HEALTHCARE SECTOR

(Introduction)
The healthcare industry (also called the medical industry or health
economy) is an aggregation and integration of sectors within
the economic system that provides goods and services to treat patients
with curative, preventive, rehabilitative, and palliative care. It
encompasses the creation and commercialization of products and
services conducive to the preservation and restoration of well-being. The
contemporary healthcare sector comprises three fundamental facets,
namely services, products, and finance. It can be further subdivided into
numerous sectors and categories and relies on interdisciplinary teams of
highly skilled professionals and paraprofessionals to address the
healthcare requirements of both individuals and communities.[1][2]

The healthcare industry is one of the world's largest and fastest-

growing industries.[3] Consuming over 10 percent of gross domestic
product (GDP) of most developed nations, health care can form an
enormous part of a country's economy. U.S. healthcare spending grew
2.7 percent in 2021, reaching $4.3 trillion or $12,914 per person. As a
share of the nation's Gross Domestic Product, health spending
accounted for 18.3 percent.[4] The per capita expenditure on health and
pharmaceuticals in OECD countries has steadily grown from a couple of
hundred in the 1970s to an average of US$4'000 per year in current
purchasing power parities.[5]

Backgrounds
For finance and management, the healthcare industry is typically divided
into several areas. As a basic framework for defining the sector, the
United Nations International Standard Industrial Classification (ISIC)
categorizes the healthcare industry as generally consisting of:

1. Hospital activities;
2. Medical and dental practice activities;
3. "Other human health activities".
This third class involves activities of or under the supervision of, nurses,
midwives, physiotherapists, scientific or diagnostic laboratories,
pathology clinics, residential health facilities, or other allied health
professions, e.g. in the field of optometry, hydrotherapy, medical
massage, yoga therapy, music therapy, occupational therapy, speech
therapy, chiropody, For the purpose of finance and management, the
healthcare industry is typically divided into several areas. As a basic
framework for defining the sector, the United Nations International
Standard Industrial Classification (ISIC) categorizes the healthcare
industry as generally consisting of:

1. Hospital activities;
2. Medical and dental practice activities;
3. "Other human health activities".
This third class involves activities of or under the supervision of, nurses,
midwives, physiotherapists, scientific or diagnostic laboratories,
pathology clinics, residential health facilities, or other allied health
professions, e.g. in the field of optometry, hydrotherapy, medical
massage, yoga therapy, music therapy, occupational therapy, speech
therapy, chiropody, homoeopathy, chiropractic, acupuncture, etc.

The Global Industry Classification Standard and the Industry

Classification Benchmark further distinguish the industry into two main
groups:

1. healthcare equipment and services; and

2. pharmaceuticals, biotechnology and related life sciences.
The healthcare equipment and services group consists of companies
and entities that provide medical equipment, medical supplies, and
healthcare services, such as hospitals, home healthcare providers,
and nursing homes. The latter listed industry group includes companies
that produce biotechnology, pharmaceuticals, and miscellaneous
scientific services.

Other approaches to defining the scope of the healthcare industry tend

to adopt a broader definition, also including other key actions related to
health, such as education and training of health professionals, regulation
and management of health services delivery, provision of traditional and
complementary medicines, and administration of health insurance.,
chiropractic, acupuncture, etc.[6]
The government does not ensure all-inclusive health care to every one
of its residents. However, certain freely supported healthcare programs
help to accommodate a portion of people who are elderly, disabled, or
poor. Elected law guarantees community to crisis benefits paying little
respect to the capacity to pay. Those without health protection scope are
relied upon to pay secretly for therapeutic administrations. Health
protection is costly and hospital expenses are overwhelmingly the most
well-known explanation behind individual liquidation in the United States.
 MIS IN HEALTHCARE SECTOR

Management Information System (MIS)is an information

which in addition to performing all necessary transaction
processing for an organization. Hospitals are
organizations where healthcare professionals provide
complex care using specialized knowledge and
equipment to meet patients’ care needs.

Conventionally, hospitals
comprise different clinical departments and functional
units. However, there have not been many studies that
have reviewed other.
research studies on how useful management
information systems are in the health care sector in the
hospital sector. This paper is a literature review that
discusses management information systems in decision
making, especially in the field of hospital health
services. Articles are collected by Google, Google
Scholars, and medley databases. The review is carried
out on articles with the topic of management
information systems or decision making.
systems, especially those related to the hospital sector.
We identified about 20 articles published in the last
decade then analysed and drew conclusions. The
results of this study indicate that the implementation of
management information systems in the field of health
services, especially hospitals, is known to be able to
have.
several impacts, such as patient satisfaction,
strengthen internal communication network, reduce
costs store data reliably in a digital environment, store
data reliably in a digital environment, improve service
quality, assist managers in decision making, fast data
collection, and speed up and simplify financial reports .

