chapter iii hospital industry -...
TRANSCRIPT
91
CHAPTER III
Hospital Industry
Sr. No. Contents Page No.
3.1 Introduction to hospital industry 93
3.2 Nature and scope of hospital industry 95
3.3 Classification of hospitals 95
3.3.1 Types of management of hospitals 97
3.4 International scenario of hospital industry 99
3.4.1 Global perspective 102
3.5 Hospital industry in India 107
3.5.1Public hospital sector in India 108
3.5.2 Structure of Ministry of Health and Family Welfare 108
3.5.3 Private hospital sector in India 112
3.5.4 Overview of Indian hospital industry 113
3.5.5 Healthcare cities in India 115
3.5.5.1 Delhi city hospitals 115
3.5.5.2 Kolkata city hospitals 116
3.5.5.3 Bangalore city hospitals 116
3.5.5.4 Mumbai city hospitals 117
3.5.5.5 Pune city hospitals 118
3.5.5.6 Hyderabad city hospitals 118
3.5.5.7 Chennai city hospitals 118
3.5.5.8 Goa city hospitals 119
3.5.6 Major players in the hospital industry of India 121
3.6 Current status of hospital industry in Maharashtra 122
3.7 Risk Factors of the Hospital Industry 123
3.8 Challenges in hospital industry 124
3.9 Current status of hospitals in PCMC 126
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Sr. No. Contents Page No.
3.9.1 Demographics of PCMC 126
3.9.2 Geographic information of PCMC 127
3.9.3 Information of Pimpri Chinchwad Municipality
Corporation
128
3.9.4 General information of hospitals in PCMC 128
3.10 Hospital profile 131
3.10.1 Yashwantrao Chavan Memorial Hospital, Pimpri 131
3.10.2 Talera Hospital, Chinchwad 136
3.10.3 Akurdi Municipality Hospital, Akurdi 139
3.10.4 Padmashree Dr. D. Y. Patil Medical College,
Hospital and Research Centre, Pimpri
141
3.10.5 Moraya Hospital, Chinchwad 148
3.10.6 Dhanwantari Hospital, Akurdi 152
3.11 Training and Development System in Selected Hospitals 155
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3.1 Introduction to hospital industry
Hospitals are the focal points of education for the health professionals and clinical research
necessary for advancement of medicine. Thus the hospital is one of the most complexes of all
administrative organizations. The hospital industry is a sector within the economic system that
provides goods and services to treat patients with curative, preventive, rehabilitative, and
palliative care. The modern health care sector is divided into many sub-sectors and depends
on interdisciplinary teams of trained professionals and paraprofessionals to meet health needs of
individuals and populations. The hospital industry is one of the world's largest and fastest-
growing industries. Consuming over 10 percent of gross domestic product (GDP) of most
developed nations, health care can form an enormous part of a country's economy137. For
purposes of finance and management, the health care industry is typically divided into several
areas. As a basic framework for defining the sector the United nations International Standard
Industrial Classification categorizes the health care industry as generally consisting of
1. Hospital activities
2. Medical and dental practice activities
3. Other human health activities
Other human health activities involve activities of nurses, midwives, physiotherapists, scientific
or diagnostic laboratories, pathology clinics, residential health facilities, or other allied health
professions. The global industry classification standard and the industry classification
benchmark further distinguish the industry as two main groups, Health care equipment and
services; and Pharmaceuticals, Biotechnology and related life sciences.
Health care equipment and services comprise companies and entities that provide medical
equipment, medical supplies and health care services such as hospitals, home health care
providers and nursing homes. The second industry group comprises sectors companies that
produce biotechnology, pharmaceuticals, and miscellaneous scientific services.
The hospital is also an organization and an integral part of the social and medical organization,
the function of which is to provide for the population, complete health care, both 'curative' and
'preventive' and whose outpatient services reach out to the family and its environment; the
137http://en.wikipedia.org/wiki/Health_care_industry
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hospital is also a centre for the training of health workers and biosocial research. A modern
hospital is an institution, which possesses adequate accommodation and well qualified and
experienced personnel to provide services of curative, restorative preventive and promotive
characters of the highest quality possible to all people, regardless of race, color, creed or
economic status. It conducts educational and training programs for the health personnel
particularly required for patient care and hospital services. It also conducts research in assisting
the advancement of medical services and hospital services and conducts programs of health
education.
In order to meet all needs, the hospital works through many departments, which deal with
different kinds of services e.g. medical, nursing, pharmacy, laboratory services etc. Among all
these services the nursing service is that part of the hospital which aims to satisfy the nursing
needs of the patient and community. The nursing service is closest to the patients 24 hours of the
day and seven days of the week.
Nursing personnel also usually constitute the largest proportion of the hospital staff. Planning,
organizing, directing and coordinating the individualized care of hospitalized patient is the most
important function of a hospital nursing service. All other nursing functions and activities are
related to it. A hospital may be soundly organized, beautifully situated and well equipped but if
nursing care is not of quality the hospital will fail in its responsibility. Therefore, a study is
conducted to study the organizational structure of Nursing department and nursing service
management in three selected hospitals.
The World Health Organization estimates that there are 9.2 million physicians, 19.4 million
nurses and midwives, 1.9 million dentists and other dentistry personnel, 2.6 million pharmacists
and other pharmaceutical personnel, and over 1.3 million community health workers
worldwide, making the health care industry one of the largest segments of the workforce138. The
delivery of hospital services from primary care to secondary and tertiary levels of care is the
most visible part of any health care system, both to users and the general public. Improving
access, coverage and quality of health services depends on the ways services are organized and
managed, and on the incentives influencing providers and users.
138 http://www.adrm.com/7_healthcareservicesprovider.htm
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3.2 Nature and scope of hospital industry:
Human beings make a society. Healthy human beings make a healthy society. However, every
society has its share of unhealthy human beings. Illness disease and invalidity may be a curse for
society; but their victims certainly are not. They are as much a part of society as the healthiest of
individuals. In the past, an individual afflicted by a wound or disease was condemned to suffer
and fend for himself. In those primitive days, the healthy never assisted or looked after the
afflicted. The practice was to consider such an afflicted person a spent-force and no longer useful
to society. Thus, complete isolation from society was the tragic lot of one who fell in. No attempt
was made to ascertain the causes and suggest cures for ailments. The belief, then, was that illness
was caused either by evil spirits or was a punishment for one’s misdeeds. Later, the ‘tribe’
assumed the responsibility of looking after the sick that were considered victims of a magic spell,
by appeasing or scaring away the evil spirits with a counter-curse.
As civilization advanced from the individual to the family, from family to the tribe and finally to
the organized community, society acknowledged a common responsibility towards the sick. It
was only when civilization progressed then man sought to provide for the welfare of his fellow-
beings (other than his own family). Illness creates dependency. The sick need medical treatment,
nursing care and shelter. With the advent of the modern society, the institution developed to cater
to the needs of the sick was the hospital.
Other approaches to defining the scope of the hospital industry tend to adopt a broader definition,
also including other key actions related to health, such as education and training of health
professionals, regulation and management of health services delivery, provision
of traditional and complementary medicines, and administration of health insurance.
3.3 Classification of hospitals:
The health sector in India comprises of government sector that provides publicly financed and
managed primitive, preventive and curative health services and private sector that mostly
provides curative services and. The private health sector consists of the ‘not-for-profit’ and the
‘for-profit’ health sectors. The not-for-profit health sector includes various health services
provided by Non Government Organizations (NGO’s), charitable institutions, missions, trusts,
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etc. Health care in the for-profit health sector consists of various types of practitioners and
institutions.
Irrespective of the classification of hospital, the primary function of a hospital is the provision of
medical care to a community, to be a centre for education and research for all types of health
professionals.
Hospitals can be classified as per ownership/control, clinical basis, length of stay of patients and
teaching or non-teaching status139. As per ownership basis the hospitals can be public, voluntary,
private and corporate hospitals. The public hospitals can be further classified as Central
Government Hospitals and State Government Hospitals.
Hospitals are classified into different types depending upon different criteria. Hospitals are
divided into:
1. Classification based on objectives
2. Classification based on ownership
3. Classification based on system of medicine
1. Classification Based on type of management and Objectives: Hospitals are classified into
categories based on objectives as follows.
a. General hospitals
b. Specialty hospitals
c. Multispecialty
d. Super specialty
e. Teaching-cum-research hospitals
f. Rural hospital
g. Isolation hospital
2. Classification based on ownership:
a. Government hospitals
b. Semi-government hospitals
c. Voluntary agencies hospitals
139 Goyal R C, (2006).Hospital Administration and Human Resource Management, PHI Learning Ltd, Fourth edition
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d. Private hospitals
e. Charity hospitals
3. Classification Based on System of Medicine
a. Allopathic hospital
b. Ayurvedic hospital
c. Homoeopathic hospital
d. Unani hospital
Hospitals have been classified in many ways. The most commonly accepted criteria for the
classification of the modern hospitals are:
1. Classification based on length of stay of patients
2. Classification based on Clinical basis
3. Classification based on Ownership control basis.
3.3.1 Types of management of hospitals:
1. Government of India: All hospitals administered by the Government of India, viz.
hospitals run by the railways, military/defense, mining, or public sector undertakings
of the Federal Government such as teaching/specialist hospital.
2. State government: All hospitals administered by the state government authorities and
public sector undertakings operated by state such as state university teaching hospitals,
specialist hospitals, general hospitals, comprehensive health centers.
3. Local bodies: All hospitals administered by local governments, viz. the rural and
basic health centers (Primary Health Care Centers), dispensaries.
4. Private: All private hospitals owned by an individual or by a private organization.
5. Voluntary organization: All hospitals operated by a voluntary body/a trust/charitable
society registered or recognized by the appropriate authority under federal/state
government laws. This includes hospitals run by missionary bodies and co-operatives.
6. Corporate body: A hospital ran by a public limited company. Its shares can be
purchased by the public and dividend distributed among its shareholders.
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The level of hospitals and specialties provided in respective type of hospitals are primary,
secondary and tertiary level and are described in Table No. 3.1 as follows140.
Table: 3.1 - Various levels of Hospital
Level of hospital Specialties
Primary-level hospital
District hospital
Rural hospital
Community hospital
General hospital
Internal medicine, obstetrics and gynecology, pediatrics, and
general surgery, general practice; laboratory services for
general pathological analysis
Secondary-level hospital
Regional hospital
Provincial hospital (or equivalent
administrative area such as county)
General hospital
Highly differentiated by function with 5 to 10 clinical
specialties; size ranges from 200 to 800 beds; often referred
to as a provincial hospital
Tertiary-level hospital
National hospital
Central hospital
Academic or teaching or
University hospital
Highly specialized staff and technical equipment such as
cardiology, intensive care unit, and specialized imaging
units; clinical services highly differentiated by function;
could have teaching activities; size ranges from 300 to 1,500
beds
It is well established that the private sector is characterized by heterogeneity. Baru (2003)141
stated that at the primary level it consists of individual practitioners; at the secondary level there
is enormous variation in the size of facilities, number of beds, and types and costs of services.
According to Baru (2005)142 and Muraleedharan (1999)143, the secondary level consists of small
140 Mulligan, J., J. Fox-Rushby, T. Adam, B. Johns, and A. Mills. (2003). “Unit Costs of Health Care Inputs in Low
and Middle Income Regions.” Working Paper 9, Disease Control Priorities Project, Fogarty International Center,
National Institutes of Health, Bethesda, MD. http://www.fic.nih.gov/dcpp/wps/wp9.pdf.
141 Baru R. (2003). “Privatization of health services: a South Asian perspective. Economic and Political
Weekly;38(42): pp.4433–37.
142Baru R. (2005). “Private health sector in india: raising inequities”. In: Gangolli L, Duggal R, Shukla A, editors.
Review of Health Care in India. Mumbai: CEHAT; pp.269–77.
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and large private hospitals or nursing homes, providing outpatient and inpatient care, the
majority with less than 25–30 beds, mainly owned by doctors as sole proprietors. Deosthali and
Khatri (2010)144 stated that tertiary specialty and super-specialty hospitals are mostly trust or
corporate hospitals and comprise only 1–2% of the total beds in the private sector.
