A Research Report

On

“RESEARCH ANALYSIS ON HEALTH CARE SECTOR AND THE

STRATEGIES ADOPTED”

By

Manasvi Deshpande

Roll No. 19148

Submitted in partial fulfillment of the requirement of

Summer Internship Programme

Under the Guidance of

Prof. M R Suresh

Marketing Dept.

SDMIMD, Mysore

SDM Institute for Management Development

Mysore, Karnataka, India

June 24, 2020

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This is to certify that Mr./Ms __Manasvi _Deshpande________________________

currently studying Post Graduate Diploma in Management at SDM Institute for

Management Development, Mysore, has satisfactorily

completed Summer Internship project titled

_____________________________________________________________
___________________________________________

related to stream of Management from to

___________.

Signature: Date:

Name: Place:

Designation:

Name of the Organization and Address:

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 CERTIFICATE BY THE FACULTY GUIDE

SDM INSTITUTE FOR MANAGEMENT DEVELOPMENT, MYSORE

This is to certify that Roll No_ 19148 Mr/Ms Manasvi Deshpande _

of PGDM Batch 2019-21 has satisfactorily completed Summer Internship Project

titled
____________________________________________________________________
____________________________________________________________

at M/S

located at from to to

partially fulfil the requirements of the PGDM program under my guidance.

Signature: Date:

Name:

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 ACKNOWLEDGEMENT

I am immensely grateful to Prof. N. R. Parasuraman Sir, Director Shri Dharmasthala

Manjunatheshwara Institute of Management Development, for providing me the opportunity to
work in the field of Marketing Research Study on “RESEARCH ANALYSIS ON HEALTHCARE
SECTOR AND THE STRATEGIES ADOPTED” for the period of two months as a part of my
Summer Internship Program in order sharpen my skills and shoulder the responsibilities through
this research. I would also like to convey my sincere gratitude to my project mentor Prof. M.R
Suresh Sir for his valuable guidance and suggestions since the very inception till the very last stage
of the project. Without his help and valuable inputs and guidelines, the completion of this Research
would not have been possible.

I would like to earnestly thank my Sir for his time and continuous insights on each stage of this
project, which leads to enhancement in my understanding of Market Study and successful and on-
time completion of this report.
 Executive Summary

Investment in social and physical services has a positive impact on the vulnerable in many ways,

directly and indirectly. Development of infrastructure is one of the major factors that directly lead to

economic growth and job creation, and by creating externalities for private sector investment.

Investing in social infrastructure and human development increases efficiency through better

schooling, strengthened workforce, skills growth, decreased absenteeism , increased mobility, faster

demographic change, increased women's participation in the workplace and better tailored social

security and welfare schemes. Like in all developing countries, by making investments in both

physical infrastructure and human growth, the government has a leading position in building

generic ex-ternalities. In particular, the Constitution has assigned major roles to the provision and

control of services with major externalities to both the Union and the governments of the States.

The aim is to enable governments at reasonable costs to provide meritorious services with strong

externalities to citizens in sufficient quantities.

Health policy is a basic principle of human wellbeing. The State must play an significant role in the

provision of health and education, despite the high degree of externality. Unfortunately, evidence

indicates that spending on public healthcare in India is low, and individuals out of pocket expenses

are more than four times that of government spending. Although the low level of public health

expenditure is an accepted fact, reliable statistics are not readily available on actual public health

spending and its history over time. The National Health Accounts, India's most au-thoritative and

comprehensive source of health spending information, are ex-extremely rare.

The continued use of partial data sets relating to public health spending leads to the wrong decision

for public health. The objective of this study is to compile on a comparable basis, over the period

2005-06 to 2014-15, a comprehensive dataset of public spending on health and related areas at

Union and State level as well as in different States. The report will also address problems in data
collection and comparability, so that more work will enhance estimates of public health spending in

this field.

In addition, the effect on the health sector due to coronavirus and innovations adapted during the

crisis and a better understanding of the contrast between the corporate healthcare system and rural

policies, and the overall growth of the healthcare sector over the years
Table of Contents
1

Industry Overview 1

About the sector 4

Health care sector background and history 4

Background focusing to Karnataka health care sector 6

Research objective: 6

Research Design: 7

Research Location: 7

Secondary source/s of Data: 8

Data Collection Method: 8

Description of the strategies adopted 8

Strategies adopted by Indian health care sector 8

Sustainable strategies adopted by Indian government 10

Overview of the strategies and methods adopted by Government of Karnataka 12

Top Government Hospitals and colleges in Karnataka 13

Top Government and private hospitals 13

Karnataka’s Health Expenditure and Infrastructure 14

Expenditure on Primary Health care 18

Adaption of technology in Health Care Sector in India 21

Current and future adaptions 23

Adaption of technology through Clouds 25

Adaption of technology with Analytics 25

Corporate Health care system 28

Introduction 28

Private and Public Sector 28

Top 10 Health care centres in India 29

Healthcare Companies disrupting the market through collaborations 31

IT & supply chain start-ups 33

Non-Profit Health Care Sectors 34

Role of Government 35

Few Top Non-Profit Organizations in Health Care Sector 35

Comparison Between corporate health care sector and non-profit organizations in health care sector

37

Rural and Public Health Care General and Insurance policies 40

Introduction 40

Major changes in Health care sector after the impact of Covid-19 43

Impact on Medical devices 43

Information Requirement Planning (IRP) Table: 45

Limitations in secondary research 46

Key results and Learning 48

Recommendations 50

Conclusion 51

References 52
 Introduction

Industry Overview
 Industry Overview

Healthcare has been one of the biggest industries in India-both in terms of income and employment.
Healthcare includes hospitals, medical devices, clinical trials, outsourcing, telemedicine, medium-
sized tourism, health insurance and medical equipment, and the Indian healthcare sector is
increasing rapidly due to expanded coverage, facilities and investment from both public and private
stakeholders..[ CITATION www \l 16393 ]

Indian healthcare delivery system is divided into two main components-public and private. State,
i.e. public health care program, provides small secondary and tertiary care facilities in key cities and
focuses on delivering basic health care services in rural areas in the form of primary health care
facilities (PHCs). The private sector offers a significant concentration of secondary , tertiary, and
quaternary treatment facilities in metro, tier I, and tier II cities.[ CITATION www \l 16393 ]

The competitive advantage of India lies in its wide pool of well-trained healthcare professionals.
India is also competitive in cost compared to its peers in Asia and countries in the West. The
surgical cost in India is around one-tenth of that in the United States or Western Europe. India ranks
145th among the 195 counterparts in terms of healthcare quality and accessibility.[ CITATION
www \l 16393 ].

Growing incidence of lifestyle diseases, rising demand for affordable healthcare delivery systems
due to the increasing healthcare costs, technological advancements, the emergence of telemedicine,
rapid health insurance penetration and government initiatives like e-health together with tax benefits
and incentives are driving healthcare market in India.[ CITATION htt \l 16393 ]

By 2020, the Indian healthcare market is expected to cross Rs 19.57 lakh crore (US$ 280bn). The
key contributors to growth would be rising income levels, increased health awareness, increased
lifestyle disease precedence and improve access to insurance. Throughout India the health insurance
industry is gaining traction. Gross direct premium income underwritten by health insurance rose to
Rs 51,637.84 crore ( US$ 7.39 billion) in FY20 by 17.16 per cent y-o-y the number of sub-centers
exceeded 169,031 by April 2020 and the number of primary health centers (PHCs) rose to 33,987
by that time. The hospital industry in India is expected to cross US$ 372 billion, from US$ 160
billion in 2017 by 2022..[ CITATION htt \l 16393 ]

The healthcare sector in India is offering a potent combination of incentives and chal-lenges,
according to KPMG. Across the years, the substantial gap between 'necessary' and 'real' health-care
1
infrastructure has prompted major investment in assets such as hospitals and other facilities. In
addition, healthcare 's increasing availability and affordability is spurring demand for other facilities
such as diagnostics, hospitals, equipment etc.

Many non-healthcare corpo-rates and private equity firms which infuse (capital and non-capital)
resources also contribute to the growth story of the healthcare industry. India has become an
enticing destination for medical tours due to the lower cost of the procedures

KPMG highlights the challenges facing the Indian healthcare sector as an optional resource use,
reducing operational costs, optimizing performance and productivity, market scaling, rapidly
changing technology, and globalizing the quality and standard of healthcare.[ CITATION htt1 \l
16393 ].

