This is a blog dedicated to the Marketing of Healthcare Services. I welcome comments and feedback.

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Sunday, July 19, 2009

An OPD Experience

The other day my wife had an appointment with her doctor at one of the well known hospitals in town. We were to see her at 8PM, but what with under construction Metro line collapsing and the resultant traffic snarls bringing the city to a halt, we were running late. Hoping against hope of catching the doctor, we reached the hospital 20 mins late.

Luckily for us, as we arrived the doctor was finishing with her last patient of the day and agreed to see my wife immediately. She indicated that some tests were needed and while she went about doing those, I might run along and pay the bills as the billing counter would be closing. She scribbled the tests on a medical form and off I went to do the needful.

Sure enough the billing counter was deserted and the billing clerk appeared to be in a hurry to rush off. As I put in my request a surly lady (let me call her N) told me to wait. I waited patiently, and again enquired about settling the bills. My wife had by then joined me as well as the doctor had finished with her. Nothing happened. Finally, I requested an audience with the duty manager, who arrived promptly. When I explained the situation to him he asked N to open her system and do the billing and for good measure added she can ‘easily do it for one patient at least’.

N finally accepted my papers and opened her billing system. After fiddling around with the system for a while, she summoned another colleague ‘D’ for help. Apparently, N was not able to find the tests on her billing list. Apparently, she did not know where to look. Her colleague D who was supposed to be more competent on the system too, could not find the tests. As I waited patiently N in true style of a government owned medical institution ordered me to move away from the counter and wait elsewhere till she sorted out the problem. (Do not forget that I am the only guy on the counter and am not holding up anything).

This is where I lost it and told her to shut up and seek help in organising my bill. The duty manager again materialised and after murmuring some instructions in N’s ears hurried away. N than started calling up some folks to figur out where and how to bill. Another guy sauntered up and tried finding a solution, he too seemed completely at sea. He disappeared just as quickly.

Finally after waiting for close to half an hour to get a service billed, I was handed over an invoice. And than it was discovered that while the procedure has been billed, a canula used during the procedure has not been billed and the entire pantomime of finding it in the system and billing the same was repeated.

We are really having a serious problem with our front office executives. They are all new as the trained ones have all moved on to greener pastures and other hospitals. Even the duty managers, who would earlier get involved and sort out these problems deftly are new” admitted a friend of mine who works in the hospital. He also added that training people in understanding medical terminology and gaining proficiency on the Hospital Information System (HIS) takes time and by the time a new set of people are reasonably proficient, they move on. ( mostly to call centres, which pay a lot higher).

While I can understand the hospital’s problems, a bad patient experience is something most hospitals can ill afford. N and D and the duty manager had a problem understanding the medical terminology, they also lacked the empathy and a caring attitude that is a must for folks who work in hospitals. In this day and age, you can not be rude with patients. Moreover, as I pondered over this I realise that a small error in billing can have some very serious consequences. For, instance whatever tests are billed, will be run by the lab. If these are not what the consultant ordered…you can imagine the problems.

Considering all this, I would like to believe that investing in employee retention is far better than having a crop of new recruits manning customer touchpoints in the hospital. Cutting people costs in a hospital can really prove a lot more expensive than what a hospital might have bargained for.

Saturday, July 11, 2009

The Healthcare Opportunity in India

Everybody acknowledges that the healthcare industry in India has a lot going for it. Patients from across the world are looking at state of the art Indian hospitals for cheap and quality care. The doctors and the nurses are considered to be one of the best in the world, their is abundant supply of good quality medical talent, health insurance is penetrating deeper and the market is predicted to grow substantially.

A quick look at the numbers tell the story. Healthcare is presently a USD 35 bn industry and is expected to grow to USD 75 bn by 2012. A Confederation of Indian Industry report says that investments worth USD 50bn are required annually for the next 20 years to meet the growing demand. India will need 3.1 mn additional beds (presently 1.1 mn) by 2018

While the sector has seen substantial investments in the last year, they are but a drop in the ocean. The healthcare sector has not really seen the kind of action that one would expect considering the opportunities.

The country has just a handful of players who have any significant presence in the market. These include the Apollo Hospitals Group, Fortis Healthcare, Max Healthcare, Wockhardt Hospitals, Manipal Hospitals and Columbia Asia. Out of these only Apollo and Fortis has a significant pan India presence. Wockhardt is largely present in the west and south India, Max is located only in Delhi and the National Capital region and Manipal Hiospitals has presence only in South India.The expansion plans of some of these are in the ‘go slow’ mode. Manipal’s hospital in Delhi, which was earlier slated to commence operations is no where near completion, Max’ hospitals expansion in East and South Delhi are yet to commence operations. New entrants including Reliance are still testing the waters. Sahara group has recently commenced operations at their first hospital in Lucknow, while the plans for many more are still pretty much on paper. Artemis Health Sciences, which had announced ambitious plans for 10 hospitals by 2015 is still struggling with its first venture in Gurgaon and plans for the other hospitals are on hold. Wockhardt is in the doldrums as its parent, the eponymous pharma company is in a financial mess and has reportedly put its hospitals business up for sale.

Strangely, not many foreign hospital chains has as yet finalised their plans to enter the country. Healthcare consulting firms have done studies for some likely entrants but nothing concrete has come of it as yet. Columbia Asia is the onlyforeign hospital chain, which is making steady investments and following a well thought through strategy of establishing its presence in tier 2 towns in India.

It appears that amongst the foreign players the reluctance to invest in India largely stems form the fear of the unknown. Everyone is waiting and watching for an opportune moment. The lack of a proper regulatory environment and an uncertain health insurance play is also acting as dampners.

However, I also believe that for wanna be investors, whether Indian Corporates or foreign players, the time is just about right to make that foray. It is being widely acknowledged that the worst of the economic downturn in India is behind us, a new government is set to take charge in less than 15 days from now and healthcare is bound to be on its priority agenda.

Pretty much like the telecom sector, I believe that the time has come for the healthcare sector to break the shackles and herald the next wave of transformation, which will fundamentally change the way most Indians access healthcare today.