3.4 International scenario of hospital industry:
Advancement in medical field, biotechnology, information technology, treatment protocols,
diagnostic tools and pharmaceutical options have allowed for great advances in hospital industry.
Despite all these improvements, hospital industry know that it is still the human resources,
members of the hospital workforce, that have the greatest impact on patient care and that make
the whole system work. The employees are also the largest cost to hospital organizations. Figure
3.1 shows top ten countries having maximum hospitals145.
Figure: 3.1 - World map showing top ten countries with maximum hospitals
143 Muraleedharan VR. (1999). “Characteristics and structure of the private hospital sector in urban India: a study of
Madras city”. Applied Research Paper. Bethesda MD: Partnership for Health Reform Project, ABT Associates.
144 Deosthali P and Khatri R.(2010). “Private health sector in Maharashtra: a study of private hospitals. Mumbai:
CEHAT”.
145 http://www.mapsofworld.com/world-top-ten/world-top-ten-countries-by-hospitals-map.html
100
The various advances in hospital industry have raised the skill level that is required of the entire
hospital employees. Hospital employers are now more likely to seek registered nurses.
The Institute of Medicine’s (2001)146 reported the various ways that the hospital system has
fallen short in terms of quality care and noted that, “If the health care system cannot consistently
deliver today’s science and technology, we may conclude that it is even less prepared to respond
to the extraordinary scientific advances that will surely emerge during the first half of the 21st
century.” Part of the solution is to “manage the growing knowledge base and ensure that all those
in the health care workforce have the skills they need.”
The Indian hospital industry would be worth USD 280 billion by 2020. Its estimated revenue is
USD 30 billion in 2010. During 2010-2015 the Indian hospital service industry is projected to
grow at a CAGR of more than 9%. Medical tourism in India is growing at a CAGR of over 27
per cent during 2009-2012. Medical tourism market is valued to be worth USD 310 million and
is expected to generate USD 2.4 billion by 2012.
Hospitals and Diagnostic centre have received FDI worth USD 786.14 million between April
2000 and April 2010. 1 per cent of India’s GDP is spending on health, whereas France spends
10.4 per cent and Japan spends 8 per cent.
WHO (2011)147 reported percentage of global expenditure on private health care in Russia,
Brazil, China and India. As per the report the expenditure of India on private healthcare among
these countries is very highest, to 81%. This report also stated the status of global healthcare
infrastructure and private expenditure as % of GDP of United states, United Kingdom, India,
China and Pakistan.
This report is describes global expenditure on private healthcare shown in figure 3.2, global
healthcare infrastructure shown in figure 3.3 and private expenditure as % of GDP shown in
figure 3.4 respectively.
146 Committee on quality healthcare in America, Institute of medicine (2001) “Crossing the quality chasm, a new
health system for the 21st century” Washington DC: National academy press.
147 World Health Organization report (2011)
101
Figure 3.2: Global Expenditure on private healthcare
Figure 3.3: Global Healthcare Infrastructure
Figure 3.4: Private Expenditure as % of GDP
0
20
40
60
80
100
Russia Brazil China India
Global expenditure on private health care
0
1
2
3
4
5
United
states
United
Kingdom
India China Pakistan
Global healthcare infrastructure
0
2
4
6
8
10
United
States
United
kingdom
India China Pakistan
Private expenditure as % of GDP
102
3.4.1 Global perspective:
India has 16,000 hospitals approximately when compared to china which has 320,000148. India’s
rising population and income levels along with a growing preference for private health services
over public services, is augmenting the growth of the hospitals market. Table 3.2 shows number
of hospitals in each country and Table 3.3 shows number of physicians and nurses per 10,000
populations.
Table 3.2: Number of Hospitals in each country
Country Hospitals
India 16000
South Africa 276
Brazil 7500
China 320000
Japan 12000
USA 7800
Mexico 1800
Australia 564
Table 3.3: Number of Physicians and Nurses /10000 Populations
Country Physicians/10000 Population Nurses/1000 Population
India 6 13
South Africa 8 41
Iran 9 16
Brazil 12 38
China 14 10
Russia 43 85
USA 26 94
Norway 38 162
Australia 25 97
148http://www.northbridgeasia.com/ResearchReports/Northbridge%20Capital_India%20Hospitals%20Reseach_Mar
ch%202011.pdf
103
India has the lowest number of doctors, nurses for every 10,000 people in comparison with the
other countries. The density of doctors at 6 per 10,000 not including Ayurvedic and
Homeopathic practitioners is expectedly far below the numbers for developed countries. Each
Primary Health Centre have only one doctor and nurse and currently serves on average a
population of 31,000.
Each Community Health centre have 4 specialists – Surgeon, Gynecologist, Physician and
Pediatrician supported by 7 nurses and currently serves on average a population of 170,000. The
shortfall of medical personnel to man the existing CHC’s and PHC’s is - Doctors short by 3,537;
Specialists short by 11,033; Nurses short by 18,021.
According to 2001 population norms, there is still a shortage of 4,477 primary healthcare centre
and 2,337 community healthcare centre. India would require 1.75 million beds by 2025149. Over
6,800 more hospitals are needed in India to provide basic health facilities to people in rural areas.
The various hospitality brands have started aggressive expansion in the country. Some of the
companies that are planning to expand include Anil Ambani’s Reliance Health, Hindujas, Sahara
Group, Apollo and Panacea Group. There is a shortage of 350,000 nurses in India, partly because
many qualified nurses leave for better prospects abroad. The nurse-doctor ratio in India is
1.5:1compared to 3:1 in developed countries. During the last five years rural health sector has
been added with 15,000 health sub-centre and 28,000 nurses and midwives.
Workforce shortages are a particular challenge, as healthcare organizations are finding it
increasingly difficult to fill key positions such as nurses, radiologic technicians and other allied
health jobs. Health resources and services administration (2002) reported the projected shortage
in nurses, which was estimated at 6% (or 1, 10,000 individuals) nationally in 2000 and is
expected to increase to a 12% shortage by 2010 and a 29% shortage by 2020. This shortage is
expected in part because of increased demand due to a growing population, a larger proportion of
elderly persons, and medical advances that heighten the need for nurses.
149http://www.northbridgeasia.com/ResearchReports/Northbridge%20Capital_India%20Hospitals%20Reseach_Mar
ch%202011.pdf
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Thrall (2001)150 reported in a survey sponsored by Hospitals and Health Networks and the
Medical Group Management Association, 86% of hospital executives who responded said that
they were experiencing staffing shortages and that employee recruitment, training and
development is one of their top five issues of concern. Harahan et al (2003)151 in a study of the
nursing home industry in California, administrators and staff said that the “largest obstacle to
delivering high quality care was the need to constantly accommodate vacancies from staff
turnover and a revolving door of new staff .
American Society for Healthcare Human Resources Administration, (2001)152 reported that, the
supply of nurses is decreasing because of the large number of the current nursing workforce that
is leaving the profession (due to retirement as well as personal choice) and because the
enrollment in nursing programs is not keeping pace with the growing demand. In the not-so-
distant past, enrollment did not meet demand largely because hospitals were not appealing to
prospective employees, compared to other work settings. More recently, however, enrollments in
entry-level baccalaureate programs in nursing have increased dramatically – more than 16%
from 2002 to 2003.
According to the American association of colleges of nursing, the constraint that is now
preventing nursing schools from meeting demand is related to capacity. In 2003, more than
11,000 qualified students were turned away from baccalaureate nursing programs due to limited
numbers of faculty, clinical sites, and classroom space. Long term care organizations,
meanwhile, face the challenge of filling Certified Nursing Assistant positions, which are often
seen by current and potential employees as unappealing jobs to hold. In many settings, these
workers feel that they are undervalued, treated poorly by supervisors, and/or provided with little
incentive to remain in such a demanding occupation. The Paraprofessional Health Care Institute
150 Thrall, Terese Hudson, (2001). Leadership: 2001 results are in ! Hospitals & Health Networks.
151 Harahan, Mary F., Kristen M. Kiefer, Anne Burns Johnson, Jan Guiliano, Barbara Bowers, Robyn I. Stone,
(2003). “Addressing shortages in the direct care workforce: the recruitment and retention practices of California’s
not-for-profit nursing homes, continuing care retirement communities and assisted living facilities”. Institute for the
Future of Aging Services.
152 American Society for Healthcare Human Resources Administration, (2001). “Building a framework for
workforce solutions”. American Hospital Association.
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reports that, as a result, the best workers often choose another occupation that offers greater
rewards in terms of salary, benefits, working conditions, or respect (PHI 2003)153.
Another demographic change of concern to healthcare administrators is the growth in the
diversity of the general population, with much of the higher-skilled healthcare workforce not
reflecting this diversity. Healthcare organizations are developing career ladder programs that
help attract new workers and move incumbent workers up to higher skilled jobs. They are
providing on-site degree programs for high demand jobs that are typically free-of-charge to
employees and, in some cases, offered on the employer’s time. They are finding ways to make
learning a part of the organization’s culture so that employees are motivated to participate in
learning activities and are aware of how new skills and credentials can help them advance their
careers internally. And they are using technology and forming partnerships with educational
institutions to help them meet their organization’s learning goals.
Pew (1998)154 observed that when the staff knows the language and cultural mores of the
population they serve, they offer a more complete and effective kind of care. Compounding the
staffing and skills issues are other concerns facing healthcare organizations, such as
reimbursement rates, safety and other regulations, and heightened competition.
To address workforce shortages, skill shortages, diversity needs, and rising cost pressures,
healthcare organizations are increasingly turning to employee learning and development
strategies for the non-physician workforce. Until recently, relatively little attention was paid to
the recruitment, advancement and retention issues of this group. Now, however, the changing
organizational needs require new approaches.
Above all, these organizations recognize that learning and development are critical tools for
helping the organizations to achieve their business goals by enhancing their ability to recruit and
retain a qualified workforce. While learning and development have become important strategies
for changing some organizations and helping them succeed, many organizations are just getting
153 Paraprofessional Health Care Institute, (2003). “Finding and Keeping Direct Care Staff”.
154 Pew Health Professions Commission, (1998). “Recreating health professional practice for a new century”. Fourth
Report.
106
started. Thrall (2001)155 carried a survey of healthcare senior managers showed that many feel
ill-prepared to deal with these workforce issues.
The strategic approach to employee learning and development recognizes that individual
learning and development provide great benefits to the organization. At the same time,
exemplary organizations also recognize that in order for these programs to be successful,
individual employees must want to participate, not take on burdens in doing so, and take
responsibility for setting and achieving their learning goals. There must be a balance of meeting
the organizational needs and individual career goals, and a connection between them. Healthcare
organizations bring the employees into the process by addressing individual circumstances and
needs, letting the employees drive the learning process, and rewarding new skills and credentials
with better pay and/or advancement opportunities.
Healthcare organizations find that partnerships with other organizations are a tremendous asset to
their success and leveraging their resources. The most common partnerships are with
postsecondary institutions such as community colleges and nursing schools, but many
organizations also reach out to the public sector, other healthcare organizations, and even the
larger community, which can be great resources for recruiting and preparing new employees and
for developing new initiatives.
Many of the partnerships are designed to increase basic skills, e.g. literacy, math,
communication, as well as technical skills associated with specific occupations. Healthcare
organizations that have invested heavily in employee learning and development, and that are
using learning programs in a strategic way, want to know whether their efforts have been
worthwhile and where improvements may be needed. Exemplary organizations use a variety of
quantitative and qualitative measurement strategies to assess the impact of their training and
development investments.”
155 Thrall, T. H. & Hoppszallern, S. (2001). “Leadership survey”. Hospitals & Health Networks, 75, pp.33-39
107
3.5 Hospital industry in India:
India officially the Republic of India (Bharat Ganrajya), is a country in South Asia. It is
the seventh-largest country by area, the second-most populous country with over 1.2 billion
people, and the most populous democracy in the world. India is bounded by the Indian Ocean on
the south, the Arabian Sea on the south-west, and the Bay of Bengal on the south-east. It shares
land borders with Pakistan to the west; China, Nepal, and Bhutan to the north-east;
and Burma and Bangladesh to the east. In the Indian Ocean, India is in the vicinity of Sri
Lanka and the Maldives; in addition, India's Andaman and Nicobar Islands share a maritime
border with Thailand and Indonesia156.
