Sharing Knowledge: Healthcare & Beyond

Corona virus update

2020-03-09T21:57:00.000+05:30

Corona virus update and compiled information

I have been getting a lot of calls from many investor friends from the industry who were anxious in the wake of the ongoing Corona virus crisis. Having qualifications in the subjects of public health and that I am a qualified doctor probably makes them get in touch with me. I thought of compiling important information which was otherwise scattered across the web into a single concise page for quick reading. I hope this mitigates a lot of queries many have regarding Corona virus, specially in Indian context.

V.IMP: India Official national update site (Please visit https://www.mohfw.gov.in for latest updates):

Total number of passengers screened at airport (9th Mar) : 9,41,717
Total number of Confirmed COVID 2019 cases across India * : 43 (27 National, 16 foreign nationals) (includingforeign nationals, as on 08.03.2020 at 10 AM)
As per MOHFW site (https://www.mohfw.gov.in) , regions with confirmed cases are Delhi, Haryana, Kerala, Rajasthan, Telengana, Uttar Pradesh, Ladakh, J&K & Tamil Nadu
Mumbai & Maharashtra have no official cases notified yet as of 9th March 2020

Official helpline numbers India:

+91-11-23978046

The Helpline Email ID for corona-virus : ncov2019@gmail.com

WHO India official update site:

https://www.who.int/india/emergencies/novel-coronavirus-2019

Official WHO India Page:

https://www.who.int/india/

Appreciation from WHO:

"The Government of India has demonstrated strong commitment for preparedness and response to COVID-19, which is being led by the Prime Minister’s office and coordinated by the Ministry of Health & Family Welfare (MoHFW)"- Dr Henk Bekedam, WHO Country Representative to India

WHO on their website for India continues to mention that the "Prime Minister's Office, MoHFW and Cabinet Secretary are closely monitoring the situation of COVID-19. States were also asked to identify possible quarantine facilities, to augment isolation wards and for active engagement of district collectors in cluster management at district, block and village levels. Passengers (foreign and Indian) arriving directly or indirectly from China, Hong Kong, Indonesia, Iran, Italy, Japan, Macau, Malaysia, Nepal, Singapore, South Korea, Taiwan, Thailand and Vietnam are screened at point of entry. Indian citizens are advised to refrain from travel to China, Iran, Italy, Republic of Korea and advised to avoid non-essential travel to other COVID-19 affected countries".

This endorsement by WHO is a sigh of relief that the Indian government is doing its best to mitigate the situation.

India Travel & Visa Advisory: https://www.mohfw.gov.in/DraftTraveladvisorytotravelersUpdated06032020.pdf

https://boi.gov.in/content/advisory-travel-and-visa-restrictions-related-covid-19

Indian Mass Gathering Advisory:

https://www.mohfw.gov.in/advisoryformassgathering.pdf

Official Indian Ministry poster:

https://www.mohfw.gov.in/Poster_Corona_ad_Eng.pdf

Indian Ministry Biometrics attendance advisory:

https://www.mohfw.gov.in/advisoryforbiometricattendance.pdf

2019-Novel CoV Testing Laboratories:

https://dhr.gov.in/sites/default/files/COVID-19%20Testing%20Laboratories.pdf

Guidance Document For State Nodal VRDL 9To give an overview on how state nodal officers react)

https://dhr.gov.in/sites/default/files/GuidanceDocument%20For%20StateNodal%20VRDL.pdf

All research updates from Indian official site:

https://dhr.gov.in/whatsnew/2019-novel-corona-virus

Official PMO Tweet with poster:

https://twitter.com/narendramodi/status/1234762662413660165?s=20

About the Virus:

With the current information available, it is suggested that the route of human-to-human transmission of 2019-nCoV is either via respiratory droplets or contact. Any person who is in close contact (within 1 meter/3Feet) with someone who has respiratory symptoms like sneezing, coughing, etc is at risk of being exposed to potentially infective respiratory droplets.

"Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans. Coronaviruses are zoonotic, meaning they are transmitted between animals and people. Several known coronaviruses are circulating in animals that have not yet infected humans" - This is concerning as strange food habbits like eating bats or live animals among various populations pose a threat in future for similar outbreaks if such habbits are not contained by the governments.

Various studies and scientific papers published on such habits were published prior to the corona virus outbreak:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6466186/

https://www.sciencedirect.com/science/article/pii/S2590053619300308

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3168224/

https://www.mdpi.com/journal/viruses/special_issues/viruses_bats_2019

Higher risks:

Early information out of China, where COVID-19 first started, shows that certain populations are at higher risk of getting very sick and include:

Older adults
People who have serious chronic medical conditions like:

Heart disease
Diabetes
Lung disease

Incubation Period:

The “incubation period” which is the time between getting exposed to the COVID19 virus and beginning to have symptoms of the disease. Most estimates of the incubation period range from 1-14 days & mostly around five days.

Common signs of infection & recommendations:

https://www.who.int/health-topics/coronavirus

Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.

WHO General advisory:

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public

1. Wash your hands frequently

2. Maintain social distancing

Maintain at least 1 metre (3 feet) distance between yourself and anyone who is coughing or sneezing. Work from home should be encouraged where feasible and intercity travel must be avoided as far as possible to avoid intermingling at airports as hubs of infection from unkown sources of infections from various foreign trvelers who may avoid detection due to incubation periods.

3. Avoid touching eyes, nose and mouth

4. Practice respiratory hygiene

Make sure good respiratory hygiene is followed which includes covering mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately in lined dustbins.

5. If you have fever, cough and difficulty breathing, seek medical care early

Stay home if you feel unwell. If you have a fever, cough and difficulty breathing, seek medical attention and call in advance. Follow the directions of your local health authority.

6. Stay informed and follow advice given by your healthcare provider

More WHO FAQ on Corona virus:

https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

Indian Ministry advise on mass gatherings:

Mass gathering is ill-advised, I suggest all Holi gatherings and other group celebrations like birthday gatherings etc should be avoided: https://www.mohfw.gov.in/advisoryformassgathering.pdf

Lab Test:

According to recommendations by the World Health Organization. the diagnosis of COVID-19 must be confirmed by RT-PCR or gene sequencing for respiratory or blood specimens, as the key indicator for hospitalisation. The samples may include a awb from throat or nose, a nasal aspirate, tracheal aspirate or a sputum test.

Confirmation of test:

Confirmation takes 12-24 hours as the test includes polymerase chain reaction (PCR) and a more sensitive form called reverse-transcription polymerase chain reaction (RTPCR). Various labs in India have been set up in government labs or in collaboration with private centres. All these labs are work under the guidance of National Institute of Virology (NIV), Pune.

WHO Advice on use of masks:

https://www.who.int/docs/default-source/documents/advice-on-the-use-of-masks-2019-ncov.pdf | https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks

Wearing a medical mask is one of the prevention measures to limit spread of certain respiratory diseases, including 2019- nCoV, in affected areas. However, the use of a mask alone is insufficient to provide the adequate level of protection and other equally relevant measures should be adopted. If you are healthy, you only need to wear a mask if you are taking care of a person with suspected 2019-nCoV infection. If masks are to be used, this measure must be combined with hand hygiene and other IPC measures to prevent the human-to- human transmission of 2019-nCov. WHO has developed guidance for home care and health care settings on infection prevention and control (IPC) strategies for use when infection with 2019-nCoV is suspected.

Wearing medical masks when not indicated may cause unnecessary cost, procurement burden and create a false sense of security that can lead to neglecting other essential measures such as hand hygiene practices.

Replace the mask with a new one as soon as it is damp and do not re-use single-use masks.

To remove the mask: remove it from behind (do not touch the front of mask); discard immediately in a closed bin; clean hands with alcohol-based hand rub or soap and water.

Cloth masks are not recommended under any circumstance.

Economic Impact and care: Several industry colleagues asked me on the economic impact of the corona virus how it compares to SARS/MERS, I have compiled some information on that as follows:

Economic impact and historic comparison with SARS/MERS https://www.weforum.org/agenda/2020/02/comparing-outbreaks-coronavirus-mers-sars-health-epidemic/Coronavirus has spread much more quickly than SARS or MERS, but…..The latest data suggests that it's less deadly than either SARS or MERS (The latest statistics indicate a fatality rate of about 2.2%, but disease experts say the actual rate may be higher or lower as there are likely more unconfirmed cases.
The SARS virus killed about 10% of all infected individuals, while the MERS outbreak identified in 2012 had a fatality rate of around 35%

International alarm over the coronavirus that emerged in Wuhan, China, in December is driven by its rapid spread and the fact that infectious disease experts cannot yet know how deadly or contagious it is.

Within weeks, the virus has infected more people than Severe Acute Respiratory Syndrome (SARS) did in months. On Jan. 30, the World Health Organization declared the outbreak a global emergency.

When compared to the new virus, the spread of SARS took much longer to gain momentum. Middle East Respiratory Syndrome (MERS) that first emerged in Saudi Arabia in 2012, took eight years to infect almost 2,500 people. SO i feel, due to the uniqueness of the world today, that its is immensely digitally connected as compared to 2003 of SARS, the learnings and execution of good effective practices from one part of the world is extremely quick into another part of the world.

The speed of spreading information (Possible in the presently digitally connected word) is the key to eventual success in dealing with the Corona virus.

Various News articles cite parallels of coronavirus outbreak with the SARS crisis of 2002/2003 where 800 people dies in about 17 countries. But in 2003 the markets were breaking out of difficult recession. But the coronavirus outbreak has not leached that epidemic level of SARS, Ebola, Bird Flu in terms of fatality percentage and the mitigation now is is much more mature and quicker.

Economic papers on SARS:

https://www.ncbi.nlm.nih.gov/books/NBK92473/

https://www.cnbc.com/2020/02/11/coronavirus-4-charts-show-how-sars-hit-chinas-economy-in-2003.html

https://www.bloomberg.com/news/articles/2020-01-31/the-coronavirus-is-more-dangerous-for-the-economy-than-sars

https://www.cnbc.com/2020/02/06/coronavirus-the-hit-to-the-global-economy-will-be-worse-than-sars.html

https://economictimes.indiatimes.com/news/economy/finance/coronavirus-fall-to-have-minimal-impact-on-indias-gdp-report/articleshow/74471188.cms

Many industry leaders citied previous epidemic related economic turmoil to be a result of panic more tan the virus.- So if the panic is curtailed, enough confidence building measures promoted, regular updates on mitigation shared by countries to its citizens, the corona virus impact can soon be mitigated without much affect on the markets.

Sequioa also had some advise for investors Facing challenges as a result of the virus outbreak,including efforts to address drop in business activity, sSupply chain disruptions, curtailment of travel and canceled meetings. It also suggest to have enough cash runway to withstand a few poor quarters with contingency plans. preapring for fundraising crunch, opportunities to create innovative & creative business models, revision in sales forecast, improving marketing efforts and change in customer acquisition strategies, to evaluate headcount critically, and reavaluating capitl spends. https://medium.com/sequoia-capital/coronavirus-the-black-swan-of-2020-7c72bdeb9753

Important caution:

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters

Cold weather and snow CANNOT kill the new coronavirus.
Taking a hot bath does not prevent the new coronavirus disease
The new coronavirus cannot be transmitted through goods manufactured in China or any country reporting COVID-19 cases.
The new coronavirus CANNOT be transmitted through mosquito bites.
Hand dryers are not effective in killing the new coronavirus?
Ultraviolet disinfection lamp should not be used as it can cause irritation
Thermal scanners are effective in detecting people who have developed a fever (i.e. have a higher than normal body temperature) because of infection with the new coronavirus, however, they cannot detect people who are infected but are not yet sick with fever. This is because it takes between 2 and 10 days before people who are infected become sick and develop a fever.
Spraying alcohol or chlorine all over your body will not kill viruses that have already entered your body.
At present, there is no evidence that companion animals/pets such as dogs or cats can be infected with the new coronavirus
Vaccines against pneumonia, such as pneumococcal vaccine and Haemophilus influenza type B (Hib) vaccine, do not provide protection against the new coronavirus.
The virus is so new and different that it needs its own vaccine. Researchers are trying to develop a vaccine against 2019-nCoV, and WHO is supporting their efforts.
There is no evidence that regularly rinsing the nose with saline has protected people from infection with the new coronavirus.
Garlic is a healthy food that may have some antimicrobial properties. However, there is no evidence from the current outbreak that eating garlic has protected people from the new coronavirus.
People of all ages can be infected by the new coronavirus (2019-nCoV). Older people, and people with pre-existing medical conditions (such as asthma, diabetes, heart disease) appear to be more vulnerable to becoming severely ill with the virus.
Antibiotics do not work against viruses, only bacteria. The new coronavirus (2019-nCoV) is a virus and, therefore, antibiotics should not be used as a means of prevention or treatment.
To date, there is no specific medicine recommended to prevent or treat the new coronavirus (2019-nCoV).

Warm Weather effect:

Various professionals suggest that warm weather has a mitigating effect in spreading the virus.

As per one news report, "Souren Panja, Head, Critical Care, RTIICS concurs with Aggarwal. The typical Indian weather is certainly a deterrent, he believes. According to him, "The geographical spread of nCoV suggests that it has so far been restricted to cooler climates." According to Arindam Biswas, and internal medicine consultant, three factors determine a virus' spread — the "agent or the virus itself, the host and the environment". While the agent and the host are present everywhere, India didn't give the virus an ideal weather condition, he thinks. https://time.com/5790880/coronavirus-warm-weather-summer/

Reasons citied by professionals is that that warm, humid weather can make it harder for respiratory droplets to spread viruses. The UV light from sunshine also helps reduce viral transmission according to some.

