Healthcare Sector Final Copy

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Hospitals & HealthCare

INDEX

TOPICS Pg. Nos.

1. Introduction To Hospitals 3.

2. Health Care Sector - Analysis 5.

3. Medical & Health Care Service 6.

4. Pest Analysis

Political 7.

Economical 8.

Social 9.

Technological 10.

Global 12.

5. Accreditation of Hospitals 14.

6. Models of Accreditation 16.

7. SWOT Analysis

Strength 18.

Weakness 19.

Opportunities 21.

Upcoming Trends 22.

Threats 25.

8. Types Of Hospitals 26.9. Segmentation 29.

Marketing Mix

10. Product

31.

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Product Mix 33.

Flower of Service 35.

TOPICS Pg. Nos.

Quality Dimensions 41.

11. Place

44.

12. Price

46.

13. Promotion

55.

14. People

67.

15. Physical Evidence

70.

16. Process

72.

Blue Printing 74.

Service Encounter 78.

Fish Bone 80.

Service Recovery 83.

17. Future Prediction & Analysis

85.

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18. Wellness Industry

89.

INTRODUCTION TO HOSPITALS

Until the early 1980s, Government-run hospitals and those operated by

charitable organizations were the main providers of subsidized healthcare.

However, the last two decades have seen the mushrooming of corporate

and privately run hospitals.

The corporate hospital sector is most evolved in the south while

charitable/trust hospitals proliferate in the west. However, the north and east

are also showing a growing trend in private hospital expansion.

Previously hospitals were set up as charitable institutions to take care of the

sick and the poor. Today its a place of diagnosis and treatment of human ills,

for the training research, promoting health care activities and to some extenta center helping biosocial research.

World Health Organization (WHO) states that hospitals are socio-medical

organization whose functions are:

Curative,

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Preventive,

Patient services and

Training of health workers in biosocial research.

Indias healthcare sector has made impressive strides in recent years. With

time the classes and quality of hospitals have changed a lot today. Most

hospitals today are trying to provide all ultra facilities and are in the

process of making state of the art hospitals . Hospitals provide the

infrastructure facility to healthcare. Earlier hospitals were thinking inline of

prolonging the duration of patients stay. Nowadays they are going for a

higher patient turnover ratio.

A hospital offers considerable advantages to both patient and society. A

number of health problems require intensive medical treatment and personal

care, which normally cant be available in a patients home or in the clinic of

the doctor. This is possible only in a hospital where a large number of

professionally and technically skilled people apply their knowledge and skill

with the help of world-class expertise, advanced sophisticated equipment and

appliances.

The excellence of hospital services depends on how well the human and

material resources are utilized to promote patient care. The hospital is not an

entity in itself. Today, the hospital is a place for the diagnosis and treatment of

human ills and restoration of health and well being of temporarily deprived

patients. The first and the foremost function of a hospital is to give proper care

to the sick and injured without having social, economic and racial

discrimination.

However, the hospitals must perform many more things in addition to the

patient care. The education and training of doctors and nurses, support tomedical research and assistance to all activities carried out by public health

and voluntary agencies to prevent diseases and further to promote health

attitude are some of the important services of modern hospitals.

The essential function of the hospital in the Indian context is to cater to very

large masses of people by providing comfortable conditions for various users.

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This necessitates creation of a system which encompasses patients, doctors

and nurses in a synergetic totality. The applications of marketing strategies

insist on the development of product or services of the hospitals against the

background of changing environmental conditions. Hospital planning in theIndian condition reflects requirements and comforts of Indian masses. The

marketing management of hospitals diverts ones attention on the planning

and development of the product in the Indian environment.

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THE HEALTHCARE SECTOR: AN ANALYSIS

Healthcare is one of the most essential services in any growing society.Propelled by an affluent and health conscious growing middle-class, the

healthcare industry in India grew by more than 13 per cent per annum in the

last decade. Indias healthcare industry is estimated at Rs 1,500 billion or

US$ 34 billion. This works out to US$ 34 per capita which is 6 per cent of

GDP.

Healthcare statistics state that India has:

5,03,900 doctors

7,37,000 nurses

162 medical colleges

143 pharmacy colleges

3,50,000 chemists

15,097 hospitals accounting for 8,70,161 hospital beds

There is an extensive three-tiered government healthcare infrastructurecomprising of:

23,000 Primary Health Centres(PHC)

1,37,000 sub-centres (serving the semi-urban and rural areas)

3000 Community Health Centres(CHC)

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MEDICAL & HEALTHCARE SERVICE

There are four types of health-care facilities: primary health centers and ruralhospitals, government hospitals, private hospitals, and teaching institutions.

The central and the state governments are major players in this sector,

running hospitals, nursing homes, medical/nursing/paramedical colleges and

medical insurance. A large majority of the population, particularly in rural and

semi urban areas, receives free or highly subsidized treatment in such

hospitals and health care centres.

Private sector investment in the sector was opened up in 1983, to bridge the

huge gap between demand and government-owned healthcare services. Since

then, the private sector has grown significantly and presently accounts for Rs

690 billion, nearly 80% of healthcare expenditure. There are almost 9500

private hospitals and nursing homes in India, majority of them located in

major cities, some of them equipped for providing the most modern state-of-

the-art technology and equipment. However, more than 30% of the national

bed strength is concentrated in 150-odd corporate hospitals. Important names

in the private sector are Escorts, Apollo Hospitals, Max Health Centre, Fortis,

and Wockhardt; several foreign healthcare chains have technical/financial tie-

ups with Indian private healthcare chains.

The health care services (excluding pharmaceuticals) market is estimated to

be growing at the rate of around 16 percent annually.

There are certain industries that directly affect and are directly affected the

status of healthcare in the region.

They may include:

1. Technology and Equipment2. Drugs and Pharmaceuticals

3. Diagnostic laboratories

Medical Insurance

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PEST ANALYSIS

POLITICAL FACTORS

The Government of India places top priority to healthcare in the

national agenda. It is very serious about encouraging indigenous

R&D and creation of human capital. The imminent changes in

Indian laws and procedures relating to recognition of

intellectual property and foreign investments will allow global

pharmaceutical and biotechnology companies to set up partnerships

with Indian counterparts.

With the second largest population in the world and a high

incidence of disease , healthcare is being accorded priority by the

Government of India and individual state governments.

A study of Government Public Health expenditure (Government,

both Central & State - spending on healthcare is 1.7% of GDP)

reveals that only 16% is allocated to primary care and 84% is

allocated to secondary & tertiary care.

Last year, the finance minister announced a list of incentives for

private hospitals to create and upgrade infrastructure, as well as

reduce their operational costs:

1. Tax sops to financial institutions lending to private groups

setting up hospitals with 100 or more beds.

2. Increase in the rate of depreciation from 25 percent to 40

percent for life-saving medical equipment.

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ECONOMIC FACTORS

The FDI policy of India is not up to mark. The 100% FDI route is not

opened in India. If the foreign hospital wants to open its hospital in

India, then the only way it can do so is via joint venture . Because of this

not many foreign players are interested to invest in India.

The Indian healthcare market is expected to grow by around 13 per cent

per annum for the next six years.

It is projected as the next boom in the country after the IT euphoria.

The amount of hospitals in India is very less when compared to the other

developed countries. Even the urban areas do not have enough medical

facilities. It is better not to talk about our rural consumers, where one

village at an average has one doctor only and the doctor is not very well

qualified.

The country lags behind international standards on basic healthcare

infrastructure and facilities. India has 94 beds per 100,000 population

as compared to the WHO norm of 333 beds per 100,000 .

India's healthcare industry is estimated at Rs 1000 billion ( 14 billion). Of

this, pharmaceutical accounts for Rs 200 billion (2.8 billion). As per some

estimates, Rs 185 billion (2.6 billion) is spent on healthcare annually.