Figure: 3.5 - Map of India157
156 http://en.wikipedia.org/wiki/India 157 www.google.co.in/ map of India
108
The hospital segment holds a major share of the healthcare industry and is outpacing the overall
industry growth. The demand for hospital services has been consistently high in the country, with
every class of the society demanding better quality and standards of healthcare. Realizing the
continuous growing demand, many investors worldwide have expressed their keenness towards
investing in the Indian hospital service market. The country is making strides in the right
direction as evident from the 100% allowance of FDI in the hospital segment under the
automatic route, since January 2000. The size of the private hospital industry in India is
estimated to be around US$25billion and growing at a CAGR of 20%158.
According to Indian Hospital Services Market Outlook, the country needs to cover the
cumulative deficit of around 3 million hospital beds to match up with the global average of 3
beds per 1000 population. Hospitals face less competitive competition because there are usually
not many hospitals in a given area and most people are brought to nearest hospital or where they
know a doctor.
3.5.1 Public hospital sector in India:
The public health sector consists of the central government, state government, municipal & local
level bodies.
The Ministry of Health and Family Welfare consist of following four Departments:
1. Department of Health and Family Welfare
2. Department of AYUSH
3. Department of Health Research
4. Department of AIDS Control
3.5.2 Structure of Ministry of Health and Family Welfare:
Department of Health and Family Welfare is responsible for implementation of national level
programs for control of communicable and non- communicable diseases, hospitals and
dispensaries and medical education, the department of AYUSH takes care of promotion of
indigenous systems of medicine such as Ayurvedic, Homeo, Unani, Siddha and ongoing research
in indigenous medicine. The Department of Health Research is mainly concerned with research
in medical and health activities. The Department of National AIDS Control Organization
158 Reference: “Indian Hospital Services Market Outlook” by RNCOS Industry Research Solutions.
109
(NACO) is responsible for planning and implementation of programs for prevention and control
of AIDS.
Health is a state responsibility, however the central government does contribute in a substantial
manner through grants and centrally sponsored health programs/ schemes. There is other
Ministries and departments of the government such as defense, railways, police, ports and mines
who have their own health services institutions for their personnel. For the organized public &
private employee’s sector provision for health services is through the medical insurance.
The role of public sector in providing hospitalization services is quite high. Service statistics
clearly show that public hospitals are overloaded with patients. These public hospitals are not
only the principal service providers for major sections of the urban population, but are also used
by persons from rural areas of nearby districts as well. Public hospitals are usually the major
providers of health care in most developing countries. As all public organizations, they are
susceptible to the inefficiency of the bureaucratic public system. Inadequate funding resulting in
low quality services is another major problem. Public hospital reform toward more autonomy,
alternative funding sources and higher efficiency, is thus one of the major health care reform
strategies. This reform varies from allowing public hospitals to use part or all of the income from
user fees.
Health and health conditions in urban areas are different from the average Indian scenario.
Statistics clearly show that the bed-population ratio is higher in urban areas than in rural areas
and according to Duggal et al, (1995)159 there has not been any significant decline in these
disparities over time. This regional imbalance is there in the public sector and in the private
sector as well. The public spending on health care is also excessively higher in urban areas.
However, it has been scrutinized while critiquing the regional bias whether the urban areas in
India have the required number of public health care facilities.
159 Duggal, R. S.Nandraj and A. Vadair. (1995). Health Expenditure across States– Part–I, Economic and Political
Weekly: 30(15): pp.834-844.
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Gupta and Mitra (2002)160 stated that the high rate of growth of the population has lead to an
over-straining of the infrastructure, and deterioration in public health. The most advanced form
of public hospital reform may be the privatization of public hospitals. Many developing countries
are moving in this direction either by themselves or under the influence of the international
development agencies.
Public hospital reform may have several complications, however. Apart from the inequity in
health care accessibility due to restrictive user fees, human resources for health development is
another important issue of concern for most health reform movers. So public health care
reformers need to carefully plan, implement and assess the implications of public hospital
reform.
The present concerns on human resource development in relation to public hospital reform
mainly focus on management issues, particularly the employment status of hospital civil
servants. These include the issues of salary scale, career path, continuing education/training,
fringe benefits and pension system. Little attention is put on the implications of longer term
issues of human resources planning, production and distribution.
Long term implications on HRD from public hospital reform should be closely monitored and
evaluated together with other issues such as financial sustainability, quality of services,
efficiency and equity. Hospital autonomy is one form of public hospital reform used in some
developing countries.
The National Health Policy161 envisages a three tier structure comprising the primary, secondary
and tertiary health care facilities to bring health care services within the reach of the people. The
primary tier is designed to have three types of health care institutions, namely, a Sub-Centre (SC)
for a population of 3000-5000, a Primary Health Centre (PHC) for 20000 to 30000 people and a
Community Health Centre (CHC) as referral centre for every four PHCs covering a population of
80,000 to 1.2 lakh.
160 Gupta I. and A Mitra. (2002). Basic Amenities and Health in Urban India, National Medical Journal of India,
15(1): pp.26-31
161 National Health Policy, (2002). Government of India
111
The district hospitals were to function as the secondary tier for the rural health care, and as the
primary tier for the urban population. The tertiary health care was to be provided by health care
institutions in urban areas which are well equipped with sophisticated diagnostic and
investigative facilities.
Low public health expenditure continues to characterize the Indian health system and is lower
than 1% of GDP. As a consequence the out-of-pocket burden on households has been the main
source of financing of health care, accounting for 80% of total health expenditure. According to
Duggal (2005)162 and Planning commission report (2006)163, the deterioration of public health
services due to reduced investments and expenditures, is increasingly forcing people to access
health care from the rapidly expanding private sector.
India has the lowest number of doctors, nurses for every 10,000 people in comparison with the
other countries. The density of doctors at 6 per 10,000 not including Ayurvedic and
Homeopathic practitioners is expectedly far below the numbers for developed countries. Each
Primary Health Centre have only one doctor and nurse and currently serves on average a
population of 31,000.
There is a shortage of 350,000 nurses in India, partly because many qualified nurses leave for
better prospects abroad. The nurse-doctor ratio in India is 1.5:1compared to 3:1 in developed
countries. During the last five years rural health sector has been added with 15,000 health sub-
centre and 28,000 nurses and midwives.
There is an increasing number of private and public healthcare facilities and are expected to rise
in demand for the industry accounting for USD 6.7 billion. The health care delivery market in
India is at a nascent stage with high demand and growth potential.
Each Community Health centre have 4 specialists – Surgeon, Gynecologist, Physician and
Pediatrician supported by 7 nurses and currently serves on average a population of 170,000. The
162 Duggal R. (2005). Public health expenditures, investments and financing under the shadow of a growing private
sector. In: Gangolli L, Duggal R, Shukla A, editors. Review of Health Care in India. Mumbai: CEHAT; p.225–46.
163 New Delhi: Planning Commission (2006). Approach paper to the 11th Five Year Plan. Government of India
112
shortfall of medical personnel to man the existing CHC’s and PHC’s is - Doctors short by 3,537;
Specialists short by 11,033; Nurses short by 18,021
3.5.3 Private hospital sector in India:
The private sector in India has a dominant presence in all the submarkets such as medical
education and training, medical technology and diagnostics, pharmaceutical manufacture and
sale, hospital construction and ancillary services and, finally, the provisioning of medical care.
India has witnessed a rapid expansion of the private health sector in the past two decades.
Central and state governments have played a critical role in this growth, by reducing public
expenditure on health, allowing the rising of private medical colleges, giving concessions and
subsidies to charitable trust hospitals to import medical equipment and selling them land to build
new facilities at nominal prices. The vacuum created by the deterioration and even, in some
places, the non-existence of public health services is being occupied by the private health sector,
resulting in an increase in the number of private hospitals. The private sector accounts for nearly
80% of the healthcare market, while public expenditure accounts for 20%. The reasons behind
the growth of private healthcare services include quality medical care, advanced technology,
better service and attractive schemes.
Duggal (2004)164 discussed on issues and challenges in urban health care; that the private
healthcare expenditure is financed through savings, debt, loans and sale of assets, which
highlights need for health insurance and social security. By 2004, nearly 70% of all hospitals and
40% of all hospital beds in the country were in the private sector, but importantly, over 80% of
these were in urban areas.
Rao et.al (2005)165 stated that though there is huge growth in investment in the private sector
across all regions, there is no proper regulation or required standard of care, unlike the public
health sector, which has norms for all facilities, from hospitals to dispensaries. The regulatory
164 Duggal R. (2004). “Urban health care: issues and challenges” Background paper for Urban Community Initiative
– A Development Challenge of the Holy Family Hospital and Tata Institute of Social Sciences.
165 Rao, Nundy SM, Dua A. (2005). “Delivery of health care services in the private sector: financing and delivery of
health care services in India”. National Commission of Macroeconomics and Health background papers. Ministry of
Health and Family Welfare, Government of India. New Delhi.
113
and institutional mechanisms for promoting accountability are weak in both public and private
sectors. Several studies have commented on the variable quality of public services due to lack of
adequate infrastructure, human resources and indifferent public employees.
The growth in the hospital industry is driven by private and public sector, healthcare facilities,
medical insurance sector, medical diagnostic and path labs. It is estimated that nearly 75 per cent
of all the hospitals and 40 per cent of hospital beds in the country are in the private sector.
The private sector provides 60 per cent of all out-patient care in India and as much as 40 per cent
of all in-patient care. Share of private expenditure as a percentage of total expenditure on
healthcare has grown to nearly 80 per cent over the last decade and it is further expected to
increase. Official registration of private hospitals is also low. Due to poor registration, there is no
reliable information on the exact size and nature of the private sector, let alone any data on
quality or cost of care.
3.5.4 Overview of Indian hospital industry:
There is an increasing number of private and public healthcare facilities and are expected to rise
in demand for the industry accounting for USD 6.7 billion. The health care delivery market in
India is at a nascent stage with high demand and growth potential. Figure 3.6, 3.7, 3.8 and 3.9
gives idea about healthcare market in India, private v/s Govt. spending, private hospital v/s
public hospitals and contribution towards health sector (%) in 2012 E 166.
Figure: 3.6 - Health care Market (%) in India
166 Source: Northbridge capital research
45%
35%
20%
Health care market (%)
primary care
secondary care
tertiary care
114
Figure: 3.7 - Private Hospital v/s Govt. Hospital Spending in India
Figure: 3.8 - Private Hospital v/s Govt. Hospital in India
Figure: 3.9 - Contribution towards Health Sector (%) in 2012 E
80%
20%
Private v/s Govt. Spending in India
Private hospital Public hospital
74%
26%
Private v/s Public Hospitals In India
Public hospitals Private hospitals
35
36
15
59
2 31
14
1
Contribution Towards Health Sector (%) in 2012 E
115
Table: 3.4 - Status of Hospital sector in 2010 and by 2012
Parameters 2010 By 2012
No. of Beds 1.2 beds per 1000 Population 914543 In Addition
No. of Doctors 5000000 625130 In Addition
No. Of Nurses 0.8 per Population 836000 In Addition
Infant Mortality Rate 34:1000 10:1000
Maternal Mortality Rate 4:1000 1:1000
% of population Insured 12% 50%
Total Private Spending 690 Million 1560 Millions
OPD Spending 440 Millions 820 Million
Hospitals 30000 Approx 17300 In Addition
PHC/ CHC 150000 Approx 164000 In Addition
Retail Chemist Outlets 350000 24000 In Addition
Medical Colleges 229 179 New
Estimated Current Market Size 1030 Millions 1800 Millions
Average Life Expectancy 63.3 Yrs 74 Yrs
3.5.5 Healthcare cities in India:
3.5.5.1 Delhi city hospitals:
In Delhi 75-80 per cent of the households prefer to use private sector treatment for minor or
major illness. The cost of the treatment in Delhi is 1/5th of the cost in Europe and USA. The
occupancy ratio for private hospital in Delhi is between 70-90 per cent. There are approximately
523 hospitals in Delhi and the total number of beds in the city is in between 33,000 to 40,000
beds. Delhi has approximately 380 private hospitals. Average occupancy ratio for private
hospitals is 70-90%. Occupancy ratio of 60-70% is good enough to break even. So there is a
demand to increase the occupancy ratio which will increase the number of out-patients and in-
patients visiting the hospital/day.
