DR NAGENDRA SWAMY
PRESIDENT
MANPAL HEALTH ENTERPRISES

• CHALLENGES
• Affordability of Quality Healthcare.
Currently ~3% of population are covered by Insurance/Third Party
Funding
• Accessibility to Quality Healthcare, especially in rural areas
• Brain Drain: Availability of trained
Doctors / Nurses / Paramedics
• Intense Competition: Entry of private players, and MNCs
• Govt. Spending(<1% of GDP): Low healthcare spending by the government and increased load towards the payment of Salaries (80%)
• Ailing Government Infrastructure: healthcare with high maintenance costs
OPPORTUNITIES
• Recognition as an Industry: Transition from “healthcare” as a Social
Responsibility to “healthcare” as a business.
• Tap Domestic Potential: Increased
Health Insurance Cover, improving
Domestic affordability
• Integrated Urban-Rural Presence: Tele-
Medicine and integrated networks of care to help tap the large rural population
• Medical Process Out-Sourcing: Clinical
Research, Tele-Radiology, Medical
Transcription etc.
• Medical Tourism: International community recognizing India as a quality care provider

Total Healthcare Market Size
US $ 21.3 billion
Pharmaceuticals
US $ 4.15 billion
Healthcare Services
US $ 17.15 billion
Hospitals Services & Practioners:
US $ 13.10 billion
Medical Software
US $ 1.45 billion
Medical Eqpnts & Consumables
US $ 1.35 billion
Medical Insurance
US $ 82.90 million
Healthcare Consultancy
US $ 41.45 million
 Traditionally, a social sector with high Govt. role
 Dominated by Small time players in the Private Sector
 Growing @ 14-16 % per annum

• Indian healthcare a US $ 35 billion industry, expected to reach
US $ 75 billion by 2012 and US $ 150 billion by 2017.
• Will grow at the rate of 10-12% over the next few years.
• WHO Recommends India to add 80,000 hospital beds a year for the next 5-8 years to meet the demands of healthcare sector
•
4 MN PEOPLE ARE EMPLOYED, MAKING IT ONE OF THE LARGEST
SERVICE SECTORS IN THE ECONOMY GOING UP TO 9 MN IN 2015
• Clinical trials have the potential to become a US$ 1 billion industry by 2010 and the health services outsourcing sector has the potential to grow to US$ 7.4 billion by 2012, from US$ 3.7 billion in 2006 .
• Private Equity funds are expected to invest at least US$ 1 billion in the healthcare in the next five years.

• With only 10% of the Indian urban population covered by health insurance, the sector has growth potential of US$ 5.75 billion by
2010
• In fact, 84% of hospital beds are in urban areas , whereas 75% of the population still resides in rural villages.
• Medical tourism will be a US$ 2 billion industry by 2012, growing at 25-30% annually. In 2007, India treated 450,000 foreign patients and ranked 2 nd in medical tourism globally.
• The total healthcare market with Pharma will be US$ 53 – 73 billion (6.2 – 8.5 per cent of the GDP) in the next 5 yrs
• The Indian middle class estimated at 300 million has strong
Purchase power.
 According to Ernst & Young, the Indian medical equipment industry was US$ 2.6 billion in 2006 and is growing at 15 per cent and expected to reach US$ 4.5 billion by 2012. Only 35 per cent is accounted for by the domestic sector, while the rest is imported

Value of Healthcare Market
300000
200000
100000
2005 2009 2012*
Figures in Rs crore
* Projected
Source: Healthcare services in India:2012, the path ahead. ASSOCHAM-YES Bank, 2009; McKinsey 2007

Expected to Increase
Expected to Decrease
• Lower Respiratory Tract
Infection
• Diarrhea diseases
• Perinatal Conditions
• Measles
• Malaria
• PEM
• Anemia
Transition from
Infectious &
Nutritional
Diseases to
Chronic &
Lifestyle related diseases
• I.H.D
• COPD
• CVA
• Diabetes
• Cancer
• Road Traffic Accident
• HIV
• Psychiatric Conditions
Source: www.cia.gov - Fact Book UK /USA 2007

USD 237 Billion in National Income for India Loss due to CNCD in
2015
Globally over 36 million will die of this epidemic- 80% death is lower and middle income groups- amounting to 44% of premature death world wide.
This is double the number of deaths dues to infectious diseases.
WHO report
FOCUS ON PREVENTIVE TO CURATIVE:
• Life style modification
• Early Diagnosis
• Ancillary & Auxiliary Therapies
• Prophylaxis
• Utilization of Genetic & Biotechnology

•
India has only 0.7 beds per 1000 people in contrast to the average of
3.3 beds per 1000 in other countries.
•
The demand completely eclipses capacity. India needs 80,000 beds each year for the next 8- 10 years at Rs 50,000 cr per year.
•
Double the number of doctors from 0.7
million to 1.5 million
•
Triple the number of nurses from 0.8 to 2.5 million.
•
Four times the number of paramedics from 2.5 to 10 million.
•
60% of the 15,393 hospitals and 80% of all qualified doctors are in private sector