Public and private health expenditure is 13% and 87% respectively. Health

insurance is extremely marginal as indicated by "Out of Pocket"

expenditure percentage of 84.6%.

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SOCIAL FACTORS

Certain percentages of beds have to be kept for poor people. E.g. in

Bombay 20% of beds has to be kept reserved for poor people whether itsa private or public hospital.

Look after the needs of local poor people.

Open counseling and relief centres.

Teach hygiene, sanitation among the poor masses.

Safe disposal of hospitals wastes like used injection needles, waste blood

etc. and taking due care of environment.

Spreading awareness about various diseases through campaigns and free

medical check ups.

In brief the social aspect of hospitals industry is to see that latesttreatment and medicines are available to people at large at concessional

rates or free of cost and that its activities are not only restricted to rich

people.

The people in India do not avail of the hospital facilities very soon. This

is because of the high cost related to it. However this may all change

because of the increasing deployment of third party payment either in the

form of Medical and Allied Insurance, or in the form of reimbursements

from the State. The people are now taking more to the hospital facilities.

This in turn will increase the employment opportunities to many people. A

study by NOSU hospital consultants revealed that the hospital industry

shall employ a large proportion of the skilled work force. In fact the

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Healthcare Industry is poised to become the biggest Employer in all

Countries.

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TECHNOLOGICAL FACTORS

The hospital is on the threshold of a major Growth Spiral which shall

assimilate all new technologies to provide cost effective Healthcare. It shall

also be the biggest consumer of all new technologies.

Innovations such as computer based hospital information systems, medical

records; decision support systems, health information networks,

telemedicine, real time image transfers and newer ways of distributing

health information to consumers are beginning to affect the cost, quality,

and accessibility of health care.

The technologies today can support vast databases, network

communications, quick distribution and reliable image transfers. The easy

availability of Healthcare related information is changing the traditional

relationship between the Doctor and the patient.

Employment of Microprocessor Technology to develop implantable devices,which can be monitored with the remote sensors. Healthcare providers in

supporting various physiological defects shall use these devices.

A greater degree of employment of CPU driven Technology, supported with

artificial intelligence, in treating or managing various physiological defect.

A greater degree of employment of Robotics Technology in Operating

Rooms to provide precise and less traumatic as well as less destructive

Surgery (Robotics Micro-surgery).

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A greater degree of employment of Robotics Technology in Laboratory

along with traditional technologies to provide automated and precise

diagnostic studies.

A greater degree of employment of LASER Technology, in and outside of,Operating Rooms to provide precise and less traumatic as well as less

destructive Surgery.

Development and deployment of instrumentation in Medical & Surgical

Practice which shall be based on capturing data on real time basis and

providing necessary electro-physiological interventions or Bio-chemical

interventions. This shall affect both - normal physiology and pathological

physiology.

Development and deployment of cultured tissues for control of vital

Biological processes.

Employment of Information Technology tools for networking of Examination

Rooms, Treatment Rooms, Operating Rooms and Diagnostic Reporting

Rooms.

Employment of Information Technology tools along with Microprocessor

Technologies and modules of (Artificial) Intelligence for remote

maintenance of Equipment and other instruments thereby enabling

development of remote controlled instrumentation for control of

Physiological & Pathological Processes.

Deployment of Information Technology tools for generation of specificdisease related Databases, classified by a number of variables.

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GLOBAL FACTORS

The healthcare sector is among the most rapidly growing services in the

world economy, estimated at $4 trillion yearly in the OECD countriesalone.

The sector has seen new and rapidly evolving forms of cross-border

transactions , spurred by factors as wide-ranging as technology,

demographics, costs, skills, growing private sector participation, natural

endowments, culture and geography.

Globalisation of healthcare is also evident from the growing foreign

equity participation in this sector and establishment of joint

ventures, alliances and management tie-ups among care

establishments, resulting in the transfer of technology, skills and

practices.

Finally, there is the global movement of doctors, nurses and

technicians, and the resulting networks of healthcare professionalsthat are sources of investment and know how.

Investment flows into developing countries and the setting up of state-

of-the-art healthcare establishments there will attract overseas patients

for quality care at low cost. Which may, in turn, be supported by

telehealth services and cross-border movement of health

personnel.

India also has potential to export telehealth services within the

region and is emerging as a base for outsourcing of clinical trials, ethical

and regulatory issues aside.

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Indias importance as a global supplier of medical personnel to

developing and developed countries is long standing.

India is also emerging as a source of foreign direct investment (FDI)in health services, as shown by the regional expansion plans of major

players, such as the Apollo group.

However, India has barely tapped its true potential in the global

healthcare market. Only 5% of all patients treated at reputed hospitals

like Escorts are foreign, compared to 25% at equivalent Thai hospitals.

Inadequacies in supporting infrastructure, equipment, supplies and

domestic regulation, lack of recognition of Indian medical qualifications

and disparity in standards of training and quality remain major

constraints.

Globalisation of our healthcare system can yield many benefits,

including improved quality and standards and more money for

investment in the sector.

Cross-border exchange of practices, knowhow, and

technologies, resulting from the flow of capital, consumers, health

personnel and information, can help in raising standards and the quality

of domestic healthcare.

Concerns have been voiced about the possible two-tiering and

cream-skimming effects of medical tourism and FDI on the

domestic healthcare system. And possible adverse effects on costs,resource allocation and equity within the system. One has to assess

their true cause.

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This growth of Healthcare Industry shall be supported by Political Will and

Social Understanding at all levels of any Society. It must, therefore, meet

the new challenges, by providing cost effective

Healthcare in a manner that improves the Quality of Humane Life.

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ACCREDITATION OF HOSPITALS

AN OVERVIEW

Health services in many developed countries have come under severe

scrutiny in recent years. Positioned against the backdrop of

globalization, there is an intense move towards accreditation of health

services.

Accreditation of hospitals is a voluntary process by which an

authorized agency or organization evaluates and recognizeshealth services according to a set of standards describing the

structures and processes that contribute to desirable patient

outcomes.

Accreditation can be understood as an indicator of professional

achievement and quality of care. Accreditation is opposed to licensing or

regulation of healthcare facilities, which is usually mandatory and state-

imposed.

Accreditation is not new to the health system. The first initiative

towards accreditation was taken in the United States of America as

early as 1910. Over a period of time after several experiments, the Joint

Commission on Accreditation of Healthcare Organisation (JCAHO), a

national accreditation programme, established itself as an esteemed

accreditation body by 1987. JCAHO has high standards of quality

assurance and rigorous process of evaluation, which makes it a much-

esteemed agency for accreditation. Health services certified by JCAHO

are given deemed status.

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THE ONSET OF ACCREDITATION IN INDIA

In India, accreditation of the health services has never been a

serious issue though some feeble attempts have been made to

evolve a voluntary accreditation system in the late eighties andearly nineties interestingly coinciding with the LPG (Liberalisation,

Privatisation, and Globalisation) reforms.

The attempts made by the Indian Hospital Association (IHA) at

both Mumbai and Delhi is worth mentioning. Their efforts were

not well received as the initiative did not involve the various

stakeholders and had moved with predetermined standards of

evaluation, membership fees and assessment mechanisms.

In India, the initial premises of introducing accreditation were

based on the overall objective to ensure the quality of care. The

Bureau of Indian Standards (BIS) had laid down standards for

hospitals having 30, 100 and 250 beds. The National Institute of

Health and Family Welfare (NIFHFW) had such rules laid for more

than 50-bed hospitals and only for equipment. Most of the

standards laid down by both BIS and NIFHFW were criticized for

having an urban bias.There have been attempts in some states to institutionalize

uniform standards for hospitals. In Maharashtra, the government

hospitals follow the Hospital Administration Manual. The Andhra

Pradesh Vaidya Vidhana Parisad has laid down standards for

secondary-level hospitals in the government sector, which comes

under it.

