Technopak Healthcare Outlook

healthcare

a q u a r t e r l y r e p o r t b y t e c h n o p a k VOLUME 6

tenindustry trends 2010

Contents

Overview 01 TREND 1Public-Private Partnership:Search for an Ingenious Model for India 02

TREND 2Single Speciality Delivery Models: Single Speciality to Single Procedural Hospitals 03

TREND 3Diagnostic Centres:Unbundling from theTraditional Setting 04

TREND 4Low-cost Healthcare Delivery Models:Increasing Penetration beyond the metros 05

TREND 5Healthcare System:Staying Connected to Your Patient 06

TREND 6Integrated Medicine:Leveraging the Inherent Strengths 07

TREND 7Technology Partnerships:Arresting the Rising Cost 08

TREND 8Operations Optimisation:Measuring and Rewarding Performance 09

TREND 9Patient Safety:A Renewed Focus 10

TREND 10Healthcare Design:Alternative Care Settings 11

About Technopak 13

©Technopak Advisors Pvt. Ltd.

‘Healthcare Outlook’, a feature is an effort by the Technopak Healthcare team to explore the dynamic changes that are occurring in the industry in India today.

We at Technopak understand the need for continuous and intensive assessment of the world’s largest service sector industry. With this report we intend to provide an insight of the key trends and underline the opportunities in this recession proof industry.

healthcare

1 A Peek into the Future of Healthcare: Trends for 2010 |

OverviewWe initiated providing informed insight into the healthcare market in India through our first ‘Health Outlook’ in 2007. Most of the earlier trends* that we predicted are shaping today’s healthcare industry in India.

Some of these trends will have a major impact in the healthcare marketplace in the future.

The coming decade will shape the future of the healthcare industry with innovations in technology, financing and delivery models. While hospitals will continue to be the mainstay of treatment for episodic acute care there, will be a fundamental shift in the nature, mode and means of delivery of care.

Advances in technology and medical research will make it possible to envision an entirely new health care system that provides more individualised care without necessarily increasing costs. Healthcare will become increasingly personalised with the development and delivery of new treatments tailor-made to patients’ needs as far as possible.

New financing schemes and partnership modes will be developed to make healthcare more accessible and affordable. This transformation is already evident and shall continue to grow.

The loss of national income due to premature deaths caused by heart disease, stroke and diabetes is estimated to be $236 billion over the next 10 years. Overall improvements in health and a 20 per cent reduction in Disability Adjusted Life Years (DALYs) over the next decade would translate into a gain of national income of over US$ 100 billion per year, 2020 onwards.

This edition continues to focus on and attract attention towards the newer trends, which range from innovative business models to logical integration possibilities.

Secondary Care Hospitals: Unleashing the new potential in smaller towns

Five year tax holiday has provided further impetus to the growth of hospitals outside the metros. Both existing & upcoming healthcare providers are already investing or announcing future plans for setting up secondary care hospitals in tier-II and tier-III cities.

Health Insurance: The changing scenario

Voluntary health insurance has seen a phenomenal growth over the past few years and is expected to grow further with the entry of new players and innovative products. The shift in the role of Government from delivery to the financing of care with launch of Rashtriya Swasthya Bima Yojana (RSBY) is expected to cover 60 million Below Poverty Line families by 2020

Corporatisation of Medical Education Corporate entities will be allowed in field of medical education in future to address huge shortage and improve quality of health workforce. This will lead to growth of Academic Medical Centers in India.

Med-polis : The emerging healthcare cities Health cities could change the way healthcare delivery, medical education, research and development is conducted in India. A growing number of players including Medanta, Narayana Hrudyalaya, Reliance, Care Hospitals are looking for set up health cities.

Standardization Adoption of clinical protocols and accreditation are in vogue. The Clinical Establishments Bill 2007 will give further impetus to this by registering all healthcare facilities.

Infusion of Private Equity Healthcare sector has emerged as one of the preferred sectors for investments by private equity and further growth is expected given the huge potential of the sector .

