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PROBLEMS AND PROSPECTS OF HEALTHCARE INDUSTRY IN GUJARAT

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CHAPTER 4

PROBLEMS AND PROSPECTS OF HEALTHCARE

INDUSTRY IN GUJARAT

4.1 OVERVIEW

Gujarat Population Census Data shows that i t has Total Population of

6.04 Crore which is around 4.99% of total Indian Population. Literacy

rate in Gujarat has seen rising tendency and is 79.31% as per 2011

population census. Of that , male li teracy stands at 87.23% while female

literacy is at 70.73%. Urban Population of the State is 42.6%, which

used to be at 37.4% in 2001. Rural population in the state in 2011 fell

to 57.4% from 62.6% in 2001. At present the state has 33 districts (226

talukas, 18,618 villages, 242 towns)

TABLE 4.1

Demographic, Socio-economic and Health Profile as compared to India

Indicator Gujarat India

Total population (In crore) (Census 2011) 6.04 121.01

Decadal Growth (%) (Census 2011) 19.3 17.64

Infant Mortali ty Rate (SRS 2013) 38 42

Maternal Mortality Rate (SRS 2010 -12) 122 178

Total Fertility Rate (SRS 2012) 2.3 2.4

Crude Birth Rate (SRS 2013) 21.1 21.6

Crude Death Rate (SRS 2013) 6.6 7.0

Natural Growth Rate (SRS 2013) 14.4 14.5

Sex Ratio (Census 2011) 919 943

Schedule Caste population (in crore) (Census 2011) 0.40 20.1

Schedule Tribe population (in crore) (Census 2011) 0.89 10.4

Total Literacy Rate (%) (Census 2011) 78.0 73.0

Male Literacy Rate (%) (Census 2011) 85.8 80.9

Female Literacy Rate (%) (Census 2011) 69.7 64.6

Source: Health Infrastructure, 2015


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Country has entered a high growth rate route of 9 per cent. This high rate of growth, though, is not accompanied by a

high level of societal growth. The social sectors predominantly health and education have been accorded a very low

concern in terms of the distribution of resources. For example, public expenditure on health services as a percentage of

Gross Domestic Product (GDP) in country is less than 1 per cent possible to be one of the lowest across the world.

Table 4.2

Trends in Health Expenditure in India

Generally trend in the Plan expenditure incurred vis -a- vis the Budget Estimates during the Two years of the Twelfth

Five Year Plan for Department of Health and Family Welfare is given below. ( Rs. in Crore)

Plan Period Budgetary Estimates (BE) Expenditure

Health NRHM/

NHM

RSBY Total Health NRHM/NHM Total

2011-12 75145.29 193405.71 -- 268551.00 -- -- --

2012-13 6585.00 20542.00 -- 27127.00 4145.40 16762.76 20908.16

2013-14 8166.00 20999.00 -- 29165.00 4202.93 18266.48 22469.41

2014-15 8733.00 21912.00 -- 30645.00 5645.36 18039.30 23684.66

2015-16 6254.00 18295.00 -- 24549.00 3624.90 14786.29 18411.19*

2016-17 10800.00 19000.00 1500.00 31300.00 -- -- --

* Expenditure figures are provisional as on 31st December, 2015


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The Twelfth Five Year Plan Central Government lay out for Health &

Family Welfare Department has been increased by about 113 per cent

to Rs. 2,68,551 crore compared to the expend of Rs. 1,25,922.22 crore

in the Eleventh Five Year Plan. The 12th Five Year Plan envisages

flawless combination of the health services in the Primary, Secondary

and Tertiary sectors, with power on intensification the primary health

care delivery services. In addition to this, the plan also envisages for

achieving universal health reporting for the population and in line with

the abovementioned objective of achieving universal health coverage,

the Department has launched the National Health Mission with a vision

to enabling Universal access to fair, reasonable and quality health care

services which is both responsible and approachable to people’s needs.

The remarkable gains made by NRHM, and other disease control

programmes, are currently being built upon to deliver Universal Health

Care (UHC) in all urban and rural areas during the 12th Plan period.

Gujarat offers holist ic medicinal services and cost effective treatment

through various district hospitals, sub -district hospitals and private

specialty hospitals. Most wanted after Super–Specialties in state

contain Cardiology, Neuro – Surgery, Orthopedics, Infert ility

treatment, joint replacement and eye surgeries. Share of primary care

in total healthcare promote of Gujarat is approximately 75-80%.

