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PROJECT ON

HEALTH PROBLEMS AND SERVICES

UNDER SUPERVISION OF:

SUBMITTED BY
NAME:

ENROLLMENT NO:

Submitted in partial fulfillment of the requirements for qualifying
MBA

HEALTH PROBLEMS AND SERVICES

Under Supervision of :

Submitted By:
Name :
Programme :
Enrolment No. :
Study Center Code :

BONAFIDE CERTIFICATE

This is to certify that the project titled “Health Problems and Services” is an original work of the Student and is being submitted in partial fulfillment for the award of the “Master’s Degree in Business Administration” of Sikkim Manipal University. This report has not been submitted earlier either to this University or to any other University/Institution for the fulfillment of the requirement of a course of study.

Signature of Student Signature of Supervisor
…………………………. …….………………………

ACKNOWLEDGEMENT

With Candor and Pleasure I take opportunity to express my sincere thanks and obligation to my esteemed guide………………. It is because of his able and mature guidance and co-operation without which it would not have been possible for me to complete my project.

It is my pleasant duty to thank all the staff member of the computer center who never hesitated me from time during the project.

Finally, I gratefully acknowledge the support, encouragement & patience of my family, and as always, nothing in my life would be possible without God, Thank You!

(STUDENT NAME)

DECLARATION

I hereby declare that this project work titled “Health Problems and Services” is my original work and no part of it has been submitted for any other degree purpose or published in any other from till date.

(STUDENT NAME)

TOPIC PAGE NO

1. Introduction ………………………………………………………………8
2. Review of literature………………………………………………………57
3. Objective………………………………………………………………….73
4. Research Methology………………………………………………………75
5. Result and discussion………………………………………………….….78
6. Data Analysis and Findings………………………………………………111
7. Conclusion……………………………………………..………….……..122
8. References …………………………………………………………….….125
9. Questionnaire ……………..………………………………………….…..129

HEALTH PROBLEMS AND SERVICES

1. INTRODUCTION

Healthcare in India features a universal health care system run by the constituent states and territories of India. The Constitution charges every state with “raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties”. The National Health Policy was endorsed by the Parliament of India in 1983 and updated in 2002.[1] However, the government sector is understaffed and underfinanced; poor services at state-run hospitals force many people to visit private medical practitioners.
Government hospitals, some of which are among the best hospitals in India, provide treatment at taxpayer expense. Most essential drugs are offered free of charge in these hospitals. Government hospitals provide treatment either free or at minimal charges. For example, an outpatient card at AIIMS (one of the best hospitals in India) costs a one time fee of rupees 10 (around 20 cents US) and thereafter outpatient medical advice is free. In-hospital treatment costs depend on financial condition of the patient and facilities utilized by him but are usually much less than the private sector. For instance, a patient is waived treatment costs if he is below poverty line. Another patient may seek for an air-conditioned room if he is willing to pay extra for it. The charges for basic in-hospital treatment and investigations are much less compared to the private sector. The cost for these subsidies comes from annual allocations from the central and state governments.
Primary health care is provided by city and district hospitals and rural primary health centres (PHCs). These hospitals provide treatment free of cost. Primary care is focused on immunization, prevention of malnutrition, pregnancy, child birth, postnatal care, and treatment of common illness Patients who receive specialized care or have complicated illnesses are referred to secondary (often located in district and taluk headquarters) and tertiary care hospitals (located in district and state headquarters or those that are teaching hospitals).
In recent times, India has eradicated mass famines, however the country still suffers from high levels of malnutrition and disease especially in rural areas. Water supply and sanitation in India is also a major issue in the country and many Indians in rural areas lack access to proper sanitation facilities and safe drinking water. However, at the same time, India’s health care system also includes entities that meet or exceed international quality standards. The medical tourism business in India has been growing in recent years and as such India is a popular destination for medical tourists who receive effective medical treatment at lower costs than in developed countries.
The Indian healthcare industry is seen to be growing at a rapid pace and is expected to become a US$280 billion industry by 2020.[2] The Indian healthcare market was estimated at US$35 billion in 2007 and is expected to reach over US$70 billion by 2012 and US$145 billion by 2017.[3] According to the Investment Commission of India the healthcare sector has experienced phenomenal growth of 12 percent per annum in the last 4 years.[4] Rising income levels and a growing elderly population are all factors that are driving this growth. In addition, changing demographics, disease profiles and the shift from chronic to lifestyle diseases in the country has led to increased spending on healthcare delivery.[5]
Even so, the vast majority of the country suffers from a poor standard of healthcare infrastructure which has not kept up with the growing economy. Despite having centers of excellence in healthcare delivery, these facilities are limited and are inadequate in meeting the current healthcare demands. Nearly one million Indians die every year due to inadequate healthcare facilities and 700 million people have no access to specialist care and 80% of specialists live in urban areas.[6]
In order to meet manpower shortages and reach world standards India would require investments of up to $20 billion over the next 5 years.[7] Forty percent of the primary health centers in India are understaffed. According to WHO statistics there are over 250 medical colleges in the modern system of medicine and over 400 in the Indian system of medicine and homeopathy (ISM&H). India produces over 25,000 doctors annually in the modern system of medicine and a similar number of ISM&H practitioners, nurses and para professionals.[8] Better policy regulations and the establishment of public private partnerships are possible solutions to the problem of manpower shortage.
India faces a huge need gap in terms of availability of number of hospital beds per 1000 population. With a world average of 3.96 hospital beds per 1000 population India stands just a little over 0.7 hospital beds per 1000 population.[9] Moreover, India faces a shortage of doctors, nurses and paramedics that are needed to propel the growing healthcare industry. India is now looking at establishing academic medical centers (AMCs) for the delivery of higher quality care with leading examples of The Manipal Group & All India Institute of Medical Sciences (AIIMS) already in place.
As incomes rise and the number of available financing options in terms of health insurance policies increase, consumers become more and more engaged in making informed decisions about their health and are well aware of the costs associated with those decisions. In order to remain competitive, healthcare providers are now not only looking at improving operational efficiency but are also looking at ways of enhancing patient experience overall.[10]
India has approximately 600,000 allopathic doctors registered to practice medicine. This number however, is higher than the actual number practicing because it includes doctors who have emigrated to other countries as well as doctors who have died. India licenses 18,000 new doctors a year.[11]
Critics say that the national policy lacks specific measures to achieve broad stated goals. Particular problems include the failure to integrate health services with wider economic and social development, the lack of nutritional support and sanitation, and the poor participatory involvement at the local level.
Central government efforts at influencing public health have focused on the five-year plans, on coordinated planning with the states, and on sponsoring major health programs. Government expenditures are jointly shared by the central and state governments. Goals and strategies are set through central-state government consultations of the Central Council of Health and Family Welfare. Central government efforts are administered by the Ministry of Health and Family Welfare, which provides both administrative and technical services and manages medical education. States provide public services and health education.
The 1983 National Health Policy is committed to providing health services to all by 2000. In 1983 health care expenditures varied greatly among the states and union territories, from Rs 13 per capita in Bihar to Rs 60 per capita in Himachal Pradesh, and Indian per capita expenditure was low when compared with other Asian countries outside of South Asia. Although government health care spending progressively grew throughout the 1980s, such spending as a percentage of the gross national product (GNP) remained fairly constant. In the meantime, health care spending as a share of total government spending decreased. During the same period, private-sector spending on health care was about 1.5 times as much as government spending.
In the mid-1990s, health spending amounted to 6% of GDP, one of the highest levels among developing nations. The established per capita spending is around Rs 320 per year with the major input from private households (75%). State governments contribute 15.2%, the central government 5.2%, third-party insurance and employers 3.3%, and municipal government and foreign donors about 1.3, according to a 1995 World Bank study. Of these proportions, 58.7% goes toward primary health care (curative, preventive, and promotive) and 38.8% is spent on secondary and tertiary inpatient care. The rest goes for nonservice costs.
The Fifth (1974–78) and Sixth Five-Year Plans and (1980–84) included programs to assist delivery of preventive medicine and improve the health status of the rural population. Supplemental nutrition programs and increasing the supply of safe drinking water were high priorities. The sixth plan aimed at training more community health workers and increasing efforts to control communicable diseases. There were also efforts to improve regional imbalances in the distribution of health care resources.
The Seventh Five-Year Plan (1985–89) budgeted Rs 33.9 billion for health, an amount roughly double the outlay of the sixth plan. Health spending as a portion of total plan outlays, however, had declined over the years since the first plan in 1951, from a high of 3.3% of the total plan spending in FY 1951-55 to 1.9% of the total for the seventh plan. Mid-way through the Eighth Five-Year Plan (1992–96), however, health and family welfare was budgeted at Rs 20 billion, or 4.3% of the total plan spending for FY 1994, with an additional Rs 3.6 billion in the nonplan budget.
Health care facilities and personnel increased substantially between the early 1950s and early 1980s, but because of fast population growth, the number of licensed medical practitioners per 10,000 individuals had fallen by the late 1980s to three per 10,000 from the 1981 level of four per 10,000. In 1991 there were approximately ten hospital beds per 10,000 individuals. For comparison, in China there are 1.4 doctors per 1000 people. nn
Primary health centers are the cornerstone of the rural health care system. By 1991, India had about 22,400 primary health centers, 11,200 hospitals, and 27,400 clinics. These facilities are part of a tiered health care system that funnels more difficult cases into urban hospitals while attempting to provide routine medical care to the vast majority in the countryside. Primary health centers and subcenters rely on trained paramedics to meet most of their needs. The main problems affecting the success of primary health centers are the predominance of clinical and curative concerns over the intended emphasis on preventive work and the reluctance of staff to work in rural areas. In addition, the integration of health services with family planning programs often causes the local population to perceive the primary health centers as hostile to their traditional preference for large families. Therefore, primary health centers often play an adversarial role in local efforts to implement national health policies.
According to data provided in 1989 by the Ministry of Health and Family Welfare, the total number of civilian hospitals for all states and union territories combined was 10,157. In 1991 there was a total of 811,000 hospital and health care facilities beds. The geographical distribution of hospitals varied according to local socio-economic conditions. In India’s most populous state, Uttar Pradesh, with a 1991 population of more than 139 million, there were 735 hospitals as of 1990. In Kerala, with a 1991 population of 29 million occupying an area only one-seventh the size of Uttar Pradesh, there were 2,053 hospitals.
Although central government has set a goal of health care for all by 2000, hospitals are distributed unevenly. Private studies of India’s total number of hospitals in the early 1990s were more conservative than official Indian data, estimating that in 1992 there were 7,300 hospitals. Of this total, nearly 4,000 were owned and managed by central, state, or local governments. Another 2,000, owned and managed by charitable trusts, received partial support from the government, and the remaining 1,300 hospitals, many of which were relatively small facilities, were owned and managed by the private sector. The use of state-of-the-art medical equipment was primarily limited to urban centers in the early 1990s. A network of regional cancer diagnostic and treatment facilities was being established in the early 1990s in major hospitals that were part of government medical colleges. By 1992 twenty-two such centers were in operation. Most of the 1,300 private hospitals lacked sophisticated medical facilities, although in 1992 approximately 12% possessed state-of-the-art equipment for diagnosis and treatment of all major diseases, including cancer. The fast pace of development of the private medical sector and the burgeoning middle class in the 1990s have led to the emergence of the new concept in India of establishing hospitals and health care facilities on a for-profit basis.
By the late 1980s, there were approximately 128 medical colleges – roughly three times more than in 1950. These medical colleges in 1987 accepted a combined annual class of 14,166 students. Data for 1987 show that there were 320,000 registered medical practitioners and 219,300 registered nurses. Various studies have shown that in both urban and rural areas people preferred to pay and seek the more sophisticated services provided by private physicians rather than use free treatment at public health centers.
Indigenous or traditional medical practitioners continue to practice throughout the country. The two main forms of traditional medicine practised are the ayurvedic system, which deals with mental and spiritual as well as physical well-being, and the unani (or Galenic) herbal medical practice. A vaidya is a practitioner of the ayurvedic tradition, and a hakim is a practitioner of the unani or Greek tradition. These professions are frequently hereditary. A variety of institutions offer training in indigenous medical practice. Only in the late 1970s did official health policy refer to any form of integration between European-trained medical personnel and indigenous medical practitioners. In the early 1990s, there were ninety-eight ayurvedic colleges and seventeen unani colleges operating in both the governmental and non-governmental sectors.