Apart from this some efforts have been made by consumer

bodies, groups of health professionals, hospital organisations and

non-governmental organisations to evolve standards for

accreditation.

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MODELS OF ACCREDITATION

Accreditation across the globe followed three models.

The first model of assessment gives priority to standards related toavailable facility norms, equipment requirements, human resources and

space specifications. Here, the criterion of accreditation is based on the

availability of basic health facilities.

The second gives importance to quality assurance and sets standards

for those institutions striving to arrive or improve quality of care, hence

accreditation is based on satisfying some basic indicators of quality and

involves ranking based on levels of quality.

The third model is based on the ground that health systems should be

accessible and acceptable to health-seekers. It gives importance to the

health-seeker with an emphasis on evaluating health systems from

indicators such as user-friendliness, providing information to users

about the services available, setting up procedures for redressing

grievances, etc. In the third model, the criterion of assessment is

explicitly geared towards people-centric indicators and brings

accountability of the health system to the health-seekers to the table.With each model, the criteria of accreditation changes.

At the threshold of globalization and increasingly opening-up of the Indian

health sector, attempts are being made at various quarters to draft systems of

accreditation. There are certain points, which cannot be missed. What does

accreditation mean for India? The answer to this question would help us to

know which model can be adopted for accreditation of hospitals in India.

If it follows the ranking-model based on quality of services provided,

accreditation will have very little to contribute to the improvement of the

overall health system in India.

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In contrast, the facility-survey model can be partially pertinent in putting in

place the basic facilities required for providing care.

The most relevant model of accreditation for the Indian health system is thepeople-centric model, which would ensure the presence of Acceptability,

Accessibility, and Accountability.

The accreditation process should begin with minimum or moderate level

standards and, over a period of time expand to higher, ideal level standards

and should be achievable by local public health agencies regardless of size

provided that they conduct the essential services of public health.

State and local accreditation programs should coordinate with and conform in

essential ways to a national accreditation program to eliminate possible

duplication and conflict. To succeed in bringing about a perceptible change in

the delivery services of the health system and to go beyond mere an on-site

survey and awarding certificates, any accreditation programme should address

all the dimensions of healthcare.

RATINGS

India's independent credit rating agency CRISIL has assigned a

grade A rating to super specialty hospitals like Escorts and multi

specialty hospitals like Apollo.

NHS of the UK has indicated that India is a favoured destination for

surgeries.

The British Standards Institute has now accredited the Delhi-based

Escorts Hospital.

Apollo Group - India's largest private hospital chain and Escorts

Hospital are now seeking certification from the US-based Joint

Commission on Accreditation of Healthcare Organizations.

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SWOT ANALYSIS

STRENGTHS

Indias healthcare sector has made impressive strides in recent years. It

has transformed to a US$ 17 billion industry and is surging ahead with an

annual growth rate of 13% a year.

In the last five years, the number of patients visiting India for medical

treatment has risen from 10,000 to about 100,000.

With an annual growth rate of 30 percent, India is already inching closer to

Singapore, an established Medicare hub that attracts 150,000 medical

tourists a year.

Hospitals in India boast of conducting the latest surgeries at a very low

cost.

The healthcare industry employs over four million people , which makes

it one of the largest service sectors in the economy.

Indian specialists have performed over 500,000 major surgeries and over

a million other surgical procedures including cardio-thoracic, neurological

and cancer surgeries, with success rates at par with international

standards .

The quality of healthcare has improved considerably with the

availability of world class high-tech medical equipment and information

technology.

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WEAKNESSES

India has poor social sector indices, given the high population of the

poor, acute lack of medical facilities in the lesser-developed parts of the

country, and a lack of public funds to provide adequate medical care and

attention to the entire population.

Indias health expenditure is 5.6 per cent of GDP, whereas most

established market economies spend 7-10 per cent of GDP on health.

USA spends over 14 per cent.

Low doctor-patient ratio : US has 2,340 doctors as compared to Indias

143 doctors for very 10,000 people.

Life Expectancy in India is amongst the lowest at 55.5 years

compared to US at 75.5 years and 66.5 years for Thailand. On an average,

80 out of every 1,000 children die. This figure is just 9 in the US and 30 for

every 1,000 in Thailand.

High deposit fees and high costs of medical services limits itself to high

income level group or is out of reach for common man.

The I dont care attitude by the government hospital. For e.g. Cooper

Hospital.

Medicine and drugs fraud by the menials. Even organ selling by

doctors to make more money.

Complex and long admission procedure for admission, which can

sometimes be fatal.

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The common men and poor men are completely at the mercy of the

overcrowded government hospitals and dispensaries .

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OPPORTUNITIES

At the current pace of growth, healthcare tourism alone can rake in over

$2 billion as additional revenue by 2012. From less than 10,000 patientsvisiting India for medical treatment five years ago, the medical tourism

market in India is worth US$ 333 million, with about 100,000 foreign

patients coming in every year.

Voluntary health insurance market is estimated at Rs 4 billion ($86.3

million) currently but is growing fast. Industry estimates put the figure at

Rs 130 billion ($2.8 billion) by 2005. Joint ventures for offering medical

insurance and other insurance services is one of the Investment & Business

Opportunities.

Trade in medical equipment and products , including warehousing,

selling and servicing the latest medical electronics equipment, diagnostic

kits, reagents and consumables.

Telemedicine systems , for treating patients in remote areas through asatellite connection.

Corporate health care clinics for providing high quality basic services in

consultation, diagnostics, minor surgeries etc .

Business Process Outsourcing of medical transcriptions and other

hospital management administration tasks.

R&D base for new molecule development, clinical trials, etc., utilizing the

high quality scientific manpower and low costs.

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UPCOMING TRENDS

MEDICAL TOURISMIt is the next big success story out of India. From less than 10,000 patients

visiting India for medical treatment five years ago, the medical tourism market

in India is worth US$ 333 million, with about 100,000 foreign patients coming

in every year.

Procedure costs

Procedure Cost (US$)

Surgery Thailand US ($) India ($)

Bone Marrow Transplant 62,500 400,000 30,000

Liver Transplant 75,000 500,000 40,000

Open Heart Surgery (CABG) 14,250 50,000 5,000 - 7,000

Neuro surgery 29,000 8000

Orthopaedic Surgery 20,000 6,000

Cosmetic Surgery 20,000 2,000

Hip Replacement 6,900 4,500

Hysterectomy 2,012 511

Gall Bladder Removal 1,755 555

Knee Surgery 7,000 16,000 4,500

* All figures in US$. The Indian costs are based on the average rates offered

by top Indian hospitals like Escorts Heart Institute, Apollo and Batra Hospital.

The Thailand rates are based on rates provided by Burnrungard Hospital,

Bangkok, which is Thailands largest private hospital.

Source: IBEF Syndication Studies

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PREVENTIVE HEALTHCARE

Growing health consciousness among middle and high-income families inIndia is heralding a new business opportunity - preventive healthcare.

The addressable population for preventive healthcare check-ups in India is

about 160 million. At current estimates, not more than a million people

may have been covered.

For hospitals, the preventive healthcare business is attractive. It allows

them to build long-term relationships, as patients who come for health

check-ups generally come back to the same hospital if they require any

treatment.

HEALTHCARE BPO

Healthcare BPO could potentially be a US$ 4.5 billion opportunity for

India by 2008, offering employment to about 200,000 people.

It includes offshoring of processes such as medical billing, disease

coding, forms processing and claims adjudication.

As healthcare BPO players mature, other businesses like claims

repricing, medical diagnosis and actuarial work are expected to gain

momentum.

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TELEMEDICINE

Telemedicine is a method by which patients can be examined, monitored and

treated, while the patient and doctor are geographically distant.Potentially, the next big success story in the healthcare sector, several

examples already offer an insight into this emergent opportunity that is

changing the lives of over 600 million people in rural India.