Market for tert iary care estimated to develop at a earl ier speed, due to

increase in income levels, increasing implementation of health

insurance and increase in difficult in-patient ailments (heart diseases,

kidney ailments, cancer)

The healthcare setting in Gujarat is shifting speedily. The accessible

medical infrastructure and straightforwardly available healthcare

services have better the health of the population of the state extremely

over the years. Gujarat is connecting in provisions of quantity of

hospitals, healthcare centers, beds and is anticipated to carry on a

encouraging movement in future. Doctor to patient portion is 1:10 and

nurse to patient proportion is 1:5 – The state Government is taking


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numerous initiatives to make state a Global Healthcare Destination.

Through use of modern technical equipment, improved health

insurance, major corporate investments and services of extremely

experienced medical personnel, the Gujarat healthcare sector is

balanced sound for a continuous explosion.

Health Education and Research

Medical Colleges in Gujarat

1. MBBS 21 (9 Govt., 5Trust & 7 Grant -in-aid)

2. Homeopathic 17 (4 Grant-in-aid & 13 private)

3. Ayurvedic 10 (4 Govt. 1 University, 2 Grant -in-

aid & 3 Private)

4. Dental 13 (2 govt. & 11 Private)

5. Physiotherapy 32 (5 Govt. &27 Private)

6. Nursing (from GNM to

M. Sc.)

66 (24 Govt. & 42 Private)

7. Pharmacy 115 (6 Govt. , 14 Grant -in-aid &•

Private)

Key Education Centres

Insti tute of Kidney Disease and Research Centre (IKDRC)

Gujarat Cancer Research Institute (GCRI)

Government Medical College, Vadodara

U. N. Mehta Cardiology Research Institute

B. J. Medical College, Ahmedabad

Gujarat Ayurvedic University, Jamnagar

Pramukh Swami Medical College, Karamsad, Anand

Nathiba Hargovinddas Lalbhai Medical College, Ahmedabad

Surat Municipal Institute of Medical Education & Research

4.2 DRIVERS OF THE HEALTH SECTOR:

1. Holistic Wellbeing


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Hospitals and wellness centers now looking at a completely and

holistic approach towards treating their patients Naturopathy or nature

cure is completely developed and scientific system which uti lizes the

scientifically planned nutritional standard in arrangement with Yoga

and physiotherapy for physical and mental health.

Wellness centers- as centers of holistic well -being in Gujarat

Kalpa Sidhi Health, Ahmedabad

Life Care, Ahmedabad

Mind Body Zone, Vadodara

Reiki, Grandmaster, Vadodara

Gujarat Ayurvedic University, Jamnagar

Kudrati Upchar Kendra, Amreli

Services offered in wellness centers in Gujarat

Diet and nutrition

Gym and fitness

Yoga

Herbal medicine

Healing touch therapy

Stress Management including

relaxation, and meditation

Reiki

Acupuncture

Acupressure

Pranic and crystal healing

Magneto therapy

Aroma Therapy

2. Moving Up The Value Chain

The healthcare sector in Gujarat has motivated the importance by

imbibing the international best practices to deliver flawless patient

care of top quality

Most important corporate hospital groups such as Sterling, Apollo,

Fortis , Wockhardt have made major investments in set up state-of-

the-art hospitals in major cities of Gujarat

Better highlighting on education, research and development


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APOLLO tyres-promoted Artemis Heal th Science is finalising

strategy to set up a INR 500 crore medical education centre on the

Surat Baroda- Ahmedabad highway in Gujarat

The medicity envisions a research centre, a medical college, nursing

college, pharma college, medical administration coll ege and a

hospital which will have more than 500 beds

Bombay Hospitals has signed an MoU during Vibrant Gujarat 2007

to establish a medical institute with Multi speciality Hospital to

recommend under graduate and post graduate courses

3. Health Insurance

Health insurance policy not only covers expenses incurred during

hospitalization but also through the pre as well as post hospitalization

stages like money spend for conducting medical tests and buying

medicines.

Integrated insurance scheme, Gujarat

This Community based Health Insurance Scheme is run by the non -

government organisation (NGO) Self -employed Women Association

(SEWA), based in Ahmedabad, Gujarat

One of i ts primary performance is provided that financial services

for women and this was widened in 1992 to consist of health

insurance as part of a wider insurance package with life, accident

and asset insurance

The scheme covers:

(i) Inpatient care

(ii) Hospitalization cover, in addition to one-time payment for

denture and hearing aid. Members can utilize any type of

hospital , public private or trust.


