healthcare

a quar terly repor t by technopak VOLUME 6

ten
industry
trends
2010
 Contents

Overview 01

TREND 1
Public-Private Partnership:
Search for an Ingenious Model for India 02

TREND 2
Single Speciality Delivery Models:
Single Speciality to Single Procedural Hospitals 03

TREND 3
Diagnostic Centres:
Unbundling from theTraditional Setting 04

TREND 4
Low-cost Healthcare Delivery Models:
Increasing Penetration beyond the metros 05

TREND 5
Healthcare System:
Staying Connected to Your Patient 06

TREND 6
Integrated Medicine:
Leveraging the Inherent Strengths 07

healthcare TREND 7
Technology Partnerships:
Arresting the Rising Cost 08

©Technopak Advisors Pvt. Ltd. TREND 8

‘Healthcare Outlook’, a feature is an
effort by the Technopak Healthcare team
to explore the dynamic changes that are
occurring in the industry in India today.
We at Technopak understand the need
for continuous and intensive assessment
of the world’s largest service sector
industry. With this report we intend to
provide an insight of the key trends
and underline the opportunities in this
recession proof industry.
Operations Optimisation:
Measuring and Rewarding Performance 09
TREND 9
Patient Safety:
A Renewed Focus 10
TREND 10
Healthcare Design:
Alternative Care Settings 11
About Technopak 13
 Overview
We initiated providing informed insight into the healthcare market in India through our first ‘Health Outlook’ in 2007. Most
of the earlier trends* that we predicted are shaping today’s healthcare industry in India.

Some of these trends will have a major impact in the healthcare marketplace in the future.
Trends Impacting Healthcare in India

Secondary Care Hospitals: Unleashing the Five year tax holiday has provided further impetus to the growth of hospitals outside the metros. Both existing &
new potential in smaller towns upcoming healthcare providers are already investing or announcing future plans for setting up secondary care
hospitals in tier-II and tier-III cities.

Voluntary health insurance has seen a phenomenal growth over the past few years and is expected to grow
further with the entry of new players and innovative products. The shift in the role of Government from delivery
Health Insurance: The changing scenario
to the financing of care with launch of Rashtriya Swasthya Bima Yojana (RSBY) is expected to cover 60 million
Below Poverty Line families by 2020

Corporatisation of Medical Education Corporate entities will be allowed in field of medical education in future to address huge shortage and improve
quality of health workforce. This will lead to growth of Academic Medical Centers in India.

Health cities could change the way healthcare delivery, medical education, research and development is
Med-polis : The emerging healthcare cities conducted in India. A growing number of players including Medanta, Narayana Hrudyalaya, Reliance, Care
Hospitals are looking for set up health cities.

Adoption of clinical protocols and accreditation are in vogue. The Clinical Establishments Bill 2007 will give
Standardization
further impetus to this by registering all healthcare facilities.

Healthcare sector has emerged as one of the preferred sectors for investments by private equity and further
Infusion of Private Equity
growth is expected given the huge potential of the sector .

The coming decade will shape the future of the healthcare industry with innovations in technology, financing and delivery
models. While hospitals will continue to be the mainstay of treatment for episodic acute care there, will be a fundamental
shift in the nature, mode and means of delivery of care.

Advances in technology and medical research will make it possible to envision an entirely new health care system that
provides more individualised care without necessarily increasing costs. Healthcare will become increasingly personalised
with the development and delivery of new treatments tailor-made to patients’ needs as far as possible.

New financing schemes and partnership modes will be developed to make healthcare more accessible and affordable.
This transformation is already evident and shall continue to grow.

The loss of national income due to premature deaths caused by heart disease, stroke and diabetes is estimated to be
$236 billion over the next 10 years. Overall improvements in health and a 20 per cent reduction in Disability Adjusted
Life Years (DALYs) over the next decade would translate into a gain of national income of over US$ 100 billion per year,
2020 onwards.

This edition continues to focus on and attract attention towards the newer trends, which range from innovative business
models to logical integration possibilities.