Gujarat : The Online Telemedicine Research Institute (OTRI)

provided telemedicine links for teleconsultation, thereby

establishing 750 sessions in a period of 30 days in Bhuj after the

earthquake in January 2001.

Karnataka : Asia Heart Foundation, Bangalore has successfully

been practising Telecardiology between Bangalore and cities in

eastern India. Paramedics are guided to save patients suffering

from Acute Myocardial Infarction by performing life-saving

procedures as per doctors directions over video conferencing.

Tamil Nadu : Apollo Hospital, Chennai is providing expert opinion

from its tertiary level hospitals in bigger cities to those in far-

flung towns of India. Over a period of 27 months, over 4,000

patients benefited from teleconsultations and over 75 per cent of

those teleconsulted were treated in their respective cities.

Haryana: Jiva International, a healthcare venture on the

outskirts of Delhi, is implementing a novel plan that takes

medical care right inside rural India by using a GPRS enabled

Java application available with Nokias 6800 model. The

Teledoc project won the World Summit Award for eHealth, at

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the World Summit on Information Society (WSIS) held in

Geneva, Switzerland.

THREATS

The government is reducing the grants given to hospitals, thus making it

impossible to cater to the poor people.

The unions of the menials and even doctors : they can go on a strike,

disrupting the functioning of the entire health care unit.

Competition from other international hospital chains , which are more,advanced in technology and better financial support.

The public spending on health in India is a mere 0.9% of GDP and the

private spending on health is 4.2%. India ranks 171st out of 175 countries

in terms of public spending on health.

Government pays more attention on age-old programmes like

tuberculosis, leprosy etc. and less attention on killer diseases cardio

vascular, diabetes, obesity and hypertension.

Unplanned urbanization and neglect of the public health system as

whole has led to the resurgence of water-borne diseases like hepatitis and

cholera every year. More virulent forms of tuberculosis are being seen in

those infected with HIV, which appears to have spread widely in India.

The number of people in India infected with the HIV/AIDS virus has risen

sharply. According to India's National AIDS Control Organisation (NACO),

more than 4.5 million Indians are infected. HIV/AIDS in India is not only

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confined to high-risk groups and in cities, but is gradually spreading into

rural areas and the general population.

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TYPES OF HOSPITALS

CLASSIFICATION ON THE BASIS OF OBJECTIVES

Hospital

Teaching-cum-Research Hospitals:

These hospitals are teaching based . They are found engaged in advancing

knowledge , promoting the research activities and training the medics.

As for example , All-India Medical Institute, New Delhi, Post-Graduate

Medical Education and Research Institute, Chandigarh, etc.

General Hospitals :

The general hospitals also offer teaching and research facilities but these

objectives are secondary. The main objective in the general hospitals is to

provide medical care. As for example, different medical colleges and district

and sub divisional hospitals like DY Patil Medical College.

Special Hospitals :

The main objective of special hospital is to provide specialized medical

services . These hospitals concentrate on a particular organ of the body or

a particular disease. For eg. The Asian Heart Hospital, Mumbai.

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Special

Hospital

Teaching cum

Research

General

Hospital


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CLASSIFICATION ON THE BASIS OF OWNERSHIP

Government Hospitals :

These hospitals are fully owned managed and controlled by the

government . They are mainly involved in healing the needy and providing

healthcare to everyone at very affordable rates.

Semi-Government Hospitals:

These hospitals are partly owned by government . Time to time government

assistance is provided to these hospitals may in the form of finance.

Voluntary Agencies:

There are some hospitals which are run and are in control of voluntary

organizations they can be of any form i.e. may be general hospitals or

special hospitals or even teaching institutes.

Private Charitable:

These private charitable hospitals are owned and controlled by the

charitable organizations , which are private.

For e.g. Ramakrishna Mission Hospital, Mumbai.

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GovernmentHospital Semi-Government

Hospital

VoluntaryAgencies PrivateCharitable

Hospital

Hospital


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CLASSIFICATION ON THE BASIS OF MEDICINE

CLASSIFICATION ON THE BASIS OF SIZE

Hospitals can also be classified on the basis of their size. There

are variations in the size of the hospitals.

As such, the teaching hospitals generally have 500 beds, which

can be increased according to the number of students.

The district hospitals generally have 200 beds, which can be

raised to 300 depending on population.

The teshil / taluk / sub-divisional hospitals generally have 50beds that can be raised to 100 depending on population.

The primary health centers generally have 6 beds that can be

raised to 10 beds.

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Hospital

TeachingHospital

DistrictHospital

Tehsil/Taluka/Subdivisional

Hospital

Primary HealthCenters

HOSPITALS AYURVEDIC

HOMEOPATHY UNANI

ALLOPATHY

OTHERS


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SEGMENTATION

EXTERNAL SEGMENTATION1. Income wise:

No income

Low income

Middle income

High income

2. Gender wise:

Maternity hospitals for females.

3. Family life cycle:

Childcare hospitals.

1. Institute of Child Health and Hospital for Children

2. Center For Genetic Health Care

The center is actively involved in Genetic Health Care of

Unborns, Children and Adults for the last 15 years. Facilitiesavailable at the centre are unique and under one roof.

4. Specialized hospitals:

Heart,

1. Asian Heart Institute & Research Centre

Speciality Heart Hospital at Bandra Kurla Complex, Mumbai

Eye,

Dental etc.

5. On basis of disease:

Tuberculosis, Tuberculosis Research Centre

Cancer, Jeevan Jyot Cancer Hospital

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http://ich.tn.nic.in/http://ich.tn.nic.in/http://www.indiaspace.com/pages/genetics.htmhttp://www.ahirc.com/http://www.trc-chennai.org/http://www.trc-chennai.org/http://epages.webindia.com/india/jeevanjyotcancer/http://epages.webindia.com/india/jeevanjyotcancer/http://ich.tn.nic.in/http://www.indiaspace.com/pages/genetics.htmhttp://www.ahirc.com/http://www.trc-chennai.org/http://epages.webindia.com/india/jeevanjyotcancer/


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INTERNAL SEGMENTATION

1. Type of care:

Intensive care unit

Normal ward

General ward for check up

2. Facilities/comfort wise:

Ac room

Non-AC room

Deluxe room

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PRODUCT

Kotler says a product is anything that can be offered to a market to

satisfy a want or a need. Products that are marketed include physical goods,

services, experiences, events, persons, places, properties, organisations,

information and ideas.

In the case of hospitals, different types of hospitals offer different services to

their users. Some of the hospitals give priority to medical education, trainingand research while some others concentrate on medical treatment.

The product of a hospital can be any of the following:

PRODUCT

PRODUCT LINE WIDTH, DEPTH & LENGTH

Medical

services

Medical training Medical

education

Medical

researchCardiac Surgery Dentistry Heart diseases

Dental Operation Ophthalmology CancerDermatology Neurology AidsNeuroscience

The following is the product width, depth & length of Lilavati Hospital:

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MEDICALSERVICES

MEDICALTRAINING

MEDICALEDUCATION

MEDICALRESEARCH


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- 37 -

LILAVATI

MEDICALSERVICES

SURGICAL DIAGNOSTIC ALLIED DENTAL

CARDIOLOGY

CLINICAL CARE

DERMATOLOGY

RESPIRATORY

ONCOLOGY

ANDROLOGY

OPTHALMOLOGY

ORTHOPAEDICS

GENERALSURGERY

ENT

NUCLEARMEDICINE

PATHOLOGY

RADIOLOGY &IMAGING

PHYSIOTHERAPY


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PRODUCT MIX

Level 1: Core / generic product:

This is the basic service product.

