September 27, 2007

St. John’s Medical College Hospital shows the way in Bio-Medical Waste Management

For very big hospitals with over a 1,000 beds and handling a large number of patients on a daily basis, managing biomedical waste is not an easy task. But the city’s St. John’s Medical College Hospital has set an example in hospital waste management practices, especially in managing liquid waste.

A percentage of the waste generated by hospitals is not only harmful for the staff and patients but also to the general public/community at large. Unless sufficient care is taken to neutralise the toxicity, and make this waste productive, communicable diseases are likely to spread, particularly in an urban environment with a high population density.

According to St. John’s authorities, the hospital generates about 1.5 kg of waste per bed. The movement of toxic waste, from its source (wards) after “segregation” to the area where treatment and final disposal takes place is extremely important. These are done in trolleys/boxed carts painted red with the bio-hazard symbol. The cartage staff are not assigned any other work. Protective clothing such as goggles, masks, boots, aprons and gloves is essential for this activity, and captive for the safety of the handlers and the surroundings.

“Earlier, we used to do our own solid waste disposal, but after the Government gave directions that no hospitals in the city should have their own incinerators, we have tied up with Maradi Eco for management of solid biomedical waste,” Rajeev Franklin, consultant for bio-medical waste management at the hospital, said.

He said that the hospital took utmost care in managing liquid waste, some of which could be highly contaminating. “We have two big plants on the premises dedicated to liquid waste, a sewage treatment plant of 500 kilolitres capacity and another of 250 kilolitres capacity. The waste is treated with various chemicals, disinfected and neutralised so that there is negligible waste water discharge,” Mr. Franklin said.

September 26, 2007

Britain health solutions in India

The medical fraternity here has begun to accept that soon enough India may monitor the healthcare of thousands or of millions of people in Britain.

Brits will have access to what promises to be a trans-boundary, market-led system in which the middle classes will routinely shop around the world for the affordable and speediest medical treatments. In this search so far India comes tops.

Almost all patients who went from here have returned fully satisfied and have praised the doctors and facilities at the hospitals they were treated.

This is just one of the latest instance of British patients flying to India for treatment. The traffic is growing fast and travel agencies like Thomas Cook have now package plans for " sun and surgery" in India.

Several Indian hospitals and pharmaceutical companies too have been probing possibilities of attracting patients from here.

A Health Tourism Exhibition held at London's sprawling Alexandra Palace last month attracted a lot of attention from not only the medical fraternity but also of families who wanted to know first hand the medical facilities and costs for treatment in India.

But more than such campaigns, the conditions in the NHS hospitals here, the fear of MRSA and the long-waiting lists are making more and more patients searching on the Internet the best offers from India.

In some hospitals the sight of corridors cluttered with trolleys, of patients occasionally lying there waiting for a bed to become available and the dismissive behaviour of over-worked nurses and doctors often reminds one of similar scenes in Sadar hospitals in a few small district towns in India.

There is of course quite a resistance here. Even one Indian GP pooh-poohed the move to send blood and urine for Lab tests in India.

The Department of Health here too does not want a movement towards India.

A team from India was told that under rules patients are not allowed to undertake any air journey, which takes more than three hours.

But such constraints have failed to dissuade patients in agony and those who cannot afford high cost f treatment or wait in pain until they reach the top of the long queues for seeing a NHS consultant.

Many Brits have returned from India with flattering tales of the quality of service there.

The exodus of junior doctors, which has started due to lack of opportunities for them, will further worsen the situation here. The outsourcing of the healthcare to India is now definitely on the cards.

September 25, 2007

Hospitals seek global tag for hard sell

What then should a hospital do to stand out among dozens cropping up across the country?

Doctors with foreign education alone wouldn't do. For, they were a dime a dozen and each big hospital had battalions of them.

Prathap C Reddy, founder-chairman of Apollo Hospitals Group, had the answer: an international accreditation for the hospital group. A collective recognition.

The idea dawned on him in 2005, the year in which Apollo Hospitals secured an accreditation from the US-based Joint Commission International (JCI).

Things were never the same. Now, more and more hospitals are following in the footsteps of Apollo Hospitals to maintain international standards in health care to attract foreign patients and strike global collaborations.

Also, with most international insurance agencies considering international certifications as a pre-requisite for tie-ups, the trend has caught on, and it's strictly business.

But again, getting that global badge of honour is no mean task.

There are 1,033 measurable elements that need to be adhered to, some of which were alien to the Indian hospital industry in 2005. Proper training, safe disposal norms, education on patient's rights, etc, were some of the areas that had to be taken care of.

The first step

On June 18, 2005, six months after filing an application, Indraprastha Apollo Hospital, New Delhi, received the first JCI accreditation in the country.

This accreditation made it easier for the group to formulate strategies for other hospitals under the banner. By March 2007, it won JCI accreditation for its Chennai, Hyderabad and Ludhiana hospitals as well. The initial investment for the international accreditation paid off well for Apollo Hospitals, which saw improved revenue and margins post certification.

The hospital witnessed an increase in the utilisation of medical service by international patients. The foreign patient in-flow doubled and is now 10 per cent of all admissions in the hospital.

Making a place in the global market with this international certification, the hospital's stocks also went up, although the exchange did not attribute the rise to the certification, said Sunita Reddy, executive director, finance, Apollo Hospitals Group.

Since 2005, eight other hospitals in the country have received JCI accreditation and there are many more awaiting certification.

