1..What is the Role of Public and Private Sector in Healthcare?

DEFINING "PUBLIC" AND "PRIVATE" The terms public and private, although not precise, are often used as descriptors for healthcare systems. In general, public refers to government involvement, while private may refer to involvement by businesses, charitable organizations or individuals. This categorization is illustrated in Table 1. Table 1 Categories of Public and Private Category Public Levels

Nation Province or state Region Local Corporate/for-profit Small business/entrepreneurial Charity/non-profit (paid employees or volunteers) Family/personal

Private

Source: Raisa Deber et al., The Public-Private Mix in Health Care, Striking a Balance: Health Care Systems in Canada and Elsewhere, paper commissioned by the National Forum on Health, MultiMondes, 1998, p. 433. Although Table 1 presents the public and private sectors as separate entities, the two are often closely related. For example, even when hospital services are delivered by charitable organizations (the private sector), the responsibility to do so is typically delegated by the government (the public sector). Governments frequently regulate private-sector involvement, as with the German Sickness Funds, or they may provide additional funding, as with the substantial government (public) subsidization of the U.S. health-care system, which is typically described as private.

THE ROLE OF THE PUBLIC SECTOR IN HEALTH CARE Public-sector involvement in health care dates back to 1883 when compulsory sickness insurance was introduced in Germany for some categories of workers. This established the first model of mandatory health-care insurance in the Western world. Almost all industrialized countries now have health-care systems in which there is a high level of public-sector involvement. Nonetheless, there is little consensus between economists about the precise role that the public sector should play in financing and delivering health care. Some of the arguments for public-sector involvement in health care include social justice, restriction of monopolies, redistribution and public goods.(3) These arguments may overlap. The social justice argument applies to situations in which the provision of health services to one person is advantageous for other members of society. For example, the treatment of an infectious disease provides a broad societal benefit. From a social standpoint, public-sector delivery of these types of health services may be preferred to private-sector delivery because when the price of a service is determined privately, it may not incorporate the positive external social benefits of delivering it. As a result, the price may be higher when it is determined privately. If the price exceeds what people can afford, or are willing, to pay, they will forego the treatment. This may have undesirable social consequences. For example, an infectious disease may spread to a broad segment of society. The second argument is that government involvement in health care prevents health-care providers from exercising a monopoly. In a health-care monopoly, the medical profession is able to control access to training or impose restrictions on medical substitutes. This can restrict the availability of services. The redistribution argument asserts that public-sector involvement permits the redistribution of funds from people who are in good health to people who are in poor health. Individuals are not equally afflicted with health problems. People with unhealthy lifestyles or dangerous jobs, for example, have a higher risk of developing health problems. In a private insurance system, these people would pay a higher premium, but in a public insurance system, the risks are pooled and everyone pays the same premium, regardless of the risk for filing a claim. In the public model, insurance must be mandatory, otherwise those at low risk would almost certainly opt out. In the private model, insurance is voluntary and insurers may choose who they wish to insure. In some cases, people in poor health may have difficulty finding an insurer who is willing to cover them. Figure 1 depicts the health-care funding, risk pooling, and insurance coverage patterns in selected countries. The public goods argument in favour of public-sector involvement in health care suggests that health care is a public good in the sense that it cannot be managed by market mechanisms because it is impossible to exclude people who have not paid from consuming it.(4) Clean air and military defence are two other examples of public goods. There is a consensus that governments have a legitimate economic role and responsibility to fund and deliver public goods.

Figure 1 Funding, Risk Pooling and Insurance Coverage

Source: World Health Organization, The World Health Report 1999, WHO, 1999, p. 41. In recent years, concerns about cost containment, quality, and accessibility to health services have prompted calls for health-care reform in many countries. As a means of addressing these concerns, public-sector involvement in health care has decreased, permitting increased involvement by the private sector in health care in many countries. Proponents argue that private-sector involvement in health-care systems encourages greater efficiency, innovation, consumer choice, and client responsiveness.(5) However, Deber et al. argue: Most reasons advanced in favour of allowing competing insurers or financers appear to be based on ideology rather than evidence. The primary justification is usually based on the assumptions that markets promote efficiency and that competition is more responsive to innovation and patient choice. There is good justification for these arguments when speaking of delivery, but none when speaking of financing.(6) Other critics argue that greater private-sector involvement will lead to inequities in access and eroded standards of care.(7) THE ORGANIZATION OF HEALTH-CARE SYSTEMS In its simplest form, a health-care system contains two components: financing and delivery. Financing refers to the generation of funds to pay for health services, while delivery refers to the provision of health services. Financing and delivery can be carried out in the public sector, the private sector, or both. As such, a variety of financing and delivery options are

available. Table 2 illustrates the possible combinations for public- and private-sector involvement in financing and delivering health care, drawing on examples from the OECD countries. A more detailed discussion of these options follows. The precise organization of a health-care system is much more complex than Table 2 implies. Most countries use a mix of financing and delivery options from both the public and the private sector, although the private-sector component is typically small. As Deber et al. point out, Virtually every country employs some combination of financing and delivery models, relying on various public-private combinations in various sectors of the health-care system or for various groups of the nations population.(8) Moreover, health-care systems are dynamic; changing needs, new policy directions, and medical developments may all necessitate health-care reform. As a result, it is quite difficult to place health-care systems into static compartments. Table 2 Private- and Public-Sector Involvement in Health Care DELIVERY

Public Insurance and service delivery are handled by a single public agency. Norway, Sweden, Denmark, Finland

Public

FINANCING

Private The public pays for services through taxes or social security and the services are provided by private agencies (commercial or non-profit). Canada, Japan, Germany, France, United Kingdom Health care is funded by private insurance or paid for directly by the patient and is provided in private facilities. United States

Private

The cost is charged directly to users (through insurance or out-ofpocket payments) but services are provided in public facilities. To our knowledge, no good examples of this system exist.

Q.2

Explain the concept of Indian Medical Tourism

The concept of medical tourism is not a new one. The first recorded instance of medical tourism dates back thousands of years to when Greek pilgrims traveled from all over the Mediterranean

to the small territory in the Saronic Gulf called Epidauria. This territory was the sanctuary of the healing god Asklepios. Epidauria became the original travel destination for medical tourism. Spa towns and sanitariums may be considered an early form of medical tourism. In eighteenth century England, for example, patients visited spas because they were places with supposedly health-giving mineral waters, treating diseases from gout to liver disorders and bronchitis.[3]

Medical tourism (also called medical travel, health tourism or global healthcare) is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of travelling across international borders to obtain health care. It also refers pejoratively to the practice of healthcare providers travelling internationally to deliver healthcare.[1][2] Services typically sought by travelers include elective procedures as well as complex specialized surgeries such as joint replacement (knee/hip), cardiac surgery, dental surgery, and cosmetic surgeries. However, virtually every type of health care, including psychiatry, alternative treatments, convalescent care and even burial services are available. Over 50 countries have identified medical tourism as a national industry.[3] However, accreditation and other measures of quality vary widely across the globe, and some destinations may become hazardous or even dangerous for medical tourists. In the context of global health, "medical tourism" is a pejorative because during such trips health care providers often practice outside of their areas of expertise or hold different (i.e., lower) standards of care.[4][5] Greater numbers than ever before of student volunteers, health professions trainees, and researchers from resource-rich countries are working temporarily and anticipating future work in resource-starved areas.[5][6] This emphasizes the importance of understanding this other definition. OR What is Medical Tourism? It is the term used to describe the situation of patients travelling across international borders to obtain health care. Medical tourism is also called health tourism or medical travel or global health care. Why people are travelling as medical tourists? There are many reasons for patients to travel across the globe to get medical treatment like Americans travel due to high medical cost in their homeland, while Canadians travel to get rid off their long medical waiting time, since their average medical waiting time is 9.4 weeks to get their treatment done. The English patients travel to other places because they cant wait for treatment by the National Health Service or cant afford to see a physician in private practice, for

others either they want to combine their vocation and treatment together or non availability of healthcare service in their home country like in Maldives or Bangladesh. Many countries like India, Singapore, South Africa, Malaysia, Thailand, Sri Lanka, etc., are actively promoting medical tourism. Medical Tourism in India India is considered the leading country promoting medical tourism and Indias National Health Policy declares that treatment of foreign patients is legally an "export" and deemed "eligible for all fiscal incentives extended to export earnings. Super specialty hospitals played a pivotal role in the success of Medical tourism in India. Almost every hospital in India has NRI (non resident Indian) patients and even patients of foreign countries. High cost of treatment in the developed countries like USA and UK, has been forcing patient from such countries to look for alternative and cost-effective destinations to get their treatments done. Virtually every type of treatment is available in India for lower cost and shorter rehabilitation period. According to the research done by the University of Delaware, the cost of surgery done in India can be one-tenth or sometimes even less than that of what is it in the USA or western Europe. For example, a heart-valve replacement that would cost $200,000 or more in US, goes for $10,000 in India. Q.4 What are the Legal Issues for Hospital Administrators

Biomedical Waste Management: An Infrastructural Survey of Hospitals

Biomedical waste consists of solids, liquids, sharps, and laboratory waste that are potentially infectious or dangerous and are considered biowaste. It must be properly managed to protect the general public, specifically healthcare and sanitation workers who are regularly exposed to biomedical waste as an occupational hazard. Biomedical waste differs from other types of hazardous waste, such as industrial waste, in that it comes from biological sources or is used in the diagnosis, prevention, or treatment of diseases. Common producers of biomedical waste include hospitals, health clinics, nursing homes, medical research laboratories, offices of physicians, dentists, and veterinarians, home health care, and funeral homes.

