Innovative healthcare delivery_models-atul behll

A health care system is the organization of
people, institutions, and resources to
deliver health care services to meet
the health needs of target populations

Healthcare System - Goals

WHO has defined these goals as :
– Good health
– Responsiveness to the expectations of the
population
– Fair financial contribution

Healthcare System – Current Scenario

• Many countries are struggling to address
increasing costs, poor or inconsistent quality
and inaccessibility to timely care

• Among developed countries, healthcare
expenditures are rising twice as fast as overall
economic growth

• Finally, as costs and demand rise, access to
care is becoming more problematic. Many
healthcare systems have demand versus
capacity issues that are extending wait
times for services

These challenges are exacerbated by driving forces
that are challenging the status quo
– Globalization
– Changing demographics and lifestyles
– Diseases that are more expensive to treat (for example,
rising incidence of chronic disease)
– Proliferation of medical technologies and treatments

Healthcare System – Focus Areas

• Greater focus on value from the entire healthcare
system
• Increasing need to activate responsible citizens
• New approaches to promoting health and delivering
care
• Growing resource challenges

The Challenge in Emerging Economies
Within developing countries, access to basic healthcare services is seen to be extremely limited
and many simply lack access to even the most basic services. The causes can be enumerated
as below:

Healthcare System - Funding

There are generally five primary methods of funding
health care systems:
• General taxation to the state
• Social health insurance
• Voluntary or private health insurance
• Out-of-pocket payments
• Donations to charities
Most countries' systems feature a mix of all five models

Healthcare System - Aspects

The effectiveness with which these instruments of state policy are
designed and used determines the extent to which the health
system is equitable, appropriate or fair

C Staying Healthy Franchising Technology Enabled Networks
•PDA, Thailand •Medical, Mexico
A •K-Met, Kenya •HMRI, India
T •PSI, Various •NHS Helpline, U.K.
•MinuteClinic, U S •Care Mgmgt Co., U.S.
E Long Term Condns
•HealthStore,Kenya •RapidSMS, Malawi
G •GreenStar,Pakistan •EMRI, India
O Mental Health
R
I
E Maternity & New
Born
S

O Care for Children
Production Specialisation
F •Arvind Eye, India
•LifeSpring, India
Acute Care •Narayana Hridyalaya, India
C
A
Integrated Care
R •Valencia, Spain
Planned Care
E •Kaiser Permanente,U.S.

Monitoring / Diagnosing Preparing/ Recovering Monitering/
Preventing Intervening Managing

CARE DELIVERY VALUE CHAIN

Six factors characterize these solutions, with
each doing some or all of the following:

2. Get close to the patient and follow established behaviour patterns: E.g., Aravind
has engaged in out-reach strategies – taking care straight to the villages

4. Reinvent the delivery model by using proven technologies disruptively: E.g.,
MinuteClinic’s IT platforms under-pinning clinical procedures and decision
making

6. Confront professional assumptions and right skill the workforce: E.g., The use of
community health workers at HealthStores reduces expenditure

8. Standardise operating procedures wherever possible: E.g., Aravind, HealthStores,
MinuteClinic and PSI have all standardised their procedures

10. Borrow someone else’s assets: E.g., HealthStores relies on already established
sites to base their micro-clinics

12. Open new revenue streams across sectors: E.g., PSI has shown its possible to
cross sector boundaries to create new market opportunities in franchising

Closer Home – in INDIA

India’s challenges with respect to availability of healthcare are
multi-fold

In INDIA
Some efforts are being made by both public and private players to address these issues :

• The government’s NATIONAL RURAL HEALTH MISSION program aimed at making
infrastructure and resources available and functional.

• FOCUSED EDUCATIONAL PROGRAMMES such as Bachelor of Rural Healthcare and Rural
MBBS are also on the anvil

• EMERGENCY AND REFERRAL TRANSPORT INITIATIVES such as EMRI, 108 and Janani express

• STREAMLINING PROCUREMENT OF DRUGS AND CONSUMABLES to improve availability at all
public healthcare facilities

• USE OF MEDICAL MOBILE UNITS, e.g., the ‘Akha Boat’ initiative in Assam that provides basic
healthcare services through mobile boats to the remote riverine islands of Assam

• PUBLIC-PRIVATE PARTNERSHIPS for operating healthcare infrastructure and medical
equipment

• SET UP OF TERTIARY CARE CORPORATE HOSPITALS IN TIER II AND III CITIES and use of
telemedicine by private players to reach a larger section of the country

Inclusive Healthcare

A A
V F
A O
I R Q
L D U
A A A
B B L
I I I
L L T
I I Y
T T
Y Y

Long Term & Sustainable Solutions

“In healthcare you don’t do one big thing and reduce
the price but have to do 1000 small things” – Dr. Devi
Shetty Chairman, Narayana Hrudayalaya

Healthcare Delivery - Stakeholders

Healthcare Delivery – Newer Models

Short Stay Surgeries take anywhere between
24 - 72 hours from admission to patient
discharge and may include Day Care Surgeries
in which the patient is discharged within a day

Advantages

Apart from cost containment, other benefits
of out patients surgery are :
• Decompression of busy hospital beds
• Less nosocomial infections
• Early recovery in home environment with the family.
Thus, there is less disruption of personal lives
• Acceptance of day care surgeries by insurance
companies has resulted in a win-win situation for all

Merrygold Health Network is an innovative
Social Franchising Program in India providing
essential health care services to the poorer
sections in the society. The program is being
implemented through a Public Private
Partnership (PPP)

The Ministry of Health and Family Welfare (MOHFW),
Government of India, through its National Rural
Health Mission (NRHM) has introduced the rapid
home pregnancy test kits (Nishchay)

THE NISHCHAY PROGRAM
is not a program for the promotion of the pregnancy test kit
alone, but is an entry point to RCH and family planning
services for women seeking quality and assured RCH and FP
services.
Important key issues addressed by Nishchay are:
 Low percent of women starting ANC in first trimester due to late
detection
 Contraceptive Provisioning (IUD/Pill) not started after ruling out
pregnancy
 High unsafe abortions due to late detection of pregnancy

IV. SINGLE SPECIALTY HOSPITALS

Single Specialty Hospitals - Advantages

• Cost efficiency due to higher volume
• Provide higher quality care due to
greater specialization
• Easily attract human resource
• Economies of scale and scope
• Ease of operation
• Increase consumer satisfaction
• Competitive pricing and increased
choice for consumer

Examples : Medfort Hospitals, Center
for Sight, Aravind Eye Care, Aster
Vision, Renkare (dialysis centers)

V. END OF LIFE CARE CENTERS
In medicine, end-of-life care refers to medical care not only of
patients in the final hours or days of their lives, but more broadly,
medical care of all those with a terminal illness or terminal
condition that has become advanced, progressive and incurable.

Therefore, end of life care centres have three objectives:
• To reduce the agony and burden of prolonged dying process
• To develop mental peace at the time of death
• To establish ethical principles supporting death in the Indian hospitals

Innovative healthcare delivery_models-atul behll

Innovative healthcare delivery_models-atul behll

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