The ones with JCI have witnessed a financial growth and also reported increase in patient inflow.

Dr Ramakanta Panda, vice-chairman and MD, Asian Heart Hospital, Mumbai, said: "The JCI accreditation process helped our hospital get the systems in place and cut costs."

Vishal Bali, CEO, Wockhardt Hospitals Group, said since Indian healthcare is moving towards globalisation, international accreditations help in maintaining global standards in quality.

The Wockhardt Group is now in the process of securing JCI accreditation for its Bangalore facility. Studies have shown that the medical tourism market in India is growing at 30 per cent and the foreign patient traffic has increased in the past few years.

International insurance agencies are also looking at such certified hospitals in countries like India. Shroff Eye Hospital, Mumbai, the only internationally accredited eye care centre in the country, has also seen an increase in the international enquiries. Based on the JCI stamp, the hospital was also able to tie up with a UK-based insurance agency.

All about health insurance cover

A health insurance policy is popularly known as mediclaim. It essentially helps an individual cover the expenses that he incurs on treatment of an injury or hospitalisation due to a disease.

It covers expenses incurred on meeting boarding charges, the payments to doctors, cost of anesthesia, expenses on blood, medicines, X-ray etc. The insurance also covers expenses incurred before and after hospitalisation. The period differs from insurer to insurer.

Health expenses tend to go up as age catches up and it is only then that most individuals start thinking of taking medical insurance. This becomes a costly affair as premiums tend to go up by then. Also, the individual is not covered for preexisting illnesses.

It makes sense to buy health insurance when the individual starts earning and is young as the premium charged will be less and the individual will be covered for diseases he develops over the years. If there is a no-claim year, next year the cover either goes up by 5 per cent or there is a 5 per cent discount in the premium.

Under Section 80 'D’ of the Income Tax Act, a deduction up to Rs 15,000 from taxable income is allowed for payments made towards meeting the medical insurance premium. For senior citizens, the limit is Rs 20,000. This deduction is besides the Rs 1 lakh allowed under Section 80 'C’.

With the insurance sector being opened to private companies, several innovative products have been launched. One of them is family mediclaim. Another is cashless mediclaim.

Insurance Regulatory Development Authority collecting data on disease patterns

The Insurance Regulatory Development Authority (Irda) is collecting data on disease patterns of the country’s insured population to help health insurance providers to effectively price premiums for health policies based on indicators about the prevalence of diseases.

“We are collecting data about disease patterns from Third Party Administrators. The sample is fairly large. We want to put in this information in the public domain. It will help health insurance providers to understand the Indian population. It will also serve academic purposes,” said Irda chairman CS Rao.

Health insurance companies feel that such data will give them more clarity to price their product. Says an official from Max India’s health insurance division: "Once you have morbidity data, companies can price their products prudently and will know the level of risk they have taken. There will be more transparency in the policy, which will help avoid claim disputes."

The data is likely to be out in a few months. It will be helpful to make a correlation about the occurrence of diseases in a particular population and companies can estimate the risk they will have to take.

In life insurance, annuity products can be priced based on mortality rates which are unlikely to change. But building a database in the case of morbidity is difficult because health profiles of populations evolve over periods of time, subject to lifestyles, consumption habits and other parameters.

Health profiles of consumers can also improve or deteriorate for a variety of reasons, said an actuary. For instance, if smoking habits undergo a change in a population, fewer cases of lung related diseases will be registered over a period of time. Thus, prices of health insurance premiums will be determined by geography, costs of healthcare across regions, gender, etc.

Many players are expected to foray in the niche health insurance segment. Apollo Hospitals have formed a JV with German health insurance company DKV. Max Hospitals is scouting for a foreign partner to foray in the health insurance segment. Dr Reddy’s is also exploring the health insurance market.

Medical :: Indian government to introduce medical devices regulation bill

The Indian Department of Science & Technology has proposed to bring in a new legislation to enforce uniform and effective standards of Medical Devices throughout the country.

This will ensure that substandard devices are not exported, especially to developing countries, which do not have medical devices regulation in place.

The Government has also proposed to create a Regulatory Authority that will seek to establish and maintain a national system of certification relating to quality, safety, efficacy and availability of medical devices. Shri Kapil Sibal, Indian Minister for Science & Technology and Earth Sciences informed this at a press conference here.

He said, as of today, medical device regulation is managed by the application of quality systems in Design, Development and Manufacture and Conformity with various standards. Medical Device Regulations have become NON-TARRIF barriers in international trade. Hence promotion and growth of Medical Devices industry in the country requires effective and prudent regulation incorporating the current accepted principles of Global Harmonizing Task Force (GHTF).

Even within the country, the Central Government is responsible for pre-market approval whereas post market surveillance is the responsibility of State Government. This was not applicable to Medical Devices, since Medical Devices would require uniform quality throughout the country, he added.

The Minister explained that a very wide and diverse range of medical devices were in use today, ranging from very simple devices with low risks (e.g. steel implants) to very sophisticated devices (e.g. heart valves) with significant risks. They use a variety of technologies and are manufactured from Small and Medium Enterprises (SMEs) to multinationals. Their duration of use of also vary from a few minutes to permanent nature. Most devices have to be sterile, some are for single use and some are reusable.