2
About the sector

3
About the sector

Health care sector background and history

Healthcare sector and the strategies adopted: Healthcare market in India is expected to reach US$

132.84 billion by year 2022, by rising income and greater health awareness is the major role that

will play in everyone life. Healthcare has been one of the main industries for both revenue and jobs

in India. Medical care covers clinics, medical supplies, clinical trials, outsourcing, telemedicine,

medium-sized healthcare, medical insurance and medical devices, and also raises public and private

sector spending

Indian healthcare delivery system is categorized into two major components - public and private

and the private sector provides majority of secondary, tertiary, and quaternary care institutions with

a major concentration in metros, tier one and tier two tier.

Looking at the market size the healthcare can increase three-fold to Rs. 8.6 trillion is the expectation

but also considering the recent pandemic this target is difficult as most of the tests and other care is

taken by the hospitals, governments or some are taken by the NGO’s. Government spending on the

health sector has risen from 1.2% in FY14India to 1.4% in FY18E is a land full of opportunities for

players in the medical devices industry. India's healthcare industry is one of the fastest-growing

markets, touching $280 billion by 2020.

The segments are: (1) Hospitals

(2) Pharmaceutical

(3) Diagnostics

(4) Medical Equipements & Supplies

(5) Medical Insurance and (6) Telemedicine.

4
  Hospitals are located. It consists of State and Private Hospitals. State hospitals – This covers

community centers, district hospitals and hospitals of general interest. Private hospitals –

Which includes private hospitals for nursing homes, and private hospitals for mid- and top-

level use.

 Pharmacies. It covers the manufacture, extraction, processing, purification and packaging of

chemical materials for human or animal use as medicines

 Diagnosis: It involves companies and laboratories providing analytical or medical ser-vices,

including an examination of body fluids.

 Medical Supplies & Equipment’s. This comprises establishments that produce mainly

medical equipment and materials, such as surgical, dental, orthopaedic equipment.

 Social care. This provides health care and rehabilitation services, covering the

hospitalization costs of an patient incurred as a result of illness.

 Telemedicine’s: Besides many other applications in education , training and management in

the health sector, telemedicine has tremendous potential to address the challenges of

providing healthcare to rural and remote areas

Market Size

The healthcare market growing rise by 2022 triple to Rs 8.6 trillion ( US$ 133.44 billion). The

demand for in-dian medical tourism is rising at an annual rate of 18 per cent and is projected to hit

US$ 9 billion by 2020. There is substantial room for expanding healthcare facilities as a proportion

of Gross Domestic Product ( GDP) healthcare expenditure rises. Government spending on health

sector rose from 1.2 per cent in FY14 to 1.4 per cent in FY18E.

In India health insurance is gaining traction. Gross direct insurance premium income grew at

14.70% y-o - y to Rs 42.328.18 (US$ 6.06 billion) in FY20 (up until January 20).

5
Background focusing to Karnataka health care sector

Karnataka is one of the first Indian states to implement a public health policy. It was also a pioneer

in state-supported health insurance schemes, with Yashaswini and Vajpayee Aa-rogyasri among

India's first initiatives. Within India's bigger states, Karnataka has one of the lowest rates of infant

mortality (IMR) at 24 per 1,000 live births. Over the last ten years , the number of births in a health

facility has risen significantly from 65 per cent in 2005 to 94 per cent in 2015. Nevertheless, the

maternal mortality ratio ( MMR) is still relatively worse, with Karnataka's MMR of 133 per

100,000 live births being the highest among South Indian states.[ CITATION htt1 \l 16393 ]

Karnataka has a solid track record in health policy formulation. It is frequently noted that the 2007

Karnataka Private Medical Establishments Act was enacted with the intention of registering private

hospitals and tracking their functioning even before the 2010 Clinical Establishment Act, a central

legislation that mainstreamed the debate of private sector regulation was also accepted in Karnataka

as the first state in India to introduce universal health care. According to the available data,

Karnataka has a network of more than:

 2,346 Primary Health Centres

 326 Community Health Centres

 8,871 Sub-centres

There are 176 Government hospitals in the state that provide free treatment to the people.

[ CITATION htt2 \l 16393 ].

Research objective:

 To understand growing healthcare sector in India and Karnataka based on secondary data

available

 To identify the strategies adopted by the state government

6
  To understand the current situation of healthcare in the villages of the state

 To identify the seriousness of health both in urban and rural areas

 To understand the benefits and facilities that are provided to doctors and nurses

 To know the benefits and facilities that are received by both urban and rural citizens

Research Design:

The typology of research here based on the data available is exploratory and descriptive encrypting

with both qualitative and quantitative methodology this is an effort to understand the various

dimensions involved in healthcare industry.

The purpose of this exploratory study includes increasing familiarity and gathering information of

service that are provided by big private hospitals and rural government hospitals and helps in

generating a research model by analyzing the data by using exploratory and descriptive type of

research methodology which will help in understanding the future view point of the healthcare

sector and what improvisation can be opted.

Research Location:

The study of healthcare sector is to understand the growth in the healthcare firm focusing on the

Karnataka state to fairly have a good understanding on strategies adopted by the state government

of Karnataka and how well are they coping up with the crisis and whether the necessary services are

provided or not and also as healthcare is one of the fastest growing firm and also contributes to the

overall nations GDP and well developed infrastructure in the hospitals of Karnataka and based on

the secondary data available focusing on the healthcare sector of Karnataka we can analyze and

gain greater knowledge to explore.

7
Secondary source/s of Data:

The data is mainly gathered from the data available from different websites, government portals and

to examine the private hospitals growth and their competitors and understand the meaning and

prospects of medical growth in the state seeking information on internet and by corresponding with

people virtually. Gathering information and data on the number or private and government hospitals

in the state, no of bed facilities, health insurance provided by the government and also by the

private firms.

Data Collection Method:

The data collection method will remain purely secondary data based on the information available on

the internet and if required basic information can be gathered by informal questionnaire from

concerned people virtually with their consent.

Description of the strategies adopted

Strategies adopted by Indian health care sector

Healthcare has become one of India's largest markets, both in terms of revenue and employment,

according to a recent study from the India Brand Equity Foundation (IBEF). The industry is

growing at a remarkable pace, owing to its strengthening of public and private sector coverage,

services and increased ex-spending.

Factors driving India's health-care sector Include:

• The prevalence of lifestyle diseases is rising

• Rising demand for affordable healthcare delivery systems as healthcare costs increase

8
• Engineering progresses

• Rise of telemedicine

• Rapid penetration of health insurance, and government programs such as e-health

• Levies and tax incentives

Indian healthcare expenditure also has strong growth indicators for the coming years. The market is

expected to record a Compound Annual Growth Rate ( CAGR) of 16.28 per cent between 2008 and

2022 and the total size of the industry is estimated to reach $372 billion by 2022. Similarly, India 's

hospital industry stood at $61.79 billion in 2017 and is forecast to grow to $132.84 billion by 2022

at a CAGR of 16-17 per cent.[ CITATION www \l 16393 ]

 Government released the National Health Policy (NHP) 2017 to serve as a guiding document for

the policymakers in the achievement of India's national goals and international commitments. NHP

recognizes some key dimensions of high-quality healthcare – consistency, positive health outcomes,

patient-centeredness, equity, and trustable service delivery. Improving the quality of health care is

also essential to meet the health-related targets of the Sustainable Development Goals (SDGs).

SDGs lay importance on improving indicators relating to maternal, fetal, and neonatal care, which

are areas where continuous quality enhancement is necessary to bring down the maternal mortality

rates (MMR), infant mortality rates (IMR), neonatal mortality rate (NMR), and under-five

mortality 

To be more specific, in October 2018, 41,887 pregnant women in their last menstrual cycle were

registered on the central server for the district, with 13,419 tagged as risk cases and only 1907 as

high risk. This immediately catches attention since in any usual context; about 10% of cases are

HRPs. Thus, there is substantial under-detection of high-risk cases despite the presence of

incentive-based programs for accredited social health activist (ASHA) workers in the state.

9
Even in cases that are identified, there is usually a very late referral that may put the mother and

child at risk. These issues remain even though routine antenatal care (ANC) is mandated and

promoted under the Pradhan Mantri surakshit mantritya program[ CITATION htt3 \l 16393 ]

Sustainable strategies adopted by Indian government

The healthcare system consists of multiple stakeholders including the government, providers,

payers, pharmaceutical and medical devices firms. Each plays a vital role in the health care system

in India. However, interactions between various stakeholders have remained limited.