*The 2007-2010 trends as detailed on page 57

A Peek into the Future of Healthcare: Trends for 2010 | 1

 trend 1
Public-Private Partnership:
Search for an Ingenious Model in India

Public-Private Partnership (PPP) models have proved to be a PPP Models

successful tool in the infrastructure sector like national highways, State PPP Model
power, transport, airports and seaports. The Central and State Karnataka Karuna Trust; Yeshaswini Scheme
Government is now increasingly pursuing this model to bridge the
Tamil Nadu Mobile health services
equity and accessibility gap prevalent in the country’s healthcare.
PPPs would usher in private sector expertise along with efficiencies Andhra Pradesh Aarogyasri
in operation and maintenance, thus leading to improved healthcare West Bengal Mobile health services
service delivery to the masses. PPP in healthcare delivery can Madhya Pradesh Community outreach program
facilitate the creation of new capacity as well as improve efficiency Rajasthan Contracting in public hospitals
in the existing facilities. As of now, there is preponderance of non- Gujarat Chiranjeevi Project
institutional than institutional PPP. The emergence of epidemics like
H1N1 swine flu, HIV, etc., also saw the Government recognising PPP engagements to combat the epidemics. However,
it is imminent that such cooperation can extend far beyond national emergencies and public health provisions.

With the advent of national schemes like Rashtriya Swastya Bima Yojana (RSBY), the Government is increasingly taking
on the role of insurer providing a substantial patient base for private providers. There seems to be a search for an ideal
PPP model for healthcare, which continues to be elusive.

Key Success Factors for PPP

• Political Commitment and enabling legislation
• Need for clear policy and legal framework for PPP
• A strong control mechanism to undertake efficient oversight and dispute resolution procedures
• Careful design of the contract with appropriate risk apportionment
• Defining an ‘acceptable rate of return’ for the private sector

Public–Private Partnership Options

Primary Health District Hospital Single Specialty Multispecialty Academic Medical
Centre Hospital Hospital Centre
Management contract Design, build and The Government The Government The possible models
Tlype of collaboration

operate provides land, provides land, could be joint

Private player/NGO
building and infrastructure at ownership model
undertaking the In addition to the
immovable. concessional rates. involving strategic
management and design, build and full
partnership,both
operation of PHC. operation of the The private player The private player
financial and technical
hospital, the private hires manpower, provides medical
Goverment pays a or pure management
player can deliver all pays salaries and services to people
portion of the running model with no equity
clinical services. provides medical below poverty line
cost. involvement
services. (BPL) within the city
The Goverment pays
and the region at
annual fixed service
subsidsed
payment for delivery
rates.
of all services.
Possible
Player

Physician Group Practice Physician Group Practice

NGO Organized Organised Providers/ Physician Group Practice
Organised Providers/ Organised Providers/
Providers Technology Providers Organised Providers
Technology Providers Technology Providers

2 | A Peek into the Future of Healthcare: Trends for 2010

trend 2
Single Speciality Delivery Models:
Single Speciality to Single Procedural Hospitals

Single speciality hospitals are a small but rapidly growing genre among today’s hospitals in India. The growing number of
speciality centres and hospitals signals a move towards maturity of the healthcare industry with an increasing complexity
of business and consumer affordability.

What sets these hospitals apart is their focus on one single Advantages of Single Speciality Models
speciality or service line. Whether it is high-end disciplines such as
oncology or neighbourhood specialities such as ophthalmology • Cost efficiency due to higher volumes
and day-care surgery, they are growing by sticking to their core • Provide higher quality care due to greater specialization
strength. While there have always been stand-alone speciality • Easily attract human resource
clinics or hospitals run by doctors, these providers are moving • Economies of scale and scope
towards corporate set-up offering the same precision of quality
• Ease of operation
care in multiple locations.
• Increase consumer satisfaction

Speciality hospital formats range from low-risk speciality including • Competitive pricing and increased choice for consumer
eye care, dermatology, mother and child to high-end speciality
including cardiology, cancer and transplant medicine. The mid-level specialities are offered in a multi speciality hospital
format. The low-risk speciality models require low capital expenditure and have comparatively low operating costs as
in-patient stay is rarely required for day procedures. This minimises the need for support infrastructure and offers easy
replication. Consumers expect convenience and are not willing to travel too far for such speciality services.

On the other hand, high-risk speciality models require a high level of expertise, capital investment and operating cost
due to the complexity of procedures and specialised equipment.

These speciality centres have been spurred by rising affordability and healthcare awareness. Currently, speciality centres
are operating in mature markets and there is a huge opportunity to offer such services in tier-II and tier-III cities. The
speciality models have become favourite investment options for private equity firms. In future, the single speciality
hospitals will transition into single procedural hospitals - such as Shouldice Hospital, Canada - that focus on conducting
surgeries only for abdominal hernias.