Trends Impacting Healthcare in India

*The 2007-2010 trends as detailed on page 57

2 | A Peek into the Future of Healthcare: Trends for 2010

trend 1Public-Private Partnership: Search for an Ingenious Model in India

Public-Private Partnership (PPP) models have proved to be a successful tool in the infrastructure sector like national highways, power, transport, airports and seaports. The Central and State Government is now increasingly pursuing this model to bridge the equity and accessibility gap prevalent in the country’s healthcare. PPPs would usher in private sector expertise along with efficiencies in operation and maintenance, thus leading to improved healthcare service delivery to the masses. PPP in healthcare delivery can facilitate the creation of new capacity as well as improve efficiency in the existing facilities. As of now, there is preponderance of non-institutional than institutional PPP. The emergence of epidemics like H1N1 swine flu, HIV, etc., also saw the Government recognising PPP engagements to combat the epidemics. However, it is imminent that such cooperation can extend far beyond national emergencies and public health provisions.

With the advent of national schemes like Rashtriya Swastya Bima Yojana (RSBY), the Government is increasingly taking on the role of insurer providing a substantial patient base for private providers. There seems to be a search for an ideal PPP model for healthcare, which continues to be elusive.

Key Success Factors for PPP

Political Commitment and enabling legislation •

Need for clear policy and legal framework for PPP•

A strong control mechanism to undertake efficient oversight and dispute resolution procedures•

Careful design of the contract with appropriate risk apportionment•

Defining an ‘acceptable rate of return’ for the private sector•

PPP Models

State PPP Model

Karnataka Karuna Trust; Yeshaswini Scheme

Tamil Nadu Mobile health services

Andhra Pradesh Aarogyasri

West Bengal Mobile health services

Madhya Pradesh Community outreach program

Rajasthan Contracting in public hospitals

Gujarat Chiranjeevi Project

Public–Private Partnership Options

Tlyp

e of

col

labo

ratio

nPo

ssib

le

Play

er

Organised Providers/Technology Providers

Physician Group PracticeOrganised Providers

Physician Group PracticeOrganised Providers/Technology Providers

Physician Group PracticeOrganised Providers/Technology Providers

NGO OrganizedProviders

Academic Medical Centre

The possible models could be joint ownership modelinvolving strategic partnership,both financial and technical or pure management model with no equity involvement

Multispecialty Hospital

The Government provides land, infrastructure atconcessional rates.

The private playerprovides medical services to people below poverty line (BPL) within the city and the region at subsidsed rates.

Single Specialty Hospital

The Government provides land, building and immovable.

The private player hires manpower, pays salaries and provides medical services.

District Hospital

Design, build and operate

In addition to the design, build and full operation of the hospital, the privateplayer can deliver all clinical services.

The Goverment pays annual fixed service payment for delivery of all services.

Primary Health Centre

Management contract

Private player/NGOundertaking the management and operation of PHC.

Goverment pays aportion of the running cost.


trend 2Single Speciality Delivery Models:Single Speciality to Single Procedural Hospitals

Single speciality hospitals are a small but rapidly growing genre among today’s hospitals in India. The growing number of speciality centres and hospitals signals a move towards maturity of the healthcare industry with an increasing complexity of business and consumer affordability.

What sets these hospitals apart is their focus on one single speciality or service line. Whether it is high-end disciplines such as oncology or neighbourhood specialities such as ophthalmology and day-care surgery, they are growing by sticking to their core strength. While there have always been stand-alone speciality clinics or hospitals run by doctors, these providers are moving towards corporate set-up offering the same precision of quality care in multiple locations.

Speciality hospital formats range from low-risk speciality including eye care, dermatology, mother and child to high-end speciality including cardiology, cancer and transplant medicine. The mid-level specialities are offered in a multi speciality hospital format. The low-risk speciality models require low capital expenditure and have comparatively low operating costs as in-patient stay is rarely required for day procedures. This minimises the need for support infrastructure and offers easy replication. Consumers expect convenience and are not willing to travel too far for such speciality services.

On the other hand, high-risk speciality models require a high level of expertise, capital investment and operating cost due to the complexity of procedures and specialised equipment.

These speciality centres have been spurred by rising affordability and healthcare awareness. Currently, speciality centres are operating in mature markets and there is a huge opportunity to offer such services in tier-II and tier-III cities. The speciality models have become favourite investment options for private equity firms. In future, the single speciality hospitals will transition into single procedural hospitals - such as Shouldice Hospital, Canada - that focus on conducting surgeries only for abdominal hernias.