The health problems of India are developing with the country, many diseases are coming to India from the west, and we are taking them as a better lifestyle. The health problems of India are:

• Communicable disease problems
• Nutritional problems
• Environmental sanitation problems
• Medical care problems
• Population problems

Malaria: with the implementation of modified plan of operation in 1977, the upsurge of malaria cases dropped down from 6.75 million cases in 1976 to 2.1 million cases in 1984 since then situation has not shown any improvement.
Europe today has a high prevalence of non-communicable diseases such as cancer, diabetes, cardiovascular diseases, obesity disorders, musculoskeletal disorders which can be attributable to the interaction of various genetic, environmental and especially lifestyle factors, including smoking, alcohol abuse, unhealthy diets and physical inactivity.
Within the 2008-2013 Health Programme, the European Union recommends addressing avoidable diseases by developing strategies and mechanisms for prevention as well as exchanging information on and responding to non-communicable disease threats, including gender-specific health threats and rare diseases. Since most of them are avoidable, the main activities identified should focus on raising public awareness, improving knowledge, and reinforcing preventive measures. The EU aims to support these actions by setting up networks and information systems across the Member States to generate a flow of information, analysis and exchange of best practice in the public health field
Influenza
Influenza is a highly contagious viral disease, which typically occurs as an epidemic during the cold months. Serious human influenza epidemics are rare, but recurrently they are more severe than the normal seasonal outbreaks, in which case they are also called pandemics. A pandemic occurs when a new influenza virus emerges and starts spreading all around the world as easily as normal influenza.
All Member States are working together to coordinate preparedness for any influenza pandemic. In the event of an increased risk of an influenza pandemic, the measures envisaged in the national and preparedness and response plans would be put into action. The European Centre for Disease Prevention and Control plays a key role in coordinating surveillance. Further action includes medical and non-medical countermeasures and close coordination between the national authorities, the European Union and the WHO.
The EU will continue to work to improve sharing of relevant information and to coordinate risk management measures. This will include cooperation on stockpiling antiviral drugs, capacity to produce better influenza vaccines faster, improving national plans and producing better risk management tools
Leprosy: is another major public health problem in India. During the year 2003 – 2004, total of 2.20 lakh new cases were detected, out of which child cases were 14.91% and deformity grade II and above was 1.8%. 35% of these cases are estimated to be multi-bacillary.

Filaria: the problem is increasing in magnitude every year, having risen from 25 million at risk in 1953 to 553 million presently. Of these 109 million are living in urban areas and the rest in rural areas. There are estimated to be at least 6 million attack of acute filarial disease per year.
Lymphatic filariasis is infection with the filarial worms, Wuchereria bancrofti, Brugia malayi or B. timori. These parasites are transmitted to humans through the bite of an infected mosquito and develop into adult worms in the lymphatic vessels, causing severe damage and swelling (lymphoedema). Elephantiasis – painful, disfiguring swelling of the legs and genital organs – is a classic sign of late-stage disease.
The infection can be treated with drugs. However, chronic conditions may not be curable by anti-filarial drugs and require other measures, eg. surgery for hydrocele, care of the skin and exercise to increase lymphatic drainage in lymphoedema.
Annual treatment of all individuals at risk (individuals living in endemic areas) with recommended anti-filarial drugs combination of either diethyl-carbamazine citrate (DEC) and albendazole, or ivermectin and albendazole; or the regular use of DEC fortified salt can prevent occurrence of new infection and disease.
AIDS: the problem of AIDS is increasing in magnitude every year. Since AIDS was first detected in the year 1986, the cumulative number of AIDS cases has risen to 124995 by the end of august 2006. It is estimated that by the end of year 2010 12 million HIV positive cases in the country.
Since the late 1980s the HIV/AIDS epidemic has been a major health concern and a high priority for the EU. The EU focuses its action on:
• The promotion of prevention and increased awareness-raising
• An improvement of surveillance
• establishing networks linking major partners involved in the response to HIV/AIDS
• facilitating the dissemination of good practice

The Health Specialist has established major bodies for the exchange of information and the coordination of activities, addressing Member States and neighbouring countries. He is also active in developing countries and at global level and provides considerable support to the ‘Global Fund’ and other institutions.
As the number of newly diagnosed HIV infections has increased in many EU Member States and in their eastern European neighbours over the last years, the measures and action already being taken have to be reinforced and should deliver a sustainable contribution towards curbing down the HIV/AIDS epidemic in the future.
Nutritional problems: from the nutrition point of view, the Indian society is a dual society, consisting of a small group of well fed, and a very large group of undernourished. The high groups are showing diseases of affluence which one finds in developed countries. Nutrition is the intake of food, considered in relation to the body’s dietary needs. Good nutrition – an adequate, well balanced diet combined with regular physical activity – is a cornerstone of good health. Poor nutrition can lead to reduced immunity, increased susceptibility to disease, impaired physical and mental development, and reduced productivity
Nutrition Problems and Their Solutions
A variety of medical problems can affect your appetite. Your illness, medicines, or surgery can cause these problems. Many patients become frustrated when they know they need to eat to get well but they aren’t hungry, or when they gain weight because they are fatigued and unable to exercise.
Each of the following sections describes a nutritional problem and suggests some possible solutions. Not all solutions will work for everyone. Choose the remedies that fit your situation.
Decreased appetite:
Lack of appetite, or decreased hunger, is one of the most troublesome nutrition problems you can experience. Although it is a common problem, its cause is unknown. There are some medicines that might stimulate your appetite. Ask your doctor if such medicines would help you.
Solutions:
• Eat smaller meals and snacks more frequently. Eating six or even or eight times a day might be more easily tolerated than eating the same amount of food in three meals.
• Talk to your doctor. Sometimes, poor appetite is due to depression, which can be treated. Your appetite is likely to improve after depression is treated.
• Avoid non-nutritious beverages such as black coffee and tea.
• Try to eat more protein and fat, and less simple sugars.
• Walk or participate in light activity to stimulate your appetite.
Meal guidelines
• Drink beverages after a meal instead of before or during a meal so you do not feel as full.
• Plan meals to include your favorite foods.
• Try eating the high-calorie foods in your meal first.
• Use your imagination to increase the variety of food you’re eating.
Snack guidelines
• Don’t waste your energy eating foods that provide little or no nutritional value (such as potato chips, candy bars, colas, and other snack foods).
• Choose high-protein and high-calorie snacks.
Dining guidelines
• Make food preparation an easy task. Choose foods that are easy to prepare and eat.
• Make eating a pleasurable experience, not a chore.
o Liven up your meals by using colorful place settings.
o Play background music during meals.
• Eat with others. Invite a guest to share your meal or go out to dinner.
• Use colorful garnishes such as parsley and red or yellow peppers to make food look more appealing and appetizing.
Weight loss
If your doctor tells you that you have lost too much weight, or if you are having difficulty maintaining a healthy weight, here are some tips:
• Drink milk or try one of the “high-calorie recipes” listed below instead of drinking low-calorie beverages.
• Ask your doctor or dietitian about nutritional supplements. Sometimes, supplements in the form of snacks, drinks (such as Ensure or Boost), or vitamins might be prescribed to eat between meals. These supplements help you increase your calories and get the right amount of nutrients every day. Note: Do not use supplements in place of your meals.
• Avoid low-fat or low-calorie products unless you have been given other dietary guidelines. Use whole milk, whole milk cheese, and yogurt.
• Use the “Calorie Boosters” listed below to add calories to your favorite foods.
High-calorie snacks
• Ice cream
• Cookies
• Pudding
• Cheese
• Granola bars
• Custard
• Sandwiches
• Nachos with cheese
• Eggs
• Crackers with peanut butter
• Bagels with peanut butter or cream cheese
• Cereal with half and half
• Fruit or vegetables with dips
• Yogurt with granola
• Popcorn with margarine and parmesan cheese
• Bread sticks with cheese sauce
Other Infectious Diseases:
Communicable diseases such as tuberculosis, measles and influenza, represent a serious risk to human health. Communicable diseases do not respect national frontiers and can spread rapidly if actions are not taken to control them. New diseases such as HIV-AIDS and SARS (Severe Acute Respiratory Syndrome) have emerged and others are developing new dangerous characteristics such as multi-drug resistant tuberculosis, and methicillin resistant Staphylococcus aureus. In addition, new scientific developments on the role of infectious agents in chronic conditions such as cancer, heart diseases or allergies are under investigation.
Europe is challenged in order to respond in the most efficient way to these threats. Close collaboration among Member States, European bodies like the European Centre for Disease Prevention and Control and International agencies such as the World Health Organisation is of pivotal importance to minimize the risks we are facing. The place appropriate and efficient surveillance systems, early warning and response mechanisms and prevention and preparedness strategies in order to be ready to respond to these threats. Detecting emerging communicable diseases and outbreaks quickly, and sharing information on their potential for international spread, is crucial for an appropriate response.
Since 1999 a Network on communicable disease has been in place and its main role is to monitor and identify quickly potential threats for the People in order to put in place response mechanisms in a coordinated way. The Network is composed by the public health authorities responsible for surveillance and response in Member States. The European Centre for Disease Prevention and Control has been operational since May 2005. This agency fosters a structured and systematic approach to the control of communicable diseases in the helping to reinforce synergies between existing capacities at National level
Alcohol
Alcohol is a key public health and social concern across the Community. Europe has the highest proportion of drinkers in the world, the highest levels of alcohol consumption per capita and a high level of alcohol-related harm. Harmful and hazardous alcohol consumption is a net cause of 7.4% of all ill-health and early death.
Environmental sanitation: the most difficult problem to tackle in this country is perhaps the environmental sanitation problem, which is multifaceted and multi-factorial. The great sanitary awakening which took place in England in 1840’s is yet to be born. Air pollution is contamination of the indoor or outdoor environment by any chemical, physical or biological agent that modifies the natural characteristics of the atmosphere. Household combustion devices, motor vehicles, industrial facilities and forest fires are common sources of air pollution. Pollutants of major public health concern include particulate matter, carbon monoxide, ozone, nitrogen dioxide and sulfur dioxide. Outdoor and indoor air pollution cause respiratory and other diseases, which can be fatal.
Medical care: India has national health policy. It does not have a national health service. The financial resources are considered inadequate to furnish the costs of running such a service.
Population: the population problem is one of the biggest problem facing the country, with its inevitable consequences on all aspects of development, especially employment, education housing, health, health care, sanitation and environment.
Cardiovascular and cerebrovascular diseases, diabetes, and cancer are emerging as major public health problems in India. Apart from a rising proportion of older adults, population exposure to risks associated with certain chronic conditions is increasing. Obesity is increasing, physical activity is declining, and tobacco use is a substantial problem in the country.
Although it is commonly believed that non-communicable diseases (NCDs) are more prevalent in higher income groups, data from India’s 1995-1996 national survey showed that tobacco intake and alcohol misuse are higher in the poorest 20% of the income quintile. As a result, the government of India is anticipating that the prevalence of tobacco-related conditions will increase in lower socio-economic groups in the coming years.
RESOURCES NEEDS TO MEET SERVICES
Resources are needed to meet the vast health needs of a community. No nation, however rich, has enough resources to meet all the needs for all health care. Therefore an assenssment of the available resources, their proper allocation and efficient utilization are important considerations for providing efficient health care services.
• Health manpower
• Money and material
• Time
The term health manpower includes both professional and auxiliary health personnel who are needed to provide health care. An auxiliary is defined by WHO as a technical worker in a certain field with less than full professional training.

The country is producing annually, on an average 26.449 allopathic doctors: 9,865 ayurvedic graduate: 1525 unani graduates: 320 siddha graduates and 12785 homoeopathic graduates. Studies in India have shown that there is a concentration of doctors (up to 73.6%) in urban areas, where only 26.4% percent of population live.

Money and material:
Money is an important resource for providing health services. Scarcity of money affects all parts of the health delivery system. In most developed countries, government expenditure for health lies between 6 to 12 percent of GNP. In underdeveloped countries it is less than 1 percent of the GNP and it seldom exceeds 2 percent of the GNP.

To achieve health for all, WHO has set as a goal the expenditure of % percent of each country’s GNP o health care. At present India is spending about 3 percent of GNP on health and family welfare development.

Time:
Time is money, someone said. It is an important dimension of health care services. Administrative delays in sanctioning health projects imply loss of time, proper use of man-hours is also an important time factor. For example a survey by WHO has shown that an auxiliary burse mid wife spends 45 percent of her time in giving medical care: 40 percent in traveling: 5 percent on paper work: and only 10 percent in performing duties for which she has been trained. Such studies may be extended to other categories of health personnel with a view to promote better utilization of the time resource.

INTRODUCTION TO DIABETES:
“Diabetes” is a Greek word meaning “a passer through; a siphon”. “Mellitus” comes from the Greek word “sweet”. Apparently, the Greeks named it thus because the excessive amounts of urine diabetics produce (when blood glucose is too high) attracted flies and bees because of the glucose content. Diabetes is the common term for several metabolic disorders in which the body no longer produces insulin or uses the insulin it produces effectively.
In 2004, according to the World Health Organization, more than 150 million people worldwide suffer from diabetes. Its incidence is increasing rapidly, and it is estimated that by the year 2025 this number will double. Diabetes is in the top 5, of the most significant diseases in the developed world, and is gaining in significance. It’s almost hit the world like an epidemic.
What is diabetes?
It is a common condition and is characterized by abnormally high blood sugar levels. Diabetes is a number of diseases that involve problems with the hormone insulin. Normally, the pancreas (an organ behind the stomach) releases insulin to help the body store and use the sugar and fat from the food we eat.

