Healthcare as Enterprise for Medical Missions

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HEALTHCARE ENTERPRISE MISSION

A CONSULTATIVE WORKSHOP

At Ecumenical Christian Center, Whitefield, Bangalore

12th & 13th of January 2007

A G U A R D I A N H E A L T H I N I T I A T I V E

G u a rd i a n H e a l t h M a na g e m e nt 1 3 9 , I n f a n t r y R o a d , B a n g a l o r e 5 6 0 0 0 1 , I n d i a P hone + 9 1 8 0 2 5 5 8 0 9 7 1


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Introduction

Medical Missions in India is generally equated with mission hospitals, rural community and development work, chari-

table services for the marginalized and responses to emergency situations of human need. These services were pioneered

by western missionaries and contributed enormously to the health and health care in India. They also brought modern

medicine and its scientific development to India. They pioneered work in tackling tuberculosis and leprosy. They cared

for the marginalized of the society especially women and dalits. Thus they laid the foundations for the emerging health

system in India. At the time of Independence of India almost 80% of the hospital beds in India were located at the Mis-

sion hospital networks.

This situation started changing with the emergence of Government health care system and the rise of private hospitals

and nursing homes.

Today, 62% of hospitalization and 80% non-hospitalization treatment is provided by the private health sector. The Not-

for-profit and the Government sector have not been able to keep up with the rising demands for facilities and quality of

care. The growth of private healthcare sector is driven by several factors:

With the overall GDP growth of 8.5 - 9% per annum, there has been a substantial rise in income levels - most signifi-

cantly for the middle and lower middle class. This means that they are able to demand higher level of facilities andcare.

The opening of the Indian economy has made domestic and foreign investments easier. The result has been heavy in-

vestments flowing into the health sector. These investments bring with them world class facilities, technology and

management which the Not-for-profit sector or the government are unable to match. Thus what the middle class needs

is being supplied by the private sector.

With the increasing penetration of internet, prospective patients are able to know all about their diseases and the

treatment. In most cases the information they possess is more than what the doctor would know. With demand for

high quality healthcare, doctors are forced to keep up and even practice in a manner that pushes up the cost of health

care.

1930s

2007

G u a rd i a n H e a l t h M a na g e m e nt H e a l t h c a re e n t e r p r i s e a s M i s s i o n2

Christian Hospitals

Private/CorporateHospitals

GovernmentHospitals

Number of hospital in different sectors


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Lifestyle diseases are on the increase among the middle class. India is soon projected to have the highest number of

diabetics in the world. This means that the population requires lifelong treatment and constant monitoring besides

treating complications arising from chronic diseases. More drugs are being consumed by the healthy than by the sick.

Health insurance sector is still trying to find its feet. There are two reasons why health insurance sector is unable to

take off in a major way. Firstly there is a serious lack of reliable mortality and morbidity data. Risk calculations are

based on this data. And if the data is unreliable premium calculations go awry. The second reason is the lack of stan-

dardization of care. There is no mandatory accreditation system in India. This results in a wide variation in costs of

interventions and the health insurance companies are unable to handle these variations. Thus there is an increasing

pressure on the government to standardize and accredit hospitals.

All these changes, particularly the rapid economic growth has widened the disparities in income as never before.

While we are producing millionaires and billionaires at the fastest rate on earth, persons below poverty line (Less than

$1 a day) has remained almost the same at 32-35% of the population. The trickle down which is supposed to take place

has not happened. Access to healthcare services for this population is a serious issue.

These and other emerging factors which drive healthcare bring with them considerable new opportunities in health care

for exploration and involvement. The aim of the workshop is discuss these broad opportunities, to listen to some who

have new ideas and to see if some of us can be of support to such healthcare ventures.

Opportunities

Opportunities in the healthcare sector in India are unprecedented. The healthcare professional has never faced such a

variety of choices and possibilities and investors had never before got such returns on investments in the healthcare sec-

tor. To list only a few:

1. India has 1.5 beds per 1000 populations while the requirement is 4.5 beds per 1000. Just adding one bed per 1000

works out to 1.1 million beds. Most of this requirement of beds would be in the Tier 1 and Tier 2 cities. The invest-

ments required is estimated to be 80,000 crores (US $20 billion). The opportunity to add bed is immense.

2. It is estimated that India will be short by 500,000 doctors and 1.3 million nurses by the year 2010. Equally high num-

ber of other healthcare professionals like the pharmacists, Auxiliary Nurse Midwife, lab technologists and healthcare

administrators are scarce. Biomedical engineers are going to be in serious shortage with the number of high tech

based equipments being deployed in all the hospitals. The opportunities in medical education, continuing and dis-

tance education, e-learning, tele-medicine are all exciting.