“The droplets that carry viruses do not stay suspended in humid air as long, and the warmer temperatures lead to more rapid virus degradation,” says Elizabeth McGraw, director of the Center for Infectious Disease Dynamics at Pennsylvania State University"

"Human activity also changes in summer months, says Thomas Bollyky, the director of the Global Health Program at the Washington D.C.-based Council on Foreign Relations. People spend less time indoors—where they tend to be in closer contact with each other, making it easier for the virus to spread—in the summer.

Warm weather affect Study: https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.0030151

Additional reading:

Realtime counters by third party sites:

https://www.worldometers.info/coronavirus/

CDC:

https://www.cdc.gov/coronavirus/2019-ncov/index.html

Cruise Ship travel advisory:

https://wwwnc.cdc.gov/travel/page/covid-19-cruise-ship

European CDC:

https://www.ecdc.europa.eu/en/novel-coronavirus-china/questions-answers

NHS:

https://www.nhs.uk/conditions/coronavirus-covid-19/

Third party Latest updates:

https://economictimes.indiatimes.com/news/politics-and-nation/coronavirus-news-live-updates-death-toll-march-9/liveblog/74545182.cms

WHO Global Guidance:
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/critical-preparedness-readiness-and-response-actions-for-covid-19

WHO has defined four transmission scenarios for COVID-19:1. Countries with no cases (No cases);2. Countries with 1 or more cases, imported or locally detected (Sporadic cases);3. Countries experiencing cases clusters in time, geographic location and/or common exposure (Clusters of cases);4. Countries experiencing larger outbreaks of local transmission (Community transmission).

Update on Covid- 19 & travel advisory as shared by Maharashtra officials (Mostly relevant to travellers to Maharashtra & International airport at Mumbai:

All travellers who have symptoms of fever, sore throat, cough, cold and difficulty in breathing within 14 days of landing , and who have a positive history of travelling to affected Countries ( China, Hong Kong, Thailand, Singapore, South Korea, Japan, Vietnam, Nepal, Malaysia, Indonesia, Iran and Italy or any other affected country) have to be sent to identified isolation facility and sample should be referred to designated lab.

Isolation facilities have been setup at Kasturaba Hospital Mumbai and Naidu Hospital,Pune. Along with these all Government Medical Colleges and District hospitals are also equipped with isolation facility.

For Asymptomatic travellers with a positive travel history home isolation for 14 days from day of landing is advised.

They should observe social distancing.

Local health authority will follow up all such travellers telephonically for their health status. If during this period any one develops above mentioned symptoms he/she will be admitted to nearby isolation facility and will be tested for corona. All travellers coming from COVID 19 affected countries must be , encouraged for self reporting to local health authority *on development of symptoms.

Every traveller should follow the do's and don'ts ( preventive measures ) i.e. frequent hand washing , cough etiquettes, avoiding crowded places.

COVID 19 Diagnostic Facility is available at following labs in Maharashtra - 1) National Institute of Virology, Pune 2) Kasturba Central Laboratory Mumbai 3) Indira Gandhi Medical College, Nagpur

For any queries contact - State Control Room - 020 - 2612 7394,Toll Free number 104Dr.Pramod Padwal MOH Mira Bhayander Municipal Corporation 8422811236 Dr.Nandkishor Lahane IDSP Mira Bhayander Municipal Corporation 8422811240Dr. Pradip Awate State Surveillance Officer 9423337556Dr. Amol Mankar State Epidemiologist 9766732163For Mumbai, Dr Yashashree Keni 9833867979For Pune Corporation, Dr. Sanjiv Vavare, 9689931541For Pune division, Dr. Sanjay Deshmukh, Deputy Director, 9422033439For Nagpur division, Dr Sanjay Jaiswal Deputy Director 9422150677For Akola division, Dr. Farukhi Deputy Director 9423422570For Aurangabad division,Dr. Lale Deputy Director 9421958419For Thane division, Dr Mrs Rathod Deputy Director 8928284072For Latur division, Dr.Male 9404042297For Kolhapur division,Dr. Borase Deputy Director,9422791259For Nashik division, Dr. Pattanshetti Deputy Director, 9422653695

India denies entry to cruise ships on virus fears

India has banned all foreign cruise ships from its ports because of the coronavirus, with one European vessel turned away from Mangalore in the south at the weekend, officials said Monday.
Cruise ships are seen as fertile breeding ground for the deadly virus, with more than 700 cases and six linked deaths from the Diamond Princess held off Japan last month. (AFP)

China opens Disney Resort

The Maharashtra Food and Drug Administration (FDA) has ordered chemists to sell coronavirus Covid-19 kits only on doctors’ prescription. The government received complaints that chemists are selling the kits and masks at higher prices than the MRP.

Official Press release page of Govt of India

All: https://pib.gov.in/AllRelease.aspx

Corona:https://pib.gov.in/PressReleseDetail.aspx?PRID=1605744

Recommended actions as suggested by WHO:

Highest priority
Enhance whole-of-society coordination mechanisms to support preparedness and response, including the health, transport, travel, trade, finance, security and other sectors. Involve public health Emergency Operations Centres and other emergency response systems early. Sensitize the public to their active role in the response. Engage with key partners to develop national and sub-national preparedness and response plans. Build on existing plans such as influenza pandemic preparedness plan. Enhance hospital and community preparedness plans; ensure that space, staffing, and supplies are adequate for a surge in patient care needs.
Secondary priorityEstablish metrics and monitoring evaluation systems to assess effectiveness of measures. Document lessons learned to inform on-going and future preparedness and response activities. Prepare for regulatory approval, market authorization and post-market surveillance of COVID-19 products (e.g. laboratory diagnostics, therapeutics, vaccines), when available.

(https://www.who.int/docs/default-source/coronaviruse/20200307-responding-to-covid-19-communitytransmission-final.pdf?sfvrsn=ec5fa30a_5):

Beware: Scam Alert:

https://www.who.int/about/communications/cyber-security

Criminals are disguising themselves as WHO or Indian official to steal money or sensitive information. If you are contacted by a person or organization that appears to be from WHO, verify their authenticity before responding.

-x-

Reset - Economy with its own Chitti (soul)

2019-10-08T16:37:00.001+05:30

I was reading Mr Subramanian Swamy's book - Reset. I have always been intrigued with his take on the economy. Sometimes radical as a thought which for obvious reasons may not have many takers.

I however got extremely facinated by one aspect in the book, which he has not spoken about much in public - "Economy based on Integral Humanism"

He says that economy is a subsystem of nation and not other way round (true). He says that a successfull economy can only be outcome of successfull recognition of life as integral part of system and policies have to recognise the interlinkages and positive complimentaries (explained later) for the economic wheel to run progressively.

Nations growth has to recognise and accept diverse nature of various people and conflicts, and economy has to respect that where man's personality & freedom is respected. For eg- Individuals have to be incentivised to be part of economic growth like tax incentive or aboltion instead of high tax rates just becuase they earn more. For eg the tax collection as per the integral humanism theory will grow if people are happy to partake in the economic growth instead of coercion (respecting diverse nature and attitudes)

He also proved it through stats where state's coercive factor is indirectly proportional to economic growth of tax collection.

He adds that global teachings of economy cannot work for every nation, specially a diverse country like India. India has to find its own chitti(soul) and make its own unique economy theorms based on mutual complimentaries - eg the demonatisation though a great initiative overlooked that fact that there were genuine housewives there who had saved a lot of cash without knowledge of their husbands one rupee at a time and many (I know that from experience) had strained relations with their spouses once they found out about this hidden stash. You know how housewives save for rainy day, for their daughters marriage, for that once in a while binge without telling their spouse.

But the Chitti eg can be explained in corporate language for the larger good as - eg we shouldnt allow a polluting factory (just because we have to make more phones or goods) in middle of civilisation or polluting vehicles as a growth of economy in that sector, as it also harms others by way of poor air & health etc. But we can allow a school or a garment factory as it benefits both the maker and local residents. Similarly we should move towards nuclear power plants or similar.

He add that household savings is one of the most important aspects of GDP growth and will have to grow along with FDI growth which is on decline. While lending rates should be low, FD rates should be high (don't know how that is possible). He also says (which makes sense) to print notes to fund infrastructure & labour wages (China did that).

Other reforms suggested by him is de-salination plants on coastal line and water grid for all agriculture. Exploiting thorium reserves and becoming self sufficient in electricity.

Would love to read more from Mr Swamy where I would request him to decipher his technical knowledge to a laymen reading.

Dr Akash Rajpal

iPhone 10 anticipations & prospective analyisis

2017-05-04T22:56:00.002+05:30

As June approaches every year the rumour windmills spin at full speed and generate the much needed power of imagination of how the new iphone would be.

It's such a fascination to watch budding designers and Apple fanboys display their creativity in public eye with some awesome iphone mockups and designs. It's tech porn fully unleashed.

Right from contactless wireless charging to SLR level camera, iris scans to 3D face recognition, hidden screen embedded Touch ID to pathbreaking display designs.

The list is endless.

But as we all know the features adopted by Apple is usually never first in industry. Actually I don't remember apple utilising a feature before anyone else does. It always has been improving upon previously experienced technology.

Whether it's fingerprint security, display resolution, waterproof body, Bluetooth earphones etc were all improved upon and never introduced first in industry. Apple does not have the inherent DNA to take innovative risks specially since jobs is not around. We have all seen how apple without jobs has in history tried to bank solely upon their money minting offerings typically and end up losing.

That is what we are seeing now. Iphone was last introduced by jobs. There is nothing which has been introduced by Apple post jobs which has been hugely successful like the iphone.

AirPods, lack of earphone socket, touch bar on mac, discontinuing jobs's favourite MacBook Air 11" have all been rejected by users by and large disappointing them to the core.

The only saving grace recently was dual camera bokeh in 7+ which apple didn't even anticipate that it would sell more,messing up the inventory management. And as analysed above the dual camera was not even first in industry by apple. Many brands have had that offering prior. And the same bokeh job can be easily done be any good cam app (I am waiting for the brilliantly demoed adobe bokeh app)

So what do I don't expect in iphone 10 which could have been worthy of apple's legacy:

1.Contactless Wireless charging as it's not introduced yet by other brands. Apple won't risk this as first comer. Tech still needs early adaptation by risk takers like real entrepreneurs on kickstarter.

2.Seamless edgeless display like the Samsung 8 as industry would ridicule them of copying.

3.TouchID inside display as no one has done that yet.
4.3D face recognition as its not introduced already. Apple wont risk this.

What I do expect in iphone 10:

1.Earphone jack to be back as it was the most ridiculous thing to do. Earphone jack is the most universal electronic component since wall socket. Imagine removing electric wall plugs and sockets and being "courageous" to make all things in house wireless for the whim and fancy of a company.

2.Waterproof to continue.

3.Touch ID to be (on side?) or back but in a more convenient location and make screen ratio bigger.

4.New OS 11 which will have battery improvement system & other improvements.

5.Custom control panel as it is most desired and popular in android.

6.Better airdrop and better file sharing features. Present files sharing is regressively restrictive in iOS.

7.Better Siri with offline support atleast for all system settings.

8.Bigger battery.

9.A display size bigger than 5.5" as that's in larger demand for apple

10.Dual camera even in 4.7 inch phone as they was saving grace for apple sale recently.

11.All glass body like iphone 4 to make it look different branding wise. Maybe even a sapphire glass option. Similarity in design has been biggest name for Apple as people buy apple also for pride of ownership. The loom change due to dual camera in larger phone was also reason for its better sale than the lower size version.

12.New Display material like OLED as that's in trend.
13. Iris scan(Maybe) as its already introduced by few brands & that Governments like India are pushing phone manufacturers to have it for UID.

So that's it folks.

Let's check back in June (or later in September if apple delays its anniversary launch) and I hope apple proves me wrong for the innovation part. My most desired feature is contactless wireless charging as it will greatly improve battery life, and dual camera in 4.7 inch too. It will be a disaster if they discontinue the 4.7 size and not reintroduce earphone jack.

In the meanwhile I'm seriously looking forward for pixel's price to drop as the price point is the only reason holding people from buying a fabulous google product.

Apple iphone sale drop trend will continue till the new phones are announced as only a breakthrough in offering can break the saturation and better features in offering by competition specially since Android OS is now almost at par with iOS.

Best

Dr Akash Rajpal

Tech Savy doctor.

Generics Vs Branded Drugs: Views & Counter-view

2017-04-21T12:06:00.002+05:30

This article is a counter-view to a blog written by my dear friend and collegue Dr Amit Thadani (http://amit-thadhani.blogspot.in/2017/04/myth-of-doctors-prescribing-expensive.html?m=1) who is against the move by government to prescribe only generics.

Woah, what a detailed blog Amit. However sorry to say there are a lot of holes in it specially for the company market cap study as it needs an apple to apple study for retail giants vs export giants.

Also the main reason why prescribing generic will be an issue is government(govt) has not considered the active Vs inactive ingredient portion of the components in the drug as both matter sometimes for efficacy in terms of absorption time etc which has not been touched upon by you as the main issue here.