Initiatives in telemedicine and m-health have contributed to greater health care scope and

efficiency, while being highly cost-effective. Various m-health initiatives around the world have

resulted in improvements in patient access through cost-effective solutions – education and

awareness, support for chronic disease management and treatment, remote monitoring, support for

diagnostics and disease surveillance.

10
Looking at the chain of stakeholders who can bring the change in the system and through which

there can be disturbance in the system. That concept is of immense value given the demographic

and epidemiological transitions in India. Prevention will help sustain a healthy population, thereby

reducing cure-related healthcare expenses, easing pressure on India's limited healthcare services and

creating a healthier one.

An estimated 97 million Indians will be 60 years of age or older by 2020, up from some 64 million

by 2010. The number of diabetes cases predicted to grow to 100 million by 2030 from

approximately 60 million in 2011. India's NCD share is expected to grow to 76 per cent by 2030.

[ CITATION htt4 \l 16393 ]

Key lever for healthcare access, productivity and quality was critical.

Collaboration: The stakeholders need to utilize the strengths of each other to leverage existing

infrastructure and resources. Innovation: Requires product and process improvements to provide

cost-effective and sustainable solutions.

This collaboration and innovation is a great synergy for tailoring new strategies and bringing

industry development. Examples such as Metropolis Health Services (a diagnostic chain) have

linked up with MerryGold Health Network's social franchising model in Uttar Pradesh to provide

patients with quality diagnostic facilities. Patient samples are sent directly to the laboratories of

Metropolis Health Ser-vices, and patients can obtain reports from MerryGold hospital.[ CITATION

htt4 \l 16393 ]

Another field where technology is constantly being used is to boost performance in the healthcare

and hospital management. Healthcare services providers, such as GE, offer a wide variety of

clinical and financial applications in information technology [ CITATION htt4 \l 16393 ]

Private facilities such as Max Mega Specialty Hospital, Apollo Clinics, Medanta and Escorts work

with public payers / insurers such as the CGHS (Central Government Health Scheme). In the United

11
States, AstraZeneca (a pharmaceutical company) has collaborated with insurance and health

benefits provider WellPoint to gain deeper insight into patients. Once the patients and their families

are equipped with medical history, insurers can make better informed decisions about the coverage

they provide [ CITATION htt4 \l 16393 ][ CITATION Ind1 \l 16393 ].

Specifically in Karnataka to achieve its target of making healthcare more inclusive and cost-

effective, the government is committed to use information technology effectively. The e-Hospital

project (linking patients with health facilities, registration, diagnostics, treatment, and big data

analysis) makes government hospitals more efficient. Telemedicine and tele-radiology help in

overcoming HR (specialists) shortages. Our IT projects in Karnataka include e-Hospital, tele-

medicine, tele-counselling, and treatment of psychiatric cases (NIMHANS Model), Janarogya, etc.

Recently, Samsung Research and Development Institute, Bengaluru (SRI-B) recently handed over

1,000 Tab IRIS to the Department of Health and Family Welfare, Government of Karnataka.

Samsung Tab IRIS, the first commercial tablet to be approved by Unique Identification Authority of

India (UIDAI) for Aadhaar verification, is set to provide advanced technological support to

efficiently manage medical subsidies and operations at public health centres across the state.

Karnataka Chief Minister Siddaramaiah flagged off 78 MMUs that will provide healthcare services

to people living in hilly remote areas, in locations which are far off from health centres, areas with

poor transport connectivity, and in vicinities which are mostly inhabited by the poor especially SCs,

STs, other economic backward classes.

Overview of the strategies and methods adopted by Government of Karnataka

Karnataka having a total area of 191,791 Km. Sq. with the population density of 319 persons/ Km.

and literacy rate of 75.36%.

In the last few decades, Karnataka has made considerable efforts to improve the health status of her

residents. Through a large institutional network delivering health care in both urban and rural areas,

12
the State has made considerable strides in developing reliable health infrastructure. Availability of

healthcare providers in Karnataka are

1. Sub-Centres around 9611

2. Community health centres are 320
3. Primary health centres are 2636
4. Sub-district hospital is 539
5. District hospital is 43

Karnataka is one of the first Indian states to adopt a public health program. It has also been a pi-

oneer in health insurance schemes funded by the government, with Yashaswini and Vajpayee

Aarog-yasri among the first initiatives in India. In 2018, Arogya Karnataka Yojane had been

announced by the former government of Karnataka to ensure that primary , secondary and tertiary

medicines are accessible to everyone in the state.[ CITATION htt5 \l 16393 ].

Top Government Hospitals and colleges in Karnataka

1. Medical colleges – 53
2. Ayurvedic colleges – 72
3. Homeopathic colleges – 11
4. Unani colleges – 5
5. Naturopathy & Yogic Sciences – 5
6. Dental colleges – 38
7. Pharmacy colleges – 61
8. Nursing colleges – 294
Source: https://hhbc.in/healthcare-scenario-of-karnataka/

1. Victoria Hospital, Bengaluru
2. Bowring & Lady Curzon Hospital, Bengaluru(Over 696 Beds)
3. Kidwai Memorial Institute of Oncology, Bengaluru
4. Narayana Hrudayalaya(3000 Beds)
5. St John Medical College Hospital(1350 Beds)
6. Manipal Hospital (650 Beds)
7. M S Ramaiah Memorial Hospital(500 Beds)
8. SRL Diagnostics, Mysuru, Karnataka

13
Top Government and private hospitals

Source: https://hhbc.in/healthcare-scenario-of-karnataka/

Karnataka is the first Indian state to take Health Policy initiative. The Kar-nataka government is

making a number of efforts to improve services and facilities for healthcare. Many of the policies in

Karnataka are being implemented, but they are not satisfactory. In comparison, just 10 per cent of

Karnataka 's total population is covered in health care schemes. Therefore, there is much room to

develop healthcare infrastructure in Karnataka's rural areas.

National Rural health mission was first implemented in Karnataka in 2005. In Karnataka, the

implementation plan for NRHM has been developed by integrating different strategies suggested by

the state health policy as well as core strategies of NRHM. The district health action plans from all

the districts of the state are integrated to form the state program implementation plan (PIP) with a

focus on the background districts and high focused districts.

Karnataka’s Health Expenditure and Infrastructure

Own state finances make up a major component of Karnataka's public health expenditure. In the

case of health status and health facilities, Kar-nataka is closer to India's average but it is too low

compared to states like Kerala. The most striking public services and health status problem emerges

from the regional disparity. The study shows that Karnataka's Gulbarga and Belgaum divisions have

weak health services and state of health status. The division of Gulbarga (means Hyderabad

Karnataka) lies in the lower position amongst these. Hyderabad Karna-taka is well known to be

underdeveloped in most sectors, compared with the rest of the regions

Less health infrastructure facilities in this region clearly indicate the neglect of government

involvement / interest in developing critical infrastructure facilities in this area. Health facilities

should be improved to better health. Public health expenditure is very important for better health

14
care facilities. The Karnataka government currently spends much less money on health, which is

about 2 per cent of the NSDP. The sum needs to be boosted. The aim can not be achieved by

through public spending alone, unless it is properly used to provide quality services and good

service mechanization. Keywords: Health Infrastructure, Health Sector.

The allocations made for the medical and public

Sector Year Total Expenditur

Budget e in Percent
allocation
(in crores)
Medical 2017-18 1,86,561 3.05
and public
health
2018-19 2,18,488 3.20

The state is recorded to be doing good in its health sector. Karnataka is one of the first Indian states

to put a state health policy in place (2004). It has also been a pioneer in government supported

health insurance schemes, with Yashaswini (2002) and Vajpayee Aarogyasri (2010) among the first

15
initiatives in India. However in the graph above Karnataka Integrated Public Health Policy(2017),

shows the stagnation in the state expenditure on public health. According to the Karnataka

government’s data in the Economic Survey of Karnataka (2017-18), the stagnation in funds has

adversely affected the functioning of the public health facilities. 

Number of hospital is in rise but beds per lakh population has touched the rock bottom of 80 in

2016-2017 from 112 in 2010-2011; the number of dispensaries are also on the decline. Against this

backdrop, the current budget of the government has to answer many questions. The state

government has been under constant attack for letting the private players in the health sector

influence policies. The yet again low-end allocation in the budget shows where the sector in the

state is heading towards. [ CITATION htt6 \l 16393 ]

The Karnataka state budget, which is being celebrated for waving off the farm loans, neglects the

education and health sector. The state, as explained here has been performing not very well in these

two sectors; with its low records in the indices in these sectors the current allotment shows no hope

this year. 

