April 27, 2007

After BPO, it's medical outsourcing

Even as uncertainty continues for thousands of Indian doctors with career plans abroad, the medical fraternity back home has a reason to cheer.

In what could be the next big step in the outsourcing saga, big corporates in the US are planning to offshore their employee healthcare to India.

Wal-Mart hires over a million employees in the US – spending $8,000 on each employee's healthcare every year takes its total expenditure to a staggering $8 billion. What if Wal-Mart could save 90 per cent of that amount with help from us?

As health insurance gets painfully expensive in the US, huge cost advantages of medical procedures in countries like India are proving to be irresistible for companies there including those on the Fortune 500 list.

Mercer Health & Benefits Dr Arnold Milstein said, “We estimate that the price advantage for the most efficient Indian hospitals would be around 85 per cent to 90 per cent."

American companies are obviously feeling the heat. Many believe that unless they control the spiraling health expenditure their profits could start taking a serious hit by 2008.

A study suggests that outsourcing of health care can easily reduce the showroom price of a GM car by a thousand dollars – it's all very simple logic so what's the problem?

Outsourcing of business processes itself is a very controversial issue in the West. Outsourcing of healthcare, which requires a degree of intimacy withy the patient can be a tricky issue.

As US still recovers from the shock of its inability to provide efficient healthcare to its people India waits with open arms.

Escorts Heart Institute and Research Centre Director Dr Naresh Trehan, Executive said, “We have patients coming from there on a regular basis so far mainly those who are uninsured if you say the trend, I think it's three times today than what it was two years ago."

Medical tourists coming to India may not be a new phenomenon but so far most of those have been without adequate insurance cover. Considering that just around 15 per cent of the Americans are uninsured, there is room for a lot more business for our health care industry - but are we ready?

Dr Naresh Trehan says, “The number of people who are coming and the pace at which it is developing I don't think it's going to overrun our systems. A lot of new capacity is coming on line.

According to current trends, India's health care industry is going to be $47-billion- strong in another 5 years and if American companies decide to play ball that figure could easily double in the years to come.

April 26, 2007

400 Health Clinics to Open in Wal-Mart Stores During Next Three Years

Wal-Mart Stores, Inc., intends to contract with local hospitals and other organizations to open as many as 400 in-store health clinics over the next two to three years, and if current market forces continue, up to 2,000 clinics could be in Wal-Mart stores over the next five to seven years, Wal-Mart president and CEO Lee Scott will say in a speech later today at the World Health Care Congress in Washington, D.C. The clinic program’s expansion is just the latest in a series of moves by Wal-Mart to help implement customer solutions to America’s health care crisis, including the $4 generic drug prescription program, health information technology and participation in a major coalition supporting comprehensive healthcare reform by 2012.

“We think the clinics will be a great opportunity for our business. But most importantly, they are going to provide something our customers and communities desperately need — affordable access at the local level to quality health care,” Scott says.

Scott will also announce that Wal-Mart customers have saved about $290 million on selected generic prescription drugs since September 2006, when the company began selling prescriptions for $4 each in Tampa, Fla. Available nationwide since November, the $4 prescriptions now account for more than 35 percent of all prescriptions filled at Wal-Mart and nearly 30 percent of the $4 prescriptions are filled without insurance.

“The response has been nothing short of spectacular,” Scott says of the $4 program. “Within days of announcing our $4 program, countless other discounters, drug stores and supermarkets dropped their prices on generic prescriptions. That has surely saved our health care system millions of more dollars. So let there be no doubt that the private sector can lead,” continued Scott.

The health clinics, which will lease space in Wal-Mart stores, will be managed by local or regional hospitals and/or other organizations that are independent of Wal-Mart. The move is a significant expansion of a pilot project begun in September 2005, when Wal-Mart started leasing space to medical clinics inside Wal-Mart stores. Currently, 76 clinics are operating inside Wal-Marts in 12 states.

