RESEARCH DESIGN

STATEMENT OF PROBLEM
Shampoo industry which is a part and parcel of FMCG industry has high market potential .There is high competition in this industry. To overcome the competition, different marketing strategies have to be implemented to increase market share. Statement of the problem is Comparative Analysis with respect to Sunsilk and Chik Shampoo. It is to compare Sunsilk shampoo of HUL with Chik shampoo of Cavin kare in all the aspects like sales, market coverage, brand image, brand loyalty, and characteristics of shampoo like quality, quantity, price, fragrance, colour, availability, dandruff control etc.,

SCOPE OF THE STUDY:

The study covers Comparative Analysis with respect to Sunsilk and Chik Shampoo carried at some of the specific retail outlets. The study helps dealers, wholesalers, retailers and petty shops to know the position of a particular brand of shampoo in the market.

OBJECTIVE OF THE STUDY:

The primary objective of the study is to compare the Sunsilk Shampoo with Chik Shampoo among retailers and consumers.

The other secondary objectives are:

Among retailers:
To know the opinion of the retailers about fluctuation in the sales of Sunsilk Shampoo, Chik Shampoo and other brands of shampoo.

To know the brand image of Sunsilk shampoo. To study the profitability of various brands of shampoo. Among consumers: To know the tastes and preferences of the consumers while purchasing shampoo. Factors considered in purchasing shampoo. Shampoo consumption among consumers. To find out brand image and loyalty for shampoos.

DESIGN OF THE STUDY:

The design of the study used is descriptive in nature. Descriptive research is focused on the accurate description of the variables in the problem model. Consumer profile studies, market potential studies, product usage studies, attitude surveys, sales analysis, media research, and price surveys are the examples of descriptive research. Any source of

information can be used in a descriptive study, although most studies of this nature rely heavily on secondary data source and survey research. As a part of descriptive study, survey is conducted using structured scientific questionnaire.

SOURCES OF DATA COLLECTION:

Data Collected from 2 sources. They are Primary data and secondary data:

1. Primary Data: Primary data are the data that are collected to help solve problem or take advantage of an opportunity on which a decision is pending. It can be collected through telephone, personal interview and structured questionnaire.

2. Secondary Data: Secondary data are data that were developed for some purpose other than helping to solve the problem at hand. Secondary data can be collected through following methods. The researcher has used structured scientific questionnaire and personal interview for collection of primary data from retailers and consumers.

LIMITATIONS OF THE STUDY:

It is hard fact that each study suffer from some limitations. So is the case with this study. One of the limitations of the study is, as the information is collected from the retailers, the monthly sales figure given by them is based entirely on their own judgment. So a few of them might have given the wrong figure related to their monthly sales. Another limitation was that some of the retailers were busy and could not give appropriate information. And also very few retailers did not want to share any information. Another limitation of the study was the customers who were personally interviewed did not want to share the actual data as few of them were giving fake data.

 Time constraints put boundaries to sample area and hence limited the extent of the study. Taking convenience sampling might have led to some bias as people with different age groups have different perceptions. Cost As the sample size is 50(retailers) and 110(Customers) in numbers, the appropriate. findings may or may not be

OBJECTIVE OF STUDY
The major objectives of the study have been outlined here: 1) 2) 3) 4) To know the major services provided by the Private hospitals. To know about the Patients opinion towards the best hospital To know the opportunities of healthcare sector To know the major players of the Hospital industry.

INTRODUCTION TO HEALTH CARE

Before the term health care became popular, English-speakers referred to medicine or to the health sector and spoke of the treatment and prevention of illness and disease. The social and political issue of access to healthcare in the US has led to public debate and confusing use of terms such as "health care" (medical management of illness or disease), health insurance (reimbursement of health care costs), and the public health (the collective state and range of health in a population).