In infrastructure, we want to upgrade the functionalising the Model Maternal and Child Health

(MCH) wings in district and taluk hospitals and streamlining free diagnostics/ free drugs

availability with online indenting/ equipment availability.[ CITATION htt3 \l 16393 ]

We are working on health reforms for quite some time now. The World Health Organisation

(WHO) is helping Karnataka in the Measles Rubella Campaign while United Nations Development

Programme (UNDP)s ongoing strategy for tackling malnutrition will go a long way in improving

health parameters in the state.

The Karnataka Health System Development and Reform Project is a World Bank-assisted project,

aimed at increasing utilisation of Curative preventive and public health programs, particularly in

underserved areas and among vulnerable groups, to facilitate the achievement of the Millennium

16
Development Goals in relation to health. Taking into account the project's positive contributions to

enhancing health results (reduction of maternal and infant mortality and communicable diseases)

and recognizing the need to suspend / continue ground breaking projects, the project was extended

until March 2016 (the original closing date was March 31, 2012) with an additional $70 million (Rs

374,50 crore) funding with impact.

Other initiatives in reforms include implementing virtual clinics to facilitate the access, availability

and affordability of primary healthcare to people in remote areas; C&R with rationalisation of

available human resources; and streamlining of Human Resource Management Systems (HRMS).

[ CITATION htt6 \l 16393 ]

Local government spending on health has the additional complexity. In states like Karna-taka and

Kerala the expenditure of the state government includes

Transfers to rural and urban health-care bodies. Some municipal authorities often use their own

money to incur health expenses. The sources of public health expenses in India are listed below. As

there are many intergovernmental transfers across various paths, a reliable calculation of

expenditure needs to be carefully omitted to prevent Any understatement.

Notionally, all States are now adopting the same accounting practices from the major to the minor

head levels, which would encourage comparable aggregation results. Yet the likeliness is here to

stop. There are no parallels between the expenses mentioned under the sub-minor heads, describing

heads, and heads of objects, making comparison difficult.

17
Expenditure on Primary Health care

One of the main aims of this study is to get an estimate of India's overall public expenditure on pri-

mary health institutions. Public health services in India are provided through a three-tiered

structure. We estimated primary healthcare expenditure for the purposes of this study by collecting

expenditure on the following institutions: Health Sub Centers (SCs), each covering a population of

about 5,000 in the plains, and around 3,000 in hilly and difficult terrain. Also para-medical staff are

required in those sub-centres. First contact points with a doctor are primary health centers (PHCs),

serving approximately 30,000 people in the plains and approximately 20,000 in hilly and difficult

terrain. Community Health Centres (CHCs) which provide secondary care and are organised at the

levels.

In most Nations, spending on PHCs and CHCs also requires budget headings for drugs used by

primary health institutions. Nevertheless, in Karnataka, All drug procurement under the government

healthcare system is centralized in one body named the Karnataka State Drug Lo-gistic & Ware

18
Housing Society (2210-01-104-0-01), which is responsible for collecting and supplying the drug

needs of all government healthcare institutions from PHCs and CHCs to hospitals and specialist

units. Spending on the logistic pharmacy & warehousing society for health institutions like PHIs is

also an in-kind drug subsidy.

As the expenditure of the drug society cannot Be divided into PHCs and CHCs using budget

documents, its spending has not been included in Karnataka 's estimates of PHI spending.

Local Government Expenditures All Karnataka health institutions with 30 beds or less are

administered in the state of Karnataka by the Zilla and Taluk Panchayats. The state budget includes

broad block grants within, say, the health sector to ZPs, TPs, and GPs-both general and particular

purposes. The State budget presents a separate collection of "ZP Sector" books which contain (only)

the Budget Estimates for each portion of the block grants. This includes compounds specific to PHC

and CHC,

Since the ZP sector includes only estimates of the budget and not real expenditures of the

comprehensive heads and heads of items, the difference between the two at the level of the block

grant (minor head) is found to be About 0.5 per cent. Therefore estimates of real expenditure at the

comprehensive level were determined by correspondingly scaling the estimates. Karnataka is

unusual in having wage expenditure at the district level, which contributes approximately ~30% of

total wage expenditure at the state level, with an additional 30% for wage grants.

19
Adaption of Technology in Health Care Sector

20
 Adaption of technology in Health Care Sector in India

Health care in India is facing several challenges including inadequate access , low insurance

penetration and an increasing burden of chronic disease. At the same time, traditional business

models, except for a few large providers, found it difficult to show attractive returns on investment.

Infusion of technology along with expanded infrastructure and process improvement efficiencies

could help improve accessibility and affordability of healthcare, according to experts who spoke

about emerging trends in this industry in 2020 Wharton India Economic Forum, held this month in

Mumbai.[ CITATION htt7 \l 16393 ]

The Indian government’s ‘Make in India’ initiative is encouraging domestic manufacture of

medical devices and helping lower the prices patients pay for products such as stents and

implants, which in the past were imported. Health care innovation in India will serve as a

global model for the shift from treating sick patients to preventive care and wellness, given

the size of its underserved populations [ CITATION htt7 \l 16393 ]

September 2018, India launched its National Health Protection Mission called “Ayushman Bharat

Yojana” "To provide health coverage to 100 million poor and needy families (approximately 500

million beneficiaries) up to Rs 500,000 each (approximately $7,150) for secondary and tertiary care

hospitalizations.

The app helps add a "performance layer across the continuum" where, for example, housekeepers

might turn around rooms quicker, and the admission desk knows which rooms are accessible by

pressing a button, Reddy said. Electronic health records help its physicians "manage and move

patient-related data." The next layer is in establishing hospital care protocols, she said. Such

protocols, for example , allow "the newer doctor in Apollo to operate at the efficiency of someone

with 20 years’ experience.

21
Next, electronic medical records (EMR) make it possible to improve the quality of service, among

other benefits,

Upgrading health-related infrastructure and human resources in public health facilities in Karnataka

are among the top priorities of the state. In 2018, Karnataka came up with Arogya Karnataka

Yojane to ensure that medications are accessible to each one in the state.

To achieve the target of making healthcare more inclusive and cost-effective, Karnataka has been

using Information Technology effectively. The e-Hospital project (linking patients with health

facilities, registration, diagnostics, treatment and big data analysis) of Karnataka makes government

hospitals more efficient, while telemedicine, telecounselling and tele-radiology help in overcoming

specialists’ shortage in the state.

The state healthcare infrastructure includes 9,611 sub-centres, 320 Community Health Centres,

2,636 Primary Health Centres, 539 subdistrict hospitals and 43 district hospitals. However, the state

has been experiencing shortage of doctors and specialists of all categories in public hospitals at

district, taluka and community health centre levels.

Other priorities include reduction of health inequality amongst people, strengthening infrastructure

and referral system from PHC up-till multi-specialty level and focus on universal health coverage

(UHC) through participation of private sector utilising tools such as telemedicine and e-

hospital management.

 Some healthcare in the country is pre-digital, and paper medical records and film-based radiolo-gy

are much more prevalent than their electronic equivalent. In this setting, even seemingly simple

systems such as an online appointment-booking system at the country's largest public hospitals in

New Delhi can have a big impact by sparing long-waiting patients and saving numerous trips to the

hospital for those who can unwillingly take a day off.

22
The last decade has also seen some fantastic examples of dedicated hardware and technology that

are designed for Indian health ecosystem's unique challenges. Which include products for tracking

adherence to tu-berculosis medicines (one of India's most important public health issues), low-cost

tracking of critical criteria for use in primary health care settings, and telemedicine services that

offer clinical knowledge to areas without doctors. These are more mature than the artificial

intelligence applications that have started to emerge in the last five years. AI systems are mainly

used for screening, tracking, and diagnostic help and include algorithms that ana-lyse X-ray chest

and other radiology images, read ECGs and spot abnormal patterns in human body, automatically

scan the pathology slides and even assess the fundus images for signs of retinopathy.

Current and future adaptions

In India, the last 5 years have seen consumer-facing 'safety tech' being debated and adopted by

investors, the government and, slowly, the public. Technology targeted at the metropolitan, edu-

cated customer is gaining momentum, primarily in the form of online health service aggregators,

telemedicine, e-commerce for prescription home delivery and a surge of fitness applications.

