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Healthcare of India: Today and Tomorrow
Abstract
India needs accessible, affordable and high-quality healthcare. This paper deals with the challenges and opportunities in Indian Healthcare. We discuss the details of the healthcare system of India: its structure, expenditure by public and private, the presence of the alternate medicines and its impact on Indian healthcare and the management of healthcare at all levels. India currently has double burden of diseases. Further we discuss the challenges in Indian healthcare system and its causes. We highlight with a few examples how hospitals can innovate and reorganize themselves to address these challenges.
... Specialized doctors are even more less. The geographical terrain creates a lot of challenge in accessibility of healthcare services in rural areas [2]. In addition, change in the population pyramid will fuel the demand for the healthcare particularly because of lifestyle diseases. ...
With the ageing population the demand for healthcare has increased extremely. Healthcare has embraced
technology significantly. The innovations are weaved around big-data and semiconductor industries. Henceforth, this paper reviews the literature on healthcare, big-data and VLSI technologies with reference to each other. The review focuses on the interrelationship/inter-dependencies between healthcare, software (big data) and hardware (VLSI technology) industries. Healthcare industry drives both the software as well as hardware industries, and their limitations would affect the healthcare industry adversely.
The health care system has begun to focus on providing more effective treatment to war veterans and promoting collaboration between state, federal, and private agencies. In this paper the authors will provide historical perspectives on the health care system and synthesize themes related to the theories of Ludwig von Bertalanffy (1968), Niklas Luhmann (1982), and Anthony Gidden (1984).
The bottom of the pyramid (BOP) in the global distribution of income has been promoted as a significant opportunity for companies to grow profitably. Under the BOP approach, poor people are identified as potential customers who can be served if companies learn to fundamentally rethink their existing strategies and business models. This involves acquiring and building new resources and capabilities and forging a multitude of local partnerships. However, current BOP literature remains relatively silent about how to actually implement such a step into the unknown. We use two BOP cases to illustrate a strategic framework that reduces managerial complexity. In our view, existing capabilities and existing local BOP models can be leveraged to build new markets that include the poor and generate sufficient financial returns for companies to justify investments.
Background:
The burden of chronic conditions is on the rise in India, necessitating long-term support from healthcare services. Healthcare, in India, is primarily financed through out-of-pocket payments by households. Considering scarce evidence available from India, our study investigates whether and how out-of-pocket payments for outpatient care affect individuals with chronic conditions.
Methods:
A large census covering 9299 households was conducted in Bangalore, India. Of these, 3202 households that reported presence of chronic condition were further analysed. Data was collected using a structured household-level questionnaire. Out-of-pocket payments, catastrophic healthcare expenditure, and the resultant impoverishment were measured using a standard technique.
Results:
The response rate for the census was 98.5%. Overall, 69.6% (95%CI=68.0-71.2) of households made out-of-pocket payments for outpatient care spending a median of 3.2% (95%CI=3.0-3.4) of their total income. Overall, 16% (95%CI=14.8-17.3) of households suffered financial catastrophe by spending more than 10% of household income on outpatient care. Occurrence and intensity of financial catastrophe were inequitably high among poor. Low household income, use of referral hospitals as place for consultation, and small household size were associated with a greater likelihood of incurring financial catastrophe.The out-of-pocket spending on chronic conditions doubled the number of people living below the poverty line in one month, with further deepening of their poverty. In order to cope, households borrowed money (4.2% instances), and sold or mortgaged their assets (0.4% instances).
Conclusions:
This study provides evidence from India that the out-of-pocket payment for chronic conditions, even for outpatient care, pushes people into poverty. Our findings suggest that improving availability of affordable medications and diagnostics for chronic conditions, as well as strengthening the gate keeping function of the primary care services are important measures to enhance financial protection for urban poor. Our findings call for inclusion of outpatient care for chronic conditions in existing government-initiated health insurance schemes.
Effective IT governance is an important requirement for strategic IT-based change. The extant literature focuses on which IT decisions should be governed and who is accountable for them. However, in multi-business organizations there is little theoretical guidance on which decisions should be made at the corporate and strategic business unit (SBU) levels, or when such decisions should be made as part of the corporate and SBU strategy processes. This paper draws on the strategic management literature to develop a theoretical framework for allocating IT decision rights between business and IT at the corporate and SBU levels. Importantly, the framework also unbundles corporate IT platform and SBU IT decision making across the corporate investment cycle. This is achieved by adopting a real options-based pricing investment model to reduce risk, uncertainty and complexity. The theoretical framework is illustrated with in-depth longitudinal case study and compared against existing normative IT governance prescriptions.
