being of that society. More educated personnel on the field
means more consideration on behalf of health of the people. Therefore
people started to seek for advancement in health through education.
To achieve that advancement people found that information technology
plays a major role. When the technology develops the facilities provided
to the educational field will be increased, thus many people can involve
in learning health related stuff. Earlier there were few places in a
country to study, Research on the medical factors as the resources were
limited. People who were willing to learn also not get the chance to do
so as a result of this less development in technology. But with the
development of information technology, resources regarding health
education are commonly available & most of them are free of charge,
thus people started learning things very quickly & willingly. This
resulted to a vast development in the society on behalf of health.

2. Invention of New Medicines & Drugs

Drugs or medicine are those triggers that make people feel comfortable
on their day today life. Drugs play a major role in hospitals & almost
all the places as patients are very much rely on these drugs. Today
drugs are helpful for not only human but for animals also. Living people
need drugs & they seek drugs for each & every medical issue. Therefore
invention of new drugs is welcomed by the world population. For that
the information technology has lot to do.
Earlier there were limited drugs for many deceases. That means some
deceases were even not identified & there were no cure to those
deceases at all. Sometimes even there exists drugs for a particular
decease; it would take months to cure as the efficiency of those drugs is
not that good. There were no drugs for immediate treatments as lack of
medical resources. This caused to sudden deaths. There were no proper
devices for surgeries like critical events & most of the time if a person is
critical, the hope for living was very little. The levels of availability of
medicines were at that poor at early stages.
Therefore with the development of technology people started developing
new drugs for various deceases. The availability of technology in a
higher stage helped people to research on vast area & to develop new
medicines using the modern technology. People are able to mix tiny
parts together using complex & most accurate devices to make reliable
& good quality drugs. Thus to increase the quality of life, drugs are
much important & invention of new drugs backed by the technology by
giving maximum output to the society.

3. Invention of New Medical Equipments

With the aid of modern technology, people think on areas which should
be developed to have a luxurious life. People identify those critical
areas & think in terms of making it more developed. Health is such area
that many people think on that should be developed more & more.
Therefore the researches do many experiments & invent new devices &
equipments using the modern technology. The prevailing technology is
highly & efficiently used to develop the medically valuable devices.
Many times ago, the technology is not at that good position thus the
health of a society was kept at a very law level. The information
technology made people to produce things which make their lives more
reliable.

These devices replaced the old, unreliable systems & mechanisms by

giving a maximum benefit to the society. For an example earlier there
were no machines to check the heart deceases & thus many people died
without identifying the subject. But now there are many types of
equipment to check each & every part of the body for its punctuality,
with a reliable & trustworthy result. As the information technology
develops, the accuracy of the devices also increased benefiting the
society. Therefore the technological development makes the inventions
arise & also give the light to new medical equipments to make a healthy
world.
4. Rise of the Expert Systems on the Health Sector
In this busy world sometimes people could not go for certain places to do
certain things because of the work load they have to carry out. Sometimes
even to take their own medicine they do not have time. Most commonly,
when we are to meet a specialist or a doctor, we have to wait for a
certain period sometimes in a queue for our turn. Sometimes that may be
1minute or 1hour or more. It depends on the number of patients & the
accuracy of the doctor. Sometimes the doctor may not present that day &
people have to come another day wasting their money & valuable time.
Therefore people needed a way to save their time & money together with
getting medicines on time. Thus the expert systems are developed as a
solution for that.
Expert systems are developed using the modern information technology.
With the aid of information technology, developers gather certain
important information regarding certain deceases & store in a
database. Then they design an expert system that can give possible
solutions for the given deceases. These expert systems are designed to
ask some questions regarding the cause from the patient & analyze the
database & give the solutions just like a doctor. These expert systems
help people to diagnose certain deceases by themselves & to understand
the amount of danger in that decease. As these expert systems can be
implemented on the internet anyone having computer literacy can use
the application.
People do not want to stay hours in the queues for their turn instead
they can go to internet & have the assistance of an expert system. These
expert systems help to increase the availability of the medical care all
most all over the world & thus increase the standard of health of the
people in a society. Thus the information technology has a great deal on
developing those expert systems on behalf of the goodwill of the people.
5. Social Awareness on Health Towards the Technology
Health is one of the crucial events on human development & therefore
people need to know certain basic things regarding health. At the early
stages people were not that much aware on most of the deceases & they
knew very few common deceases only. That made themselves into
trouble when they are fallen from unknown decease, what should be
done at the first hand. The basic skills & knowledge ware not there with
those people as the communication between doctors & patients were
lack & also the methods of communication were less. With the poor
technology, people were unable to aware on certain things like how to
prevent from decease, what are the first aids on certain cause etc. as
these problems arisen people started to use technology to aware the
society more on the health care.
With the information technology, many communication methods are
available for people to get to know on things. The television, radio,
newspapers like traditional media also contributed to the social
awareness regarding the health. But the technology advancement made
things much easier by having the internet, emailing, fax etc. these media
made information commonly available for any person in the world at
any time. When people aware on certain deceases & the actions to be
taken, the level of health of the society increases. The awareness made
people to do certain pre-actions to avoid from certain deceases & do the
exact thing on a critical situation. All these are because of the
availability of the knowledge for the general public & it was done by the
information technology.