Shri Sibal further stated that failure of medical devices could be fatal. Complex implantable devices can be handled only by a professionally qualified multidisciplinary team. Some medical devices may emit or be affected by electromagnetic interferences and need to be adequately safeguarded. Disposal of medical devices also poses special problems in view of environmental issues. Hence, some sort of regulatory mechanism was required to put in place, the Minister said

September 24, 2007

Hospitals test patients for HIV without consent

Next time you go to the hospital for a routine test, you may get tested for HIV as well. Private hospitals have begun testing all patients for HIV/AIDS, without seeking their consent or offering them counselling.

Medical experts call it a ‘violation of one’s fundamental rights’. Private hospitals have made the tests mandatory, as they say it protects their healthcare providers from contracting such diseases.

But in the process, they have overlooked the Ministry of Health and Family Welfare’s guideline: ‘HIV screening is recommended for patients in all healthcare settings, provided the patient is notified that testing will be performed.”

The National AIDS Control Organisation (NACO) has questioned the necessity of such tests and has also recommended that if these tests are performed, they should conform to rules laid down by some expert body.

Dr Alaka Deshpande, AIDS specialist at JJ hospital, says three tests should be performed before calling somebody HIV+. She says that there have been cases where the first test has shown up positive, but the other two tests have proved otherwise.

“However, some hospitals perform only one test and if the result is positive, tag the person HIV+ without confirming with subsequent tests,” says Deshpande. She adds that lack of stringent laws is making things worse.

A bill drafted by the Lawyers Collective HIV/AIDS Network about ‘informed consent’ is presently being scrutinised by the Union Law Ministry and is expected to be presented in the winter session of the parliament this year. “The bill clearly states that informed consent in the form of writing has to be sought,” says Anand Grover, director of Lawyers’ Collective.

But some private hospitals support their stand on testing patients. “Where is the problem in testing each and every patient?” asks Dr Ashish Tiwari, media officer of Bombay Hospital. “Tests protect the staff who are at risk of getting the infection,” he adds.

“If we start counselling patients, many patients might opt out of treatment.” Ironically, the state government has done little to help. Dr Prakash Doke, director of health services, admits that tests are done without consent, but says that only a strict law can help and recommends precautions.

Some doctors even insist that people should go ahead and sue the hospital. “It is a known fact that pre-test counselling does not happen. Therefore, one has every right to fight against it,” says Dr Madhuri Kulkarni, dean, Sion hospital.

“What if there were no laws? Medical ethics itself should stop hospitals from conducting the tests surreptitiously,” she adds.

September 22, 2007

'Lancet' hits out at U.N. agencies on health data

A top medical journal on Thursday accused U.N. agencies of playing "fast and loose" with scientific data, and faulted UNICEF for what it called the hasty release of global child mortality figures.

The Lancet medical journal criticized the way the United Nations Children's Fund announced last week that worldwide deaths of children under 5 had fallen below 10 million in 2006, which UNICEF hailed as a public health milestone.

The Lancet also faulted the way the World Health Organization used research data on a key method of preventing malaria -- using bed nets treated with insecticides to ward off the mosquitoes that spread the disease.

The Lancet editorial said WHO ignored certain limitations in the study in making a public statement about the use of the bed nets.

"Both of these examples show how U.N. agencies are willing to play fast and loose with scientific findings in order to further their own institutional interests," the Lancet said in an editorial.

"The danger is that by appearing to manipulate science, breach trust, resist competition, and reject accountability, WHO and UNICEF are acting contrary to responsible scientific norms that one would have expected U.N. technical agencies to uphold. Worse, they risk inadvertently corroding their own long-term credibility," according to the Lancet editorial.

The Lancet said the agency annually publishes child mortality data in December and suggested UNICEF rushed this year's release to make it public before the journal published a more critical assessment on Thursday, in the same issue as the editorial.

In the assessment published in Lancet, Christopher Murray, a professor of global health at the University of Washington and a former WHO official, estimated that between 9.5 and 10 million children under 5 died in 2005.

His team concluded there had been too little progress in reducing child deaths, writing, "Globally, we are not doing a better job of reducing child mortality now than we were three decades ago."

A UNICEF spokeswoman said the agency had done nothing wrong in releasing the child mortality figures as it did.

"UNICEF first announced that the under-5 mortality figures were likely to fall below 10 million at two major conferences in June," the agency said in a statement.

"As soon as we had confidence in a more precise figure (9.7 million), we also made this available. UNICEF hopes that the progress revealed by the new figure will act as a spur for greater urgency to achieve the child survival goals," the statement added.

UNICEF said last week global efforts to promote childhood immunization, breast-feeding and anti-malaria measures had helped cut the death rate of children under age 5 by nearly a quarter since 1990 and more than 60 percent since 1960.

Medical equipment companies make a beeline for India

In a bid to tap the booming healthcare market, global medical equipment manufacturers are now setting up plants in India. While companies such as Aloka Science and Humanity of Japan and Starkey of the US have recently set up their units, others like Philips Medical Equipment are scouting for partners.

Japanese ultrasound manufacturer Aloka has entered into a 60:40 joint venture with Chennai-based Trivitron. The joint venture will invest Rs 50 crore and manufacture 1,000 ultrasound equipment annually. Trivitron said it would soon form similar joint ventures with 3-4 more foreign companies to manufacture various medical equipment with an investment of Rs 250 crore in a medical equipment manufacturing park in Chennai.

In the past six months, Japanese opthalmist company Hoya, Nova India of Brazil and Chinese company Mind Ray have set up assembly units in India. Niche player Starkey, the No 1 hearing aid maker in the US, has also set up a manufacturing unit in India “As there is a good demand, companies can now break even in 2-3 years, compared with 8-10 years some years ago. It is now much more viable for companies to set up units in India,” said Starkey India managing director Rohit Misra. However, all these units will mostly manufacture low or middle level segment products and require relatively small investments.