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(iii) Delivery profit for fixed deposit members.

There is a limit on compensation of Rs. 2,000 per year. At the time

of discharge, the member must give for the bill and apply for refund

from the scheme

The scheme is managed by SEWA which purchases medical

insurance from a Government Insurance Company subsidiary

National Insurance Company (NIC) and ICICI Lombard.

Employees State Insurance Scheme, Gujarat

Each individual after joining an insurable employment, after

implementation certain rules and regulations , is issued an identity

card which has all necessary details i .e. name, insurance no. of the

IP, dispensary and local office to which he is attach and names of

his/her family members.

This card is a very essential document and has to be shown while

obtaining medical benefits

Beneficiaries can claim treatment at the dispensary/clinic of the

IMP to which he/she is allotted on the construction of the certificate

Total number of beneficiaries are approximately 5,14,000

Private players in Gujarat

Bajaj Allianz Health Insurance Company Limited

TATA AIG General Insurance Company

Vysya life Insurance Company

National Insurance Company Ltd.


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Public Private Participation (PPP) in Gujarat

122 grant in aid Hospitals.

Shamlaji Hospital located in tribal area of Sabarkantha

5 CHCs (Malav, shamlaji , Rajsitapur, Mota Phospholiya, Golagandi)

and 4 PHCs (Chansad, Dahej, Khoreli Mata no Madh)

Centre of Health, Education, Training and Nutrition Awareness

(CHETNA) has been actively suppor ting a total of 23 Mother NGOs

and 4 Service NGOs working effectively to implement Reproductive

and Child Program (RCH)

Out sourcing of MRI services to a CBO in Surat

PPP for Maternal and Child Health Services under Chiranjivi Yojna

and Bal Sakha Yojna

Hyderabad based Emergency Medical Research Institution (EMRI)

with the Gujarat Government will take care of road and fire accident

victims on a 24-hour basis through the year by just dialing 108

Assisted Reproductive Technology (ART) clinics by private

organizations.

Sarva Swastha Abhiyan (SSA, an NGO dedicated to taking quality

healthcare to inaccessible areas) has opened 10 centres in five

predominantly tribal areas of Idar, Prrantij, Bardoli, Hansot and

Mundra that will be connected through telemedicine to super

speciality hospitals at Ahmedabad, Nadiad, Vadodara and Surat.

Surat setting-up of Medical Colleges in PPP mode at Bhuj.

The challenges opposite to Health Care Organizations and Health Care

Professionals at present are more difficult than at any other time in our


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history mainly contained by the si tuation of globalization and social ,

political and economic changes.

4.3 HEALTH INFRASTRUCTURE (GUJARAT)

Table 4.3

Number of Sub-Centers, PHCs & CHCs Functioning

No. State/ UT Sub

Centers

Primary

Health

Centers

Community

Health

Centers

1 Uttar Pradesh 20521 3497 773

2 Rajasthan 14407 2083 568

3 Maharashtra 10580 1811 360

4 West Bengal 10357 909 347

5 Bihar 9729 1883 70

6 Karnataka 9264 2353 206

7 Madhya Pradesh 9192 1171 334

8 Tamil Nadu 8706 1372 385

9 Gujarat 8063 1247 320

10 Andhra Pradesh 7659 1069 179

All India 153655 25308 5396

Source: Rural Health Infrastructure, 2015

All over India, out of 153655, 25308 were primary health centers and

5396 were community health centers.


9

Now, when we deliberate in our study area i.e. Gujarat stands 9 t hrank

among all states with 8063 sub-centers . Gujarat has 1247 and 320

PHCs and CHCs among 25308 and 5396 respectively all over India.