Components
The following is a list of materials that are generally considered biomedical waste:
Solids

Catheters and tubes[1] Disposable gowns, masks,[1] and scrubs Disposable tools, such as some scalpels and surgical staplers Medical gloves[1][2] Surgical sutures and staples Wound dressings[1]

Liquids

Blood[1][2] Body fluids and tissues[1][2] Cell, organ,[1] and tissue[1] cultures

Sharps

Blades, such as razor or scalpel blades[1][2] Lancets[1][3] Materials made of glass, such as cuvettes and slides[1][2] Metal stylets Needles[1][2] Plastic pipettes and tips[1][2] Syringes[2]

Laboratory waste

Animal carcasses[1][2] Hazardous chemicals with biological components[2] Media[2] Medicinal plants Radioactive material with biological components[2] Supernatants[2] Syringes

Biomedical Waste Management

Sorting of medical wastes in hospital.At the site where it is generated, biomedical waste is placed in specially-labelled bags and containers for removal by biomedical waste transporters. Other forms of waste should not be mixed with biomedical waste as different rules apply to the treatment of different types of waste.

Household biomedical waste usually consists of needles and syringes from drugs administered at home (such as insulin), soiled wound dressings, disposable gloves, and bedsheets or other cloths that have come into contact with bodily fluids.[3] Disposing of these materials with regular household garbage puts waste collectors at risk for injury and infection especially from sharps as they can easily puncture a standard household garbage bag. Many communities have programs in place for the disposal of household biomedical waste. Some waste treatment facilities also have mail-in disposal programs. Biomedical waste treatment facilities are licensed by the local governing body which maintains laws regarding the operation of these facilities. The laws ensure that the general public is protected from contamination of air, soil,groundwater, or municipal water supply. One company, BioMedical Technology Solutions, Inc., offers a green alternative to haul-away services for disposal of biomedical waste. The Company's desktop unit, the Demolizer II, is the only patented, portable, and self-contained system able to process both sharps and typical red bag biomedical waste onsite. Upon processing the biomedical waste in the unit, all regulatory paperwork is printed from the system and the waste is able to be disposed of as common trash.

Protection from Biomedical Waste

Wash your hands with soap and warm water after handling biomedical waste. Also, wash all areas of your body with soap and water that you think may have come into contact with biomedical waste, even if you are not sure your body actually touched the biomedical waste.

Keep all sores and cuts covered. Immediately replace wet bandages with clean, dry bandages. Wear disposable latex gloves when handling biomedical waste. Discard the gloves immediately after use. Wear an apron or another type of cover to protect your clothes from contact with the waste. If your clothes become soiled, put on fresh clothes, and take a shower, if possible. Launder or throw away clothes soiled with biomedical waste. Promptly clean and disinfect soiled, hard-surfaced floors by using a germicidal or bleach solution and mopping up with paper towels. Clean soiled carpets. First blot up as much of the spill as possible with paper towels and put the soiled paper towels in a plastic lined, leak-proof container. Then try one of the following: Steam clean the carpet with an extraction method. Scrub the carpet with germicidal rug shampoo and a brush. Soak the brush used for scrubbing in a disinfectant solution and rinse the brush. Let the carpet dry, and then vacuum it. Never handle syringes, needles, or lancets with your hands. Use a towel, shovel, and/or broom and a dustpan to pick up these sharp objects. Dispose of them in a plastic soda pop bottle with a cap. Tape down the bottle cap. Then throw the bottle in the trash.

OR

Introduction

ospital is one of the complex institutions which is

frequented by people from every walk of life in the society without any distinction between age, sex, race and religion. This is over and above the normal inhabitants of hospital i.e patients and staff. All of them produce waste which is increasing in its amount and type due to advances in scientific knowledge and is creating its impact [1]. The hospital waste, in addition to the risk for patients and personnel who handle these wastes poses a threat to public health and environment [2]. Keeping in view inappropriate biomedical waste management, the Ministry of Environment and Forests notified the Biomedical Waste (management and handling) Rules, 1998 in July 1998. In accordance with these Rules (Rule 4), it is the duty of every occupier i.e a person who has the control over the institution and or its premises, to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment. The hospitals, nursing homes, clinic, dispensary, animal house, pathological lab etc., are therefore required to set in place the biological waste treatment facilities. It is however not incumbent that every institution has to have its own waste treatment facility. The rules also envisage that common facility or any other facilities can be used for waste treatment. However it is incumbent on the occupier to ensure that the waste is treated within a period of 48 hours. Biomedical Waste Management Process Handling, segregation, mutilation, disinfection, storage, transportation and final disposal are vital steps for safe and scientific management of biomedial waste in any establishment [3]. The key to minimisation and effective management of biomedical waste is segregation (separation) and identification of the waste. The most appropriate way of identifying the categories of biomedical waste is by sorting the waste into colour coded plastic bags or containers. Biomedical waste
MJAFI, Vol. 60, No. 4, 2004

380 Rao et al

incineration, autoclave, hydroclave or microwave. Cost of Biomedical Waste Management

The cost of construction, operation and maintenance of system for managing biomedical waste represents a significant part of overall budget of a hospital if the BMW handling rules 1998 have to be implemented in their true spirit. Govt of India in its pilot project for hospital waste management in Govt hospitals has estimated Rs.85 lakh as capital cost in 1000 bedded super speciality teaching hospital which includes on site final disposal of BMW. Two types of costs are required to be incurred by hospitals for BMW mgt, internal and external. Internal cost is the cost for segregation, mutilation, disinfection, internal storage and transportation including hidden cost of protective equipment. External cost involves off site transport of waste, treatment and final disposal [5]. Recommendations 1. After analysing the results of the study it was felt that there is an urgent need to standardise the infrastructural requirement so that hospitals following BMW handling rules meticulously do not suffer additional costs. 2. Hospitals having defunct / defective incinerators should be made to utilise central incineration facility as efforts of Govt are towards reducing the number of incinerators in cities to prevent rise in air pollution. 3. Small health care establishments in city which have still not registered with central facility should be encouraged to register thereby bringing down the operating cost of contractor and decrease the cost of incineration per kg. 4. Govt hospitals which at present are totally left on their own, should be brought into net of rigorous checking as far as BMW management is concerned and a corpus grant can be allotted to them to improve their infrastructural requirements for which provision exists in Govt of India Rules. 5. Community is utilising the services of hospitals and by Polluter Pays principle, it needs to contribute in building infrastructure for BMW mgt. This contribution can be in the form of assistance in sharing the cost of consumables and capital cost of BMW mgt by Municipality, State Govt, Public bodies and Voluntary bodies like Rotary Club etc.
28250 32800 36500

Q.4

What are the Legal Issues for Hospital Administrators

Definition

Hospital administration is a phrase used to describe those professionals who choose to be a part of upper management in organized hospitals.
Hospital administrators spend a significant amount of time addressing legal issues including contracts, partnerships, joint ventures, joint operating agreements, group purchasing, and management contracts. There are multiple skills needed for effective hospital administration. Knowledge of basic leadership skills and organizational management is required along with an understanding of organizational culture, i.e., the unwritten rules that determine how an organization operates as a separate system. The hospital administrator provides leadership and strategic directions within the organization to insure continuity and targeted growth over time. People-skills is a phrase used to describe someone who interacts positively with others at all levels. Administrators use people-skills along with an effective communication style to deal with issues in human resources, negotiation, and conflict resolution. Ability to interact positively with the Board of Directors/Trustees, the varied specialty physician groups, allied health care providers, paid staff in general, and the public is essential. Intermixed with the above skills, an administrator uses marketing expertise to ensure that the organization is meeting its market share in providing care. Administrators often interact with patients and families to determine if the organization is meeting patient/family expectations. Also, the administrator must be concerned with maintaining a positive image for the organization and must be able to maintain effective public relations within the community.