Recent discussions in health reform circles have pinned great hopes on the prospect of innovation as the solution to the high-cost, inadequate-quality U.S. health system. But U.S. health care institutions-insurers, providers, and specialists-have ceded leadership in innovation to Indian hospitals such as Care Hospital in Hyderabad and the Fortis Hospitals around New Delhi, which have U.S.-trained doctors and can perform open heart surgery for 100,000 in the United States). The Indian success is a window into America's stalemate with inflating costs and stagnant innovation.
Series editor: Priscilla AldersonThis is the first in a series of six articles on the importance of theories and valuesin health research“Medical journals and research funders are mainly concerned with practical factual research, not with research that develops theories.” This widespread view includes several assumptions: that research and facts can be separated from theory; that considering theories is not necessarily practical or useful; and that thinking about theories means developing them.But theories are at the heart of practice, planning, and research. All thinking involvges theories, and it is not necessary to read academic texts about theories before using them—any more than it is essential to read texts on reproductive medicine before having a baby. Because theories powerfully influence how evidence is collected, analysed, understood, and used, it is practical and scientific to examine them. Hypotheses are explicit, but when theories are implicit their power to clarify or to confuse, and to reveal or obscure new insights, can work unnoticed. Summary points Theories are integral to healthcare practice, promotion, and research The choice of theory, although often unacknowledged, shapes the way practitioners and researchers collect and interpret evidence Theories range from explicit hypotheses to working models and frameworks of thinking about reality It is important, scientifically and practically, to recognise implicit theories: they powerfully influence understandings of health care
The past few years have seen rapid advances in communication and information technology (C&IT), and the pervasion of the worldwide web into everyday life has important implications for education. Most medical schools provide extensive computer networks for their students, and these are increasingly becoming a central component of the learning and teaching environment. Such advances bring new opportunities and challenges to medical education, and are having an impact on the way that we teach and on the way that students learn, and on the very design and delivery of the curriculum. The plethora of information available on the web is overwhelming, and both students and staff need to be taught how to manage it effectively. Medical schools must develop clear strategies to address the issues raised by these technologies. We describe how medical schools are rising to this challenge, look at some of the ways in which communication and information technology can be used to enhance the learning and teaching environment, and discuss the potential impact of future developments on medical education.
India is the second most populous country of the world and has changing socio-political-demographic and morbidity patterns that have been drawing global attention in recent years. Despite several growth-orientated policies adopted by the government, the widening economic, regional and gender disparities are posing challenges for the health sector. About 75% of health infrastructure, medical man power and other health resources are concentrated in urban areas where 27% of the population live. Contagious, infectious and waterborne diseases such as diarrhoea, amoebiasis, typhoid, infectious hepatitis, worm infestations, measles, malaria, tuberculosis, whooping cough, respiratory infections, pneumonia and reproductive tract infections dominate the morbidity pattern, especially in rural areas. However, non-communicable diseases such as cancer, blindness, mental illness, hypertension, diabetes, HIV/AIDS, accidents and injuries are also on the rise. The health status of Indians, is still a cause for grave concern, especially that of the rural population. This is reflected in the life expectancy (63 years), infant mortality rate (80/1000 live births), maternal mortality rate (438/100 000 live births); however, over a period of time some progress has been made. To improve the prevailing situation, the problem of rural health is to be addressed both at macro (national and state) and micro (district and regional) levels. This is to be done in an holistic way, with a genuine effort to bring the poorest of the population to the centre of the fiscal policies. A paradigm shift from the current 'biomedical model' to a 'sociocultural model', which should bridge the gaps and improve quality of rural life, is the current need. A revised National Health Policy addressing the prevailing inequalities, and working towards promoting a long-term perspective plan, mainly for rural health, is imperative.
The successful implementation of health information systems in complex health care organizations ultimately hinges on the receptivity and preparedness of the user. Although the Information Age is well underway, user resistance to information systems is still a valid concern facing the informatics community. This book provides effective management strategies to health care administrators for the productive integration and maintainence of such information systems. The Second Edition covers three main areas: technical skills, project management skills, and organizational and people skills, including the practical implementation strategies necessary to make the system an operational success. The audience for this book consists of health care administrators, CEOs, clinicians, IT developers, librarians, and professors.
