Search results

According to Global Healthcare Security Index 2021, India ranked 66 out of 195 countries, indicating the need and scope for improvement. The Cooperative healthcare system which has been rendering exemplary services is yet to gain visible recognition in India. Given the need for upgrading the health infrastructure in India and providing more affordable health services to the country’s growing population, it would help appreciate the large role that cooperative healthcare can play along with others. This study explores the structure, conduct, and performance of healthcare co-operatives in India, the factors contributing to their success and failure, and the challenges they face. The Health Cooperatives have a strong presence in Kerala and Karnataka and are also coming up in other parts of the country. However, a detailed database of them for public awareness is very limited. The cooperative hospitals can meet the basic requirements of curative treatment in rural and poorly-endowed urban areas. The democratic way in which they function makes them a destination for a financially weaker section. They must retain this feature. The study covers two successful cases which reveal that India needs a more dense healthcare cooperative network. Since cooperative hospitals in tune with the spirit of service run on the principle of being ‘Not-for-Profit’ they need to be supported by the governments more liberally, without however interfering with their governance and administration.

Healthcare is indispensable for any civilisation to attain a good quality of life and well-being on both mental and physical levels. The healthcare domain primarily falls under pharma, medical, biotechnology, and nursing. Also, other fields may be aligned with these primary fields. Healthcare amasses the contemporary trends and knowledge of upcoming techniques to improve healthcare processes. The practitioners are primarily doctors, nurses, specialists and health professionals, hospital administrators, and health insurance.

It is a fundamental attribute needed for any society to attain good quality of life and well-being in mental and physical health. It is a fundamental right of people to receive good healthcare where drug treatment and hospitalization are available at a nominal cost, as a requirement of today’s modern era. There appears to be a significant disparity in the availability of good healthcare in rural areas compared to urban in India. Even though we enter the digital era with the facilities offered in Industry 4.0 and other advanced technologies brings about a significant change of overall processing within healthcare systems. During the pandemic of COVID-19, there has been digital transformation with success globally. Healthcare cooperatives are a new norm to support the healthcare systems globally. The chapter discusses Gampaha healthcare cooperative and reviews Ayushman Sahakar scheme in India. The reforms require time to evolve.

The central lesson to be learned from studying the case is to understand the challenges and constraints posed by contextual conditions in designing contracts in public–private partnerships (PPP) for financing and delivering health care in emerging economies such as India.

Perverse incentives, along with contextual conditions, led to extensive opportunistic behaviors among involved agencies, limiting the effectiveness of otherwise highly regarded innovative design of the program.

India’s “Rashtriya Swasthya Bima Yojana” or National Health Insurance Program, launched in 2007 provided free health insurance coverage to protect millions of low-income families from getting pushed into poverty due to catastrophic health-care expenditure. The program was implemented through a PPP using standardized contracts between multiple stakeholders from the public and private sector – insurance companies, hospitals, intermediaries, the provincial and federal government.

Teaching Notes are available for educators only.

CSS: 10 Public Sector Management.

Health-care delivery organizations (hospitals) constitute a complex adaptive system; hence, a contingency perspective is imperative to guide the design of customized approaches to quality management in different health-care settings. Accordingly, this paper aims to propose a contingency framework to advance the understanding of the relationship between situational factors and effectiveness of quality approaches in health-care organizations (HCOs), such as hospitals in India.

Related literature was reviewed to identify existing research and theories related to quality and quality approaches, situational factors of the HCOs (hospitals) and some existing logical evidence on public and private hospitals in India. Then a contingencies framework for quality and quality approaches was conceptualized.

This paper proposes contingent determinants arise out of conceptualization of the HCOs (hospitals) from different system perspective such as rational system, natural system, open system and integrative system; uncertainty because of physicians’ behaviour, nurses’ approach and a dual line of authority; and the task environment such as patients, competition and economic pressure. These determinants represent situational constructs to the quality enhancement of any attempt at quality approaches. While these determinants have an influence on the quality and quality approaches of the HCOs (hospital), it is imperative to build any quality improvement strategy to work effectively, i.e., quality approach is dependent on determinants of the contingencies of the hospital’s environment, be it external or internal. Propositions for future research are also incorporated.