Evolution of Hospitals Break-up of Speciality-wise Market

Future
Single Procedral
INR Crore
Hospital
18% Women & Children
(INR 40,500)
Cardiology (INR 38,250)
2000 Oncology (INR 20,250)
Speciality 53% 17%
1950 centre Ophthalmology
Multispeciality ( INR 6,750)
Hospital Others (INR 119,250)
1500 - 1800 AD 9%
400 - 100 BC General Hospital & 1980
Religious Inpatient Nursing Homes Tertiary Care Hospital 3%
Homes
1900
Teaching Hospital Total Healthcare Delivery Market: INR 205,000 Crore
100BC- 500 AD
Military & Slave Hospital

A Peek into the Future of Healthcare: Trends for 2010 | 3

 trend 3
Diagnostic Centres:
Unbundling from the Traditional Setting

Traditionally, diagnostic centres have been part of hospitals and physician offices. The marketplace is evolving, with
diagnostic centres operating as stand-alone entities. In the future, diagnostic services will be offered at retail outlets,
pharmacies and at home (personalised testing).

Diagnostic test results impact more than 70 per cent of healthcare decisions and thus form an essential element in the
delivery of healthcare services. Physicians use lab tests and radiology procedures to assist in the diagnosis, evaluation,
monitoring and treatment of medical conditions.
Diagnostic Centers: Services
Pathology Radiology & Imaging Speciality Diagnostics
Haematology PET CT Cardiology
Biochemistry MRI Neurology
Microbiology & Infectious Diseases CT Oncology
Histopathology Ultrasound (Services offered based on
Immunology & Radio Immunoassay Mammography local market needs)
Gene Testing X Ray

The Indian market for diagnostics is worth US$ 2 billion, and constitutes 4 per cent of the overall healthcare delivery
market. Currently the marketplace has several hundred smaller players with a handful of organised players who have a
good presence in the metros. Unfortunately, the good quality diagnostic services are inaccessible in rural areas. Despite
current business challenges, the diagnostic marketplace will continue to grow due to some of the key trends, such as:
• The growing and ageing population will increase demand for diagnostics testing.
• Continuing research and development in area of genomics is expected to yield new and specialised tests. These
advances are spurring interest in and demand for personalised medicine which relies on diagnostic and prognostic
testing.
• Consumers and insurers increasingly recognise the value of diagnostics as a means to improve health and reduce the
overall cost of healthcare through early detection and prevention.
• Organised players offer consumers increasing convenience and access to quality diagnostic services.
• Point-of-care testing will enable solutions that improve care to the patients by enabling faster diagnosis and
treatment.
• There are new opportunities arising in infectious disease testing, molecular oncology and pharmacogenomics.

Diagnostic Centres: Moving Closer to the Patient Growth of Diagnostic Market in India
Home based testing 60,000
INR Crore
point of care testing
40,000
Retail outlet pharmacy % 54,000
testing centers R 20
20,000 CAG
Stand alone labs & 10,000
diagnostic centers 22,500
Hospital & physician 9,000
office labs 0
2010 2015 2020

4 | A Peek into the Future of Healthcare: Trends for 2010

trend 4
Low-cost Healthcare Delivery Models:
Increasing Penetration beyond the metros

Over the years, most healthcare models were developed keeping

Low-cost Secondary Care Hospital Services
in mind the metro markets. But now, metros with developed
healthcare infrastructure and rising competition have reached a
• Secondary care with basic and a few super specialties
saturation level serving a certain socio-economic segment of the
• 100 beds
population. The healthcare providers have now started realising
that they cannot serve all segments of population through high- • 15-20 ICU beds
cost structures. To serve different consumer segments such • 3-4 operation theatres
as lower middle income, urban poor and rural population, they • Endoscopy
need to develop low-cost healthcare delivery models. Low capital • Health check-up services
intensive models will ensure viability of the project and expand
• Lab, radiology and blood bank services
the healthcare providers’ reach in different geographies and
• Fully equipped ambulance services
consumer segments. There are some hotel brands such as Taj
that are operating luxury as well as budget hotels (Ginger), thus
serving different consumer segments with appropriate services.

There is much that can be done to reduce healthcare costs without reducing the quality of care. To reduce initial capital
cost for setting up low-cost healthcare facilities, land can be bought on the outskirts rather than in the centre of town.
The overall built-up area per bed can be reduced to reduce per-bed cost. Similarly, rather than buying the latest medical
equipment, appropriate technology needs to be deployed. Usage of good quality indigenous medical equipments can
be promoted. Also, outsourcing or third party arrangements can be evaluated for diagnostic and other support services.
Air-conditioning can be considered just for special rooms and areas instead of full building air-conditioning solutions.