Cost efficiency due to higher volumes •

Provide higher quality care due to greater specialization•

Easily attract human resource•

Economies of scale and scope •

Ease of operation•

Increase consumer satisfaction•

Competitive pricing and increased choice for consumer•

Advantages of Single Speciality Models

18% Women & Children(INR 40,500)

INR Crore

Total Healthcare Delivery Market: INR 205,000 Crore

17%

9%

3%

53%

Cardiology (INR 38,250)

Oncology (INR 20,250)

Ophthalmology( INR 6,750)Others (INR 119,250)

Future

2000

Single Procedral Hospital

Speciality centre

1980Tertiary Care Hospital

1950MultispecialityHospital

1900Teaching Hospital

1500 - 1800 AD

100BC- 500 AD

400 - 100 BC General Hospital &Nursing Homes

Military & Slave Hospital

Religious InpatientHomes

Evolution of Hospitals Break-up of Speciality-wise Market


Traditionally, diagnostic centres have been part of hospitals and physician offices. The marketplace is evolving, with diagnostic centres operating as stand-alone entities. In the future, diagnostic services will be offered at retail outlets, pharmacies and at home (personalised testing).

Diagnostic test results impact more than 70 per cent of healthcare decisions and thus form an essential element in the delivery of healthcare services. Physicians use lab tests and radiology procedures to assist in the diagnosis, evaluation, monitoring and treatment of medical conditions.

The Indian market for diagnostics is worth US$ 2 billion, and constitutes 4 per cent of the overall healthcare delivery market. Currently the marketplace has several hundred smaller players with a handful of organised players who have a good presence in the metros. Unfortunately, the good quality diagnostic services are inaccessible in rural areas. Despite current business challenges, the diagnostic marketplace will continue to grow due to some of the key trends, such as:

The growing and ageing population will increase demand for diagnostics testing. •

Continuing research and development in area of genomics is expected to yield new and specialised tests. These •advances are spurring interest in and demand for personalised medicine which relies on diagnostic and prognostic testing.

Consumers and insurers increasingly recognise the value of diagnostics as a means to improve health and reduce the •overall cost of healthcare through early detection and prevention.

Organised players offer consumers increasing convenience and access to quality diagnostic services.•

Point-of-care testing will enable solutions that improve care to the patients by enabling faster diagnosis and •treatment.

There are new opportunities arising in infectious disease testing, molecular oncology and pharmacogenomics.•

Diagnostic Centers: Services

PathologyHaematologyBiochemistry

Microbiology & Infectious DiseasesHistopathology

Immunology & Radio ImmunoassayGene Testing

Radiology & ImagingPET CT

MRICT

UltrasoundMammography

X Ray

Speciality DiagnosticsCardiologyNeurologyOncology

(Services offered based on

local market needs)

Growth of Diagnostic Market in IndiaDiagnostic Centres: Moving Closer to the Patient

0

10,000

20,000

40,000

60,000

9,00022,500

54,000CAGR 20%

2010 2015 2020

INR Crore

Hospital & physician office labs

Stand alone labs &diagnostic centers

Retail outlet pharmacytesting centers

Home based testingpoint of care testing

trend 3Diagnostic Centres: Unbundling from the Traditional Setting


Over the years, most healthcare models were developed keeping in mind the metro markets. But now, metros with developed healthcare infrastructure and rising competition have reached a saturation level serving a certain socio-economic segment of the population. The healthcare providers have now started realising that they cannot serve all segments of population through high-cost structures. To serve different consumer segments such as lower middle income, urban poor and rural population, they need to develop low-cost healthcare delivery models. Low capital intensive models will ensure viability of the project and expand the healthcare providers’ reach in different geographies and consumer segments. There are some hotel brands such as Taj that are operating luxury as well as budget hotels (Ginger), thus serving different consumer segments with appropriate services.

There is much that can be done to reduce healthcare costs without reducing the quality of care. To reduce initial capital cost for setting up low-cost healthcare facilities, land can be bought on the outskirts rather than in the centre of town. The overall built-up area per bed can be reduced to reduce per-bed cost. Similarly, rather than buying the latest medical equipment, appropriate technology needs to be deployed. Usage of good quality indigenous medical equipments can be promoted. Also, outsourcing or third party arrangements can be evaluated for diagnostic and other support services. Air-conditioning can be considered just for special rooms and areas instead of full building air-conditioning solutions.