"Billions of government dollars, and thousands of charitable organizations and NGOs, are dedicated to helping the world's poor. But much of the work they do is based on assumptions that are untested generalizations at best, flat out harmful misperceptions at worst. Banerjee and Duflo have pioneered the use of randomized control trials in development economics. Work based on these principles, supervised by the Poverty Action Lab at MIT, is being carried out in dozens of countries. Their work transforms certain presumptions: that microfinance is a cure-all, that schooling equals learning, that poverty at the level of 99 cents a day is just a more extreme version of the experience any of us have when our income falls uncomfortably low. Throughout, the authors emphasize that life for the poor is simply not like life for everyone else: it is a much more perilous adventure, denied many of the cushions and advantages that are routinely provided to the more affluent"--
The adoption of health information systems is seen world wide as one method to mitigate the widening health care demand and supply gap. The purpose of this review was to identify the current state of knowledge about health information systems adoption in primary care. The goal was to understand factors and influencers affecting implementation outcomes from previous health information systems implementations experiences. A comprehensive systematic literature review of peer reviewed and grey literature was undertaken to identify the current state of knowledge regarding the implementation of health information systems. A total of 6 databases, 27 journal websites, 20 websites from grey sources, 9 websites from medical colleges and professional associations as well as 22 government/commission websites were searched. The searches returned almost 3700 article titles. Eighty-six articles met our inclusion and exclusion criteria.
This article has suggested a model that can provide some consistency and order as hospital managers attempt to find reliable yet palatable means of cutting their institutions' costs. Like any model, it is only as sensitive as the manner in which it is applied; it is a guide rather than a substitute for clear thinking by management. Used in context, however, the model encourages clear thinking when hospital managers might otherwise be tempted to dispose of facts that do not conform to their own theories or, alternatively, find isolated budget solutions that are simple and neat but suboptimal. In the final analysis, thinking clearly is the ultimate model when the order comes to cut costs.
Successfully implementing patient care information systems (PCIS) in health care organizations appears to be a difficult task. After critically examining the very notions of 'success' and 'failure', and after discussing the problematic nature of lists of 'critical success- or failure factors', this paper discusses three myths that often hamper implementation processes. Alternative insights are presented, and illustrated with concrete examples. First of all, the implementation of a PCIS is a process of mutual transformation; the organization and the technology transform each other during the implementation process. When this is foreseen, PCIS implementations can be intended strategically to help transform the organization. Second, such a process can only get off the ground when properly supported by both central management and future users. A top down framework for the implementation is crucial to turn user-input into a coherent steering force, creating a solid basis for organizational transformation. Finally, the management of IS implementation processes is a careful balancing act between initiating organizational change, and drawing upon IS as a change agent, without attempting to pre-specify and control this process. Accepting, and even drawing upon, this inevitable uncertainty might be the hardest lesson to learn.
To prevent errors made during the prescription of drugs, we need to know why they arise. Theories of human error used to understand the causes of mistakes made in high-risk industries are being used in health-care. They have not, however, been applied to prescribing errors, which are a great cause of patient harm. Our aim was to use this approach to investigate the causes of such errors.
Pharmacists at a UK teaching hospital prospectively identified 88 potentially serious prescribing errors. We interviewed the prescribers who made 44 of these, and analysed our findings with human error theory.
Our results suggest that most mistakes were made because of slips in attention, or because prescribers did not apply relevant rules. Doctors identified many risk factors-work environment, workload, whether or not they were prescribing for their own patient, communication within their team, physical and mental well-being, and lack of knowledge. Organisational factors were also identified, and included inadequate training, low perceived importance of prescribing, a hierarchical medical team, and an absence of self-awareness of errors.
To reduce prescribing errors, hospitals should train junior doctors in the principles of drug dosing before they start prescribing, and enforce good practice in documentation. They should also create a culture in which prescription writing is seen as important, and formally review interventions made by pharmacists, locum arrangements, and the workload of junior doctors, and make doctors aware of situations in which they are likely to commit errors.
Public–private partnerships have become a common approach to health care problems worldwide. Many public–private partnerships were created during the late 1990s, but most were focused on specific diseases such as HIV/AIDS, tuberculosis, and malaria.
Recently there has been enthusiasm for using public–private partnerships to improve the delivery of health and welfare services for a wider range of health problems, especially in developing countries. The success of public–private partnerships in this context appears to be mixed, and few data are available to evaluate their effectiveness.
This analysis provides an overview of the history of health-related public–private partnerships during the past 20 years and describes a research protocol commissioned by the World Health Organization to evaluate the effectiveness of public–private partnerships in a research context.
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