The delivery of modern health care depends on an expanding group of trained professionals coming together as an interdisciplinary team. The health-care industry incorporates several sectors that are dedicated to providing services and products dedicated to improving the health of individuals. According to market classifications of industry such as the Global Industry Classification Standard and the Industry Classification Benchmark the health-care industry includes health care equipment & services and pharmaceuticals, biotechnology & life sciences. The particular sectors associated with these groups are: biotechnology, diagnostic substances, drug delivery, drug manufacturers, hospitals, medical equipment and instruments, diagnostic laboratories, nursing homes, providers of health care plans and home health care. According to government classifications of Industry, which are mostly based on the United Nations system, the International Standard Industrial Classification, health care generally consists of hospital activities, medical and dental practice activities, and other human health activities. The last class consists of all activities for human health not performed by hospitals or by medical doctors or dentists. This involves activities of, or under the supervision of, nurses, midwives, physiotherapists, scientific or diagnostic laboratiories, pathology clinics, ambulance, nursing home, or other para-medical practitioners in the field of optometry, hydrotherapy, medical massage, music therapy, occupational therapy, speech therapy, chiropody, homeopathy, chiropractice, acupuncture, etc The World Health Organization (WHO) is a specialized United Nations agency which acts as a coordinator and researcher for public health around the world. Established on 7 April 1948, and headquartered in Geneva, Switzerland, the agency inherited the mandate and

resources of its predecessor, the Health Organization, which had been an agency of the League of Nations. The WHO's constitution states that its mission "is the attainment by all peoples of the highest possible level of health." Its major task is to combat disease, especially key infectious diseases, and to promote the general health of the peoples of the world. Examples of its work include years of fighting smallpox. In 1979 the WHO declared that the disease had been eradicated - the first disease in history to be completely eliminated by deliberate human design. The WHO is nearing success in developing vaccines against malaria and schistosomiasis and aims to eradicate polio within the next few years. The organization has already endorsed the world's first official HIV/AIDS Toolkit for Zimbabwe from October 3, 2006, making it an international standard. The WHO is financed by contributions from member states and from donors. In recent years the WHO's work has involved more collaboration, currently around 80 such partnerships, with NGOs and the pharmaceutical industry, as well as with foundations such as the Bill and Melinda Gates Foundation and the Rockefeller Foundation. Voluntary contributions to the WHO from national and local governments, foundations and NGOs, other UN organizations, and the private sector (including pharmaceutical companies), now exceed that of assessed contributions (dues) from its 193 member nations.

HEALTHCARE IN INDIA
Healthcare is one of Indias largest sectors, in terms of revenue and employment, and the sector is expanding rapidly. During the 1990s, Indian healthcare grew at a compound annual rate of 16%. Today the total value of the sector is more than $34 billion. This translates to $34 per capita, or roughly 6% of GDP. By 2012, Indias healthcare sector is projected to grow to nearly $40 billion. The private sector accounts for more than 80% of total healthcare spending in India. Unless there is a decline in the combined federal and state government deficit, which

currently stands at roughly 9%, the opportunity for significantly higher public health spending will be limited.

GROWING POPULATION AND ECONOMY

One driver of growth in the healthcare sector is Indias booming population, currently 1.1 billion and increasing at a 2% annual rate. By 2030, India is expected to surpass China as the worlds most populous nation. By 2050, the population is projected to reach 1.6 billion. This population increase is due in part to a decline in infant mortality, the result of better healthcare facilities and the governments emphasis on eradicating diseases such as hepatitis and polio among infants. In addition, life expectancy is rapidly approaching

the levels of the western world. By 2025, an estimated 189 million Indians will be at least 60 years of agetriple the number in 2004, thanks to greater affluence and better hygiene. The growing elderly population will place an enormous burden on Indias healthcare infrastructure. The Indian economy, estimated at roughly $1 trillion, is growing in tandem with the population. Goldman Sachs predicts that the Indian economy will expand by at least 5% annually for the next 45 years (see chart), and that it will be the only emerging economy to maintain such a robust pace of growth.