Existing methods are also used to reinvent the delivery of healthcare through online consultations or

chat-based basic healthcare services apps.[ CITATION htt8 \l 16393 ]

More recently , digital healthcare technology has begun to emerge, such as technology that

performs or supports core healthcare or medical tasks such as radiology analysis, pathology or

ophthalmology.

Moreover, ordering medicines online is filled with discounts and convenient delivery. For example,

organizations like Apollo use their Telemedicine network to share everything from reports to

graphics and have better healthcare facilities reach rural areas. The advantage here is, it takes lower

capital investment (setting up an entire hospital or buying new machinery) and effectively uses

available facilities like satellite networks and the internet.[ CITATION htt8 \l 16393 ]

23
Government Initiatives

 Some of India's main industrial health promotion programs are as follows:

 The EU budget for 2020-21 allocated Rs 35,600 crore ( US$ 5.09 billion) to nutrition-

related programmes.

 Government announced an outlay of Rs 69,000 crore (USD 9.87 billion) for health-care

sectors including Rs 6,400 crore (USD 915,72 million) for PMJAY in the budget of the

Union 2020-21.

 The Government of India plans to increase healthcare spending to 3 % of GDP by 2022.

 In February 2019 , the Government of India established a new All India Institute of Medical

Sciences (AIIMS) in Manethi, Rewari district, Haryana at a cost of Rs 1,299 crore ( US$

180.04 million).The Union Cabinet authorized the establishment of a National Nutrition

Mission (NNM) with a three-year budget of Rs 9,046 crore (US$ 1,29 billion) to track,

supervise, set targets and direct ministry-wide nutrition related interventions.

 • Pradhan Mantri Jan Arogya Yojana (PMJAY) was launched by the Government of India

on 23 September 2018 to provide Rs 500,000 (US$ 7,124.54) of health insurance to over

100 Mil-Lion families each year.

 • In August 2018, the Government of India approved the Ayushman Bharat National Health

Protection Mission as a 60:40 federally sponsored program for all States, 90:10 for the hilly

North-Eastern States and 6 for the central and state governments. To Union Territories

without a legislature, the Center must pay 100 per cent.

 The Government of India launched the Indradhanush Mission with a view to enhancing

immunization coverage in the region. It aims to achieve atleast 90% immunization coverage

24
 in rural and urban areas of India by December 2018, which will cover unvaccinated and

partially vaccinated children.

The Government's results are as follows:

 • As of July 2019, about 125.7 million families registered as beneficiaries under Pra-dhan

Mantri Jan Arogya Yojana (PMJAY). The program also involved 16,085 hospitals including

8,059 private hospitals and 7,980 public hospitals. In the treatment system it will contain 19

Ayush packets.

 • As of September 2019, under Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana about

50 lakhs earned free wellness.

 • In India the number of medical schools increased from 381 in 13FY to 529 in 19FY.As of

2013, India has reported a 26.9% reduction in the Maternal Mortality Ratio (MMR)

according to the Sample Registration System Bulletin-2016.

  Adaption of technology through Clouds

The advantage of having online storage and going paperless lies in the usability of the data. This is

achieved by the cloud feature of the healthcare industry. Both public and private enterprises are

opting to tie-up with cloud service providers and giving access to respective patients and doctors.

This way, even if a doctor is travelling and their patient gets urgently admitted, he can monitor the

case without being physically present. Many big brands like Microsoft, Google and Amazon

provide cloud services and are opting to bring more healthcare brands under their umbrella.

 Adaption of technology with Analytics

Algorithms, Big Data, and Artificial intelligence are shaking the world right from its roots, mostly

for the better. The healthcare industry has many startups working to combine Big data with existing

doctors, allowing them to be more accurate in diagnosis, eliminating any possibility of human error.

25
Not only is this used to find out the problem faster, but it is also being targeted as a way to find a

cure to diseases like Cancer and AIDS.[ CITATION htt8 \l 16393 ]

26
Corporate Health Care System

27
 Corporate Health care system

Introduction

India 's health ministry was established in 1947 with independence from Britain. In its series of

five-year plans, each of which determines state spending priorities for the next five years , the

government has made health a priority. In 1983 Parlia-ment endorsed the National Health Policy.

The strategy aimed at universal provision of health care by 2000, and the plan was revised in 2002.

Throughout India the health care system is governed mainly by the states. The Constitution of India

requires every state to provide healthcare to its citizens. In 2005 the national government initiated

the National Rural Health Initiative to tackle the shortage of medical coverage in rural areas. This

mission focuses resources on rural areas and poor states that have weak health services hoping to

improve health care in the poorest regions of India.

Private and Public Sector

India's health-care program is universal. That being said, the quality and coverage of medical

treatment in India is highly disparate. Health care can be vastly different between states and rural

and urban areas. Rural areas often suffer from physician shortages and state disparities mean that

residents of the poorest states, such as Bihar, often have less access to adequate healthcare than

residents of relatively wealthier states.

On the other hand, private hospitals in India provide standard, world-class health care at a fraction

of the hospital price in developed countries. The aspect of health care in India makes it a popular

medical tourist destination. India is also a top destination for medical tourists looking for alternative

therapies like ayurvedic medicine. India is also a popular destination for al-al- alternative medicine

students.

International students should expect to rely on private hospitals for advanced medical treatment in

India. Local pharmacists can be a valuable resource for most minor health ailments
28
Top 10 Health care centres in India

1. Apollo Companies Hospitals

It is a Chain of Indian hospitals located in Chennai , India. In the year 1983 Apollo

Hospitals was established. Hospitals, pharmacy and testing center are its things. Apollo

Hospital is India's largest corporate hospital and leader in the country's private health

movement

2. Aster Healthcare DM

Aster DM Healthcare was founded in 1987 and is one of India's leading healthcare

companies. It is based in Dubai. The company operates Middle East hospitals , clinics,

diagnostic centres, medical centres, and pharmacies, India and the Philippines

3. The labs of Dr Lal Path

Dr. Lal Path laboratories Ltd was established in 1949 and has its headquarters in Delhi ,

India. The company is an international provider of diagnostic tests and services related

to the healthcare. Currently the organization operates numerous laboratories.

4. Fortis Sanitary Ltd.

Fortis Healthcare Ltd was created by Malvinder Mohan Singh in the year 2001. It is a

chain of Indian specialty hospitals that have branches in all top cities. It has several

vertical healthcare facilities including specialist daycare centers, among others. The

company operates through the Medical Services and Clinical Establishments Division

29
1. Health Care Global Enterprises

HealthCare Global Enterprises Ltd is engaged in managing cancer hospitals, cancer centers,

and medical diagnotic services, including scientific testing and consultancy services in the

pharmaceutical and medical sector. The company is also involved in retail sales of

pharmaceuticals, medical and orthopedic goods and toilet articles. The company operates a

cancer care network under the HCG brand.

2. Indraprastha Medical Corporation

Indraprastha Medical Corporation Ltd was founded in the year 1996 and is headquartered in

New Delhi. The company is owned by the famous Apollo Hospital Group. It is one of the

top 10 healthcare companies in India. The company provides diagnostic, medical, and

surgical facilities for patients. The company provides various medical services in various

areas

3. Narayana Hrudaylaya

Narayana Hrudayalaya Ltd operates a network of hospitals and diagnostic clinical centres in

India and internationally. The company operates through medical and healthcare services

business segment. It offers medical, surgery and diagnostics, and support services. The

company operates a network of over 20 hospitals, approx. 7 heart centres and over 20

primary care facilities, across India and a hospital at Cayman Islands. The company was

founded in the year 2000 and is headquartered in Bangalore, India.

4. Piramal Enterprises

In the year 1988 Piramal Enterprises Ltd was established. It sits in Mumbai, Ma-harashtra,

India. The business is well established in the pharmaceutical industry and also ranks among

the top healthcare firms. The company operates through 3 major segments-Healthcare,
30
 Financial Services and Management of Information. The healthcare division covers

prescription treatments, critical care , medical and imaging products. The company sells its

products under the names Saridon, Lacto Calamine, I-Pill, Polycrol, Tetmo-sol, Untox and

Throatsil, among others.

5. Religare Health Insurance Company Ltd.

It is one of India's top 10 health-care firms. The health care provider insurer is interested in

the procurement and distribution of health insurance goods. Religare Enterprises Limited

promotes the leading health-care business. It is a leading company of diversified finance

services. The company provides various services including financial, preventive health

solutions, healthcare provision.