 Health issues related with information technology.

Introduction
This chapter is to describe that what negative impacts of health by using
information technology to individuals and society are. How information
technology deals with these health hazards and how to prevent those
damages are mainly discusses here.

1. Mobile phone usage and health issues

Mobile phone is one of the main communication devices which are
commonly used in modern world. By 2009, there are nearly 4.4 billion
mobile phone users in the world. This fact shows that how this small
communication device becomes a powerful tool to human’s day today
activities. But the over-usage of mobile phones and usage of poor
quality phones makes so many mentally and physically health issues.
According to the latest experiment, scientists found out that there might
be a connection between increasing the patients with brain tumors and
mobile phone usage. They emphasis that usage poor quality phones
which are heavily emit radiation waves causes to this brain tumors and
at length becomes a brain cancer. As well as using handsets with a huge
volume causes to damage the hearing level. If that habit continues for a
long time period, the hearing will be lost. So the governments of many
countries introduce laws to reduce the volume levels of hand sets. To
reduce those health issues, Apollo medical team said that always use the
left ear for phones not right ear which has a direct link with brain. Not
only physical issues, but also mobile phones arise so many mentally
health issues as well. Excessive usage of mobile phones causes to stress,
fatigue, restlessness and sleeping problems for people.
2. IT improves the manufacturing of alcohol (“Evil of health”).
There is no argument that consuming alcohol (Beer,Arrack,Vine etc.)
causes to many health problems. So, the interesting point is that how IT
interacts with manufacturing and promoting alcohols. At present,
leading alcohol manufacturers use IT to increase the efficiency of their
production. To perform the calculations in distillery in reliable manner,
they use “ABS (alcohol blending software) like software’s. As well as
these companies use software to perform their financial and advertising
activities also. There are so many software’s to learn how to brewing
beer in home. They are “BeerSmith”, “cyberbrau” etc. Using these
software’s, the user can input receipts and do brewing step by step.
“Orchestrated Beer” is one of main business software which is used by
small and medium scale brewing companies.
Drinking alcohol arises many health issues in physically and mentally.
Alcohol damages the liver of human beings. Excessive usage of alcohol
definitely causes to Cirrhosis like liver damages. As well as usage of
alcohol has affects to certain cancers (liver, breast) also. Heart
diseases, hemorrhagic stroke, digestive disturbance, high blood
pressure, neurological disorders and sleep disruptions are several
health issues which are caused by the usage of alcohol. So growing
alcohol manufacturing with information technology is done a huge
damage to humans‟ health. So these brewing software sand expert
systems have a responsibility to increase above mentioned health issues
in the society.

3. Playing computer games and health hazards

Playing computer games is the most popular cyber activity among kids
and teenagers. Creators of these computer games also focus the group
aged below 25 and introduce many games with more attractiveness.
Most of the kids and teenagers addict to these games and spend more
time to play these games. Because of this addiction, several health
issues are arisen.
Pressing specific keys and clicking the mouse repeatedly causes to
overuse damages on hands. This happens especially while playing car
and action games like things. In this kind of games, user has to control
the player by using few keys (shooting, regulate directions) only. In
computer games, the user may have to gaze at a specific point for a long
time period. This may cause to eyestrain also. There are several actions
which can be taken by parents to reduce those problems. Allow to play
games in a certain time period, advice to take regular relax while
playing; change the controllers (key board, mouse or joystick)
regularly.
In recently, there was news that a kid was dead without taking foods
while playing computer games. This kid plays a certain game for days
without moving or performing other activities. So this is the best
example which proves that computer games addiction causes to severe
health diseases. Stress, restlessness and certain phobias may be
occurred by this game addiction too.