In hospitals, health or well-being by way of the treatment provided by the

doctor to deal with the ailment of the patients is the core product or service.

Level 2: Expected products:

This is the basic product and minimum purchase conditions that must be met.

In hospitals, in addition to the core product, all other supplementary services

like a bed, waiting area, availability of medicines and drugs, meals, hygiene

etc.

Cooper Hospital Waiting Area, Beds

Lilavati Hospital Waiting Area,

Beds,

Availability of medicines (24

hours),

Availability of Blood Banks, etc.

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Level 3: Augmented Product:

Along with the basic and expected offering, the service provider needs to

differentiate its services from its competitors.

Lilavati Hospital Great Infrastructure,

Cardiac Ambulances,

Centrally AC,

Cafeteria

Product Augmentation is not observed much in case of BMC hospitals because

these hospitals are established to provide free (or at nominal rate) services to

the customers. They dont find the need to differentiate. They are established

as they form a part of the basic infrastructure of the city.

Level 4: Potential product:

The potential product contains potentially feasible features and benefits that

play a significant role in holding and attracting the customer. These features

and benefits are useful or likely to be useful to the buyers.

AHIRC Beds are provided for ICU attendants

free of charge along with other

communication facilities like internet

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FLOWER OF SERVICE

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INFORMATION

+ In a hospital, providing information refers to making the patients or the

general public aware of the services and facilities offered by the hospital.

+ The customer needs to have some basic information about the service

provider so that he/she can make a choice between the different service

providers.

In the hospitals the basic information that a customer would require is as

follows:

+ The different types of services that the hospital offers. Eg:

General, specialized

+ The technologies that are being used.

+ About the in-house doctors and their qualification

+ About the visiting doctors i.e. their qualification, number of

times they visit in a day and at what time, etc.

The tools which hospitals use to provide information are television, internet,

radio, etc.

Dr. Batras Health Care Clinic radio advertisements

Lilavati Hospital has used internet as one of its tool to provide information.

The webpage appears as:

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ORDER TAKING

This refers to the promptness of the service provider in taking the order of the

customers.Promptness should be in the following areas:

+ Formalities: The paper work & the legal formalities prior to the

admission must be minimum.

+ Accommodation: the patient should be given the accommodation as soon

as he\she completes the formalities.

+ Responsiveness: the patient must be attended as soon as he is

accommodated.

At AHIRC, a patient is required to come in with two relatives. This is because,

when the patient enters the hospital, he is either sent to the bed allotted to

him (through prior booking) or to the pathology department if certain tests

need to be carried out. One relative accompanies the patient, while the other

relative remains at the admission counter to complete the admission

formalities. This way, the patient is not kept waiting while the admission is

carried out.

SAFE KEEPING: [SAFETY AND HYGIENE]

When a patient has to undergo a surgery or an operation, he always has a fear

that whether he\she is in safe hands.

Therefore the doctors, nurses, ward boys and all the other employees, who

come in direct contact of the patient, must possess an ability to build trust,win his confidence & make him feel that he is in safe hands.

Eg: Most of the hospitals display the success rate of their doctors.

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HOSPITALITY

This is becoming increasingly important in the healthcare sector, particularly in

hospitals as the expectations of people towards medical care are everincreasing. No longer are they limited to only the clinical outcomes but also

involve the delivery process, margin of safety and behavior of personnel.

The AHIRC provides a host of conveniences to patients and their relatives.

Service to patients:

+ A choice of packages from twin sharing, single room and deluxe suites

are available to patients.

+ A lot of care has been taken to ensure that the patient does not feel

walled in. For example, all rooms have natural and indirect lighting with

huge windows and in some cases, terrace gardens. A number of

facilities are provided to the patient such as a television, in-house meals

etc. So as to make the room aesthetically pleasing and improve patient

mentality (they are usually depressed), all medical sockets, instruments

or attachments are hidden from view, behind a panel beside the bed.

Service to relatives:

The AHIRC is the only hospital in Mumbai that has a separate family waiting

area for relatives of patients in ICU. Each cubicle in the waiting area has

provisions for sleeping such as a bed, pillows, blankets etc. The reason for

such an arrangement is that , in the ICU cases, one person should be present

in the hospital 24 hours so that he is available to sign the consent form.

Patient number is allotted to the relatives bed and in the case of an

emergency, the relative is immediately called by the secretary in charge.Relatives also enjoy facilities like internet connection, a multi-cuisine cafeteria,

prayer rooms, library, public call booths, coffee machines, a gift shop etc.

There is even a travel agency located on the ground floor that caters to the

traveling and sight seeing needs of the visitors (particularly in the case of

patients from abroad).

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EXCEPTION

Exceptional service is not what you are expected to give, its a kind of service

which you provide to your customers to win customer satisfaction so that hewould be loyal to you & spread good word.

This petal is deformed in case of many BMC hospitals. Private hospitals make

use of this petal at its best to differentiate their service.

BILLING

Hospitals should ensure that billing and payment procedures are quick so as to

enable the patient to return home soon after discharge.At AHIRC, two types of

bills are generated i.e. Interim bills and Final bill. The interim bills are

generated to give on a bi-weekly basis. They give the patient an idea about

the charge payable for the specified period. It helps is avoiding any confusion

at the time of generating the final bill.

The final bill is generated at the time of discharge. This considers all the

interim bills and the advance deposit paid.

PAYMENT :

The norms for payment of the bill must be simple.

1. The payment counter should be easily accessible. The

customer must be able to easily locate it.

2. The mode of the payment should be easy and quick. The

customer should be able to easily settle the bill and leave.

If the payment is made by the credit cards, even this must be quick andshould be on the different counter.

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SERVICE QUALITY DIMENSION

RELIABILITY

The ability of the service provider to meet the promises made by them

accurately. The customer must develop a feeling that they can depend on

that particular service provider for their problem.

1. The staff of the hospital has to be very accurate while performing their

job. Only than the customers would rely on them. For e.g. during

surgery the amount of anesthesia to be given to the particular patient

has to be accurate.

2. The service provided should be such that the customers develop a

feeling of loyalty so that the hospitals get the repeat customers as well

as new customers. e.g. if Mr. X goes to Lilavati hospital for the bypass

surgery and the surgery is conducted successfully and he recovers

soon, he would not only become loyal to the hospital but also he will

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narrate the whole incident to many others thereby giving Lilavati more

customers.

ASSURANCE

The service provider and the employees must be capable of winning the

trust and confidence of the customers.

1. The customers can be assured by informing them that the doctors,

nurses, ward boys and the other related staff is competent enough in

providing them their expected level of service.

2. The frontline staffs have to be very polite and friendly to the patient and

the relatives.

3. The patient must develop the feel that he is safe in that particular

hospital. For e.g. when a patient is brought to the hospital in emergency

he and the relatives must be attended with courtesy and also the

doctors and the nurses must politely tell them, that nothing will happen

to the patient, we will try our level best and not react with abrupt and

angry statements. His words should sound empathetic and at the same

time consoling.

TANGIBLES

This includes the ambience, the technologies used, the facilities used to

communicate things etc.

1. The ambience of the hospitals must be gentle and clean. The

technologies used in the hospitals have to be latest or updated

regularly. Because now a days people do not buy the product butbenefits.

2. The environment of the hospital has to be peaceful. The corridors

outside the rooms should not be crowded. Even in the visiting hours too

many people should not be allowed at a time.

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3. The seating arrangements for the patient who have just come for some

tests and the person accompanying him have to be comfortable.

4. The signboards must be the perfect indicators so that there is no

difficulty for the customer to locate the place, he wants to go to. Foreg., in Asian Heart Hospital, the technologies used are latest, the

visitors are given two passes so only two people can go and see the

patient in the visiting hours.

EMPATHY

The attitude of the service provider should be caring and if possible

individual attention to each customer should be given

1. The attitude of the doctors and nurses should be concerned. They

should be approachable as and when required.