3. For the success of a healthcare institution, healthcare professional is the key. In most hospitals patients come to see a

particular doctor who has established a relationship. But healthcare professionals are difficult to retain. Increasing

number of professionals leave the mainstream of medicine at a very early phase in their career. Mentoring and per-



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sonal formation of healthcare professionals is strategic and critical area of opportunity to infuse meaning and pur-

pose and to encourage a vocation in healthcare.

4. Standardization of quality of care and facilities is going to be key if hospitals want to continue to attract patients.

Quality Council of India has already started accrediting hospitals through its National Accreditation Board for Hos-

pitals and Healthcare Providers (NABH). Several corporate hospitals have already received JCI (Joint Commission

International - US) certification. Standardization is important for Health Insurance companies to develop a relation-

ship with the hospitals with confidence. Medical tourism with its huge revenue possibilities require hospitals to

adopt international standards.

5. Medical Research is an emerging filed in India. Ability to conduct clinical trials not only keeps up the academic and

clinical quality of services but also could be a good revenue source for hospitals. To do this hospitals have to reach a

certain standard and will need to have academically oriented quality professionals. Such level of research can bring

in international recognition of health professionals and hospitals.

6. Quality healthcare is largely inaccessible to the population at the Bottom of the Pyramid (BOP). Besides this, BOP

population pays a Poverty Penalty.' Many in the BOP, and perhaps most, pay higher prices for basic goods and

services than do wealthier consumerseither in cash or in the effort they must expend to obtain themand they

often receive lower quality as well1. How to make quality healthcare accessible to this population is a question that

demands serious consideration of any socially responsive health care enterprise.

7. Ethics of healthcare practice in India today has several disturbing trends. Because of built in benefits, physicians

benefit disproportionately through commissions based on the procedures done and investigations performed. There

are also blatant wrong doing by performing unnecessary investigations and procedures. Organ transplant, particu-

larly kidney transplant, racket is something that goes on in major cities in India. An unfortunate impact of such

practices has been that the general public view private and corporate hospitals with suspicion. In this milieu a hos-

pital which stands for integrity, honesty, transparency and ethical principles commands of respect of the community

and will hopefully attract large number of patients. Many hospitals fail to understand that it is good for them, even

financially, in the long run to provide patient care with integrity, honesty, transparency based on a strong ethicalfoundation.

Innovation & Enterprise

To capture these and many other healthcare opportunities new perspectives and new paradigms are needed. The context

of these opportunities, the way work is organized and the tools of work and engagement are all completely different

from what existed earlier when classical mission hospitals were founded. A spirit of innovation and enterprise are essen-

tial to make sense out of these opportunities and to find a way forward.

The Biblical view of creation and personhood presupposes creative instinct in all human beings. It is this spirit of creativ-

ity and innovation that is going to help him/her manage the garden and explore the wild and beautiful world that the

Creator made. We are invited as co-laborers to pursue this vision of a new heaven and a new earth thus becoming mes-

sengers of hope and good news of Jesus to our generation.

Medical Mission in the past have applied this spirit of innovation and enterprise in creating mission hospitals to meet the

needs of communities and people in need. But somewhere along the way we seem to have lost this spirit and have set-

tled down to managing dying or dead institutions.

With the opportunities that have presented themselves in the field of health care we need to regain this spirit of enter-

prise. This will set us on a new direction and give us a new vigor to face the future and make a difference to many lives.


1 Hammond, A L; William J K; Robert S K, 2007, The next 4 billion, World Resources Institute


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The Workshop

The purpose of the workshop is to examine emerging opportunities in healthcare in India and frame a response to these

challenges. The sessions will consist of presentations by several key people who are experts in different areas, followed

by brainstorming sessions. Some of the questions that we need to examine are:

1. What is the nature of linkage between enterprise and mission?

2. What is required to improve quality of care?

3. How do we retain and nurture healthcare professionals?

4. What is the future of medical technology and what should be our response?

5. What does it mean to be an entrepreneur?

6. How do we mobilize financial resources for enterprise?

7. How can we support entrepreneurs? Action plan for the future.

Expected outcome

By the end of the workshop we would have

1. Identified Strategic Direction for Socially Responsive Enterprises in Healthcare (SREH)

2. Placed two options before each of the participants - to be a promoter of enterprise or to start an enterprise in health-

care.

3. Identified a pool of senior resource people who are willing to support those going out on new ventures.

4. Made definitive action plan for the coming months.

Written by:

Dr. Varghese Philip

25th October 2007


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Healthcare as Enterprise for Medical Missions