Growth rate is highest in Cardiac and Cancer and it will grow at 14 per cent but there are very
less Cancer and cardiac centers in Delhi. The number of beds/1000 population is 2.2 in Delhi but
the required ratio is 3.96beds/1000 population. In order to reach 3.96beds/1000 population,
approximately 31,000 beds need to be added. The average number of out-patients visiting the
116
hospital /day is about 1,530; and the average number of in-patients admitted/day is 600 in Delhi
for the bed strength of 1000 beds. The average number of out-patients visiting the hospital/day is
about 350 and the number of in-patients admitted/ day is 150 in Delhi for the bed strength of 200
beds. There are 46 private hospitals that are having 100-200 beds and there are 15 private
hospitals that are having more than 200 beds.
3.5.5.2 Kolkata city hospitals:
The average occupancy ratio for private hospital in Kolkata is 75-80 per cent. Medical care cost
in Kolkata private hospital is 1/5th of the cost when compared with that of USA. Kolkata’s
literacy rate is 81 per cent and exceeds the all-India average of 66 per cent. With high literacy
rate and high per capita income there is high health awareness and willingness to spend more.
There are approximately 200 hospitals in the city, and the total number of beds in the city is
20000 to 25000 beds.
The number of beds /1000 population is 1.2 but the world average requirement is 3.96/1000
population. In order to reach the ratio of 3.6/1000 population, approximately 18000 beds needs
to be added. For the bed strength of 700 beds, the average number of out-patients visiting the
hospital/day is about 1200, and the number of in-patients admitted /day is 500. For the bed
strength of 200 beds, the average number of out-patients visiting the hospital/day is about 350,
and the number of in-patients admitted /day is 140. There are 55 private hospitals that are having
100-200 beds and 15 private hospitals that are having more than 200 beds.
3.5.5.3 Bangalore city hospitals:
The average occupancy ratio for private hospital in Bangalore is 70-80 per cent. The cost of
treatment in Bangalore hospitals is 1/5th of that the cost in Europe and USA. Bangalore has
second highest literacy rate i.e. 83 per cent and the per capita income of 0.03 USD million. So
there is better health awareness and willingness to spend. There are approximately 320 hospitals
with the total number of 22,000 beds. It has approximately 212 private hospitals.
The growth for Cardiac and Cancer will grow at 13 per cent, but there are very less Cardiac and
Cancer Centers in Bangalore. The demand for beds/1000 population is 3.96 beds/1000
populations but the supply is only 2.2 beds/1000 population, so in order to reach the demand
approximately 16,000 beds needs to be added. For the bed strength of 700 beds, the average
117
number of out-patients visiting the hospital/day is about 1000, and the average number of in-
patients admitted/day is 420. For the bed strength of 200 beds, the average number of out-
patients visiting the hospital/day is about 290, and the average number of in-patients
admitted/day is 140.
3.5.5.4 Mumbai city hospitals:
Mumbai is primarily divided into 2 regions- city & suburbs. In Mumbai there are 72 government
hospitals and 95 private hospitals. At present, private hospitals in Mumbai have 80-85 per cent
occupancy rate and which could come down in the next five years to 60-70 per cent. Mumbai
may soon face an over-capacity in hospital beds as three new heart hospitals are expected to be
operational in the next 12-18 months and as majority of privately-run hospitals are on an
expansion spree.
There are altogether 539 hospitals in Mumbai. Out of these 48 per cent are nursing homes,
followed by private hospitals. Mumbai has approximately only 37,370 beds for its constantly
rising population. Mumbai hasn't had a new public hospital in decades. Out of 37,370 beds,
11,000 beds belong to BMC and 6,700 beds belong to the state and central governments. Around
21,500 beds belong to private and trust hospitals.
Healthcare demands a ratio of 4 beds per 1000 population. In Mumbai it does not exist and it is
less than 2 beds per 1,000 populations. The world average requirement is 3.96 beds/1000
populations but this should increase to 7 beds/1000 population with the increasing population
and growing healthcare diseases. So, approximately 35,000 beds are needed in order to reach the
ratio of 3.96 beds/1000 population.
The average occupancy ratio for private hospitals is 70-90 per cent. The average number of out-
patients visiting the hospital/day is about 1600, and the number of in-patients admitted/day is
700, for the hospitals having bed strength of 1000 beds.
The number of out-patients visiting the hospital/day is about 400, and the number of in-patients
admitted/day is 200, for the hospitals having bed strength of 200 beds. Mumbai has
approximately only 37,370 beds for its constantly rising population. Out of 37,730 beds
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approximately 17,200 beds belong to private hospitals. There are 26 hospitals in Mumbai having
more than 200 beds and 35 hospitals having 100-200 beds.
3.5.5.5 Pune city hospitals:
The average occupancy ratio for private hospitals is 60-70 per cent. The cost of treatment in
Pune private hospitals is 1/5th of the cost in Europe and USA. There are approximately 360
hospitals within the city and the total number of beds in the city is around 5,500 to 7,000. The
average number of out-patients visiting the hospital /day is about 225, and the average number of
in-patients admitted/day is 120 for the bed strength of 200 beds. The average number of out-
patients visiting the hospital/day is about 111 and the number of in-patients admitted/ day is 60
for the bed strength of 100 beds. The demand for beds/1000 population is 3.96 beds/1000
populations but the supply is only 1.07 beds/1000 population, so in order to reach the demand
approximately 15,500 beds needs to be added.
3.5.5.6 Hyderabad city hospitals:
The cost of treatment in Hyderabad hospitals is 1/10th of the cost in Europe and USA. The
average occupancy ratio for private hospitals is 70-85 per cent. There are approximately 523
hospitals within the city and the total number of beds is around 10,000-15,000 beds in the city.
The city has around 300 private hospitals. The average number of beds/1000 population is 1.75.
In order to meet the demand, approximately 36,000 beds need to be added to reach the ratio of 6
beds/1000 population. The average number of out-patients visiting the hospital/day is around
1,100 and the number of in-patients admitted/day is around 90, for the bed strength of 1,000
beds. The average number of out-patients visiting the hospital/day is around 600 and the number
of in-patients admitted/day is around 33, for the bed strength of 400 beds.
3.5.5.7 Chennai city hospitals:
The cost of treatment in Chennai hospitals is 1/10th of the cost in Europe and USA. The average
occupancy ratio for private hospitals is 75-80 per cent. There are approximately 330 hospitals
within the city and the total number of beds is around 10,000-15,000 beds in the city. The city
has around 220 private hospitals. The average number of beds/1000 population is 1.75. In order
to meet the demand, approximately 36,000 beds need to be added to reach the ratio of 6
beds/1000 population. The average number of out-patients visiting the hospital/day is around
2,000 and the number of in-patients admitted/day is around 90, for the bed strength of 1000 beds.
119
The average number of out-patients visiting the hospital/day is around 600 and the number of in-
patients admitted/day is around 33, for the bed strength of 400 beds.
3.5.5.8 Goa city hospitals:
The cost of treatment in Goa hospitals is 1/8th of the cost in Europe and USA. The average
occupancy ratio for private hospitals is 75-80 per cent. The total bed strength in Goa is 5531
beds. The doctor: Population is 1:636. Population served per bead is 268 and population served
per hospital is 9313. Each hospital covers approximately 24.7 sqkm.
Healthcare players are now targeting smaller cities due to: increasing focus on unexplored
regions of India in terms of healthcare, growing need for improved healthcare infrastructure in
tier II & III cities and even due to better access owing to development of new
national/international airports. Over five lakh beds are required in Tier II and Tier III cities.
Table 3.5 and 3.6 gives information regarding number of different types of hospitals and number
of specialty hospitals in major healthcare cities in India.
Table: 3.5 - Number of hospitals in healthcare cities in India
Type of hospital Delhi Kolkata Bangalore Pune Hyderabad Chennai Goa
Government hospitals 38 20 20 55 23 26 32
Trust hospitals 15 3.2 15 5 6 37 106
Private hospitals 380 72 212 240 300 221 --
Nursing homes 120 10 63 60 194 32 --
Table: 3.6 - Number of specialty hospitals in healthcare cities in India
Type of specialty Delhi Kolkata Bangalore Pune Hyderabad Chennai Goa
Multispecialty 76 35 64 72 80 45 25
Super specialty 38 15 21 24 15 22 7
Single specialty 114 70 85 52 205 154 75
General private 152 50 42 92 -- -- --
120
Figure: 3.10 - Number of hospitals in major healthcare cities in India
Figure: 3.11 - Number of hospitals in healthcare cities in India
0
50
100
150
200
250
300
350
400
Government
hospitals
Trust hospitals Private hospitals Nursing homes
Delhi
Kalkatta
Bangalore
Pune
Hyderabad
Chennai
Goa
0
50
100
150
200
250
Multyspecialty Super specialty Single specialty General private
Delhi
Kalkatta
Bangalore
Pune
Hyderabad
Chennai
Goa
121
3.5.6 Major players in the hospital industry of India :( Reference)167
The various hospitality brands have started aggressive expansion in the country. Some of the
companies that are planning to expand include Anil Ambani’s Reliance Health, Hindujas, Sahara
Group, Apollo Tyres and Panacea Group. Table 3.8 shows major players in the hospital industry
in India.
Table: 3.7 - Major players in the hospital industry
Company No. of beds City
Apollo
Hospitals
Enterprise Ltd.
8,717 Chennai, Madurai, Hyderabad, Karur, Karim
nagar, Mysore, Pune, Mauritius, Noida,
Indore, Kolkata, Delhi, Dhaka, Ranchi,
Aragonda, Kakinada, Ranipet, Visakhapatnam,
Ludhiana
Aravind Eye
Hospitals
3,649 Theni, Tirunelveli, Coimbatore, Pondicherry, Madurai,
Amethi, Kolkata
CARE
Hospitals
1,912 Hyderabad, Vijayawada, Nagpur, Raipur,
Bhubaneswar, Surat, Pune, Visakhapatanam
Fortis
Healthcare Ltd.
10,307 Mumbai, Bangalore, Kolkata, Mohali, Noida, Delhi,
Amritsar, Raipur, Jaipur, Chennai , Kota
Max Hospitals 1,100 Delhi and NCR
Manipal Group
of hospitals
4,400 Udupi, Bangalore, Manipal, Attavar, Manglore, Goa,
Tumkur, Vijaywada, Kasaragod, Visakhapatnam
167 Source: Northbridge capital research
122
3.6 Hospital industry in Maharashtra:
The number of private hospitals in Maharashtra has grown from 68% of the total number of
hospitals in 1981 to 88% in 2001. According to Health information of India (2005)168 rural
Maharashtra ranks fifth in the country for the presence of private doctors in the villages and 15th
among the 28 states for the ratio of number of beds in the public sector to population. Ministry of
Statistics and Program Implementation (1996)169, (2004)170 reported that in Maharashtra, the
increase in utilization of private health services grew from 84% in 1993–94 to 89% in 2003–04.
The report also states that the utilization of public sector hospitals has concomitantly been
declining in several states, including Maharashtra
Figure: 3.12 - Map of Maharashtra state171
168Health information of India (2005). At: <http://cbhidghs.nic.in/hia2005/content.asp>.
169Ministry of Statistics and Programme Implementation, India (1996). National Sample Survey Organization 52 nd
round. New Delhi.
170 Ministry of Statistics and Programme Implementation, India (2004). National Sample Survey Organization 60th
round. New Delhi.
171 www.google.co.in/map-maharashtra
123
A study in Mumbai by Dilip and Duggal (2004)172 reported that though the private sector is
widely used by all classes, it clearly showed the non-availability of public health care services,
which drove the poor to private hospitals, where the cost of treatment was several times higher.