Ego
Emotions & Feelings
Family & Friends
Reach
Cures
Compassion
Patient Friendliness
Labor intensive
Cost
Super Specialty
Technological Advancements
Hope
Continuum of Care Complex
Quality
Health Tourism
Anxiety
Expense
Commercialization
Healing Managed Care
Telemedicine

(Spectrum of Skill Sets Involved in Service Delivery)
Attendants
Security Staff
Housekeeping
Lift Operators
Canteen
Room Boys
LOW
•Socio-Economic Status
•Education Levels
•Intellectual Capability
Counselors
Technicians
Receptionist
OT Staff
OPD Secretaries Dietician
Pt. Care Coordinators Admissions
Admin Manager Nursing
Pharmacist PRO Cashier
MEDIUM
•Socio-Economic Status
•Education Levels
•Intellectual Capability
Healthcare Organization
Complex interaction
Super Specialist
Primary Physician
Anesthetist
Radiologist
Physiotherapist
Jr. Doctors
Sr. Management
HIGH
•Socio-Economic Status
•Education Levels
•Intellectual Capability
LOW
•Socio-Economic Status
•Education Levels
•Intellectual Capability
PATIENT / RELATIVES
MEDIUM
•Socio-Economic Status
•Education Levels
•Intellectual Capability
HIGH
•Socio-Economic Status
•Education Levels
•Intellectual Capability

Patients
Hospitals
Profession
Generalist
Transformation of Patients’ Status,
Hospitals’ Attitude and Doctors’ Profession
Customers Guests
Hospitality
Blood Relatives
Homely Care
Specialist Super specialists
Sub Specialist

Ego Levels vs. Criticality of Organs
Anatomy handled

• Doctors
– More Communicative, Humility
– Doctor–Patient Relationship
– Hospital-Doctor Relationships
– Encouraging Second Opinion
– Integrated approach- Respect all systems
– Patient Safety / Medical Errors
• Patients
– Patient Education and Charter of Right
– More Demanding
• Nursing, Paramedical & Administrative Staff
– Equipped with Tech Tools
– Care Beyond Nursing

PREPARING THE 21ST CENTURY GLOBAL
HEALTHCARE WORKFORCE
To meet the growing global demands of caring for the increasing numbers of patients with chronic conditions, we need to develop a new approach to training.
A different set of competencies
The five basic competencies
Patient centred care
Partnering
Quality improvement
Information and communication technology
Public health perspective

QUALITY AND QUANTITY OF HUMAN RESOURCE
TO ENHANCE
• The Govt Policy must encourage PG Courses so that Hospitals meeting certain minimum criteria can offer these courses with relaxation in terms of restrictions. ( Fellowship / DNB)
• Qualitative Educational Institutions to be commenced.
• Continued medical education (CMEs) for medical, nursing and para-medical professionals,
• Mandatory credentialing of Medical Professionals while recruiting.
• The current compulsory rural stint for medical professionals.
• Huge Health cities/ medi-cities will induce employment and even provide human resources through education facilities.
• To have 2nd line – Health Assistants to assist Nursing in non clinical work and Physician assistant programmes
• To give importance to Healthcare management programmes and make them popular career option.
• Staff for accreditation programmes- NABH / NABL/ JCI / ISO etc

• ACUTE SHORTAGE OF QUALIFIED AND TRAINED STAFF
• GETTING REPLACEMENT IN TIME – SERVICE GETS EFFECTED
• UP COMING NEW FACILITIES TAKING AWAY TRAINED STAFF
WHICH RESULTS IN REPLACEMENT BY UNTRAINED STAFF-
GAPS IN SERVICE.
• MOST OF THE CONSULTANTS ARE ON CONTRACT, NON-
EMPLOYEE STATUS WHICH MAKES IT DIFFICULT TO MANAGE
THEM.
• ABSENCE OF BENCH MARKING FOR STAFF : BED RATIO
• QUALITY / PATEINET SAFETY / MEDICAL ERRORS –
PROACTIVE REPORTING.
• INCREASED MEDICO-LEGAL RISK, COMPLIANCE TO
STATUTORY OBLIGATIONS.
• IR ISSUES AND LABOR UNION ACTIVITIES.
• VICARIOUS RESPONSIBILITY OF CONTRACT EMPLOYEES.

NABH

2004
2005
2006
2010
2007
2008
2009
Ranked 1 st in Bangalore for the 7th consecutive year by ‘The Week’ among ‘India’s Best Hospitals’

Sources:
McKinsey report – Technopark- E&Y – KPMG- WHO-Cygnus -ASSOCHAM-YES Bank-
MOH- CRIS-INFAC-IRDA-HOSMAC-NIPER- Netscribe-FIICI
- Dr Nagendra Swamy