6. Wockhardt Ltd

In the year 1960 Habil Khorakiwala founded Wockhardt Ltd. Headquartered in Mumbai ,

India, is multinational biotech-nology and pharmaceutical business. Wockhardt is a global

company with production plans in various countries including Ireland, the USA , France and

Ireland

Healthcare Companies disrupting the market through collaborations

Disruption in healthcare is driven by changing patients/customers’ needs, digitalisation of the

services and advancements of medical technologies and clinical processes. And, with changing

customer/patient needs, traditional operating models of healthcare delivery have turned inside out.

Today, companies focus on two ways to disrupt the Indian-market innovation of products and

services as well as achieve transformational goals.

Take the example of global IT and med-tech companies like IBM, Microsoft, Apple, GE, Phillips,

Medtronic, BD and more. These players have various collaboration programmes or strategic

31
alliances in which they work with start-ups, IT companies, medtech companies, hospitals,

diagnostic centres, logistics and supply chain companies, third-party payers and insurance firms to

bring in technologies, products and innovations that are country-specific. These strategic

partnerships focus on co-creating solutions for real-world healthcare challenges in the areas of

digital applications for early detection, productivity solutions, telemedicine services, innovative

payment models, and remote and connected care, among others.

Few Examples:

IBM and partners: Aetna, Anthem, Health Care Service Corporation, PNC Bank and IBM last

year announced a new collaboration to design and create a network using blockchain technology to

improve transparency and interoperability in the healthcare industry.  The aim is to create an

inclusive blockchain network that can benefit multiple members of the healthcare ecosystem in a

highly secure and shared environment.

The goal is to allow the blockchain network to enable healthcare companies to build, share and

deploy solutions that drive digital transformation in the industry. The collaboration members intend

to use blockchain to address a range of industry challenges, including promoting efficient claims

and payment processing, to enable secure and frictionless healthcare information exchanges, and to

maintain current and accurate provider directories.

Aetna, Anthem, HCSC, PNC Bank and IBM are actively working to further define the initial use

cases for the health utility network. The collaboration will add additional members to the network in

the coming times including other health organisations, healthcare providers, startups and technology

companies.

GE Healthcare: In 2018, GE Healthcare launched a collaborative programme for its Edison

platform. This platform comprises applications focused on clinical, operational and financial

32
outcomes; smart devices embedded with advanced intelligence to improve workflow, productivity

and diagnostics; and the Edison platform.

The platform enables GE Healthcare and its strategic partners to develop, deploy, manage, secure

and distribute advanced applications, services and AI algorithms.

Leveraging GE Healthcare’s expertise as a leading global medtech and diagnostics innovator,

Edison aggregates the deep data from GE Healthcare devices with horizontal health information

from across the healthcare ecosystem. Through this programme, GE Healthcare collaborated with

startups to arrive at solutions that improve patient outcomes and experience, the efficiency of

clinical practice and that of the healthcare facilities, reduce waste and inefficiencies, and eliminate

costly and harmful errors.

L&T Technology Services: In the medical devices and healthcare segment, LTTS partnered with a

leading medical equipment manufacturer to rectify multiple critical issues with their slidemaker

strainer equipment to increase its efficiency and decrease service cost. LTTS, as part of the

government’s ‘Make in India’ initiative, partnered with Agappe Diagnostics, an in-vitro

diagnostics company, to launch an automated blood cell counter in the Indian subcontinent which

would result in lower diagnostic costs.

LTTS also developed the world’s first cost-effective robotic endo-training kit, a futuristic surgical

training robot, in association with Global Innovation & Technology Alliance (GITA) and

Department of Science and Technology (DST).[ CITATION htt9 \l 16393 ]

IT & supply chain start-ups

Leveraging the digital ecosystem, companies such as Practo and MedikaBazaar are creating value

for customers/healthcare providers and patients in many ways. MedikaBazaar has created a supply

chain AI module that collaborates with hospitals, consumables and pharma suppliers to predict the

33
right inventory for any hospital based on its patient load, and helps provide the best quality supplies

at the lowest rate and least amount of working capital.

Likewise, some of the online pharmacy platforms are collaborating with insurance companies to

offer OPD insurance and provide cashless OPD medical facility to its subscribers through a closed-

loop model which constitutes doctors and labs who are on the pharmacy network.[ CITATION

htt9 \l 16393 ]

Several other examples show how companies are initiating collaborative models to disrupt market

competitiveness and achieve transformational goals.

Non-Profit Health Care Sectors

Too many non-profit NGOs work in India to provide people with preventive and curative health

care services. A small number of those NGOs also offer health insurance schemes in advance of

payment. Such community-based, non-profit insurers will provide the best chance of providing

disadvantaged people with good quality , accessible and sustainable healthcare. This paper ex-

plores the factors related to these schemes' long-term success. Thus, it is hoped that other NGOs

will initiate risk-sharing schemes among their target population by identifying the factors

The need to involve NGOs in Indian health insurance schemes arises because of the four factors

which follow:

First, private spending in India accounts for around two-thirds of overall spending on health care.

Studies by Sunder and Duggal et al show that only 3 – 4% of the overall health care expenditure

and only 9 – 13% of the Government of India's hospital care expenditure is for the poor

34
A survey of 1000 households in Karnataka State in India also showed that 6-11 per cent of total

annual income was spent on health care.3 In the present research, members of lower castes were

found to spend a higher proportion of their annual income on health care. Practically all out-of-

pocket spending was on preventive rather than curative care.

There have been some examples in recent years of private sectors establishing a link with Gov-

ernment insurance companies working for health care financing. The Seba Cooperative Health

Society in Calcutta, Hyderabad Apollo Hospital Group, Madras and Delhi, Delhi Batra Hospital,

Bombay Beach Candy Hospital, Saurashtra Cooperative Hospital soceity Bombay, Jamkher health

project and Kasturba Hospital which were few tie ups in this regard.

Role of Government

Responsibility for the health system 's administration, procurement, and service is split between

federal and state governments.

The Ministry of Health and Family Welfare has regulatory power over the majority of health policy

decisions at the federal level, but is not directly involved in the delivery of health care. The

Department consists of two Departments:

1. The Health and Family Welfare Department is responsible for the coordination and

implementation of all national health services, with each program being led by its own

administrative body.

2. The Department of Health Research is responsible for encouraging safety and clinical re-

investigation, establishing recommendations for health research and ethics,guidelines,

outbreak investigations, and provision of advanced research training and grants for such

training.

Few Top Non-Profit Organizations in Health Care Sector

1. Help Age India

35
 A leading charity working for the disadvantaged elderly of India, HelpAge India has been

active for over four decades. It has one of the largest mobile healthcare programs across

India, providing free healthcare services to destitute elders. HelpAge India also works

towards providing palliative care to end-stage cancer patients. Pairing with several credible

and competent hospitals, the organisation helps the poor elderly who cannot afford

expensive medication for cancer.

HelpAge India has received several awards for his commendable contribution to society. It

holds the Chairman’s Challenge Award, Times Social Impact Award and NGO Leadership

& Excellence Award among several others.

2. CRY: Child Rights and You

It was started by Rippan Kapur in 1979 with six of his friends and fifty rupees at his

mother’s dining table. They had a dream of witnessing a day when every single Indian child

would enjoy his/her rights such as survival, protection and development. Rippan, a young

airline purser, hated seeing children work as servants.

CRY works towards several causes for children, one of them being malnutrition. It

introduced kitchen gardens in anganwadis in Chhattisgarh to provide fresh and healthy food

to children. This not only came as a boon to the underprivileged children but also

accelerated the anganwadi workers in the same direction. This noble initiative of CRY has

helped to see a decrease in the number of malnourished children by about 9-10%.

3. Smile Foundation

Inspired by the philosophy of Peter Senge, the founder of ‘Society for Organisational

Learning’, a group of young corporate professionals founded Smile Foundation in 2002.

They began working from scratch to bring about a difference in the lives of underprivileged

families and communities.

36
 Owing to the lack of awareness for urban slum dwellers to be aware of diseases and

healthcare, they do not approach hospitals for check-ups out of losing day wages. Smile has

a dual approach for tackling this issue. They introduce first quality healthcare services to the

vulnerable within easy access. The second step is to raise understanding of healthcare and to

enable the vulnerable to receive assistance.