Q.5

Explain the Marketing of Hospital services

Hospital marketing is a specialized field that deals with connecting patients, physicians, and hospitals in mutual relationships.
HOSPITAL MARKETING MIX PRODUCT A product is a set of attributes assembled in an identifiable form. The product is the central component of any marketing mix. The product component of the marketing mix deals with a variety of issues relating to development, presentation and management of the product which is to be offered to the market place. It covers issues such as service package, core services and peripherals, managing service offering and developing service offering. Hospitals today offer the following services: 1. Emergency services Emergency services and care at most of the hospitals is unique and advanced. The hospitals have state-of-the-art ambulances. The CCU's on Wheels under supervision by medical and para-medical staff. There is hi-tech telecommunication available to a patient in an emergency at any given time. 2. Ambulance services Hi-tech ambulances linked by state-of-the-art telecommunications are fully equipped with doctors that are available to render medical

attention and assistance in case of emergencies at the patient's doorstep. 3. Diagnostic services Modern Hospitals are multi-speiality and multi-disciplinary, that can handle any kind of ailment, they offer a wide range of facilities for instance, Oncology, Orthopedics, Neurology, Plastic surgery and so on. 4. Pharmacy services Most of the hospitals also have a pharmacy which is open 24 hours. It caters to the needs not only of the inpatients and outpatients, but also patients from other hospitals who require emergency drugs. 5. Causality services Causality service includes a 24 hrs. causality department, which attends to the accident or emergency cases. Apart from the above mentioned services, hospital also offers "Health Diagnosis Programme" which is a complete, comprehensive, periodic health check up offered for busy executives, professionals, business persons and so on. The health diagnosis programme comprises of the following: 1. Master health check up 2. Executive Health check up 3. Diabetics health check ups etc., Generally, the service offering in a hospital comprises of the following levels: 1. Core level it comprises of the basic treatment facilities and services offered by the hospital like diagnostic services, emergency services, casuality services etc. 2. Expected level it comprises of cleanliness and hygiene levels maintained in the hospital. 3. Augmented level it comprises of dress code for staff, air conditioning of the hospital, use of state of art technology, services of renowned consultants.

Or
NOW YOU MUST PROFILE THE MARKET SEGMENT BY CUSTOMERS Market needs should be interpreted very broadly, in terms far broader than only product characteristics. Customers and prospects may differ also in their needs for information, re-assurance, technical support, service, distribution, and a host of other benefits that are part of their purchase.

1. MARKET SIZE FOR EACH PRODUCT It is difficult to see how marketing can be properly planned unless the relationship of the company's product sales to the total market sales is known.

2.

COMPETITIVE STRUCTURE FOR EACH PRODUCT

The competitive structure also effects the opportunity to force a change in market structure, this information is vital. 3. MARKET TRENDS FOR EACH PRODUCT This is the most important of all information, which is needed to assess the opportunities for increased profits. There are three critical areas to review:

(A) MARKET TREND: 1.IS THE MARKET GROWING RAPIDLY? This should provide the change for good profits on growing sales.

2.IS THE MARKET STATIC? This is often highly competitive, with corresponding low profit margins.

3.IS THE MARKET DECLINING? This, again, is often highly competitive, with correspondingly low profit margins, is not only due to competition but also due to higher overheads on a smaller volume. (B) PRODUCT SERVICE VOLUME TREND:

1. IS THE SERVICE VOLUME AT THE DEVELOPMENT STAGE? Accelerate the sales, exploit this stage and increase the profit level.

2.IS THE SALES VOLUME AT THE GROWTH STAGE?

Stretch this stage of the product cycle through proper promotions.

3.IS THE SALES VOLUME AT THE MATURITY LEVEL? Stretch this stage by innovation of the product or extending into a new market. 4.IS THIS SERVICE VOLUME AT THE DECLINING LEVEL? This stage needs complete rethinking - product, market, channel and sales operation.

(C) PRODUCT UNIT PROFIT TREND Unit contribution trend has different structure. It normally peaks-out before the end of the "growth" stage of the product life cycle and then drops rapidly. This "change point" in the curve is the most important point of the life cycle to identify.

Q.6

Describe about role Hospital Administrators in legal matters

Role of hospital administrators in legal matters Though all hospital administrators are not qualified legal persons yet they are supposed to possess sufficient knowledge of the Indian Laws to be able to take decisions on legal matters. For example, if he wants to terminate a contract with the contractor who is building a particular portion of the hospital building he needs to have knowledge of the Nigerian Contract Act. Similarly, if he wants to terminate services of an employee, he should know the provisions of the Industrial Employment Standing Orders Act, the Industrial Disputes Act and the principles of natural justice. No doubt he is briefed by the law officer of his hospital before he takes decision on any legal matter, but he is still required to have some knowledge of the laws. Secondly, all hospitals cannot afford

to engage full time law officers or retain part time legal advisors. It is the hospital administrator who keeps the reign of legal kingdom in his hand in small and medium size hospitals and decides all matters rightly or wrongly on the basis of his knowledge and common sense. Thirdly, the hospitals are no longer immune to legal suits due to reinduction of the Industrial Disputes Act, 1947 and application of the Consumer Protection Act, 1986. These acts have made employees as well as patients more conscious about their rights and privileges and they expect better working conditions and services from the hospital administrator. Thus the hospital administrator has crucial role to play in legal matters these days. CEOs vision to improve hospital services What does a hospital employee want from his job? Money, security and career development can be high on the list for most of them, but Mike Rudd, Logistics Director at Bulmers, says that what really motivates employees is sharing the CEOs vision. Though it sounds odd, with the new world of independent and short stay of personnel, it is true. The CEO should communicate his vision about the hospitals as well as involve the employees at every step. They should be invited to give their views and discuss how they would work towards the vision. It would be easy to say that such as activity is nothing more than a paper exercise, but it can be very productive and useful because each individuals job contributes towards achieving the vision. The process should entail remaining firmly focused on the CEOs vision in conversations and meetings. Thus, one can defuse difficult situations very quickly by understanding where the personnel are, why they are there and where they need to go next so that everyone in the hospital begins to work in a

better way and the vision of the CEO becomes the vision of each and every employee of the hospital. The focus should be on people first and always on caring rather than managing. The following approach works in good as well as bad times: 1. Share the vision with high and low personnel leaving no place for suspicion. 2. Share even confidential information, personal hopes and fears to create a common vision and promote trust. 3. Seize every opportunity such as open doors, management by walking around, networks etc. to make a point, emphasize values, disseminate information, share your experience, express interest and show your care and concern. 4. Recognize performance and contribution of your personnel. 5. Use incentive programmes whose main objective is not compensation but recognition.

Q.7

Write about the Classification of hospitals

CLASSIFICATION OF HOSPITALS AND OTHER HEALTH FACILITIES 1. Government or Private 1.1. Government operated and maintained partially or wholly by the national, provincial, city or municipal government, or other political unit; or by any department, division, board or agency thereof. 1.2. Private privately owned, established and operated with funds through donation, principal, investment, or other means, by any individual, corporation, association, or organization. 2. General or Special 2.1. General provides services for all types of deformity, disease, illness or injury.

2.2. Special primarily engaged in the provision of specific clinical care and management. A primary care hospital, secondary care hospital, tertiary care hospital, or infirmary, may provide special clinical service(s). 3. Service Capability 3.1. Primary Care Hospital 3.1.1. Non-departmentalized hospital that provides clinical care and management on the prevalent diseases in the locality 3.1.2. Clinical services include general medicine, pediatrics, obstetrics and gynecology, surgery and anesthesia 3.1.3. Provides appropriate administrative and ancillary services (clinical laboratory, radiology, pharmacy) 3.1.4. Provides nursing care for patients who require intermediate, moderate and partial category of supervised care for 24 hours or longer 3.2. Secondary Care Hospital 3.2.1. Departmentalized hospital that provides clinical care and management on the prevalent diseases in the locality, as well as particular forms of treatment, surgical procedure and intensive care 3.2.2. Clinical services provided in the Primary Care Hospital, as well as specialty clinical care 3.2.3. Provides appropriate administrative and ancillary services (clinical laboratory, radiology, pharmacy) 3.2.4. Nursing care provided in the Primary Care Hospital, as well as total and intensive skilled care 3.3. Tertiary Care Hospital 3.3.1. Teaching and training hospital that provides clinical care and management on the prevalent diseases in the locality, as well as specialized and sub-specialized forms of treatment, surgical procedure and intensive care 3.3.2. Clinical services provided in the Secondary Care Hospital, as well as sub-specialty clinical care 3.3.3. Provides appropriate administrative and ancillary services (clinical laboratory, radiology, pharmacy) 3.3.4. Nursing care provided in the Secondary Care Hospital, as well as continuous and highly specialized critical care 3.4. Infirmary a health facility that provides emergency treatment and care to the sick and injured, as well as clinical care and management to mothers and newborn babies. 3.5. Birthing Home a health facility that provides maternity service on pre-natal and post-natal care, normal spontaneous delivery, and care of newborn babies. 3.6. Acute-Chronic Psychiatric Care Facility a health facility that provides medical service, nursing care, pharmacological treatment and psychosocial intervention for mentally ill patients. 3.7. Custodial Psychiatric Care Facility a health facility that provides long-term care, including basic human services such as food and shelter, to chronic mentally ill patients.