Issue/Challenges for the Health Care Sector

 Rise of Diseases
Another factor driving the growth of India’s healthcare sector is a rise
in both infectious and chronic degenerative diseases. In addition to
battling infectious diseases like Dengue & Malaria, India is grappling
with the emergence of diseases such as AIDS as well as food- and
water-borne illnesses. And as Indians live more affluent lives and adopt
unhealthy western diets that are high in fat and sugar, the country is
experiencing a rise in lifestyle diseases such as hypertension, cancer,
and diabetes, which is reaching epidemic proportions.

 Slow Growth of Medical Health Insurance

A widespread lack of health insurance compounds the healthcare
challenges that India faces. Although some form of health protection is
provided by government and major private employers, the health
insurance schemes available to the Indian public are generally basic
and inaccessible to most people. Only 11% of the population has any
form of health insurance coverage.

 Lack of Uniform Healthcare Services Pricing

When it comes to healthcare, there are two India’s: the country with
that provides high-quality medical care to middle-class Indians and
medical tourists, and the India in which the majority of the population
lives—a country whose residents have limited or no access to quality
care. Many of the rural poor must rely on alternative forms of
treatment, such as ayurvedic medicine, unani and acupuncture.
Moreover most of the Private healthcare facilities are too costly to
afford. With increasing research on the pharmaceuticals the cost of
medicines are also increasing day by day. Government has begun taking
steps to improve rural healthcare. Among other things, the government
launched the National Rural Health Mission 2005-2012 in April 2005.

 Deteriorating infrastructure
India’s healthcare infrastructure has not kept pace with the economy’s
growth. The physical infrastructure is woefully inadequate to meet
today’s healthcare demands, much less tomorrows. While India has
several centers of excellence in healthcare delivery, these facilities are
limited in their ability to drive healthcare standards because of the poor
condition of the infrastructure in the vast majority of the country. The
number of public health facilities also is inadequate.

HEALTH POLICIES
1983 - National Health Policy
1993 - National Nutrition Policy
2002 - National Health Policy – 2% of health budget for research
2003 - Introduction of Universal Health Insurance schemes for the
poor .
National Rural Health Mission (NRHM) 2005

Give more powers to the village councils.

Availability and accessibility of quality healthcare especially for

the rural people, poor, women and children.

To cover 3, 00,000 villages.

 To revitalize local health traditions – ISM, AYUSH.

Success depends on alertness of civil society.

Golden triangle partnership mission to develop drugs for 13

Specific diseases.

National health programmer – TB, leprosy, HIV/AIDS, etc.

Marketing Mix of the Health Care Sector (7 P’s):

Introduction:-

Having the right marketing mix to market the services of the health care
industry is very important. The fact that healthcare service where the
customer will not be satisfied with anything but the best makes it
essential for service providers to take extra care in planning their
marketing mix. Using the right balance of marketing elements,
marketers can ensure that their marketing efforts fetch them expected
result.

1. PRODUCT:
The product elements of healthcare consist of the actual medical
treatment provided in the hospitals, education and training provided by
medical colleges and nursing schools and R&D activities carried on by
research centers. These are the physical good features of health care
sectors. The product lines of hospital sectors contains three broad
areas, viz. diagnosis, treatment which maybe pill oriented or surgery
oriented, and post-operational care. The product also includes
supplementary services like maintenance of the case history of patients,
 registration, billing and support operation like laundry, diet, pharmacy,
stores, security etc. These all service comes under packaging of any
hospital.

2. PRICE:
Pricing healthcare services is done keeping in view the cost of running the
hospital, the overheads, salaries and wages of the doctors , nurses and
admin stuffs, cost of equipment and infrastructure, bed occupancy, quality
of service and the income level of the patients. Most hospitals follow
different pricing policies depending on the diagnosis and services selected
by the patient. Patient opting for general wards and private wards are
charged for different rates. But still some of the hospitals are not yet fully
commercialized. So services are provided for normal prices. Paramedical
centers and fitness centers charged prices for different rates on the basis of
their popularity and the income level of target groups.

3. PLACE:
It is one of the key elements, in the sense that the service provider
(hospital) should be easily accessible to the patient. Hospital should be
located somewhere which is easily accessible by patients and transport
services are also available for them easily. Like hospital located inside a
city where transport facility always available is definitely preferable by
patients. Hospital can also use ambulance to offer immediate care to
patients in emergency conditions. These are intermediaries for any
hospital to take patient.