Table 4.4

District Wise Availability of Health Centre in Gujarat

(As on March 2015)

District Sub

Centers PHCs CHCs

Sub-

District

Hospital

District

Hospitals

Ahmedabad 214 37 10 1 0

Amreli 247 39 12 3 1

Anand 274 48 11 0 1

Aravali (Modasa) 215 35 10 1 0

Banskantha 468 91 21 1 1

Bharuch 222 38 9 0 1

Bhavnagar 297 43 13 2 0

Botad 87 14 5 0 1

Chootaudepur 310 45 10 1 1

Dahod 637 85 13 1 1

Devbhoomi

Dwarka

107 17 4 1 0

Gandhinagar 171 25 9 1 0

Gir Somnatah

(Veraval)

158 23 8 1 0

Jamnagar 152 24 6 0 0

Junagadh 232 36 10 0 0

Kutch- Bhuj

(Kachchha)

285 44 15 2 0


0

District Sub

Centers PHCs CHCs

Sub-

District

Hospital

District

Hospitals

Kheda 279 46 11 1 1

Mehsana 288 55 14 2 1

Mahisagar

(Lunavada)

222 32 5 1 1

Morbi 136 19 5 1 0

Narmada 174 24 3 1 1

Navsari 296 44 10 2 1

Panchmahals 279 46 10 0 1

Patan 210 36 15 1 0

Porbandar 84 11 4 0 1

Rajkot 240 34 11 4 1

Sabarkantha 276 42 12 1 1

Surat 394 53 14 0 0

Surendranagar 195 37 11 2 1

Dang 68 9 3 0 1

Vadodara 242 40 10 0 1

Valsad 363 45 11 1 0

Tapi 241 30 5 0 1

Total 8063 1247 320 31 21

Source:Rural Health Infrastructure, 2015

Here, out of 33 districts of Gujarat , there are 8063 sub centers of

health are available in which Dahod district has 637 highest sub

centers and Dahod district has only 68 which is lowest. In the same

way, with 91 PHCs Banaskantha district has highest PHCs and Dang

has lowest i.e. only 9 and in case of CHCs Banaskantha has highest 21

and Dang with 3 CHCs lowest.


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Other than this only 31 sub-district hospitals and 21 district hospitals

are there.

Table 4.5

Shortfall in Health Infrastructure

As per 2011 Population in Gujarat (as On 31 s t March, 2015)

No. Particulars In Gujarat In India

1. Total population in Rural

Areas 34694609 833748852

2 Trible Population in

Rural Areas 8021848 93819162

3. Sub Centers Required 8008 179240

In Position 8063 153655

Surplus * 35145

% of

shortfall * 20

4. Primary Health Centers Required 1290 29337


Surplus 43 6556

% of

shortfall 3 22

5. Community Health

Centers Required 322 7322


Surplus 2 2316

% of

Shortfall 1 32

Source: Rural Health Infrastructure, 2015 * As on 31 s t March, 2015

As per 2011 population in India the total population in rural area is

833748852 in India and 34694609 at Gujarat level and in Trible


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population in rural areas is 93819162 at India level where as 8021848

in Gujarat.

According to the population at India level there are 179240 sub

centers, 29337 PHCs and 7332 CHCs required, while as compared to

Gujarat state 8008 sub centers, 1290 PHCs and 322 CHCs are required.

But the actual situation is 153655 sub centers, 25308 PHCs and 5396

CHCs are in position at India level. As compared to Gujarat 8063 sub

centers, 1243 PHCs and 320 CHCs are in position.

So in Gujarat the sub centers are working more than required so there

is no shortfall of sub centers but in PHCs 3% of and in CHCs 1% of

shortfall is seen. Whereas 20 % of sub centers, 22% in PHCs and 32 %

of CHCs is seen at India level.

Table 4.6

Building Position for Sub Centers, Primary Health Centers &

Community Health Centers in Gujarat

No. Particulars Sub

Centers

Primary

Health

Centers

Community

Health

Centers

1 Total No. of Centers

Functioning

152326 25020 5363

2 Government Buildings 102319 20521 5028

3 Rented Buildings 34346 953 90

4 Rent Free Panchayat/ Vol.

Society Buildings

15661 1663 245

5 Buildings Under Construction 10349 1283 314

6 Building Required to be

Constructed

39658 1509 172



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As per the Rural Health Infrastructure total 152326 sub centers, 25020

PHCs and 5363 CHCs functioning in India out of which 102319 sub

centers, 20521 PHCs and 5028 CHCs are government buildings.

Also 34346 sub centers, 953 PHCs and 90 CHCs are taken as rents

while 15661 sub centers, 1663 PHCs and 245 CHCs are taken as rent

from panchayat or society.

Besides all this remaining buildings are under construction or required

to be constructed.