Currently, India’s medical equipment market, including small devices, is estimated to be Rs 2,500 crore. It is growing at 10% but is expected to increase to 15-20% in the next couple of years. About 80-90% of the medical equipment used in the country are imported. Industry officials said once global companies started full-scale manufacturing in India, prices of medical products could fall 15-50%. Hospitals spend a large chunk of their investment in procuring equipment. In the case of top speciality hospitals, medical equipment account for as much as 35% of their total capital investment.

GE has a tie-up with Wipro, which manufactures diagnostic equipment in India. Philips Medical Equipment has said it is looking for suitable partner to start manufacturing in India. “The country has never seen such kind of growth. Companies, which want to cash in on the boom, would like to be close to the centre of action than just depend on imports. The country’s healthcare industry could see a boom similar to the one it is witnessing in the auto sector today,” said Philips Medical Equipment senior director (Indian Sub-continent) Anjan Bose.

US-based healthcare IT and technology provider PekinElmer Inc is also looking for partners to develop its products in India. “Besides the cost advantage, the Indian healthcare industry is a large market and has the right skill set. We plan to make India the centre of our exports to unregulated markets such as the Middle East, Asia and Africa,” said the company’s chairman and CEO, Gregory L Summe. However, he added that the company would develop its sophisticated equipment for regulated markets such as the US and the UK from its global centres.

Tanzania keen on tie-ups with Bangalore hospitals for telemedicine

With the IT city fast emerging as a global health destination, Tanzania is looking at tie-ups with two Bangalore-based hospitals for telemedicine.

"Lions Club of Dar Es Salam is seriously contemplating tie-ups with Narayana Hrudayalaya and Manipal Hospital in Bangalore in the sphere of telemedicine in the coming years,'' Lion's Club President Hyderali Gangji told PTI on Tuesday. Gangji is here as part of the club's "Heart Babies Project'' wherein 41 poor patients from Tanzania, including 28 children, underwent surgery for congenital and rheumatic heart diseases at Narayana Hrudayalaya. The "cost of surgery here was much lower compared to South A frica, UK and the US while the quality matched global standards,'' he said.

"We will be bringing in 160 more Tanzanian children in the coming months for heart surgeries at Narayana Hrudayalaya and Manipal Hospital,'' he said. India is a preferred destination for surgeries because of cost effectiveness and high success rates. "C ost of heart surgery at Bangalore is $1,650 (excluding cost of valves) and a month's stay,'' Mr Gangji said.

Over 1,300 surgeries have been facilitated through this initiative which was heralded by Dr Rajni Kanabar way back in 1979. One in every 150 children in Tanzania is born with congenital heart defect and over 7,000 children with congenital heart diseases await open heart surgeries which cannot be taken up due to lack of sophisticated surgery centre in the country and they lack the means to go abroad for treatment.

September 17, 2007

US insurance firms sell Indian treatment

That healthcare is unaffordable in the USA is well documented. That is also the reason why people from that part of the world are seeking out Indian doctors and hospitals to take care of their medical needs.

And contrary to popular perception in India, even if people in these countries have an insurance cover, life isn’t easy for a simple reason. The premiums are out of whack with what people can afford to pay. And that has now started a new trend that has Indian healthcare companies drooling.

American health insurance firms, particularly from the US are offering their customers a carrot: If you’re unwell, you've got two options. Either you pay the regular premium and get admitted to a hospital in your country of residence.

Alternatively, you choose to go to India for treatment; in return for which you get a hefty 30-40% discount on the annual premium you pay. The way things are in US, 71 million Americans in a population of roughly 350 million, are either uninsured or underinsured because they cannot afford it.

If industry watchers are to be believed, demand for the services is high and global players like Blue Cross, Blue Shield, Cigna Insurance and Aetna Insurance have latched on to the possibility and are hot-footing it to India not just to set liaison offices in the country, but to tie up with Indian hospitals where their clients can be sent to for life saving procedures like coronary bypass surgeries and heart valve replacements.

Germany-based DKV Group for instance, which has teamed up with Apollo group of hospitals, is also eager to set up a stand alone health insurance company in India to cater to this huge and growing overseas demand. The firm has applied for a licence to the regulatory authorities.

Star Health, another Us healthcare firm with investments from insurance companies has set up base in Chennai. It is believed to be in talks with leading hospitals across the country for tie ups.

Then there is American health insurer Cigna, which was present in the country until a few years ago. It is now looking to make a comeback. In its earlier stint, the company had arrangements with major Indian hospitals like Wockhardt that allowed its clients to seek treatment here.

"People are getting desperate for good, cheap and realiable medical care," says Vishal Bali, CEO of Wockhardt Hospitals. "Insurance companies are looking at their own viability and the need to save money. The trend of insurance companies latching on also illustrates the growing unaffordability of the US health care system," he added.

Hospitals in India usually charge around $6,000-8,000 for coronary bypass surgery, $6,500 for a joint replacement and $6,500 for a hip resurfacing, which represent a small fraction of the typical costs at US hospitals. "India is not just known for its outsourced back-office skills any more, like reading of X-rays, medical transcription or billing. It's the actual clinical care that is now being outsourced," says Bali.