About HMIS

 Health Management Information System (HMIS) is a

Government to Government (G2G) web-based Monitoring
Information System that has been put in place by Ministry of
Health & Family Welfare (MoHFW), Government of India to
monitor the National Health Mission and other Health
programmes and provide key inputs for policy formulation and
appropriate programme interventions.
 HMIS has been utilised in Grading of Health Facilities,
identifications of aspirational districts, review of State
Programme Implementation Plan (PIPs), etc.
 The analytical reports generated through HMIS also provides
gap analysis and evidence-based course correction.
 HMIS was launched in October 2008. Currently, around 2.25
lakh health facilities (across all States/UTs) are uploading facility
wise service delivery data on monthly basis, training data on
quarterly basis and infrastructure related data on annual basis on
HMIS web portal.
 HMIS captures facility-wise information as follows:
 o Service Delivery (Reproductive, Maternal and Child
Health related, Immunisation family planning, Vector
borne disease, Tuberculosis, Morbidity and Mortality,
OPD, IPD Services, Surgeries etc. data) on monthly
basis.
o Infrastructure (Manpower, Equipment, Cleanliness,
Building, Availability of Medical Services such as
Surgery etc., Super Specialties services such as
Cardiology etc., Diagnostics, Para Medical and Clinical
Services etc. data) on monthly basis.
The HMIS Portal facilitates the flow of physical performance from
the Facility level to the Sub-district, District, State and National
level using a web-based Health Management Information System
(HMIS) interface.
As per the Journal of Medical System HMIS systems help
reduce medication administration errors by 50% to 80%. HMIS
systems have made significant contributions in the
development of healthcare infrastructure. These systems
optimise the complex and confidential management of
paperwork across all of the departments of the hospital.
HMIS helps the healthcare institutions and hospitals to track
the level of patient satisfaction score, their readmission rates,
and how often they are being infected. This crucial data is very
useful to identify current pain points in a hospital and help it
identify emergencies efficiently.
Hospital management information system (HMIS)-
 Manages the entire operations of the hospital and
improves efficiency.
 Ensures smooth flow of information within departments.
 Improves quality of services and effectiveness.
 Automates processes thus reducing manpower.
 Easier health data assessments improve patient care and
satisfaction.
 Solutions and Success Stories

1. Telehealth Expansion in Rural

Areas

In rural India, a small community struggled with limited

access to healthcare services due to its remote
location. A loan facilitated the implementation of a
telehealth program, connecting residents with
specialists in urban centers.

Success Story: The telehealth initiative significantly

reduced travel times and costs for patients, improving
access to specialized care. Patient satisfaction
increased, and the management of chronic conditions
such as asthma and heart disease improved notably.
How Does the Healthcare Industry Use
MIS?

Management information systems provide business

leaders with the tools to organize, evaluate and
efficiently manage departments within an organization,
including collecting, storing, processing and analysing
data to inform decision-making and strategic planning.
In the healthcare sector, digitization boomed when
patients could not safely go to doctors’ offices and
clinics during peak outbreaks of COVID-19. Therefore,
telemedicine remains the strategy of choice to reduce
infection risk and increase care access. Its effectiveness
and safety rely largely on how well providers use MIS to
manage increasingly large and complex data sets
generated at the clinical and research levels.

MIS platforms in healthcare settings and their benefits

include the following:

 Patient safety improves as providers use data to

prevent diagnosing and treatment errors that
lead to adverse outcomes, responding to them
more rapidly and tracking them in real time.

 Electronic healthcare records enable providers to

share accurate, up-to-date data with clinicians to
improve diagnoses, coordinate safer care to
ensure optimal outcomes, reduce errors and
improve operational efficiency.
 Clinical support decision systems help physicians
make better decisions about patient care faster
with higher degrees of certainty, reduce
misdiagnoses and risk of prescribing errors, and
gain efficiencies to reduce costs.

 Population health management can reduce total

healthcare costs through preventive strategies
targeting high-risk populations, equipping
patients with knowledge and resources to
manage chronic conditions, and reducing patient
reliance on hospital emergency rooms for acute
care.

 Supply chain management weaknesses were

highlighted by the COVID-19 lockdowns —
particularly in the procurement of personal
protective equipment — which has forced the
industry to view the supply chain as “less
transactional and more strategic; we recognize
just how essential it is to the day-to-day
functioning of the health system.”
 SURVEYS

 David S. Rodgers
o Managing Director of Owlsfield Financial Corporation

According to Sir David in the ever-evolving landscape of

healthcare, numerous challenges persist, impacting both
providers and patients. From access to care and the high cost of
treatments to workforce shortages and technological integration,
these pain points can hinder the delivery of effective and
equitable healthcare. However, innovative solutions and strategic
investments, particularly through loans, have proven instrumental
in addressing these issues and transforming healthcare
outcomes.

Pain Points in Healthcare according to Sir David

1. Access to Care Access to healthcare remains a significant

challenge, particularly in rural and underserved areas.
Geographic barriers, coupled with socioeconomic disparities,
often leave many without the necessary medical services.

2. Cost of Care The exorbitant cost of medical treatments and

prescription drugs poses a substantial burden on patients. High
out-of-pocket expenses can lead to financial strain, causing
some to forgo essential care.