Diabetes occurs:
When the pancreas does not produce any insulin, or
When the pancreas produces very little insulin, or
When the body does not respond appropriately to insulin, a condition called “insulin resistance.”
Diabetes is a lifelong disease. As yet, there is no cure. People with diabetes need to manage their disease to stay healthy. India has currently the world’s largest population of diabetics, with an estimated 30 million people suffering from the disease. According to the World Health Organization (WHO), India is expected to encompass 57 million people, ailing from diabetes by 2025 and this would become 80 million in by 2030.
Diabetes is characterized by a partial or complete lack of insulin production by the body. the classification of diabetes mellitus include five clinical classes. Type 1, type2, other specific types of diabetes, gestational diabetes, and pre-diabetes. Type1 diabetes is characterized by absolute insulin deficiency. Type2 diabetes which has relative insulin deficiency combined with defects in insulin action account for 95-97% of adult population suffering from the disease. One specific to our country is malnutrition related diabetes mellitus and fibro calcus pancreatic diabetes. Gestational diabetes is described as diabetes related to pregnancy. Pre-diabetes is a tern coined for people who have only fasting high blood sugar and have no other sign and/or symptomsofdiabetes.
The persistent rise of blood glucose levels in diabetes can lead to long term complications (if not treated properly) involving important organs like: eyes, kidneys, nerves, heart, blood vessels.
Who is at risk?
People who are:
In children with unexplained weight loss, fever, nausea and vomiting.
Obese
Aged 40 years above
Having family history of diabetes (any body in the family affected by diabetes),
who have sedentary lifestyle (not exercising) and
Unhealthy dietary habits are at risk of developing diabetes.
Women who have suffered from Gestational diabetes (diabetes you have during your pregnancy) or have given birth to a baby who weighs more than 9 pounds may also have increased risk of developing diabetes.

Consequences of Uncontrolled Diabetes:
When diabetes isn’t well controlled, a number of serious or life-threatening problems may develop, including:
• Retinopathy. This eye problem occurs in 75% to 95% of adults who have had diabetes for more than 15 years. Diabetic retinopathy diabetes is extremely rare before puberty no matter how long they have had the disease. Medical conditions such as good control of sugars, management of hypertension and regulation of blood lipids are important to prevent retinopathy. Fortunately, the vision loss isn’t significant in most people with the condition.
• Kidney damage. About 35% to 45% of people with diabetes develop kidney damage, a condition called nephropathy. The risk for kidney disease increases over time and becomes evident 15 to 25 years after the onset of the disease. This complication carries significant risk of serious illness — such as kidney failure and heart disease.
• Poor blood circulation. Damage to nerves and hardening of the arteries leads to decreased sensation and poor blood circulation in the feet. This can lead to increased risk of injury and decreased ability to heal open sores and wounds, which in turn significantly raises the risk of amputation. Damage to nerves may also lead to digestive problems such as nausea, vomiting and diarrhea.

HEALTHCARE
Healthcare industry is a wide and intensive form of services which are related to well being of human beings. Health care is the social sector and it is provided at State level with the help of Central Government. Health care industry covers hospitals, health insurances, medical software, health equipments and pharmacy in it.

Right from the time of Ramayana and Mahabharata, health care was there but with time, Health care sector has changed substantially. With improvement in Medical Science and technology it has gone through considerable change and improved a lot.

The major inputs of health care industries are as listed below:
I. Hospitals
II Medical insurance
III. Medical software
IV. Health equipments

Health care service is the combination of tangible and intangible aspect with the intangible aspect dominating the intangible aspect. In fact it can be said to be completely intangible, in that, the services (consultancy) offered by the doctor are completely intangible. The tangible things could include the bed, the décor, etc. Efforts made by hospitals to tangiblize the service offering would be discussed in details in the unique characteristics part of the report.
Different types of health care services available in India
• Hospitals
• Pathology Clinics
• Blood Banks
• Meditation Centers
• Emergency services like Ambulances, etc.
• Online Medical Services
• Telemedicine
• Naturopathy
• Yoga Centers
• Fitness Centres
• Laughter Clubs
• Health Spas

In the Constitution of India, health is a state subject. Central govt intervention to assist the state govt is needed in the areas of control and eradication of major communicable & non- communicable diseases, policy formulation, international health, medical & para-medical education along with regulatory measures, drug control and prevention of food adulteration, besides activities concerning the containment of population growth including safe motherhood, child survival and immunization Program. The plan outlay for central sector health programmed in the Annual Plans 1997-98 is Rs.920.20 crore including a foreign aid component of Rs.400 Crore. A major portion of outlay is for the control and eradication of diseases like malaria, blindness being implemented under centrally sponsored schemes.

Another major component of the central sector health programmed is purely Central schemes through which financial assistance is given to institutions engaged in various health related activities. These institutions are responsible for contribution in the field of control of communicable & non-communicable diseases, medical education, training, research and parent -care.

In our project our focus has been the hospital sector which is the major component of the healthcare industry.
THE HOSPITAL INDUSTRY
Some Facts
• India’s healthcare industry is currently worth Rs 73,000 crore which is roughly 4 percent of the GDP. The industry is expected to grow at the rate of 13 percent for the next six years which amounts to an addition of Rs 9,000 millions each year.
• The national average of proportion of households in the middle and higher middle income group has increased from 14% in 1990 to 20 % in 1999.
• The population to bed ratio in India is 1 bed per 1000, in relation to the WHO norm of 1 bed per 300.
• In India, there exists space for 75000 to 100000 hospital beds.
• Private insurance will drive the healthcare revenues. Considering the rising middle and higher middle income group we get a conservative estimate of 200 million insurable lives
• Over the last five years, there has been an attitudinal change amongst a section of Indians who are spending more on healthcare.
Corporate hospitals mushroomed in the late eighties. The boom remained short-lived and out of the 22 listed hospitals scrip’s, most are being trading below par. An increasingly fragmented market, lack of statistics, capital intensive operations and a long gestation period are all wise reasons to shy away from investing in the healthcare industry. Government and trust hospitals dominate the scene. Many of the trust hospitals suffer from poor management. Good corporate hospitals are still too few to amount to a critical mass.
Corporate hospitals failed a decade ago because they emerged in isolation and weren’t part of a larger phenomenon. However, now, there are the insurance companies, the hospital hardware and the software companies that have come together to create the boom.

Factors Attracting Corporatism In the Healthcare Sector
Recognition as an industry: In the mid 80’s, the healthcare sector was recognized as an industry. Hence it became possible to get long term funding from the Financial Institutions. The government also reduced the import duty on medical equipment’s and technology, thus opening up the sector.
Since the National Health Policy (the policy’s main objective was ‘Health For All’ by the Year 2000) was approved in 1983, little has been done to update or amend the policy even as the country changes and the new health problems arise from ecological degradation. The focus has been on epidemiological profile of the medical care and not on comprehensive healthcare.
Socio-Economic Changes: The rise of literacy rate, higher levels of income and increasing awareness through deep penetration of media channels, contributed to greater attention being paid to health. With the rise in the system of nuclear families, it became necessary for regular health check-ups and increase in health expenses for the bread-earner of the family.
Brand Development: Many family run business houses have set-up charity hospitals. By lending their name to the hospital, they develop a good image in the markets which further improves the brand image of products from their other businesses.
Extension to Related Business: Some pharmaceutical companies like Wockhardt and Max India, have ventured into this sector as it is a direct extension to their line of business.
Opening Of The Insurance Sector: In India, approx. 60% of the total health expenditure comes from self paid category as against governments contribution of 25-30 %. A majority of private hospitals are expensive for a normal middle class family. The opening up of the insurance sector to private players is expected to give a shot in the arms of the healthcare industry. Health Insurance will make healthcare affordable to a large number of people. Currently, in India only 2 million people ( 0.2 % of total population of 1 billion), are covered under Mediclaim, whereas in developed nations like USA about 75 % of the total population are covered under some insurance scheme. General Insurance Company, has never aggressively marketed health insurance. Moreover, GIC takes up to 6 months to process a claim and reimburses customers after they have paid for treatment out of their own pockets. This will give a great advantage to private players like Cigna which is planning to launch Smart Cards that can be used in hospitals, patient guidance facilities, travel insurance, etc.
The Consultants, Financiers and Insurance Agencies are to benefit from this boom. The insurers will use PPOs that will grow into HMOs, to assume insurance risks on clients’ behalf. Medical Equipments, Medical Software and Hospitals will see the biggest boom.

THE SERVICE MARKETING TRIANGLE:

 Company: Here, the hospital is the company that dreams up an idea of service offering (treatment), which will satisfy the customer’s (patient’s) expectations (of getting cured).
 Customer: The patient who seeks to get cured is the customer for the hospital as he is the one who avails the service and pays for it.
 Provider: Doctor, the inseparable part of the hospital is the provider, as he is the one who comes in direct contact with the patient. The reputation of the hospital is directly in the hands of the doctor. A satisfied patient is a very important source of word of mouth promotion for the organization.

-Unique Characteristics: –
The service industry has the following characteristics.

1) Intangibility: –
Intangibility means that a customer would have to visualize the service offering. Since the offering cannot be seen or felt there would be no stock and hence one would not be able to jeep a track of the sales etc. This characteristic also makes it different to measure the benefits and utilities of the product. An individual would only be able to experience the same.

In the product service continuum, hospitals fall in the bracket of highly intangible where the service has credence qualities.
i) The services of a doctor i.e. the consulatation provided by the doctor , his diagnosis etc cannot be touched felt or seen. One can only visulalise the same.
ii) They can also not measure the benefits. These can only be experienced by the customer. There is no ownership over the doctor or the services provided by him.

The remedial measures to overcome intangibility are:-

a) The marketer should visualize the product/service for the patient.In case of hospitals any visual of the hospital displaying the well maintained interiors, the hi-tech equipments used for treatment would help to tangibilise the product.

b) Association: –
The association of a hospital with any well known personality would help as a good image building exercise. It would also give the customer a certain level of confidence regarding the services provided in the hospital.

For (eg 1)- Hospitals like the Tata Memorial Hospital or the Hinduja hospital are associated with Corporate Houses. They are owned by these corporate families.
Hence a customer is sure about the services provided in these hospitals. (eg 2)The Dinanath Mangeshkar Hospital. Since it is owned by Lata Mangeshkar the customer is sure to receive quality services.

c)Physical Representation :-

Intangibility could also be overcome in case of hospital through physical Representation in the form of :-
1)Color- The Red Cross signifies the Hospital.
2)Uniforms- The white uniforms of the Doctors And Nurses in enemy hospitals.
3)Symbols – The Red Cross is the common logo with which people indentify hospitals. Also logos of hospitals like Wockhardt.
4)Buildings – In case of hospitals the external appearance of the building or the maintenance i.e how well maintained it is
d)Documentation –There are a numbers of hospitals which have received ISO 9000 certificates. ( Eg) Apollo Hospital.

2) Perishability
A services cannot be stored . So if the service is not consumed immediately then it loses its value. For Eg – If a doctor does not reach his dispensary on time or has his clinic locked for that particular day. He loses all his patients for that day. A situation may also arise when the doctor may be unable to attend to some of his patients due to a huge rush. In such a case again the doctor could lose out on all his patients.Same would be the situation faced by the hospitals. In such a case the hospital too may lose all its patients for that day.

Solution to the problem of perishability

a) In such a situation the doctor can appoint an assistant who could cater to the excess patients or he could have students training under him who during their course of training could also help him with the excess patients.
(Eg)- Rajgovind Hospital in CBD appoints interns of Medical College for night duty on a stipend

b) Peak time Essential Services
In a rush hour situation when there are too many customers to attend to only essential services should be catered to. For (eg 1) In hospitals during the late night when accident reporting are high all hands are required at the trauma centers (eg 2) Part time volunteers for national Emergencies.

3) Variability

It means that the quality of service provided to different people may not be the same. (ie) Irrespective of the fact that the job carried out by them is the same the service quality may differ because they may be from different backgrounds have different aptitude, skills, attitude etc.
For Eg :- 2 Doctors, one from a municipal hospital and another from a reputed hospital may treat a person for the same problem. But their quality might differ. In such a case doctors/hospitals are the internal customers and the patients are the external customers.
Since a transaction is always two way communication, a customers willingness, background, attitude etc may also effect the transaction
For ( Eg) – A patient may want to avail of a doctors services but may not be able to afford the services.
(Eg) A patient suffering from Arthritis may be required to lose weight for further treatment. But the patient may not have the drive/willingness to lose weight .

Solutions
1)The internal customers or the fresh recruiters could be given training. They could be given a chance to perform the small parts of an operation in order to gain experience.
1)The doctors could be given training and could be updated with all the latest happenings in the medical field in regular intervals. For (Eg ) AMA prescribes for its member doctors 6 weeks training every year and 6 months training every 6 years.
1)Training of External customers
( Eg) Diabetic patients are trained to inject insulin on their own
( Eg ) In Case of health care services, a gym instructor may teach his members to use the gym equipments on their own.
( Eg ) Auto Diagnostic equipments are used in hospital.
These kind of training programmes provided to the external customer helps to increase the quality of transaction.
4)Inseparability –
For any service to take place it is necessary that both the service provider and the customer be present in the location at the same time

( eg) An operation cannot be conducted without the doctors presence. As a result a number of patients due to geographical distances lose out on the opportunity to get themselves treated from the very best surgeons and doctors.
Solutions
This can be overcome to a certain extent through the following:-

1)Training of internal customer-
Here one experienced person can provide training to the amateurs. For Eg A surgeon during an operation is surrounded by interns watching the operation. They could also carry out some small parts of the operation.