When we speak of generics it's mostly for core active molecule and the move by govt is based on international best practice to prevent financial moral degradation and to reduce nation's's economic wastage when technically something cheaper can be procured (http://www.health.harvard.edu/blog/generic-drugs-dont-ask-just-tell-201301075766). Imagine the potential to reduce insurance premium costs. United States of America and many developed nations are already considering options to do so.

Also the generic names are long names many times and do not include convenient combinations and that could be an issue.

We are facing this move by the government as it was expected some time due to the huge huge moral degradation which I have seen, researched and experienced during my ekohealth times. That is not a myth. The moral degradation is so rotten that even unaffording poor patients are prescribed unaffordable brands when a cheaper brand/generic is easily available. 80% of all debts in Indian Families are due to healthcare expenses & the major contributor to that expense is medicine.

There may be some rare breed of docs who don't take cuts etc, and a lot of docs genuinely won't know about many upcoming quality pharma firms if the ground marketing reach is inadequate. But the research clearly says the degradation is as high as 99% (forget research, we all know the ground reality. you yourself accepted that many hospitals get high MRP printed on cheap drugs for the high margin sale & don't even give a choice to patients to buy another cheaper drug)

I don't know why doctors are the first ones to react so negatively specially on generic medicines if pricing is not an issue. The haa hoopla just on quality is nothing but the insecurity of losing their commissions and nothing else. I can share studies which show that quality and efficacy don't change with different companies (check citation at the end). Also big pharma firms like ranbaxy do not many times adhere to quality and are fined and even small firms like mankind rise in popularity on word of mouth. So that is a different domain altogether and doctors need not worry about it. Govt and FDA will. I'm not even touching upon the rut in diagnostics domain.

I personally consume all medicines which are cheaper than popular ones. The biggest myth is that generics don't have a brand name is false. All medicines which are retailed at chemists have a brand name as per FDA rules and therefore all medicines are branded. Many times the same big manufacturer like Cipla manufacturers multiple different brands of same molecules at different MRP for different markets for retail and export with different MRPs.

So I feel doctors should be concerned with their fees and not the cuts from the sale of medicines. If quality is a concern, doctors can spend some time reading the efficacy reports, articles or peer review. There are some awesome pharmacovigilance portals which doctors can prescribe to know what brands are better effective based on actual practical use. Doctors will be surprised to know that there is hardly ever any difference among different brands/generics & even most popular brand sometimes has a problem and low cost brands equally never do.

It's time docs stand up with courage and hike their fees to what they deserve/desire and stop hiding behind the cover of some drug myths to show a cleaner face and blame everything on the government policies.

The quality will always remain an issue and the same issue needs to be dealt by govt for all manufactures whether their MRP is low or high, known or unknown brand/generic.

You yourself contradicted yourself by saying some hospitals buy at 300 and sell at 3500 as their own brands. Then why is that acceptable to the same doctors who cry on quality?

I sincerely hope there is a price cap on all medicines to bring a level playing field, so no MRP manipulation can happen. Price cap will bring better efficient process to manufacture and bring in stringent quality checks to prevent wastage & returns/rejections.
I had suggested to the govt to bring in a negative price list where only as exception some medicines are beyond price cap and by default all medicines are price capped. High time this happened to prevent any doctor favouring a particular brand only for sake of commissions.

Time has come to improve our moral compass & stop taking cuts or commissions or gifts or holidays to prescribe a certain medicine. Time has come to engage with patients and give them informed choices so they can buy a brand of medicine they want. Time has come to shed our skin of hypocrisy & accept the fact that only doctors can improve the confidence in the general public which is eroding at a pace we cant even imagine. Time has come to being a 'doctor sahab' we once used to be perceived as. That will go a long way as a great patriotic service for the nation.

Time has come to understand the ground realities of moral degradation which has led to a huge collateral damage unfortunately.

Additional readings:

http://bit.ly/generic1

A widely cited research on how generics and branded drugs have same quality and effectiveness and generics are for obvious malefic reasons being disregarded for monetary reasons.

An Apple a Day keeps the Doctor Away

2017-02-07T13:07:00.001+05:30

So today's blog is on perception. Perceptions can be dangerous not just for personal stakes but a mindset if becomes a heard mentality can be harmful for the entire community.

I am an ardent fan of Steve Jobs and his creations at apple. I was surely among the first adopters for Apple products. I remember owning proudly the G4 450 Mac which was an amazing piece of technology in the year 2000. As expected that machine still purrs to life and powers on even today without a hitch. I've never had to take it for repairs ever. I later owned an iphone 4 and iPad and a MacBook Air in its initial launch. Those too never had any problems ever. There were eager customer waiting to buy these used beauties.
But then I just realised that every apple product I've bought since 2011 has needed repairs. Fortunately most of them were in warranty but still. I never had that issue with a product from HP or Nokia or blackberry etc. I now remember getting my iphone 5, 6 replaced a couple of times, MacBook Air components and Imac repaired or replaced and so on and so forth. All these apple products bought coincidentally in the last few years. The problem worsens when the warranty is over and just to have a look or diagnostics the service centres (atleast in India) charge large fees.
No doubt that apple has highly superior products (till the time it breaks down) but these frequent breakdowns brings the skeptic in me. I also realised Apple has highest number of repair extension programs for one problem or the other (for those who own apple products please do check internet under heading "repair extension program" for apple. Most of times your problem would be eligible for free repairs even if out of warranty).

Why am I writing this blog?
Main reason being - a loyal passionate customer can become the biggest hatter of a brand as expectations ran high. It therefore becomes a bigger responsibility of a trusted brand to reach out to its ardent brand ambassadors. This should be a learning for all brands no matter what type of an organisation you are.
A product for which you are always willing to pay more for needs to achieve certain benchmarks of quality which it always stood for.
And I see deteriorating customer service, no care attitude of apple brand lately with hundreds of community forum issues unresolved and no significant patches for talked about complains in various updates.
No doubt apple products are superior in experiential point of view for UI and feel, however (as per trends now) till the time repairs are needed.
I'm not saying products are infailable. But then apple did not become a cult for no reason. And I fear that cult ship fading and disappearing over the horizon of better competing brands and products on the envil.
I'm not even saying that apple does not respond to your grievance. It does and it takes a lot of effort and followup from the customer's side. But then it's more of a polite courstesy extended by apple than a genuine attempt to resolve an issue quickly and for good (for example my iOS spotlight issue is unresolved by Apple since more than a year)
This is the first time I'm considering switching to a Windows or android product for obvious reasons of meeting a certain expectation and not getting swayed by the cult and getting disappointed all over again.

A Disenchanted Apple Loyalist

Dr Akash Rajpal

First Hurdles : The Rajiv Gandhi Jeevandayi Arogya Yojna (RGJAY) implementation in Maharashtra

2012-12-01T16:53:00.001+05:30

Pleas read this Mumbai mirror article first:
http://www.mumbaimirror.com/index.aspx?page=article&sectid=2&contentid=2012120120121201101329585a34b6329
Beautifully written by Ms Jyoti, a Journalist.

The Rajiv Gandhi Jeevandayi Arogya Yojna (RGJAY), covering more than 5 million families in Maharashtra,is poised to cover more than 80 million people. Based on the immensely southern success story "Arogyasree" health scheme. Within this scheme patient get cashless surgeries and other treament from empannel private and public hospitals. The state sponsors this at a highly discounted premium with TPAs / insurance companies.

Fall outs:
As mentioned in the story, there are bogus claims, unecessary treaments, and wrong escalated bills.
This was expected, and i did mention this is in one of my previous blogs / articles.

Reasons:
RGJAY does not follow in spirit the entire learnings of Arogyasree scheme.
Arogyasree does not involve any TPA or third party mediation.
The claim process has to be done with 24 hours. Any further delay leads to fraud and wrong claims and manupilation.
All interaction is with the insurance company without any TPA.
There is no variation in pricing and all hospitals have to follow the same pricing.
There are clinical processes and instructions on what tests, medicines and lenghth of stay and preconditions have to be followed mentioned by Arogyasree, which is left to the hospital here.
All centres are linked by common software and mandatory online MIS. You can actually see vacant beds and MIS online in public, making it transparent.
There is a large call centre and support by local health workers on implementation of this scheme.
There is on an avearge 15 day delay in TPA claim submission by hospital which leads to all the manupilations etc.

Way forward:
This work should be given to insurance companies directly without involving TPA.
The hospitals should follow a common cloud based / linked software for MIS and claim processing.
Clinical proccess should be laid down to prevent unnecssary treamtents.
hospitals whose claims have been found to be fraudulent should be banned /licence cancelled as an example.
Arogyasree scheme should be replicated in same essence and operations.

All this is necesary as the faith in medicine, and doctors will soon go away.
Such programs will not see the light of day if bad examples are reffered to.
Ethics Ethic Ethics. All doctors should be made to stand in line and made to read the hippocratic oath again.
Its High Time.

Author is social impact award winner & MD & CEO of EKohealth. Ekohealth has been fighting against referral fees, cut practice and striving to create a transparent health industry with cost comparisons and information to public to make them better informed.

Author:
Dr Akash S Rajpal
MD & CEO,
EKOHEALTH Management Consultants PVT LTD,
Mumbai
Tel: 9820007137
Awardee, Ramanujan Bose Award 2012: http://www.ramanujan-bose-prize.org/#!2012-prize
Feature on Young Turks-CNBC: http://t.co/hkzEzeDY
feature on CNBC Young turks chat with Dr Naresh Trehan : http://bit.ly/PeyPbN
Feature in Entrepreneur Magazine: http://scr.bi/HrBQSf
Feature in Business India Magazine: http://scr.bi/HltyQa
Feature on CNBC Awaaz: http://bit.ly/H9jdTF
Feature on National TV (DD) : http://bit.ly/TsFJ0s
---------------------------------------------------------------------------------------------------------------
EKOHEALTH website & blogs: http://www.ekohealth.in
Ekohealth @ Linked in : http://linkedin.com/company/ekohealth

Facebook : http://www.facebook.com/ekohealth

Twitter: http://twitter.com/ekohealthindia

Skype: akrajpal

Dr Akash Rajpal @ Linkedin : http://www.linkedin.com/in/akashrajpal

Good intention

2012-11-25T01:44:00.001+05:30

I was reading a fantastic article by professor Rodwin in New England Journal. Interesting perspective on the conflict of interest by medical practitioners who make investments in place they work. The primary objective logically will be ROI rather than patients interest. (Prof Rodwin's Article : http://bit.ly/U3mlIm)

When I shared this with my students & industry colleagues, some interesting arguments started.

Some practicing clinicians & hospital owners said that (sarcastically of course) that if Prof Rodwin is understood, then practicing medicine for fee itself is a conflict of interest. And I agree to that perspective too without any sarcasm.

Practitioners have been arguing since long time on why patients (consumers) just can't accept art of medicine & healing like any other profession & realize that like any other profession the care provider needs to earn a living too. Almost all surgeons have their own hospitals & physicians their own clinics. So the aspect of ROI (Return on Investment) & a commercial angle to seeing a patient always will arise. Afterall the hospital owners have their bills & salaries to pay. And some argue that offering costlier procedures for increased financial gains though is the norm today, is justified as it "apparently" offers significant advantages over the time tested older cheaper ones. Examples cited were minimally invasive laparoscopic surgery v/s open surgery. And the argument went on further that finally it is market forces which determine ones actions :) (me smiling)

No, I don't mind these responses. Actually, its an interesting argument.

However my concerns:
For first time since last few batches, medical, dental seats are lying vacant to tune of 20 to 35%. 20 to 60 % of doctors & nurses don't clinically practice anymore (many of them are becoming administrators, & even changing industries :) I'm afraid the trend will continue. Fortunately you will see reduction in donation price & fees to fill seats in medical colleges. But over all there is huge competition from other industries like IT, offering better pay packets ( & for ethical work). Youth realize that.
Ethical Work? Yes, youth realise that every investment needs to have a return. The youth spends a fortune & almost a decade in becoming a doctor. With restriction on marketing & publicity, the hierarchy of sorts (of unethical nature) starts to work in healthcare. The hospital pays to family physician a referral fee to influence a patient to visit them. This comes at an ever increasing cost. The ROI will demand naturally more tests, treatment, expensive brands of drugs & so on which may even not be required by a patient. I still remember in disgust how a GP never prescribed antacids (or made patient aware) when prescribing chloroquine. The patient was forced to come back for a second consultation for treatment of acidity. ROI in classic play.

I'm afraid, healthcare is soon going to see a major setback across the globe & in India specially as we will see mass exodus of doctors & nurses to foreign shores for better pay packets. & potential doctors & nurses choosing other professions.

There is a serious introspection needed. This is the time to change & start having a good intention. Intention to see good of patient & sincerely honour hippocratic oath.

My argument on conflict of interest on fee for practice is that in other industries for any harm to an individual there are strict penalties & legal actions imminent (for example life imprisonment for murder, harm), but there is a huge relief given to medical practitioners for such outcomes (death for example) on account of a wrong judgement call. Why? Because we are playing with human lives & trust. The way we honour a soldier for killing in larger interest of the nation, similarly a lot of wrong doing & bad judgement calls are ignored by court of law so that the medical practitioner keeps practising & uses he prior bad experiences to save more lives. Alas that gets lost somewhere in the so called ' fee for practice', right to earn a living.