3. Quality of Care Inconsistencies in the quality of care can result

in disparities in health outcomes. Issues such as misdiagnosis,
medical errors, and varying adherence to evidence-based
practices undermine patient trust and health.
4. Patient Experience Patients frequently encounter long wait
times, complex appointment scheduling, and insufficient
communication from healthcare providers. These issues can
diminish patient satisfaction and engagement.

Solutions for pain points according to

Sir David

Healthcare systems worldwide face

persistent challenges that affect the
quality, accessibility, and efficiency of
care. By identifying and addressing
these pain points, and through strategic
investments, especially in the form of
loans, healthcare providers can enhance
service delivery and improve patient
outcomes. This article explores common
pain points in healthcare and successful
solutions that have been implemented
to overcome them.
  𝐃𝐫.𝐑𝐚𝐯𝐢 𝐃𝐞𝐬𝐡𝐦𝐮𝐤𝐡
(District health 𝐨𝐟𝐟𝐢𝐜𝐞𝐫)

According to Dr. Ravi Deshmukh, a hypothetical District Health Officer

with over two decades of experience in managing rural healthcare
systems, key pain points include inadequate *resource allocation,
**workforce shortages, **infrastructure deficits, **data management
issues, and poor **coordination and communication* between different
healthcare levels. His extensive background highlights the need for
improved funding, better workforce strategies, upgraded facilities,
efficient data management, and enhanced communication to address
these challenges.

Pain Points and Solutions According to Dr. Ravi Deshmukh:

1. Resource Allocation:
- Pain Point: Limited funding and unequal distribution of resources
hinder the ability to adequately support rural healthcare facilities and
initiatives.
- Solution: Increase funding through government and private sector
partnerships and implement policies for more equitable resource
distribution.

2. Workforce Shortages:
- Pain Point: Recruiting and retaining qualified healthcare professionals
in rural areas is challenging, leading to understaffed facilities and
overworked staff.
- Solution: Develop incentives such as financial benefits, professional
development opportunities, and housing support to attract and retain
healthcare workers in rural regions.
3. Infrastructure Deficits:
- Pain Point: Outdated or inadequate infrastructure in rural healthcare
centers affects the quality of care provided and requires significant
renovations.
- Solution: Invest in upgrading and modernizing healthcare facilities
and infrastructure to enhance care quality.

4. Data Management Issues:

- Pain Point: Inconsistent and inefficient data collection and
management make it difficult to track health outcomes and plan effective
interventions.
- Solution: Implement comprehensive health information systems with
standardized data collection methods for better tracking and planning.

5. Coordination and Communication:

- Pain Point: Poor coordination and communication between different
levels of healthcare services lead to gaps in patient care and fragmented
services.
- Solution: Develop better communication platforms and coordination
protocols between various healthcare levels to ensure integrated and
continuous care.
 Procare Medex
Medical Practices, Keansburg, New Jersey
According to this small-scale industry, doctors find themselves
entangled in a web of challenges, and one significant hurdle they
come across with is the complex world of medical billing. While
the primary focus of medical professionals is on patient care and
well-being, the financial aspect, particularly medical billing, often
emerges as a daunting obstacle. In this exploration, we delve into
the myriad pain points doctors face in medical billing, shedding
light on the challenges that impact both the efficiency of
healthcare delivery and the financial health of medical practices.

Pain points
1. Billing Errors and Rejections: Inaccuracies in medical billing are
a pervasive issue that can have severe financial repercussions.
Billing errors, whether in coding, documentation, or submission,
can result in claim rejections or denials. Doctors then find
themselves caught in a cycle of resubmission, leading to delayed
payments, increased administrative workload, and potential
revenue loss.
2. Delayed Reimbursements: The lengthy reimbursement process
exacerbates the financial strain on medical practices. The time gap
between providing services, submitting claims, and receiving
payments can be extensive, impacting cash flow and hindering the
ability of medical professionals to invest in the growth and
improvement of their practices.
3. Administrative Overhead: Medical billing involves an intricate
administrative process that requires dedicated personnel and
resources. Doctors often find themselves managing administrative
tasks or employing billing staff, diverting valuable time and
resources away from patient care. The administrative overhead
associated with medical billing becomes a significant pain point for
many medical practices.
4. Insurance Company Interactions: Dealing with insurance
companies can be a challenging aspect of medical billing. Doctors
must navigate complex insurance processes, including pre-
authorizations, claim disputes, and negotiations. The lack of
standardized procedures across different insurance providers adds
an extra layer of complexity, requiring doctors to invest time and
effort in understanding the unique requirements of each.
5. Patient Financial Responsibility: The rise in high-
deductible health plans places an additional burden on
doctors to navigate patient financial responsibility.
Collecting payments directly from patients,
understanding insurance coverage, and
communicating effectively about financial obligations
become essential tasks that demand time and
attention, diverting focus from core medical
responsibilities.

Solutions
Addressing these pain points requires a multi-faceted approach,
combining technological solutions, ongoing education, and a shift
toward more streamlined and efficient billing processes. By
understanding and actively mitigating these challenges, the
healthcare industry can empower doctors to reclaim their focus on
patient well-being and foster a more sustainable and efficient
healthcare ecosystem.