Q.8

Describe the Health Committees recommendations

2 A.

C. Beal, M. M. Doty, S. E. Hernandez, K. K. Shea, and K. Davis, Closing the Divide: How Medical Homes Promote Equity in Health Care: Results From The Commonwealth Fund 2006 Health Care Quality Survey (New York: The Commonwealth Fund, June 2007).

Recommendation 1: Promote population-based approaches The Health Equities Committee recommends an on-going, substantial investment in public health activities that will prevent disease and promote the health of Oregonians. Culturally-specific approaches to disease prevention and health promotion must be part of this investment. Recommendation 2: Strengthen the relationship between health-focused Community-Based Organizations and the health care delivery system. The Health Equities Committee recommends designing a contracting mechanism that will empower primary care clinics who primarily serve vulnerable populations to build financial agreements with health-focused community-based organizations that provide culturally-specific health promotion and disease management services. Recognizing that not every organization providing an integrated health home is focused on serving vulnerable populations, an alternative to renewable contracts should exist that will enable a provider to purchase community-based and/or culturally-specific services. The Health Equities Committee recommends that high-value community-based health promotion, disease prevention, and chronic disease management services be eligible for direct reimbursement. Accountable Health Plans must reimburse a broader range of health professionals including, but not limited to, Community Health Workers, and a broader range of services including, but not limited to, peer-led disease management support groups in culturally-specific programs to maximize the health and function of individuals, families, and communities. Recommendation 3: Develop programs to incentivize healthy personal decision-making HEALTH EQUITIES COMMITTEE FINAL REPORT 9

The Health Equities Committee recommends that the state create a Wellness Account for individuals participating in the Oregon Health Fund program who receive a subsidy. The state would deposit money in the Wellness Account based on completion of wellness activities. Monies accrued in the account could be used towards program cost-sharing expenses such as premiums and co-pays, or towards non-covered wellness activities, such as gym memberships or yoga classes. Financial incentives would encourage individuals to engage in activities that promote health, such as participating in a smoking-cessation program, getting recommended tests and procedures, and chronic disease management activities. The Wellness Account is modeled after Enhanced Benefit Accounts (EBAs) that are currently being implemented in several state Medicaid programs.

Q.10 Explain Patient and CPA, 1986,

THE CONSUMER PROTECTION ACT, 1986

(68 of 1986) [24th December, 198"6) An Act to provide for better protection of the interests of consumers and for that purpose to make provision for the establishment of consumer councils and other authorities for the settlement of consumers' disputes and for matters connected therewith. BE it enacted by Parliament in the Thirty-seventh Year of the Republic of India as follows:CHAPTER I PRELIMINARY 1. Short title, extent, commencement and application.--( I) This Act may be called the Consumer Protection Act, 1986. (2) It extends to the whole of India except the State of Jammu and Kashmir. (3) It shall come into force on such date I as the Central Government may, by notification, appoint and different dates may be appointed for different States and for different provisions of this Act. (4) Save as otherwise expressly provided by the Central Government by notification, this Act shall apply to all goods and services. 2. Definitions.--(I) In this Act, unless the context otherwise requires,2[(a)"appropriate laboratory" means a laboratory or organisation(i) recognised by the Central Government;

(ii) recognised by a State Government, subject to such guidelines as may be prescribed by the Central Government in this behalf; or (iii) any such laboratory or organisation established by or under any law for the time being in force, which is maintained, financed or aided by the Central Government or a State Government for carrying out analysis or test of any goods with a view to determining whether such goods suffer from any defect; ] 3[(aa) "branch office" means(i) any establishment described as a branch by the opposite party; or (ii) any establishment carrying on either the same or substantially the same activity as that carried on by the head office of the establishment;] __________________
1. The provisions of Chapters I, II and IV of this Act have come into force in the whole of India except the State of Jammu and Kashmir on 15-4-1987: vide Notification No. S.O. 390 (E), dated 15th April, 1987, published in the Gazette of India, 1987, Extra., Pt. II, Sec. 3 (ii). The provisions of Chapter III of this Act have come into force in the whole of India except the State of Jammu and Kashmir on 1-7-1987: vide Notification, No. S.O. 568(E), dated 10th June, 1987, published in the Gazette of India, 1987, Extra., Pt. II, Sec. 3(ii). 2. .Subs. by Act 50 of 1993, sec. 2 (w.e.f. 18-6-1993). 3. .Ins. by Act 50 of 1993, sec. 2 (w.e.f. 18-6-1993). 3

(b) "complainant" means(i) a consumer; or (ii) any voluntary consumer association registered under the Companies Act,1956 (1 of 1956) or under any other law for the time being in force; or (iii) the Central Government or any State Government; . 1[(iv) one or more consumers, where there are numerous consumers having the same interest;] (v) in case of death of a consumer, his legal heir or representative ;) who or which makes a complaint; (c) "complaint" means any allegation in writing made by a complainant that2[(i) an unfair trade practice or a restrictive trade practice has been adopted by (any trader or service provider ;] (ii) 2[the goods bought by him or agreed to be bought by him] suffer from one or more defects; (iii)2[the services hired or availed of or agreed to be hired or availed of by him] suffer from deficiency in any respect; (iv) a trader or the service provider, as the case may be, has charged for the goods or for the services mentioned in the complaint, a price in excess of the price(a) Fixed by or under any law for the time being in force; (b) displayed on the goods or any package containing such goods; (c) displayed on the price list exhibited by him by or under any law for the time being in force; (d) agreed between the parties;) 3[(V) goods which will be hazardous to life and safety when used, are being-offered for

sale to the public(a) in contravention of any standard relating to safety of such goods as required to be complied with, by or under any law for the time being in force; (b) if the trader could have known with due diligence that the goods so offered are unsafe to the public;) (vi) services which are hazardous or likely to be hazardous to life and safety of the public when used, are being offered by the service provider which such person could have known with due diligence to be injurious to life and safety;) with a view to obtaining any relief provided by or under this Act; . (d) "consumer" means any person who(i) buys any goods for a consideration which has been paid or promised or partly paid and partly promised, or under any system of deferred payment and includes any user of such goods other than the person who buys such goods for consideration paid or promised or partly paid or partly promised, or under any system of deferred payment when such use is made with the approval of such person, but does not include a person who obtains such goods for resale or for any commercial purpose; or (ii) 4[hires or avails of] any services for a consideration which has been paid or promised or partly paid and partly promised, or under any system of deferred payment and includes any beneficiary of such services other than the person who 4[hires or avails of] the services for consideration paid or promised, or partly paid and partly promised, or under any system of deferred payment, _________________
1. Ins.byAct50ofI993,sec.2(w.e.f.18-6-1993). 2. Subs. by Act 50 of 1993, sec. 2 (w.e.f. 18-6-1993). 3. Ins. by Act 50 of 1993, sec. 2 (w.e.f. 18-6-1993). ,,! 4. Subs. by Act 50 of 1993, sec. 2 (w.e.f. 18-6-1993). ~., S

when such services are availed of with the approval of the first mentioned person; (but does not include a person who avails of such services of any commercial purpose;) 1[Explanation.-For the purposes of sub-clause (i), "commercial purpose" does not include use by a consumer of goods bought and used by him exclusively for the purpose of earning his livelihood, by means of self-employment;] (e) "consumer dispute" means a dispute where the person against whom a complaint has been made, denies or disputes the allegations contained in the complaint; (f) "defect" means any fault, imperfection or shortcoming in the quality, quantity, potency, purity or standard which is required to be maintained by or under any law for the time being in force or 2[under any contract, express or implied or] as is claimed by the trader in any manner whatsoever in relation to any goods;

(g) "deficiency" means any fault, imperfection, shortcoming or inadequacy in the quality, nature and manner of performance which is required to be maintained by or under any law for the time being in force or has been undertaken to be performed by a person in pursuance of a contract or otherwise in relation to any service; (h) "District Forum" means a Consumer Disputes Redressal Forum established under clause (a) of section 9; (i) "goods" means goods as defined in the Sale of Goods Act, 1930; (3 of 1930); (j) "manufacturer" means a person who-(i) makes or manufactures any goods or parts thereof; or (iii) does not make or manufacture any goods but assembles parts thereof made or manufactured by others; or (iv) puts or causes to be put his own mark on any goods made or manufactured by any other manufacturer ;) 3[(jj) "member" includes the President and a member of the National Commission or a State Commission or a District Forum, as the case may be;} (k) "National Commission" means the National Consumer Disputes Redressal Commission established under clause (c) of section 9; (1) "notification" means a notification published in the Official Gazette; (m) "person" includes,(i) a firm whether registered or not; __________________
1. Ins. by Act 50 of 1993, sec. 2 (w.e.f. 18-6-1993). 2. Ins. by Act 50 of 1993, sec. 2 (w.e.f. 18-6-1993). 3. Ins. by Act 50 of 1993, sec. 2 (w.e.f. 18-6-1993).