I remember Dr Naresh Trehan in an exclusive interview on CNBC with my company Ekohealth's Director Nehha Rajpal, said that for success in healthcare the most import thing required is good intention. Else one should choose any other industry. Therefore we have likes of Devi Shetty who come up once in a while as a breather.

If it was for me, I would have made healthcare akin to armed forces. Government spends on it being essential services (Obama trying to do the same exactly for same reason). And there are time tested good examples from past & present. Singapore is worlds most successful public health model followed by NHS. There the citizens prefer to visit a government hospitals, being so good. In such systems, all medicos are hired (there are better opportunities for governance due to low population too, but... Then you can have more centres & resources too) So no conflict of interest arises as patient don't have to pay. India is different, rest of world is different. This discussion is still an interesting argument.

Obviously government can look at a nicely IT enabled nicely monitored PPP delivery at fixed pricing with fixed clinical protocols (like arogyasree)
Obviously more clinical resources like doctors & nurses need to be created by removing red tapes, reasonable nationalistic rules governing medical/nursing colleges (3yr community professional course by govt is a right step. What can you do if doctors won't work even with bonds in villages. & bonds are not efficient & right way to keep doctors where they don't want to be)
OBviously everyone could be insured in the interim to pay for care.
Obviously all treatment should be free as matter of right of better living.

And I hope that day will come.

What is required is just a good intention.

Dr Akash S Rajpal
Author is CEO of Ekohealth (www.ekohealth.in)
He is a ramanujan bose awardee for social impact & is working against fee splitting (referal fee / cut practice)
Sent on my BlackBerry® from Vodafone

Singularity Summer

2012-09-04T23:37:00.000+05:30

Dear all,

This blog perhaps is my most exciting blog ever.

I share my experiences at Singularity University at NASA Research Park, USA.

Singularity summer

Students and diversity

Peter & Ray & Firesides

Lectures and insight by various faculties

Site visits & Workshops

Team Projects

Fun

Concluding Remarks

Students and diversity

It was humbling to be among a highly diverse class with students from 35 countries. Women represent 40% of the class and that was positively a striking contrast to what I typically see back in India. It was good to know that I was selected among the 3000 odd applications and was one of the 20 global competition winners.

Average age being 35, most of the students are entrepreneurs; many of them have already started a company as early as 19 years of their age. Sharing experiences and knowledge being a learning experience every day, making you realize that ones achievement is not enough in comparison to the rich background of the class, and that much has to be done in life.

All share a common goal - of creating an impression on the global scene, and helping millions of people at the same time.

Peter & Ray & Firesides

Most amazing part of the Singularity Summer has been a close interaction with visionaries like Peter Diamandis and Ray Kurzweil. It’s an immense pleasure to see the aura of passion for technology-change for good in them, that it is nothing less than infectious.

Whether its listening to Ray talking about increasing life expectancy, not worrying about robots replacing human jobs, his predictions to the precise time and date in future and how his positive influence of his father on his childhood made him think the way he does was just an amazing experience. He however reiterated that technology changes would not be able to eliminate the influence of sex love and money. And he was serious about it.

While Ray’s passion reflects in his unique style of calmness, Peter Diamandis just exuberates with energy. Very approachable, and humble and it was an amazing experience interacting with him. While everybody worries about privacy and security due to Facebook and other social media sites, Peter has been positively insisting that such openness has been the biggest neutralizer to threat of security everyone being there, creating a more transparent community. He is a strong propagator of radical transparency and reflected the same in his fireside chat with Philip Linden of Second Life Virtual World.

The Fireside sessions in late evenings of Peter Diamandis where he invited many leading successful entrepreneurs for a close interaction is unforgettable.

Philip Rosedale AKA Philip Linden of Second Life and his out of box ‘commit to pay’ crowd source ventures like coffee&power, Eric Migicovsky of Pebble and how he raised 10 million dollars on Kickstarter site, Josh Kopelman’s marketing genius to rename a town to his company name ‘half.com’ which got sold to eBay later were amazing stories to listen to. It was encouraging to hear from Philip Linden say that great ideas sound crazy or of disinterest few years before they happen.

Lectures and insight by various faculties

The core strength of the Singularity summer was the faculty and invited guests to interact with the students. We had some amazing personalities interacting with us on various subjects including exponentials of Nanotechnology, Biotechnology, Robotics, Space, Health, policy law and ethics, Information Technology, and many more. While we were excited to gain an insight into the cutting edge technology, Marc Goodman reminded us of the dark side of the technologies - be it stealing a persons DNA, or 3D printing Guns. It was chilling to hear his work against terrorism & his insight on the technology used by terrorists in the Mumbai attacks.

Very approachable Salim Ismail discussed purpose of life, while Aubreyde Grey discussed curing ageing and longevity. Ever-spoken Vivek Wadhwa updated us with exponential technologies with his frequent Forbes articles and write-ups.

Eric Reis of Lean Startup encouraged us not to be insecure of ideas being stolen, and instead worry about execution, while Greg Maryniak told us about energy resources and future of energy. Bob Richards discussed multiplanatary civilization, and Navin Jain spoke about social enterprises. SR Das on economic modeling, Sushmita Gosh from Ashoka Foundation, Catherine Mohir's concern on gradually shifting agriculture land scape to developed countries, and Matt Ranen of GBN on forecasting future were among many lectures which helped us form a vision for our team projects which could help a billion people.

Hod Lipson introduced us to 3D printing allows printing customized implants, flexible batteries, bio cartilage, food using any material

India and Indian companies were frequently citied as good examples by many of the faculty.

Interaction with Hugo award winning science fiction writers like Verner Vinge, Greg Bear, David Brin, was very engaging, I specially being an avid science fiction reader.

Ben Goertzel on Genral AI via skype spoke about problems with the Turing's Test & wozniak cofee test and challenges to make AI better than humans.

Nano tech H2 fuel cells, terraforming desserts, supercomputing, early disease detection indicates that this is a Nano decade for sure.

Dan berry, astronaut and space faculty shared his passionate story of his desire to be an astronaut and how his persistence paid off.

The women at Frontier Event was organized by Singularity University which had inspiring speeches by women entrepreneur’s like Lakshmi Pratury of TED India and Kay Koplovitz founder of channel-SciFi.

Peter Schwartz predicting space travel by year 2200 & Bangladesh underwater by 2050, and exclusive revelation of Cambridge Decleration by Philips Tevenlow that Humans are not the only conscious beings, interaction with Dr Amy Lehman of Lake Tanganyika Floating clinic were other highlites.

Insight by Yasuyuki Motoyama of Kauffman FDN that VCs invest typically within 70KMs of their base was interesting to know.

An interesting coincidence observed though listening to all these technologies was that ‘something is happening at Global IT as an organism. Total transistors, web links are now similar to a human brain synaptics now. Whether a super AI brain in making was extensively discussed.

Site visits & workshops

Google site visit was a beautiful experience, and I experienced up and close the great working environment it had. Interacting with teams behind Google car and Google maps was exiting.

We visited Autodesk, flew real aero models, had hands on with genetic sequencing during various site visits, built robots, moon rovers, programed circuit boards, and much more.

Team project workshops by external faculty, marshmallow challenge and an amazing session by Tom Wujeck & Maurice Conti was very helpful in preparing for our team project.

The students made Ignite presentations, and I did an ignite on use of the ‘Force Field’ as an answer to global grand challenges.

Team Project:

My team project was called as ‘CARE9’ and addressed Global Grand Challenge of Healthcare. The Team project integrates exponential technologies like Artificial Intelligence and sensors to make an artificial doctor to bridge the gap of inaccessible healthcare in remote corners. The application also has an extension to monitor falls and fainting for care of elders staying alone in developed world.

The team is strong and has diverse expertise from fields of sensors, artificial intelligence, public health and policy, Venture capitalists and others. Our team project already has got traction from companies like Genentech.

Our Care9 team project was rated as the best project with potential to reach 1 Billion dollar valuation in 10 years. We are working towards formation of a formal company and making a business plan to get funded.

Other exciting team projects in class included Zero G drones for economical lab experimentation, Artificial Womb and many others.

Fun

While were extremely busy, the diversity called for a lot of fun. We were invited to the Tony Robbins Motivation event, and many of us including me ended up doing the adventurous Firewalk. Tony Robbins also came for a exclusive one on one interaction at the Singularity University and it was very engaging.

We had various culture nights and the Asian/Indian culture night was very popular.

I got to participate in the annual San Fransisco Marathon, and had a lot of fun.

The class was very fun loving and ended up with a surprising flash dance to entertain the stressed staff and management. Video link -http://t.co/wQlEXKx6

We had various competetions which my team won including a 1000$ Android Application development opportunity, and other contests.

I got the opportunity to test various products including a foldable electric Bike ‘Yike Bike’

Concluding remarks.

The Singularity Summer has been a great unforgettable experience. Thanks to Ramanujan Bose Award that I could participate in this un-expectable journey of unique over whelming knowledge of exponential technologies called as ‘Singularity University’

My students in India have been following me and have insisted that I share my experiences when I return.

I plan to share such opportunities in schools and colleges as I feel the seed of exponential technology to help one billion people need to be sown in the young minds to affect in future.

Dr. Akash S Rajpal

- x -

Insurance dilemma and the outstanding billing issues.

2012-05-14T23:34:00.000+05:30

In the United States the recent trends indicate that the uninsured population is rising and is at a high of 17 to 20% of population left uninsured. There the problems are very different and law suits against patients are common for un-paid bills which run in millions. Hospitals are also being sued by patients for aggressive payment collections methods for defaults and news articles are many citing incidents of payment sleuths from hospitals asking for money inhumanely in the emergency rooms from the uninsured.

Well the scenario is different here in India.

The insurance reach is less than 2%. And majority of payments are out of pocket.

However widespread grievance by a lot of INSURED patients is a little different.

They complain of jacked up prices when they informed the hospital that they were eligible for cash less services.

According to a recent survey as cited in Forbes, when the pricing for hospitalization was compared between insured and uninsured there was a striking upward billing of upto 40% for insured patients in comparison to cash paying patients.

This indicated obvious unethical billing and suspected collusion with many TPAs. This was bound to force many insurance companies to do away with TPAs and fixing certain costs of procedures.

The matter will only worsen over a period of time and will further lead to a disillusionment of patients from Insurance due to such instances and hassles, and the insurance penetration will not rise to a desired level.

With inflation and cost of health care rising, problems are going to worsen a lot leading to unutilized beds and non-competitive revenues and EBITAs. The problem of un-paid bills from TPAs to the hospitals and individual patients is on the rise. The reasons are many for the same but leads to a situation where either patients stay away from such hospitals, hospitals stay from such

TPAs and Patients stay away from getting insured.

However there is enough time to bring in trust among stakeholders:

Hospitals should look at long term solutions to acquire patients and not give into unethical referrals. Today majority of the hospitals pay 20% as referral fee, the competition will pay 30% tomorrow, and then how long will you up the scale? Effort based engagement with patients will build trust and cost of acquisition will be much lower. Leading to higher profit centres.

Hospitals should keep the tariff standardized for all kind of patients for the same class of beds. It should not change from opportunity to opportunity. The pricing for insurance too should not change.

In the long run Insurance companies will prefer such hospital who do competitive and standardized billing. Many hospitals now doing away with bed class wise exponential billing and only charge extra for the room type and not the services. This makes all stakeholders happy.

Hospitals should invest time in making good all-inclusive packages with no variable. Its not that it can't be done. This will increase trust and competitiveness.

Hospitals should list their prices transparently and on all its communication channels including the website.

Hospitals should not take legal action against any patient. This will be like axing ones own foot. It will only lead to bad publicity. A gesture of good-will shall create a word of mouth to compensate for your loss if any.

Train your staff, specially the billing and customer care. A nice gentle but persistent followup with patients or relative every day reminding of their outstanding will sort out billing issues in majority of cases.

It is advisable that a tactful dedicated team (depending on the size of hospital) be assigned for such tasks.

Focus on 'Customer satisfaction'. That is what will make you survive in the business of healthcare.

Remember patients are only becoming more educated and informed.

Sincerely,
Dr Akash S Rajpal
MD & CEO,
EKOHEALTH Management Consultants PVT LTD,
Mumbai
Awardee, Ramanujan Bose Award 2012: http://www.ramanujan-bose-prize.org/#!2012-prize
Feature on Young Turks-CNBC: http://t.co/hkzEzeDY
Feature in Entrepreneur Magazine: http://scr.bi/HrBQSf
Feature in Business India Magazine: http://scr.bi/HltyQa
Feature on CNBC Awaaz: http://bit.ly/H9jdTF
---------------------------------------------------------------------------------------------------------------
EKOHEALTH website & blogs: http://www.ekohealth.in
Ekohealth @ Linked in : http://linkedin.com/company/ekohealth

Facebook : http://www.facebook.com/ekohealth

Twitter: http://twitter.com/ekohealthindia

Dr Akash Rajpal @ Linkedin : http://www.linkedin.com/in/akashrajpal

Gold out of dust

2012-04-18T12:10:00.001+05:30

This is in reference to the recent government action against Kokilaben Dhirubhai Ambani Hospital to recover 175 crores just because they changed the trust constitution & ran some few innovative non health earning centres within the premises. http://m.thehindubusinessline.com/industry-and-economy/government-and-policy/article3324975.ece/?page=1

My take:
I guess unless govt is healthcare provider friendly there will not be many takers for creating a good quality health setup. Govt seems to become greedy when a pvt setup creates gold out of dust. The case seems to be duplicated in almost all professionally run centres now - seven hills, fortis vashi & others whoa re all in some trouble even with agreed MOUs. Govt needs to realize that no pvt setup will be there without profits for self sustenance even if it is a trust run centre. All prudent establishments who don't want to run on donations will want a self sustenance model. Govt should be happy that its city has such brilliant health setups catering to their obligation towards its citizens of providing excellent health facilities which they fail to do on their own.