Survey backs preventive health care

A quarter of Indian firms lose abut 14 per cent of their annual working days due to employees’ sickness and it is not only heart ailments but also mental stress, trauma and skin problems that are causing the productivity decline among the staff.

This has been reported in a recent survey, “Impact of Preventive Health Care on Indian Industry and Economy”, conducted by the Indian Council for Research on International Economic Relations (ICRIER) released this past week. The study was aimed at giving policy makers a perspective on the impact of preventive health care on Indian employees and their employer’s competitiveness and profitability.

The report indicates a strong relationship between preventive health care and corporate profitability. Eighty two per cent of firm respondents surveyed by ICRIER said preventive health care measures increased a company’s productivity and profitability.

In addition, researchers examined the role of health care delivery.

Almost all of those who had undergone preventive health check-ups felt that these were beneficial, with many reporting better quality of life and happiness at work.

Ninety one per cent of the respondents’ employees felt that it was a good idea that employers provide preventive health care vouchers to them for better performance at work. This study, being the first of its kind in India, is also being seen as a landmark study to overhaul the productivity and employee welfare environment in the country.

Said ICRIER director and chief executive Rajiv Kumar: “This is in some sense a continuation of the work ICRIER has been doing in the past on health economics, but in another sense it is a path-breaking study because we haven’t done anything yet on preventive health care and its impact on the productivity levels of the corporate sector.”

The study also highlights the fact that though the corporate sector has been quick to realise the benefits of preventive health care (two thirds of the companies surveyed have incorporated preventive health care in their corporate governance strategy), policy has lagged behind, and we do not yet have fiscal or other incentives that encourage prevention.

“While public spending on health has stagnated at 0.9 per cent of the GDP since the mid-1980s, and the government per capita health expenditure is one of the lowest in the world, the government should focus its limited resources towards the health of the poor, and provide tax exemptions to sections which can take care of their own health needs, specifically the corporate world. In a highly competitive environment, the corporate sector cannot afford the absence/poor performance of their employees due to sickness, caused by a sedentary lifestyle,” notes the report.

“India’s growth potential depends substantially on preventive health care, which can emerge as a cost effective mechanism,” adds the report.

September 14, 2007

Acquisition bug bites Health care Industry

Firms are opting for acquisitions over new projects as operational hospitals mean immediate revenue at lower costs.

For an industry that is moving faster than fire in a vineyard, having to wait for more than five years just to get a green field project going can be rather frustrating.

But increasingly now, in the healthcare industry, numerous hospital chains — in attempts to clamp down on their waiting periods, boost cash flow and expand into other parts of the country — are on the prowl for strategic acquisitions of other hospitals.

Fortis Healthcare’s 46 per cent acquisition of Chennai’s famous Malar Hospitals last week was the second such acquisition for the north Indian hospital chain and also marked its first step into the south.

Previously, in 2005, Fortis had acquired 90 per cent in the Escorts Heart Institute in Delhi along with three other Escort hospitals in Amritsar, Faridabad, and Chhattisgarh and a vacant plot marked for an Escorts hospital at Jaipur for more than Rs 600 crore.

Towards the end of 2005, Apollo Hospitals acquired 51 per cent stake in Bangalore’s Imperial Cancer Centre and Multi-Specialty Hospital for Rs 35 crore, having already acquired Gleneagles Hospital in Kolkata, Sagar Hospital in Mysore and hospitals in Kakinada, Chennai and Madurai.

Today, roughly 5-6 per cent of Fortis Healthcare’s entire revenue comes from Escorts alone. The acquisition that put the company on a financial backfoot that will only break next year, in retrospect, worked brilliantly for Fortis.

Says Shivinder Mohan Singh, chairman and managing director, Fortis Healthcare, “The Escorts acquisition has been a big boon for us. In fact, it encouraged us to take the acquisition root for gaining a pan India presence.”

Manipal Health Systems, in May this year, grew its acquisitions portfolio by acquiring the 130-bed Providence Hospital in Salem, Tamil Nadu. The company already had a hospital through the same route in Visakhapatnam.

R Basil, managing director and CEO, Manipal Health Systems, explains, “Acquisitions of running hospitals help us in immediately ramping up our revenue at lower investment costs. You will never be able to generate such quick returns from a green field project.”

It was probably this advantage that closed the acquisition of Chennai’s Sankara Hospital by Hyderabad-based Global Hospitals for Rs 257 crore earlier this year.

Acquisitions may be ideal strategies for large hospital chains to expand their portfolio, but for the acquired entity, they are often a means of rising above debts, loans and financial crunches.

Sankara Hospital, for instance, established by the Sri Kanchi Kamakoti Peetam Charitable Trust was put on the block last year after the Trust approached the Madras High Court seeking permission to sell the property because it could not run the hospital and it had become heavily indebted.

And one’s escape turns out to be another’s profit. With private hospitals filling moneybags with crores, the idea of adding a new facility at a much lower investment is appealing.

S K Venkataraman, chief financial officer, Apollo Hospitals, explains, “Normally, if the owner of an operational hospital wants to make an exit from the entity, he invites bidders. The party that wins the bid and acquires the hospital gets the benefit of immediate cash flows. The only thing left to do then is to reconfigure the hospital according to the acquirer’s needs and guidelines.”

Despite this, most chains like Apollo and Fortis like to ride on the existing brand value of the hospital they acquire. Singh, for example, has not only stuck to the Escorts brand name, according to him, any new cardiac-centric specialty set up by Fortis will also most likely be marketed under the Escorts brand.