(ii) a Hindu undivided family; (iii) a co-operative society; (iv) every other association of persons whether registered under the Societies Registration Act, 1860 (21 of 1860) or not; (n) "prescribed" means prescribed by rules made by the State Government, or as the, case may be, by the Central Government under this Act; 1[(nn) "regulation means the regulations made by the National Commission under this Act;) (nnn) restrictive trade practice means a trade practice which tends to bring about manipulation of price or its conditions of delivery or to affect flow of supplies in the market relating to goods or services in such a manner as to impose on the consumers unjustified costs or restrictions and shall include;

(a) delay beyond the period agreed to by a trader in supply of such goods or in providing the services which has led or is likely to lead to rise in the price; (b) any trade practice which requires a consumer to buy, hire or avail of any goods or, as the case may be, services as condition precedent to buying, hiring or availing of other goods or services;) . (0) "service" means service of any description which is made available to potential (users and includes the provision of facilities in connection with banking, financing insurance, transport, processing, supply of electrical or other energy, board or lodging or both, 2[housing construction] entertainment, amusement or the purveying of news or other information, but does not include the rendering of any service free of charge or under a contract of personal service; (oo) spurious goods & services mean such goods and services which are claimed to be genuine but they are actually not so;) (p) "State Commission" means a Consumer Disputes Redressal Commission established in a State under clause (b) of section 9; (q) "trader" in relation to any goods means a person who sells or distributes any goods for sale and includes the manufacturer thereof, and where such goods are sold or distributed in package form, includes the packer thereof; 3[( r) "unfair trade practice" means a trade practice which, for the purpose of promoting the sale, use or supply of any goods or for the provision of any service, adopts any unfair method or unfair or deceptive practice including any of the following practices, namely;(1) the practice of making any statement, whether orally or in writing or by visible representation which,(i) falsely represents that the goods are of a particular standard, quality, quantity, grade, composition, style or model; (ii) falsely represents that the services are of a particular standard, quality or grade; (jii) falsely represents any re-built, second-hand, renovated, reconditioned or old goods as new goods; (iv) represents that the goods or services have sponsorship, approval, performance, characteristics, accessories, uses or benefits which such goods or services do not have; (v) represents that the seller or the supplier has a sponsorship or approval or affiliation which such seller or supplier does not have;

(vi)makes a false or misleading representation concerning the need for, or the usefulness of, any goods or services; ____________________
1. Ins. byAct50ofI993,sec. 2 (w.e.f. 18-6-1993). 2. Ins. .by Act 50 of 1993, sec. 2 (w.e.f. 18-6-1993). '..u ., 3. Subs. by Act 50 of 1993, sec. 2 (w.e.f. 18-6-1993).

(vii) gives to the public any warranty or guarantee of the performance, efficacy or length of life of a product or of any goods that is not based on an adequate or proper test thereof: Provided that where a defence is raised to the effect that such warranty or guarantee is based on adequate or proper test, the burden of proof of such defence shall lie on the person raising such defence; (viii) makes to the public a representation in a form that purports to be(i) a warranty or guarantee of a product or of any goods or services; or (ii) a promise to replace, maintain or repair an article or any part thereof or to repeat or continue a service until it has achieved a specified result, if such purported warranty or guarantee or promise is materially misleading or if there is no reasonable prospect that such warranty, guarantee or promise will be carried out; (ix) materially misleads the public concerning the price at which a product or like products or goods or services, have been or 'are, ordinarily sold or provided, and, for this purpose, a representation as to price shall be deemed to refer to the price at which the product or goods or services has or have been sold by sellers or provided by suppliers generally. in the relevant market unless it is clearly specified to be .the price at which the product has been sold or services have been provided by the person by whom or on whose behalf the representation is made; (x) gives false or misleading facts disparaging the goods, services or trade of another person. Explanation.-For the purposes of clause (1), a statement that is(a) expressed on an article offered or displayed for sale, or on its wrapper or container; or (b) expressed on anything attached to, inserted in, or accompanying, an article offered or displayed for sale, or on anything on which the article is mounted for display or sale; or (c) contained in or on anything that is sold, sent, delivered, transmitted or in any other manner whatsoever made available to a member of the public, shall be deemed to be a statement made to the public by, and only by, the person who had

caused the statement to be so expressed, made or contained; (2) permits the publication of any advertisement whether in any newspaper or otherwise, for the sale or supply at a bargain price, of goods or services that are not intended to be offered for sale or supply at the bargain price, or for a period that is, and in quantities that are, reasonable, having regard to the nature of the market in which the business is carried on, the nature and size of business, and the nature of the advertisement. Explanation.-For the purpose of clause (2), "bargaining price" means(a) a price that is stated in any advertisement to be a bargain price, by reference to an ordinary price or otherwise, or (b) a price that a person who reads, hears or sees the advertisement, would reasonably understand to be a bargain price having regard to the prices at which the product advertised or like products are ordinarily sold; (3) permits(a) the offering of gifts, prizes or other items with the intention of not providing them as offered or creating impression that something is being given or offered free of charge when it is fully or partly covered by the amount charged ,in the transaction as a whole; the conduct of any contest, lottery, game of chance or skill, for the purpose of promoting, directly or indirectly, the sale, use or supply of any product or any business interest; (3A) withholding from the participants of any scheme offering gifts, prices or other items free of charge on its closure the information about final results of the scheme. Explanation : for the purpose of this sub clause, the participants of a scheme shall be deemed to have been informed of the final results of the scheme where such results are within a reasonable time published, prominently in the same newspaper in which the scheme was originally advertised;) (4) permits the sale or supply of goods intended to be used, or are of a kind likely to be used, by consumers, knowing or having reason to believe that the goods do not comply with the standards prescribed by competent authority relating to performance, composition, contents, design, constructions, finishing or packaging as are necessary to prevent or reduce the risk of injury to the person using the goods; (5) permits the hoarding or destruction of goods, or refuses to sell the goods or to make them available for sale or to provide any service, if such hoarding or destruction or refusal raises or

tends to raise or is intended to raise, the cost of those or other similar goods or services.] (6) Manufacture of spurious goods or offering such goods for sale or adopting deceptive practices in the provision of services;) (2) Any reference in this Act to any other Act or provision thereof which is not in force in any area to which this Act applies shall be construed to have a reference to the corresponding Act or provision thereof in force in such area. Q.1 Mention the Objectives, of NATIONAL HEALTH POLICY 2002

OBJECTIVES The main objective of this policy is to achieve an acceptable standard of good health amongst the general population of the country. The approach would be to increase access to the decentralized public health system by establishing new infrastructure in deficient areas, and by upgrading the infrastructure in the existing institutions. Overriding importance would be given to ensuring a more equitable access to health services across the social and geographical expanse of the country. Emphasis will be given to increasing the aggregate public health investment through a substantially increased contribution by the Central Government. It is expected that this initiative will strengthen the capacity of the public health administration at the State level to render effective service delivery. The contribution of the private sector in providing health services would be much enhanced, particularly for the population group which can afford to pay for services. Primacy will be given to preventive and first-line curative initiatives at the primary health level through increased sectoral share of allocation. Emphasis will be laid on rational use of drugs within the allopathic system. Increased access to tried and tested systems of traditional medicine will be ensured. Within these broad objectives, NHP-2002 will endeavour to achieve the time-bound goals mentioned in Box-IV.

Box-IV: Goals to be achieved by 2000-2015 Eradic ate Polio and Yaws 2005 Eliminate Leprosy 2005 Eliminate Kala Azar 2010 Eliminate Lymphatic Filariasis 2015 Ac hieve Zero level growth of HIV/AIDS 2007 Reduc e Mortality by 50% on ac c ount of TB, Malaria and Other Vec tor and Water Borne diseases 2010 Reduc e Prevalenc e of Blindness to 0.5% 2010 Reduc e IMR to 30/ 1000 And MMR to 100/ Lakh 2010 Inc rease utilization of public health fac ilities from c urrent Level of <20 to >75% 2010 Establish an integrated system of surveillanc e, National Health Ac c ounts and Health Statistic s. 2005 Inc rease health expenditure by Government as a % of GDP from the existing 0.9 % to 2.0% 2010 Inc rease share of Central grants to Constitute at least 25% of total health spending 2010 Inc rease State Sec tor Health spending from 5.5% to 7% of the budget Further inc rease to 8%

2005 2010 Q.2

What are the Functions of hospital,

FUNCTIONS OF THE HOSPITAL Hospital administration functions can be classified into three broad categories: 1. Medical - which involves the treatment and management of patients through the staff of physicians. 2. Patient Support - which relates directly to patient care and includes nursing, dietary diagnostic, therapy, pharmacy and laboratory services. 3. Administrative - which concerns the execution of policies and directions of the hospital governing discharge of support services in the area of finance, personnel, materials and property, housekeeping, laundry, security, transport, engineering and board and the maintenance. MAJOR FUNCTIONS OF THE ADMINISTRATIVE SERVICE 1. Provide service related to accounting, billing, budget, cashiering, housekeeping, laundry, personnel, property and supply, security, transport, engineering, and maintenance; and 2. Render support services to hospital care providers, clients, other government, and private agencies, and professional groups. Q.3 Write about Hospital Ethics.

Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.

Q.4 Mention the Health Committees appointed by Government

I mentioned that there are now eight different UN committees of governmentappointed independent experts, serviced by the UN Office of the High Commissioner for Human Rights, reviewing states policies and practices across a wide range of issues. Two deserve special mention because they are key to womens and childrens health. The Child Rights Committee reviews implementation of the Convention on the Rights

of the Child that all countries in the world have signed up to (all countries bar two). And the Womens Rights Committee reviews implementation of the Convention on the Elimination of all form of Discrimination against Women that 186 countries have agreed to be bound by. Because of their subject matter - and because they are almost universally ratified we should use, and build upon, these international commitments in our work. Frankly, it would look very strange if we didnt. Of course, international independent accountability arrangements are not confined to the UN Office of the High Commissioner for Human Rights. For decades, ILO committees of independent experts have reviewed whether or not countries are complying with their obligations under a wide-range of labour-related international instruments and recommendations. The ILO understands recommendations to be agreed guidelines for national action. UNESCO also has procedures to review whether or not countries are conforming to a number of international instruments and recommendations falling within its mandate. Because one international instrument (relating to the terms and conditions of teaching staff) is relevant to both their mandates, the ILO and UNESCO have established a joint committee of twelve independent experts six appointed by the ILO and six by UNESCO to review countries conduct on this issue. UNESCO also has a joint expert group with the UN Committee on Economic, Social and Cultural Rights. In other words, here you have a UN specialised agency joining with a UN human rights treaty-body to consider the right to education. Established in 1993, the World Bank Inspection Panel consists of three independent experts who determine whether or not the Bank is complying with its own policies and procedures, which are intended to ensure that Bank-financed operations provide social and environmental benefits and avoid harm to people and the environment. UNFPA has recently established an independent External Advisory Panel to help the Executive Director and senior management ensure that they are meeting UNFPAs goals and targets. I have the honour to serve on this Panel we call ourselves critical friends of UNFPA. Of course, WHO also has independent panels of experts to assist with its work, such as the independent Technical Steering Committee that, for some years, has reviewed and advised the Department of Child and Adolescent Health and Development. Recently, in light of the H1N1 pandemic, WHO established the expert Review Committee anticipated by the International Health Regulations (2005). While the 5 WHO Framework Convention on Tobacco Control does not establish an independent review body, it is instructive for present purposes because it sets up a process whereby governments report, every few years, on implementation of their commitments under the Convention. There are numerous other diverse examples and I am not holding up any of them as models to be slavishly followed. Nonetheless, they confirm that independent expert reviews are commonplace within the United Nations. While some of these independent arrangements are designed to ensure that international agencies are effective and do as they said they would, others are designed to check whether or not governments are keeping their international commitments.

Q.5

Explain the Challenges to Hospital Administration

FIVE CHALLENGES FOR HEALTHCARE LEADERS 1. Sustaining the organization's viability and mission in the face of growing resource needs and reimbursement constraints Most healthcare organizations are faced with an aging population, growing numbers of uninsured and underinsured persons, the need for costly technology, and other pressures that require greater resources. At the same time, both governmental and private payers are constraining reimbursement, and most organizations' income from investments has been affected adversely by events over the past three years. Twentyfive of the 29 responding CEOs believed these factors represent a problem for healthcare executives, governance, and clinical leaders who are responsible for maintaining their organizations' viability and mission and for responding to their communities' needs. In February, PriceWaterhouseCoopers (2003) published a report, entitled "Cost of Caring: Key Drivers of Growth in Spending on Hospital Care," that informs us of the impact of these factors on hospitals. To a considerable degree, however, the same factors affect all providers of healthcare services and, at least indirectly, all health-related firms. 2. Meeting the multifaceted workforce crisis that exists throughout the country Twenty-two of the 29 responding CEOs identified workforce issues as a principal challenge. Their deep concerns mirror the position taken by many healthcare organizations, including the American Hospital Association, that the healthcare industry is in the midst of a real workforce crisis. This crisis is not simply about the short supply of workers, although we are experiencing significant shortages of nursing personnel, certain physician specialists, and other professional caregivers. Other dimensions of the workforce crisis include: * changes in the skill mix to meet new service requirements, * high levels of dissatisfaction expressed by many nurses and other employees about their work situation, and * the tremendous need for care continuity in a period where recruitment is difficult and turnover is high. All of these elements affect the cost and quality of care. A study prepared by the VHA

(Voluntary Hospitals of America [2003]), entitled "The Business Case for Workforce Stability," found that the average annual turnover rate in hospitals is nearly 21 percent. The study also documents the adverse effects of high turnover rates on cost per discharge, severity-adjusted length of stay, return on assets, and other quality and cost variables. This is a report worth reading. It paints a sobering picture. The CEOs know that our problems have no easy solutions and that we have to address their root causes, not just their symptoms. 3. Ensuring patient safety and good clinical outcomes; reducing variability in quality and costs; and demonstrating positive impact on the health status of individuals, families, and communities Over the past decade or so, there had been little evidence to indicate that managed care programs have had a positive impact on improving access to and quality of healthcare services or containing healthcare costs. The Institute of Medicine (IOM) reports--Crossing the Quality Chasm and To Err Is Human--and other studies have described serious problems and defects in the U.S. healthcare system. As does the IOM, the CEOs I spoke to agreed that we need to provide care that is safe, effective, patient centered, timely, efficient, and equitable. But they understand clearly that we are a long way from fulfilling these six aims. Pioneering work at the University of Michigan, Dartmouth College, and elsewhere has revealed the startling variability in levels of healthcare utilization, quality, and cost from community to community. In the early 1980s, John Griffith of the University of Michigan acquainted me and colleagues at the Sisters of Mercy Health Corporation with data on the large variation in use rates among Michigan communities where the Sisters of Mercy operated healthcare facilities. I recall our early efforts, which were far less than adequate, to understand the underlying reasons for the variations and to do something about them. A new study by Elliot Fisher and colleagues (2003) at Dartmouth, entitled "The Implications of Regional Variations in Medicare Spending-Part I: The Content, Quality, and Accessibility of Care" (as quoted in the Wall Street Journal [2003]) speaks graphically of this variation: The federal Medicare Program spends about 60% more for health care for beneficiaries in White Plains, N.Y. and Detroit than it does in Rochester, N.Y. and Grand Rapids, Michigan. Yet the quality of care delivered to patients living in 'high-spending' communities is no better and in some cases worse than what people in low-spending communities get ... a large fraction of medical care is devoted to services that neither improve health nor quality of care. Both healthcare leaders and the public at large are feeling a growing discomfort with the performance, the impact, and the cost of our nation's healthcare system. Closing the

gaps and achieving measurable improvements are great mandates for executive, clinical, and governance leaders. It is a challenge for us in the academic community as well. 4. Redesigning systems and processes, building new operating models, and overcoming both technical and cultural obstacles along the way Various reports, including those by the IOM, have illustrated the importance of assessing and redesigning systems and processes to bring about improvements in patient safety, quality outcomes, and costs. Crossing the Quality Chasm strongly recommends "the systematic identification of priority areas for improvement" (IOM 2001). Subsequent IOM reports--Fostering Rapid Advances in Healthcare: Learning from System Demonstrations, which was developed by a committee chaired by Gall Warden of the Henry Ford Health System, and Priority Areas for National Action: Transforming Healthcare Quality--also provide useful roadmaps for moving toward improvement goals. Great work is being done in many communities. Here are a few examples: * At Texas Health Resources, a multiunit system based in Arlington, Texas, headed by Douglas Hawthorne, a strategic initiative called "The Patient and Family Journey" is transforming processes and services systemwide, from the point of initial contact through the care processes to discharge and follow-up care. * At Sentara Healthcare in Tidewater, Virginia, with David Bernd's leadership, intensive care specialists remotely monitor ICU patients through electronic means. This remote ICU supplements and enhances traditional rounds and onsite monitoring. Sentara has reported that patient mortality rates have dropped between 25 percent and 35 percent since this system was installed. In addition, Sentara has achieved a 150 percent payback on its investment (Trustee 2003). * With the leadership of Sister Mary Jean Ryan, SSM Health Care (based in St. Louis, Missouri) received the Malcolm Baldrige National Quality Award in 2003, making the system the first healthcare organization to be so honored. SSM's strategies involved a fundamental redesign of its systems, processes, and operating models and necessitated sustained commitment to overcoming the cultural resistance and technical barriers that arose during the transformation. The CEOs spoke candidly about the vast amount of work that lies ahead. Many feel, and I concur, that redesigning systems and processes is necessary but not sufficient, that what is needed are entirely new operating models. 5. Maintaining access to capital to enable needed investments in facilities, technology, and equipment

Even with concerted efforts to improve the appropriateness of utilization and to enhance the efficiency of existing facilities, healthcare organizations clearly need large amounts of capital to meet the growing demand for services, to acquire needed technology, and to redesign existing processes. Firms like KaufmanHall and The Advisory Board and several CEOs with whom I work believe healthcare organizations need to generate an EBITDA (earnings before interest, taxes, depreciation, and amortization) of at least 14 percent to maintain long-term viability. Many organizations are not coming close to this standard. As Gary Mecklenburg of Northwestern Memorial Healthcare stated to me: "Healthcare will face a capital crisis in the near future and be unable to respond to the growth in demands.... [A] lot of institutions have no access to the debt markets and have not funded depreciation. With limited margins, how will we replace those old Hill-Burton hospitals or acquire contemporary technology?" Raising capital is an enormous challenge, particularly for small institutions that are not part of strong systems. With a broader, more diversified base, these systems are somewhat more likely to have access to capital, at least for the near term.