Dear Govt, please be supportive of all who want to provide a brilliant setup &, please hand hold them. Make it un-bureaucratic, attractive, & un interfering so more private enterprises show willingness to invest in great quality health setups & ultimately providing world class healthcare to all with investments & maintainence from government.
Dr Akash S Rajpal
MD & CEO
Ekohealth Management Consultants PVT LTD

Feature on Young Turks-CNBC: http://t.co/hkzEzeDY
Feature in Entrepreneur Magazine: http://lnkd.in/PwN4H4
Feature in Business India Magazine: http://www.scribd.com/doc/82435630/
Feature on CNBC : http://youtu.be/Nh5vpH_SErE

Website:
www.ekohealth.in
Linked in :
http://in.linkedin.com/in/akashrajpal
Facebook :
http://www.facebook.com/ekohealth
Twitter:
http://www.twitter.com/ekohealthindia

Sent from a Blackberry Device.
This communication is for intended recipients only. Standard confidentiality and nondisclosure clauses applicable.

Is marketing a healthcare provider ethically also 'ethical?

2012-04-17T11:56:00.001+05:30

I was at Raipur & Korba, Chattisgadh last few days to promote 'Ekohealth' through road shows. I had interesting interactions with the medical fraternity & other stakeholders. A lot of them were surprised when I told them that Ekohealth will not take any 'cut' from them if Ekohealth patients come to them.
I said that someone had to begin ethical medical practice as unethical practice of referral fees is degrading the competence & faith in such a lovely profession.
On this many practitioners put forward their pain points on how difficult it is to get patients without referral fees.
Obviously, much of medical establishment is driven by doctors turned owners. Almost all of them are uncomfortable working for 'others'.
This creates a problem. Almost none of them get time to write about their good work, give adequate attention to patients & this leads to a degrading practice over a period of time. Such doctors who were busy earlier are find lesser patients coming to them in many centres. They never invested in themselves.
They never took opportunity to 'brand' themselves through publishing articles, creating patient forums, taking customer feedback & thus loosing an opportunity to act on it for appropriate course correction.
This also leads to a desperate 'spegheti' marketing & advertisement which is unethical in a lot of ways, but also unfruitful. So I have always propagated my belief of handholding your patient as a 'customer' who expects 'satisfaction' like any other purchase of a product. Today customer is smarter than before & therefore the patient too, as they both are the same.
One elderly gentleman during my interaction pointed out that in this case even writing articles, telling people how many amazing surgeries you have done, clinical outcomes etc is also 'marketing' & is therefore unethical. And he was very uncomfortable with patient being termed as 'customer'.
On this I deliberated that doctors are themselves to blame for it. They made patients customer the day they started encouraging a 'referral fee'. This ultimately made costs higher & patient started counting value for the buck. This also paved way for more professionally run corporate setups.
I told him that its absolutely fair that one's achievement be known to patients, else how would he know?
And unless you write on internet or contribute to various publications sharing your research outcomes, & learnings from the experience how would your peers & patients know you exist. Writing well would increase confidence among all stakeholders & create ethical peer referrals & direct patients.
I think he was convinced in the end.
Dr Akash S Rajpal
MD & CEO
Ekohealth Management Consultants PVT LTD

Feature on Young Turks-CNBC: http://t.co/hkzEzeDY
Feature in Entrepreneur Magazine: http://lnkd.in/PwN4H4
Feature in Business India Magazine: http://www.scribd.com/doc/82435630/
Feature on CNBC : http://youtu.be/Nh5vpH_SErE

Website:
www.ekohealth.in
Linked in :
http://in.linkedin.com/in/akashrajpal
Facebook :
http://www.facebook.com/ekohealth
Twitter:
http://www.twitter.com/ekohealthindia

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Marketing your medical centre for free & get 20% more patients

2012-01-11T13:39:00.000+05:30

Dear Readers,

Wishing you and your family a great 2012.

Well the above mention was nothing but a small gesture of welcoming you to my world of blogs.

Well similarly, the same is expected of a medical centre. Just putting a smile, doing a namaste and welcoming a patient into your premises is the least bit any medical centre can do. This elicits a response - positive mind frame, and let's the patient open up to you in a more receptive way.

Background: I was invited as a panelist at a conference on ways to improve patient productivity (turnaround) in Nagpur recently.

It was pleasure to share the dais with luminaries of the industry like Mr VP Kamath COO of Wockhardt hospitals, Dr Vedprakash Mishra - Pro chancellor of Datta Meghe Institute of Medical sciences, Dr Mr & Mrs Gode, Dr V Ranjan- Director at HMI KEM hospital Pune, and of course, interact with bright energetic hospital management students - the leaders of tomorrow.

So, taking the insights forward, this blog post shall highlight some key ingredients to increase productivity in a medical centre - be it a hospital, nursing home, day centre or even a diagnostic centre. And the best part is - one can improve productivity by almost 20% and more by just doing the things below which does not cost anything. No advertisements required, no publicity, no unethical cut practice. Just sheer WILL and PATIENCE.

1. Greet all customers: But the catch is - the greeting should be felt from within and should show on face. There is no language barrier to greet. A simple namaste does the trick. In all areas this gesture should be followed. Be it a nurse caring for patient, or doctor examining, housekeeping cleaning the room or security frisking you. This however needs to match your action. Just plain greeting is not enough. Your gesture to welcome indicates that patient is a guest and you will take good care. So if there is a problem then it should be immediately 'looked into' without being defensive. (Discussed later in blog)
The best way to inculcate this habit is the initiative starting from ceo/trustees directly. They should start greeting even the housekeeping boys, doctors, nurses etc themselves. This shock of a gesture will embarrass all into following the same habit.

2. Take complains very seriously: To begin with you should have a strict command chain which makes it mandatory to collect feedback from 'all' patients. Though difficult, but needs to be done. An internal objective number of feedback's collected can increase month on month and can be linked to performance appraisals. Start off with a small sample size. All feedback forms should reach CEO 'after' root cause analysis and action taken. This process though has to be very prompt. CEO should create a environment among his employee to do this. The pretext of all complains should be handled with philosophy that ' All customers are right. And if customer is wrong, you led him to be that'

3. Display internally created publications: Well always remember one thing. Patient does not want to come to a hospital. Its a unavoidable need. So patient is not looking to be entertained there. He just wants to be treated, and well. So avoid keep entertainment magazines in your premises. On the contrary the only publication which should be there for people to read is your own. Why should you promote anyone else other than your organization and people in your own premises without getting paid?

Create a monthly news letter or magazine which has poetry's written by your own staff(including housekeeping), disease articles by your doctors (one which you can handle and not some procedure which only your competitor can do), patient management processes and stories by your nurses, administrative hassles (ways you are overcoming wait times etc) by your admin staff, billing trends by your front office, lab/imaging trends/info etc. All should of your own hospital. Promote all department's salient offerings, explain in detail what you can do. Highlight one department of the month and introduce all staff members with group photo etc. Include their travel woes and their dedication to work. Best employees, awards etc, NEWS article copies of your hospital's mention. Write about the experience and back ground of your doctors, nurses, admin staff etc over a period of time in various issues.

This will not only motivate the staff, reduce attrition, but entice patient's confidence and bring them closer to your staff. Increase the confidence further by highlighting you clinical and administrative indicator statistics with benchmarks like infection rates, UTI rates, ALOS, YOY productivity in various departments, etc).

And always print testimonials and positive patient remarks from feedback, etc(with patients permission, of course)

4. Publish or perish: Well a saying which is centuries old has still got relevance. Our Indian doctors are the busiest in the world. The kind of patients and experience we gain cannot be compared by anyone in this world. We all know that at times we see about 200 to 300 patients a day, each. In government setups this number is per hour.

Only problem - the treasure of experience gained, the unique cases seen, the amazing outcomes achieved are rarely shared with the world by my Indian colleagues. The Indian doctors kill an opportunity everyday to become famous and share the global dais among their western counterparts.

'Their' OPDs are 'full when they see about 30 patients a day. Their single patient research gets accolades world wide and then patients from across the globe hoard to see them. Then why not us? I have though argued the other side of the story too (defending the non publishing friends of mine) that India is a developing country and we all are eager to create a financial security first than fame. That's ingrained into our mindsets. Western worlds have social security, population is less - so internal competition for work is less, so it leaves them time to publish what ever they see. But I guess its time to think again, as competition is increasing, patients are becoming more learned, word of mouth is the best source of reference and Internet is the best source to search for talent.

So if your article and paper is not there for world to see, and is not there in an indexed journal (at-least begin with a simple article every month online on free sites like slide share or Facebook or blogs) work done by you will not be noticed and you will not be able create a word of mouth among your referring fraternity and net savvy patients.

5. Internally cross promote your departments: Well as I said earlier, a patient never wants to come to a hospital. So the chances are that he will rush to your specific department, get treated and rush back. He would not know about some other great things you offer in your hospital.

Though waiting time is a bane, you can convert that into boon by highlighting services offered in other departments.

For example, if your patient is in imaging centre you should definitely highlight what services you offer in imaging. He may have only come (maybe through reference) for USG, but now you should ensure he also knows that you carry out dental OPG, CT etc. You just marketed your services to this patient which may go out as a word of mouth to other friends of his who may need that service apart from him. That recall will be there. This should be further extended by highlighting salient services of other departments (in this example - non imaging like dental, physic therapy, cardiac unit etc) and create foot falls for those departments too and vice a versa in all departments.

You will be surprised to know that many times even the local patients are surprised to know of a service which may have existed for months in your centre.

You may offer some promotional attractions to visit the new department (eg. Free consultation - show your bill from previous visit in another department)

6. Track all patients/Capture all registration data: The patients who have visited you are a rich treasure of opportunity for repeated acquisition to sustain your business. A healthy hospital is the one which has about 70 % existing patients who come again and again, and 30% new patients. Have you calculated this figure? Please do that today itself. A large number of new patients means that you are depending too much of referred patients and is a danger to business sustenance (the case may be a little different for centers of excellence like dancer institutes etc where patient come from all over the country). The data of phone number, email etc which you capture can be a channel for you to keep on communicating with your patients to offer discounts, disease awareness, promoting new department, wishing them on their birthdays (but with with caution) etc. This will help you get the same patients again and again and improve your revenue.

7. Last but not the least - signages: Have good signboards and signages. They should not be dirty, should be in language which is understood by majority of your visitors, and should easily direct the patients to the relevant location within the centre. Its a great turnoff for a patient to keep on asking for directions. The worst is when your staff is not trained well to guide further. Imagine your security saying 'nahi maloom'. Signages are the first reflection of the 'brand' and are the first aspect in marketing oneself. If one can invest (and therefore my last mention in this post), one should have good signages both internally and externally. If you are at a location which can provide opportunity for a large floating population in the vicinity to see that big signboard, one should invest in a large distantly visible signage(neon etc). This will give you free publicity and recall. Your external signage itself can become a landmark for many addresses.

And for the internal signages, you can begin with nice economical printouts from your computer printer, and use a economical acrylic standees which will be cheap to acquire and install.

Please ensure there is no grammar or spelling mistakes. PLEASE DON'T USE MEDICAL TAPES OR CELLOPHANE TAPES. ITS A BIG TURN OFF. AND DO NOT JOT ANY PHONE NUMBERS ON THOSE SIGNAGES. Do invest in professionally made internal sign ages also over a period of time.

So get going and make patients happy, and profit from it.

Warm Regards,

Dr Akash S Rajpal

Founder, MD & CEO of Ekohealth.

Looking forward for any particular topics that I should write on? Do write in. Reply on my blogs or leave a comment.

Press, media, management schools and others can use my articles and blogs without permission. Kindly just give due credit and inform me of the inclusion.

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About Ekohealth:

(Watch the CNBC feature on Ekohealth at http://youtu.be/Nh5vpH_SErE)

Ekohealth facilitates discounts for the medically uninsured.
There are many patients in this country who do not get medical
insurance even if they wanted to. Health Insurance does not cover
senior citizens, and those with pre existing diseases like Diabetes,
cancer, etc, and such patients end up with huge medical bills. These
patients are the ones who have to get blood tests done more
frequently, visit doctors more often, and get admitted more
frequently.

Ekohealth strives to help such patients numbering between 100 and 200
million in this country.

Ekohealth has tied up with various hospitals, clinics, diagnostic
centres, chemist shops, dental clinics, cosmetic centres and ambulance
services. Ekohealth members can avail from 5 to 50 % of discounts on
various services at these centers. Ekohealth has tied up with Bombay Hospital, Saifee Hospital, Yash Birla group of medical centers, Nova Day care, Life care, 1298 ambulance, Nirmaya, Rajpal geriatric nursing care, and many more.

There is no age limit to become a member and any person with any
disease or otherwise can join ekohealth. There is no limit on using
the membership card and can be used any number of times.