Maharashtra is one of the eight states in India with some law on registration of private hospitals.
The Bombay Nursing Home Registration Act (1949)173 was formulated. Nandraj (1994)174
reported that this act has been poorly implemented.
Padma Bhate et.al (2011)175 concluded that, the number of hospitals with fewer than 30 beds in
the private health sector in Maharashtra has grown over the years without effective regulation or
accountability. Existing regulatory bodies, from the medical councils to consumer courts, have
been largely ineffective. It also reported that the state needs to play a stronger role in regulation
not just of quality of care but also by setting, monitoring and enforcing minimum standards and
determining the scope of the private sector.
It is essential to collect information on health outcomes and quality of care before the state
involves these hospitals further in provision of maternity care. Until this is done, including this
sector in partnerships with the state for providing services such as maternity care, and
particularly emergency obstetric care, may be putting patients at risk and could even end up
regularizing the poor functioning of this sector. This study suggested that the states own
managerial capacity for monitoring public– private partnerships needs to be improved.
3.7 Risk Factors of the Hospital Industry:
1. Hospitals require significant upfront investments and have a long payback period. This
makes investments in the sector less attractive.
172 Dilip TR, Duggal R.(2004). Unmet need for public health care services in Mumbai. Asia-Pacific Population
Journal; 19(2). 173 Bombay Nursing Home Registration Act 1949. Government of Maharashtra. Public Health Department.
Directorate of Health Services.At: <www.maharashtra.gov.in/data/gr/marathi/2003/05/10/20030819165545001.pdf>
174 Nandraj S. (1994) Beyond the law and the Lord, quality of private health care. Economic and Political Weekly;
29(27):1680–85.
175 Padma Bhate Deosthali, Ritu Khatri, Suchitra Wagle (2011) Poor standards of care in small, private hospitals in
Maharashtra, India: implications for public–private partnerships for maternity care www.rhmjournal.org.uk
Reproductive Health Matters. Reproductive Health Matters; 19(37):32–41 www.rhm-elsevier.com
124
2. Finding qualified staff & specialized doctors is a major challenge for hospitals in India
especially for new start ups, leading to wage inflation and inadequate quality
3. Increasing real estate prices lead to higher initial outlay or higher lease payments,
resulting in decreased profitability.
4. Huge capital will be required to meet the growing demand of healthcare facilities and
only a few big business houses can afford such expenditures and have the patience to
reap the steady returns over a long period of time.
5. Increasing cost of equipment and labour lead to margin pressure and lower profitability
and it is also difficult to keep increasing pricing for patient care.
3.8 Challenges to hospital industry:
Healthcare is a labor-intensive industry, with human resources being the most important
component in the provision of healthcare services. However, the sector is severely under-
resourced due to a global skills shortage. The increase in demand for healthcare services has
made the recruiting and retaining of experienced and qualified staff a priority for healthcare
organizations.
Healthcare services are required to manage medical emergencies around the clock. Healthcare
professionals are under pressure to continually improve the services they offer to care for a
growing number of patients - often with inadequate resources. Today, the healthcare industry
faces a range of significant challenges in the delivery of patient care. These include rising
healthcare costs, high patient expectations, resource management, emergency management, long-
term planning and strategic investment. Rapidly escalating healthcare costs are quickly becoming
a key issue in many countries around the world. This is largely attributable to ageing populations
and the increased prevalence of chronic diseases.
Hospitals will always have a community / charitable angle to them so will face constant
government regulation and scrutiny and thus super-profits will always raise eyebrows. Many
hospitals and healthcare providers are struggling with outdated information technology in India
today A major challenge for our nation and the healthcare industry would be not only to retain
the healthcare workforce but also to develop an environment, which would attract those abroad
to return (reverse brain drain) The growing demand for quality healthcare and the absence of
125
matching delivery mechanism pose a great challenge There is an acute shortage of faculty of
medical teachers all over the country. One of the pivotal factors to sustain the projected growth
of the healthcare industry in India would be the availability of a trained workforce, besides
cheaper technology, better infrastructure etc. Another challenge will be to find good talent in
India to provide the ancillary healthcare services; especially the voice based ones which require
not only good English communication skills but also very good analytical skills.
The healthcare industry today faces huge challenges, due to ever increasing demands. The World
Health Report (2007)176 focuses on Global Public Health Security in the 21st Century² It
describes how the world is at increasing risk of disease outbreaks, epidemics, industrial
accidents, natural disasters and other health emergencies which can rapidly threaten global
public health. At present global public health is dependent on international cooperation and the
willingness of all countries to act effectively in tackling new and emerging threats.
According to PWC Report (2012)177 the government initiatives are set as follows:
1. The government plans to build 6 super specialty tertiary care hospitals with research and
education centers across the country. These would cater to the economically challenged sections
and make high-end clinical care available to the masses (but a lot more needs to be done).
2. The government has also undertaken initiatives through its flagship programs such as the
Rashtriya Swastha Bima Yojana (RSBY) and State level Insurance schemes like the Arogyashri
and Chiranjeevi.
3. The Central government is setting up the first specialized device center National Center for
Medical Devices in Gujarat to promote indigenous R&D efforts.
4. Customs duty on life-saving equipment has been reduced to 5% from 25%, and is exempted
from countervailing duty. Import duty on medical equipment has been reduced to 7.5% in the
current budget.
5. The government take on the current compulsory rural stint for medical professionals is that it
should be continued; however it needs to be augmented with better facilities and support system.
176 The World Health Report (2007). A Safer Future: Global Public Health Security in the 21st Century, World
Health Organization
177 Reference: PWC Report, (2012)
126
3.9 Pimpri Chinchwad Municipal Corporation:
Pimpri-Chinchwad is a city in the Pune district in the state of Maharashtra, India. On 4th March
1970 late Annasaheb Magar established Pimpri Chinchwad Municipal Council by merging four
villages namely Pimpri, Chinchwad, Akurdi and Bhosari. It was established in 1982 covering an
area of about 87 square km. It is located to the North-West of Pune and is well connected to the
center of Pune city via the Old Pune-Mumbai Highway (Part of NH 4).Pimpri-Chinchwad is a
subarban area in the pune metro city in the Indian state of Maharashtra. It consists of the twin
towns of Pimpri and Chinchwad which are governed by a common municipal body (the Pimpri-
Chinchwad Municipal Corporation or PCMC). It is located in the west part of Pune City.
This was the Richest Municipal Corporation of Asia. And the reason behind it is that, it has an
industrial belt of small as well as big National & Multinational Companies. It consists of the twin
towns of Pimpri and Chinchwad which are governed by a common municipal body (The Pimpri-
Chinchwad Municipal Corporation i.e. PCMC). In the beginning four villages
Pimpri, Chinchwad, Akurdi and Bhosari were merged into this corporation area.
Pimpri Chinchwad is known by many nomenclatures worldwide. The industrial area of PCMC
was started with the established of Hindustan Antibiotic the first pharmaceutical company in the
year 1954.Widely famous as Industrial Township; it is also recognized as Detroit of the East with
the presence of many national and multinational automobile companies. Blessed with rich
cultural heritage and history, Pimpri Chinchwad is the birthplace of many freedom fighters like
Chaphekar and Halbe. This township is also the birthplace of Ganesh devotee & Saint
MoryaGosavi whose holy tomb is located at Chinchwad.178
3.9.1 Demographics of PCMC:
As of 2011 India census, Pimpri Chinchwad had a population of 1,729,320. Male population is 9,
45,000 and female population is 7, 83,000. Pimpri Chinchwad has an average literacy rate of
87.19, higher than the national average of 74.04%. In Pimpri Chinchwad, 14% of the population
is under 6 years of age. The main language spoken in the town is Marathi. The JNNURM award
for Best Performing City under Sub-Mission for Urban Infrastructure and Governance was given
to Pimpri-Chinchwad.
178 http://www.pcmcindia.gov.in/history.php
127
3.9.2 Geographic information of PCMC:
Table 3.8 gives idea regarding the geographic information of Pimpri Chinchwad Municipality
Corporation.
Table: 3.8 - Geographic information of PCMC
Continent Asia
Country India
State Maharashtra
State Capital Mumbai
Location 191 km. from Mumbai
Area 177.3 Sq. Km.
Time +5.30 GMT
Languages Marathi
Established 11th October 1982
Figure 3.13 and 3.14 shows map of geographic area of Pimpri and Chinchwad respectively179.
Figure 3.13: Map of Pimpri
Figure 3.14: Map of Chinchwad
179 https://www.pcmcindia.gov.in/marathi/location.php
128
3.9.3 Information of Pimpri Chinchwad Municipality Corporation:
The city has seen tremendous growth in the last few years owing to its proximity to the IT hub of
Pune. The existing hospital network has to address the expected future growth of city. Currently
there are 369 registered private hospitals in PCMC region as per 2012 record. A steep increase in
the ownership of private hospitals has been observed over the last five years. Rapid expansion of
the industrial city of Pimpri Chinchwad led to rising demand for health care services. Table 3.9
gives information of PCMC180.
Table: 3.9 - Information of PCMC
Population and area Population
As per 2011 census 17,29,359
Present population (approximate) 20,00,000
Literate as per 2011 census 90.90%
Population in slum 1,34,429
Number of Municipal Hospital 8
Number of Municipal Dispensaries 8
3.9.4 General information of hospitals in PCMC:
Government hospitals in PCMC provide General Hospital Service, Dispensaries Service,
Maternity Hospital Service, Ambulance Service and Blood Bank service. The timings are as
follows:
1. General Hospital Service: Monday to Saturday 9-00 am to 1-00 pm and O.P.D. 24
hours Service
2. Dispensaries Service: Monday to Friday 9-00 am to 1-00 pm, 2-00 pm to 5-00 pm,
and Saturday 9-00 am to 1-00 pm
3. Maternity Hospital Service: Within 24 hours
4. Ambulance Service: On demand 24 hours Service
5. Blood Bank: 24 hours Service
180 http://www.pcmcindia.gov.in/location_info.php
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The hospitals run by the Pimpri-Chinchwad Municipal Corporation (PCMC) are as follows:
1. Yashwantrao Chavan Memorial Hospital (YCMH), Pimpri, Pune
2. Akurdi Maternity Hospital, Main Road Akurdigaon, Akurdi, Pune 35
3. Jijamata Hospital, Pimpri Camp, Kalewadi Raod, Near Delux Cinema, Pimpri,
Pune17.
4. Talera Hospital, Tanaji Nagar, Chinchwad, Pune 411 033.
5. Bhosari Hospital, Bhosari, Pune 39
6. Sanghvi Hospital, Indira Gandhi Maternity Home, Sanghvi.
7. Yamunnagar Hospital, Sec. No. 22, Yamnunagar, Nigdi.
8. Khivsara Patil Hospital, Gujarnagar, Near Sunny tone, Thergaon, Pune 33.
Following figure 3.15 shows the percentage of different types of hospitals in PCMC area. 181
Figure: 3.15 - Percentage of different types of hospitals in PCMC area.
181 Source: Health Department, PCMC
23%
4%
0%
0%
1%
5%
1%
2%46%
6%
6%
3%
3%
Number of hospitals in PCMC
General
Eye
Dental
Neuro
Homeopathy
Ortho
ENT
Maternity & General
Maternity
Maternity & Paed
Paed
Public hospitals
Multispecialty hospital
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In this study researcher has selected six hospitals from that three are public and three are private
hospitals.
Public hospitals:
1. Yashwantrao Chavan Memorial Hospital, Pimpri
2. Talera Hospital, Chinchwad
3. Akurdi Municipality Hospital, Akurdi
Private hospitals:
1. Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri
2. Moraya Hospital, Chinchwad
3. Dhanwantari Hospital, Akurdi
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3.10 Hospital profile:
3.10.1 Yashwantrao Chavan Memorial Hospital:
Yashwantrao Chavan Memorial Hospital is a 750 bedded, multidisciplinary public referral
hospital. Hospital complex consist of 8 storied building with built up area of 5 lack sq. feet,
erected on 10.4 acres of land. YCMH is one of the highly sophisticated & ultra modern hospitals
with numerous hi-tech features which have changed the concept of a public hospital. YCMH has
a galaxy of highly qualified & experienced faculty of specialist/ super specialist medical
professionals along with well trained & devoted Para-medical & technical personnel & well
versed prompt supportive staff. It provides all diagnostic & treatment facilities up to tertiary
level in 16 basic specialties including Dentistry & Physiotherapy (11 treatment modalities)182.