The low-cost models will have a lower cost of operation. The tariff for the services will be low as compared to that offered in high cost hospitals. Initially, such models will feature in secondary care space and later graduate to tertiary care speciality and super speciality based on local market needs.

Lower capital and operation costs will translate into tariffs which are affordable for all segments of the population.

Secondary care with basic and a few super specialties•

100 beds•

15-20 ICU beds•

3-4 operation theatres•

Endoscopy •

Health check-up services•

Lab, radiology and blood bank services•

Fully equipped ambulance services•

Low-cost Secondary Care Hospital Services

Parameters Current Secondary Care 100-bed Hospital

Low-cost Secondary Care 100-bed Hospital Remarks

Floor space per bed (sq. ft.)

1,000 - 1,200 700 - 800 Optimising space allocation without compromising on functionality

Building cost (Rs. /sq.ft)

3000-3500 2000-2400Reducing building cost by value engineering, choice of material cost based on project vision and model

Equipment cost (INR lakhs /bed)

20-25 10-15Reducing equipment cost by deploying appropriate technology in diagnostic and laboratory services. Further reduction can be brought about by group purchasing and outsourcing of certain services.

Total cost (INR lakhs /bed)

50-60 25-30

Reinventing the Value Chain: Low-cost Models

trend 4Low-cost Healthcare Delivery Models: Increasing Penetration beyond the metros


Traditionally, healthcare providers have been offering in-patient services in the geographies they serve. With the evolving healthcare marketplace, major organised healthcare providers operating in tertiary care space are diversifying apart from their core hospital business to include retail pharmacies, clinics and other services to serve patients better and to achieve economies of scale. With increasing accessibility to insurance and rising consumer awareness, healthcare providers will offer the entire gamut of services across the value chain, including primary, secondary and tertiary services to attract patients into the healthcare system right from the entry point.

Characteristics of the Healthcare System

Develop integrated healthcare delivery model around core •‘hospital’ business

Offer a broad spectrum of services across the value chain in the •most cost-effective manner

The hospitals have high volume specialty services•

Out-patient services are an integral component of the healthcare •system to increase attractiveness to patients

Ability to negotiate service contracts with purchasers of group •health care services

Implement advanced health information technology to improve •the quality and convenience of services

Achieve price efficiencies through group purchasing•

Build cost savings by sharing of support and other services•

Hospital Corporation of America, US

166 hospitals including 160 general acute care hospitals, 5 •psychiatric hospitals, 1 rehabilitation hospital

104 free-standing ambulatory surgery centres •

49 free-standing diagnostic treatment facilities, and 74 provider-•based imaging facilities

Comprehensive rehabilitation and physical therapy centres•

Netcare, South Africa

120 hospitals•

Primary care community care centres offering GPs, dental, •pharma, pathology and imaging services

120 retail pharmacy outlets•

Diagnostics: 6 main laboratories, 215 collection centre depots •and 120 radiology centres

Ancillary Healthcare Business: 41 dialysis centres, 14 travel •clinics, 7 radiotherapy/oncology centres, emergency medical services

Leading Healthcare Networks

Components of the Healthcare System

Common IT Infrastructure and Services

Sharing of Support Services, Group Purchasing

Emergency Services

Day CareSurgeryCentres

Pharmacies

DiagnosticServicesHospitals

As

Core Services

SpecialityServices

trend 5Healthcare System:Staying Connected to Your Patient


Integrated medicine is a new paradigm in health care that focuses on the synergy and deployment of the best aspects of diverse systems of medicine including modern medicine, Homeopathy, Siddha, Unani, Yoga and Naturopathy in the best interest of the patients and the community.

The increasing public demand for traditional medicine use has led to considerable interest among policy-makers, health administrators and medical doctors on the possibilities of bringing together traditional and modern medicine. The integration of traditional medicine with modern medicine may mean the incorporation of traditional medicine into the general health service system. The purpose of integrated medicine is not simply to yield a better understanding of differing practices, but primarily to promote the best care for patients by intelligently selecting the best route to health and wellness.

Surveys and other sources of evidence indicate that traditional medical practices are frequently utilised in the management of chronic diseases. Traditional medicine presents a low-cost alternative for rural and semi-urban areas where modern medicine is inaccessible.