INNOVATIONS IN HOSPITAL INDUSTRY

Auto check-in and check out Specialty hospitals Aromatherapy at Apollo. Biventricular pacing. Bone bank at AIIMS. Hospital administration. Medical records management. Oxygen under pressure treatment at Apollo. Waste management. Telemedicine. Virtual Hospitals

TECHNOLOGIES IN HOSPITAL INDUSTRY

Same day OPD Online reports Imaging/ MRI Scan Key Hole Surgery Medical transcription Biotechnology Nanotechnology SST: Self checking Machines/ equipments

MARKET SEGMENTATION FOR HOSPITALS

A market is composed of different users having different responses to market offerings. This makes it essential that hospital organizations, especially for making a microscopic

study of users needs and requirement, make possible grouping of markets. The marketing strategy formulated on the basis for segmenting the market is income. To some extent regional considerations may also be adopted as a base for segmenting the market. The below is the segmentation on the basis of regional consideration: The aforesaid segmentation makes it clear that doctors would find a variation in the living habits of both the segments. Another important base for segmenting hospital services may be income group. This helps hospital organisations in identifying the status of the users of services. It is essential as the marketing principles recommend different pricing strategies on the basis of level of income. This would help hospital organisations in charging more from high and middle income groups, charging equal to cost from the low income group and making available free services to the no income group. Another important advantage of this segmentation is concerned with implementation of modernization and expansion plan for the hospitals.

CLASSIFICATION OF HOSPITALS

The classification of Hospitals on the basis of objective, ownership, path and size.

ON THE BASIS OF THE OBJECTIVE THERE ARE THREE TYPES:

Teaching cum research for developing medicines and promoting research to improve the quality of medical aid. General hospital for treating general ailments. Special hospitals for specialized services in one or few selected areas.

ON THE BASIS OF THE OWNERSHIP, THERE ARE FOUR TYPES:

Government hospital, which is owned, managed and controlled by government Semi-government hospital, which is partially shared by the government. Voluntary organisations also run hospitals. Charitable trusts also run hospitals.

ON THE BASIS OF PATH OF TREATMENT, THERE ARE:

Allopath which is the system promoted under the English system. Ayurved, which is based on the Indian system where herbals are used for preparing medicines. Unani Homeopath

Others

ON THE BASIS OF THE SIZE, THERE ARE:

Teaching hospitals generally have 500 beds, which can be adjusted in tune with number of students. District hospital generally have 200 beds, which can be raised to 300 in contingencies. Taluka hospital generally have 50 beds that can be raised to 100 depending on the requirement. Primary health centers generally have 6 beds, which can be raised to 10.

ISM/ 8 P`s WITH REFERENCE TO HOSPITAL

PRODUCT The main product in a hospital maybe any of the following: Medical Services Medical Training Medical Education Medical Research

The main products of hospitals are medical services. The services rendered by hospitals or public health centers occupy a place of significance, especially while designing the product mix. In addition to medical care, some hospitals also impart education; training and research facilities and some hospitals also educate and train paramedical officers, nurses and other technical staff. It is thus clear that the nature of the hospital governs the designing of product mix Medical services can further be classified as follows:Emergency Out-Patient In-Patient

Intensive Care Operation

SUPPORTIVE SERVICES
To enrich the hospital services certain supportive services are found to be important e.g. sterilization, supply and maintenance of instruments, materials and garments etc. The catering department comprises the kitchen, bulk food stores and dining rooms and supplies meals in the hospital. Heated trolleys have to be used to transport meals to patients. Pharmaceutical services also occupy a significant place as they influence the treatment programme of a hospital. An official laundry is essential to provide bacteria free garments and clothes. The patients need to be provided with disinfected and clean linen. The laboratories need to be properly manned and proper diagnosis needs to be given by them to enable right medical prescription. The establishment of laboratories should be between the OPD and indoors so that both areas are covered without delay or disruption. Clinical pathology, blood bank and pathological anatomy are important areas to streamline functional management of hospital laboratories. The radiology department should have hitech facilities keeping in mind patient load of the hospital. Currently ultrasound scanning and CAT scanning have been found significant in improving services of the radiology department. The nursing services are also important among supporting services. Nursing services are managed by a matron who is assisted by a sister-in charge. The norms accepted by the Indian Nursing Council should be followed. An ideal nurse-patient ratio is 1:5 which is hardly found in Indian hospitals.

