HR CHALLENGES IN HEALTHCARE DR NAGENDRA SWAMY PRESIDENT MANPAL HEALTH ENTERPRISES

CHALLENGES & OPPORTUNITIES-HEALTHCARE IN INDIA

• 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

Healthcare Snapshot

Total Healthcare Market SizeUS $ 21.3 billion

PharmaceuticalsUS $ 4.15 billion

Healthcare ServicesUS $ 17.15 billion

Hospitals Services & Practioners: US $ 13.10 billion

Medical Eqpnts & ConsumablesUS $ 1.35 billion

Medical SoftwareUS $ 1.45 billion

Medical InsuranceUS $ 82.90 million

Healthcare ConsultancyUS $ 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

SUMMARY: INDIAN HEALTHCARE MARKET

• 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.

SUMMARY: INDIAN HEALTHCARE MARKET

• 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 2nd 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

100000

200000

300000

Value of Healthcare Market

2005 2009 2012*

Figures in Rs crore

* ProjectedSource: Healthcare services in India:2012, the path ahead. ASSOCHAM-YES Bank, 2009; McKinsey 2007

CHANGING – DISEASE PROFILE

Expected to Decrease• Lower Respiratory Tract

Infection• Diarrhea diseases• Perinatal Conditions• Measles• Malaria• PEM• Anemia

Expected to Increase

• I.H.D• COPD• CVA• Diabetes• Cancer• Road Traffic Accident• HIV• Psychiatric Conditions

Transition from Infectious & Nutritional Diseases to Chronic &

Lifestyle related diseases

Source: www.cia.gov - Fact Book UK /USA 2007

CHANGING – DISEASE PROFILEUSD 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

MARKET REALITY

• 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

MANPOWER GAP

HEALTHCARE TODAY

Industrial Age Medicine to

Information Age Medicine

UNIQUE CHALLENGES OF HEALTHCARE ( HOSPITALS)

Healthcare Today

Telemedicine

Quality

Cost

Health Tourism

Reach

Technological Advancements

Cures

Super Specialty

Complex

ExpenseCommercialization

Patient Friendliness

Anxiety

Compassion

Hope

Managed Care

Continuum of Care

Emotions & Feelings

Ego

Healing

Labor intensive

Family & Friends

HEALTH CARE TODAY(Spectrum of Skill Sets Involved in Service Delivery)

PATIENT / RELATIVES

LOW•Socio-Economic Status•Education Levels•Intellectual Capability

MEDIUM•Socio-Economic Status•Education Levels•Intellectual Capability

HIGH•Socio-Economic Status•Education Levels•Intellectual Capability

LOW•Socio-Economic Status•Education Levels•Intellectual Capability

MEDIUM•Socio-Economic Status•Education Levels•Intellectual Capability

HIGH•Socio-Economic Status•Education Levels•Intellectual Capability

Attendants

Security Staff

Housekeeping

Lift Operators

Canteen

Room Boys

Counselors Receptionist

Technicians OT Staff

OPD Secretaries Dietician

Pt. Care Coordinators Admissions

Admin Manager Nursing

Pharmacist PRO Cashier

Super Specialist

Primary Physician

Anesthetist

Radiologist

Physiotherapist

Jr. Doctors

Sr. Management

Healthcare Organization

Complex interaction

CHANGING TRENDS

Sub Specialist

Patients Customers Guests Blood Relatives

Hospitals Hospitality Homely Care

ProfessionGeneralist Specialist Super specialists

Transformation of Patients’ Status,Hospitals’ Attitude and Doctors’ Profession

CHANGING EGO LEVELS

Anatomy handledEg

o L

evel

s o

f H

ealt

h P

rofe

ssio

nal

s

Ego Levels vs. Criticality of Organs

CHANGING TRENDS-BEHAVIORAL

• 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

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 competenciesPatient centred carePartneringQuality improvementInformation and communication technologyPublic health perspective

PREPARING THE 21ST CENTURY GLOBAL HEALTHCARE WORKFORCE

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

FEW DAUNTING CHALLENGES

• 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.

THE REAL CHALLENGE IS ……..

Managing

Diversity

MHB – Awards and Accolades

NABH

Ranked 1st in Bangalore for the 7th consecutive year by ‘The Week’ among ‘India’s Best Hospitals’

2004

20072008

20062005

Recognition & Awards

20092010

Sources: McKinsey report – Technopark- E&Y – KPMG- WHO-Cygnus -ASSOCHAM-YES Bank-MOH-

CRIS-INFAC-IRDA-HOSMAC-NIPER- Netscribe-FIICI

THANK YOU VERY MUCH FOR YOUR

PATIENCE - Dr Nagendra Swamy