It also provides certain diagnostic & treatment facilities in 8 super specialties such as
Cardiology, Cardiac surgery, Urology, Nephrology, Neurology, Neurosurgery, Pediatric Surgery,
Hand & Plastic Surgery) also available. A separate Trauma care unit backed up by mobile
trauma unit is under progress. Average bed occupancy in all departments is more than 85 %.
Overall daily outpatients are around 1500.
It has round the clock working Pathology with sophisticated investigations & annual turnover of
more than 5 lack tests and diagnostic imaging facilities including 2D - ECHO, Portable USG &
C - arm image intensifier with annual turnover of 60,000 X -rays & 15,000 UGS exams. Some
other notable diagnostic facilities in hospital are free field Audiometry, EEG, A–Scan,
computerized stress test, diagnostic endoscopies as OGD scopy, Bronchoscope, Arthroscopy ,
colonoscopy, Laparoscopy, Hysteroscopy , ERCP etc.
YCMH has 12 OT facilities out of which a complex of 8 OT is with laminar flow, central A.C.
and central compression--suction & medical gases. Annual turnover of operations in all basic &
super specialties is more than 10,000 procedures including Endoscopic surgeries in Gastro
enterology, Gynecology, Orthopedic & Pediatric surgery. Major operations like Whipples, APR,
Oesophagectomy & close heart surgeries are also regularly undertaken in YCMH. The O.T.s of
hospital is best suited for surgical workshops of National & International conferences.
182 Source: Administration Department, Yashwantrao Chavan Memorial Hospital
132
This hospital has well equipped dialysis unit with state of the art dialyses providing treatment to
kidney failure patients at nominal rates. It is highly equipped & well staffed 24 bed general ICU,
6 beds NICU & 3 beds PICU for critical care at nominal or free charges. A 4 bedded dialysis
unit is also functioning in this hospital. It has day & night functioning pharmacy department for
supply of drugs at nominal charges.
It has Round the Clock Blood Bank services at a nearby sister concern with storage centers in
YCMH. It also has round the clock post-mortem examination, other medico legal services,
casualty services in all specialties and Birth & Death Registration services. A separate fully
equipped & well staffed Bio-medical Engineering department for immediate, on the spot, repair
of equipments / machinery to ensure minimal breakdown time. A well equipped & manned
separate Central Sterilization Services Department (CSSD) with steam and ETO sterilizer. It is
facilitated with fleet of twelve vehicles for round the clock & prompts ambulatory services at
very meager charges.
It has a separate well equipped & manned Audio Visual department with spacious conference
hall for CME & other academic activities. The biggest Incinerator in and around Pune for
hospital waste disposal, with a burning capacity of 75 kg per hour which copes with hospital
wastes of entire corporation area.
YCMH is a recognized Teaching institute for various courses as shown under -
1. Urban internship training of MBBS graduates for MUHS.
2. By College of Physicians & Surgeons of Bombay (CPS) for Post Graduate Diploma courses in
12 subjects (50 admissions per term)
YCMH has Life membership of Indian Hospital Association (IHA), New Delhi & Indian Society
for Health Administrators (ISHA), Bangalore, to help keep pace with modern management.
YCMH has a Central Medical Library with wealth of text books, reference books & periodicals
with satellite departmental mini libraries & a spacious reading room. This hospital has facilities
for free access to British Council Library through Institutional membership. Internet facilities are
also available in this hospital. This hospital has a well set Medical Record Section.
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All the diagnostic & treatment facilities at very nominal rates, as evident from per day per patient
running cost of Rs. 1155 /- ( overall running cost 19 crores ) and per day per patient revenue of
Rs. 48 /- only ( overall revenue of 2 crores) during the year 2003 - 2004. The running cost does
not include any capital expenditure or depreciation but consists of only recurring or maintenance
expenditures.
There are residential quarters with necessary amenities for Resident Doctors. This hospital also
provides rate & quality controlled canteen services till late night on all days. Hydro - Pneumatic
water supply, Huge Gen-sets of 600 KV capacity, solar heater system, fleet of 12 lifts and
fully fledged big laundry department are additional & worth mentioning features. Ample parking
arrangement, alluring landscape and spotless & beautified housekeeping - all for making the
environment people friendly in general & patient friendly in particular.
YCMH is one of the few Municipal Hospitals in the country to embark on large scale
computerization as a part of the E-governance drive launched by Maharashtra State. We have
computerized all departments. Free internet hub for accessing medical journals for residents and
doctors on internet available round the clock.
YCMH has newly set up an Artificial Limb center to provide artificial limbs at very nominal
rates to the unfortunate patients who have lost their limbs due to personal calamities. YCM
hospital name has been entered in Limca book of records for conducting 83 hernia surgeries in
record 6 hours and 10 minutes in May 2005.
YCMH has super specialty cardiac centre which is fully equipped with cardiac OT & two labs
which is being managed by Ruby Ail care Services on Public Private Partnership Basis. YCMH
also has a newly set up CT scan unit as well as an MRI machine which provides services at
concessional rates round the clock. YCMH also has advanced in NICU, Casualty /Accident
Service, Security / CCTV cameras, Orthopedic & Joint Replacement.
3.10.1.1 Services available at the cardiac centre are:
a. Stress Test / TMT
b. Holter Monitor
c. 2 D Echo Cardiograph
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d. Colour Doppler Studies
e. Coronary & Renal Angiography
3.10.1.2 Therapeutic services available
a. Coronary & Renal Angiography with stenting
b. Balloon Mitral Valvotomy (BMV)
c. Closed Heart Surgeries
d. Coronary Artery Bypass graft.
e. Repairs of various septal defects
f. A 20 beds cardiac ICU unit working nonstop 24 hrs.
The Pimpri-Chinchwad Municipal Corporation is getting ready to set up its third ICU at YCMH.
The hospital has two ICUs on the first floor, each with 13 beds. The new ICU would be set up on
the ground floor. The new one will also have 13 beds. So, YCM will have a nearly 40-bed ICU
facility, which is unique for any government-run or civic hospital.
YCMH caters to patients not only from Pimpri-Chinchwad, but also from Khadki, Pune city,
Mulshi, Hinjewadi, Talegaon, Dehu Road, Junnar and Khed areas of Pune district. YCM staff is
constantly busy by demands for ICU beds for serious patients from Pimpri-Chinchwad and
beyond. Pune's biggest casualty ward has come up not at a private hospital, but at the civic-run
Yashwantrao Chavan Memorial Hospital in Pimpri.
The hospital, run by the Pimpri-Chinchwad Municipal Corporation (PCMC), has set up a 50-bed
well-equipped casualty ward. The earlier casualty ward had a capacity of just 12 beds. The
government-run Sassoon Hospital which is Pune's biggest hospital has 12 beds. YCMH has now
overtaken Sassoon," he said. Pune's other much-sought after hospital for advanced treatment, the
Aditya Birla Hospital in Chinchwad, also has 12-beds in the casualty. This is because the ICU
charge per day at YCMH is only Rs 500 while it can be up to Rs 10,000 elsewhere, which is not
affordable for even a middle class family.
The YCM hospital which is a 750-bedded hospital had started in 1989 with 50 beds. The
operation theatre, ICU and NICU were set up over the years and in recent times the hospital has
seen massive expansion. The maternity ward has been revamped and the cancer ward added to
provide effective and affordable treatment to patients not only from Pimpri-Chinchwad, but also
135
from nearby areas. YCMH have been able to give the best services because the doctors, nurses
and other staff remained highly committed while putting in their might for providing best
treatment to poor patients who could not afford costly treatment at private hospitals. Municipal
commissioner has planned revamp of medical services and upgrade of periphery hospitals which
further ensures affordable treatment for patients.
Nearly 200 patients are brought to the casualty ward. YCMH take care of each and every patient.
Many of them don't even have the money to pay the bill. For such patients, they either waive the
bill or give them big concessions. Besides increased bed capacity, there are separate clinics in the
casualty ward where specialists from different fields like orthopedics, ENT and accidents would
examine and provide the necessary treatment before they are shifted to the concerned wards. The
new casualty ward however suffers from shortage of nurses and ward boys. YCMH determined
to provide better and advanced treatment to the poor and the middle-class by improving the
facilities at the hospital. PCMC hospitals were supposed to provide basic treatment to patients; it
also ensures advanced treatment.
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3.10.2 Talera Hospital:
Talera hospital is 78 bedded hospitals. The hospital runs by the Pimpri-Chinchwad Municipal
Corporation (PCMC). Average bed occupancy of this hospital is 60. This place comes under
Ward B of Chinchwad gaon, Chinchwad. Total land Area occupied by Talera hospital is of 7380
Sq.mt. Total built up area of Talera hospital is 9081 Sq.ft.
The population that come under Talera hospital zone is 2,48,998. From total population 14137
population lives in Slum. Surrounding Prabhag of Talera Hospital includes 6 wards (12
Corporators) and Prabhag population is 4, 50,000. The proposed new building of Talera hospital
is big and it covers total area of 30,000 Sq.ft. Four dispensaire come under Talera hospital183.
3.10.2.1 Dispensaire which come under Talera Hospital are as follows :
1. Walhekarwadi Dispensary
2. Apghat Dispensary
3. Bijalinagar Dispensary
4. Kiwale Dispensary
3.10.2.2 Existing departments in Talera Hospital:
1. Medicine
2. Obstetrics and Gynecology
3. Pediatric
4. Surgery
5. Skin and VD
6. ENT
7. TB Dept
8. Ortho
9. Physiotherapy
10. Ophthalmic
11. City TB Center, Tuberculosis unit
12. Dental
183 Administration Department, Talera Hospital.
137
Talera hospital is facilitated with 4 Operation theaters and daily 12 operative procedures are
carried in this hospital. Talera hospital determined to provide better and advanced treatment to
the poor and the middle-class by improving the facilities at the hospital. As this hospital comes
under Municipality Corporation, This hospital supposed to provide basic treatment to patients; it
also ensures super special treatment like Surgery, Skin and VD, ENT, TB Dept, Ortho,
Physiotherapy and Ophthalmic.
3.10.2.3 Services provided in Talera Hospital:
1. OPD and IPD services of various specialties
2. General OPD
3. Family Welfare department
4. Birth and Death department
5. Integrated counselling and treatment centre
6. National Aids Research Institute - Centre
3.10.2.4 Supportive services:
1. Blood bank
2. X- Ray and Sonography
3. ECG
4. Pathology Laboratory
3.10.2.5 Strengthening objectives of Talera Hospital :
1. Shifting of various OPD’s, Labs and Administrative dept. physiotherapy, TB centre,
Medical store.
2. To create new wards in old building and to increase bed capacity up to 120 beds.
3. To strengthen Obstretics services i.e. increasing normal deliveries upto 200/month
(Now 100 to 120/month) and Caesarean section upto 50/month (Now 25/month)
4. To strengthen Pediatrics services by creating a seperate Paediatric ward and increasing
admissions.
5. To strengthen Medicine, Surgical and Orthopaedic OPD, IPD and operative services.
6. To provide necessary infrastructure, manpower, equipments and machinery.
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7. Shifting OPD complex to newly constructed Talera building including Lab,
Administrative dept and CTC.