An approach to harmonising activities between modern and traditional medicine will promote a clearer understanding of the strengths and weaknesses of each, and encourage the provision of the best therapeutic option for patients.

Yoga & Naturopathy (INR 500)

4%

71%

18%

7%

Unani & Siddha (INR 1,000 )

Homeopathy (INR 2,500 )Ayurveda (INR 10,000 )

INR Crore

Components of Integrated Medicine Market Size of Integrated Medicine

Modern Medicine

Ayurveda

Unani &Siddha

Yoga & Naturopathy

Homeopathy

Widest array of options available to patients(One in three adults in the United •States used at least one complementary or alternative medical therapy (CAM))

Provides an opportunity to combine the ‘best’ of both conventional medicine •and complementary alternative medicine.

Provides cost-effective treatment options•

Results in better patient outcomes, measured in terms of symptom relief, •functional status and patient satisfaction

Focus on holistic health and well-being•

The hospital was founded on the principles of patient-centred care and evidence-•based medicine. The patient is provided with evaluations that are holistic and involve a conference of five on-site experts: Medical Doctors (MD) specialising in internal and preventive medicine, a Nurse Practitioner, and two Naturopathic Physicians with expertise in a wide array of natural, complementary and alternative therapies.

Treatment approaches available at the IMC include internal medicine, naturopathic •medicine, preventive medicine, nutritional counselling, nutritional supplements, nutriceuticals, herbal medicine, acupuncture, craniosacral therapy, therapeutic touch, homeopathy, intravenous micronutrients, relaxation therapies, as well as referrals to counselors, trauma therapists (EMDR), and chiropractors.

Integrated Medicine: A Balanced ApproachIntegrative Medicine Centre at Griffin

Hospital, Connecticut USA

trend 6Integrated Medicine: Leveraging the Inherent Strengths


Technology is seen as one of the three important drivers of increasing healthcare accessibility. Selection and adoption of appropriate technology often makes a critical difference in the success of a healthcare project. It has the capability to revolutionise the way healthcare is delivered.

However adopting and implementing technology in healthcare forms a significant area of cost. It is estimated that almost 30–40 per cent of the project cost is allocated to medical technology and information technology. Therefore it is imperative to devise ways to rationalise this cost by adopting some innovative methods.

Top medical technology companies like GE, Philips and Siemens-in their effort to lower the costs of care and improve the quality of outcomes-have been using innovation as their main tool. These companies have come up with a slew of products endeavouring to bring down cost while upgrading the level of technology. For example, the Active Technology Partnership (ATP) initiative of GE enables the provider to control their equipment budget over a long period of time while managing technology obsolescence through planned equipment renewals.

Reducing the cost of medical technology research and •development

Encouraging indigenous production of medical devices•

Devising innovative ways of dealing with obsolescence•

Testing the new and upcoming business models of technology •services

Novel Ways to Rationalise Technology Cost

Innovative Options in Healthcare Technology

Company Model Differentiating Factor

Health Hiway

Pay-per-use Model

Software As A service (SaaS) model wherein the vendor sets up an IT infrastructure in hospitals, looks after the complete maintenance, training and effective implementation of the modules and the provider has to pay some annual fee only for the required modules within the hospital.

The model allows easy adoption of technology and helps •save on the cost of further development and upgrading of solutions.

Innovative pricing mechanisms based on a subscription •model .

YOS Technologies

Pay-per-use Model

Provides record management and hospital management software to hospitals along with value-added services like smart cards and patient portal.

Smart card issued by the hospital acts as Hospital ID card •which stores patient health information, eliminating the need to carry bulky medical files.

The card is also linked to the record management and •hospital management software of YOS, enabling ready retrieval of required records and thus reducing patient wait time.

GE

Active TechnologyPartnership Solution

The ATP program is individually tailored to the hospital needs, both at an organisational and departmental level.

Enables the provider to control their equipment budget •over a long period of time while managing technology obsolescence through planned equipment renewals.

trend 7Technology Partnerships: Arresting the Rising Cost


Healthcare providers and administrators today are under constant pressure to meet the ever-increasing customer expectation and stay ahead in the competitive race. Operations optimisation in hospitals can enable to provide world-class services with a finite set of resources and can significantly impact competitive strengths, enhancing the business performance of the organisation.