GENERAL FACILITIES
Central Enquiry For all public information related to Hospital Inpatients. Cash & Billing Multiple service counters handle all Cash & Credit transactions relating to patient services, apart from Pharmacy. In House Pharmacy with Resident Pharmacists For all prescribed medications required at any time, by the patients. Pharmacy related financial transactions are processed here. Ambulance Services The Hospital owns a fleet of Ambulances, which transport OPD/ Inpatients within the Hospital, from one block to another, as well as to & from the Hospital. In addition to these, the Hospital also uses cars for the transport of its Consultants, Visiting Doctors, Guests & Dignitaries whenever required. Common Canteen

For the staff & the visitors, serving a satisfying variety of regional cuisine.

Patient Canteen To serve food for Inpatients as per their Dietary recommendation monitored by our Dieticians.. They also serve standard regional cuisine, in keeping with the hygiene standards of Hospital food handling & processing. This is not accessible for the common public. Bank The Hospital Counter of the United Bank of India, Thakurpukur Branch, handles all types of Financial Transactions including Foreign Exchange matters. Public Toilets A pay & use facility provided by Sulabh International ensures the users with complete hygiene & safety. Apart from these, all patient service areas have multiple public Toilets, for the use of the relatives & families of patients. These are completely segregated from the toilets for patients. Guest House Comfortable accommodation, in single or double occupancy, for the scholars & delegates who collaborate with the Hospital, on its various research projects & seminars and

therefore are required to spend a few days, at the Hospital, in close proximity to the Research Institute.

AUXILIARY SERVICES
Auxiliary services consist of registration and indoors case records, stores management, transportation management, mortuary arrangement, dietary services, engineering and maintenance service etc. It is important that these services are maintained properly which would govern the successful operation of a particular department. The security arrangements, supplies, transport facilities etc cannot be ignored. For a hospital registration is a must as it helps in collecting statistics for a hospital e.g. admission, discharge and average stay of patients in the hospital. The central store issues bulk items. There are different types of stores like pharmacy stores, chemical stores, linen stores, glassware stores, surgical stores etc. For carriage of supplies and patients trolleys, wheelchairs and stretchers are used. The hospital also needs a cold storage or mortuary for preservation of dead bodies till they are claimed by relatives or for post-mortem. The dietics department plays a vital role as it provides the hospital menu to meet the needs of patients. The services of well-qualified and trained dieticians help in providing nutritious diets. The engineering and maintenance services are concerned with hospital building, furniture and other equipment. A security force is essential to provide protection to the hospital property. Personnel related with defense or police should be given preference while appointing the

security force. Thus the line services, supportive services and auxiliary services are mainly concerned with Medicare facilities available in a hospital. The designing of product mix is meant to make suitable arrangements for improving the level of services in all concerned areas and in this context the medical education, training and research services play a significant part. OTHER AUXILIARY SERVICES PROVIDED BY SOME HOSPITALS INCLUDE Rehabilitation center Physio therapy Occupational Therapy: Occupational therapy trains individuals on activities of daily living which will allow them to return home after getting cured from long drawn diseases Speech Therapy: De-addiction & mental health: Volunteer services: A few examples of areas volunteers can work include: Community Education Emergency Department Environmental Services Information Desks Marketing and Community Relations Medical Records Nutritional Services

Patient Care

MEDICAL EDUCATION: TRAINING AND RESEARCH

The teaching hospitals are mainly engaged in offering medical education facilities. Research and training facilities are also made available in these hospitals where patients are used as inputs for teaching and research both by the teachers and by those who are taught. Medical institutes and medical colleges both offer education, training and research activities with one difference being that the institutes are specialized in a particular field and colleges are generalized

LEVELS OF SERVICE:
CORE PRODUCT Treatment of human ills

EXPECTED PRODUCT Infrastructure to support reasonable number of beds Operation theatres Equipments like Cardio-respiratory supportive equipment

AUGMENTED PRODUCT Ambience: Central Air-conditioning Automation equipments (X-Ray Scanners, Printers, Photo Scanners, etc POTENTIAL PRODUCT TeleMedicines & Preventive Care

