By E. Kumar Sharma
Chinagari krishna, 36, a driver in a private company inHyderabad, was recently treated at Care Hospital for a stone in hiskidney. A procedure that uses shock waves to break a kidney stoneinto small pieces that can easily pass out from the body in normalcourse was applied on him. Krishna was sent home the same day and inhis doctor's words, "He will be street-fit in the next 48 hours."For the hospital, it was yet another day-care surgery (10-15 percent of its surgeries are day-care cases). But to patients likeKrishna, it means not just being able to get back home quickly butalso a cheaper option--30 to 40 per cent cheaper than thetraditional hospitalisation option. Moreover, the non-invasiveprocedure allows him to recover and return to work in no time.
Around the same time, in the neonatal intensive care unit ofRainbow Hospital, situated barely a kilometre from Care Hospital,three newborn babies got a fresh lease of life thanks to a modelthat focusses on specialisation. The three were treated forcongenital diaphragmatic hernia, a condition where organs likeintestines, liver and kidney are present in the chest region. Thehospital, almost at the same time, saved another baby that was bornso prematurely that it could not properly breathe by itself becauseof its immature lungs, a condition called 'hyline membrane disease'or respiratory distress syndrome.
Different Formats
The two instances, in a sense, represent models at the two endsof the healthcare delivery spectrum in India. One is a super-speciality with a format for quick surgery, treatment and recovery(Care, in fact, has built its reputation on cardiac care and itsfounder Dr B. Somaraju and former Indian president A.P.J. AbdulKalam were the first to have indigenously developed a coronary stent--Kalam-Raju stent that is used in some conditions to removeblockages in heart vessels). The other is engaged in child care witha focus on salvaging sick babies. "We get about 6,000 admissionsevery year and about 40 per cent require intensive care and sub-speciality treatment," says Dr Ramesh Kancharla, who founded Rainbowin 1999 in Hyderabad. It started with a 50-bed facility with 10 inNICU and is today a 150-bed facility with 40 NICU beds. Also, one inevery eight cases that it gets now comes from outside Andhra.
Says Vishal Bali, CEO of Wockhardt Hospitals: "India is currentlygoing through a maturing of its healthcare delivery system with thegrowth and emergence of corporate hospitals across the country.While this growth has been fuelled by the rising consumer spend onhealthcare, the foundation of this change is the growing consumerexpectation for innovative and quality healthcare services.Providing synergy to these changes is the growth of health insuranceand third-party payment mechanisms, which is giving consumers theaccessibility and affordability of high-end care."
Technology has been a key factor. The world-famous L.V. PrasadEye Institute in Hyderabad, for instance, is the only one to haveperfected a method in India (and one of the few in the world) thatuses stem cells for corneal reconstruction to restore eyesight. Ithas treated over 500 such cases in the last five years, the highestnumber by any single institute so far in the world. "Every day, weget about 700 patients in all and we do about 80 surgeries, and 40per cent are from outside Andhra," says institute's chairman DrGullapalli N. Rao, who is also president of the International Agencyfor Prevention of Blindness, a WHO partner in blindness prevention.The institute now expends most of its resources on critical caresuch as corneal transplant, ophthalmic plastic surgery, care oftumours, cancers of the eye, etc. It charges the rich heavily byproviding them with a luxurious ambience in order to defray the costof nearly half of all surgeries that are done gratis.
Nearby, the Apollo Health City is trying out all sorts of formatsin the emerging healthcare space. "Apollo is very clear that it willdo formats outside of the hospital," says Sangita Reddy, ExecutiveDirector (Operations), Apollo Hospitals Group. Apollo Clinics, 57 ofthem at present with plans to grow to 100 by 2008 end, have emergedas efficient, clean, friendly, accessible to everyone, in-your-neighbourhood clinics. A separate ambulatory care facility is comingup for handling day-care surgeries that are currently performedwithin the hospital. Reddy informs that of the 1,000 to 1,200surgeries done daily at the Hyderabad hospital, 400 to 450 are inthe outpatient.
Apollo launched its upscale "boutique birthing centre" called TheCradle in Bangalore early this year, followed by a second centre inGurgaon (it has plans to have 15 to 20 outlets in the next threeyears).
Giving the rationale behind the boutique, Ratan Jalan, CEO,Apollo Health and Lifestyle Limited, says: "A lady going for thedelivery of a child is by no stretch of imagination sick. It is nota disease or an illness. Instead, it is a social event and a momentto celebrate."
Pampering the Consumer
The Cradle is a high-end model where people come and pay for theexperience. Just like Gayathri, 28, who recently delivered her childat The Cradle in Bangalore. She and her husband, R. Venkateshan, anengineer with Accenture, chose The Cradle because, as he says: "Weopted for this place mainly to undergo the experience. It's veryhomely here and of international standards." His corporate insurancetook care of the bills.
