Marketing hospitals: a tight-rope walk

by: Ms.Khushboo Kumari, MHA-Hospital (2010-12)

Healthcare is a basic human need; and hospitals are the institutions, which cater to that need. There is no denying the fact that hospitals do need marketing, especially in the present day context, when healthcare is seen as an industry and when the competition is getting increasingly tougher with mushrooming private players. Customer focus has become primarily important in order to improve the bottom-line (profit/surplus). As a matter of fact, financial success of a hospital often depends on its marketing ability.

But the ethicists have always raised brows on this subject. Is marketing a healthcare institution ethical? What are the ethical standards that must be maintained while marketing the hospital services? Apparently, there is a huge knowledge gap between the providers and the customers (patients) in case of medicine. Hence these concerns are valid; and there is need of a strong healthcare marketing ethics model.

In case of hospitals, patients’ welfare should always be the prime motive, and not the profit. Marketing should never lead a patient to accept unnecessary service/s, irrespective of the costs or risks involved. A supplier (hospital)-induced demand for unnecessary services must be vehemently discouraged in healthcare. For instance, including X-ray as a part of routine check-up procedure or promoting cosmetic surgeries etc.

Advertisements should never be misleading, whether of any new equipment employed or of any new facility or service, introduced at experimental level. The best marketing is marketing that educates, i.e. letting people know what’s true; being honest and helping them to make an informed choice.

Customers are the best marketing agents that an organization can secure; and this can be achieved only by means of building up the confidence in them that their welfare is being given highest priority. This confidence further can be instilled only by means of offering honest and sincere services to them. The marketing team in a hospital must concentrate on relationship management with customers, aimed at improving their satisfaction level.

The 4P of marketing must be integrated with the 4Cs, i.e. Product as Customer solution, Price as Customer Cost, Place as Convenience to Customer and Promotion as Customer Communication. A satisfied customer base automatically improves the market share and consequently, the profit.

AYUSH and Public Health System in India

By: Dr. Sarosh and Vanita Singh
MHA-Health (2011-13)

Ayurveda, Unani, Siddha and Homeopathy (AYUSH) are rationally recognized systems of medicine and have been integrated into the national health delivery system. The NRHM seeks to revitalize the traditional medicine system of our country and to mainstream AYUSH to strengthen the public health system at all levels.

It is a rational decision because these systems have age-old acceptance in our country. Ayurveda is the oldest system with known efficacy. Yoga is gaining popularity as it has been found very effective in treating life-style diseases, which are on a rise presently. Homeopathy propagates indigenous knowledge aimed largely on chronic illness and preventive care e.g skin conditions, sinusitis, hair-loss etc. Many prefer these systems over Allopathic system because of the latter’s known side-effects.

The lack of state patronage in the past had prevented this form of medicine to be practiced at the same platform as Allopathy, which has a more scientific base and approach. Pharmacopial standards in manufacturing of AYUSH drugs, standard teaching institutes and scientific research which will answer the 'what' 'when' 'how' and 'why' will lead to more acceptance of this system. The increase in budget allocation for AYUSH is the right step in that direction. Integrating AYUSH with other system of medicine at lower levels like CHCS, PHCS in rural areas will definitely strengthen our public health system because this system enjoys a popular base in the mass rural population and is slowly attracting urban inhabitants as well.

Also, preventive care emphasis is universally accepted for its benefits in day to day life as prevention is surely better than cure. Hence, AYUSH can and will be a helpful adjunct to the system of medicine for curative and preventive aspect of public health.

“Demand” Vs. “Need” in healthcare

by: Dr.Ajitendra, MHA-Health

Demand is an economic concept which describes the quantity of a good or service per unit time that an individual or household will purchase and consume at given price of goods or services. It is distinct from need which, in the context of health- can be seen as the level of health services which a medical specialist finds necessary to meet particular health indicator. When demand and need do not coincide the real problem surfaces.

When individuals demand for health services that medical specialist suggests they do not need, it causes waste of resources. On the other hand if individuals do not demand health services, which they medically require, it will lead to worsening of their health and if that disease is communicable, then of others too.

Concept of shortage: Both for Poor and Rich

“Rich: ever-growing demands not met”

“Poor: basic needs not met”

Apparently, market forces can’t provide the needed health care at affordable prices. Hence the government has to intervene to keep medical services within the reach of vulnerable poor and restore equity.

In rural areas, the need is very high, but demand or the purchasing parity is quite low, thus it results in lower supply. On the other hand stands the ultra modern urban city, where the demand has far more exceed the need and hence there is a continuous supply of medical care. The gap between urban and rural and the ‘haves’ and ‘have-nots’ is increasing as 75% of India’s health infrastructure & medical manpower are located in urban areas, where only 27% of population resides. Also largely preventable contagious and water borne diseases cause over twice number of death per year in rural areas than urban areas and immunization rates, pattern of delivery, IMR, MMR and other health indicator are skewed in rural areas.

This disparity clearly indicates the restructuring of workforce and other resources according to the need of people rather than demand. For better management and to achieve a more rational distribution of health care resources, one has to clearly distinguish between Demand and need and set the priority to meet 'Need' and tame 'Demand'.