8. Increasing bed capacity upto 120 beds in old existing building.
9. Shifting X- ray dept to newly constructed building
10. To reconstruct existing old building and to develop 150 bedded multi specialty hospital.
3.10.2.6 Future plans of Talera Hospital:
1. Shifting of various OPD’s, Labs and Administrative department to new building.
2. Shifting of physiotherapy, TB centre and Medical store to new building.
3. Utilizing old building OPD area for creation of new wards.
4. Increasing bed strength in Old building by 78 to 120 beds.
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3.10.3 Akurdi Municipality Hospital:
Akurdi Municipality Hospital was established in 1980. The hospital runs by the Pimpri-
Chinchwad Municipal Corporation (PCMC). This is 26 bedded hospitals. Average bed
occupancy of this hospital is 20. This place comes under Akurdigaon. The population that come
under Akurdi municipality hospital zone is near by places in Akurdi and Bhel chowlk. One
Dispensary come under Akurdi municipality hospital i.e. Akurdi Dispensary near Bhel chowlk.
Akurdi Municipality Hospital determined to provide basic treatment to the poor and the middle-
class by improving the facilities at the hospital. Akurdi Municipality Hospital is facilitated with 1
Operation theater as facility of cesarean which is newly started184.
3.10.3.1 Existing departments in Akurdi Municipality Hospital:
1. Medicine
2. Obstetrics and Gynecology
3. Pediatric
4. TB Department
3.10.3.2 Strengthening objectives of Akurdi Municipality Hospital:
1. Developing OPD’s, Labs and Administrative dept., TB centre, Medical store.
2. To create new wards for cesarean delivery
3. To increase bed capacity up to 30 beds.
4. To strengthen Obstetrics services i.e. increasing normal deliveries up to 40 /month (Now
20-25 per month) and Caesarean section up to 5/month (Now 0-1/month)
5. To strengthen Pediatrics services by creating a separate Pediatric ward and increasing
admissions.
6. To support general, Medicine, OPD, IPD and operative services.
7. To provide necessary infrastructure, manpower, equipments and machinery.
3.10.3.3 Services provided in Akurdi Municipality Hospital:
1. OPD and IPD services of various specialties
2. General OPD
3. Family Welfare department
184 Administration Department, Akurdi Municipality Hospital.
140
4. Birth and Death department
5. D.O.T. Tuberculosis treatment
3.10.3.4 Supportive services:
1. Pathology Laboratory
2. Medical store
3.10.3.5 Akurdi Municipality Hospital staff:
1. I/C Medical Officer
2. Senior medical officer
3. Medical officer
4. R.M.O.
5. Sister In charge
6. P.H.N
7. Staff nurse
8. A.N.M
9. M.P.W
10. TB.HV
11. Head Clerk
12. Clerk
13. Lab technician
14. Pharmacist
15. Asst. Store keeper
16. Ward boy
17. Ward Ayaa
18. Safai Kamgar
19. Watchman
20. Safai sevak
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3.10.4 Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre:
Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre established in 1996,
received recognition of the Medical Council of India (MCI), for the award of MBBS degree from
its very first batch. The Dr. D.Y. Patil Vidyapeeth comprising of Padmashree Dr. D.Y. Patil
Medical College, Hospital & Research Centre, has been accorded the status of University under
section 3 of the UGC Act, 1956.
In 2003, the college was permitted to teach post-graduate courses in a couple of subjects. In June
2005, the college was allowed an intake of 81 students in post graduate degree and diploma
courses and presently there are 123 PG-students in the following 19 subjects: General Surgery,
Obstetrics & Gynecology, Orthopedics, Ophthalmology, ENT (Oto Rhino Laryngology),
General Medicine, Pediatrics, Anesthesiology, Psychiatry, Radio-diagnosis, Tb & Chest
Diseases, Skin & Venereal Diseases, Pathology, Community Medicine, Pharmacology,
Microbiology, Anatomy, Physiology and Biochemistry. The college has also been permitted to
conduct super specialty courses in Neurosurgery, Urology and Nephrology.185
These recognitions and expansions granted by the MCI, UGC, MHRD and by the Ministry of
Health & Family Welfare, Government of India are the result of visionary guidance and whole
hearted support of Dr. P. D. Patil, the efforts put in by the faculty and the excellent facilities like
spacious buildings, measuring 4,50,000 sq. ft., large lecture halls, well-equipped laboratories,
well-stocked library, a hospital with super specialty facilities, such as MRI, whole body CT
Scan, ICUs with ventilators, and the equipment required for Neurosurgery, Plastic Surgery, etc.
Besides regular lectures and practicals, the college gives importance to research. Several research
proposals of post-graduate students and of the faculty members are approved and funded by
bodies, such as, Indian Council of Medical Research (ICMR), DST and the Dr. D.Y. Patil
Vidyapeeth, Pune. The MBBS program offered by Padmashree Dr. D.Y.Patil Medical College,
Hospital and Research Center, Pune, is recognized by the Malaysian Government and Malaysian
Medical Council. The International Recognition will enable the students of Dr. D. Y. Patil
Vidyapeeth, Pune, to be appointed as Government Doctors in Malaysia, a unique opportunity to
have international exposure in the field of Medicine. The study is conducted in a 1000 bedded
185 Administration Department, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre.
142
multi specialty teaching hospital. Out of the 1000 beds 500 beds have already commissioned at
present with required parameters.
The hospital provides free services to 30 % of its patients. The hospital provides stainless steel
OT’s, state of the art ICU’s latest diagnosis and imaging facilities supported by 24 hours
emergency care and pharmacy services. The medicine department is functioning outpatient
facilities to treat most of the medical problems including cardiology, neurology, pulmonology
etc. Special clinics like geriatric clinic, diabetology clinic, hyper tension clinic, ayurgram are
also being conducted. Investigation facilities like ECG, Tread mill, radio diagnostic imaging,
ultrasound etc are also available. The hospital also caters to corporate clients such as America
online, Wipro GE, IMC projects, Kodak India etc.
3.10.4.1 Particulars of Hospital:
1. Deputy Medical Superintendent
2. RMO
3. CMO
4. Matron
5. Office Superintendent
6. Bio-Medical Technicians
3.10.4.2 Specialties available:
a. Medicine & allied Specialties
i) Gen. Medicine
ii) Paediatrics
iii) Tuberculosis & Respiratory Diseases
iv) Dermatology, Venereology & Leprosy
v) Psychiatry
b. Surgery & allied Specialties:
i) Gen. Surgery including Paediatrics Surgery
ii) Orthopaedics
iii) Ophthalmology
iv) Oto-rhino- laryngology
143
c. Obstetrics & Gynaecology:
i) Obstetrics Gynaecology
d. Super-specialty
i) Neurosurgery
ii) Urology
iii) Nephrology
3.10.4.3 Distribution of Beds:
This hospital has 1290 total beds. Table 3.10, 3.11, 3.12, 3.13 and 3.14 shows number of
teaching beds and existing units in each specialty.
Table: 3.10 - Number of teaching beds and units existing in Medicine & allied Specialties
department of Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre
(A) Medicine & allied Specialties No. of Teaching beds Existing No. of Units Existing
i) Gen. Medicine 240 8
ii) Paediatrics 160 4
iii) Tuberculosis & Respiratory Diseases 50 2
iv) Dermatology, Venereology & Leprosy 80 2
v) Psychiatry 40 1
Total 570 17
Table: 3.11 - Number of teaching beds existing in Surgery & allied Specialties department
of Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre
(B) Surgery & allied Specialties No. of Teaching beds Existing No. of Units Existing
i) Gen. Surgery including Paediatrics Surgery 240 8
ii) Orthopaedics 150 5
iii) Ophthalmology 80 2
iv) Oto-rhino- laryngology 40 1
Total 510 16
144
Table: 3.12 - Number of teaching beds existing in Obstetrics & Gynecology department of
Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre
(C) Obstetrics & ANC Gynecology No. of Teaching beds Existing No. of Units Existing
i) Obstetrics Gynecology Postpartum 150 5
Total 150 5
Table: 3.13 - Number of teaching beds existing in Super specialty department of
Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre
(D) Super specialty No. of Teaching beds Existing No. of Units Existing
i) Neurosurgery 20 1
ii) Urology 20 1
iii) Nephrology 20 1
Total 60 3
Table: 3.14 - Number of other additional beds existing in Super specialty department of
Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre
i) ICCU 05 vi) PICU 08
ii) MICU 05 vii) Pre-operative 07
iii) SICU 10 viii) Post-operative 10
iv) RICU 02 ix) Burn 02
v) NICU 10 Total : 59
3.10.4.4 Infrastructure Available
1. Reception
2. Registration Counter
3. Spacious OPD Complex each for every specialty with good seating arrangement for Doctors
,waiting hall for patients and relatives
4. Indoor wards – clean, well equipped and manned
5. Free medicines to Indoor and OPD Patients Diagnostic Facilities
6. X-ray
7. Sonography
145
8. C.T. Scan
9. 2 MRI machine
10. Mammography
11. Color Doppler
12. 2 D Echo
13. Special Procedures
14. Central Clinical laboratory working 24 x 7 for
a. Hematology
b. Biochemistry
c. Pathology
d. Microbiology
15. Special Investigation
3.10.4.5 Facilities available:
1. Operation Theater Complex
2. 24 x 7 Casualty Services
3. ICU, ICCU, SICU, PICU, NICU
4. Blood Bank 24x7
5. Medical Store
6. Kitchen - Very good quality food , provided free of cost two times in day
7. Laundry
8. Cafeteria – Available 24 x 7 for staff, patients and their relatives
9. Mortuary facility available 24x7
10. Bio- Medical waste Management
3.10.4.6 Patient charter:
1. Information about treatment:
Patients should get clear explanation of their diagnosis and treatment (and any associated risks),
the associated cost, and other treatment options available. The Doctor / The hospital staff should
obtain patients’ consent prior to any treatment, except in an emergency where it may not be
possible.
146
2. Informed Financial Consent:
Patients should get information about the costs of your proposed treatment, and obtain their
agreement to the likely costs in writing before proceeding with the treatment.
3. Other medical opinions: Patients can ask for referrals for other medical opinions
4. Confidentiality and access to your medical records:
Patients’ personal details are kept strictly confidential. However, there may be times when
information about patients needs to be provided to another health worker to assist in patients care
if this is required or authorized by law. Under the Freedom of information legislation patients are
entitled to see and obtain a copy of their medical records with prior permission from the Hospital
Administration.
5. Treatment with respect and dignity:
While in hospital patients can expect to be treated with courtesy and have their ethnic, cultural
and religious practices and beliefs respected. Patients should also be polite to hospital health care
workers and other patients and treat them with courtesy and respect.
6. Visitors:
In this hospital information is provided about visiting arrangements for patients family and
friends while they are in hospital including family access (and who is considered family),
arrangements for the parents or guardians if the patient is a child, and when their friends can visit
them.
7. Care and support from nurses and allied health professionals:
Nurses and allied health professionals provide vital care and support and are an important part of
patients’ treatment. Staffs who attend patients should always identify themselves and patients
should feel confident to discuss any issues in relation to their treatment or hospital experience
with the health care workers.
8. Hospital Participation in decisions about patient care:
Before patients’ leave hospital they should be consulted about the continuing care that they may
need after their leave hospital. This includes receiving information about any medical care,
medication.
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9. Comments or complaints:
If patients’ are concerned about any aspect of the hospital care, they should raise this issue with
the staff caring for patients or / Hospital Administration.
10. Provide accurate information:
To help doctors / Specialists and hospital staff to provide patients with appropriate care, patients’
need to provide information such as family and medical history, allergies, physical or
psychological conditions affecting them and any other treatment they are receiving or medication
they are taking (even if not prescribed by their doctor).
11. Right to Safety:
Right to safe and hazard free functioning of facilities, services and equipment. Right to safe
practices, safe procedures, safe medication, safe and appropriate food ( if provided) and safe
environment.
12. Right to a Healthy Environment: Right to a healthy and safe environment conducive to
early healing and health promotion, including safe water supply, adequate sanitation,
uninterrupted and stable power supply, safe management of Bio – Medical waste as well as
protection from air pollution, noise pollution and infections.
13. Right to redressal of grievances: Right to a grievance redressal mechanism.
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3.10.5 Moraya Multispecialty Hospital:
Moraya Multispecialty Hospital is an institution under the aegis of Ashwin Medical Foundation,
which is a Public Charitable Trust. By the grace of the presiding deity ‘Moraya Chintamani’, the
Hospital was inaugurated in August 1982 in the premises of the famous ‘Mangalmurtiwada’ in
Chinchwadgaon, Pune 411 033.