4. Rural Health Care Foundation

Is an organization that late Arun Nevatia founded. It seeks to provide the lowest strata of the

socio-economic pyramid with primary healthcare at low cost and is doing well in achieving

its goals. Foundation Rural Health Care.

RHCF has a structure which is well laid out. Each clinic has four departments, General

Medicine, Optometry, Homeopathy and Dentistry, respectively. Diagnosis and medicine

supplies are offered to the patients for a week. The center also arranges cataract surgery and

lip surgery for cleft surgery. Free food and lodging are given to the doctors. It also

distributes films, wheel chairs, crutches and blankets.

Comparison Between corporate health care sector and non-profit organizations in health care

sector

All hospitals every time serve the patients, employ physicians and nurses, and operate in tightly

regulated framework for clinical services and for-profit hospitals add a unique element to the mix:

generating return for the investors.

The five Primary differences are:

1. Tax Status

2. Operational Discipline

3. Financial Pressure

4. Scale
37
 5. Competitive edge

While non-profit healthcare organizations enjoy tax-exempt status from property and income taxes,

they rely on donor funding, minor investment, and community funding to enable patient care to be

provided. Healthcare organizations that are not for profit do not realize profits in any real sense.

Although they have some restrictions on their ability to spend without sacrificing their non-profit

status, they usually reinvest any overage into repairing facilities, purchasing new medical

equipment, upgrading technologies and other medical upgrades that are required.

Healthcare organizations that are not for profit usually foster a culture that is service-driven rather

than business-driven. Non-profit healthcare companies, as service-driven agencies, tend to be more

effective negotiators when addressing costs like managed care contracts.

For-profit health care organizations, such as open-heart surgeries, are more likely to support

services that yield higher profits. They are much more likely to downplay unprofitable programs

such as immediate medical care, or treatment for drug abuse.

On a political note, for-profit healthcare organizations adapt to changes in the law and sources of

government funding faster than non-profit organizations. When governments offered extra funding

for certain services such as home healthcare, healthcare for-profit organizations acted faster and

increased the number of services more rapidly than non-profits. When legislation cut support for the

same programs, healthcare organizations for profit reduced the same programs and took this step far

more rapidly than non-profit healthcare organizations..

Another collection of legal distinctions between investor-owned and non-profit hospitals are rules

that demand a greater degree of public "accountability" from controlling boards of non-profit

hospital. For example, West Virginia has enacted a law requiring non-profit meetings of hospital

boards to be open to the public, much the same as board meetings of government-owned and

operated institutions in a number of states. Investor-owned hospitals are exempt from this provision,

38
possibly to protect their busi-ness data and plans against rivals, which are independent hospitals in

most areas. In comparison, Pennsylvania needs all hospitals to give the general public 'any

opportunity attend meetings of the governing body on occasion.

The problem with such open-meeting requirements is not that board meetings will be overwhelmed

by a flood of spectators; most people couldn't care less what goes on with a hospital board. Rather,

the presence of reporters or possibly competitors—who are more likely to attend than the general

public—will hamper the board if it has to discuss sensitive or confidential matters, such as

financing options, legal positions, or medical staff credentialing.

As this paper has shown, there are a number of differences in how the law treats hospitals owned by

investors and not-for-profit. While many of these variations can logically be expected to affect

hospital operations and their finances, in the absence of large-scale, instil-tuition-specific

longitudinal research , it is difficult to detect any gen-earl patterns along those lines.

The distinction between non-profit hospitals and hospitals owned by investors has been blurred by

the recent push toward corporate restructuring of many non-profit hospitals. A single hospital

organization has grown into a holding company with a variety of subsidies, one of which is the

hospital, the normal corporate transformation plan subsidiaries.

The other subsidiaries may be owned by investors or not-for-profit, depending on the activity to be

carried out. Even in this area, however, nonprofit hospitals lag behind those owned by investors.

Because corporations are owned by shareholders, it is relatively easy to merge them under the

umbrella of a holding company that owns all of their stock into multi-corporate systems. In addition

, as stated earlier, transfer of assets between parent and subsidiary corporations is relatively easy.

[ CITATION htt10 \l 16393 ]

39
 Rural and Public Health Care General and Insurance policies

Introduction

Governments around the world are working to ensure high quality healthcare for their people.

Creating recognition of health concerns, maintaining good services and encouraging health

insurance are successful practices performed by the authorities for the benefit of the people. The

Indian Government still, rarely, undertakes such measures. Read on to learn more about health

insurance policies of the government in India.

Few Health Insurance schemes in India are:

1. Ayushman Bharat

This program came into being because of public health policy guidelines. Ayushman Bharat

Yojana is planned with a Universal Health Coverage ( UHC) in mind. Health facilities are

mainly segmented in India and Ayushman Bharat aims at preparing them comprehensive. It

is all about looking at the health care system as a whole and then ensuring sustained

treatment for the Indian people.

2. Awaz Health Insurance

It is a health insurance policy for migrant workers and is introduced by the Kerala Gov-ernment.

This also includes accidental death compensation for labourers. In 2017, the scheme was

launched to recruit 5 interstate lakh migrant laborers working in Kerala. Under Awaz Health

Insurance, the in-surance cover is Rs.15000, while the death cover is Rs.2 lakh.

3. Aam Bima Yojna

The Aam Aadmi Bima Yojana (AABY) is intended for people who are interested in other

vocations, such as carpentry, fishing, weaving by hand, etc. These specified vocations exist in

40
 48. Before 2013, there were two policies of similar nature, AABY and Janashree Bima Yojana

(JBY). After 2013, JBY was merged with AABY.

The premium for Rs.30000 insurance policy is Rs. 200 for a year. The eligibility criteria for this

policy is that one should be a family head or an earning member of one’s family (around the

poverty line) and should be performing one of the 48 mentioned vocations.

4. Bhamashah Swasthya Bima Yojana:

Rajasthan Government supports insurance initiatives towards its citizens under the Bahmashah

Swasthya Bima Yojana. This is a cashless claims scheme for rural people of Rajasthan. There is

no prescribed age limit for availing the benefits of this scheme.

Those who are a part of the National Food Security Act (NFSA) and the Rashtriya Swasthya

Bima Yojana (RSBY) are also qualified for this insurance policy. This scheme covers

hospitalization expenses for general illness as well as critical illnesses as per the terms and

conditions. It covers both in-patient as well as out-patient expenses.

5. Chief Minister’s Comprehensive Insurance Schemes are:

This is a state government scheme. It is promoted by Tamil Nadu Government in association

with United India Insurance Company Ltd. The Chief Minister’s Comprehensive Insurance

Scheme is a family floater plan designed for quality health care.

One can claim for hospitalization expenses up to Rs. 5 lakhs under this policy. Select

government and private hospitals are a part of this scheme. People residing in Tamil Nadu

earning less than Rs. 75000 annually are eligible for this scheme. More than a thousand

procedures are covered under the Chief Minister’s Comprehensive Insurance Scheme.

6. Employees’ State Insurance Scheme:

In India a large number of people worked in factories of post-independence. Working

conditions were such that there were injuries, and even fatalities. This is where the con-cept
41
 of insurance proved beneficial. The State Insurance Program for Employees was introduced

in 1952 to provide financial protection for covered workers / employees in the event of

sickness, injury or death.

Initially only Kanpur and Delhi were considered but the scale of the scheme expanded with time.

This technique did receive an upgrade in 2015. Around seven lakh factories are part of the sys-tem

now.Also looking at the broader spectrum of new schemes taken by the private and government

sectors are :

India has initiated a series of reforms which could have far-reaching consequences for the health

sector and the broader economy. Including:

• Launch of the National Health Protection Scheme (Pradhan Mantri Jan Arogya Yojana)

Ayushman Bharat for tertiary care for vulnerable populations and the Health and Wellness Centers

initiative for the delivery of comprehensive and in-tegrated primary care;

• Creation of a National Health Authority to enforce the PM-JAY.

 To introduce universal sanitation coverage and to make the country open defecation–free

through the Swachch Bharat Mission.

 Intensified Indradhanush 2.0 plan to achieve vaccination coverage of 90 per cent for

children under 2.

 Under the Pradhan Mantri Ujjwala Yojana scheme providing safe cooking fuel.

 Providing nutritional and social support to all tuberculosis benefactors of the National

Health Protection Scheme.