3 Reasons why Government Hospitals in India should provide good quality health care

by: Dr Sandeep Moolchandani, MHA-HO (2009-11)

Hospitals form an important arm of the healthcare delivery system. Though the focus of various National programmes may be on primary health but secondary and tertiary public hospitals form one of the largest expenditure category in the national health budget. Over the past decade, inspite of the complexity of hospitals having increased many fold, not many changes have been made in the management structure of public hospitals.

It is very well known that hospitals should be hundred percent clean and hygienic, but in practice government hospitals are generally the filthiest places. Even central level tertiary government hospitals are run on primitive principles; problems of poor governance and administration is not a hidden fact. Waiting times in government hospitals can reach upto two hours just for accessing outpatient services.

Lack of governments’ commitment towards quality assurance in government setups, low management capacities at health facilities, lack of policies and guidelines from the State, as well as structural problems of the centralized health system are key problems in Public Health Sector leading to inefficient use of scarce resources and deficiencies in the quality of services provided (Davey, 2006)

This post enumerates the reasons why the public hospitals should start focusing upon delivering optimum quality of services.

1. Public Hospitals impose significant opportunity costs to the society

The secondary and tertiary care as such has a limited impact on the population health. Inspite of this known fact a major chunk of healthcare budget is spent on secondary and tertiary care which can be upto 40-50% of state healthcare budgets. Thus infrastructure and administrative costs of hospitals carry a big opportunity costs with them.

Maharashtra 2000-01
Public Health Expenditure (Rs. Million) in Urban Areas

In 2000-01, 48percent of public health expenditure in Maharashtra, which amounts to Rs 5396.11 million, was incurred on medical care alone.

2. Decreasing utilization of Public Hospitals for Inpatient and Outpatient Care

Some studies on the patterns of utilization of health care facilities indicate that the private health care provider is preferred for the cost and quality of the health care services provided (Uplekar 1989a, 1989b; Viswanathan and Rohde 1995).


80percent of households prefer to use private sector treatment in India for minor illnesses, and 75percent of households prefer to go to the private sector for major illnesses (M.Uplekar, V.Pathania, & M.Raviglione). Numerous other studies have confirmed the dominance of the private sector and the reasons for this dominance: government health services entailed longer waiting periods, arrogant behaviour of doctors and non-availability of medicines (Ananthakrishnan). Even though the treatment in public hospitals is free, the patients have to pay for tests, and bear the incidental costs of boarding and lodging (Pasricha, 2006).

Chart: Sources of Utilization
of Health Care Services, Maharashtra (Adapted from “Health And Healthcare In Maharashtra: A Status Report”, Ravi Duggal,
2005)

The users don’t prefer to use public facilities for medical services like Inpatient and Outpatient services in contrast to other primary healthcare services especially in urban setup as per the data published by National Sample Survey Organization (NSSO). The major public providers which provide these services in urban setups are teaching hospitals and general hospitals. There is a clear preference towards private providers despite of costly treatments in secondary and tertiary domain. This data points towards the failure of public hospitals in meeting the expectations of the public.

3. Health Expenditure incurred by patients in Public Hospitals vs Private Hospitals

The ratio of hospitalisation expenditures in public vs private hospitals in urban setups ranges between 0.16 in Tamil Nadu to 1.75 in Haryana. The services provided in public hospitals amount to a considerable fraction of the costs in private hospital. Even after spending a comparable amount, all patient gets is dismal sanitary conditions, long waiting times, rude behaviour of staff, high infection rates and substandard clinical care. This is one of the prominent reasons why the patients prefer private healthcare providers more than public hospitals.

A significant dilemma is faced by middle income groups who can spend on healthcare but not as much as charged in good private tertiary setups; while in case of treatments in government hospitals the quality of services provided is too bad to meet their expectations. The middle class comprises to around 25 to 30 percent of the total population of India.

Major State-wise Average
Total Expenditure (Rs.) Per Hospitalisation by
Type of Hospital for Rural and
Urban Areas in India

There are three things which should be clear with respect to the treatment in a government hospital, firstly the treatment in government hospitals is not completely free, secondly apart from these costs there are costs involved due to loss of daily livelihood and thirdly there are potential costs that can come into picture due to bad quality of treatment (improper instructions while prescribing, post op infections, medical errors, medical negligence etc).

Conclusion

A significant amount of taxpayer’s money is spent on Government hospitals which puts these hospitals in a critical position to be accountable for the quality of services and deliver quality services within the constraints of available resources. It should be tried by the public hospitals to prevent diversion of its customer to private setups due bad quality of services. This warrants an existence of a quality management and control mechanism for government hospitals.

Quality of service should not be denied just because the direct consumer is not asking for it; but concrete measures towards quality assurance are necessary because lots of money is being spent in providing the infrastructure and bearing the administrative costs in the public hospitals. A few state governments (Gujarat, Kerala) are coming up with answers to these questions by taking concrete actions towards quality assurance and commitment for continuous quality improvement.