2) Innovational Service-
Psychiatrists have innovated group therapy where they call in 10+ patients together to an oval conference table and encourage them to talk about themselves and their ailments.

4) Video Conferencing
Business Conferences, Consultancy and the Medical world .Only recently have instructions for operation through video conferencing been initated but mostly video conferencing has been used in the medical world as a pedagogical tool. (eg) A unique and rare brain tumour operation can be broadcast live all over the world to subscribed medical colleges.

7 Ps of marketing for hospitals
 Product:
The service product is an offering of commercial intent having features of both intangible and tangible, seeking to satisfy the new wants and demands of the consumer. Hospital industry is action oriented and there is a lot of interaction with the customers (patients). The service product of the hospitals normally have the following features:
o Quality Level: When we talk about marketing hospitals, it is natural that we are very particular about managing our services in the right fashion. Supportive services play an important role in improving the quality of medicare. These services which include laboratory, blood-banks, catering, radiology and laundry, in a true sense determine the quality of services made available by medical and para-medical personnel. They get a strong base for treatment since the diagnostic aspect determines a direction. To get the best result from OT, it is natural that equipments are properly sterlised. In addition, the dresses and clothes are also required to be made bacteria free. The patients are required to wear disinfected linen which should be made available. The radiology department should have hi-tech facilities keeping in view the pressure of work. Of late, we find sophisticated equipments and unless hospitals make the same services available the same, the quality of services cannot be improved.
o Accessories: This is a very good way of segmenting customers. Many hospitals provide additional services such as catering, laundry, yoga sessions, cafeterias, etc. for the customers (patients)who are willing to pay extra. Hospitals have different wards – General and Special. Certain hospitals provide services for the family members of the patients (when they are not from the same city) – accommodation and catering.
o Packaging: It is the bundling of many services into the core service. Eg: Apollo hospital offers a full health check-up to the patients. Similarly other hospitals also offer package deals for health check-ups. For example if a person has to undergo a bypass surgery, he can pay a lump sum amount during admission, say rupees 1 lakh for all procedures, tests, stay, etc, at once.
o Product line: hospitals through their services offer many choices to the patients and cover a wide range of customer needs. For example: Apollo hospital has dental department, cardiology department, etc. and within the dental department it has dental surgery, root canal, etc.
o Brand name: The hospitals, to differentiate themselves, and their services from others use a brand name. The intangibility factor of the service makes it all the more important for the hospitals to do so.

 Place
Under hospital marketing, distribution of Medicare services plays a crucial role. This focuses on the instrumentality of almost all who are found involved in making services available to the ultimate users. In case of hospitals the location of hospital plays a very important role. The kind of services a hospital is rendering is also very important for determining the location of the hospital.
Eg. Tata memorial hospital specializes in cancer treatment and is located at a centre place unlike other normal hospitals, which you can find all over other places.
It can be unambiguously accepted that the medical personnel need a fair blending of two important properties i.e. – they should be professionally sound and should have in-depth knowledge at psychology. A particular doctor might be famous for his case handling records but he may not be made available for all the patients because of the place factor. Now in this case the service provided, that is the doctor may be a visiting doctor for different hospitals at different locations to beat the place factors.
Unlike other service industries, under hospital marketing all efforts should be for making available to the society the best possible medical aid.
In a country like India, which is geographically vast and where majority of the population lives in the rural areas, place factor for the hospitals play a very crucial role. A typical small village / town may be having small dispensaries but they will not have super speciality hospitals. For that they will have to be dependent on the hospitals in the urban areas.
 People
Under hospital marketing the marketing mix variable people includes all the different people involved in the service providing process (internal customers of the hospitals) which includes doctors, nurses, supporting staff etc. The earliest and the best way of having control on the quality of people will be by approving professionally sound doctors and other staff.
Hospital is a place where small activity undertaken can be a matter of life and death, so the people factor is very important. One of the major classifications of hospitals is – private and government. In the government hospital the people factor has to be specially taken care of. In Indian government hospitals except a few almost all the hospitals and their personnel hardly find the behavioural dimensions significant. It is against this background that even if the users get the quality medical aid they are found dissatisfied with the rough and indecent behaviour of the doctors.
Under hospital marketing a right person for the right job has to be appointed and they should be adaptable and possess versatility. The patients in the hospitals are already suffering from trauma, which has to be understood by the doctors and other staff. The people of the hospital should be constantly motivated to give the best of their effort.
 Process
Process generally forms the different tasks that are performed by the hospital. The process factor is mainly dependent on the size of the hospital and kind of service it is offering. A typical process involved in a medium sized hospital can be as follows.

Apart from this flow there are other allied activities like record keeping administration at services etc which fall under the process factor. These stages do not exist separately but are interlinked. The most important elements are lines of communication within the setup. The experience of the patient depends on the final interplay of all these factors.

 Physical evidence
It does play an important role in health care services, as the core benefit a customer seeks is proper diagnosis and cure of the problem. For a local small time dispensary or hospital physical evidence may not be of much help. In recent days some major super speciality hospitals are using physical evidence for distinguishing itself as something unique.
Physical evidence can be in the form of smart buildings, logos, mascots etc. a smart building infrastructure indicates that the hospital can take care of all the needs of the patient.
Examples –
1. Lilavati hospital has got a smart building, which helps, in developing in the minds of the people, the impression that it is the safest option among the different hospitals available to the people.
2. Fortis and Apollo hospitals have a unique logo, which can be easily identified.
Physical evidence also helps in beating the intangibility factor.
 Promotion:
Hospitals for promotion use either advertisement or PR or both after taking into consideration the target customers, media type, budget and the sales promotion.
Since a few years the prime times in T.V. are reserved for advertising social issues like family planning, use of different types of contraceptives, care for the girl child and so on. These commercials use the common man approach for reference group appeal. In case of health care products and services use for “common man” appeal is widely prevalent. The use of celebrities is not as effective as that of a common man. An ordinary person thinks that if it works well for people like him, it will also work equally well for him. The identification with the common man is easy and quick.
Besides TV, other media of promotion are to be used innovatively. Unlike the urban area, in rural areas newspapers and magazines do not have the same impact in conveying messages. In villages, hoardings and wall writings near the markets and recreation centers attract the attention of villagers. This market consists of 180 million strong middle income group and a small income group. This group has a large discretionary income. These discerning consumers are very careful in choosing health care services. The last decade has witnessed a health, appearance and nutrition conscious population.
The health care field has become very competitive. Although around one-fourth of our population stays in urban India, three fourths of the total doctors have engaged themselves in this part. Many of these doctors visit the contiguous rural areas, but they may operate from the urban area. The patients of upper middle and upper income group have a wide choice to make from a number of clinics and hospitals. Therefore, many hospitals have abandoned traditions and adopted marketing strategies to woo more and more patients to their clinics.
Word-of-mouth plays a very important role in promotion of hospitals. A person in need of a health care service does not know for sure where to search for relevant information. He consults his family members, relations and friends first. The patients who come to a hospital generally have the old patients of that hospital as referrals. Word-of-mouth plays an important role during information acquisition stage of the customers as there are no objective performance measures to judge the various alternatives available to them. Therefore, satisfied past patients of a hospital can bring more number of patients to that hospital than a number of advertisements.
In a competitive market place, the images of the firms swill affect their competitive standing. One factor that is likely to have a significant impact on the health care scene is the growth of hospital chains such as Apollo Hospitals, Birla Health Centres, etc. Artificial heart transplants and other complex operations although are few in number and generate a small portion of the total revenue, they help in generating word-of-mouth which health care providers are actually interested. Many of these companies are spending a lot in corporate advertising for Image building.

Rational use of medicines
Rational use of medicines requires that “patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community.
A major global problem
Irrational use of medicines is a major problem worldwide. WHO estimates that more than half of all medicines are prescribed, dispensed or sold inappropriately, and that half of all patients fail to take them correctly. The overuse, underuse or misuse of medicines results in wastage of scarce resources and widespread health hazards. Examples of irrational use of medicines include: use of too many medicines per patient (“poly-pharmacy”); inappropriate use of antimicrobials, often in inadequate dosage, for non-bacterial infections; over-use of injections when oral formulations would be more appropriate; failure to prescribe in accordance with clinical guidelines; inappropriate self-medication, often of prescription-only medicines; non-adherence to dosing regimes.

2. REVIEW OF LITERATURE

The purpose of this literature review is to provide information that clearly discusses in a scientific, experimental, qualitative, and quantitative way the relationship between the hours a person works, drives, and the structure of the work schedule.

The following findings were drawn from the available literature reviewed as part of this synthesis.
• Lung cancer is likely caused by exposure to diesel exhaust and the longer that exposure lasts the more likely it is that a cancer will develop. Though the evidence linking this exposure to bladder cancer is less robust than that to lung cancer, it remains likely that there is such a relationship and that it is governed by a positive dose response curve[8].
• There is some evidence that cardiovascular disease is caused in part by truck driving and its risk increases with the duration of this activity and the disruption of the sleep cycle[6]
• Based on exposure assessments, noise-induced hearing loss could well be a result of a working lifetime as a driver. This effect would be mitigated by the improvement in cab design reported to be occurring with consequent reduction in the intensity of noise reaching the driver[9].
• The evidence concerning a relationship between wholebody vibration (WBV) and musculoskeletal effects, such as low back pain (LBP) syndrome, relies primarily on self-reporting and application of risks derived from other environments. There are several studies available though that contain objective evidence of vertebral pathology related to an occupation as a professional driver. In conclusion, the available data support the hypothesis that there is likely a causative relationship between professional driving and a variety of vertebral disorders as well as LBP syndrome. While the literature suggests a role for WBV in the genesis of these disorders, it cannot be established based on current published materials[7].
• The literature related to commercial driving and other musculoskeletal disorders has the same limitations as the previous item, and while a causative relationship is logical, it can only be viewed as suggestive within this context.
• Gastrointestinal (GI) disorders would be expected to be impacted by varying shift assignments and disruption to normal circadian rhythm. While the information currently available documents an increase in symptoms in drivers, it is inadequate to implicate the specific risk factors that impact on these symptoms.
• The literature suggests, but does not establish, that disruption of circadian rhythm may have negative impacts on the general health of workers. The stabilization of shift especially when stabilized to a day schedule appears to have a beneficial effect on subjective health complaints\ though stabilizing to an evening or night schedule may not provide the same benefit.
• Finally, the literature contains no definitive information concerning (a) the relationship between reproductive health and duration of driving, (b) the effects of prolonged work hours, or (c) increasing driving from 10 to 11 hr while decreasing overall work time from 15 to 14 hr on the general health of workers. No data are available concerning the effects of allowing for increased sleep time from 6 to 8 hr in an adult working population.
• The Department of Child and Adolescent Health and Development’s (CAH) work is similarly guided by international goals, in particular the Millennium Development Goals (MDGs) as well as those articulated in the United Nations General Assembly Special Session on HIV/AIDS (2001) and on children (2002, see links below). The MDGs set clear goals and targets for eradicating extreme poverty and hunger, reducing child mortality, maternal mortality and the spread of HIV/AIDS.
• CAH has committed to working towards these goals as a matter of human rights, development and security. The Department galvanizes efforts at country and regional level to help governments develop national child health policies; raises awareness at global level through conferences and work shops; and assists countries in the different WHO regions in devising child survival strategies.
2002WHO reference number: WHO/FCH/CAH/02.14
This document is intended for policy makers and progamme managers in both developed and developing countries, as well as decision makers in international organizations supporting public health initiatives in developing countries.
It makes a compelling case for concerted action to improve the quality – and especially the friendliness – of health services to adolescents. Drawing upon case studies from around the world, it reiterates that this can be – and has been done – by non governmental organisations and government bodies working with limited financial resources. It highlights the critical role that adolescents themselves can play, in conjunction with committed adults, to contribute to their own health and well being.
New York, NY, US: Springer-Verlag Publishing. (1989).
Our objective in this book is to present national baseline epidemiological and etiological data on the joint occurrence of delinquent behavior and alcohol, drug, and mental health (ADM) problems. Specifically, we propose to address each of the following questions. 1. What patterns of joint delinquent-ADM problems are found within the adolescent population? 2. What proportion of youth exhibit each multiple pattern, and how are youth exhibiting these patterns distributed in the general population by age, sex, race, class, and place of residence? 3. How do these patterns differ with regard to the frequency of each type of behavior? 4. Is there a particular temporal order or developmental sequence in the onset of these behaviors or disorders that is more likely than others? 5. Can we identify a common set of causes for these problems? 6. What is the predictive effect of joint involvement in these behaviors on subsequent long-range “career” or chronic involvement in crime or ADM disorders? (For example, does the presence of heavy drug use with crime during adolescence increase the risk of a long-range criminal career and, if so, is the effect additive or interactive.
According to Neil D. Weinstein in 2002
A mailed questionnaire was used to obtain comparative risk judgments for 32 different hazards from a random sample of 296 individuals living in central New Jersey. The results demonstrate that an optimistic bias about susceptibility to harm-a tendency to claim that one is less at risk than one”s peers—is not limited to any particular age, sex, educational, or occupational group. It was found that an optimistic bias is often introduced when people extrapolate from their past experience to estimate their future vulnerability. Thus, the hazards most likely to elicit unrealistic optimism are those associated with the belief (often incorrect) that if the problem has not yet appeared, it is unlikely to occur in the future. Optimistic biases also increase with the perceived preventability of a hazard and decrease with perceived frequency and personal experience. Other data presented illustrate the inconsistent relationships between personal risk judgments and objective risk factors.
According to Lonnie R. Snowden in 15 APR 1999
The present study examined racial differences in use of mental health services in the specialty mental health and general medical sectors of care. Data came from household and institutional surveys and permitted estimation of services use both in the general population alone and when supplemented with samples of persons confined in jails, prisons, and mental hospitals. In uncontrolled analysis, African Americans in the community presented a mixed pattern of under-, equal-, and overrepresentation in services. Weighting the sample and controlling for sociodemographic differences and diagnoses yielded results indicating that African Americans in the community were consistently less likely than Whites to have sought help. Adding to the analysis persons who were confined eliminated the disparity in the general medical-sector services and reduced the disparity in specialty mental health sector services. Conclusions as to parity and underutilization of mental health services vary with methodological factors linked to adverse social circumstances of African American life
According to Katie Buston in 17TH June 2002
This study explored the health-related views and experiences of adolescent users of mental health services through semi-structured interviews with 32 14–20-year olds who had been diagnosed with a mental illness. The majority of respondents had both negative and positive things to say about their contact with health services. These relate to: the doctor—patient relationship, treatment received, the health-care system, and the environs of the hospital or clinic. The views and experiences of young people with regard to their health care must be taken into account in efforts to boost help-seeking, attendance and compliance rates and, generally, to improve child and adolescent mental health services. In particular, further attention needs to be given to the development of empathic communication skills by health professionals working with adolescents with mental health problems. Work on the health-related views and experiences of representative samples of young people with mental health problems should be prioritized.
According to Sam Shapiro; Elizabeth A. Skinner in 2002
Utilization of health and mental health services by noninstitutionalized persons aged 18 years and older is examined based on interviews with probability samples of 3,000 to 3,500 persons In each of three sites of the National Institute of Mental Health Epidemiologic Catchment Area (ECA) program: New Haven, Conn, Baltimore, and St Louis. In all three ECAs, 6% to 7% of the adults made a visit during the prior six months for mental health reasons; proportions were considerably higher among persons with recent DSM-III disorders covered by the Diagnostic Interview Schedule (DIS) or severe cognitive impairment. Between 24% and 38% of all ambulatory visits by persons with DIS disorders were to mental health specialists. In seeking mental health services, men were more likely to turn to the specialty sector than to the generalist; women used both sectors about equally. The aged infrequently received care from mental health specialists. Visits for mental health reasons varied considerably depending on specific types of DIS disorder.