2. The doctors and nurses must have the ability to understand the problem

of the patient and give the solution accordingly.

3. The doctors must communicate well to the patient and the relatives

about the disease the patient is suffering from.

4. The nurse and the ward boy should be assigned to look after the

patient.

RESPONSIVENESS

The service delivery should be prompt and up to the mark.

1. The patient should be attended as soon as he comes to the hospital and

registers himself. In case of emergency he should be attendedimmediately.

2. The nurse should be able to locate the doctor soon if he is needed.

For e.g. a patient suddenly starts sinking or breathing at a faster rate

the nurse should be able to call the doctor immediately. For this, a good

intercom facility is required.

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PLACE

STATISTICS REVEALS THAT :

PROBLEMS-OF-ACCESS:

Fifty-four per cent delivered their babies without the support of trained

personnel.

Fifty-eight per cent of children have not completed their immunisation

schedule and 14 per cent have not received a single vaccine.

Only one in two women seeks treatment for illness, usually because

the nearest health service is too far away, or it's too expensive.

These examples are only meant to illustrate the fact that people's

access to health care is limited by their ability to pay, as well the

availability of services.

DISTRIBUTION

The most commonly recognized medical facility is probably the hospital. In the

past decade, however, the shift has been away from providing all care in the

most expensive medical environment. As a result, a number of other less

expensive options have developed. There are ambulatory surgery centers,

rehabilitation centers, nursing homes and other residential care facilities,

specialty service centers and home care programs, just to name a few.

1. Medical camps

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They are the most common form of distributing the medical services. These

camps are generally held when there is a calamity. As we recently saw,

these camps being held at various parts of Mumbai, in the aftermath of

the floods of 26th

July. Such camps are organized on an even larger scalewhen the calamity is of a very high magnitude. Eg. The camps that were

set up in Gujarat ( areas of Bhuj & Anjar) were huge enough to have

several Operation Theatres in them & they accommodate upto 100

patients at one point of time. They are equipped with quite a lot of

equipments like X ray machine, the ECG etc. they are manned by nurses,

general practitioners, specialists, & other medical professionals.

2. Air Ambulances

Rooftop heli-pad is available for the emergency airlifting of patients to and

from the hospital for specialized trauma treatment.

These air ambulances have a crew of up to 5 people, which includes one

specialized doctor, a Para-medical staff, 3 member rescue team. Family

members of the patient are generally not allowed to accompany him. Though

not very common in India, its a regular feature in the hospitals of developed

countries. Even in India, these emergency services are developed. Eg. The

Madke Hospital in Mumbai.

3. Ambulances

As we all know, they are the most common mode of transport used in moving

in the patients from the place of illness to the hospitals.

4. Mobile Vans

Mobile Hospital and Research Centre, was flagged off on October 19, 2002 byHis Excellency Dr.APJ Abdul Kalam, President of India.

It has been found to be extremely popular & a practical health care model for

Uttaranchal.

The aim has been to bring advancements in modern medical sciences at the

doorstep of the common man, who otherwise would have been neglected of its

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benefits. The project has been conceived, keeping in mind the specific needs

of remote hilly terrain of Uttaranchal where negligible modern health care is

available to needy and poor people who are staying in far-flung areas of

Uttaranchal

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PRICE

The pricing management of a social institution becomes complicated as the

policy makers are expected to take social factors into considerations. The

lower sections of society look forth to free and cost-free services, as they are

not economically backed to support their familys healthcare expenses.

Naturally this jeopardizes the task of top management. It is close to

impossible for even the government, specially in an over populated country

like ours, to make available world-class services to all without charging any

fee. But then, it is also not rational that we expect free services, though wehave the capacity to pay, which is another problem with the middle-income

class of the country.

The pricing strategy helps us to projecting our image . Not only this, if the

strategies are welfare oriented, the task of satisfying the users is also

simplified. But the satisfaction depends upon sophistication. And sophistication

cant be possible unless we change our pricing strategies. Even the affluent

sections of society expect low cost services from social institutions in general

and hospitals in particular the task of innovating services in line with latest

developments in the field of physical sciences is difficult.

Healthcare services involve the use of expensive and complex machinery,

which involve huge investments. Apart from that, the cost of maintaining them

and cost of running the hospital is in no terms cheap. Doctors salaries along

with the salaries of the nurses and helpers constitute a great part of the cost

too. In a developing country like ours, where the level of income of the

general masses is found low, it is significant that pricing decisions are liberal

to the economically weaker sections of the society.

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There are a number of questions that service marketers need to ask

themselves as they prepare to create and implement a well thought out

pricing strategy.

HOW MUCH TO CHARGE?

PRICING IN GOVT. HOSPITALS

In the Indian setting where a number of persons are below the poverty line it

is challenging task to formulate a pricing strategy, which is successful in

serving the social interests and generating profits. It is due to this that mostgovernment hospitals are in deplorable condition. The ultimate sufferers are

the society and specially the poorer sections. Since the affluent sections have

an option to avail the expensive medical services made available by private

hospitals. The societal marketing principles make an advocacy in favors of

protecting the public interests but it is not meant that the hospitals have a

uniform pricing/free structure for all the users. The fee strategy for

hospitals should be in proportion to the incomes of users, which would

engineer a sound foundation for qualitative or quantitative

improvements.

DISCRIMINATORY PRICING:

For social institutions like govt. hospitals a discriminatory fee structure is

preferred since it provides even the weaker sections of society, an opportunity

to avail the quality medical services. This enables hospitals to innovateservices to keep pace with the latest developments in medical sciences.

1. Free service: Generally speaking, all categories of hospitals should

adopt cost-free services to the weaker sections of the society having no

source of income for paying even the nominal charges. In this

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context, the government hospitals should be given special grants to

avoid an imbalance in their financial management.

2. Subsidised services: The users belonging to the low-income groupshould be made available subsidized services. That is, the public or

hospitals make nominal charges for the services made available to

them. It is more or less clear that subsidized services are a bit lower

than the cost involved on treatment. Both the central and state

governments would give the subsidies.

3. Cost-based Services: This is based on the principle of no-profit, no-

loss. Or say, the cost based strategy in which prices or fees are equal to

the costs involved on treatment. This is basically for the middle

income group.

4. Cost plus Subsidy: This strategy allows charging more than the costs

involved on the services, but only from the better-off sections of

society. The transfer of these surpluses to the account of subsidy for

compensating the losses on account of providing free or subsidized

services to the weaker sections and low-income group users is also

necessary.

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1. 2.

3. 4.

On one hand, it is judicious that no discrimination is found in respect of

making available the medical aids, but on the other hand, we cant adopt

uniform policy while making available to the users and their attendants other

facilities like standard of room, indoor facilities and other non medical

amenities.

This is justified on the ground that all groups are not paying equal fees for

availing their services. Moreover when no income group has been availing the

services without paying any fee, their expectations would not be more than

the proper medical aids.

At Cooper Hospital all the patients are not charged. Only those who can

afford to pay would pay others can pay whatever they can or pay nothing atall.

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Government HospitalsFEE/CHARGE

FREE(For No Income group)

SUBSIDISED(For Low Income group)

COST + LOSSES FROM 2(Middle Income group)

COST + SURPLUS TOMAKE UP THE LOSSESOF 1.(High Income group)

DiscriminatoryPricing


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PRICING IN PRIVATE HOSPITALS

It is difficult to offer free or subsidized services to the masses. On the otherhand, the technological sophistication has raised the cost of services as the

inputs used in making available the medical services are found costly due

to rising inflationary pressure.

Thus private hospitals take the following approaches to pricing:

1. Cost Based Pricing:

Direct price + overhead costs + profit margin.