By definition, operations optimisation relates to appropriate workforce management, quality management, planning and control, sound clinical processes and outcome performance.

Although many healthcare providers rely mainly on technology to optimise service delivery, it is largely felt that automated support can only help the organisation to a certain level of process management. The key to any real improvement lies with better understanding of process workflow and tackling the bottlenecks. While staff performance also plays a very important role, it is process design and management-or lack of it-that needs to be tackled on a priority basis.

Introducing and implementing operations optimisation techniques is a complex and time-consuming procedure. However, the associated benefits of operations optimisation far outweigh the difficulties. There are reports of a number of benefits associated with the introduction of techniques like queuing, clinical pathways, standard operating protocol and integrated care pathways. These include reduction in the length of stay in hospital, reduction of costs in patient care, improved patient outcome, improved quality of life, reduced complications, increased patient satisfaction with service, improved communication between staff, and reduction in time spent by health staff on paperwork.

Service Quality Clinical Outcomes Commercials

Shorter waiting time

Increased patient satisfaction

Lower ALOS

Reduction in the trend of re-admission

Increased sales and revenue

Performance Parameters

Variability methodology•

Queuing theory•

Scheduling and forecasting•

Simulation modeling•

DMAIC (Define, Measure, Analyse, Improve, Control)•

Tools for Operations Optimisation in Hospitals

30%20%

40%

53%

Increase in medicine

availability at customer end

Increase in OPD pharmacy

revenue

Savings ininventory

Reduction in lead time

Note: Results representative from Indian Hospitals

Benefit Analysis of Operations Optimization

trend 8Operations Optimisation: Measuring and Rewarding Performance


Patient safety is a serious issue. Estimates show that in developed countries as many as one in 10 patients is harmed while receiving hospital care. In developing countries, the probability of patients being harmed in hospitals is higher than in industrialized nations. At any given time, 1.4 million people worldwide suffer from infections acquired in hospitals. Every year, tens of millions of patients worldwide suffer disabling injuries or death due to unsafe medical care.

The Joint Commission established its National Patient Safety Goals program in 2003 to help healthcare organizations to improve patient safety.

The 2010 Hospital National Patient Safety Goals are:

Identify patients correctly. •

Improve staff communication •

Use medicines safely •

Prevent infection •

Check patient medicines •

Identify patient safety risks •

The first step towards achieving these safety goals would be imbibing and crystallising a culture of safety within the organisation. Encouraging an open and non-punitive environment goes a long way in enhancing patient safety. The Indian healthcare industry, too, is moving towards acquiring patient safety goals.

Estimates of as many as 44,000 to 98,000 people die in •US hospitals each year as the result of problems in patient safety.

Every hour, 10 Americans die in a hospital due to avoidable •errors; another 50 are disabled.

Implementing computer physician order entry•

Having full-time doctors and nurses certified in critical care•

Implementing a patient safety compliance checklist•

Encouraging adverse event reporting•

Robust infection control mechanism•

Patient Safety FactsWhat Steps Can a Hospital Take to

Improve Patient Safety?

Source: To Err is Human: Building a Safer Health System, Institute of Medicine report, 1999.

WHO’s Proposed High 5s Project to Facilitate Implementation and Evaluation of Standardised Patient Safety Solutions

Managing Concentrated Injectable Medicines

Assuring Medication Accuracy at Transitions in Care

Communication During Patient Care Handovers

Improved Hand Hygiene to Prevent Health Care-Associated Infections

Performance of Correct Procedure at Correct Body

Site

trend 9Patient Safety: A Renewed Focus


Healthcare design has undergone an incredible change over the last few years. The emergence of ambulatory care services has transformed the way healthcare facilities are programmed and configured. Due to faster procedures and fewer in-patient stays, ambulatory care centres are able to deliver care in less intensive settings, covering a wide range of health care services for patients who do not need to be admitted overnight.

Some design implications for ambulatory care centres are:

Need to emphasize more on providing structured spaces along with aesthetic appeal to achieve efficiency in design.•

Reduced travel time and distance between clinical areas and offices results in cost-effectiveness and better services.•

Standardisation of spaces such as the operating rooms, recovery and treatment rooms helps achieve functional •efficiency.