This paper proposes a conceptual model as well as research propositions that need to be validated and confirmed empirically. It advances the research and theory related to quality and quality approaches in a health-care setting. It can enable policymakers, hospital managers to analyze and gauge the appropriateness of quality approaches in a given context before implementing them and could help to improve the introverted quality approaches and quality dimensions currently followed in HCOs (hospitals).

Contingency framework is a new approach for research on the effectiveness of quality approaches in hospitals. The fundamental idea behind this framework is that effectiveness of quality approaches can be understood best by examining its contingent determinants. Thus, it has the capacity to contribute to the efforts of government and policymakers to make the quality of care affordable to all in India. Essentially, we examine the contexts and variables that determine the effectiveness of quality approaches.

The present paper aims to analyse who actually benefits from the policies to promote international trade in healthcare services through medical tourism in India. It also assesses the implications of unfettered and unchecked medical tourism for public health policy-making.

The research methodology adopted in this paper is inter-disciplinary (socioeconomic and legal) and includes a mix of doctrinal and empirical qualitative research.

The present paper argues that in the absence of any baseline data in the public domain on inbound traffic of tourists visiting India on medical tourism, it is difficult to assess and evaluate the private sector claims and that the absence of any format for data collection, management and analysis results in questionable accountability and institutional fragmentation and non-coordination. Furthermore, it results in asymmetrical policy-making in areas like international trade, which may have unintended negative effects for public health.

The research findings of the present paper will also assist other developing countries considering to promote medical tourism to learn lessons from India’s experiences.

The present paper uses the qualitative empirical research conducted by the author to analyse the state of affair of medical tourism in India.

The purpose of this paper is to compare perceived service quality of public/government and private medical college hospitals.

This study adopts a descriptive, cross-sectional and research design. The research sample includes 340 in patients from six medical college hospitals located in the state of Odisha, India. Primary data are collected through a structured closed ended questionnaire containing 66 items on 1–7 point Likert scale. Statistical tools like factor analysis and ANOVA are performed with the help of SPSS-17 software to analyze the collected data.

This study identifies 13 dimensions of perceived hospital service quality. The comparative study indicates better performance of public/government hospitals across the technical dimensions of perceived service quality, whereas private hospitals report better performance across majority of the functional dimensions.

In the Indian healthcare system, public hospitals provide low-cost healthcare targeted toward low to middle socio-economic population whereas, large corporate private hospitals provide high-cost healthcare targeted toward high-income group. So the comparison between them produces an obvious result indicating better service quality in private hospitals. Present study minimizes this gap by comparing the service quality of public and private medical college hospitals. Medical colleges ensure access to health services for a larger group of people. Thus, similarity in the segment of population receiving medical services in public and private medical colleges is higher, making the comparison of perceived service quality fairer.

Providing public healthcare to people is a major challenge for governments. In this sector, public-funded systems are grossly inadequate in India, and excessive commercialization and exploitation by the private sector are a stark reality. The cooperative healthcare model is emerging as an alternate system in Kerala with its strong service objective to challenge the woes of private healthcare. The cooperative hospitals in the state worked round the clock to serve the poor and needy during the devastating COVID-19 pandemic. The pandemic has also badly exposed the weakness of our healthcare system in the wake of challenges posed by an increase in demand for health services, especially in rural areas. The resultant rise in the cost of treatment has put severe strains on the people at a time when even their day to day jobs were in peril. India has a strong cooperative movement and world-class institutions to serve as models in each sector. The Thrikkakara Municipal Co-operative Hospital, located at Cochin in the Kerala State of India on which this case study is written was established by the Hospital Society Ltd. in 1999, as a project under the People’s Planning Programme of the Government. Today, it has grown into a medium-sized healthcare establishment with the prime objective ‘Modern healthcare to all at affordable costs’ and cater to an average of 700 outpatients a day. This case study reveals the inception, development over years, facilities available, operations, management, public interface, and outlook for the hospital to become a modern healthcare institution to serve the people still better.