Other than buildings some more basic infrastructure facilities for their

smooth functioning requires amenities like elec tric supply, water

supply, computers, operation theaters, labour rooms, beds, machineries,

transportation, pharmacy, etc.

Table 4.7

Facilities Available at Sub Centers in Gujarat

No. Facilities Gujarat India

1 No. Of sub centers functioning 8063 153655

2 No. of sub centers with ANM Quarter 5212 84078

3 No. of Sub centers with ANM living in

sub centers Quarter

65212 54939

4 No. of sub centers functioning as per

IPHS norms

7274 31742

5 No. of sub centers without regular

water supply

0 43695

6 No. of sub centers without electric

supply

0 39295

7 Without all-weather motorable

approach road

0 17250



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There are 8063 sub centers functioning in which 5212 with the

facili ties of ANM Quarter in Gujarat65212 sub centers with ANM

living in sub centers Quarter and 7274 functioning as per IPHS norms.

As compared to India level Gujarat have regular water supply, electric

supply and motorway road.

Table 4.8

Facilities Available at PHCs in Gujarat


1 No. of PHCs functioning 1247 25308

2 With Labour Room 1123 17815

3 With Operation Theater 1158 9875

4 Without least 4 beds 1123 17796

5 Without Electric supply 0 1107

6 Without Regular water supply 0 1773

7 Without all-weather motorable

approach road

0 1756

8 With telephone 1158 13276

9 With computer 1158 14293


PHCs require some basic infrastructure facilities for their smooth

functioning. It requires building with necessary facilit ies like

electricity supply, water supply, communication, computers, OT,

labour rooms beds etc.

In India 2508 PHCs are functioning, in which 1247 are from Gujarat.

At India level there are 1107 PHCs having without electrical supply

and 1773 without water supply centers. In Gujarat there are 1153 PHCs

having telephone and computer facili ties.


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In Gujarat there are 1123 PHCs having less than 4 beds as against

177796 at India level. This shows that PHCs in Gujarat are in better

working condition with sufficient facilities.

Table 4.9

Facilities Available at CHCs in Gujarat


1 No. of CHCs functioning 320 5396

2 With all four specialties 86 751

3 With Computer/ Statistical assistant for

MIS/ Accountant

3018 4224

4 With functional laboratory 318 5024

5 With functional Operation Theater 305 4473

6 With functional Labour Room 305 4913

7 With functionally stabilization units for

new born

135 1862

8 With new born care corm 144 4244

9 With least 30 beds 318 3933

10 With functional X ray machine 253 2707

11 With quarter for specialist Doctors 65 2613

12 With specialist doctors living in quarter 28 1721

13 With referral transport available 318 5022

14 With registered RKS 297 4925

15 Functioning as per IPHS norms 100 1420

16 Allopathic drugs for common ailments 318 5158

17 AYUSH drugs for Common ailment 305 3590


In Gujarat level 3018 Community Health Centers available with

computer/ statistical assistant for MIS/ Accountant, 318 with


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functional laboratory, 305 with functional operation theater, 305 with

functional labour room, 135 with functioning stabilization units for

new born baby and 144 with new born care corm. Also there are 318

centers with at least 30 beds where 253 with functional X -ray

machines.

65 centers are available with quarter for specialist doctors and 28

specialist doctors living in quarters. Medical appointment

transportation is available in 318 centers.

As per the RKS registered there are 297 centers at Gujarat level also

100 centers are functioning as per IPHS norms.

If we talk about the pharmacy or drugs available at Gujarat level there

are 318 centers of Allopathic drugs and 305 centers for AYUSH drugs

for common illness.

Gujarat has directed all its hard work towards productive development

in every possible structure. Be it infrastructure or economic capacities,

this state is a good example of progress for al l states to follow. So,

how has the land of colour, romance and heritage performed in terms of

developing healthcare inside the state?

Well, the progress made by the state of Gujarat in the healthcare sector

is highly praised by all . From governance of small nursing homes 25

years ago to state-of-the-art tert iary care corporate hospitals, today

state has made a quick development. It is gradually but progressively

transforming into a warm stain for investment in terms of the

healthcare sector.