Youngsters who are insured can also benefit with ekohealth membership
as they can now avail services in OPD like dental care, maternity care
etc at discounted rates. Insurance does not cover OPD expenses like
executive health checks, Maternity child birth etc.

Corporates can buy ekohealth memberships for their employees to extend
an existing insurance scope and reduce expenses on medical
reimbursements. They can also extend this facility to the parents of
the employees who are normally not covered any corporate insurance.

Ekohealth becomes a single corporate like setup for individual
patients who can collectively bargain for better rates for common
ailments.

Insurance will be the biggest beneficiary as they will not have to run
around to get hospitals to offer discounts and their reimbursements
will be lesser saving them millions in cash payouts to patients.

To know more about Ekohealth write to me, call our toll free number
1800 2094 356 or email at benefit@ekohealth.in

Short sighted governance

2012-01-03T15:40:00.001+05:30

I refer to the recent issue in Jharkhand where heated arguments over bio waste disposal have begun between Jharkhand State Pollution control board and the private hospitals. http://telegraphindia.com/1120103/jsp/jharkhand/story_14955191.jsp

The state pollution control board of Jharkhand wants all big hospitals to setup their own incinerator infrastructure to treat the biowaste. This is a very short sighted approach, and will only lead to further pollution of the neighboring areas and cause lot of health problems to the citizens nearby.

Incernerators also need Diesel (considering the poor power situation there) and will be a great fire hazard as loads of diesel would need to be stored on premises.

Plus the capital costs will only worsen the existing poor ROI of the hospital.

Jharkhand government authorities cites lack of funds for land acquisition and capital funding issues as main reasons.

This is classic example of concerned agencies not planning with all stakeholders. If a land crunched and expensive real estate location like Mumbai and Navi Mumbai can have a great arrangement of a centralised bio waste disposal then why not Jharkhand?

Such arrangements necessarily need to be done on a a PPP model, and needs farsightedness and willfullness on behalf of the governance.

Problem which still lingers with the government is that they are not still willing to let go its micro involvement in - everything. They should act (as I have always deliberated) as facilitators and create a environment of inviting all stakeholders for a simple solution. Let the private bodies do such things, offer them great incentives, and just supervise from time to time.

I hope the new year sets some great PPP examples and cites landmark benchmark in good governance.

Wishing all a very happy new year.

Warm regards & best wishes.

Sincerely,
Dr Akash S Rajpal
MD & CEO,
EKOHEALTH Management Consultants PVT LTD

Watch Dr Akash S Rajpal Speak on CNBC. http://youtu.be/Nh5vpH_SErE
---------------------------------------------------------------------------------------------------------------
EKOHEALTH website & blogs: http://www.ekohealth.in
Ekohealth @ Linked in : http://linkedin.com/company/ekohealth

Facebook : http://www.facebook.com/ekohealth

Twitter: http://twitter.com/ekohealthindia

Dr Akash Rajpal @ Linkedin : http://www.linkedin.com/in/akashrajpal

Why this kolaveri kolaveri di??

2011-12-09T15:14:00.001+05:30

You must be wondering why dr akash is referring to a great musical hit here on this health blog!!

Well I got this interesting piece of insight from a friend of mine who runs distance education programs.

The insight is true to fact and as the placement seasons for the healthcare management students are round the corner, this should help.

Do thank me for this post if you land up with a great job after reading this.

And if you don't get that job you can always sing kolaveri (translated as why this murderous look?) Or give one instead. :)
Enjoy.

Dr. Akash S Rajpal

If you haven't already listened to "Why This Kolaveri Di", please do
so before you proceed any further:
http://www.youtube.com/watch?v=YR12Z8f1Dh8

If you have listened to it, then you contributed to the 18 million times this tamil movie song has been viewed in the last 23 days. Why this Kolaveri Di' offers important lessons (I am serious!) for all of us preparing for upcoming interviews and career changes

1. Highlight your strengths
The word "Kolaveri" is repeated 34 times in the song. Yes, 34 times in a 4 minute song. Like the song or hate the song, but its impossible to get that word out of your head once you have watched the full song.

At the end of a 30 minute interview, it is critical that the interviewer leaves the room with 1-2 words in his/her mind to describe you. Otherwise you will not stand out from your competition. It doesn't matter if you have topped your class, debating champ, state cricket player, national talent test winner etc etc. Unless you reiterate your 1-2 key strengths throughout the interview, you stand the risk of being washed out in a sea of words. A helpful practice is to write down a few things that you must absolutely convey during the interview. Keep that list in front of you during the interview and refer to it and make sure its done.

2. Structure your answers
In the song, Dhanush spends the first two minutes describing the girls state of mind (kolaveri). He then spends the next 40 seconds describing the girls looks (white skinu, heart blacku). The next 1 minute is spent on describing his own state of mind (kaila/handla glassu, empty lifeu).

Similarly, in your interviews, it is very important that you present your answers in a structured analytical manner. Don't confuse your interviewer by jumping from one topic to another. For example, the best way to answer a question such as "Why are you the best person for this job" is to say something like "I think this job needs expertise in 3 domains – a,b & c. I have expertise in 'a' because of experience 1, I have expertise in 'b' because of experience 2, I have expertise in 'c' because of experience 3. Hence I think I am qualified for this job". Your interviewer will appreciate the effort you are putting in to structure your answer and it also conveys that you have clarity of thought and are organized.

3. Add Appeal / Tell a Story
Can anyone tell me why is Shruti Hasan (the cute girl in olive green top) in this video ? I can understand Aishwarya Dhanush in the video even though she is not singing – she wrote the song. If I had to dare a guess, Shruti Hassan is an excellent image for the "white skinu girlu whose eyes meetu with soup boys"

If you are interviewing for a highly competitive job like the ones in finance, consulting etc, all your competitors are smart, well educated, articulate and hard-working. How are you going to stand out, so your interviewers remember you after meeting 100 other candidates – weave a story, tell them how your experiences have crafted you, why you and only you can help them conquer the world, show them a little bit of themselves in you, tell them why you think your higher purpose is their industry (it better be true, else your life will be miserable once you get the job!)

4. Keep it Simple
Boy meets girl, boy and girls eyes lock, boy thinks girl loves him, girl barely noticed him, boy is heart-broken!! "Why this Kolaveri Di" is based on a storyline that has unfailingly powered tens of thousands of movies, TV serials, books and articles.....not to forget thousands of real life stories that draw inspiration from these works.

Don't over-complicate your answers. Especially in industries such as finance and consulting where presentation is as important as content, it is really important that people understand what you are saying as against you saying a bunch of super-smart sounding stuff that your interviewer can't comprehend. A great way to implement this, is to start your answer with a couple of simple statements and then gradually build in complexity as you proceed with the answer. Your interviewer will stop you, if he/she has heard enough.

In the time it has taken you to read this article "Why this Kolaveri Di" has been viewed another 300,000 times on Youtube!

Good Luck with your interviews!

Binny
Co-founder & CEO
www.Dezyre.com - Online University
Sent on my BlackBerry® from Vodafone

PPP - Its always prudent to outsource (ref pvt labs in public hospitals-Mumbai)

2011-09-26T12:14:00.001+05:30

This is in reference to the page 2 news of TOI today that private players are to be invited by public hospitals in Mumbai for outsourcing of labs.

Though there is always a negative speculation by the narrow minded administrators and ignorant consumer that the costs would go up for the common man, its actually otherwise.

I had outsourced many critical departments while working as administrative officer at NMMC way back in early 2000's. My initiatives were also lauded and featured by European commission's PROD india compilation of PPP initiatives in the country to replicate.
We had outsourced Imaging, housekeeping, laundry, kitchen and many more departments ultimately culminating to the most talked about 'Hiranandani Fortis NMMC' multispeciality tertiary care hospital(this project is facing certain hiccups on lines of seven hills, but should ultimately resolve as its a win win deal for both parties. Its a sincere suggestion to both not to let go this project in larger interest of both parties and the junta at large. This project just needs a little extra willfull support from either parties and will benefit both in long run)

I recently met the outsourced partner for the imaging centres and he was surprisingly pleased at the long lasting relationship with NMMC which lasted almost 5 to 7 years as per terms of contract.

I remember our equipments earlier used to fail, there was shortage of staff, training was always an issue and the patients anyways had to be referred to outside centres for imaging. Recruitment and maintainence requests always used to get lost in bureaucratic approvals and budgetary constraints.

Our negotiations with the outsourced partner not only enabled maintained equipment and optimized strength of staff, but resulted in one 5th to tenth of rates from then prevailing market rates as the volumes based incentives were built in.

I have always believed that government should never use public money on capital infrastructure and should use it on efficient monitoring mechanism for optimal outputs.

The lethargic and unavoidable red tapism and bureaucracy will always slow the process of approvals and decision making to run the systems in streamlined manner, as every one always reels under the fear of getting implicated in some corruption or favoritism charges. So the tender process, policies etc end up being so difficult that the Maintainence of equipment, recruitment of staff etc always remains an issue and leads to a failed operations.

The outsourcing is the key to success not only in labs but in every area of operations. Government needs to just tighten the administrative and monitoring mechanism and build practical policies and attractors for the outsourced partner.

If one does a study on cost of 'ownership' of self owned vs outsourced, government would be surprised to realize that a PPP costs less to the government than managing things on own.

Government should be only involved in making right far sighted policies and should entrust everything to the private players with appropriate monitoring mechanism in place.

PPP ultimately will lead to drastic reduction in corruption, and probably a reason for resistance among the babus and politicians. :)

Dr Akash S Rajpal
Founder, MD & CEO
Ekohealth Management Consultants PVT LTD, Mumbai
Sent on my BlackBerry® from Vodafone

Kickbacks & unethical cut referral medical practice. An Anna Hazare Movement in healthcare desperately required.

2011-08-21T17:44:00.000+05:30

Did you know that upto 50% of health costs can be reduced if patient goes to hospital directly, & not take referral from a Family Physician?

Sorry to say (and probably upsetting few of my industry colleagues), but the cut-practice is so ugly now that a majority of physicians now charge a referral fee upto 50% of patients bill from the treating hospital to refer a patient.

So what happens then?

This referral fee gets added to patients bill and rises the healthcare costs.

It is a well known fact that the EBITA's in healthcare is low. Ironically even with a huge bed deficit many hospitals and clinics struggle to attract a good productivity in the initial years. There are various reasons for that (will discuss that in detail in another blog soon). But the low productivity makes these providers desperate and succumb to cut practice.

One major reason for low productivity is that typically the patients rely a lot on the primary care physician (friendly neighborhood Doctor ) who has such an immense rapport with his patient that he is virtually a friend, mentor and guardian angel to them. So whatever this family doctor says is followed. So this family doctor now can dictate and channelize where (hospital/diagnostic center & even chemist) these patients would ultimately go!

The family physician (majority of them) have made this opportunity so ugly, that what could have been a patient friendly exercise to negotiate economical deals and quality for benefit of their loyal patients, has actually become a business to extort money from the hospitals and other healthcare providers & ultimately cheat the poorly informed patient. If the provider (hospital etc) does not succumb to pay the referral fees, the 'ethical hospital' is bad mouthed and the patient does not go to that hospital on fear of 'bad quality' as informed by his doctor.

This referral fee practice or popularly known as CUT (also mentioned as Cee Yoo Tee) is to the tune of 50% of patients total bill.

The referral fee has now become such a mindset & walk of life for the medical practitioners that even the specialists have started asking for referral fees. Many Orthopedic surgeons ask for a referral fee from a physiotherapist, an Anesthetist is asked to pay a preference fee by his surgeon, and many Chemists pay the local specialist a fixed monthly fee to keep on receiving patients from the busy practitioner for medicines.

Pharmaceutical companies are well known to buy cars, fund doctor's children's education and carry out an entire revamp of doctor's clinic to prescribe expensive branded drugs for which a cheaper generic is also available.

If the above is taken care of, the patients bill can reduce to the tune of 50%.

Even insurance companies bleed. They end up paying higher reimbursements to the patients/hospitals.

This needs to stop on urgent basis as patients don't realize that to cover the expense on cut practice, many hospitals and diagnostic centers end up conducting unwanted tests or even 'ghost tests' where a report is only generated without even running the tests.

Ekohealth (www.ekohealth.in) is a company which has started a very ambitious health savings program in India to counter the above mentioned evils of referral practice.

Ekohealth is striving to make the member patients more aware (with help of such blogs and newsletters) and encourage them to visit a specialist or a hospital directly without any references.

The patients are finally getting educated and Ekohealth wants to ignite this further so that they can 'engage with their doctor and healthcare provider better'.

This will not only help patient demand better rates, but ethical and quality treatment.

I know this is a very difficult task, but everything starts with a vision.

Do forward this post to as many people as possible and help educate patients to encourage them to make fearless and better informed decisions.

I hope the Anna movement transcends into healthcare too. 'Ekohealth' supports Annaji.

Opportunity to learn - lost in ambition for glamour?

2011-07-19T23:31:00.001+05:30

This blog post is for the young hospital Management students. Please read the content on the link first, before reading my blog.

http://www.businessinsider.com/this-email-got-one-stanford-student-a-huge-job-at-foursquare-2011-7

If you have read the post on the link above, you must have realized that the above link is not a good example to share with the young management students as I feel Tristan was lucky.