The providers running the clinics will determine what services to offer, which will generally include preventive and routine care for conditions such as allergies and sinus infections, as well as basic services such as cholesterol screenings and school physicals at affordable prices. They will be staffed by either certified nurse practitioners or physicians.

“We also think there is tremendous potential with local hospitals as partners for some or all of these clinics. Patients trust the role hospitals play in providing quality medical care. They have the medical experience and expertise — and the larger network if more serious treatment is needed,” Scott says.

The clinics will post clear prices for services and procedures, helping to bring much-needed price transparency to the American health care system.
Scott today urges other companies and organizations to join the coalition. “There is not a person or group anywhere in this country that cannot play a role,” he says.

About Wal-Mart

Wal-Mart Stores, Inc. operates Wal-Mart discount stores, Supercenters, Neighborhood Markets and Sam’s Club locations in the United States. The Company operates in Argentina, Brazil, Canada, China, Costa Rica, El Salvador, Guatemala, Honduras, Japan, Mexico, Nicaragua, Puerto Rico and the United Kingdom. The Company’s securities are listed on the New York Stock Exchange under the symbol WMT. More information about Wal-Mart can be found by visiting http://www.walmartfacts.com/ . Online merchandise sales are available at http://www.walmart.com/ .

Walmart is all set to enter the Indian markets through a partnership with Bhari (Airtel) soon, but is facing stiff opposition from the communists and similar groups.

April 17, 2007

AIIMS-like super specialty hospitals to be set up

Centre’s ambitious project to set up a chain of 13 AIIMS-like super specialty hospitals in the country finally took off on Monday with the Health Ministry clearing three such projects for Kolkata, Jammu and Lucknow.

A high power Project Management Committee of the Ministry, headed by secretary health, gave a go-ahead for upgradation of medical colleges at these places to super-speciality hospitals. The projects will be completed in a time bound manner, within 18 months, at a cost of Rs 120 crore each with December 2008 as the deadline.

The Health Ministry sources said the Centre will contribute Rs 100 crore in each of the projects. Rest will be the state governments’ share. On its part, the Centre has appointed Hospital Supplies and Construction Corporation, a public sector undertaking, as the nodal agency to oversee the projects.

The proposals involve augmenting the existing infrastructure in the medical colleges in addition to the creation of new super-specialties in different streams. This has been done to save time and make the projects cost effective, the ministry sources said.

Significantly, Jammu and Kashmir will have two such hospitals. The proposal for the upgradation of the Srinagar medical college is likely to be considered in the PMC’s next meeting.

The Jammu medical college project involves setting up of six new super-specialty departments of cardiology, cardiothorasic surgery, nephrology, nephrology surgery, neurology and neurology surgery. Super-specialty facilities will also be created in the existing nine departments. In addition, an ultra-modern 30-bed pediatrics ward is also proposed to be set, state health secretary K B Jandial said.

The state government has already spend Rs 22.50 crore to acquire 45 kanals of prime land in Jammu city for the project. Given the special focus of the government to create health care facilities in the terrorism- hit state, chief minister Ghulam Nabi Azad cleared the land acquisition project on priority. The land cost, borne by the state, is over and above the Rs 120 crore project expenditure, Jandial said.

Apart from the creation of new OPDs, the Lucknow medical college project will have half-a-dozen new super-specialties. These include pulmonary surgery, plastic surgery and burns unit, pulmonary medicine and maternal and reproductive healthcare set up.

April 15, 2007

UK hospitals mulling outsourcing work to India

Some of the hospitals in the UK are planning to outsource medical secretarial work to India. Among them is Southport and Ormskirk Hospital, which is battling to reduce 15 million pounds deficit and is considering outsourcing its doctors' digital dictations to India.

It said the state-aided National Health Service is looking at a range of options, including outsourcing doctors' digital dictations, a move stiffly opposed by the local MP and the union representing medical secretaries.