The low-cost models will have a lower cost of operation. The tariff for the services will be low as compared to that offered
in high cost hospitals. Initially, such models will feature in secondary care space and later graduate to tertiary care
speciality and super speciality based on local market needs.

Lower capital and operation costs will translate into tariffs which are affordable for all segments of the population.

Reinventing the Value Chain: Low-cost Models

Current Secondary Care 100- Low-cost Secondary
Parameters Remarks
bed Hospital Care 100-bed Hospital
Floor space per bed
1,000 - 1,200 700 - 800 Optimising space allocation without compromising on functionality
(sq. ft.)
Building cost Reducing building cost by value engineering, choice of material cost based on
3000-3500 2000-2400
(Rs. /sq.ft) project vision and model
Reducing equipment cost by deploying appropriate technology in diagnostic
Equipment cost
20-25 10-15 and laboratory services. Further reduction can be brought about by group
(INR lakhs /bed)
purchasing and outsourcing of certain services.
Total cost
50-60 25-30
(INR lakhs /bed)

A Peek into the Future of Healthcare: Trends for 2010 | 5

 trend 5
Healthcare System:
Staying Connected to Your Patient

Traditionally, healthcare providers have been offering in-patient services in the geographies they serve. With the evolving
healthcare marketplace, major organised healthcare providers operating in tertiary care space are diversifying apart
from their core hospital business to include retail pharmacies, clinics and other services to serve patients better and
to achieve economies of scale. With increasing accessibility to insurance and rising consumer awareness, healthcare
providers will offer the entire gamut of services across the value chain, including primary, secondary and tertiary services
to attract patients into the healthcare system right from the entry point.

Characteristics of the Healthcare System

Leading Healthcare Networks
• Develop integrated healthcare delivery model around core Hospital Corporation of America, US
‘hospital’ business • 166 hospitals including 160 general acute care hospitals, 5
psychiatric hospitals, 1 rehabilitation hospital
• Offer a broad spectrum of services across the value chain in the
most cost-effective manner • 104 free-standing ambulatory surgery centres
• 49 free-standing diagnostic treatment facilities, and 74 provider-
• The hospitals have high volume specialty services based imaging facilities
• Comprehensive rehabilitation and physical therapy centres
• Out-patient services are an integral component of the healthcare
system to increase attractiveness to patients
Netcare, South Africa
• Ability to negotiate service contracts with purchasers of group • 120 hospitals
health care services • Primary care community care centres offering GPs, dental,
pharma, pathology and imaging services
• Implement advanced health information technology to improve
the quality and convenience of services • 120 retail pharmacy outlets
• Diagnostics: 6 main laboratories, 215 collection centre depots
• Achieve price efficiencies through group purchasing and 120 radiology centres
• Ancillary Healthcare Business: 41 dialysis centres, 14 travel
• Build cost savings by sharing of support and other services clinics, 7 radiotherapy/oncology centres, emergency medical
services

Components of the Healthcare System

Common IT Infrastructure and Services

Diagnostic
Hospitals Services
Emergency As Day Care
Services Surgery
Core Speciality Centres
Pharmacies Services Services

Sharing of Support Services, Group Purchasing

6 | A Peek into the Future of Healthcare: Trends for 2010

trend 6
Integrated Medicine:
Leveraging the Inherent Strengths

Integrated medicine is a new paradigm in health care that focuses on the synergy and deployment of the best aspects
of diverse systems of medicine including modern medicine, Homeopathy, Siddha, Unani, Yoga and Naturopathy in the
best interest of the patients and the community.

Components of Integrated Medicine Market Size of Integrated Medicine

Ayurveda
7% 4%
INR Crore
18% Yoga & Naturopathy (INR 500)
Yoga & Modern Unani & Siddha (INR 1,000 )
Medicine Homeopathy
Naturopathy
Homeopathy (INR 2,500 )
71% Ayurveda (INR 10,000 )

Unani &
Siddha

The increasing public demand for traditional medicine use has led to considerable interest among policy-makers, health
administrators and medical doctors on the possibilities of bringing together traditional and modern medicine.

The integration of traditional medicine with modern medicine may mean the incorporation of traditional medicine into
the general health service system. The purpose of integrated medicine is not simply to yield a better understanding of
differing practices, but primarily to promote the best care for patients by intelligently selecting the best route to health
and wellness.