I sometime feel scared when I see the management students desperately trying to get internships at 'great/renowned' companies/hospitals. They hope that they will learn something there. I see that 'annoyed' look on their faces when they are not assigned a fortis or apollo or a big consulting firm. They feel dejected feeling that the opportunity to learn has suddenly diminished. But the problem dear students: Learning depends on who teaches you and what. Teaching depends on the aptitude to share knowledge. Unfortunately the popular companies are usually too busy and may not be able to impart enough to add value to the students. The other ridiculous problem is that healthcare organisations do not share knowledge too easily.

Intrestingly, the places where the students will learn the most will be the small setups, startups, setups struggling to grow. These are the avenues where both - the organisation and the student will learn from each other, and there will be immense freedom to do so. Glamour only lasts so much, but experience will last forever.

My mantra for success has been : stay hungry to learn, from anyone.

Regards.

Dr Akash S Rajpal - MD & CEO, EKOHEALTH.

http://www.ekohealth.in , http://www.facebook.com.ekohealth, http://www.linkedin.com/company/ekohealth

About: Ekohealth is a startup promoted to change the face of the Indian Healthcare Industry. It aims at providing a never envisioned before value to every stake holder of the health industry, be it the patient or the provider. Ekohealth aims at improving the quality of the health provider via nabh/iso/business excellence and aims at increasing the awareness of the patient and bringing him/her at the platform to demand quality healthcare at great value. Ekohealth envisions enrolling one lakh patients within a years time. Ekohealth is looking forward eagerly to work with bright young enterprising management students and other interested individuals and organisations to make ekohealth known in every household in this country.

After thoughts:

In the post on the pasted link above, there is though a very relevant excerpt, which is a must read to be ahead of the rat race and be successful:

"be so enamored with the product that you would work for the company even if they didnt hire you….more importantly find where the needs are within the organization and be willing to do whatever it takes to help them fill the need (work for free even!)…and MOST importantly make sure that youre filling a need that the organization doesnt have the resources to fill on its own.

If a company is not willing to let a hungry, passionate, smart, unpaid advocate of the product help the organization to fill that need (when it doesnt have the resources to do it itself) then you probably shouldnt be working at the company anyway.

Re: What Happens Online in 60 Seconds - Knowledge gone in 60 seconds

2011-07-13T14:28:00.001+05:30

I just went through the amazing statistics on usage of internet.
Bottom-line : We are all going the 'Junk' information highway with not enough real value addition to the knowledge based content sharing which will make this world a better place.

Facts as observed:
Seven Lac Google searches made in 60 seconds, but only one article published in the same time. It means people just refer and follow what others are doing, and no new content is posted which others will want to search or cite. I am of the opinion that over a period of time only copy paste and citations are happening with the same old content be read, re-read and reviewed and ultimately every progress projection may be based on a archaic relatively obsolete database.

Eight lac facebook/twitter updates are posted in 60 seconds, but only 60 blogs are added in the same time. Also only 1600 reads on knowledge based scribd portal. People are only interested in others lives, but not enough knowledge based content is added even by way of blogs.

There are only 100 questions asked on answer.com in 60 seconds, to which 40 are only answered back. So knowledge is degrading over a period of time, where not enough people are asking and not enough answers are available.

And finally, 168 million emails are sent in 60 seconds but still communication gap seems to be so much that 4 lac minutes of skype voice calls are still made to communicate.

This in context to healthcare is of great concern as healthcare is largely dependent on knowledge update, and experience sharing. Recent trends indicate a significant drop in liking for a medical seat, and this will only add to deficient status of healthcare professionals and skilled healthcare workers int he country.
New medical colleges are not being added at a pace required, and the pre-conditions to open such colleges though 'sound' are not very relevant in today's scenario.
We need management professionals in healthcare but we disuade from even sharing knowledge when they visit the healthcare centres. Very few guide these students to a level which will do justice to their learning.

I remember how difficult it was to convince clinicians and nurses to share thier experiences and post blogs or articles for benefit of all. The situation still persists. Much though which comes out is a lot of citation or copy paste.

This situation needs to change, else all posts which we will see on internet through facebook and twitter will be to find answers to our daily problems with no solutions at hand.

Please share knowledge. Please research problems and share solutions for everyone's benefit.

EKOHEALTH (WWW.EKOHEALTH.IN) is one such initiative to aggregate knowledge and content from doctors, nurses, management students and any stakeholder in the healthcare domain to share the experiences and seek knowledge. Please share your case studies, journal publications, surgery videos, PPTs, Time motion studies, health awareness slides, disease/procedure explanations for patients, but all created by you. Please email the same to benefit@ekohealth.in AND i SHALL HAVE IT POSTED ON THE EKOHEALTH WEBSITE for all to view.

Sincerely,
Dr Akash Rajpal

Linked in : http://in.linkedin.com/in/akashrajpal

Facebook : http://www.facebook.com/akashrajpal

Website and blogs: http://www.akashrajpal.com

Disclaimer:
Contents of this e-mail and any files transmitted along with it may contain confidential and privileged information and are for the sole use of the addressee indicated in this mail. If you are not the indicated addressee or have received this communication in error, kindly notify the sender by reply e-mail immediately and destroy this e-mail and any attachments permanently.

Subject: What Happens Online in 60 Seconds

Phenomenal:)
168 Million emails are sent out...
and now with this one i am adding to a statistic!!

Obligation to share knowledge

2011-06-17T12:11:00.000+05:30

To all the CEOs and managers of the hospitals and other healthcare providers.
To all the management consultants.
To all my industry colleagues,

I love to teach. And I have come across hundreds of students who love to learn. So the association fortunately becomes fruitful.
I always feel that everyone has an obligation to share knowledge, as what you are today is because of someone who shared his or her knowledge with you and taught you something you may not have been aware of before.
And when you share knowledge, you yourself become wiser as you may realize fallacies of your practice over a period of time, and would improvise and go back to your books and other learned colleagues to gather more knowledge, and this ultimately makes you more wiser.

All said and done, I feel very disappointed when experienced professionals do not readily share their knowledge and do not readily share information and end up acting very pricey.
And pricey for what? What inventions did they do, or what new facet of knowledge they have created on their own, that they keep it to themselves as if it was their own. They forget, that if they don't take this opportunity to impart knowledge when requested, someone else would.

I feel amazed when the students have to run around from pillar to post to gather basic information in hospitals which can give them a better insight in to hospital operations.
Information sharing is avoided on the pretext of it being 'confidential' ! I come accross many students, who say that so and so hospital did not allow an interview because they found it intrusive.
Understanding how a quality assurance is in OT (good or bad) is intrusive? or how a medical records department is managed is intrusive?
On the contrary these students who labor for free can give amazing insights to the management on various wrongs, and which can be used to improve. They actually should thank these students to help them out, and for free.

On one hand we are worried how the industry will fill the large gap of managers, and skilled experienced people, and on the other hand we do not want to even let them learn.
Learning can only happen on the field. Text books can give you only limited knowledge.

I have worked with colleagues, who though are very learnerd, do not eagerly dispense their treasure of experience to many hospital management students.
Their reason : they have struggled so much in their learning curve in colleges and otherwise, so why should they teach all and sundry so readily. What will they gain out of it? Let the student undergo the rut too.
This I feel is becoming a cycle of sorts - "You don't teach me well, I wont teach anyone else well"

Somehow I feel the treassure of experience they gather makes them feel so rich and proud, that they forget that they will soon forget what they learned if they do not practice daily. The best way to practice is to teach. Therefore in healthcare, the lecturers, or professors are most sought after by the corporate healthcare sector as they have the best knowledge and experience.

I love to share what ever I have learnt in the field of quality and operations in healthcare with any interested healthcare management student. I always found a void in teaching, though information is available. I feel much of 'teaching' is not up-to-date with current times. Many times what I wanted to learn was not taught, and was not readily shared from my teachers, or learned colleagues. I ultimately went about learning on my own a lot of things. I feel this trouble I went through should not be repeated with the others who learn from me.
I feel I have an obligation to share knowledge. And I still have to learn a lot.
I hope my learned colleagues, will understand and comply.

Sincerely,
Dr Akash Rajpal

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Website and blogs: http://www.akashrajpal.com

IT in malaria reporting by private practitioners

2011-06-03T09:02:00.001+05:30

The times of india article today (june3 2011by pratibha masand) on malaria disturbs me as usual. The problem of malaria eradication is that it also depends on good surveillance and support of all medical practitioners. As 85% of india's healthcare is delivered by private players, their role is essential in helping public health department by informing them on trends of malaria cases seen in their private clinics. This helps the public health take it one step forward by following up on malaria or fever positive cases to see similar occurrences in the patient's neighborhood and pro actively prevent further spread of malaria by checking for sources causing the same like stagnant water, etc or carry out a appropriate prophylaxis.
However the support from private practitioners is not to the satisfaction of the public health authorities. Private doctors and labs do not report malaria positive cases. The reason also includes the problem of dispatching such info to the public health office to the convenience of the doctor, and many times the public health department too busy to answer phone calls etc.
Solution: With information technology today and many useful and cheap utilities in mobile communication available, I wonder why the same is not used to reduce the workload of everyone.
Public health department can setup this innovative and cheap 'missed call' analytical service and register all private practitioners numbers. The private practitioner would then just need to give a "missed call" to the central number when ever he comes across a malaria positive case. The missed calls are automatically registered in database against the pre-registered details of the doctor. No charge to him. The public health department can on real time basis then can analyze region wise malaria trends and take immediate action. The IT setup can be created similarly for SMS integration to get name and address of the patient which can be similarly sent by the private doctor to a tollfree sms number.
There is similarly a lot which can and should be done by using technology to improve healthcare delivery.
Sent on my BlackBerry® from Vodafone

Fwd: TSB Now a Barber come out with an IPO

2011-04-18T22:10:00.001+05:30

Interesting read. I personally feel JHB ipo will do good (else it will
be a learning) as there is a huge vaccum of branded saloons, though 60
crores may not be enough. This is shared as a thought that such
interesting IPOs are missing in healthcare domain.

---------- Forwarded message ----------
From: Kiran Chheda <kiranbchheda@gmail.com>
Date: Mon, 18 Apr 2011 11:40:11 +0530
Subject: TSB Now a Barber come out with an IPO
To: TSB-JBIMS-M&A group <tsb_ma@googlegroups.com>

*The Barber Takes Stock *

Jawed Habib, the first hair dresser to tap the Indian capital market, is
confident his shares will command a premium. His business mantra: a good
haircut is like a bad habit, difficult to shake off

For a moment, overlook the quirkiness. A barber hoping to raise 60 crore
through an IPO begs a fundamental business question: how will he give value
to his shareholders? The service—haircuts—can't be mechanised. Hence,
maintaining consistent quality is impossible. Revenue growth will be limited
to the expansion of the network of hair salons to tier I and tier II cities.
Profits will remain constant for long periods as the fee of haircuts cannot
be changed frequently. Most important, the company's brand value will depend
on one man: Jawed Habib, celebrity hair stylist, now managing director of
Jawed Habib Hair and Beauty Ltd (JHHBL).

Habib appears unfazed by the scepticism. He has taken several risky
decisions in the past, the biggest being to start out on his own in 2005,
without the support of his father Jahir Habib, hairstylist of Jawaharlal
Nehru. In five years, he owns a chain of 225 salons across 62 cities that
attract customers mostly because they carry his name: Jawed Habib's.

"People are amazed at my decision but I have no doubts," he says. The move
is gutsy, to say the least. Despite a wider bouquet of services, several
other companies in the beauty and wellness sector have been unable to take
this leap of faith. Vandana Luthra's Curls and Curves is a case in point.
Wellness arms of companies with deep pockets have also not been listed. For
example, Marico's popular beauty clinic, Kaya.

Globally, only a handful of salons, like Hong Kong-based Modern Beauty Salon
Holdings, have taken the public route. Even they bank on a wide range of
beauty treatments and branded beauty products to accelerate growth.
Currently, JHHBL doesn't have the comfort of either. So what makes Habib so
confident? An analysis of the industry reveals some less apparent
opportunities and prospects of scalable business model.

*
Brand Vacuum*

The hair and beauty sector forms 40% of the wellness industry. According to
a study by 2S Consulting and JHHBL, the wellness sector is valued at 6,900
crore and is growing at around 35% annually. "The size of the industry will
grow to 28,400 crore by 2015," claims Rohit Arora, JHHBL's executive
director. In the same period, the per capita spend on hair and beauty is
predicted to go up by 316%—from $1.2 to $5. However, KPMG estimates say the
size of the wellness industry in India is expected to reach 14,500 crore in
FY2014.

Though the numbers are impressive, the sector is unorganised. For instance,
hair styling is dominated by beauty product manufacturers and
personality-based players. At one end companies like L'Oreal, Keune, Wella
and Schwarzkopf have started lending their brand name to salons. On the
other end celebrity hair stylists like Aalim Hakim and Adhuna Bhabani Akhtar
in Mumbai are powering their parlours by an A-list clientele from the
glamour industry.

The opportunity lies in creating a national brand known for quality service
at reasonable prices. "Jawed Habib is positioned as a brand for the masses,
it makes sense for him to go for an IPO. No one else in the fragmented
market can do this," says Yatan Ahluwalia, image consultant and director,
Y&E Style Media. Habib claims he saw this potential early. "Through my
salons, workshops and seminars in various cities, I realised the need for a
salon in every city," he says. The IPO is his way to accomplish this.
However, an industry insider who wishes to remain anonymous doesn't think
Habib's name can pull in haut monde customers. His salons are not the 'it'
destinations.