Typically, a Cesarean section delivery costs about Rs 80,000 atThe Cradle. That's not too much if you consider the facilities. Theplace hardly looks like a hospital with its bright colours, novisiting hours, a cake shop, private birthing suites, and all-in-one labour, delivery and recovery room equipped with imported Hill-Rom beds that cost around Rs 10 lakh and can perform many tasks--for instance, it has drawers fitted with infant monitors.
In the nine months of its existence, the hospital has handled 382deliveries and most mothers have returned home with their babieswithin 48 hours. "We do not see the need for a longer stay, unlessthere is some complication. Ours is a western way of recovery. Wehave 70-80 per cent occupancy and we get all kinds of people rangingfrom housewives to wives of bureaucrats and politicians and MNCprofessionals," says Dr R. Kishore Kumar, The Cradle MD, and aneonatologist.
Distance also determines the choice of hospitals. For 57-year-old Shantha, who was suffering from colitis, Wockhardt's ICCU &Community Centre in the Rajajinagar neighbourhood of Bangaloreproved a better option, as it was near her home. The 25-bedsecondary care hospital is complete with ICU facility. Since ittakes long hours in Bangalore to travel from one place to another,people prefer hospitals in their vicinity, especially if it is aknown brand.
The idea, according to Wockhardt's Bali, is "to be able to takeICCU closer to the community and be the first point of care. Therecould be a sudden heart attack, brain stroke or an acute abdominalcut and the patient needs quick and quality care in an ICUenvironment."
Another niche format is represented by La Femme of FortisHealthcare, which seeks to target the healthcare needs of women; itsstate-of-the-art facility handles cases relating to obstetrics,gynaecology, neonatalogy, general surgery, cosmetic surgery, breastsurgery, besides health checks. Last year, Fortis set up a hospitalin Delhi focussed on lifestyle diseases; it now plans to set up aSports Institute that will look at the health aspects in sports. "Wehope to have it up and running in about a year," says ShivinderSingh, CMD, Fortis Healthcare.
As Mukesh Shivdasani, Executive Director, Max Healthcare sees it,healthcare delivery will veer towards multi-speciality hospitalswith identified centres of excellence, further creation of sub-specialisations, stratification of hospitals services on account ofdifferential needs of the consumer, formal collaboration betweendifferent service providers especially within narrow geography. Max,he says, has adopted a hub-and-spoke model with a couple of centresof excellence supported by multi-speciality hospitals. At present,Max has two such centres of excellence supported by four multi-speciality hospitals in addition to two medical centres that offerconsultation, diagnostics tests, pharmacy and day- care surgery. By2012, Max plans to increase this to three centres of excellence withseven specialisations, and supported by eight to 10 multi-speciality hospitals and two to four medical clinics.
The Way Forward
As a recent Technopak study (healthcare outlook) points out:"While hospitals will continue to be the mainstay of treatment forepisodic acute care, we see a fundamental shift in the nature, modeand means of delivery." And its study of the trends abroad suggeststhat the way forward would only be in formats that range from retailhealthcare, day-care centres, assisted living formats,rehabilitation centres to even medical malls!
At the end of the day, Shivinder Singh feels, India is such adiverse market where a lot of experimentation is possible, anddifferent formats will evolve depending on which way one decides toslice the market. He is sure there will be room for all. Few canargue with him, for given India's size, any which way you slice theIndian market, you are bound to end up with millions.
Additional reporting by K. R. Balasubramanyam
BOX
Dispensing Differently
The large and diverse Indian market allows companies toexperiment and evolve newer formats with enough profitability.
Formats Major players
Clinic model with a wellness Apollo, Fortis, Nicholas
focus: One-stop healthcare Piramal (its Wellspring model
shop complete with a physician, is more into diagnostics),
a pharmacy and diagnostic Max Healthcare (evaluating
services. plans to re-enter).
Retail healthcare model: Fortis has outlets in malls
Medical care outfit in retail outlets. and is looking to expand.
Day-care surgeries/Ambulatory Apollo, Care, Wockhardt,
care model: These exist within Fortis, Max Healthcare.
hospitals or as stand-alone entities.
Specialists model: Stand-alone Rainbow, Dr Mohan's, L.V.
entities that specialise in any Prasad Eye Institute, BJ
one aspect of healthcare. Wadia Children's Hospital
Assisted living facility: Homes Apollo plans to launch four of
for senior citizens where residential these facilities soon.
care is combined with medical care.
Community-based models: ICCU Wockhardt, Nicholas Piramal,
facilities near residential areas; Fortis.
medical camps run by doctors.
Boutique healthcare model: It Apollo, Fortis, Wockhardt.
caters to high-end clients in
select segments. Some examples
are The Cradle, a boutique birthing
centre, and La Femme that addresses
women's health needs.
Rehabilitation centres: Typically Apollo, Fortis, Wockhardt,
function as a support for the Max Healthcare.
main hospital, but newer ones
are now coming up as
stand-alone units.
Telemedicine and Teleconsulting: Apollo, Care, Fortis.
Diagnosis is provided over phone,
internet or via video conferencing.
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