At present, the Gujarat 's healthcare sector is witnessing an exponential

growth, as evidenced by the increasing number of hospitals and

healthcare institutes, improving emergency medical services with the

assist of 108 ambulance services, and growing medical tourism,

flourishing public private partnership (PPP) models and improved


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medical education. This development is a result of a concentrated

attempt by government and the private sector such as corporate

hospital groups, research organisations, educational institute s,

pharmacies, medical device manufacturing companies and other

healthcare delivery systems which support substitute medicines. Dr

Ashutosh Raghuvanshi, MD, Vice Chairman & Group CEO, Narayan

Hrudayalaya Hospitals, attributes this success to three importan t

mechanism that the state has paying attention on — technology

advancement, quality oriented healthcare service and government

initiatives taken to boost convenience.

The traditional challenges of managing cost, access and quali ty are still

on the front position of today’s health care leaders. Up til l now health

care organizations, professionals and practit ioners look at existing

challenges as well as : federal and state legislation

Advanced technology

Information systems

Patient demographics

Skilled labour shortage

Growing awareness of public opinion

Today’s Health Care Manager not only has to be knowledgeable in the

traditional practices of management and leadership but in addition they

have to skilled, educated and strategic in his/her approach to adapting

their organization to the changing and frequently perplexing challenges

confronting today’s Health Care environment.

4.4 PROBLEMS OF HEALTHCARE IN GUJARAT

Management is all about planning, monitoring and cont rol. Effective

and well-organized management relies on schedule data collection,

collection, analysis and opinion of performance indicators at regular


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intervals, and not on adhoc and un -thoughtful data collected works for

constitutional reporting requirements.

1. Financial Challenges

Healthcare is the second most energy-intensive buildings after

restaurants, and internationally, healthcare costs are on the rise. These

financial challenges— in calculation to an aging world population and

rising energy expenditure—are putting pressure on healthcare

organizations to do extra with less lacking compromising quality of

care.

2. Health Reform Implementation

Table 4.10

Areas of Concern and Relevant Reform Levers

Area of

Concern

Causes amenable to

Reforms Relevant Reform Levers

Non-

availability of

Staff

Outdated policies &

incentives Structure

Role of Paramedics

Limited

Remote Decision

Making

Organisational Change and

Policy Reforms

Empowerment of Nurses and

Paramedical Staff

Decentralisation

Weak Referral

System

Lack of Integration

Ignorance of Referral

System

Strengthen Communication

and Transport Infrastructure

Behavioural Change

Health Awareness

Poor Service

Delivery

Weak logistic

Management

Underutilisation of

Resources

Data based management

Planning, Monitoring and

Granting Autonomy

Funding Absolute Shortfall Public-Private Partnerships


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Area of

Concern

Causes amenable to

Reforms Relevant Reform Levers

Shortfalls Systemise

Inefficiencies

Increasing Government

Health Budgets

Organisational Change

Lack of

Accountability

for Quality

Care

Obsession with FP

Targets

Low Staff Motivation

Lack of Transparency

Overall Performance of the

Health System

e-Governance

Managerial solutions may l ie in the areas on organisational changes to

take action to user requirements, delegation, compromise

independence, logistics management, resource mobilization through

public-private partnership, management information system and so on.

Many of these solutions are attempted during Health Sector Reforms in

developing countries .

Health sector is difficult relating some stakeholders, multiple goals,

multiple products and different beneficiaries. Health sector reforms

have to be with awareness intended and implemented. Health System

change is political and calls for behavioural changes. Below table is

the list of essential areas of management concerns, causes willing to

health sector reforms and relevant reform levers. To tackle the

managerial challenges in delivering quality health services at

reasonable cost.

3. Patients Satisfaction

The well-being of patients is a key to dropping duration of stay and

preventing readmissions. According to the American Society for

Healthcare Engineering (ASHE), in green hospitals, patients are

discharged an average of 2.5 days before compared to traditional

hospitals. Moreover, patient satisfaction can also concern with a


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hospital’s revenue. If the systems are working inadequately or not at

all, quality metrics such as Hospital Consumer Assessment of

Healthcare Providers and Systems can be adversely affected.

As a result , how can healthcare organizations treat with these

challenges though controlling costs, reducing waste and implementing

a sustainabil ity policy? By utilizing an release and incorporated

resolution that provides the right information to the right user at t he

right time—such as Schneider Electric’s Structure War for

Healthcare—healthcare organizations can make more informed

decisions regarding their facilities to get together these challenges

head on.

4. Physician – Hospital Relations

As a rising amount of Americans expand insurance coverage, the

demand for primary care increases. It is the building block of

healthcare restructuring. Until now is not sufficient medical students

are available into primary care, as an alternative choosing more

rewarding subspecialties.