These facilities have more potential to incorporate natural light and ventilation due to factors such as narrower floor •plates.

A single service core surrounded by operating/treatment/recovery rooms reduces the amount of equipment required •for individual units.

The ambulatory care hospitals are intended to serve patients who have not undergone complex surgeries and are able to walk; nevertheless facilities must incorporate measures for handicapped and patients under slight sedation.

Larger number of units of care at significantly lower cost •per unit

Faster construction•

Less complicated planning•

Improved quality of care•

Cosmetic and facial surgery centres•

Endoscopy centres•

Ophthalmology practices•

Laser eye surgery centres•

Centres for oral and maxillofacial surgery•

Advantages of Ambulatory Care Settings Ambulatory Surgery Centres

Parameter Ambulatory Care Hospital In-patient Hospital

Space Requirement* 40,000–60,000 sq. ft(typical size of facility)

100,000 sq. ft (100-bed facility)

Standardisation of space Works more effectively Less efficient due to specific individual requirements

Need for support infrastructure Reduced requirement for facilities such as dietary and linen Full support services required

Space Implications: Ambulatory Vs. In-patient Environment

*The size of a typical and well designed ambulatory care facility is significantly less than that of an inpatient hospital for similar patient volumes/ workloads.

trend 10Healthcare Design: Alternative Care Settings


Typical Patient Flow in Surgical Ambulatory Care Setting

Reception Registration

Waiting

Consents Lab WorkAnesthetic Assessmment

Change(Accompanied By Relative)

Patient to Prep/Hold(Relative to Surgical Waiting)

Day Care Bed(Relative joins)

Special Procedure

Endoscopy

Operating Room

Post-OPRecovery

Discharge Follow up Scheduling

Follow up OP Visits

Nurse Station

2007 2008 2009 2010

The private sector takes the lead Academic Medical Centres: Delivering excellence in care, education & research

Public–Private Partnerships: The current imperative

Public–Private Partnership: Search for an ingenious model for India

Health Insurance: Increasing accessibility

Healthcare Consumerism in India: Rising awareness and spend

Corporatisation of Medical Education:The impact

Single Speciality Delivery Models: Speciality to Single Procedural Hospitals

Standardisation: Need for uniformity Newer Formats of Healthcare Delivery: Taking healthcare closer to the consumer

Medpolis: The emerging healthcare cities

Diagnostic Centres: Unbundling from the traditional setting

The Empowered Indian Patient Healthcare REITS: Addressing the real-estate challenge

Secondary Care Hospitals: Unleashing the potential in smaller towns

Low-cost Healthcare Delivery Models: Increasing penetration beyond the metros

Manpower: Reversing the brain drain Private Equity: The race for value deals Designing Cost-effective Infrastructure: A green approach

Healthcare System: Staying connected to your patient

Technology Takes Centrestage Clinical Trials: Making inroads Newer Partnerships: Catalysing growth of healthcare delivery

Integrated Medicine: Leveraging the Inherent Strengths

Public–Private Partnership: The way ahead

Emergency Evacuation Services: Building a network for India

Appropriate Technology: Optimising healthcare delivery

Technology Partnerships: Arresting the rising cost

Medical Value Travel: Hype and reality Healthcare Architecture: The business of design

Lean Thinking: Improving the bottom line

Operations Optimisation: Measuring and rewarding performance

Special Economic Zones Healthcare Outsourcing: Providers focus on their core competence

Clinical Protocols : Standardizing care Patient Safety: A renewed focus

Infusion of Private Equity Medical Device Innovation : Involving providers and physicians

Health Insurance: The changing scenario

Healthcare Design: Alternative care settings

Ten Trends 2007–2010

The India Healthcare Trends 2008, the first primary study report on the healthcare Industry received an overwhelming response from all the stakeholders of the sector. In continuation of the same, Technopak has started work on the second report, India Healthcare Trends 2010, which would give a far greater insight about the industry.

With abundant opportunities for businessmen, equipment makers and service providers to invest in curative and preventive services and possibilities of investing in medical infrastructure and medical tourism, it becomes imperative for providers to get a feel of what's happening in the industry to make informed decisions on investment options.

The Report will be a primary analysis of the Providers (Hospitals, Physicians), Consumers, Healthcare Insurance Companies and Private Equity.