Q.6

Explain Succession planning with reference to Hospital Administration

Succession planning is a process for identifying and developing internal people with the potential to fill key leadership positions in the company. Succession planning increases the availability of experienced and capable employees that are prepared to assume these roles as they become available. Taken narrowly, "replacement planning" for key roles is the heart of succession planning. Effective succession or talent-pool management concerns itself with building a series of feeder groups up and down the entire leadership pipeline or progression (Charan, Drotter, Noel, 2001). In contrast, replacement planning is focused narrowly on identifying specific back-up candidates for given senior management positions. For the most part position-driven replacement planning (often referred to as the "truck scenario") is a forecast, which research indicates does not have substantial impact on outcomes. Fundamental to the succession-management process is an underlying philosophy that argues that top talent in the corporation must be managed for the greater good of the enterprise. Merck and other companies argue that a "talent mindset" must be part of the leadership culture for these practices to be effective. Research indicates many succession-planning initiatives fall short of their intent (Corporate Leadership Council, 1998). "Bench strength," as it is commonly called, remains a stubborn problem in many if not most companies. Studies indicate that companies that report the greatest gains from succession planning feature high ownership by the CEO and high degrees of engagement among the larger leadership team [1]

Companies that are well known for their succession planning and executive talent development practices include: GE, Honeywell, IBM, Marriott, Microsoft, Pepsi and Proctor and Gamble. Research indicates that clear objectives are critical to establishing effective succession planning.[2] These objectives tend to be core to many or most companies that have wellestablished practices:

Identify those with the potential to assume greater responsibility in the organization Provide critical development experiences to those that can move into key roles Engage the leadership in supporting the development of high-potential leaders Build a data base that can be used to make better staffing decisions for key jobs

In other companies these additional objectives may be embedded in the succession process:

Improve employee commitment and retention Meet the career development expectations of existing employees Counter the increasing difficulty and costs of recruiting employees externally

OR

Succession planning is a process whereby an organization ensures that employees are recruited and developed to fill each key role within the company. Through your succession planning process, you recruit superior employees, develop their knowledge, skills, and abilities, and prepare them for advancement or promotion into ever more challenging roles. Actively pursuing succession planning ensures that employees are constantly developed to fill each needed role. As your organization expands, loses key employees, provides promotional opportunities, and increases sales, your succession planning guarantees that you have employees on hand ready and waiting to fill new roles. Effective, proactive succession planning leaves your organization well prepared for expansion, the loss of a key employee, filling a new, needed job, employee promotions, and organizational redesign for opportunities. Successful succession planning builds bench strength.
Develop Employees for Succession Planning

To develop the employees you need for your succession plan, you use such practices as lateral moves, assignment to special projects, team leadership roles, and both internal and external training and development opportunities. Through your succession planning process, you also retain superior employees because they appreciate the time, attention, and development that you are investing in them. Employees are motivated and engaged when they can see a career path for their continued growth and

development. To effectively do succession planning in your organization, you must identify the organizations long term goals. You must hire superior staff. You need to identify and understand the developmental needs of your employees. You must ensure that all key employees understand their career paths and the roles they are being developed to fill. You need to focus resources on key employee retention. You need to be aware of employment trends in your area to know the roles you will have a difficult time filling externally.

Q.7

Mention briefly about Nursing Service administration

Specific objectives 1. Understand the principles and functions of management 2. Understand the elements and process of management 3. Appreciate the management of nursing services in the hospital and community. 4. Apply the concepts, theories and techniques of organizational behaviour and human relations. 5. Develop skills in planning and organizing in service education 6. Understand the management of nursing educational institutions. 7. Describe the ethical and legal responsibilities of a professional nurse 8. Understand the various opportunities for professional advancement

Unit Time (Hrs) Th. Pr. Objectives Content Teaching Learning activities Assessment methods

I (4) 1111 Explain the principles and functions of managemen t Introduction to Management in Nursing History, Definition, concepts and theories Functions of management Principles of management Role of nurse as a manager and her qualities Lecture Discussion Explain using organizatio n chart Short answers II (6) 1 1 1 1 1 1

Describe elements and process of management Management Process Planning, mission, philosophy, objectives, operational plan Staffing: Philosophy, staffing study, norms, activities, patient classification system, scheduling Human resource management, recruiting, selecting, deployment, retaining, promoting, superannuation. Budgeting: Concept, principles, types, cost benefit analysis audit Material management: equipment and supplies Directing process (Leading) Controlling: Quality management Program Evaluation Review Technique (PERT), Bench marking, Activity Plan (Gantt Chart) Lecture Discussion Simulated Exercises Case studies

Essay type Short answers Unit Time (Hrs) Th. Pr. Objectives Content Teaching Learning activities Assessment methods III (8) 1 1 12 1 2 5 To understand the modern concepts, components and changing trends in hospital organization Hospital Organization Definition, types and functions of hospital Governing body- Hospital administration

Control & line of authority Hospital statistics including hospital utilization indices Role of hospital in comprehensive health care Development of new management practices: Marketing of Hospitals, Specialty Hospitals Lecture Discussion Preparation of organizatio n chart of hospital Essay type Short answers MCQ IV (8) 1 1 1 1 1 20 Describe the management of nursing services in the

hospital and community Management of nursing services in the hospital Planning Hospital & patient care units including ward management Emergency and disaster management Human resource management Recruiting, selecting, deployment, retaining, promoting, superannuation Categories of nursing personnel including job description of all levels Patients/ population classification system Patients/ population assignment and nursing care responsibilities Staff development and welfare programmes Budgeting: Proposal, projecting requirements for staff, equipments and supplies for Hospital and patient care units Emergency and disaster

management Material management: Procurement, inventory control, auditing and maintenance in Hospital and patient care units Emergency and disaster management Lecture Discussion Demonstra tion Case studies Supervised practice in wardwriting indents, preparing rotation plan and duty roaster, ward supervisio n Assignme nt on duties and

responsibi lities of ward sister Writing report Preparing diet sheets Essay type Short answers Assessmen t of problem solving exercises Assessmen t of the assignment s Performanc e evaluation by ward sister with rating scale Unit Time (Hrs) Th. Pr. Objectives Content Teaching Learning

activities Assessment methods 2 1 Directing & Leading: delegation, participatory management Assignments, rotations, delegations Supervision & guidance Implement standards, policies, procedures and practices Staff development & welfare Maintenance of discipline Controlling/ Evaluation Nursing rounds/ visits, Nursing protocols, Manuals Quality assurance model, documentation Records and reports Performance appraisal V (5) 1 1 11 1 Describe the concepts, theories

and techniqu es of Organiza tional behavior and human relations Organizational behavior and human relations Concepts and theories of organizational behaviors Review of channels of communication Leadership styles, Power, types Review of motivation: concepts and theories Group dynamics Techniques of: Communication and Interpersonal relationships Human relations Public relations in context of nursing Relations with professional associations and employee union Collective bargaining Lecture Discussion Role plays

Group games Self assessmen t Case discussion Practice session Essay type Short answers Assessmen t of problem solving VI (5) 1 1 11 1 5 Participate in planning and organizing in-service education program In-service education Nature & scope of in-service

education program Organization of in-service education Principles of adult learning Planning for in-service education program, techniques, methods, and evaluation of staff education program Preparation of report Lecture Discussion Plan and conduct an education al session for inservice nursing personnel Essay type Short answers Assess the planning and conduct of education

al session VII (10) 1 Describe management of Nursing educational institutions Management of Nursing educational institutions Establishment of nursing educational institution INC norms and guidelines Lecture Discussion Role plays Counselin g session Essay type Short answers Unit Time (Hrs) Th. Pr. Objectives Content Teaching Learning activities Assessment methods 1 1

11 3 1 1 Co-ordination with Regulatory bodies Accreditation Affiliation Philosophy/ Objectives, Organization Structure Committees Physical facilities College / School Hostel Students Selection Admission procedures Guidance and counseling Maintaining disciplineFaculty and staff Selection Recruitment Job description Placement Performance appraisal Development and welfare Budgeting Equipments and supplies: audio visual equipments, laboratory equipments, books, journals etc. Curriculum: Planning,