According to M.Goddard in 2004:
The pursuit of equity of access to health care is a central objective of many health care systems. This paper first sets out a general theoretical framework within which equity of access can be examined. It then applies the framework by examining the extent to which research evidence has been able to detect systematic inequities of access in UK, where equity of access has been a central focus in the National Health Service since its inception in 1948. Inequity between socio-economic groups is used as an illustrative example, and the extent of inequity of access experienced is explored in each of five service areas: general practitioner consultations; acute hospital care; mental health services; preventative medicine and health promotion; and long-term health care. The paper concludes that there appear to be important inequities in access to some types of health care in the UK, but that the evidence is often methodologically inadequate, making it difficult to draw firm conclusions. In particular, it is difficult to establish the causes of inequities which in turn limits the scope for recommending appropriate policy to reduce inequities of access. The theoretical framework and the lessons learned from the UK are of direct relevance to researchers from other countries seeking to examine equity of access in a wide variety of institutional settings.

According to Padgett, in 2001:

This study describes use of medical, mental health, alcohol, and drug services by 832 adult residents of the New York City homeless shelter system and examines associations between service use during the past three months and an array of predisposing, enabling, and need factors. Utilization rates were 23% for medical services, 13% for mental health services, and 10 and 7.5% for alcohol and drug treatment services, respectively. Service contacts were more often hospitals than ambulatory care clinics. Logistic regression analyses revealed that need factors were stronger predictors of all four types of service use. Predisposing factors other than education and black ethnic status were not significant, and the enabling factor of enrollment in Medicaid and/or Medicare was significant only for use of medical and drug services. Among the need factors, measures of mental health status were analyzed as indices of distress to test a stress-utilization model of prediction for all four types of service use. While these measures did not predict use of nonmental health services, physical health problems were associated with use of all four types of services. Implications for future health services research and for service delivery to the homeless are discussed, including the need for more information on availability of services and on psychosocial and cultural characteristics of homeless persons that may affect their help-seeking behavior.
According to S.Fanshal and J.W.Bush in 1992:
In order to develop an operational definition of health, we found it necessary first to develop the concept of function/dysfunction as a continuum, based on one’s ability to carry on the usual daily activities appropriate to social roles. Then, to those operating the health system, each member of the population can be seen as belonging to one and only one state from a class of functional states that can be defined on an ordinal scale. Next, we found it necessary to assign to each state a weight defined on a cardinal scale, the set of weights for these states being called the Health Status Index (HSI). The HSI rests on value judgments, of a societal nature, expressed by the administrators responsible for policy decisions. Prognosis is then defined as the transitional probability of a change in functional state with time. Thus, the concepts ‘state of health’ and ‘severity of illness’ are decomposed into the parameters function/dysfunction and prognosis. Finally, together with an operational definition of time and target population, it becomes possible to give a quantitative definition of the output of a health program (or health system) as the changes in the functional history of the target population resulting from the intervention of the health program (or system). Other concepts that are given quantitative definitions are program effectiveness and population health status. This study next explores the relation between health program output and modern decision theory for program planning, and shows how these analytical tools are useful for fitting the results of the study into larger conceptual frameworks. Finally, the method developed is illustrated, first with a simplified simulated program for computer use, and then with an analysis of a small section of a tuberculosis-control program.
According to N Engl J Med in 2003
To determine whether groups other than the elderly and the uninsured have difficulty obtaining access to medical care, we studied 7633 adults nationwide. As we expected, the insured had much greater access than the uninsured, but among the insured there were substantial disparities in access to care.
Insured adults of working age were 3.5 times as likely (95 percent confidence interval, 2.7 to 4.4) as the elderly to have needed supportive medical services (including medications and supplies) but not to have received them, and 3.4 times (2.3 to 4.4) as likely to have had major financial difficulties because of illness. Among insured, working-age adults, the poor were 4.4 times (3.5 to 5.3) as likely as those who were not poor to have needed supportive services but not to have received them, and 5.2 times (3.6 to 6.8) as likely to have had major financial problems because of illness. Apart from insurance status and income, blacks were 1.7 times (1.1 to 2.2) as likely as whites to have needed supportive services but not to have received them. Hispanics with a medical illness were 2.2 times (1.3 to 3.2) as likely as whites not to have seen a physician within the past year.
We conclude that insured, working-age adults have less access to medical care than the elderly, and that poor, black, or Hispanic persons in this group are at risk for even greater problems with access to care. Current policy strategies are unlikely to improve the ability of these groups to obtain care
According to Buckingham in 2002:
This new edition of Ann Bowling’s well-known and highly respected text has been thoroughly revised and updated to reflect key methodological developments in health research. It is a comprehensive, easy to read, guide to the range of methods used to study and evaluate health and health services. It describes the concepts and methods used by the main disciplines involved in health research, including: demography, epidemiology, health economics, psychology and sociology.The research methods described cover the assessment of health needs, morbidity and mortality trends and rates, costing health services, sampling for survey research, cross-sectional and longitudinal survey design, experimental methods and techniques of group assignment, questionnaire design, interviewing techniques, coding and analysis of quantitative data, methods and analysis of qualitative observational studies, and types of unstructured interviewing. With new material on topics such as cluster randomization, utility analyses, patients’ preferences, and perception of risk, the text is aimed at students and researchers of health and health services. It has also been designed for health professionals and policy makers who have responsibility for applying research findings in practice, and who need to know how to judge the value of that research.

According to ANDERSEN, R. in 1999:

In this monograph the author uses data from his study with ANDERSON [A decade of health services. Social survey trends in use and expenditure, Chicago 1967, Abstr. Hyg., 1969, v. 44, abstr. 3151] to develop a three-stage model in which predisposing, enabling, and need components are used in an attempt to explain families’ widely differing use of medical care services.
It postulates that use takes place (1) where a family is predisposed to receive medical care, (2) where conditions make health services available to the family and (3) where the family perceives a need for these services and responds to it. Use is then the fourth and resultant component. Degrees of discretion exercised in using hospital, physician and dental services, the three major categories of care, are differentiated. Finally hypotheses derived from the model are summarized. A common unit of use is developed, the aim being to allow comparisons and summations of use across services. The model is then applied, and by an empirical analysis an examination is made of the interrelationships between its components and families’ varying use of health services, and their differential importance for the three major care categories. Each component includes sub-components, all of which are measured empirically by selected variables. The final chapter then returns to consider the implications of this analysis for modifying the model and for social policies on distribution of services.
This model is a valuable contribution towards a theoretical framework for analysing patterns of use. Particularly useful is the development beyond simple one-to-one variables provided by the Sonquist and Morgan computer programme-“Automatic Interaction Detector” (AID) (The detection o f interaction effects. 1964. Ann Arbor: Univ. of Michigan, Survey Research centre for Social Research, Monograph 35). This indicates the single predictor which will most
improve ability to predict values of the dependent variables at any stage of the analysis. Interpretation, however, demands strict and explicit consideration of the assumed causal priorities which determine the stages at which different variables are introduced, and hence the final results
According to A. S Levey, R Atkins, J Coresh, in 2007:
Chronic kidney disease (CKD) is increasingly recognized as a global public health problem. There is now convincing evidence that CKD can be detected using simple laboratory tests, and that treatment can prevent or delay complications of decreased kidney function, slow the progression of kidney disease, and reduce the risk of cardiovascular disease (CVD). Translating these advances to simple and applicable public health measures must be adopted as a goal worldwide. Understanding the relationship between CKD and other chronic diseases is important to developing a public health policy to improve outcomes. The 2004 Kidney Disease Improving Global Outcomes (KDIGO) Controversies Conference on ‘Definition and Classification of Chronic Kidney Disease’ represented an important endorsement of the Kidney Disease Outcome Quality Initiative definition and classification of CKD by the international community. The 2006 KDIGO Controversies Conference on CKD was convened to consider six major topics: (1) CKD classification, (2) CKD screening and surveillance, (3) public policy for CKD, (4) CVD and CVD risk factors as risk factors for development and progression of CKD, (5) association of CKD with chronic infections, and (6) association of CKD with cancer. This report contains the recommendations from the meeting. It has been reviewed by the conference participants and approved as position statement by the KDIGO Board of Directors. KDIGO will work in collaboration with international and national public health organizations to facilitate implementation of these recommendations.

3. OBJECTIVES

1. To find the curable and non curable diseases which are coming to India. And inform the government or non government organizations that the way they are fighting with the situation is not enough to meet the health problems.
2. To find the diseases which are coming from the bad life style and bad habits to just take care of minor things. The government should take appropriate step or programs to make people beware of all communicable or non communicable diseases.
3. To find if the modern India is able to fight the epidemic or the communicable diseases in the controlled manner.
4. To find if the adequate health facility is available in the metros as well as the rural areas of India.

3. RESEARCH MEHDOLOGY

The research design is a pattern or an outline of research project working. It is a statement of only essential elements of study, those that provide basic guidelines for the details of the project. The present study is being conducted followed by Descriptive Research Design.

1) NATURE OF REAEARCH:

Exploratory Research:

2) Research Technique:
• Direct Interviews
• Survey
i) Total population: 598
ii) Sample Size: 30

• Sampling criteria
Familiar with the medical services & policies related to medical professional.

3) Tools Used:
• Questionnaire

4) Sources of Data

Primary Data:

All Primary data has been collected through personal interviews with the medical professionals of the company and also personal observation to get valuable information on the related topic of the company.

• Sample Size
• Sampling methods

Secondary Data

Secondary data has been collected as follows:
Paper-based sources – books, journals, market reports, annual reports, internal records of organizations, newspapers and magazines
Electronic sources– Internet, Intranet & Health Department website.

5. RESULT AND DISCUSSION

India’s healthcare sector has made impressive strides in recent years. It has transformed to a US$ 17 billion industry and is surging ahead with an annual growth rate of 13% a year. The healthcare industry in India expected to grow in size to Rs 270,000 core by 2012. The healthcare industry employs over four million people, which makes it one of the largest service sectors in the economy of our country.