About $13 billion federal dollars are given to 759 medical institutions

with residency programs, but 158 of them do not make any primary

care physicians, according to an Atlantic art icle from July 2013.

More than 6,000 regions across the U.S. are selected Health

Professional Shortage Areas for their lack of primary care, according

to the U.S. Department of Health and Human Services. Each physician

in a Health Professional Shortage Area sees 3,500 or more patients.

Yet in spite of the increasing need for primary care, the health industry

may stil l be able to fend off a developed emergency. Newly, there has

been more discussion dedicated to whether the physician shortage may

spread out as predicted.

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"The outdated shortage modeling is the assumption of how much an

individual physician can treat. As we look at creating a more effective

care model, we have seen a substantial in crease in the number of

patients that a primary care physician can see because they are working

in conjunction with primary care coaches," says Rob Lazerow, practice

manager of research and insights at the Advisory Board Company.

The shortage model may in detail be out-of-date — HHS shortage area

modeling doesn't report for primary care provided by nurse

practitioners or physician assistants in their projections.

"There is absolutely a move toward team-based care. In some cases i t

is nurse practi tioners or community-based providers, [and] even

paramedics are conducting in -home visits as part of their weekly

shifts," says Mr. Lazerow. "Some have projected shortages there as

well. It would not surprise me if supply does not keep up."

If he is correct , the break in primary care physicians is due to over

specialization can only be to some extent abated by other healthcare

providers.

"One way around a shortage, if you can't increase supply, is to figure

out how you can restrict demand. ACO-style models are all about

preventing care in the first place. That absolutely could be a strategy.

The reality, though, is that it takes time to do that," says Mr. Lazerow.

"It 's not an overnight solution. The amount of time it takes to prevent

someone from needing a surgery is a matter of years."

In anticipation of medical schools are incentivized to graduate more

primary care physicians and ACOs catch up, healthcare improvement

may need to depend on interchange primary care providers.

5. Population Health Management


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Population health was one of the biggest ideas in healthcare this earlier

period, and it will probable continue or increase momentum in the next

few years to approach. But in spite of regular use of the term in the

healthcare bubble, population health is a multidisciplinary concept to

be common between public health agencies, social insti tutions and

policymakers. Hospitals fit in there anywhere. Defining that

responsibility is one of the continuing challenges they will look in

2015.

Hospitals ' require for population health expertise overwhelms the

supply. Nearly 60 percent of health system and hospital CEOs ranked

population health as the hardest talent to get within the broader

healthcare area. Further, almost half of executives polled recognized

community and population health management as a talent gap within

their organizations. Some health systems are fi lling this space by

creating new C-suite positions: 10 percent of executives indicated their

health system had a chief population health manager.

Quantifying population health is second challenge. While healthcare

leaders need to think innovatively about how to get better health of a

geographic population, in addition they should maintain a healthy

sense of doubt about population health efforts. What strength seems

like a much-needed involvement on document , such as a grocery store

in a food desert , may be one small piece of a multipronged resolution.

There is no silver ammunition, after all . In the middle of excitement

for population health, systems may simplify problems and overinvest in

solutions only to see the same health outcomes.

To find achievement, hospital leaders may require diminishing their

traditional reliance on “programs” and as an alternative focusing more

on partnerships with community organizations and nonprofits. S till

some health systems act as separately as they can, ignoring a assets of

expertise and resources.


Page 123

"When we talk to other population health managers, they have

unearthed a number of unique challenges inside their populati ons, such

as domestic violence, elder abuse and other public health crises," says

Jason Dinger, PhD, CEO of Mission Point Health Partners in Nashville,

the accountable care organization affiliated with Saint Thomas Health.

"Unfortunately, most respond by t rying to implement their own unique

program to respond to the issue. We usually encourage them to first

speak with the experts in their community who work on these issues

every day. In many cases these are nonprofit organizations that can add

great value to the population health effort but often have trouble

engaging and integrating with a health system's efforts."

6. Lack of Advancement Opportunities

Lack of advancement creates confidence trouble when employees

understand they’re caught in a dead-end position. Poor confidence

manifests itself in a variety of ways, such as neglect of leave policies,

loss in job positions and a lack of enthusiasm to hold changes in the

workplace.