SERVICE FLOWER

Price is one of the most prominent elements in the marketing mix. Price charged must be acceptable to the target customer and it should co-ordinate with other elements of the marketing mix. Price charged by the hospitals usually depends on treatment prescribed by the respective consultants and the facilities offered to the patients. As the service is intangible it is very hard for determining the price of the particular service rendered on admission, an initial deposit will be collected at the impatient billing counter. The amount depends on the category of room and the treatment/surgical

planned. Various category of rooms, ranging from the general ward, which attends to the need of the lower classes to the deluxe suite, which attends to the need of the middle and the upper classes. The prices vary from Rs. 250 for the general ward to Rs 20,000 for the deluxe suite. A hospital does not believe in profit maximization, it aims at providing quality for its customer at a reasonable price.

PRICING METHODS IN PRIVATE HOSPITALS

1. Cost based pricing 2. Competition based pricing 3. 3. Demand based pricing

DIFFERENTIAL PRICING ALSO TAKES PLACE:

EXTERNALLY (BETWEEN TWO HOSPITALS) & INTERNALLY (WITHIN A HOSPITAL) Externally: - Between 2 hospitals even to provide the same treatment, the prices differ. Even though the operation to be might be the same, pricing differs due to the kind of the service provided pre-post operation cost is associated with the kind of service you provide & so the hospital is bound to charge the patient for it. Lilavati believes that it is not only a service organization but also a business organization but Nanavati believes that providing health care service is a charity it provides 250 free beds thus differentiating it. Lilavatis location, the training provider hygiene/ ambience all is other contributing factors.

Internally: -There is a price differentiation even between the 2 wards of the same hospitals. There is a difference between general ward and special ward where the rooms are air-conditioned and extra services are provided. Thus the pricing would be different even the doctors visiting/consultation charges are different. Sometime if the patient is very poor then the doctor may wave his fees.

PLACE In hospitals, distribution of Medicare services plays a crucial role. This focuses on the instrumentality of almost all who are found involved in making services available to the ultimate users. In case of hospitals the location of hospital plays a very important role. The kind of services a hospital is rendering is also very important for determining the location of the hospital.

Eg. Tata memorial hospital specializes in cancer treatment and is located at a centre place unlike other normal hospitals, which you can find all over other places.

It can be unambiguously accepted that the medical personnel need a fair blending of two important properties i.e. they should be professionally sound and should have in-depth knowledge at psychology. A particular doctor might be famous for his case handling records but he may not be made available for all the patients because of the place factor. Now in this case the service provided, that is the doctor may be a visiting doctor for different hospitals at different locations to beat the place factors.

Unlike other service industries, under hospital marketing all efforts should be for making available to the society the best possible medical aid. In a country like India, which is geographically vast and where majority of the population lives in the rural areas, place factor for the hospitals play a very crucial role. A typical small village / town may be having small dispensaries but they will not have super specialty hospitals. For that they will have to be dependent on the hospitals in the urban areas.

PROMOTION Customers need to be made aware of the existence of the service provided. Promotion includes advertising, sales promotion, personal selling & publicity. Hospitals generally do not undertake aggressive promotion; they rely a lot on a favorable word of mouth. To increase the clientele, a hospital may continuously introduce different health services. Hospitals conduct camps in rural areas to give medical check ups at a

reasonable price so that they approach the hospitals in the future. They generally advertise in the health & fitness magazines.

As hospitals spend millions of rupees in technology and infrastructure, it becomes necessary, that they attract patients and generate funds. In order, to do the same, the hospitals follow various marketing and brand building exercises. Some of them are listed below: 1. Many hospitals have eminent personalities from the industry in their Board of trustees. This indirectly leads to increase in, inflow of patients, working in the companies of these Trustees. Besides the presence of eminent personalities creates a sense of confidence in the minds of people. 2 Private hospitals can attract their shareholders by offering discounts. For example, a special discount of 20 percent on all preventive health checks is offered to all shareholders of Apollo Hospitals Limited. 3. Hospitals have a long-term understanding with PPOs (Preferred Provider

Organization), which further have understanding with corporates. Any case of sickness found in the employees of these corporates refer them to the PPOs which further sends them to the hospital for check-ups and treatment. 4. The success rate of crucial operations and surgeries, reflect the technological and

knowledge- based edge of the hospital over the competitors. Such successes are discussed in health magazines and newspapers, which become a natural advantage for the hospital.