4. PROMOTION:
Promotional activities by a hospital should be able to communicate the
right message to patient’s as well general public. The communication
can be regarding the treatment and auxiliary arrangements like
transport, communication, diet, facilities for the patient, prices etc.
Some hospitals also run special promotional campaigns. For example,
MEDICITY issues ‘GOLD CARDS’ to patients, who entitle them to free
monthly checkups and treatment at concessional prices. Media based
advertisements and promotional messages displayed on hoardings at
public places are gaining popularity with corporate hospitals. Many
hospitals run awareness programs like ‘AIDS prevention campaigns’,
‘Polio pulse’, ‘ALCOHOL and DRUG rehabilitation etc. They also run
special campaigns to promote heart check-up or dental check up at
concessional rate.
 5. PEOPLE:

Without people, healthcare as an industry cannot exist or survive.

People include patients, doctors and the staff who treat and take care of
those patients. Health care is also a knowledge based industry. Doctors
and technicians, who take care of the diagnosis and treatment of
patients, form core of this knowledge base. Therefore it is important for
any hospital to retain doctors with excellent knowledge and skill, and
also the right attitude. Patient should be provided utmost care as their
recovery depends not just on the medical treatment but also the human
touch provided by the support staff.
So, apart from being technically qualified, support staff like nurses and
housekeeping personnel should be well-mannered, gentle, hygienic and
meticulous. Patients also play a role in service delivery. It is impossible
to have an efficient delivery if the patient is not either confident or
supportive.
 6. PHYSICAL EVIDENCE:

Some kind of document or O.P.D. card given to the patient acts as

physical evidence in hospitals. Apart from the location, the ambience of
a hospital is also very important for making a positive impression on
patients and their attendants. Therefore corporate hospitals should be
very careful about presenting the right kind of atmosphere which is both
hygienic and relaxing. Apart from interior decoration, lighting and
ventilation, attention should be paid to necessary infrastructure like-
electricity, water, sewerage, communication and transportation,
security etc. The certification and awards won by Doctors and Hospitals
can all be displayed at the reception to install confidence in the
customers.
 7. PROCESS:
Services are provided under two broad categories, services for inpatient
and those for outpatients. The processes for these two services are a
little different. Services for inpatients are spread over operation
theaters, intensive care units, emergency units, regular wards etc. Apart
from the in house treatment, some hospital runs mobile clinics to
provide patients easy access to their services. Providing online
consultation is also fast gaining popularity in west though in India
technical awareness is comparatively low, it may take some time for the
masses to welcome such innovative concepts
Comparison between Private Hospital & Public Hospital
Public Hospital Private Hospital
(BSES Hospital) (Kripa Nursing Home)
Rates Rates are comparatively less Rates are decided on the
as compared to a private bases of patient. Poor
hospital. Middle Class people are given many
people can easily afford it. Discounts & charged
reasonably.
Clean- Cleanliness in the hospital Cleanliness & the
liness is satisfactory. Internal environment is
very good. The
ambience is perfect for
patients.

Tech- Many latest technologies The technology which

nology are available in the form are present are far less
of cancer treatment & as compared to the
open heart surgery. Public Hospital.

Doctor The ratio is 1 doctor The ratio is 1 doctor

Patient per 50 patients. per 20 patients.
Ratio

Infra- Infrastructure of the Infrastructure of the

Structure is very good with many hospital is satisfactory.
modern amenities.

Staff The staff present in the The staff present in the

hospital is helpful & hospital is properly
reliable. Dressed in clean cloths,
very skilled &
responsible towards
 patients.

CONCLUSION

The Indian healthcare sector can be viewed as a glass half empty or a

glass half full. The challenges the sector faces are substantial, from the
need to improve physical infrastructure to the necessity of providing
health insurance and ensuring the availability of trained medical
personnel. But the opportunities are equally compelling, from
developing new infrastructure and providing medical equipment to
delivering telemedicine solutions and conducting cost-effective clinical
trials.
Corporate hospitals are trying to attract customer by offering value
added services. To retain the patients it’s necessary that the hospitals
provide good services to all the patients and that too at affordable
prices. The success of the hospital will mainly be dependent on the
people offering the services. So it’s very necessary for the hospitals that
they retain the good doctors and support staff to serve the patients
better and be successful.

For companies that view the Indian healthcare sector as a glass half
full, the potential is enormous.