Surveys and other sources of evidence indicate that traditional medical practices are frequently utilised in the management
of chronic diseases. Traditional medicine presents a low-cost alternative for rural and semi-urban areas where modern
medicine is inaccessible.

An approach to harmonising activities between modern and traditional medicine will promote a clearer understanding of
the strengths and weaknesses of each, and encourage the provision of the best therapeutic option for patients.

Integrative Medicine Centre at Griffin

Integrated Medicine: A Balanced Approach
• Widest array of options available to patients(One in three adults in the United
States used at least one complementary or alternative medical therapy (CAM))
• Provides an opportunity to combine the ‘best’ of both conventional medicine
and complementary alternative medicine.
• Provides cost-effective treatment options
• Results in better patient outcomes, measured in terms of symptom relief,
functional status and patient satisfaction
• Focus on holistic health and well-being
Hospital, Connecticut USA
• The hospital was founded on the principles of patient-centred care and evidence-
based medicine. The patient is provided with evaluations that are holistic and
involve a conference of five on-site experts: Medical Doctors (MD) specialising
in internal and preventive medicine, a Nurse Practitioner, and two Naturopathic
Physicians with expertise in a wide array of natural, complementary and
alternative therapies.
• Treatment approaches available at the IMC include internal medicine, naturopathic
medicine, preventive medicine, nutritional counselling, nutritional supplements,
nutriceuticals, herbal medicine, acupuncture, craniosacral therapy, therapeutic
touch, homeopathy, intravenous micronutrients, relaxation therapies, as well as
referrals to counselors, trauma therapists (EMDR), and chiropractors.

A Peek into the Future of Healthcare: Trends for 2010 | 7

 trend 7
Technology Partnerships:
Arresting the Rising Cost

Technology is seen as one of the three important drivers of

increasing healthcare accessibility. Selection and adoption of
Novel Ways to Rationalise Technology Cost
appropriate technology often makes a critical difference in the
success of a healthcare project. It has the capability to revolutionise
• Reducing the cost of medical technology research and
the way healthcare is delivered. development
• Encouraging indigenous production of medical devices
However adopting and implementing technology in healthcare
• Devising innovative ways of dealing with obsolescence
forms a significant area of cost. It is estimated that almost 30–40
per cent of the project cost is allocated to medical technology and • Testing the new and upcoming business models of technology
services
information technology. Therefore it is imperative to devise ways
to rationalise this cost by adopting some innovative methods.

Top medical technology companies like GE, Philips and Siemens-in their effort to lower the costs of care and improve
the quality of outcomes-have been using innovation as their main tool. These companies have come up with a slew of
products endeavouring to bring down cost while upgrading the level of technology. For example, the Active Technology
Partnership (ATP) initiative of GE enables the provider to control their equipment budget over a long period of time while
managing technology obsolescence through planned equipment renewals.

Innovative Options in Healthcare Technology

Company Model Differentiating Factor
• The model allows easy adoption of technology and helps
Software As A service (SaaS) model wherein the vendor sets up an IT save on the cost of further development and upgrading of
Health Hiway
infrastructure in hospitals, looks after the complete maintenance, training solutions.
and effective implementation of the modules and the provider has to pay
Pay-per-use Model • Innovative pricing mechanisms based on a subscription
some annual fee only for the required modules within the hospital.
model .
• Smart card issued by the hospital acts as Hospital ID card
which stores patient health information, eliminating the
YOS Technologies need to carry bulky medical files.
Provides record management and hospital management software to
hospitals along with value-added services like smart cards and patient • The card is also linked to the record management and
Pay-per-use Model
portal. hospital management software of YOS, enabling ready
retrieval of required records and thus reducing patient wait
time.
GE
• Enables the provider to control their equipment budget
The ATP program is individually tailored to the hospital needs, both at an
over a long period of time while managing technology
Active Technology organisational and departmental level.
obsolescence through planned equipment renewals.
Partnership Solution

8 | A Peek into the Future of Healthcare: Trends for 2010

trend 8
Operations Optimisation:
Measuring and Rewarding Performance

Healthcare providers and administrators today are under constant Performance Parameters
pressure to meet the ever-increasing customer expectation and Service Quality Clinical Outcomes Commercials
stay ahead in the competitive race. Operations optimisation in
Shorter waiting time Lower ALOS Increased sales and
hospitals can enable to provide world-class services with a finite revenue
Increased patient Reduction in the trend
set of resources and can significantly impact competitive strengths,
satisfaction of re-admission
enhancing the business performance of the organisation.