Healthcare is dependent on the people served; India’s huge population of a billion people represents a big opportunity. People are spending more on healthcare. The rise in literacy rate; the higher levels of income; and an increased awareness through the deep penetration of media, has constituted to greater attention being paid to health. India has a very low density of doctors. Infant mortality is amongst the highest in India.

Hospitals in India are running at 80-90% occupancy. Major corporations like the Tatas, Apollo Group, Fortis, Max, Wockhardt, Piramal, Duncan, Ispat, Escorts have made significant investments in setting up state-of–the-art private hospitals in cities like Mumbai, New Delhi, Chennai and Hyderabad.

Good Healthcare in India is in extreme short supply and it is this gap that Corporate are looking to plug. Most users of healthcare prefer private services to government ones. The private Healthcare segment has grown into a formidable industry estimated to be Rs.8,00,000 crores. Using the latest technical equipment and the services of highly skilled medical personnel these hospitals are in a position to provide a variety of general as well as specialists’ services.

“India is well positioned to tap the top end of the $3 trillion global healthcare industry because of the facilities and services it offers, and by leveraging the brand equity of Indian healthcare professionals across the globe”, said Vinod Khanna, Union Minister of State for External Affairs.

The Government of India places top priority to healthcare in the national agenda. It is very serious about encouraging indigenous R&D and creation of human capital. This would improve the quality of life of our people, leading to greater socio-economic progress of the country.

As medical costs sky rocket in the developed world, countries like India have immense potential for what is called “Medical Tourism”, highlighted Harpal Singh, Conference Chairman, in his theme address. “India, with outstanding human resource talent and the setting up of world class medical facilities, was now poised to take leadership in the fast emerging arena of healthcare management which is witnessing the first signs of globalization”.

MARKET ANALYSIS

Market Overview

India has a fairly comprehensive healthcare system comprising of government and private service providers. However, the system reaches barely fifty percent of the population – mainly on account of general infrastructure bottlenecks. The country lags behind international standards on basic healthcare infrastructure and facilities. India has 94 beds per 100,000 population as compared to the WHO norm of 333 beds per 100,000. The density of doctors is also low. There are only 43 doctors for a population of 10,000.

Size of Market

India’s healthcare industry is estimated at Rs 1000 billion. Of this, pharmaceuticals account for Rs 200 billion. As per some estimates, Rs 185 billion is spent on healthcare annually. On average, Indian families spend 600 per month on healthcare which is 11% of the household income, showing that they are willing to spend provided the service they get is of high standard. According to The World Health Report 2000, India’s health expenditure is 5.2% of its GDP. Public and private health expenditure is 13% and 87% respectively.

CII-McKinsey Study
A joint study “Healthcare in India: The Road Ahead” done by the Confederation of Indian Industry and McKinsey & Company in 2002 mentions that India has 1.5 beds per 1000 people while China, Brazil & Thailand have an average of 4.3 beds. The study projects that changing demographic and disease profiles and rising treatment costs will result in healthcare spending more than doubling over the next 10 years. Private healthcare will be the largest component of this spending in 2012, rising to Rs 1560 billion from the current level of Rs 690 billion. In addition, public spending could double from Rs 170 billion if the Government reaches its target spending level of 2% of the GDP, up from 0.9% today.

PEST ANALYSIS:

Political factors:
Most of the healthy nations are also wealthy nations. In India even after 53 years of independence we all have to accept that government has failed to provide basic healthcare. Healthcare is the neglected field, only meant for slogans by our politicians.
To improve healthcare facilities we have to provide special assistance to private healthcare sector. The reality in private healthcare sector is that as an industry it has long gestation period and so most of the bigger projects fail.

Government has to give certain concessions to private health sector. It can be in the form of free land for small hospitals at district levels or concession in power tariff. Government later on gets back revenue in the form of tax when these institutions start making profits. Concessions can be limited to first five years or so.
Maharashtra government is playing an important role in the development of the hospital sector.

Economic factors:
The Indian healthcare is the next boom in the country after the IT euphoria. Setting up hospitals is not an easy task.
The amount of hospitals in India is very less when compared to the other developed countries. Even the urban areas do not have enough medical facilities. In the rural areas one village has only one doctor, who may not be very well qualified.

The other governments of other states should take up a cue from the Maharashtra government, in setting up similar Joint ventures all over the state with the assistance of World Bank. The World Bank can make available funds of around Rs 700 crore for state health systems and development projects.

The people in India do not avail of the hospital facilities very soon. This is because of the high cost related to it. However this may all change because of the increasing deployment of third party payment either in the form of Medical and Allied Insurance, or in the form of reimbursements from the State. This in turn will increase the employment opportunities to many people.
Social Factors:
1. Certain percentages of beds have to be kept for poor people. E.g. in Bombay 20% of beds has to be kept reserved for poor people.
2. Look after the needs of local poor people.
3. Open counseling and relief centers.
4. Teach hygiene, sanitation among the poor masses.
5. Safe disposal of hospitals wastes like used injection needles, waste blood etc. and taking due care of environment.
6. Spreading awareness about various diseases through campaigns and free medical check ups.
7. In brief the social aspect of hospitals industry is to see that latest treatment and medicines are available to people at large at concessional rates or free of cost and that its activities are not only restricted to rich people.

Technological Factors
We are witnessing Information technologies transforming the way health care shall be delivered. Innovations such as computer based hospital information systems, medical records; decision support systems, health information networks, telemedicine, real time image transfers and newer ways of distributing health information to consumers are beginning to affect the cost, quality, and accessibility of health care.
The technologies today can support vast databases, network communications, quick distribution and reliable image transfers.
INTRODUCTION TO HOSPITALS:
Until the early 1980s, Government-run hospitals and those operated by charitable organizations. The last two decades have seen the mushrooming of corporate and privately run hospitals. Most large trust and corporate hospitals have invested in modern equipment and focus on super-specialties.
The private sector accounts for 70% of primary medical care and 40% of all hospital care in India. They employ 80% of the country’s medical personnel.
The corporate hospital sector is most evolved in the south while charitable/trust hospitals proliferate in the west. However, the north and east are also showing a growing trend in private hospital expansion. Key therapeutic areas are cardiology, nephrology, oncology, orthopaedics, geriatrics, maternity and trauma/critical care.

Hospitals are not for profit making, they are social institution to make available to society the required Medicare services. However this may not be true for private hospitals. Today hospitals are a place of diagnosis and treatment of human ills, for the training research, promoting health care activities and to some extent a center helping biosocial research. WHO states that hospitals are socio-medical organization whose functions are: Curative, preventive, patient services and training of health workers in biosocial research.

With time the classes and quality of hospitals have changed a lot today. Most hospitals today are trying to provide all ultra facilities and are in the process of making state of the art hospitals. Hospitals provide the infrastructure facility to healthcare.

CLASSIFICATION OF HOSPITALS:

The classification of Hospitals on the basis of objective, ownership, path and size.

1. On the basis of the OBJECTIVE there are three types:
Teaching cum research for developing medicines and promoting research to improve the quality of medical aid.
General hospital for treating general ailments.
Special hospitals for specialized services in one or few selected areas.

2. On the basis of the OWNERSHIP, there are four types:
Government hospital, which is owned, managed and controlled by government
Semi-government hospital, which is partially shared by the government.
Voluntary organisations also run hospitals.
Charitable trusts also runs hospitals.

3. On the basis of PATH OF TREATMENT, there are:
Allopath which is the system promoted under the English system.
Ayurved, which is based on the Indian system where herbals are used for preparing medicines.
Unani
Homeopath
Others

4. On the basis of the SIZE, there are:
Teaching hospitals – generally have 500 beds, which can be adjusted in tune with number of students.
District hospital – generally have 200 beds, which can be raised to 300 in contingencies.
Taluka hospital – generally have 50 beds that can be raised to 100 depending on the requirement.
Primary health centres – generally have 6 beds, which can be raised to 10.

Classification of Hospitals

LATEST HOSPITAL INDUSTRY FOR PATIENTS:

Intangibility

Intangibility indicates that the service has no physical attributes and as a result, impossible for customer to taste, hears, feel or smell before they actually use it. Hospital industry is where the customers (patients) get treated for physical problems they have. The customers can’t really realize the service provided until they get well. For this they have to provide good supplementary services.The only way they can provide tangible clues to make the service provided a success. For e.g. the hospitals provide extra facilities like television, or then friendly personnel’s can make a difference.

Inconsistency

It’s also referred to as heterogeneity or variability. The inconsistency occurs largely because of
• Different service providers perform differently on different occasions.
• Interaction between customer and provider may vary from customer to customer.
Standardization is hard to maintain. Every doctor is not the same and may not give the same diagnosis. Also a patient may not each diagnosis in a different way. Also since the quality of work done can be determined only after the service is performed the providers have to be well trained in case of performing the service process.

Inseparability

Inseparability means that the service can not be separated from the creator-seller of the service. Infact there are many services which are created, delivered and consumed simultaneously through interaction between customer and service producers.
Here too the customer, i.e. the patient has to come upto the hospital to get the treatment. The customer has to be present when the service is performed. Infact in case of hospitals the service is created and delivered simultaneously. The type of service to be provided depends on the customer.

Inventory
Services cannot be easily saved, stored or inventoried. This is all due to the perishable nature of the services. Also there’s cost also associated with the carrying of inventory. Here the costs are more subjective and are related to capacity utilization for e.g. if a doctor is available but there’s no patient during that period, the fixed cost of the idle physicians salary is a high inventory carrying cost.
Also due to demand fluctuations the services cannot be stored. E.g. there’s a lot of rush at the dentists clinic in December and January as that’s the time when there are lots of tourist visiting India.

OPPORTUNITIES
With global revenues of approximately US$ 2.8 trillion, the healthcare industry is the world’s largest industry and India is emerging as a major player in this industry, because of its high population.
As per the Insurance Regulatory and Development Authority (IRDA), the Indian healthcare industry has the potential to show the same exponential growth that the software and pharmaceutical industries have shown in the past decade. Further, as per the IRDA, only 10 percent of the market potential has been tapped till date and market studies indicate a 35 percent growthin thecomingyears.
A big opportunity for the industry emerges from the privatisation of the insurance segment, which would extrapolate into a new delivery system in India. There is a vast insurable population in India, given that only 2 million people ie 0.2 percent of the total population are covered under Mediclaim. According to a recent study, there are 315 million potentially insurable lives in the country.
A World Health Organisation report states that India needs to add 80,000 hospital beds each year to meet the demand of its population. The huge shortage of beds outlines a major opportunity for the industry.

The healthcare industry is a fast growing industry and coupled with strength of Indian innovative and scientific manpower and also low costs, it is slowly achieving key industry status in India.
Some Suggestions for improving the position of the hospitals

1. The general perception that large hospitals, with high bed-occupancy rate, are profitable, is misleading. Global experience shows that hospital with more than 250 beds don’t do well. Many Indian hospitals are following the US healthcare industry, by decreasing the average length of stay of patients and increasing patient turnover. US research shows that 80% of the revenues form a patient comes in the first 72 hours post- admission. Hospitals generate a lot of revenues from General Inspection, because the patient turnover is very high.
A large percent of revenues come from specialized services like operations and surgeries. It is because of these reasons that many corporates are planning for a small 100 beds specialized hospitals, which caters to specific diseases like cardiac, cosmetic surgery, neurology etc. Research shows that there exist a lot of space for super-specialized hospitals with 100-150 beds, which generate revenues equivalent to large 500 bed general hospital. Typically large hospitals with approximately 500 bed capacity takes about 9-10 years to break even whereas super-specialty hospitals with about 100 beds take about 6-7 years to break even. Therefore, going in for super-speciality hospitals seems to be a more viable option today.
2. Hospitals could also generate revenues from medicines if they are supplying them in-house. Some hospitals make it mandatory for the patients to buy medicines from the hospital’s chemist shop. A margin of 15-20 % can be charged for such medicinal supplies. Though many hospitals run by Trusts do not earn this way, but new entrants or corporates for whom private healthcare sector is a direct extension of their line of business ( eg. Pharma companies), can generate good returns from medicine supply.

3. Health Plan packages can be provided by hospitals to family and corporate. For example Family Health Plan Services (FHP), a subsidiary of Apollo Hospitals does health management of employees of its clients.With a wide net work of Hospitals and Healthcare providers countrywide, and a tie -up with General Insurance Corporation of India, FHP offers a range of services to employees and dependants, such as Preventive Healthcare, Corporate Counselling, welfare Programmes, Claims Administration, Patient-care Coordination and so on. So FHP’s healthcare packages, optimize the benefits while keeping the cost under control.

4. Apart from preventive healthcare, stress management programs could be provided. For example ‘Effective Stress Management Programme’ offered by Wockhardt Hospital.This programme provides a medical perspective of stress and is conducted by a medical professional. The programme includes a series of one-to-one sessions, with a clinical Psychologist highlighting the factors responsible for inducing stress, and the methodologies, which can be adopted to cope with this phenomenon practically.
5. Hospitals can become integrated healthcare systems i.e. when medicines, food services, laundry and linen etc will become “purchased” services. These third-party operations will increase the profit margins.