The study covers all the regions of the country to present a comprehensive picture of the Healthcare.

The pan India study endeavors to bring forth the opportunities and the roadblocks which prevent in realizing those opportunities.

Current Status of Healthcare Sector in IndiaInvestment patterns in the sector

The best cities to invest in for Healthcare

Healthcare Provider Study

Tier wise and zone wise analysis of healthcare providers on various operational factors

Best hospital formats to invest in

Hospital ArchitectureHospital planning and its effects on functional ity and costs

Healthcare Consumer StudyHealthcare Consumer Survey and Analysis, Health Seeking behavior, Expenditure on various components of Healthcare

The Opportunities in Medical, Nursing and Allied Education

Key HighlightsOne-of-its-kind report with primary survey data from a cross-section of sources including Consumers, Physicians, Hospitals.

Identification of opportunities in Healthcare Infrastructure, financially & geographically, manpower requirements & opportunities.

Identification of the allied businesses' role and their individual market share, the future dynamics of healthcare delivery.

Tracking the business modules of physicians, their outlook on future practices, and how they gear up to face the challenge posed by organised healthcare sector.

Consumer insights: Current behavior and practices in the household, decision making process on physicians, hospitals, perceptions on current options and satisfaction levels

2010

For more information and suggestions; please feel free to [email protected]

About Technopak

A leading Management Consulting firm offering strategic advice, start up assistance, performance enhancement impetus, consumer insights and capital advisory, to leading Indian and International

companies, operating in Retail, Food and Agriculture, Consumer Products, Fashion (Textiles & Apparel), Healthcare, Hospitality, Education, Entertainment and Real Estate sectors

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•CorporateStrategy•OrganicGrowthStrategy•GrowththroughPartnershipsandJVs•ValueBasedManagement

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•Organisation Effectiveness•ProductivityEnhancement•SupplyChainImprovement•CostandCapitalEfficiency•SourcingbaseEffectiveness

Consumer InsightsHolistic consumer understanding applied to offer implementable business solutions

•ShopperInsights•TrendInsights•DesignandInnovationInsights

Start-Up Assistance Leveraging operations & industry expertise to ‘commission’ the ‘concept’ on a turnkey basis

•Design and Build Start-up Organisation•AssistinInstallingBusinessInfrastructure•DevelopandImplementBusinessProcesses

Capital AdvisorySupporting business strategy and execution with comprehensive capital advisory in our industries of focus

•M&A•DueDiligence–commercial&financial•FundRaising•CorporateFinance

Services We Offer

Healthcare Segments We Serve

The Healthcare Practice is uniquely positioned to advice clients based on its expertise in the Indian scenario, insight into consumer behaviour in India and its access to the best international practices. The Healthcare Practice provides the whole gamut of services from concept to commissioning for the healthcare delivery chain.

•HealthcareProviders- Network Hospital Systems- Tertiary Care - Centers of Excellence- Charitable Trust Hospitals- Academic Medical Centers- Ambulatory Care Centers- Boutique Healthcare Centers

•SEZsandMedi-Cities

•Payors/HealthInsurers

•GovernmentOrganizations

•NGO’s/FundingAgencies

•International,PrivateandPublicSectorBanks

•PrivateEquity/VentureCapitalFunds

•TransactionAdvisorsforPPP

healthcare

Head Office4th Floor, Tower A, Building 8, DLF Cyber City, Phase II,Gurgaon 122 002, (National Capital Region of Delhi)T: +91-124-454 1111, F: +91-124-454 1199

BangalorePrestige Solitaire, Ground Floor, 6 Brunton Road,Off MG Road, Bangalore 560 025T: +91-80-4034 8600, F: +91-80-4034 869

Mumbai101-105, 2nd Floor, Sunjana Tower,Sun Magnetica Service Road,Luis Wadi, Thane West,Mumbai 400 602T: +91-22-2583 2222, F: +91-22-2583 8408

www.technopak.com

Dr. Rana MehtaVice President, [email protected]

Gulshan BawejaAssociate Director, [email protected]

Monika KejriwalAssociate Director, [email protected]

Abhishek Pratap SinghAssociate Director, [email protected]

Ritika AroraSenior Consultant, [email protected]

Akanksha AkhauriConsultant, [email protected]

Documents

Technopak Healthcare Outlook