By definition, operations optimisation relates to appropriate workforce management, quality management, planning and
control, sound clinical processes and outcome performance.

Although many healthcare providers rely mainly on technology to optimise service delivery, it is largely felt that automated
support can only help the organisation to a certain level of process management. The key to any real improvement lies
with better understanding of process workflow and tackling the bottlenecks. While staff performance also plays a very
important role, it is process design and management-or lack of it-that needs to be tackled on a priority basis.

Introducing and implementing operations optimisation techniques is a complex and time-consuming procedure.
However, the associated benefits of operations optimisation far outweigh the difficulties. There are reports of a number
of benefits associated with the introduction of techniques like queuing, clinical pathways, standard operating protocol
and integrated care pathways. These include reduction in the length of stay in hospital, reduction of costs in patient care,
improved patient outcome, improved quality of life, reduced complications, increased patient satisfaction with service,
improved communication between staff, and reduction in time spent by health staff on paperwork.

Benefit Analysis of Operations Optimization

Tools for Operations Optimisation in Hospitals

53%
• Variability methodology
40%
• Queuing theory 30%
• Scheduling and forecasting 20%
• Simulation modeling
Increase in Increase in Savings in Reduction in
• DMAIC (Define, Measure, Analyse, Improve, Control)
medicine OPD pharmacy inventory lead time
availability at revenue
customer end
Note: Results representative from Indian Hospitals

A Peek into the Future of Healthcare: Trends for 2010 | 9

 trend 9
Patient Safety:
A Renewed Focus

Patient safety is a serious issue. Estimates show that in developed countries as many as one in 10 patients is harmed
while receiving hospital care. In developing countries, the probability of patients being harmed in hospitals is higher than
in industrialized nations. At any given time, 1.4 million people worldwide suffer from infections acquired in hospitals.
Every year, tens of millions of patients worldwide suffer disabling injuries or death due to unsafe medical care.

The Joint Commission established its National Patient Safety Goals program in 2003 to help healthcare organizations
to improve patient safety.

The 2010 Hospital National Patient Safety Goals are:

• Identify patients correctly.
• Improve staff communication
• Use medicines safely
• Prevent infection
• Check patient medicines
• Identify patient safety risks

The first step towards achieving these safety goals would be imbibing and crystallising a culture of safety within the
organisation. Encouraging an open and non-punitive environment goes a long way in enhancing patient safety. The
Indian healthcare industry, too, is moving towards acquiring patient safety goals.

What Steps Can a Hospital Take to

Patient Safety Facts Improve Patient Safety?

• Estimates of as many as 44,000 to 98,000 people die in
US hospitals each year as the result of problems in patient
safety.
• Every hour, 10 Americans die in a hospital due to avoidable
errors; another 50 are disabled.
• Implementing computer physician order entry
• Having full-time doctors and nurses certified in critical care
• Implementing a patient safety compliance checklist
• Encouraging adverse event reporting
• Robust infection control mechanism

Source: To Err is Human: Building a Safer Health System,

Institute of Medicine report, 1999.

WHO’s Proposed High 5s Project to Facilitate Implementation and

Evaluation of Standardised Patient Safety Solutions

Improved Hand Hygiene Performance of Correct

Managing Concentrated Assuring Medication Accuracy Communication During Patient
to Prevent Health Care- Procedure at Correct Body
Injectable Medicines at Transitions in Care Care Handovers
Associated Infections Site

10 | A Peek into the Future of Healthcare: Trends for 2010

trend 10
Healthcare Design:
Alternative Care Settings

Healthcare design has undergone an incredible change over the last few years. The emergence of ambulatory care
services has transformed the way healthcare facilities are programmed and configured. Due to faster procedures and
fewer in-patient stays, ambulatory care centres are able to deliver care in less intensive settings, covering a wide range
of health care services for patients who do not need to be admitted overnight.

Some design implications for ambulatory care centres are:

• Need to emphasize more on providing structured spaces along with aesthetic appeal to achieve efficiency in design.
• Reduced travel time and distance between clinical areas and offices results in cost-effectiveness and better services.
• Standardisation of spaces such as the operating rooms, recovery and treatment rooms helps achieve functional
efficiency.
• These facilities have more potential to incorporate natural light and ventilation due to factors such as narrower floor
plates.
• A single service core surrounded by operating/treatment/recovery rooms reduces the amount of equipment required
for individual units.