With the assistance of four socially conscious doctors, in a short time, Moraya Multispeciality
Hospital took shape from what was previously only an Out Patient Department. Today the very
same Hospital is a renowned name that has gained the trust of just about everybody, not only
from Chinchwad but also from nearby suburban186.
Despite wishing to introduce new facilities and services, the existing premises of the hospital
were inadequate to provide them. In order to build a spacious hospital, the Chinchwad Devasthan
Trust has made available a plot of about 14000 sq. ft. near Chaphekar Chowk on a 99 years’
lease. A two-storied hospital building having bed-strength of 50 has been erected on this land,
which offers various medical and surgical facilities.
Moraya hospital has full flagged 8 bedded Intensive Care Unit boasts of a spacious OPD, Special
Rooms, State of art Operation Theatre, Laboratory, Radiology Department having the facility of
X-Ray, Sonography‚ Color Doppler‚ Mammography‚ 2D Echo‚ Stress Test‚ PFT‚ Yoga
Therapy, Physio Therapy‚ Puva Therapy & Ambulance. Along with conventional Allopathic;
Ayurvedic‚ Panchkarma and Homeopathic Soforology treatments are also available in the
hospital. The OPD, which is open from 8.00 am to 10.30 pm, has 15 departments with 3
specialists assigned to each department. In addition to this there is a 24 hrs Casualty ward, which
is supervised at all times by specially appointed doctors. This hospital is a Government
authorized Centre for M.T.P. & Family Planning Operations. These operations are done at
concessional rates for economically backward patients.
From June 2007, Moraya hospital has started training course of patient’s assistance of Y.C.M.O.
University, Nasik. From 24th January 2010 this hospital has started “Clinical Trial Centre” as
186 Administration Department, Moraya Hospital.
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well as “Soforology & Holistic Healing Centre.” Facilities provided at Moraya hospital are as
follows:
Table 3.15: Facilities provided at Moraya hospital
IPD W/O ICU Panchkarma
ICU Radiology (a) X-RAY
OPD Sonography
Casualty (a) IPD 2 D ECO
General OPD Colour doppler
Bed occupancy % Stress test /PFT
O.T. Mammography
Physiotherapy Speech centre for deaf
3.10.5.1 Social Services of Moraya Hospital:
Moraya Hospital is an institution with a social conscience; hence they are not driven by the profit
motive. Their social efforts are not restricted or limited to their patients only but start from there
and extend into every stream of society. This hospital tries to understand the levels of health
awareness at various levels and how to bring about complete awareness and eradication of
disease. This is done through various services noted below.
They have conducted OPD facility at Vetal Nagar slum area from 1988 to 1994 on trial basis.
The hospital has undertaken a special program for people affected by leprosy. The general
tendency especially in slum areas is to hide this dreaded disease. This program actually seeks to
investigate and find out leprosy patients and to provide the necessary medication treatment and
work towards their total rehabilitation. This treatment is provided totally ‘free of cost’ to half
population of Pimpri Chinchwad corporation. This program, which has been carried out
consistently for the past 18 years, has been granted recognition by the central government,
Maharashtra Government & Pimpri Chinchwad Municipal Corporation.
This hospital conducts free health check up camps in house as well as in surrounding villages;
schools and industries, to facilitate medical aid to maximum number of people. They are also
conducting regular special Speech Training Classes for pre-school, pre-lingual children in the
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age group of 0-6 years under the supervision of specially Trained Teachers for Deaf. This is a
joint venture of Moraya Hospital & Cochlea Pune for Hearing and Speech, Pune. The initial
field work consisting of Survey, Search, Diagnosis, Audiological & Operative Work if any,
distribution of Hearing Aids is done jointly.
To make available every possible medical facility to the underprivileged sections of society
either at the lowest possible cost or even free. Recently hospital has started Sunday OPD for the
Patients below Poverty Line (Yellow Ration Card Holders) as well as the patients Above poverty
Line. This Sunday OPD is named as “Shripati Shastri Memorial Charitable OPD”. Below
Poverty Line (BPL) patients treated free of cost APL (Above Poverty Line) Patients are given
concessional treatment of 60%. The OPD timing is from 10 am to 2 pm on every Sundays.
Simultaneously Moraya hospital has arranged Sunday Lectures Series on different Medical
subjects. The lectures are given by one of the specialist consultants in that subject. Government
pensioners & Senior Citizens are given 10% concession on their OPD/IPD treatment. Moraya
hospital has tie up agreement with Industries for concessional medical treatment to their
employees. Free food is provided to all admitted patients.
“Under Prevention is better than Cure” scheme, we provide concessional package of 7 tests for
Rs. 400/- which includes pathological & diagnostic test with MD Physicians advice. If they need
further treatment the same is provided at concessional rate depending on his economical status.
We offer 25% concession on all Pathological & Diagnostic Tests on OPD basis for yearly
membership of Rs. 150/- only. Moraya hospital is registered under 80G Income Tax Act. Study
Room is provided for students from slum Area. Hospital also provides counseling centre for the
addicted patients to improve their mental health.
3.10.5.2 Hospital culture:
Hospital has adapted some policies to maintain the healthy relation between employees and
employer. Out of 7 Trustees, 2 representatives from employees are taken on Board of Trustees to
have transparency. Group wise monthly meetings are arranged. The employees are taken on
various committees. For day to day smooth working, their valuable suggestions are honored.
Monthly general meeting of employees in presence of Managing Trustee is arranged to provide
them platform for exchanging their thoughts. Agenda at this meeting is given below:
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1. Lecture by Consultant on one of the medical subject.
2. Department wise progress report.
3. Celebration of employees Birthday.
4. Guest lecture
5. Sum up by Managing Trustee.
Moraya hospital provides free food & tea to all employees. It also provides free medical
insurance to 4 members of the family & concessional mediclaim are provided to other relatives
by the hospital. OPD Treatment is free for employees & 50% concession for 4 members of the
family & 25% concession to other relatives. 5/6 Festivals & National days are celebrated &
competitions are conducted among them. Once in a year trip is conducted by Hospital.
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3.10.6 Dhanwantari Hospital:
Dhanwantari Hospital was founded to meet these demands. Inaugurated at the hands of
Honourable Shri.SharadPawar on 3rd March 1987, Dhanwantari had a humble origin as a twelve
bedded hospital. Honorable Shri. Vasantdada Patil & Shri. Vishnupant Patil are our inspiration &
patrons. Dr. Sudheer Patil, Dr. Swarup Patil & Dr. T .Y. Patil are the founder members &
trustees. Dr. Sudheer Patil is Managing Trustee. Motto of this hospital is comprehensive,
dedicated health care under one roof. Standard health care should be available to all, at
affordable cost. A team of experienced, devoted consultants and dedicated staff is striving to
achieve it187.
3.10.6.1 Vision of Dhanwantari Hospital:
To become partners in health promotion of every section of Society.
3.10.6.2 Rural Community Health Services:
Dhanwantari Hospital is 4 storied well equipped hospital, centrally located in Pradhikaran Nigdi,
with a 30 bed capacity. The in-patient accommodation consists of 3 Ac Deluxe rooms, 2 AC
special rooms, 7 Non AC special rooms, 4 semi special rooms with 2 beds each and 3 general
wards with 3, 4 & 5 beds each. There is one conference hall.
This hospital offers consultation and surgery in all major branches viz., General Medicine,
Urology, General surgery, Orthopedics, Paediatrics, Urology, Ophthalmology, Gynecology,
E.N.T., Psychiatry, Gastroenterology, Neurology and Physiotherapy etc.
3.10.6.3 Facilities at Dhanwantari Hospital
1. Well equipped, air-conditioned operation Theatre with air curtain, C-arm
Endoscopy unit, Operative Microscope, monitors, defibrillators, Boyle’s apparatus
Well equipped Labour room
2. ECG
3. X – Ray
4. Ultrasonography
5. 2 – D Echo cardiography with Colour Doppler.
6. Stress Test
187 Administration Deaprtment, Dhanwantari Hospital.
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7. Neonatal Phototherapy & Warmer
8. Electronic fetal monitoring
9. Painless labour
10. Physiotherapy & Rehabilitation
11. Ventilator facility
12. Pathological Laboratory with tie up with thyrocare & Ranbaxy Specialty for
sophisticated investigations
13. Lift facility for physically disabled patients
14. Well trained, efficient & helping Nursing staff, & resident doctors round the clock
15. In house laundry
16. Photocopy machine
17. 50 K.V. Generator and invertors back-up
Thus the hospital can meet the requirements of the patients efficiently on outdoor & indoor basis.
All types of surgeries, including Endoscopic Surgery, Cancer Surgery, Gynecological Surgery,
General Surgery, Orthopedic Surgery, Ophthalmological Surgery, E.N.T. Surgery, Urological
Surgery, Plastic Surgery, and Pediatric Surgery are performed here, but not Cardiac and
Neurosurgery.
3.10.6.4 Pathology Department at Dhanwantari Hospital:
The Pathological Laboratory is attached to Dhanwantari Hospital run by Dhanwantari Medical
Foundation. It is managed & run by pathologist
The lab is fully air conditioned with full generator & inverter backup. The spacious lab has glass
partitioned working area Separated from the seating arrangement for patients. The working of the
lab in form 8.00 am till 10.00pm & all night emergencies are attended to. Samples from O.P.D,
I.P.D of Dhanwantari Hospital as well as from other Private Practitioners are processed.
All types of routine haematology, biochemistry, microbiology, parasitology investigations are
done in the lab & specialized tests are outsourced to renowned recognized labs.
The Lab has instruments viz:
1. Fully automated haematology Cell counter
2. Fully automatic electrolyte analyzes
3. Semiautomatic biochemistry blood analyzer
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4. Semiautomatic biochemistry blood analyzer
5. Calorimeter
6. Glucometer
7. Incubator & Oven
Expected soon:
1. ELISA reader
2. Fully automatic biochemistry analyzer
3.10.6.5 Charity for Economically Weaker Sections of Society:
We provide treatment at concessional rates or free of cost if required, to the economically weaker
sections of society. Providing financial assistance to charitable organizations working for
underprivileged & physically handicapped people is also undertaken by the trust.
3.10.6.6 Information about Indigent and Weaker Section Patients:
Kindly request you to contact administration dept. of Dhanwantari Hospital for getting more
information about indigent and weaker section patients
3.10.6.7 Future Plans:
1. Ambulance Services:
In medical emergencies, the leading cause of morbidity and mortality is delay in calling
for assistance, followed by inadequate or delayed treatment within the “Golden
hour” i.e. in the first hour of the incident. In order to make available essential emergency
medical care in that critical period, hospital envisage setting up a 24 hour well equipped
ambulance service based at Dhanwantari Medical Foundation.
2. Community Outreach Program: In accordance with our goal of providing
comprehensive healthcare to all sections of society, we propose to supplement our
ongoing efforts for the weaker sections through partnership with local NGO’s enabling us
to reach out to those who need but cannot avail of our services.
This long term commitment of Dhanwantari hospital towards ensuring and uplifting public
health is a step leading to a better tomorrow.
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3.11 Training and Development System in Selected Hospitals:
Mostly two types of training programs are implemented one is employee training program and
executive training program. It was observed that most of the hospitals conduct technical and
behavioral training programs.
Table 3.16: Technical training Programs adopted in Hospitals
Sr. No. Technical training
1. Special instruments handling
2. Operation theatre management
3. Sterilization techniques
4. Radiation protection guidance
5. Mass casualty incident handling training
6. Hospital Waste Management
7. Maintenance of operation theatre
Table 3.17: Behavioral training Programs adopted in Hospitals
Communication Skills Time Management
Personality Development program Team building
Customer service Leadership skills
Career development Problem solving skills
Ethical training Decision making skills
Human relations Patient handling skills
Mass casualty accident management Stress tolerance
Safety training Quality initiatives
Diversity training Risk management
Having studied international, national and state level scenario of hospital industry, information of
hospitals in Pimpri Chinchwad Municipality Corporation and the profiles of hospitals under
study, the next chapter let us look at the data analysis and interpretation.