 Replacing India's Medical Council with the National Medical Commission and creating

uniform requirements for medical education;

42
  Creation of an assessment body for health technology (Health Technology Assessment in

India) under the Health Department Research and Health Research to evaluate all medical

technologies.[ CITATION htt11 \l 16393 ]

Major changes in Health care sector after the impact of Covid-19

In finance markets, the effect of the coronavirus pandemic and the shutdown it caused is clearly

evident. Yet there is still little clarification about the wider impact it has through companies and

industry sectors. Here is an impact study in the healthcare sector focused on evaluations made by

various experts and industry body Ficci.

Although the private healthcare sector is completely prepared for any eventuality, it is also a fact

that the sector faces a twin-burden unlike other sectors:

(A) Spending extra staff, supplies, consumables and other resources to ensure 100% hospital safety

preparedness and subsequent patient care, if necessary.

(b) Experiencing a sharp drop in the OP footfalls and elective surgeries and the international

patients.

Impact on Medical devices

The medical devices industry, too, has made a profit. The country is importing consumables,

disposables, and capital equipment from China including orthopedic implants, gloves, syringes,

bandages, computed to-mography and magnetic resonance imaging devices. Because of the current

crisis in China, it is difficult for medical device manufacturers in India to procure essential raw

materials and electronic components from Chinese factories.

43
Even though some of China's factories have restored service, there is still a shortage of some

essential electronic parts and raw material. This adversely affects the profits and competitiveness of

Indian companies that import medical devices and small components for finished product

manufacture. This can also in the short term bring upward pressure on medical device prices.

Extraordinary decline in demand affecting cash flow leading to difficulties in payroll accounting

and fixed costs

• At the end of March, the private healthcare sector experienced an 80% decline in patient visits and

test volumes and a 50-70% decline in revenue.

• Late-March occupancy levels dropped to just 30-40 percent compared to pre-COVID occupancy

levels of ~65-70 percent, which is expected to exacerbate further with April's lockdown.

The study suggests below that recommendations for providing the urgent financial stimulus for the

sector:

Liquidity injection- Short-term free interest / concessional interest loans to resolve operational

losses anticipated for the quarter and 100 percent immediate release of duties locked with central

and state authorities.

Indirect tax reliefs / exemptions / waivers like- recovery amount equivalent to ineligible GST

credits paid on procurement for a specified period; exemption from customs duty / GST on essential

medicines, consumables and devices for treatment of COVID patients; waiver or reduction of

cessation of health on medical devices, extension of time under the EPCG scheme, etc.

Income tax benefits and deferment of statutory payments of liabilities without interest, penalty for a

specified period (3-6 months) which rebate on commercial rate of the power for a stipulated period.

44
 Information Requirement Planning (IRP) Table:

Source of Primary/ secondary Information point Measurement and

Information scaling
Websites Secondary Hospitals in Indian Nominal Scale
details
Websites Secondary Hospitals especially Nominal Scale
in Karnataka details
Websites Secondary Policies and Nominal Scale
regulations
Research papers Secondary Data sets of total no Ordinal Scale
of beds and the
equipment’s
Research papers Secondary Insurance Ordinal Scale
Research papers Secondary Strategies adopted in Nominal Scale
rural and urban
News paper Secondary Impact of before and Nominal Scale
after crisis
Annual government Secondary Change in the Nominal Scale
reports upcoming years
Annual company Secondary Total data for the Ordinal Scale
reports different types of
patients

45
 Limitations in secondary research

 Quality of the Researcher

As we will explain, the mar-keter primarily regulates work carried out using primary methods. This

is not the case, however, when it comes to data obtained by others. Consequently, the accuracy of

secondary research should be closely scrutinized because the information's source can be unclear.

Organizations that rely on secondary data as an essential component of their decision-making (e.g.

market research studies) must take appropriate steps to determine the quality and reliability of the

information by objectively reviewing how the information was gathered, interpreted and delivered.

 Not Specific pertaining to Researcher’s Needs

Secondary data is also not delivered in a way that specifically meets the needs of the marketer. For

example, a marketer gets a costly research study which explores how different age groups feel about

certain products within the marketer industry. Sadly, the marketer can find that the way work

separates age groups

 Not in time

Caution must be exercised when depending on secondary data which may well have been obtained

in the past. Out-of-date information can be of little value especially for companies operating in

rapidly changing markets

Records may be lacking in authenticity – parts of the document may be missing due to age, and we

may not even be verifying who actually wrote the document, which means we can not verify

whether it is biased or not.

Representativeness – documents can not represent the broader population – especially an problem

with older documents. Some records do not survive because they are not preserved, and some are

46
unusable and deteriorate with age. Scientists and the public are intentionally deprived of other

records and are thus not accessible

47
 Key results and Learning

It was great learning about this sector as it has many segments to study about the data and can

predict the growth as per the expenditure and response from the people.

Majority of the medical institutes that are located in urban and rural are difficult to access by village

population for advanced treatment benefits though rapid urbanization has made many changes in

the sector and has adapted lot of new trending technology but this leans towards heavy pricing for

the treatment and also due to ageing population and demographic changes that may also drive to

difficulties in the number of beds in hospitals.

The quality of medicine provided is very good in urban hospitals but poor testing capacities in

certain states.

Also, low capacity and skill gap within the regulatory system is delaying drug approvals and

individuals have to bear a huge cost of the disease and by the study cardiovascular diseases will

alone be responsible for 50 percent of the economic burden.

Through the course of study we can also observe that the low doctor count and also the number of

best doctors when compared to the other countries where in the count shows that there is only one

doctor per 1700 people and additional requirement is necessary in the coming years.

Also, had a better understanding on how health care sector impacts on the Indian economy and by

capitalizing on it our nation can bring a new change.

Many government policies which are available to the people in most of the states they are using it

widely but still many more policies can be made available.

The major gaps are high prices of medicines and quality control needs to be strengthened also

regulatory hurdles is hindering innovation.

48
Staffing of the AYUSH doctors at primary and the secondary level can strengthen healthcare

delivery practices and increase healthcare workforce in financial and non-monetary ways to work in

rural areas there are some of the human resource segment that they need to take care.

49
 Recommendations

 Need to incentivise the focus on additional of the growing new infrastructure and beds

 Steps to make easy the regulatory regime and tax incentives for private has to be laid out

clearly

 Steps required to supply free drugs and diagnostics need to be substantiated enough from a

supply chain perspective

 Plans and procedures to maintain the quality of healthcare facilities need to be revealed in

detailed manner

 Empowerment of nurses and paramedical staff is a short term plan and India needs a long

term plan to solve the human resource

 Restructuring of government insurance scheme to ensure smooth implementation of

transparent payment process players.

 Steps to improve staffing and that needs to be taken into priority.

50
 Conclusion

Health policy is crucial to a nation like India, which lags behind many important human

development metrics, thereby creating further obstacles for Indians to escape poverty and reach

relative prosperity. In this policy area, policymakers have a vital role to play, given the existence of

knowledge asymmetry and market failures. Debates and alternatives on health policy are currently

hampered by the lack of comparable data on spending on public health in India. The Na-tional

Health Accounts, India's most reliable source of knowledge about health spending is extremely rare.

The subsequent use of partial data sets on ex-expenditures for public health leads to policymaking

and the desirable health care.

Determining access to quality basic health care is a big concern that needs to be tackled as a matter

of urgency in order to provide financial support for low-income sectors of the population. Given a

substantial portion of the population resides in rural areas.

The country also needs to strengthen its low-cost drug delivery network, and the implementation of

many projects in this regard is a step in the right direction, and human capital development is also

an significant field, as there is a severe gap in supply and demand. Creating and upgrading the

existing health education systems in combination with the development of local health care

programs would fill the current gap and lead health care.

Social security, drug security, transparency and good governance are key areas that can transform

the health-care system in India. With proper government policies and active private sector

involvement, India will achieve its healthcare dream for all

References

51
http://www.prsindia.org/uploads/media/Draft_National_Bill.pdf. (n.d.).

https://ehealth.eletsonline.com/. (n.d.).

https://hhbc.in/healthcare-scenario-of-karnataka/. (n.d.).

https://knowledge.wharton.upenn.edu/article/technology-changing-health-care-india/. (n.d.).

https://techstory.in/. (n.d.).

https://www.expresshealthcare.in/. (n.d.).

https://www.indiahealth-exhibition.com/. (n.d.).

https://www.investindia.gov.in/sector/healthcare. (n.d.).

https://www.karnataka.com/govt/health. (n.d.).

https://www.ncbi.nlm.nih.gov/. (n.d.).

https://www.ncbi.nlm.nih.gov/pmc/articles. (n.d.).

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