This approach involves setting prices relative to financial costs. The

hospital sets a price sufficient to recover the full costs (variable, semi

variable & fixed) of providing the service. These ads a sufficient margin

to yield the described level of profit at the predicted sales volume.

Hospitals generally incur high fixed costs due to expensive physicalfacilities.

In hospital services, this method is cumbersome because the tracking &

identification of costs apart from doctors fee, is difficult.

In spite of this, some hospitals in the private sector do follow this

method.

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2. Demand/Value Based Pricing:

This involves settling a price consistent with the customers

perception of service value. That is, prices are based on whatcustomers will pay for the services provided.

Hospitals with a reputation for high quality successful treatments etc.

can & do charge a premium simply based on the sheer perception of

quality health care. Those who can afford are generally willing to spend

high amounts on quality care.

However there was a case during the out break of leptospirosis , when

the was a huge requirement of white blood platelets they were not

easily available in the city. As a result its charges rose from Rs.250- 300

to Rs.1000+ deposit of Rs. 600

3. Relationship Pricing:

Hospitals may undertake relationship pricing with regard to corporate

clients so as to develop & maintain long-term customer relationships.

Here the hospital offers companys o n treatment of its employees over

a period of time.

4. Competition based pricing:

Using other price as an anchor for the hospitals price, heterogeneity of

service across and within providers makes the approach complicated.

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WHAT SHOULD BE THE BASIS OF PRICING?

Pricing in hospitals may be based on the following:

1. Time based: It is based on the time of use. Fr example: In case of

an admission the duration of the patients stay is un predictable, so

rooms may be charged on a daily basis. In AHI, the rate of a suit is

Rs.5500 /- per day.

2. Value based: it is based on the value or the importance of the

service. In case of consultation with a doctor or out patients, doctor's

fee may reflect till expertise or be tied to the complexity of the

diagnosis etc.

3. Flat rate basis: This is charging flat/ standard rates for some

services. Again, there may be flat rates assigned to various

treatments for example: charges for an X- Ray, ECG & so on.

At Breach Candy Hospital on admission, an initial deposit is collectedat the in-patient billing counter. The amount depends on the category of

room and the treatment / surgical procedure planned.

The in-house doctors are paid salaries by the hospital as per the

hospital norms whereas the visiting doctors decide the fees in

consultation with the patients and only 10% of this fee is retained

by the hospital. All the billing transactions are done through the

hospital.

Various categories of rooms ranging from a shared room to the deluxe

suite are available.

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Room Charges and Deposits at Breach Candy Hospital:-

GENERAL:

Room Category Tariff (Rs.) Deposit (Rs.)Deluxe 4,500 40,000New wing 4,200 40,000Single Rooms (West) 3,000 30,000Single Rooms (East) 2,500 25,000Single Rooms (Shared Bath) 1,500 20,000Double Shared Room 1,300 20,000Non A/C Single Room (Shared

Bath)

1,200 20,000

MATERNITY:

Room Category Tariff (Rs.) Deposit (Rs.)Deluxe Maternity 4,500 20,000Single Room (With Attendant Couch) 3,500 20,000Single Room 3,200 20,000Single Rooms (Shared Bath) 2,400 20,000Double Shared Room (Shared Bath) 2,200 20,000Shared Room (Shared Bath) 1,300 20,000Labour Room 1,800

INTENSIVE CARE UNITS:

Room Category Tariff (Rs.) Deposit (Rs.)Surgical 5,000 40,000Medical 5,000 40,000Neonatal 1 3,500 35,000Neonatal 2 2,200 30,000High Dependency Unit 3,200 30,000Day Care 900 20,000

CHARGES AT COOPER HOSPITAL :

Category Amount (Rs.)1. a) Outside patient- for case paper

b) 14 days after for re-checking

Rs.10

Rs.102. a) Light checking

b) E.C.G

Rs.30

Rs.303. a) Ultra sonography

b) If they need the imaging film

Rs.100

Rs.50

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4. E.E.G. - brain Checking for

psychiatric

Rs.250

5. Extra special Surgery Rs.50006. Special Surgery Rs.500

7. Normal Surgery Rs.200

PROMOTION

Buoyed by corporatisation of healthcare, Indias promotion as a sought after

medical tourism destination and threatened by the mushrooming of new

hospitals, it is becoming difficult for hospitals these days to depend on mere

word of mouth promotion to attract patients.

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Hospitals usually resort to personal selling for business-to-business

marketing. Both in the case of corporate tie-ups and approaching doctors for

patient referrals, it is the hospitals marketing executive who personally

approaches the corporate or the doctor so as to pitch and finalize the deal.

Network of doctors:

On the other hand, they also have a network of doctors linked to them.

These doctors are consulting doctors who dont have clinics of their own.

Thus, they treat all their patients in the hospital premises itself. Other visiting

doctors are also linked to the hospital and even they pull their patient-base to

the hospital for surgery, treatment and recovery. Many hospitals also provide

incentives to the doctors so as to ensure that the hospital is the first

preference of the doctors for referral.

Apollo Hospital in Chennai interacts with doctors on one on one basis. They

regularly conduct seminars and continual education programmes to explain to

doctors the advances in the medical sciences and the infrastructure that their

hospital has.

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(b) Customer service and training:

In hospitals, almost all the services are delivered in the customers presence.Front-line personnel are directly involved in the process of offering the

services, due to which they must be efficiently informed, trained and

supported.

For instance, if nurses neglect patients, receptionists misbehave and doctors

do not show a human approach, the hospital will fail in delivering good service

to the society in spite of the availability of most sophisticated equipments and

technologies, efficient doctors and nurses and most comfortable buildings and

infrastructure facilities.

Thus, hospitals invest a lot in internal marketing by way of training so as to

ensure that the employees are at their best of behavior with the patients and

well informed about the various activities of the hospital, including free check-

up camps and talks. Important ways of internal marketing is analyzing

feedback from regular customer satisfaction surveys and improve service

delivery so that the way of service delivery itself is the marketing of the

service.

Example: One way in which AHI ensures good customer service is by holding

training programs for nurses every 15 days, enlightening them about how to

handle various patients etc.

At Fortis Hospital at Noida, theres also a system of taking feedback from

patients and visitor, which enables them to check flow in their service.

(c) Word of mouth:

In Medicare services, word of mouth plays a very important role, as people are

more likely to trust a hospital if they have heard about its success in

treatments or quality care from a patient. Thus, by ensuring good customer

service, hospitals also get a lot of promotion by way of word of mouth.

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CAMPS FOR SOCIAL PURPOSE:

They conduct camps in rural areas to give medical check ups at reasonable

prices, they sponsor visits to old age homes etc. Participating in the countrysbiggest medical conventions and conducting health camps are also other

prominent forms of making their presence felt.

For example: Hinduja Hospital had also sent a team of their medics to Bhuj

when the catastrophic earthquake hit the place some time ago.

ADVERTISING

They are not used frequently in hospital marketing. Hospitals can focus on the

quality of their services, their contribution to the social transformation

process, but they cannot advertise for generating profits.

Mostly, advertising through mass communication media like TV ( special

programmes, interviews of specialists), print media (fitness

magazines, news papers) etc. is only used in social marketing where the

objective is to pass on a social message like family planning, childimmunization, health and family welfare etc.

SALES PROMOTION

In hospitals, sales promotion usually by way of:

- Sign up rebates or discounts, especially in the case of corporate clients

- Gift premiums, for ex. Doctors are offered various gifts and benefits in returnfor patient referrals.

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PUBLICITY AND PUBLIC RELATIONS

Hospitals may sometimes issue press releases regarding the success of rare

and crucial operations and surgeries. This is because its success rate of crucialoperations and surgeries reflects the technological and knowledge- based edge

of the hospitals over the competitors. When many successes are discussed in

health magazines and newspapers, it becomes a natural advantage for the

hospital.