"It sounds like this idea came from the deranged brains of management consultants," Southport MP John Pugh said.

"I sincerely hope that they retain the service locally because there will be all sorts of communication problems both for clinicians and patients. The only merit is cost-saving, which is probably not going to be associated with increased efficiency. It sounds like false economy and bad for staff morale," he added.

Kathy Perkins, Chairman, British Society of Medical Secretaries warned that moving medical secretaries' services abroad could lead to patient deaths.

"Inevitably, there will in due course, be the death of a patient directly attributable to the wrongful interpretation of crucial word or drug dosage by an outsourced worker unfamiliar with the language or terminology," she claimed.

"By then the damage will be done. The majority of medical secretaries will either have been made redundant or will have left the service through low morale, no job satisfaction or retirement," Perkins said.

Clare Vattev, Southport and Ormskirk Hospital NHS Trust business manager, said "The Trust is currently reviewing its secretarial functions with a view to improving both the efficiency and timeliness of its communications.

"As part of this work we will be looking at a number of options and the use of digital dictation and outsourced transcribing may be considered.

"A project group has been formed to consider all aspects of the process and the group will consider the effect of any proposals on the roles of staff currently involved in the production of clinical letters."

She said, "The project is still at a very early stage and no decisions have been made. Staff will be kept fully informed of any developments."

April 07, 2007

Prices of 200 medicines set to fall

Prices of commonly used medicines are expected to fall with the government planning to cap trade margins paid by companies to retailer at 50%.

The move is expected to push down prices of over of around 200 drugs, including those used as analgesics, cough syrups, tonics, antibiotics, medicines used to treat infectious diseases, bronchial disorders and lifestyle diseases such as diabetes and hypertension and anxiety disorders, may come down by more than 50% in a large number of cases.

For bringing in uniform trade margins, government has proposed marketing expenses, or MAPE in trade jargon, of 300% be added on to the ex-factory price and trade margin of 50% be calculated on the maximum retail price (MRP).

While patent holders are known to charge a high premium in the name of innovation, large margins are common even for non-patented medicines which are sold under generic names or the branded generics. In some cases the trade margins go beyond 1,500% of the cost at which the medicine is sold to the retailer.

For instance, a strip of 10 tablets of Ceticad bought by the chemist at Rs 1.60 from the manufacturer, is sold at Rs 26 in the market, translating into a margin of over 1525%. If government is able to cap margins, cost of the medicine for the consumer will drop to Rs 6.40.

Ceiling on trade margins has proved to be a bone of contention between the government and industry, with the latter unable to do much. Last year, the industry had agreed to cap margins of 886 formulations of 100-odd drugs, but the move was not implemented by all companies.

"If the norms are issued, then the entire industry (branded generic and generic-generic categories) would implement it," sources said. They said the 300% limit has been proposed after factoring in the cost incurred on manufacturing by smaller players.

The ministry intends to put out draft guidelines and will take a final decision only after consulting the industry. Sources said the National Pharmaceutical Pricing Authority will monitor margins charged by these companies, once guidelines are issued.

"If companies are not agreeable to limiting margins, then they would be asked to switch to the branded category," sources added. For branded drugs, which are outside the purview of price control, industry had agreed to cap margins at 10% to the wholesaler and 20% to the retailer.

April 06, 2007

IBM, Apollo Hospitals in Join to create online platform for Doctors

In a bid to develop an online professional platform for medical doctors across the world, Apollo Hospital Group has joined hands with IBM. Speaking to the media on the sidelines of a CII seminar, Apollo Hospital Group chairman C Pratap Reddy said that the company has joined IBM for a 50:50 partnership. The proposed online platform is christened ‘Healthcare Super Highway’ and it will be implemented in phases, Reddy said.
Microsoft has also evinced interest in partnering the project, he added. “Microsoft says that it can add value to the project. We are yet to decide on their entry, but if they really add value, I think they should join,” Reddy told FE.