With plans of having 40 hospitals by 2010, Singh’s strategy is simple — construct a third, manage a third and acquire the rest to reach the target. For Basil too, the takeover strategy is based on requirement and could be a path taken to make their footprints in Mumbai, Delhi, Kolkata, Chennai or Hyderabad.

However, like every strategy, there are pitfalls to this too. With just about two per cent of the country’s hospitals being more than 250-bed facilities, there aren’t enough opportunities for takeover giants.

September 13, 2007

Apollo, Deccan Aviation offer air ambulance service

Apollo Hospitals Enterprises and Deccan Aviation, partners in a new heli-ambulance service plan, hope to rope in medical insurance companies to drive up the market.

A large number of emergency cases need air-lifting for timely medical attention and helicopter service being expensive, it is up to health insurance companies to make it affordable by offering it in their policies, said Ms Sangita Reddy, Executive Director, Operations, Apollo Hospitals Enterprises, and Capt. G.R. Gopinath, Executive Chairman, Deccan Aviation, here on Wednesday.

Talks are on with 3-4 insurance providers and the concept could be a reality soon pending approval of the insurance regulator, they said at the demonstration of the service.

The Apollo group has made 400 emergency air-lifts in the past two-and-a-half years and each trip can cost the patient Rs 1-2 lakh depending on the distance to the hospital, or around Rs 75,000 an hour, Ms Reddy said. With a formal policy, the cost could be brought down.

Corporates tie-up


Another mode would be to allow corporates to tie up with insurance companies for the service.

According to Ms Reddy, up to 10 cases a day across the country could be requiring emergency air-lifts.

“The time has come for insurance companies to step forth and provide medical insurance which covers air ambulance services, on the lines of Western countries,” Capt. Gopinath said. “An alarming number of patients or accident victims succumb without medical help in the first or golden hour [of a medical crisis]. There is an urgent need to plug this gap by providing immediate medical assistance which also includes air-lifting.”

Third-party administrator MediAssist India P Ltd is sharing the cost with Apollo Hospitals, said Mr B. Madhavan, CEO, MediAssist.

Deccan Aviation, the 10-year-old chartered helicopter operator, has a fleet of 10 helicopters and two small planes stationed at Bangalore, Mumbai, Delhi, Hyderabad, Ranchi, Surat and Katra in Jammu & Kashmir.

Apollo will offer the services of Deccan Aviation’s helicopters at its centres in Bangalore, Delhi, Bhubaneswar and Kolkata, where it has either roof helipads or landing facilities. One of Deccan’s helicopters took off from Jakkur, 30 km away, and landed within 15 minutes at the 250-bed New Apollo Hospitals in south Bangalore.

The service, part of Apollo Emergency Specialists 1066, will be available within half an hour of call, along with onboard life support systems, trained personnel and care during flight, said Dr Umapathy Panyala, COO, New Apollo. Creating the landing facility would be another onus on hospitals, he said.

Vice-President of India for focus on health care

Vice-President Mohammad Hamid Ansari has said high infant mortality (IMR) was a violation of the right to life as guaranteed in Article 21 of the Constitution.

The right to life is meaningless if the new born citizens of country did not live long enough to enjoy the rights of citizenship for want of basic health care, he said while releasing the Indian Medical Parliamentarians Forum (IMPF) Policy Notes for Parliamentarians on Access to Medicines.

Stressing on the need to improve health care facilities in the country, Mr. Ansari said lack of access to health care amounted to denial of right to life. He found it strange that while the pharmaceutical sector contributed 2.5 per cent to the Gross Domestic Product (GDP), only 1 per cent of the GDP went to healthcare.

According to the Vice-President, while the country had made great achievements in almost every walk of life, health and education were the two areas where much remained to be done. Suggesting corrective measures, Mr. Ansari said creating awareness about the issues was important, even as he appreciated the government’s proposal of compulsory rural postings for doctors.

Speaking at the function, Union Health Minister Anbumani Ramadoss said the issues faced by the government in the pharmaceutical sector were the accessibility and affordability of quality drugs. He said 3 to 3.5 per cent of the drugs in the market were adulterated, sub-standard or spurious and the Centre was making laws more stringent to check this. A National Drug Authority was also being constituted that would act as a regulatory body.

Further, he also expressed concern over the irrational use of drugs and said that 50 per cent of the drugs were being unnecessarily prescribed by the doctors. It was for this purpose that we were stressing on mandatory continuing medical education, he said.

The policy notes are a compilation of articles by medical practitioners, now in Parliament, and experts in the field of pharmaceutical sector.

This policy note attempts to highlights certain issues, which have direct and indirect implications on access to medicines including access to medicines, regulation, pricing, branding, intellectual property rights and promotional strategies. “We hope this would adequately inform and help MPs and policy makers to address these issues inside Parliament to bring about changes in the relevant laws and policies,” R. Senthil, convenor-secretary of the Forum, said.

September 08, 2007

Govt. to open Medical Park near Chennai

The government will soon launch its first "Medical Park" near Chennai to enable domestic health industry to manufacture medical equipment on a large scale.

Union Health and Family Welfare Minister Anbumani Ramadoss today said the 200-acre Medical Park will be one of the many the Health Ministry is planning in the country.

"We are soon starting the first public Medical Park in Chinglepet, 40 km away from Chennai. It will be a vaccine and medical devices park," he told reporters at the launch of a joint venture between Trivitron, a Chennai-based medical equipment company, and Japan's Aloka for manufacturing high technology ultrasound equipment in India.