Owing to the rising costs and shrinking budgets; inefficiency can be observed in the financing and delivery of health service both in the private and public sectors, which is not only causing organizations to reconsider their management patterns but also to use new strategies to achieve competitive merits in the current world of business. Outsourcing is one of the best alternates. The purpose of this paper is to study: the nature and magnitude of outsourcing of health-care services in a Smart City of Eastern India; the motives behind outsourcing: and the factors affecting outsourcing decisions.

The study was conducted in Bhubaneswar, a Smart City of Eastern India and capital of Odisha State. Data relating to the outsourcing of health-care services were collected from 40 hospitals (each having a minimum of 10 beds) through a structured schedule. Descriptive statistics were calculated through Statistical Package for Social Science to substantiate the objectives.

Most of the clinical services were outsourced by small hospitals, while a significant portion of non-clinical services were outsourced by large and medium hospitals. Reduction in cost and better management control were the major driving forces of outsourcing. Loss of control over service providers and quality of measurement were considered as the main disadvantages in the decision-making process of not outsourcing the services by hospitals.

The study is the first-ever survey based on empirical evidence about the state of facilities management services outsourced in public and private hospitals in Odisha, India. The paper concluded that the effect of outsourcing did not synchronize successfully as shown in international literature.

The purpose of this paper is to ascertain the performance of Indian hospitals in recent past and derive meaningful insights for policy makers and practicing managers in this area.

This paper analyses the technical efficiency of select Indian private hospitals using three related methodologies: data envelopment analysis (DEA), Malmquist Productivity Index (MPI) and Tobit regression. Two output variables (i.e. total income and profit after tax) and four input variables (i.e. cost of labour, net fixed assets, current assets and other operating expenses) were selected for the purpose of the study.

DEA analysis has shown that 14 out of 37 hospitals are found to be efficient under the Cooper and Rhodes model of DEA and 20 out of 37 hospitals are efficient under the Banker, Charles and Cooper model of DEA. The empirical results pertaining to MPI indicate an overall productivity progress in the private Indian hospital industry during the study period, which is largely due to technological advancement in the industry. Tobit regression demonstrates that chain affiliated, specialized and multi-city located hospitals exhibit a higher technical efficiency.

This study has a limitation with reference to the unavailability of data on the input and output parameters of the model. The data related to the number of beds, number of doctors, number of nurses, etc., were not available for the period under consideration.

This study seems to be one of the few studies applying productivity and performance analysis using DEA, MPI and Tobit regression for the Indian private hospital industry.

The author studies the determinants of public trust in government doctors and hospitals (DH) – a crucial indicator of the quality of a country's healthcare system – in India by analyzing the India Human Development Survey (IHDS) 2011–2012.

The author uses descriptive statistics and a set of ordered probit regression models controlling for a set of individual-specific, household-level and other covariates and analyze across heterogeneous contexts (national/rural/urban/male heads/female heads/social groups).

Across contexts, people reporting a great deal of trust in private DH (PDH) are significantly more likely to report a great deal of trust in government DH. Those people with a great deal of trust in government schools to provide good education (vis-à-vis people with only some trust in government school) have significantly higher likelihood of reporting a great deal of trust in government DH. Visiting a private doctor last time (vis-à-vis a government doctor) makes reporting higher trust levels in government DH less likely.

India's healthcare system is afflicted with several resource allocation problems and low public trust issues are indicative of misgovernance. In presence of limited state capacity, ubiquitous corruption and underwhelming institutional trust, understanding the factors influencing public trust in healthcare providers is critical to designing appropriate trust-enhancing public health policies.

Given the sparse empirical literature on public trust in healthcare systems in the developing countries such as India, this study is a pertinent contribution as the study explains the determinants of public trust in DH using a comprehensive unit-recorded household survey dataset.