The project is expected to be completed in a phased manner. “Hopefully, the project would commence in a year. Right now, we are just working on the modalities and other nitty-gritty,” he pointed out.

The aim of the project is to provide access platform to 500,000-odd physicians across countries enabling them to interact for profession-related information including consultation and second opinion. There are very few professionals who can offer second opinion even in the developed countries. If the project gets finalised, it will open new vistas for Indian doctors, Apollo Chairman opined.

Reddy further revealed that the Apollo Hospital Group along with other nine major hospitals in the country will be offering telemedicine facility to 52 African nations from May 1, 2007. The patients from these countries will be accessed for the online diagnose and treatment system.

April 04, 2007

Health Minister assures help for NRI Doctors in UK

India has said it will write to Britain to treat NRI doctors "fairly and equally" and assured the medicos who could be affected by new immigration rules that they would be provided assistance in finding appropriate jobs if they return to the country of their origin.

Union Health Minister Anbumani Ramadoss told representatives of the British Association of Physicians of Indian Origin (BAPIO) here that he would personally write to British Health Secretary Patricia Hewitt asking her "to ensure that Indian doctors are treated fairly and equally."

Commending BAPIO's work for doctors of Indian origin in the UK, Ramdoss, himself a doctor, assured the organisation that "Government of India will provide assistance in finding appropriate jobs for doctors who want to return to India." He also promised to work on ensuring their British qualifications and training get proper recognition.

"We are very happy to meet the minister and were impressed with his understanding of the issues facing Indian doctors in the UK. BAPIO is grateful for all the Government of India is doing to help the affected doctors," Dr Ramesh Mehta, president of BAPIO, said in a statement here.

Dr Raman Lakshman, Vice-Chair for Policy, said, "We are confident this meeting has set in motion the beginnings of a close and fruitful relationship between BAPIO and the Government of India."

April 01, 2007

Australia issues alert over metal content in traditional Indian medicines

Australia has joined the UK, USA and Canada in warning its citizens against using unapproved traditional medicines from India and China.

Its main worry is the metal content in these medicines.

The department of health and ageing therapeutic goods administration of Australia (ADRAC) wants the citizens to consider the possibility of contamination and adulteration before buying any herb or herbal medicine for personal use, especially over the Internet.

The ADRAC, in its latest advisory in February, said the agency received a report of a couple who showed higher lead levels in the blood after taking ayurvedic herbal medicines, dispensed from an Indian hospital. Stating that the man, who had taken the unidentified ayurvedic medicine for five months was admitted to a hospital.

The agency has warned patients to buy only the medicines that are approved by the Australian drug regulatory authority - Therapeutic Goods Administration (TGA).

“Traditional Indian and Chinese medicines authorised for supply in Australia are regulated as complementary medicines and are required by the TGA to meet set standards of manufacturing and quality that aim to ensure that medicines do not contain unsafe levels of these metals. These products can be identified by an AUST L number on the product label. No assurance can be provided about the standards of manufacturing or the content of heavy metals in herbal remedies or medicines that are not approved for supply in Australia,” the agency said.

It said there were several possible explanations for the presence of heavy metals in traditional herbal remedies. “Salts of heavy metals (for example those of lead, mercury and arsenic) are used as principal ingredients in some traditional Indian and (to a lesser extent) Chinese herbal remedies. In addition, cross-contamination of ingredients can occur between these types of products and products not intended to contain metal salts if manufacturing conditions are not controlled,” the agency said.

Health agencies in the developed countries, including the US, Canada and the UK, are known to be sensitive towards the lead content in ayurvedic medicines. The agencies had recently black-listed several ayurvedic products from India due to higher toxic metal content.

India’s stance on the issue has been that “some ayurveda, siddha and unani drugs have heavy metals for therapeutic value and are processed in such a way that they are de-toxified”. The government had some time ago made testing for metallic content mandatory for traditional drugs meant for exports.

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