The Minister said currently, only 10 per cent of health-related equipment are produced by domestic industry and 90 per cent are imported.

"When these Parks will be set up, the domestic industry will be able to manufacture products catering to the Indian population," he added.

Talking about the joint venture, he said such moves will help bring down the cost of treatment.

Ramadoss said he has requested the Finance and Commerce Ministries to provide subsidy for setting up such parks.

"I want Indian and global companies to come together to come out with medical equipments and devices which will be first used in India and if they manufactured in excess could be exported, a policy followed successfully in China," he said.

No direct involvement of Health Minister in AIIMS: MPs panel

Noting that the government intervention proves "baneful" for the autonomy of institutions of excellence, a parliamentary panel today suggested the union health minister remain out of any form of direct involvement in AIIMS and other such institutions.

The Standing Committee, which presented the report in the Rajya Sabha, however, said it is not averse to the idea of government having a say in the management of the Central institutions.

"But if the intervention of the government proves baneful for the autonomy of the institutions of excellence the issue of nomination of the health minister and health secretary needs to be revisited," the committee said.

The committee, chaired by Samajwadi Party MP Amar Singh, said they were "compelled to make such a statement as there have been several unsavoury developments in the recent past that have cast their shadow on the autonomy of AIIMS."

"A host of issues involving AIIMS and the Ministry of Health and Family Welfare are again before the Delhi High Court," it said.

"... the minister and the secretary of the ministry of Health and Family Welfare should remain out of any form of direct involvement in any of the Institute Bodies," the report said.

The committee also expressed its deep concern over the non-issuance of degree certificates to the resident doctors of AIIMS and the resultant strike which severely paralysed the patient care services at the institute.

Health Minister Anbumani Ramadoss and AIIMS Director P Venugopal are involved in a tug of war for more than one year over the running of the premier institute.

DRL eyes health insurance, organised pharma retail

DR Reddy’s Laboratories (DRL) is eyeing an entry into health insurance and pharma retail as part of its ambitious plan to diversify in the health business. The growing business opportunities in both these segments could be the trigger.

“We have taken note of recent developments in health insurance where hospitals are tying up with foreign insurance companies for joint ventures as well as organised retail. Our board is still looking at ways to respond to these developments, though the deliberations are still at the preliminary stage,” Dr Reddy’s vice-chairman GV Prasad told ET. Last month, the Apollo Hospital Group and Europe’s largest private insurer DKV joined hands to start a standalone health insurance company, the second one in India. But this is the first ever insurance venture of a hospital group in the country.

The minimum paid-up capital requirement for companies entering insurance is Rs 100 crore. The existing regulations allow only up to 26% FDI in the insurance sector. This means DRL may have to look for a foreign insurance partner if it does not want to chip in the entire Rs 100 crore.

At present, there are 15 general insurers offering traditional health insurance policies. But new players are keen on entering the health segment, considering that less than 3% of the country’s population is covered by health insurance. Analysts tracking DRL, however, seem sceptical on the core pharmaceutical maker’s possible entry in new areas of business. “If DRL does want to enter organised retail, it needs to make huge investments to set up chains and employ trained pharmacists. The company may have to raise extra capital to fund a retail venture. So is the case for an insurance venture,” said a senior industry analyst.

Some other analysts, however, maintain that Dr Reddy’s possible entry into the $5-billion Indian retail space is logical from a branding perspective and the company can leverage on its nationwide distribution chain to drive sales.
A host of players are already operating in the market, including Subhiksha, Apollo Pharmacies, Med Plus and 98.4 degrees. In fact, Med Plus is also looking at starting a manufacturing unit to develop it own brand of pharmaceuticals that will be sold through its outlets.

As of now, DRL is pushing its rural sales hard. The rural market contributed to a whopping one-fifth of its total sales in India and the market continues to grow at a rapid rate. “Now, there is no distinction on drug consumption patterns between rural and urban areas. For instance, our heart disease-related drugs sell rather well in rural areas, as cardiac (heart-related) diseases are no more rampant only in cities,” said GV Prasad.

September 04, 2007

Intel launches tele-health project

World’s largest computer chip maker Intel Corporation today embarked on a programme here to transform healthcare in rural India along with the union ministry of health and family welfare, sending a message of social responsibility of MNCs operating in the country.

Intel Corporation chairman Craig Barrett and union health minister Dr Anbumani Ramadoss today inaugurated a tele-health project at this small town, 120 km from Chennai.

Barrett said, “Applying technology in pioneering ways can help increase access to healthcare and improve quality of care for people everywhere.”

The Intel chief, who also chairs the United Nations Global Alliance for ICT and development, said, “We have seen how technology has enhanced people’s lives in Baramati, and look forward to seeing this replicated on a larger scale across Tamil Nadu and the rest of the country.”

Intel had deployed its first remote health programmes in a digital village pilot in Baramati, about 120 km from Pune, in Mahrashtra.

Barret said the pilot in Baramati attracted the attention of government and industry leaders, inspiring e-health projects that will be deployed across Tamil Nadu and the country. The projects include a tele-health programme for community hospitals and a school health-monitoring system.

Ramadoss said, “Digital health solutions are the most appropriate tools for achieving our objective of providing healthcare to the poorest citizens living in the remote areas of our country.

These health projects, starting in Tamil Nadu, but later spread out all over the country, are an extension of the Intel World Ahead Program, a global initiative to provide people in developing countries with the benefits of better, faster access to information and communications technology (ICT).