The ambulatory care hospitals are intended to serve patients who have not undergone complex surgeries and are able
to walk; nevertheless facilities must incorporate measures for handicapped and patients under slight sedation.

Advantages of Ambulatory Care Settings Ambulatory Surgery Centres

• Larger number of units of care at significantly lower cost • Cosmetic and facial surgery centres
per unit
• Endoscopy centres
• Faster construction
• Ophthalmology practices
• Less complicated planning
• Laser eye surgery centres
• Improved quality of care
• Centres for oral and maxillofacial surgery

Space Implications: Ambulatory Vs. In-patient Environment

Parameter Ambulatory Care Hospital In-patient Hospital
40,000–60,000 sq. ft 100,000 sq. ft
Space Requirement*
(typical size of facility) (100-bed facility)
Standardisation of space Works more effectively Less efficient due to specific individual requirements
Need for support infrastructure Reduced requirement for facilities such as dietary and linen Full support services required
*The size of a typical and well designed ambulatory care facility is significantly less than that of an inpatient hospital for similar patient volumes/ workloads.

A Peek into the Future of Healthcare: Trends for 2010 | 11

 Typical Patient Flow in Surgical Ambulatory Care Setting

Reception
Registration Consents Lab Work
Waiting Anesthetic Assessmment
Special
Procedure
Patient to Prep/Hold Change
(Relative to Surgical Waiting) (Accompanied By Relative)

Endoscopy
Nurse Station

Day Care Bed

Operating (Relative joins)
Room Discharge Follow up Follow up OP
Scheduling Visits
Post-OP
Recovery

12 | A Peek into the Future of Healthcare: Trends for 2010

Ten Trends 2007–2010

2007 2008 2009 2010

Academic Medical Centres: Delivering

Public–Private Partnerships: The Public–Private Partnership: Search for
The private sector takes the lead excellence in care, education &
current imperative an ingenious model for India
research

Single Speciality Delivery Models:

Health Insurance: Increasing Healthcare Consumerism in India: Corporatisation of Medical
Speciality to Single Procedural
accessibility Rising awareness and spend Education:The impact
Hospitals

Newer Formats of Healthcare Delivery:

Medpolis: The emerging healthcare Diagnostic Centres: Unbundling from
Standardisation: Need for uniformity Taking healthcare closer to the
cities the traditional setting
consumer

Low-cost Healthcare Delivery Models:

Healthcare REITS: Addressing the real- Secondary Care Hospitals: Unleashing
The Empowered Indian Patient Increasing penetration beyond the
estate challenge the potential in smaller towns
metros

Designing Cost-effective Infrastructure: Healthcare System: Staying connected

Manpower: Reversing the brain drain Private Equity: The race for value deals
A green approach to your patient

Newer Partnerships: Catalysing growth Integrated Medicine: Leveraging the

Technology Takes Centrestage Clinical Trials: Making inroads
of healthcare delivery Inherent Strengths

Public–Private Partnership: The way Emergency Evacuation Services: Appropriate Technology: Optimising Technology Partnerships: Arresting the
ahead Building a network for India healthcare delivery rising cost

Healthcare Architecture: The business Lean Thinking: Improving the bottom Operations Optimisation: Measuring
Medical Value Travel: Hype and reality
of design line and rewarding performance

Healthcare Outsourcing: Providers

Special Economic Zones Clinical Protocols : Standardizing care Patient Safety: A renewed focus
focus on their core competence

Medical Device Innovation : Involving Health Insurance: The changing Healthcare Design: Alternative care
Infusion of Private Equity
providers and physicians scenario settings