Implementation and Evaluation Clinical facilities Transport facilities Institutional Records, and reports Administrative, Faculty, Staff and Students. Group exercises VIII (10) 4 1 1) Describe the ethical and legal responsibil ities of a profession al nurse 2) Explain the Nursing practice standard s Nursing as a Profession Nursing as a Profession Philosophy; nursing practice Aims and Objectives Characteristics of a professional nurse Regulatory bodies; INC, SNC

Acts:- Constitution, functions Current trends and issues in Nursing Professional ethics Code of ethics; INC, ICN Code of professional conduct; INC, ICN. Lecture Discussion Case discussion Panel discussion Role plays Critical incidents Visit to INC/ SNRCs Short answers Assessme nt of critical incidents Unit Time (Hrs) Th. Pr. Objectives Content Teaching Learning

activities Assessme nt methods 212 Practice standards for nursing; INC Consumer Protection Act Legal aspects in Nursing Legal terms related to practice; Registration and licensing Legal terms related to Nursing practice; Breach and penalties Malpractice and Negligence IX (4) 1 1 1 1 Explain various opportunities for professional advancement Professional Advancement Continuing education Career opportunities Collective bargaining Membership with Professional Organizations; National and International Participation in research activities

Publications; Journals, Newspaper etc. Lecture Discussion Review/ Presentatio n of published articles Group work on maintenanc e of bulletin board

Q.8

Write about the Prospects & Challenges of Telemedicine

Challenges Of Telemedicine In Developing Countries.

Experiences in countries like Cambodia, Kosova and Uzbekistan has shown that low bandwidth can reach very remote areas. And in fact it has been said telemedicine may have more impact in developing countries than in developed countries. Obviously cost will be the major determining factor. However, I think the long term benefits far outweigh the costs. Once set up and running there are many challenges that will have to faced. From my own experience in PNG, technical and system support must be regular and continuous. Lack of these kind of support may lead to virus or worm infection. A regular and reliable Internet connection is also very vital and it must be affordable. In the PNG context, Telikom PNG may become a partner in telemedicine in PNG so as to subsidise the cost of telecommunication in telehealth.

A major challenge of telemedicine in developing countries will also be how local telemedicine service providers will carry own after the out side help has moved on. There are many examples in PNG where after the donor funding agencies move on after the planned funding period (eg five years) of project, in most instances, the locals are not able to maintain and continue whatever that was established with donor funding. Systems have to be set up for the telemedicine services to be self sufficient. This will also allow softwares and hardwares used to be updated regularly. Another thing that need consideration is that once telemedicine is set up in a developing country, care must be taken so that the locals do not become too dependent on the outside help. Telemedicine must be not be used to replace existing health care systems in developing countries but rather must complement them. Questions of legal implications in case of a law suit have also been raised. For example, if a specialist in USA makes the diagnosis of a case in Enga province, PNG, and it turns out that the diagnosis was wrong. And knowing Engans, they decide to take the doctor to court for professional negligence, the question now is, under which jurisdiction will the doctor be tried? Papua New Guinea or USA? Having said all these, telemedicine has a lot more potential and its a new field of medicine that is evolving with information communication technology that seem to change daily. I think if we bear the challenges in mind, telemedince may in fact help solve some our problems of specialists shortage and quality health care delivery to remote areas.

Q.9

Write about the History of Indian Hospitals,

A hospital, in the modern sense, is an institution for health care providing patient treatment by specialized staff and equipment, and often, but not always providing for longer-term patient stays. Its historical meaning, until relatively recent times, was "a place of hospitality", for example the Chelsea Royal Hospital, established in 1681 to house veteran soldiers. Today, hospitals are usually funded by the public sector, by health organizations (for profit or nonprofit), health insurance companies or charities, including by direct charitable donations. Historically, however, hospitals were often founded and funded by religious orders or charitable individuals and leaders. Conversely, modern-day hospitals are largely staffed by professional physicians, surgeons, and nurses, whereas in history, this work was usually performed by the founding religious orders or by volunteers. Today, there are various Catholic religious orders, such as the Alexians and the Bon Secours Sisters which still focus on hospital ministry. There are over 17,000 hospitals in the world.[1]

Types

Some patients go to a hospital just for diagnosis, treatment, or therapy and then leave ('outpatients') without staying overnight; while others are 'admitted' and stay overnight or for several days or weeks or months ('inpatients'). Hospitals usually are distinguished from other types of medical facilities by their ability to admit and care for inpatients whilst the others often are described as clinics.
General

The best-known type of hospital is the general hospital, which is set up to deal with many kinds of disease and injury, and normally has an emergency department to deal with immediate and urgent threats to health. Larger cities may have several hospitals of varying sizes and facilities. Some hospitals, especially in the United States, have their own ambulance service.
District

A district hospital typically is the major health care facility in its region, with large numbers of beds for intensive care and long-term care; and specialized facilities for surgery, plastic surgery, childbirth, bioassay laboratories, and so forth.
Specialized

teaching hospital in Canada

Types of specialized hospitals include trauma centers, rehabilitation hospitals, children's hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such as psychiatric problems (see psychiatric hospital), certain disease categories such as cardiac, oncology, or orthopedic problems, and so forth. A hospital may be a single building or a number of buildings on a campus. Many hospitals with pre-twentieth-century origins began as one building and evolved into campuses. Some hospitals are affiliated with universities for medical research and the training of medical personnel such as physicians and nurses, often called teaching hospitals. Worldwide, most hospitals are run on a nonprofit basis by governments or charities. Within the United States, most hospitals are nonprofit.[citation needed]
Teaching

A teaching hospital combines assistance to patients with teaching to medical students and nurses and often is linked to a medical school, nursing school or university.
Clinics Main article: Clinic

A medical facility smaller than a hospital is generally called a clinic, and often is run by a government agency for health services or a private partnership of physicians (in nations where private practice is allowed). Clinics generally provide only outpatient services.

History
he earliest surviving encyclopedia of medicine in Sanskrit is the Carakasamhita (Compendium of Caraka). This text, which describes the building of a hospital is dated by Dominik Wujastyk of the University College London from the period between 100 BCE and CE150.[8] According to Dr.Wujastyk, the description by Fa Xian is one of the earliest accounts of a civic hospital system anywhere in the world and, coupled with Carakas description of how a clinic should be equipped, suggests that India may have been the first part of the world to have evolved an organized cosmopolitan system of institutionally-based medical provision.[8] King Ashoka is said to have founded at least eighteen hospitals ca. 230 B.C., with physicians and nursing staff, the expense being borne by the royal treasury.[9] Stanley Finger (2001) in his book, Origins of Neuroscience: A History of Explorations Into Brain Function, cites an Ashokan edict translated as: "Everywhere King Piyadasi (Asoka) erected two kinds of hospitals, hospitals for people and hospitals for animals. Where there were no healing herbs for people and animals, he ordered that they be bought and planted."[10] However Dominik Wujastyk disputes this, arguing that the edict indicates that Ashoka built rest houses (for travellers) instead of hospitals, and that this was misinterpreted due to the reference to medical herbs. According to the Mahavamsa, the ancient chronicle of Sinhalese royalty, written in the sixth century A.D., King Pandukabhaya of Sri Lanka (reigned 437 BC to 367 BC) had lying-in-homes and hospitals (Sivikasotthi-Sala) built in various parts of the country. This is the earliest documentary evidence we have of institutions specifically dedicated to the care of the sick anywhere in the world.[11][12] Mihintale Hospital is the oldest in the world.[13] Ruins of ancient hospitals in Sri Lanka are still in existence in Mihintale, Anuradhapura, and Medirigiriya.[14] The first teaching hospital where students were authorized to practice methodically on patients under the supervision of physicians as part of their education, was the Academy of Gundishapur in the Persian Empire. One expert has argued that "to a very large extent, the credit for the whole hospital system must be given to Persia".[ Q.10 Write briefly about the levels of Health Care.

Health care is the diagnosis, treatment and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, dentistry, nursing, pharmacy and allied health. The exact configuration of health care systems varies from country to country, but in all cases requires a robust financing mechanism; a well-trained and adequately paid workforce; reliable information on which to base decisions and policies; and well maintained facilities and logistics to deliver quality medicines and technologies.

What are the 3 levels of health care

Primary health care is about preventing illness or disability. This would include Well Women's Clinics, child immunisation programs, malaria prevention and that sort of thing. Secondary health care is where a patient is ill and is treated, usually by nurses and doctors. Treatment of diabetes, high blood pressure, bronchitis and minor fractures are some examples of secondary health care. Tertiary health care is where things have gone wrong and long term care and rehabilitation programs are used, for instance if someone had a double amputation, they would need artificial limbs and physiotherapy and possibly adaptations to the home.