6. Mergers could be used for synergy of skills – i.e. to help the merged organisations benefit from one another’s individual strengths by applying them across the board. It also helps them to make joint investments in branding or information technology and also to react effectively to the changed market forces.
Alternatively hospitals can go in for Group Purchases, as in USA. The buying power of large GPOs in USA like Premier, VHA / UHC and AmeriNet gives them the clout to exert price pressure on suppliers, particularly for products in lower demand. And as GPOs have consolidated, manufacturers have offered bigger discounts to hang on to their contracts. So there exists a lot of supply management opportunity, which will affect spending productivity.

The Future

Healthcare industry is booming all over the world. In the US it is already the largest service sector. And world-wide it is slated to be a $4 trillion market by 2005. A World Bank Report in November 1999 points at the emergence of large-scale, investor-owned hospitals in the country as a “dramatic” development. The Corporate hospitals will play a positive role in the healthcare sector by taking the load off government hospitals, whose performance hasn’t been upto the mark.
The Healthcare Industry is on the threshold of a major Growth Spiral which shall assimilate all new technologies to provide cost effective Healthcare. It shall not only employ the largest chunk of all available capital but shall also employ a large proportion of the skilled work force. The Healthcare Industry is poised to become the biggest Employer in all Countries. It shall also be the biggest consumer of all new technologies.
Specifically, in the next decade, it is anticipate that the Healthcare Industry shall grow at an accelerated pace and will achieve a Growth Rate of 8 – 10 % per annum in India and a Growth Rate of 4 – 8 % per annum in most of the Countries of third World. As a result, most of the Countries in the world (Other than USA) shall add more Hospital Beds.
This accelerated growth will require a large body of skilled Healthcare Providers. As a result, the Medical Education Sector, including Medical and all Para-medical staff, shall also witness a faster growth. It is anticipated that the numbers of skilled Healthcare Providers shall double in next decade.
The addition of Hospital Beds shall catalyse a Growth in Hospital Equipment Industry. It shall also fuel the growth of Pharmaceutical Industry. It shall specifically affect the Medical and Surgical Supply Segment and there too, the Prosthetic Devices Segment shall witness a very rapid growth.
In the next decade, the Earth’s Population shall reach a peak number. This, coupled with availability of better Healthcare shall lead to a higher Expectancy of Life at Birth. The average age of Earth’s Population shall increase. This will require a far superior understanding of Multiple Organ Syndromes and there treatments. There shall be a shift in focus of providing Healthcare. The Hospitals shall tend to be the providers of Acute & Intensive Healthcare; while new cost effective modalities shall provide intermediate care or nursing only care.
These new modalities shall not follow the rigid standards as set for Hospitals & shall employ a smaller number of trained medical manpower. These modalities shall augment the Home Care, as is available in the Joint Family Environment to more than half the population of world today. This will necessitate a greater interaction between the Healthcare Provider, the Medical Charge and the other segments of Healthcare Industry.
This growth of Healthcare Industry shall be supported by Political Will and Social Understanding at all levels of any Society. It must, therefore, meet the new challenges, by providing cost effective Healthcare in a manner that improves the Quality of Humane Life.
SOME PLAYERS

The Apollo Group of Hospitals
Driven by its line of being the “architect of healthcare” in India, the Apollo Hospitals Group, comprising of one of the largest networks of 26 hospitals, 10 clinics and over 10,000 employees across the country, represents the changing face of healthcare in India contemporary and corporatized. It has been the first private company to administer health insurance in the country and Indraprastha Apollo Hospital in Delhi is the fourth largest corporate hospital in the world.
The Apollo group is India’s first corporate hospital, the first to set-up hospital outside the country and the first to attract foreign investment. With 2600 beds, Apollo is one of Asia’s largest healthcare players. The recent merger between its 3 group companies, Indian Hospitals Corporation Ltd., Deccan hospitals Corporation Limited and Om Sindoori Hospitals Limited, will help the group raise money at a better rate and by consolidating inventory, it will save around 10% of the material cost. The group is planning to invest Rs. 2000 crore , to bulid around 15 new hospitals, in India, Sri Lanka, Nepal and Malaysia.
Apollo claims to maintain the best of medical standards with a record of over 7.4 million treated patients, 3,15,000 preventive health checks done, 98.5 percent success rate in 45,000 cardiac surgeries, etc. And helping the company maintain a balance between the corporate culture and rigorous medical excellence is recognition of IT as intrinsic to every process, whether it is day-to-day running of hospitals, education or telemedicine.
The application of IT in the day-to-day working of the largest hospital of the group, Indraprastha Apollo, throws light on the extent of the automation drive within the company. The management realised the fact that in order to have a modern hospital in place all the work processes had to be related to IT. Hence, the need for an end-to-end integrated solution. This led to the implementation of the Hospital Information System (HIS), which was an integral part of the hospital inception project.
The hospital today boasts of an integrated HIS, which provides for end-to-end integration of the various processes and functional areas within the hospital to make for a seamless workflow. The work processes of the hospital are primarily divided into two areas the patient (comprising of in-patient and out-patient) and the non-patient all the back-end departments like housekeeping, engineering, finance, materials, purchase and HRD.
The workflow process starts with the patient seeking an appointment with the doctor. HIS contains all the information relating to appointment schedules of the doctors. Depending on the availability of the doctor, the patient is given the date and time of appointment. This information is then fed into the system and the updated information is available to the doctor in real-time.
On the date of his appointment, the patient registers himself at the counter by filling up of a form, which contains all the basic information related to the patient. This data is feeded into the system with a Unique Hospital Identifier (UHI) number allotted to the patient so that by the time the patient meets the doctor, he already has all the required basic information. This is followed by 15 minutes of consultation with the doctor after which the doctor gives his prescription, the data is again keyed into the system as a patient record under his UHI and is accessible for quick reference.
One of the biggest advantages of HIS is that any medically relevant information related to the patient is available at the click of a button, thereby saving precious time, which means a lot when it comes to saving a life. HIS also acts as a kind of ERP for the hospital with its automation of various back-end areas like financial, accounting and inventory, which are integrated with the patient areas wherever required.
The hospital has also developed a very effective mailing system for its employees, which is based on Microsoft Exchange. The company’s Intranet is being used to run mailing applications as well as information relating to company policies, leave information and basic information relating to the company. Telemedicine Healthcare for all.

A very significant IT initiative of the Apollo Hospitals Group, and of great relevance to a developing country like India in taking healthcare to the masses, is the area of telemedicine. Incorporated in 1999, Apollo Telemedicine Enterprises (ATEL), the telemedicine division of the Apollo Hospitals Group, has already set up over 10 telemedicine links between the Apollo Institutions at Delhi, Hyderabad and Chennai and distant locations across the country. It has developed competence in developing cost-effective turnkey telemedicine solutions.
Teleme-dicine ensures that the benefits of hi-tech medicine can go to everyone, and not just to people who live in big cities. The group has forged alliances with government organisations like the Indian Space Research Organisation (ISRO) for VSAT bandwidth and Wipro for hardware, to provide telemedicine facilities to far-flung and rural areas. The division is working towards developing a strong Apollo Telemedicine Network, which allows the participant sites to collaborate with institutions in the country and abroad, and provides their clientele access to better healthcare in areas not adequately served by the medical community.
A patient and his doctor can interact with specialists based in the specialty centers and receive second opinion or interpretations to complex medical cases. The patient reports can be transmitted from a consulting canter to a specialty canter using the telemedicine software and the communication link, which could be ISDN or VSAT connectivity.

Other Services offered by Apollo:
-Apollo Pharmacy
Apollo Pharmacy operates round the clock catering to all your medicine needs.
-Café Apollo
Café Apollo is a sit down dining facility of the hospital. It offers a wide selection of snacks and a variety of meals.

-Apollo Food Plaza
There is food facility located in the atrium of the hospital serving a delightful array of delicacies.

Timings : 8.00am – 9:00pm

-Fast Food Cafe
For the convenience of ICU attendants there is a 24 hours cafe in the ICU lobby.
-Gift Shop
The Gift Shop carries a wide range of gifts including Confectionery, Cards, Books, Newspapers, Magazines and other novelties.
-Bank Facilities

-The Oriental Bank of Commerce
The Indraprastha Apollo Branch of the Oriental Bank of Commerce is located at one of the Gates.
Bank Hours
Monday to Friday : 10:00am – 2:00pm
Saturday : 10:00am – 12:00pm
The bank remains closed on Sundays and National Holidays.

-The ICICI ATM Counter
The ICICI ATM counter is also located in the hospital.
– Fortis Healthcare
Fortis is the late Ranbaxy’s Parvinder Singh’s privately owned company. The company is a 250 crore, 200 bed cardiac hospital, located in the town of Mohali. The company also has 12 cardiac and information centres in and around the town, to arrange travel and stay for patients and family. The company has plans of increasing the capacity to around 375 beds and also plans to tie up with an overseas partner.
Max India
After selling of his stake in Hutchison Max Telecom, Analjit Singh has decided to invest around 200 crores, for setting up worldclass healthcare services in India. Max India plans a three tier structure of medical services – Max Consultation and Diagnostic Clinics, MaxMed, a 150 bed multispeciality hospital and Max General, a 400 bed hospital. The company has already tied up with Harvard Medical International, to undertake clinical trials for drugs, under research abroad and setting up of Max University, for education and research.
Escorts
EHIRC located in New Delhi has more than 220 beds. The hospital has a total 77 Critical Care beds to provide intensive care to patients after surgery or angioplasty, emergency admissions or other patients needing highly specialized management including Telecardiology (ECG transmission through telephone). The EHIRC is unique in the field of Preventive Cardiology with a fully developed programme of Monitored Exercise, Yoga and Meditation for Life style management.
WOCKHARDT and DUNCANS GLENEAGLES INTERNATIONAL also have major expansion plans.
This report is prepared by Mona Pandit and Parin Mehta of Sydneham Institute of Management exclusively for India Infoline as part of their project curriculum.

India’s healthcare sector has made impressive strides in recent years. It has transformed to a US$ 17 billion industry and is surging ahead with an annual growth rate of 13% a year. The healthcare industry in India expected to grow in size to Rs 270,000 core by 2012. The healthcare industry employs over four million people, which makes it one of the largest service sectors in the economy of our country.

Healthcare is dependent on the people served; India’s huge population of a billion people represents a big opportunity. People are spending more on healthcare. The rise in literacy rate; the higher levels of income; and an increased awareness through the deep penetration of media, has constituted to greater attention being paid to health. India has a very low density of doctors. Infant mortality is amongst the highest in India.

Global Health Observatory (GHO)
Mortality and Global Burden of Disease (GBD)

Age standardized death rates: Measuring how many people die each year and why they have died is one of the most important means – along with gauging how various diseases and injuries are affecting the living – of assessing the effectiveness of a country’s health system. Having those numbers helps health authorities determine whether they are focussing on the right kinds of public health actions that will reduce the number of preventable deaths and disease. Globally, around 60 million people die each year. Almost 20% of these deaths occur in children under the age of 5. Most of these preventable deaths in children occur in low- and middle-income countries.
The GHO issues analytical reports on the current situation and trends for priority health issues. A key output of the GHO is the annual publication World Health Statistics, which compiles statistics for key health indicators on an annual basis. The World Health Statistics also include a brief report on annual progress towards the health-related MDGs. In addition, the GHO provides analytical reports on cross-cutting topics such as the report on women and health and burden of disease. Lastly, the GHO provides the link to specific disease or programme reports with a strong analytical component
Bringing together all existing WHO Global Nutrition Databases dynamically, as well as other existing food and nutrition-related data from partner agencies, NLIS is a web-based tool which provides nutrition and nutrition-related health and development data in the form of automated country profiles and user-defined downloadable data. Data presented in the country profiles are structured by the UNICEF conceptual framework for causes of malnutrition and intend to give an overview snapshot of a country’s nutrition, health, and development at the national level.
NLIS draws data for the country profiles from available databases. Sources include the World Health Organization (WHO), United Nations Children’s Fund (UNICEF), UN Statistics Division, UN Development Programme (UNDP), Food and Agriculture Organization of the UN (FAO), Demographic and Health Surveys (DHS), the World Bank, International Food Policy Research Institute (IFPRI), and the International Labour Organization (ILO). More recent data might be available from other sources, including in-country sources.