5.

Some hospitals by means of their past track record have created a niche market for

themselves. For example, Hinduja is known for its high-quality healthcare at reasonable rates, whereas Lilavati Hospital is known for its five star services. 6. Hospitals hold seminars and conferences relating to specific diseases, where they

invite the doctors from all round the country, for detailed discussion. This makes the hospital well known amongst the doctors, who could in future refer complicated cases to the hospital. 7. Hospitals can also promote medical colleges. This helps them to generate extra

resources in form of fees using the same infrastructure.

PEOPLE In hospitals, the marketing mix variable people includes all the different people involved in the service providing process (internal customers of the hospitals) which includes doctors,

nurses, supporting staff etc. The earliest and the best way of having control on the quality of people will be by approving professionally sound doctors and other staff.

Hospital is a place where small activity undertaken can be a matter of life and death, so the people factor is very important. One of the major classifications of hospitals is private and government. In the government hospital the people factor has to be specially taken care of. In Indian government hospitals except a few almost all the hospitals and their personnel hardly find the behavioral dimensions significant. It is against this background that even if the users get the quality medical aid they are found dissatisfied with the rough and indecent behavior of the doctors.

PHYSICAL EVIDENCE It does play an important role in health care services, as the core benefit a customer seeks is proper diagnosis and cure of the problem. For a local small time dispensary or hospital physical evidence may not be of much help. In recent days some major super specialty hospitals are using physical evidence for distinguishing itself as something unique.

Physical evidence can be in the form of smart buildings, logos, mascots etc. a smart building infrastructure indicates that the hospital can take care of all the needs of the patient. Examples: -

1. Lilavati hospital has got a smart building, which helps, in developing in the minds of the people, the impression that it is the safest option among the different hospitals available to the people.

2. Fortis and Apollo hospitals have a unique logo, which can be easily identified.

Three Aspects of Physical Evidence are: Ambient Factors: Smell in the hospital, Effect of Colors used on walls Design Factors: Design of the rooms, plush interiors, ICU location, etc. Social Factors: Type of Patients that come to the Hospital PROCESS It is the way of undertaking transactions, supplying information and providing services in a way that is acceptable to the consumers and effective to the organizations. Since service is inseparable, it is the process through which consumers get into interaction with the service provider. Process generally forms the different tasks that are performed by the hospital. The process factor is mainly dependent on the size of the hospital and kind of service it is offering. PRODUCTIVITY AND QUALITY RELIABILITY Ensuring that Doctors are well trained and

ASSURANCE

Trust, the number of successful treatments

TANGIBLES EMPATHY RESPONSIVENESS

Gate of bldg, surrounding area, Surgery equipments, Courtesy shown by nurses, ward boys etc Emergency responsiveness

PEST ANALYSIS 1) Political Analysis: The government is reducing its hold on subsidies. There are particular pressure groups which tend to have an influence on government hospitals The cost of medicines also tends to affect hospitals besides affecting the pharmaceutical industries Relationships between neighboring countries also affect the hospital sector

2) Economic Analysis: Increase in income would lead to an increase in the standard of living. Thus peoples lifestyles changes and health is better understood. Thus there is a room for specialized treatment, doctors, and hospitals Government has made loans easily available and thus people with limited means could avail better/specialized treatment

3) Social Environment Analysis: Medical facilities have increased since there is more awareness of healthcare among the population Certain percentages of beds have to be kept for poor people. E.g. in Bombay 20% of beds has to be kept reserved for poor people. Look after the needs of local poor people. Open counseling and relief centers. Teach hygiene, sanitation among the poor masses. Safe disposal of hospitals wastes like used injection needles, waste blood etc. and taking due care of environment. Spreading awareness about various diseases through campaigns and free medical check ups.

