Gap analysis: Assess unmet need in the community Assess current utilization of Infrastructure and

Resources Set Targets:

Based on community need Lead to optimum utilization

Strategic approaches to achieve targets Financial viability: what it takes to provide

services/achieve targets and how to meet the expenditure

Assumptions about the environment Assumptions about the Mission Assumptions about the core

competence

Applying it to the “Present” and “Future”

Relevance Standardisation of processes and

protocols Ensure service uptake levels Quality of diagnosis & treatment Patient comfort Outcome

Helps in: Instrumentation Training Patient flow Quality improvements Patient’s understanding & co-operation

10

Performance Addressing challenges Monitoring changes & variations Review effectiveness of the strategies

& introduce necessary changes to programme implementation

Cost Containment

Improve Resourc

e Utilizati

on

Implement Low-cost

Technologies

e.g. Surgeries/SurgeonOperations/bed/year

e.g. Surgeries/SurgeonOperations/bed/year

e.g. Sutures, Eye drops, IOL/Specs, Maintenance

e.g. Sutures, Eye drops, IOL/Specs, Maintenance

Fixed Cost

Variable Cost

Revenue Generation

Self Generate

d

Other Sources

Subsidy/Donation

e.g. Rich patients, Support services, Spectacles

e.g. Rich patients, Support services, Spectacles

e.g. Govt, Local NGO, Community

e.g. Govt, Local NGO, CommunityPatient

Generated

Revenue

Subsidy Other

countries

e.g. Multilateral, Bilateral, INGO

e.g. Multilateral, Bilateral, INGO

Subsidy Nationa

l

Self-reliance Ext. Dependence

Continually refine pricing &management processes

Diversify the portfolio

Sustainability Process

Maximize Revenue

Minimize costs

Revenue > Cost of eye care services

Tension: Social obligation

Tension: Quality & Patient Satisfaction

Scale: Investment in infrastructure, size of the facility and staffing are the major determinants

Efficiency Optimum utilization of the

infrastructure Seasonal variations in patient load Staffing & Staff utilization pattern Productivity

Logistics driven good inventory management group purchasing for better price Good materials management (reduce

wastage in storage & pilferage) Cost engineer your clinical protocol

Eliminating unnecessary investigations, procedures & medications

Hospital’s perspective:

Hospital Charges Medication ??

Patients’ perspective:

Cost of care Transportation Food Lost wages Cost of accompanying

person Family visits Follow-up visits Restrictions

Total Beds: 63 + 100 Total Beds: 63 + 100 •PayingPaying : 40 (22 %): 40 (22 %)•Free walk-inFree walk-in : 23: 23•CampCamp : 100: 100

Location: 80 km, west of Madurai 80 km, west of Madurai Service area populationService area population•Theni DistrictTheni District : 1 million: 1 million•City PopulationCity Population : 111,500: 111,500•Kerala districtsKerala districts : 3.2 million : 3.2 million

55% of population in rural area55% of population in rural areaHuman Resources:Human Resources:OphthalmologistsOphthalmologists : 2: 2ResidentsResidents : 7: 7Clinical staffClinical staff : 37: 37Administrative staffAdministrative staff : 29: 29

Services offered:Services offered:Cataract; Refractive Errors; Cataract; Refractive Errors; Glaucoma; Medical Retina & Glaucoma; Medical Retina & LasersLasers

Patient Fee Strucutre (US$): Patient Fee Strucutre (US$): OP Consultation: OP Consultation: Paying: 1.00; Walk-in: FreePaying: 1.00; Walk-in: FreeCataract: Cataract: •Camp: US$ 0 (- US$ 6)Camp: US$ 0 (- US$ 6)•Subsidized: US$ 17Subsidized: US$ 17•Paying: US$ 30 - $ 380Paying: US$ 30 - $ 380

  PayingFree Hospital

TotalSubsidised  Camp

Cataract Surgeries 2,008 1,841 3,707 7,556Fixed Costs $ 150,630  -    $ 150,630Variable Costs $ 40,965 $ 10,958 $ 35,305 $ 87,228Total Cost $ 191,595 $ 10,958 $ 35,305 $ 237,858Unit Cost $ 95 $ 6 $ 10 $ 32Fee/Subsidy per case 122 12 14  Contribution per case $ 27 $ 6 $ 4  Total Surplus $ 54,216 $ 11,046 $ 14,828 $ 80,090

32%

All Financial figures are in US$

Capital cost: Cost of Land, Building, major equipment, etc

Recurring cost: Ongoing cost of providing the services Fixed Cost: Costs that have to be incurred

regardless of the level of activity Variable cost: Costs that vary directly with

the level of activity Unit cost: (Fixed cost + variable cost) per

unit of service