To reach the consumers, Apollo Hospitals rely mostly on public relations.

Whenever their doctors perform pioneering surgeries or winning awards for

their achievements, they talk to the media and when people come to know

about their achievements they get confidence to go for the services.

INSTRUCTIONAL MATERIALS

Use of traditional approaches like printed materials , ranging from brochers

and instruction manuals to step-by-step instructions are used by hospitals

they also follow printing and making readily available various emergency or

appointment numbers .

AHIC:

AHIC has a patient guide in every patients room which gives patient valuable

information regarding booking, cancellations, various facilities available, what

to expect during the stay, discharge procedure, billing and payment

procedures etc..

They also have a patient education service, wherein brochers regarding the

heart, what the various heart ailments are, what the various heart surgeries or

treatments involve, how heart disease can be avoided by way of healthy

eating and exercise etc.

Almost all the private hospitals have web sites with information for patients,

doctors, facilities available, price for the same etc. One of the most effective

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marketing tool of Jaslok Hospital is a web site (www.jaslokhospital.net), which

is constantly updated by their technical staff.

Brochures and printed material are also available at certain other places.

For ex. Printed material at the blood bank helps educate patients or donors onwhy to donate blood, precautions to be taken before donating blood etc.

CORPORATE TIE-UPS

There are 2 ways of doing this:

Direct Tie- Ups:

Hospitals may either tie-up directly with corporate and offer health check-

ups and treatments at discounted rates to the employees of the corporate

Sometimes free conferences or camps are also conducted for the

employees of corporate by the hospital so as to educate them on prevention of

heart diseases etc. Corporate Tie-ups - entitles executives to consultation and

admission without payment formalities.

The bills are settled directly by the company, simplifying the admission and

discharge procedures for selected employees. Regular correspondence is

maintained with their corporate clients, they are sent brochures and flyers

regularly.

For Example, Breach Candy Hospital has tie-ups with 150 corporate

companies and consulates, Also Hinduja hospital has around 170 Corporate

tie-ups.

The marketing strategy of Jaslok Hospital involves tying up with corporates,

some of them being Oil and Natural Gas Commission (ONGC), Mumbai Port

Trust (MBT), Bhabha Atomic Research Centre (BARC) and Air India.

At AHIC they undertake corporate marketing by approaching various

corporate and inviting them to join their panel. Different packages are offered

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to these corporate such as discounts of 5-10% depending on the strength of

employees, health check ups and programs for employees etc. corporate are

also offered credit facilities i.e. the bill of employees is sent to the company

after 15 days for settlement.

PPOs (Preferred Provider Organization):

They can attract corporate business through PPOs (Preferred Provider

Organization). PPOs have an understanding with corporate and in case an

employee falls sick, the corporate refers the employee to the PPO, which in

turn sends them to the hospital for check-ups and treatments. which brings

them a lot of business and also, helps in promoting the high class quality of

service they provide.

FREE HEALTH CHECK-UPS

This can be an important marketing tool as a patient attending a free health

check up camp or talk at the hospital, goes back with a nice and charitable

image of the hospital. Thus, the next time he is sick, he thinks of coming tothat hospital. Most hospitals feel that if more than 50% of the patients who

attend these free camps turn for further check ups, then organizing the camps

are worth the trouble.

For example Breach Candy Hospital conducts conducts free pediatric camps

and eye camps . They also offer free check ups and free treatment to

outpatients from time to time.

Other marketing strategies of Jaslok Hospital involves that the hospital

conducts free health check-ups like diabetes and cardiac check ups for the

general public.

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CONTINUOUS MEDICAL EDUCATION PROGRAMS/

EXHIBITIONS

Under this, hospitals hold seminars and conferences relating to specific

diseases or latest technology, where they involve the doctors from all around

the country, for detailed discussion. This makes the hospital well known

amongst the doctors, who could in future refer complicated cases to the

hospital.

For example Liver Day was celebrated at Apollo Hospital, which was aimed

at educating and creating awareness amongst children and parents, theyorganized a fashion show and health quiz, which generated a lot of interest

Fortis Hospital at Noida was the first hospital to organise an exhibition in

the National Capital Region, wherein the general public could visit all

departments of the hospital and get answers from experts. Secondly, Fortis

launched a dialysis technician programme for women from the weaker section

of society in which they were given free training by the hospital and they will

be assimilated in the hospital itself.

PRESENCE OF EMINENT PERSONALITIES

In board of trustees:

Many hospitals have eminent personalities from the industry in their Board of

trustees so as to create a sense of confidence in the minds of people.

As Patients:

Celebrities, who, when admitted, are spoken about in the newspapers whichgains a lot of indirect promotion for the hospital. Breach Candys clientele

consists of a lot of celebrities treated which includes the Former Prime

Minister Mr. Vajpayee, Late Mr. Dhirubhai Ambani, Shammi Kapoor,

Shahrukh Khan, etc .

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INTERNATIONAL MARKETING

With medical tourism picking up, hospitals are emphasizing on marketing

themselves in the developed special packages for those overseas patientsand have tie ups with various hotels.

At AHIC International marketing is done by organizing cutting edge medical

programs & inviting foreign doctors to participate in them. Besides, many

members of the surgical & cardiology team hold positions in international

bodies pertaining to cardiac care and are on the editorial boards of

international journals. Some of them are also visiting professors to various

universities abroad.

Also tie-ups with foreign consulates help them make their brand name. For

the same reason Jaslok hospita l has recently tied-up with FICCI to utilise the

potential of this upcoming sector. They are also inviting foreign faculty and

holding joint symposiums with the foreign delegates to share their skills,

knowledge and experience. The hospital has a tie up with Stanford University

Medical Centre, US and they hold video conferencing every month with the

doctors of the centre, who interact with the faculty of their hospital.

BRANDING

A small hospital set-up that caters to the needs of the local community may

not feel the need to create a brand. For them, local identity through word of

mouth is sufficient. However, brand plays a vital role in the growth of

ambitious healthcare service providers like corporate hospitals. The healthcare

industry is moving towards corporatisation.

Unlike other industries, healthcare is highly consumer driven. Since branding

goes parallel to any consumer related activities , hospitals are moving

towards satisfying consumer needs. Therefore, the need of getting branded is

originating from the consumer itself.

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Branding is an empowerment of the Indian healthcare consumer.

Experts feel that without a strong branded customer service, a hospitals

marketing budget is wasted.We live in a very different healthcare world today where the consumer is far

more knowledgeable about the diseases and their choices of treatment.

Institutions which will focus their energies in identifying the needs of their

patients and create seamlessness in the experience of their patients will

become the trusted brands of the community

It is formed by keeping tin mind the following factors :

1. Reputation:

Marketing or brand building may not be a conscious attempt . Brand speaks a

level of reputation. If one has developed a good reputation, this will lead to

creating a brand. When one achieves a superlative reputation, it extends into

a great brand. For instance, institutions like CMC Vellore, Lilavati hospital,

Nanavati hospital have created a strong brand for themselves through their

decades of dedicated service.

2. Exclusivity of the Hospital:

A brand should have some exclusivity and must be built around the vision

that the hospital stands for . Brands should convey this upfront, otherwise it

is futile spending on brand building. Brands communicate in a certain

language.A Hospital should ask oneself- Which language does my hospital speak?

Hospital should find its key strengths and then build its brand based on these

key factors. Factors like service delivery, clinical expertise, and medical

technology help to create an image.

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3. Word of mouth:

This being a promotional technique adds to build a brand. Unlike consumerbrands, healthcare is a very sensitive, personal experience. It depends on a in

a hospital. Brands are established in healthcare through and therefore brand-

building in healthcare is a lengthy process.

4. Patients experience:

Healthcare brands emerge not through advertising but through the power of

patient experience. Hospitals should see things from a patients perspective.

Each patient has different needs. The hospital should

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