4) Technological Environment Analysis:

Breakthrough innovation in the field of specialized equipment Communication has managed to bridge the gap between places located at long distances Test tube babies Mobility of medical services Mobile phones, credit cards (for payment purposes) etc have made doctors and medical facilities easily available

MAJOR CORPORATE PLAYERS

The Apollo Group of Hospitals: The Apollo group is India's first corporate hospital, the first to set-up hospital outside the country and the first to attract foreign investment. With 2600 beds, Apollo is one of Asia's largest healthcare players. The recent merger between its 3 group companies, Indian Hospitals Corporation Ltd., Deccan Hospitals Corporation Limited and Om Sindoori Hospitals Limited, will help the group raise money at a better rate and by consolidating inventory; it will save around 10% of the material cost. The group is planning to invest Rs.2000 crore, to build around 15 new hospitals in India, Sri Lanka, Nepal and Malaysia.

Fortis Healthcare: Fortis is the late Ranbaxy's Parvinder Singh's privately owned company. The company is a 250 crore, 200 bed cardiac hospital, located in the town of Mohali. The company also has 12 cardiac and information centers in and around the town, to arrange travel and stay for patients and family. The company has plans of increasing the capacity to around 375 beds and also plans to tie up with an overseas partner. Max India: After selling of his stake in Hutchison Max Telecom, Analjit Singh has decided to invest around 200 crores, for setting up world class healthcare services in India. Max India plans a three tier structure of medical services - Max Consultation and Diagnostic Clinics, MaxMed, a 150 bed multi-specialty hospital and Max General, a 400 bed hospital. The company has already tied up with Harvard Medical International, to undertake clinical trials for drugs, under research abroad and setting up of Max University, for education and research.

Escorts: EHIRC located in New Delhi has more than 220 beds. The hospital has a total 77 Critical Care beds to provide intensive care to patients after surgery or angioplasty, emergency admissions or other patients needing highly specialized management including Telecardiology (ECG transmission through telephone). The EHIRC is unique in the field of Preventive Cardiology with a fully developed programme of Monitored Exercise, Yoga and Meditation for Life style management.

Wockhardt & Duncans Gleneagles International: They are South Asia's first Journal of Clinical Investigation accredited super specialty hospitals. Have associations with Harvard Medical International, which gives them access to the best hospitals in the US for knowledge and research. Leader in medical tourism in India

MEDICAL TOURISM

Medical tourism (also called medical travel, health tourism or global healthcare) is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of traveling across international borders to obtain health care. Such services typically include elective procedures as well as complex specialized surgeries such as joint replacement (knee/hip), cardiac surgery, dental surgery, and cosmetic surgeries. As a practical matter, providers and customers commonly use informal channels of communication-connectioncontract, and in such cases this tends to mean less regulatory or legal oversight to assure quality and less formal recourse to reimbursement or redress, if needed.

Leisure aspects typically associated with travel and tourism may be included on such medical travel trips. Prospective medical tourism patients need to keep in mind the extra cost of travel and accommodations when deciding on treatment locations. Factors that have led to the increasing popularity of medical travel include the high cost of health care, long wait times for certain procedures, the ease and affordability of international travel, and improvements in both technology and standards of care in many countries.

OPPORTUNITIES WITHIN INDIAS HEALTHCARE SECTOR

Given the current state of Indias healthcare system, its challenges and its growth prospects, PricewaterhouseCoopers has identified a number of market opportunities for foreign companies that want to participate in the sector.

MEDICAL TOURISM ON THE RISE

Medical tourism is one of the major external drivers of growth of the Indian healthcare sector. A Google search of India medical tourism turns up more than two million results. The emergence of India as a destination for medical tourism leverages the countrys well educated, English-speaking medical staff, state-of-the-art private hospitals and diagnostic facilities, and relatively low cost to address the spiralling healthcare costs of the western world. India provides best-in-class treatment, in some cases at less than one-tenth the cost incurred in the US (see chart). Indias private hospitals excel in fields such as cardiology, joint replacement, orthopaedic surgery, gastroenterology, ophthalmology, transplants and urology.