The web-based health referral system at the state government owned hospital here aims to provide improved and cost-effective access to high-quality healthcare and is hosted by Tata Consultancy Services (TCS) on its web health central portal.

It will also enable doctors to view patient records and diagnostic images such as retinal scans over a secure computer network. Through videoconferences, specialists across India can also examine patients remotely.

While at this small town, Barrett also visited a girls’ school for a firsthand look at a children’s health monitoring system developed by TCS. This first-of-its-kind project in Tamil Nadu addresses both healthcare and education by installing technology that helps ensure that government-aided schools are a safe and healthy place for children.

September 03, 2007

Doubts raised over quality of MBBS training in China

While China has decided to reduce the number of Indian students in its medical colleges - to 30 per college - on the ground that foreign students were diluting the quality of education, a fact-finding mission sent by the Union Ministry of Health and Family Welfare has raised serious concerns about the quality of medical education provided at some of the Chinese universities.

Notably, the mission is known to have doubted the practical, training aspect of the course. The visiting team comprised two ministry representatives and 12 doctors, including principals, medical superintendents and deans of medical colleges across India.
From June 3 to June 17, the team visited six medical colleges across China, including Southern Medical College and Jinan University, Guanzhou and Luzhou Medical College, Luzhou, among others.

Highly-placed ministry sources said the team was sent on the Indian Embassy's request. In its report submitted to the ministry, the mission is learnt to have raised a few questions on the clinical and hands-on training offered as part of the programmes.

A member of the mission said: "Most of the students are at the pre-clinical stage. We have submitted a report, stating facts like lack of adequate number of teachers and that the Chinese faculty in these colleges have very little knowledge of English."

The team also questioned the lack of entrance exams to admit students. Joint secretary, ministry of health and family welfare, K Ramamoorthy, was part of the mission.

According to Dr Amod Gupta, faculty of ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, "How can just five or six faculty conduct an MBBS programme even for a year, when we need a whole team of faculty and paramedicals even to run a single department? These students will be good in theory and will clear the Medical Council of India's screening test, but will they be able to treat people?"

A second-year MBBS student of Jinan University told TOI: "They are running a complete MBBS programme with just four or five teachers for the past two years. And we are told that in the third year, we will not have clinical. What is the use of theory to a doctor without hands-on experience?"

India's medical facilities big hit in UK

Medical tourism in India is increasingly gaining momentum. About 150,000 foreigners seek treatment in Indian hospitals for non-emergency conditions every year.

According to Taj Medical Group, a knee operation that might cost £10,000 in the UK can be done in India for £4,900, including travel and accommodation. Patients seeking minor surgery combine their treatment with holidays at posh resorts, which are included in the price.

It is a business growing at double-digit rates, worth $300 million (£170 million) annually for India. Taj Hotels is soon to announce a tie-up with Apollo Hospitals, a private medical group, to promote and exploit the soaring demand for cheaper medicine.

BUPA is sending patients to Jaslok hospital in Mumbai, says Colonel Masand, the hospital's director-general. The NHS, however, is proving reluctant. It has denied that it had sent any patients to India or planned to do so but declined to give any explanation for the policy.

However firms like Siemens, sees India as a huge market for its medical technology, worth $1.3 billion and expected to double in size within five years.

It is not only medical tourism but offshore diagnostics that offers huge opportunities for India, says Dhandapany Ragavan of Siemens Medical Solutions. The annual salary of a top radiologist in the US might be $300,000, compared with $20,000 in India. X-ray images are already being sent overnight from the US to be read by Indian radiologists. "It is only a question of time before public institutions send patients to India to reduce healthcare costs," Ragavan says.

At Taj Medical, they are already seeing UK patients that the public service rejects. "The Government has told obese people they will not have operations unless they lose weight, which is a problem if they have hip or knee problems and cannot exercise."

But a spokesman for the NHS says, "patients have a choice of four hospitals and will be treated within six months".

Court tells Ramadoss to sign AIIMS doctors' certificates

The Delhi High Court on Friday directed Union Health Minister Anbumani Ramadoss to sign the postgraduate degree certificates of All India Institute of Medical Sciences (AIIMS) resident doctors within 48 hours or it would hamper the prospects of students seeking admission to foreign universities.

The direction was given by a division bench headed by Chief Justice MK Sarma.

The minister, who is also president of the institute, had earlier returned the certificates without signing them, citing some discrepancy. The affected resident doctors had gone on a lightning strike at the hospital, badly affecting its services. The strike was called off on Thursday and fresh certificates issued, but minus the signature of the health minister and the dean.

The court's observation came during the hearing on a petition filed by some resident doctors who had apprehensions about the validity of their degrees as these did not have the four requisite signatures - of the dean, the director, the president and registrar.

"We do not know whether there is any dispute in AIIMS or not. But these students, who are innocent, should not suffer because of all these things," the court observed.

Mukta Gupta, appearing for the dean, academics, of the institution, said: "The certificates were not valid ones and we are not going to put our signatures on them."

Taking strong note of her statement, the bench said the future of innocent students should be protected.

The AIIMS Residents Doctors Association had withdrawn their strike after the matter came up for hearing following Advocate Ashok Aggrawal filing an application seeking direction to declare the strike illegal.

The AIIMS staff council, which met on Thursday, had decided to give the certificates to the agitating doctors but without the signatures of the dean and director.

Ramadoss had said certificates without his signature do not hold "validity".

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