Since small workforces create fewer open positions, i t can be

complicated for small business owners to inside support their workers

at a speed fast enough to work against issues that take place because of

lack of promotion. Improvement opportunities don’t need to be to

senior positions within the company. Developing a plan for employee

improvement, from planned raises to increases in responsibility levels

and training for new skills, can help employees believe as if they’re

advancing within their positions even without complete promotions.

7. Poor Salary

There are main two avenues of employment for these considerate yet

strong professional women: Public sector hospitals or the huge number

of private outfits that have mushroomed across cities and small towns.


Page 124

A evaluation of the working conditions in these two sectors can easily

be prepared on the double scales of compensation and necessary

employment situation.

While in the private sector is a different story. Utilization marks the

experiences of nurses here. Dangerous areas of ignore and

mismanagement exist and rules are frequently flouted to make higher

profits . Here, the lower level staff and nurses who mostly tolerate the

burden of this because it is their salaries that get compromised and not

only that of the specialist physicians only, but whose authority and

mobility can’t be restricted by hospital managements.

In addition to, the contractual agreement that nurses come into includes

signing a "bond" that requires them to work in the hospital for two to

three years and today even confiscating nursing certificates has be come

an established practice to control their professional mobility. This kind

of arrangements , prevent nurses from in search of other placements

without the understanding of their current employers. Such unfairness

is mostly possible because of a tolerant, and fundamentally bad, health

sector.

8. Shortages in Staff and Resources

Attached with shortages in staff and resources, exceed of the central

hospitals has caused the previously inadequate resources to be

expanded thin and has been responsible as the main 11 constriction

towards extending healthcare convenience to the majority of the

population. This has unenthusiastically impacted on the quality of the

patient care existing mainly in the following:

(1) Inpatient wards are overloaded, with patients who sleep on the

floor accounting for approximately one-third of the total patient

population,


Page 125

(2) Patients repeatedly wait for hours outside the outpatient clinics to

observe a supplier,

(3) The amount of time used up with clinicians has been increasingly

reduced in order to accommodate all patients,

(4) The medicine provide is usually running very low, and the medical

equipment is repeatedly not in function.

These fundamental factors have prepared it part icularly complicated

for hospital managers at all levels to manage. The managers recognize

with their sense of weakness and exposure to deal with the problems

and also identify the need for extreme actions. In observation of the

above reasons, primary health care provided at central hospitals has

become a very expensive work out for government.

Table 4.11

Health Manpower in Rural Areas in Gujarat

Re

qu

ire

d

Su

rp

lus

In

Po

sit

ion

Va

ca

nt

Sh

or

tfa

ll

Health Worker (Female) Sub

Center & PHCs

9310 7274 6932 336 2372

Doctors PHCs 1247 1504 889 615 358

Total Specialists CHCs 1280 NA 74 NA 1206

Radiographer CHCs 320 330 175 155 145

Pharmacists PHCs & CHCs 1567 1550 879 671 688

Lab Technicians PHCs & CHCs 1567 1556 1401 155 166

Nursing Staff 3487 4058 2705 1353 782



Page 126

As per the table given above, there is 9310 Health Worker (Female) for

sub centers and PHCs required in which 7274 are surplus, 6932 are in

positions, 336 places are vacant and 2372 are shortfall of staff.

In the same way 1247 Doctors of PHCs required, 889 in posit ion which

is surplus by 1504, 615 are vacant and 358 are shortfall . Out of total

required 1280 specialties of CHCs only 74 are in position and 1206 are

shortfall of total specialist .

320 radiographers of CHCs, 1567 Pha rmacists of PHCs & CHCs, 1567

Lab technicians of PHCs & CHCs and 3487 Nursing Staff are required

where 155, 671, 155 and 1353 are vacant respectively.

Table 4.12

Training of Medical and Paramedical Personnel in Gujarat

Training Gujarat India

ANM/ HW (Female) training school fund by

Govt. of India

26 355

LHV/ HA (Female) promotional school

established by Govt. of India

4 30

HFWTC training center 1 54

MPW (Male) training schools 0 54


Training is necessary for general health staff l ike medical and

paramedical personnel are conducted to develop skills in diagnosis and

management cases. Here for ANM or Health Worker (Female) out of

355, 26 training school funded by Government of India. 4 LHV/ Hea lth

Assistant (Female) promotional schools established by Govt. of India

and only one HF WTC training centers are available, no MPW (male)

training schools in Gujarat.

***********

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