EMERGING HEALTH INSURANCE MARKET

In recent years, there has been a liberalization of the Indian healthcare sector to allow for a much-needed private insurance market to emerge. Due to liberalization and a growing

middle class with increased spending power, there has been an increase in the number of insurance policies issued in the country. In 2001-02, 7.5 million policies were sold. By 2003-4, the number of policies issued had increased by 37%, to 10.3 million. The Insurance Regulatory and Development Authority (IRDA) eliminated tariffs on general insurance as of January 1, 2007, and this move is expected to drive additional growth of private insurance products. In the wake of liberalization, health insurance is projected to grow to $5.75 billion by 2010, according to a study by the New Delhi-based PHD Chamber of Commerce and Industry. The IRDA believes that eliminating tariffs will encourage scientific rating and adoption of better risk management practices, and lead to independent pricing for each line of business, so that premiums will be based on actual risks and costs. The implementation of the new policy also will encourage the development of innovative practices and customer-friendly options for policyholders, boosting penetration. Removal of tariffs also will result in wider acceptance of individual health coverage. Health insurance will make healthcare more affordable to larger segments of the populace, boosting healthcare expenditures per household and driving the demand for quality care. Finally, the elimination of insurance tariffs will serve as a litmus test for further legislation, such as co-payments and hospital accreditations, which the government plans to implement over the next two to three years. In the post liberalization era, some companies have been licensed to act as third party administrators of health services. The objective is to strengthen the health insurance industry and increase its penetration by bringing more professionalism to claims management, facilitating cashless services to policyholders, and reducing the claims ratio.

Currently there are 25 licensed third party administrators in the Indian health insurance industry

GROWTH OF TELEMEDICINE
Only 25% of Indias specialist physicians reside in semi-urban areas, and a mere 3 % live in rural areas. As a result, rural areas, with a population approaching 700 million, continue to be deprived of proper healthcare facilities. One solution is telemedicinethe remote diagnosis, monitoring and treatment of patients via videoconferencing or the Internet. Telemedicine is a fast-emerging trend in India, supported by exponential growth in the countrys information and communications technology (ICT) sector, and plummeting telecom costs. Several major private hospitals have adopted telemedicine services, and a number of hospitals have developed public-private partnerships (PPPs), among them Apollo, AIIMS, Narayana Hridayalaya, Aravind Hospitals and San kara Nethralaya

MEDICAL EQUIPMENT MARKET

The rebuilding of Indias healthcare infrastructure, combined with the emergence of medical tourism and telemedicine, will drive strong demand for medical equipment, such as x-ray machines, CT scanners and electrocardiograph (EKG) machines. Leading international companies market most high value medical equipment, while only consumables and disposable equipment are made locally. Many international companies

have expanded their operations in the Indian market in recent years and established manufacturing facilities to assemble equipment for the domestic market and export sales. The competition is expected to intensify with the entry of more global firms into the medical equipment marketplace.

The government is encouraging the growth of this market, through policies such as a reduction in import duties on medical equipment, higher depreciation on life-saving medical equipment (40%, up from 25%), and a number of other tax incentives

PHARMACEUTICAL INDUSTRY OPPORTUNITIES

Despite widespread poverty and inadequate public healthcare provision, India has much to offer the leading drug makers. An increase in lifestyle diseases resulting from the adoption of unhealthy western diets, combined with a growing middle class that has more disposable income to spend on treatment, will provide new opportunities for global pharmaceutical firms.

PROBLEMS FACED BY THE INDUSTRY

Low public spending on health Lack of adequate beds in the hospitals Lack of emphasis on prevention Enforcing standards of medical care rendered by hospitals and private health practitioners Extremely low bed : people ratio Dominated by Government and Charitable Hospitals Excessive overlap across primary, secondary and tertiary care Skewed towards urban populace Lack of adequate corporatization Insurance to provide financial protection from catastrophic events More research, awareness and communication and greater public involvement in understanding health issues.

CONCLUSION

The Indian healthcare sector can be viewed as a glass half empty or a glass half full. The challenges the sector faces are substantial, from the need to improve physical infrastructure to the necessity of providing health insurance and ensuring the availability of trained medical personnel. But the opportunities are equally compelling, from developing new infrastructure and providing medical equipment to delivering telemedicine solutions and conducting cost-effective clinical trials. For companies that view the Indian healthcare sector as a glass half full, the potential is enormous.