The WHO Global Data Bank on Infant and Young Child Feeding

WHO began the Global Data Bank on Breastfeeding in 1991 as part of its monitoring and surveillance activities. Since then the Data Bank has undergone several revisions to accommodate new sets of definitions and indicators and integrate all operational targets of the Global Strategy for Infant and Young Child Feeding, changing as a result the name to “WHO Global Data Bank on Infant and Young Child Feeding”.
The Data Bank is maintained and managed in keeping with internationally accepted definitions and indicators. It pools information mainly from national and regional surveys, and studies dealing specifically with the prevalence and duration of breastfeeding and complementary feeding. The Global Data Bank on Infant and Young Child Feeding is continually updated as new studies and surveys become available.
Data for inclusion are based on indicators from household surveys and for some countries from facility based surveys.
The aim is to achieve worldwide coverage in order to permit:
• Comparison between countries and regions, and within countries
• Assessment of breastfeeding and complementary feeding trends and practices as a basis for future action
• Monitoring and analysis of trends over time
• Evaluation of the impact of infant and young child feeding promotion programmes
• Ready access to current data for use by policy- and decision-makers, scientists, researchers, hospital administrators, health workers, and other interested parties

Global Database on National Nutrition Policies and Programmes:
The Global Database on National Nutrition Policies and Programmes was established in 1995 initially to monitor and evaluate the progress in implementing the World Declaration and Plan of Action for Nutrition. However, it has been further developed to monitor country progress in developing, strengthening and implementing national nutrition plans, policies and programmes, including multi-sectoral actions, development of dietary guidelines, undertaking of nutrition surveys, demographic, and epidemiological data. Included in the database are:
• outcomes of a 1994 evaluation on country progress in implementing the World Declaration and Plan of Action for Nutrition;1
• status of the development and implementation of national food and nutrition policies and plans since 1994;
• summary of available national food and nutrition policies and plans, including priority goals and strategies and planned programme activities, together with estimated budget, where available;
• technical and financial support provided to Member States by WHO and other agencies;
• demographic data relating to health and nutrition for each country;
• information on multisectoral action, development of dietary guidelines, and nutrition surveys;
• trends in WHO’s global and regional nutrition budget since 1988; and
• information on regional activities, where applicable.
The data and information is derived mainly from government polices and plans, such as national plans of action for nutrition, national food and nutrition polices, national health policies, and other food and nutrition related polices, where applicable. Data have also been obtained from country reports prepared for the International Conference on Nutrition in 1992, the World Food Summit in 1996 and various regional follow-up meetings and consultations. Additional data and information are also provided periodically by each WHO Regional Office. It is envisaged that the regional review meetings planned for 2000 for the African Region, the Region of the Americas, and the Eastern Mediterranean Region will generate additional new data and information for countries in those respective regions.
The Section on Developing and Implementing National Nutrition Policies and Plans (Section 4.1 in this report) was prepared using the data and information extracted from this database. Furthermore, currently a global review and comparative analysis of national nutrition policies, and plans of action is being undertaken using the data and information available in this database to evaluate progress and country experiences. This review will look at priority nutrition issues identified by countries, key elements for developing and implementing effective and sustainable nutrition policies and programmes, lessons learned, and the way forward, including further actions and support required.

6. DATA ANALYSIS & FINDINGS

During the research work a questionnaire has been prepared and the analysis and interpretation is mode on the basis of it which is as follows:-

1. When people are asked how many times a year they go for the medical checkup then the response is collected and summarized in the Table 1.
TABLE – 1
Criteria Frequency Percentage
Once in a week NIL 0
Once in a month NIL 0
Once in three months 7 7
Once in six months 15 15
Once in a year 20 20
Only If Required 58 58

FINDINGS:

58% percentage of the sample population goes for the medical checkup when they required in emergency, 20% goes once in a year 15% people go for medical checkup once in 6 months while only 7% goes once in a three months.

ANALYSIS:

Health Problems in India are not detected at the primary stage since the people does not go for the medical checkup the regular basis. They only goes when a medical emergency comes around them.

2. When Sample population were asked how often you eat outside. The responses are collected and summarized in the Table 2.

TABLE – 2
Criteria Frequency Percentage
Once in a week or more 32 32
Once in a month or more 26 26
Once in three months or more 25 25
Once in six months 8 8
Once in a year 9 9
Never — —

FINDINGS:

From the Population sample most of the people preferred to eat outside once in a week or a month duration while very few goes once in a year for the food court outside

ANALYSIS:

If is observed that due to the outside unhealthy eating habits the Indians are more prone to the infection diseases. Which we can reduce by eating healthy from the good place/ Restaurants / Hotels etc.

3. When the respondents we asked If, they workout, then the response is collected and the summarized in Table 3.
TABLE 3

Criteria Frequency Percentage
Four days a week 20 20
Five days a week 20 20
Six days a week 7 7
Not at all 53 53

FINDINGS:

20% percentage of the sample population doing the workout in four days a week, 7% doing the workout in six days a week and 53% people does not work out.

ANALYSIS:
An observed that due to less work out is the main reason for unhealthy or bad fitness problem.

4. When respondents were asked, If they are involved in the outdoor sports.

TABLE – 4
Criteria Frequency Percentage
Yes 43 43
No 57 7

FINDINGS:

43% percentage of the sample population involved in outdoor sport and 57% population does not involve any kinds of outdoor sports.

ANALYSIS:

According to above observation people does not want to show interest in outdoor sports. That’s why they face many health problems in future.

5. The answer to the question do you feel tired after working for a short span of time. The response is

TABLE – 5
Criteria Frequency Percentage
Yes 38 38%
No 62 62%

FINDINGS:

38% percentage of the sample population feel tired after working for a short span of time and 62% population does not feel tired after working for a short span of time.

ANALYSIS:

An above Observation showing that people does not working regularly that’s why they feel tired after working for a short span of time.

6. When Respondents were asked if they feel the adequate medical facility is available throughout the result then the result is gathered & Summarized in table 6.

TABLE – 6
Criteria Frequency Percentage
Yes 80 80%
No 20 20%

FINDINGS:
80% percentage of the sample population were feel adequate medical facility is available throughout the country and 20% sample population does not feel like that.

ANALYSIS:
An above observation showing that adequate medical facility is an available in India. There is available all require medical facilities.
7. When Respondents were asked If India is able to Combat the epidemics situation rise due to Communicable diseases. The responses are summarized to table 7.

TABLE – 7

Criteria Frequency Percentage
Yes 77 77%
No 23 23%

FINDINGS:

77% percentage of the sample population were feel that India is able to combat epidemics situation rise due to Communicable diseases and other hand 23% sample population does not feel like that.

ANALYSIS:
If is observed that India is able to combat epidemics situation rise due to Communicable diseases and there is provide all medical facilities for peoples.

7. CONCLUSION

58% percentage of the sample population goes for the medical checkup when they required in emergency, 20% goes once in a year 15% people go for medical checkup once in 6 months while only 7% goes once in a three months.

Health Problems in India are not detected at the primary stage since the people does not go for the medical checkup the regular basis. They only go when a medical emergency comes around them.

From the Population sample most of the people preferred to eat outside once in a week or a month duration while very few goes once in a year for the food court outside, If is observed that due to the outside unhealthy eating habits the Indians are more prone to the infection diseases. Which we can reduce by eating healthy from the good place/ Restaurants / Hotels etc.

20% percentage of the sample population doing the workout in four days a week, 7% doing the workout in six days a week and 53% people does not work out.
An observed that due to less work out is the main reason for unhealthy or bad fitness problem.

43% percentage of the sample population involved in outdoor sport and 57% population does not involve any kinds of outdoor sports.

According to above observation people does not want to show interest in outdoor sports. That’s why they face many health problems in future.
38% percentage of the sample population feel tired after working for a short span of time and 62% population does not feel tired after working for a short span of time.

An above Observation showing that people does not working regularly that’s why they feel tired after working for a short span of time.

80% percentage of the sample population were feel adequate medical facility is available throughout the country and 20% sample population does not feel like that.

An above observation showing that adequate medical facility is an available in India. There is available all require medical facilities.

77% percentage of the sample population were feel that India is able to combat epidemics situation rise due to Communicable diseases and other hand 23% sample population does not feel like that.

If is observed that India is able to combat epidemics situation rise due to Communicable diseases and there is provide all medical facilities for peoples.

8. REFERENCES
1. NATIONAL HEALTH POLICY – 2002
2. http://www.indianhealthcare.in/index.php?option=com_content&view=article&catid=131&id=168%3AIndian+Healthcare:+The+Growth+Story
3. http://www.ibef.org/industry/healthcare.aspx
4. http://cii.in/menu_content.php?menu_id=238
5. http://knowledge.wharton.upenn.edu/india/article.cfm?articleid=4277
6. The Times Of India. http://economictimes.indiatimes.com/Healthcare/Lacking_healthcare_a_million_Indians_die_every_year_Oxford_University/articleshow/4066183.cms.
7. http://knowledge.wharton.upenn.edu/india/article.cfm;jsessionid=a830ad0556799af14ed03640274d5d3a1b70?articleid=4277
8. http://searo.who.int/EN/Section313/Section1519_10852.htm
9. http://www.technopak.com/tkc/index.asp?ol=5
10. http://www.technopak.com/tkc/index.asp?ol=6
11. http://202.131.96.59:8080/dspace/bitstream/123456789/113/1/Medical+Tourism-Pheba+Chacko.pdf
12. http://www.technopak.com/tkc/index.asp?ol=8
13. Healthcare in India”. Boston Analytics. http://www.bostonanalytics.com/india_watch/Healthcare%20in%20India%20Executive%20Summary.pdf.
14. http://www.irdaindia.org/
15. http://www.indianhealthcare.in/index.php?option=com_content&view=article&catid=121&id=170
16. http://www.indianhealthcare.in/index.php?option=com_content&view=article&catid=39:&id=330:MALVINDER,+SHIVINDER+PLAN+TO+ENTER+HEALTH+INSURANCE+BIZ+&Itemid=
17. Status of Malaria in India”. http://medind.nic.in/jac/t00/i1/jact00i1p19.pdf.
18. 2.5 million people in India living with Aids, according to new estimates”. New York Times. http://data.unaids.org/pub/PressRelease/2007/070706_indiapressrelease_en.pdf. Retrieved 2007-06-08.
19. Sharp drop’ in India Aids levels, BBC
20. “2.5 million people in India living with HIV, according to new estimates”. World Heath Organization. http://www.who.int/mediacentre/news/releases/2007/pr37/en/index.html. Retrieved 2007-06-08.
21. Robinson, Simon (2008-05-01). “India’s Medical Emergency”. Time. http://www.time.com/time/nation/article/0,8599,1736516,00.html. Retrieved 2010-05-04.
22. http://www.worldbank.org.in/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/INDIAEXTN/0,,contentMDK:21461167~pagePK:141137~piPK:141127~theSitePK:295584,00.html
23. “India: Undernourished Children: A Call for Reform and Action”. World Bank. http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/0,,contentMDK:20916955~pagePK:146736~piPK:146830~theSitePK:223547,00.html.
24. Pandey, Geeta (2006-10-13). “‘Hunger critical’ in South Asia”. BBC. http://news.bbc.co.uk/2/hi/south_asia/6046718.stm. Retrieved 2010-01-05.
25. Using shame to change sanitary habits, Los Angeles Times, 6 September 2007
26. The Politics of Toilets, Boloji
27. Mumbai Slum: Dharavi, National Geographic, May 2007
28. “Development Policy Review”. World Bank. http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/0,,contentMDK:20980493~pagePK:146736~piPK:146830~theSitePK:223547,00.html.
29. http://www.indianhealthcare.in/index.php?option=com_content&view=article&catid=39%3A&id=327%3AINDIA+TURNING+AFFORDABLE,+QUALITY+OPTION+FOR+MEDICAL+TOURISTS&Itemid=
30. http://www.indianhealthcare.in/index.php?option=com_content&view=article&catid=131&id=168&start=2
31. http://www.indianhealthcare.in/index.php?option=com_content&view=article&catid=122&id=173
National health policy 2002
Health situation in India
World report, making a difference
Health information of India
Delivery of healthcare services in India published by national commission on macroeconomics and health
Researches methodology by R. Panneerselvam
Health screen….. Volume 2, No.7, July 2005(diabetes clinical management ……cover story pg 10 – 17)

Health care: www.wipro.in/domains/healthcare/indexhtm
www.ahrg.gov
http:/en.wikipedia.org/wiki/healthcare_in_India
http://en.wikipedia.org.wiki.ministry_of_health_and_family_welfare_India
www.indmedica.com
www.herc.research.va.gov
www.wpro.who.int/health_topics
www.whoind.org
www.who.int

7. QUESTIONNAIRE
Questionnaire:
Name: __________________
Date of birth: _________________
Sex: _______________
Marital status: ___________
No. of children (if any): ______________
Physical address: ______________________
1. How often do you go for a medical checkup?
a) Once a week or more
b) Once a month or more
c) Once in three months or more
d) Once in six months or more
e) Once in a year
f) Only if required
2. How often do you eat outside?
a) Once a week or more
b) Once a month or more
c) Once in three months or more
d) Once in six months or more
e) Once in a year
f) Never
3. Do you workout?
a) Four days a week
b) Five days a week
c) Six days a week
d)Not at all.
4. Are you involved in any outdoor sports?
a) Yes
b) No
5. Do you feel tired after working for a short span of time?
a) Yes
b) No
6. Do you think there is enough medical facility available to the population of India right from metro cities to the rural India?
a) Yes
b) No
7. Do you consider India is able to fight the epidemic situations?
a) Yes
b) No
8. Do you consider India is able to Communicable diseases?
a) Yes
b) No

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