Ishan Amit

IIM Indore
 1947 – 1970s
I homes (2-20 beds)
 Largely Govt./Para Govt.
 Seen as Social/ charitable
activity
 Private activity limited to
Individuals
 Patients travel long distance
for simple diseases
1980s-1991 1991-2008
 Middle class emergence
and need for high medical &
service standards
 Private insurance
 Mushrooming of nursing companies began
operations
 First signs of Corporate  No. of corporates grew
activity- Apollo, Escorts, multi-fold but still no. of
hospitals > 200 beds = 2%
etc.
 Adoption of technology &  Patients travel long distance
for only sub-specialties
emergence of sub-
specialties
 Patients travel long
distance for secondary
care
2
 Life Expectancy at birth (years)
85
78 78
72 73
63 66
59
50
32

1951 1981 1991 2005 2005 2005 2005 2005 2005 2005
INDIA Brazil China Russia US UK Japan

Infant Mortality Rate (per 1,000 live births)

146

110

80
56
28 23
11 6.5 5.2 2.8

1951 1981 1991 2005 2005 2005 2005 2005 2005 2005
INDIA Brazil China Russia US UK Japan
Source: FICCI & E&Y report 2008 3
•Health care structure in the country is over-burdened by increasing
population
•Economic deprivation in a large segment of population results in poor access
to health care
•Poor educational status leads to non-utilization of scanty health services
and increase in avoidable risk factors
•India ranks low amongst world nations judged by HDI
•Lack of education, gender inequality and explosive growth of population
contribute to increasing burden of disease
•India faces high burden of disease because of lack of environmental
sanitation and safe drinking water, under-nutrition, poor living conditions,
and limited access to preventive and curative health services
•Expenditure on health by the Government continues to be low. It is not
viewed as an investment but rather as a dead loss!
•Lack of accountability for the current initiatives
 Accessibility

Reliability Affordability
 Increase accessibility

 Focus on Preventive Health

 Govt. to graduate to become Buyers of

Healthcare

 Safeguard quality of Healthcare Suppliers


•A performance incentive plan that targets
specific treatment parameters
•Develop multi-specialty group practices
that have their incentives aligned with those
of hospitals and payers
Incentives
•Encourage business schools to develop executive
training programmes in healthcare, which will effectively
reduce the talent gap for leadership in this area
•Revise the curriculum in medical, nursing, pharmacy and
other schools that train healthcare professionals, so that
they too are trained in the new paradigm
•Develop and implement national standards for
examination by which doctors, nurses and pharmacists
are able to practice and get employment
Rapidly develop and implement national
accreditation of hospitals
Increase accountability in the current hospitals
Markets
Accessibility PPP
Develop partnerships between the public and
private sectors that design newer ways to
Talent deliver healthcare. An example of this would
include outpatient radiology and diagnostic
testing centres
 • Create an infrastructure to support basic levels of hygiene
Govt. • Establish effective and comprehensive immunization programs
• Encourage healthy lifestyles – fiscal/non-fiscal: Teach them young!

Insurance • Carrot & stick approach: Encourage policyholders to follow healthy

companies lifestyles and go in for preventive health checks and early diagnosis

Corporate • Reward and Recognition for Lean/weight within limit employees

Buyers • Provide low calorie content food in company cafeteria

• Take up social campaigns

NGOs - Anti-smoking
- Benefits of daily exercise
- Promotion of natural and healthy food
- Promoting healthy life style from early life is a ‘no cost’ intervention
which needs to be incorporated in school curricula. There is need for
increasing public awareness of the benefits of healthy life style
Provider –
Secondary & 
Provider – Primary
& Preventive care 
Tertiary care

Buyers of
Healthcare 
• Innovative insurance
schemes for the poor –
e.g. in India, GoI has
started Rashtriya
Swasthya Bima Yogana
(RSBY)
 Approach

Risk based Enhance

Clinical Availability of
monitoring & productivity of
Practices information
audits processes

High Quality is ensured !

 Existing infrastructure for health care needs to be
strengthened. Health should be perceived as an
investment and receive greater budgetary allocation
 Education, safe water and sanitation need priority
 Vaccination coverage needs to be improved
 Better implementation of national health programs
 Judicious use of the scant resources by promoting most
cost-effective strategies for disease prevention
 Inclusion of all level of stakeholders in planning and
policy making using tremendous human resource
available in the country