The India Healthcare Trends 2008, the first
primary study report on the healthcare Industry
received an overwhelming response from all the
stakeholders of the sector. In continuation of the
same, Technopak has started work on the
second report, India Healthcare Trends 2010,
which would give a far greater insight about the
industry.
With abundant opportunities for businessmen,
equipment makers and service providers to
invest in curative and preventive services and
possibilities of investing in medical infrastructure
and medical tourism, it becomes imperative for
providers to get a feel of what's happening in the
industry to make informed decisions on
investment options.
The Report will be a primary analysis of the
Providers (Hospitals, Physicians), Consumers,
Healthcare Insurance Companies and Private
Equity.
The study covers all the regions of the country to
present a comprehensive picture of the
Healthcare.
The pan India study endeavors to bring forth the
opportunities and the roadblocks which prevent
in realizing those opportunities.
Current Status of Healthcare
Sector in India
Investment patterns in the sector
The best cities to invest in for Healthcare
Healthcare Provider Study
Tier wise and zone wise analysis of healthcare
providers on various operational factors
Best hospital formats to invest in
For more information and suggestions; please feel free to contact
iht2010@technopak.com
2010
Key Highlights
One-of-its-kind report with primary survey data
from a cross-section of sources including
Consumers, Physicians, Hospitals.
Identification of opportunities in Healthcare
Infrastructure, financially & geographically,
manpower requirements & opportunities.
Identification of the allied businesses' role and
their individual market share, the future dynamics
of healthcare delivery.
Tracking the business modules of physicians,
their outlook on future practices, and how they
gear up to face the challenge posed by organised
healthcare sector.
Consumer insights: Current behavior and
practices in the household, decision making
process on physicians, hospitals, perceptions on
current options and satisfaction levels
Hospital Architecture
Hospital planning and its effects on functional
ity and costs
Healthcare Consumer Study
Healthcare Consumer Survey and Analysis,
Health Seeking behavior, Expenditure on
various components of Healthcare
The Opportunities in Medical, Nursing and
Allied Education
About Technopak

A leading Management Consulting firm offering strategic advice, start up assistance, performance
enhancement impetus, consumer insights and capital advisory, to leading Indian and International
companies, operating in Retail, Food and Agriculture, Consumer Products, Fashion (Textiles & Apparel),
Healthcare, Hospitality, Education, Entertainment and Real Estate sectors

Services We Offer The Healthcare Practice is uniquely positioned to advice

clients based on its expertise in the Indian scenario,
Business Strategy insight into consumer behaviour in India and its access to
Assistance in developing value creating strategies based the best international practices. The Healthcare Practice
on consumer insights, competition mapping, International provides the whole gamut of services from concept to
benchmarking and clients capabilities commissioning for the healthcare delivery chain.
• Corporate Strategy
• Organic Growth Strategy Healthcare Segments We Serve
• Growth through Partnerships and JVs • Healthcare Providers
• Value Based Management - Network Hospital Systems
- Tertiary Care - Centers of Excellence
- Charitable Trust Hospitals
Start-Up Assistance - Academic Medical Centers
Leveraging operations & industry expertise to ‘commission’ - Ambulatory Care Centers
the ‘concept’ on a turnkey basis - Boutique Healthcare Centers
• Design and Build Start-up Organisation
• SEZs and Medi-Cities
• Assist in Installing Business Infrastructure
• Develop and Implement Business Processes • Payors / Health Insurers
• Government Organizations
Performance Enhancement
Operations, industry & MOC expertise to enhance the • NGO’s / Funding Agencies
performance and value of client businesses • International, Private and Public Sector Banks
• Organisation Effectiveness • Private Equity / Venture Capital Funds
• Productivity Enhancement
• Transaction Advisors for PPP
• Supply Chain Improvement
• Cost and Capital Efficiency
• Sourcing base Effectiveness

Consumer Insights
Holistic consumer understanding applied to offer
implementable business solutions

• Shopper Insights
• Trend Insights
• Design and Innovation Insights

Capital Advisory
Supporting business strategy and execution with
comprehensive capital advisory in our industries of focus

• M&A
• Due Diligence – commercial & financial
• Fund Raising
• Corporate Finance
healthcare

Dr. Rana Mehta

Vice President, Healthcare
Head Office rana.mehta@technopak.com
4th Floor, Tower A, Building 8, DLF Cyber City, Phase II,
Gulshan Baweja
Gurgaon 122 002, (National Capital Region of Delhi) Associate Director, Healthcare
T: +91-124-454 1111, F: +91-124-454 1199 gulshan.baweja@technopak.com

Bangalore Monika Kejriwal

Prestige Solitaire, Ground Floor, 6 Brunton Road, Associate Director, Healthcare
Off MG Road, Bangalore 560 025 monika.kejriwal@technopak.com
T: +91-80-4034 8600, F: +91-80-4034 869 Abhishek Pratap Singh
Associate Director, Healthcare
Mumbai abhishek.singh@technopak.com
101-105, 2nd Floor, Sunjana Tower,
Sun Magnetica Service Road, Ritika Arora
Luis Wadi, Thane West, Senior Consultant, Healthcare
ritika.arora@technopak.com
Mumbai 400 602
T: +91-22-2583 2222, F: +91-22-2583 8408 Akanksha Akhauri
Consultant, Healthcare
www.technopak.com akanksha.akhauri@technopak.com