This may have disastrous consequences in the fashion circuit. But for
business the mass market means higher revenues. This can never be bad. Habib
has a different take on this perception: "Celebrity or a common man—hair is
hair."

*Growth Pangs*

Though experts do not deny the potential, they are unsure that the business
is scalable. Lifestyle companies usually faced this problem in the past.
According to Sarabjit Kour, vice-president (research), Angel Broking,
scaling up is the biggest challenge for any company entering an unorganised
sector. The competition is high and operates at several local and regional
levels.

"Companies like Marico have not listed the Kaya brand because it has not
scaled up to such a level. It will be interesting to watch the market's
response to Habib's IPO," she adds.

Vikram Hosangady, executive director (transactions and services), KPMG India
highlights another challenge: there is a lot of interest in consumer
stocks—a company like Habib's will face the pressure of being listed and
reporting increasing profitability, very often a challenge for a small
growing business where several outlets may not have achieved scale.

He has some more doubts: "It is a personality driven company. How will Habib
ensure consistency of quality? The profit margins too are set as each salon
will accrue fixed revenues." There are HR issues as well. The beauty and
wellness industry is plagued by a talent crunch and high churn.

But the barber businessman claims to have covered all angles. His team of
managers—spearheaded by Arora, marketing and sales head Zafar Khan, human
resource manager Amrit Rao and information technology head Prakash Singh—has
spent many days honing the business model.
On doubts of whether the stock will excite investors, Arora says: "The stock
will carry a scarcity premium. We are expecting to raise 60 crore though the
IPO—25% of the total equity. This means we value the company at 240 crore."

What about giving investors their money's worth? Arora cites past data as
the company's ability to scale up quickly. In 2006, the company had a chain
of 37 salons. At the time of filing the draft red herring prospectus, the
number had zoomed to 225. Also, Habib's Hair Xpreso—a 99 dry haircut for
anyone—is catching on in malls in tier I cities. "There are multiple levels
of scalability—by adding more salons, starting franchises and exploiting the
floor space for branding," he says. JHHBL has already tied up with Katha
Media for branding the floor space of the salon for 4 crore.

Will Jawed Habib hair and beauty products flood the market in the near
future? Arora is tight lipped. But he says the option is not outside their
radar: "Salons like Lakmé and L'Oreal are a move from products to services.
We will have the advantage of transitioning from services to products."

But what will really set the business going is the craze for looking good,
always. Not just youngsters, even people past their prime want to be
groomed. As Habib says, "A good haircut is a bad habit." He's hoping the
nation will get addicted.

Thanks & regards,
Kiran B. Chheda
*CA CPA CISA*

*Every morning I check the Forbes 100 Richest Indians' list. If I am not
there, I go to work.*

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PPP in healthcare - what can make it tick?

2011-03-27T14:11:00.001+05:30

I got the opportunity to chair two sessions recently in a CII
healthcare PPP conference at Ahmedabad. I was surprised with the large
delegate turn out. Delegates from across the country had come to
attend. The good quality profile of delegates was another surprising
factor. This indicated rising interest among stakeholders in public
private partnership in healthcare.

The 'take home' points were:

1. PPP has been better successful where government has been a 'PAYOR'
where it pays for the services rendered by the private partner.
Chiranjivi program in Gujrat is a good example where the obstetrician
is paid Rs 800 for conducting one normal delivery. The government pays
the clinicians 15000 Rs in advance to boost compliance and reduce
payment delays. This has reduced maternal mortality by half there.
Other successful projects are seen in the PPP or outsourcing of
diagnostic and imaging centres which also works on a 'pay' per case
model.
And when the private partner is expected to give things beyond
service, the ppp tends to fail. The instances of seven hills hospital
in mumbai where BMC wants the private partner to pay for consumables
and medicines is putting the PPP project in doldrums.
So the 'take home' is to realistically prioritize PPP initiatives
based on a payor model (to begin with) to make it successful.
Government should understand that the private partner (unless it is a
spiritual or religious donor funded entity) is there to earn and ROI
in healthcare are very thin to expect unreasonable deliverables from
them.
2. There should be a 'solid' legal contract and not just an MOU. It
should be ensured that the agreed terms are honoured by both partners
and should be shielded from possible interference by a civic body or
state administrations and change in regimes later. One should realize
that the financial projections for private partner will be based on
agreed upon assumptions and terms at the time of signing the contract,
and any change later can make the project unviable. In all failing
PPPs the interference has always been from the public partner to
change the terms of the contract, usually when the governing
administration changed and finds some contract terms objectionable.
This has resulted in majority of private entities shying away from PPP
initiatives.
3. Even though it is expected that PPP contract terms eventually will
become better and both parties will be congenial to each other, the
projects will not take off well till the issue of Human resources and
skill sets which are deficient in huge numbers is addressed. There is
a severe dirth of doctors, nurses, front office personnel, radiology
technicians and more. A large human resource base should be set in on
priority basis to make these skill sets available as the healthcare
expansion in any form-PPP or otherwise would not takeoff if there are
no human resources available. PPP initiatives should be initiated or
intensified in healthcare education also on a priority basis.
Education loans on low interests and other incentives could be
provided to make healthcare education affordable. All this will help
creating a larger base of healthcare skill sets.
Telemedicine should be seriously looked into to mitigate the human
resource constraints where the skilled doctors from remote urban setup
can interact with patients in rural setups where these medical skill
sets are deficient.
4.Banks are unwilling to fund PPPs due the prevailing 'state of
confusion' and lack of confidence in sustenance of such projects. A
clear legal contract, setting of regulation mechanism, etc will make
prospects better for banks to look at financing such projects.
5.Private players are willing to even service rural areas and harsh
terrains - contradictory to the myth that the private players are only
urban centric. However the interest would be motivated more by
availability of clear legally binding contract terms, and under a
'payor' mechanism.
6. A national PPP policy framework should be created on immediate
basis. Though it seems that work on the same is going on, a result on
ground and adoption by all states should be visible. A standardised
contract terms keeping in mind certain popular PPP scenarios should be
looked into, to address atleast a large proportion of PPP projects in
the pipeline. All guidelines should be made to make a 'win win'
contract.

My notes:

Public and private partners need to go 'beyond' contracts and should
'work towards' making the 'marriage' successful. As the PPP phenomenon
is relatively new and has yet to gain maturity, both parties should
make an attempt to reasonably 'bend down' to accept each others
limitations and practicalities and ensure that the PPP results into a
'successful role model' for others to replicate.

Newer avenues for PPP in healthcare should be looked at. Government
should also look beyond usual health PPPs and consider partnering with
private players to improve quality (NABH accreditations/ISO) of their
existing public health setups (some work on this avenue has already
started but will need more momentum), avail from private partner -
professional administrative insights by way of managed administration
of PHCs/district hospitals, etc, and most importantly, opening up
attractive avenues in health education for the private partner for
creating the much needed skill sets to sustain the progress in
healthcare delivery.

A 'let's sign contract and will see later' attitude needs to be shed.

Everyone should keep in mind that the private party will always look
at earning and sustaining any business. It will be unreasonable to
expect the private player to 'pay out of pocket' and there fore a
'payor' model where public partner will pay the private partner for
services rendered will be a reasonable model and will work better.

Public partner should also realize that the underprivileged citizens
for whom this PPP is typically created for, would be unwilling to pay
out of pocket even for consumables. It will also be unreasonable to
expect that the private party will pay for expense on patients and
expect them to earn too. So ultimately the only party left to pay is
the public entity. A volume based highly low cost rates could be
negotiated with the private party for a 'win win' partnership. Such
volume based low cost payments have worked previously and there is no
reason why it should not work again. A effective monitoring and
regulatory mechanism though should be in place for every PPP to ensure
timely and due payments to private partner and also to ensure that the
private party delivers the right quality of service as agreed upon.

Better incentives as provided in other industries (like 150% tax
deduction in pharma research, unconditional subsidies, zero duties
etc) will be other great attractors.

There is no doubt that the healthcare needs of a nation cannot be
mitigated without PPP, and all stakeholders therefore should strive
for a successful, meaningful and reasonable sustainable partnership.

Dr Akash S Rajpal
www.akashrajpal.com

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Misery rolled back....but is it enough?

2011-03-22T18:16:00.001+05:30

News source:

Govt. rolls back five per cent healthcare tax

The Government on Tuesday rolled back the five per cent tax
healthcare, which many called the misery tax as it made treatment more
expensive.

The proposal which was put forth during the Budget invoked Opposition
from the medical fraternity.

Medical fraternity had told the minister that the health tax was a
misery tax for the common man and had explained him the consequences
of the tax.

My notes: I think Mr finance minister could have avoided unnecessary
negative publicity. This was bound to happen and some people should
not feel happy taking credit for ensuring the roll back. This tax
anyway did not generate a huge cashflow. What the fraternity should
fight for is to have all taxes removed from all goods related to
healthcare to make health care cheaper or more profitable to attract
more investments in healthcare. Investor find other industries more
attractive as the ROI is much faster and better there. Government
should understand one thing that this country needs more and more
quality infrastructure, staff and clinicians to deliver good need
based healthcare. The patient bed, patient doctor and nurse ratios are
among the poorest in the world. Government cannot invest further on
its own in providing healthcare and should partner with the private
sector. Unconditional subsidies, zero taxes (probably 150percent tax
rebates like pharma research), industry status, and creating more and
more educational and vocational institutions for creating skill sets
etc will make the industry more attractive for investment and will
ultimately counter the healthcare delivery needs of the country faster
and better and cheaper.
Dr Akash S Rajpal

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Misery tax

2011-03-10T10:44:00.001+05:30

Probably India is the only country where now citizens are taxed as punishment to fall sick.
So when you get treated in a hospital you will pay 5% tax.
Though the same is only for Airconditioned hospitals, almost every hospital has airconditioning, atleast in the OT and ICU complex. The industry has been advised and encouraged since long to go in for airconditioning keeping in mind infection control and comfort of patients.
Typically the cost of aircoinditioning infrastructure does not change drastically if some units are made devoid of airconditioning. There are many hospitals now where they provide airconditioning by default even to general class and charity catagory rooms.
Healthcare in India is unfortunately looked at a money making business, both by patients and the government. Patients are not readily willing to pay in comparison to their spend on entertainment, government is not readily willing to take measures to make the healthcare industry commercially more attractive.

Unfortunately the healthcare EBIDTAs/PAT are among the lowest among all industries. The reason why a lot PE/VC do not find it attractive to invest in healthcare and therefore the progress of healthcare infrastructure and delivery is at a snails pace.

Instead of making healthcare cheaper by eliminating taxes, surcharges, excise, import duties and allocating more in its budget, it comes out with such irrational taxes. Tax holiday on 100 beds and above for five years wont make a great difference as margins are very low in initial years.

AND yes, why should the health industry be not making money? No institution, even the charity organisations can function if it is not self sustaining. More than 80% of healthcare spend is out of pocket in India. There is a huge demand for quality health services. There is severe manpower shortage to support the healthcare delivery. Medicines are expensive, and professionals like doctors and nurses are hard to get. Instead of focusing on mitigating this deficiency, government is trying to make a quick buck on this demand, but forgetting its larger responsibility to make quality healthcare accessible to all.

I remember a colleague of mine from IT industry replying to my question: "why majority of doctors or healthcare industry does not make much money like IT industry? Pat came the reply from him : Doctors are supposed to do social work. Doctors should not think of making money. That will be unethical. They should only heal. If one has to make money then they should not become doctors." Not to mention - I was taken aback. And unfortunately this is the majority opinion of the country at large.

One should remember that there are much larger unseen consequences of running a business where margins are low. A lot of unethical practices crop up to sustain business or it shuts shop. Either way it is derogatory for the community at large.

Sincerely,
Dr Akash Rajpal
Head HOSMAC Consultancy

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UID/Bar code compulsory for drug dispensing/retailing

2011-02-21T14:47:00.000+05:30

http://timesofindia.indiatimes.com/india/Soon-bar-code-unique-no-on-pill-strips-to-check-fakes/articleshow/7529728.cms

Drug Consultative Committee (DCC) in its last meeting on Febuary 15 -- has approved the proposal that for every strip of medicine available in India ought to have a 2D bar code and a unique randomly generated numeric code (UID).

This will have various repercussions:

Among many, i feel the biggest repercussion would be that this will make the cut strips retailing a problem. The onus now will be on patient (as it is).
This may make it more unaffordable for patients to buy the medicines in short trenches.
Also as a lot of antibiotics need to be changed keeping in mind the prognosis of patient, the cut strips act as a cost saving for these patients as the unsused cut strip is taken back by the retailer. This facility though not ideal acts as a boon for the lower segment of patients in terms of cost savings, and helps the retailers too to sell to others. Many times the policy of whole strip retail leaves the patient in a lot of problem as the leftover strip is wasted (as not taken back by retailer) as the doctor had to change the drug as per prognosis.
However even now the cut strips leads to a lot of labeling issues anc can be solved with this bar coding opportunity.
The guidelines also should make it mandatory to manufacture strips in strippable/indented cuts in portions of two or four to make the purchases affordable to general public at large, with still maintaining the UID/barcode/basic labeling.
Many drug manufactures are doing this for OTC drugs, but can actually do it for other generics too.

Sincerely,
Dr Akash Rajpal

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