ISSUES AND CHALLENGES FACED BY THE HOSPITAL SECTOR IN INDIA India has very often been described as a country

of contradictions. Wherein on one hand its at power with most developed nations on some terms, there still exists a large part of the country which can be clubbed along with the third world. When we talk about the hospital sector in India, this gap is evident here too. The country houses some world class hospitals with state- of- the art facilities. But millions of its citizens are still at the mercy of poorly run, ill-equipped public sector facilities. Besides this obvious challenge of lopsided distribution, the hospital sector in India faces several other issues like:

INSUFFICIENT CAPACITY: Hospitals across the country face severe shortage in terms of basic facilities like available beds, emergency rooms etc. According to the 2012 McKinsey& Company report, Indias current bed to patient ratio is a little over 1:1000. This leads to overcrowding, delay in providing medical services and patient care.

LACK OF TRAINED MEDICAL PERSONEL: India produces approximately 27,000 doctors annually out of which 75% are based in urban areas. The state run facilities especially in rural areas pay for this distribution pattern dearly. Also, the urban and corporate hospitals are now looking to offer high end medical breakthroughs for which again there is a severe scarcity of trained doctors. Former president of the Federation of Indian Chambers of Commerce and Industry Onkar S. Kanwar noted at the Global Healthcare Conference January 2007 that while the projected physician shortfall would top 45 000 in 2012, the shortfall for nurses would be even greater roughly 350 000 nurses are required for primary and secondary care by 2015.(source: CMAJ)

SUB-OPTIMAL OPERATIONAL PERFORMANCE: Poor management framework in most hospitals often leads to inter-departmental inefficiencies, inadequate use of human resources, and suboptimal utilization of infrastructure reflects on the final delivery of healthcare services.

IMPROPER INVENTORY MANAGEMENT: Problems such as overstocking of materials, inability to monitor flow of near expiry date medicines, large stock of out of date medications, and inability to keep a track of the actual consumption of most supplies leads to exaggerated costs.

ENTRY AND EXPANSION BARRIERS: There exists a dearth of hospitals in the country both in private and public sector. The obvious answer to this problem may seem to be setting up of new hospitals or expanding existing ones. However, entry and expansion barriers are one of the major challenges faced by the hospitals today. Three types of barriers faced by potential new entrant: 1. Natural or intrinsic barriers 2. Regulatory barriers 3. Strategic barriers

Natural barrier: Natural or intrinsic barriers are the unavoidable costs incurred when setting up or expanding a commercial operation. These involve the cost of putting the production process in place, gaining access to essential facilities or inputs and the acquisition of any necessary intellectual property rights The cost of designing, building and equipping a private hospital able to provide a full range of inpatient, day-care and outpatient facilities is significant. In addition, the ability to recoup these costs in the event that entry fails to be viable is limited.

Regulatory barrier: New healthcare facilities are subject to industry-specific and general regulatory requirements and permissions. A new hospital facility will have to be approved by the relevant regulator and will require planning permission. Most of the times this is a stringent, cumbersome and a time consuming process.

Strategic barriers: The problems regarding entry and expansion which fall into this category: PMI (private medical insurance) declining to recognize new healthcare facilities, and arrangements between private healthcare providers and clinicians which may deter clinicians from working with the entrant.

The high fixed costs of hospital businesses make their profitability very sensitive to variations in patient volumes Hence the private medical insurance companies are very reluctant with new entrants.

UNPREPAREDNESS FOR DISASTER MANAGEMENT: Hospitals are the lifelines where people would be brought in huge numbers when a disaster strikes floods, earthquakes, major fire, landslides, terrorist attacks or tsunami . Hospitals should be structurally safe to withstand a disaster such as earthquake, but more importantly, a hospital should be able to function even after a disaster. Problems that hospitals face are: insufficient infrastructure to handle huge number of patients at a time, lack of trained professionals needed in such a time, doctors and nurses along with other caregivers do not have any specialized training in disaster management to deal with such situations. Stocks and supplies needed for an emergency like this is not always practical.

ISSUES REGARDING WASTE MANAGEMENT: The quantum of waste that is generated in India is estimated to be 1-2kg per bed per day in a hospital and 600 grams per day per bed in a general practitioners clinic. A hundred bedded hospital will generate 100-200 kgs of hospital waste per day. Of which 5-10% comprises of hazardous waste. (Source: Indian society of hospital waste management report). Besides infectious waste there is also cytotoxic, radioactive and corrosive waste generated in every hospital and collection, segregation and safe disposal of this waste is always an issue faced by the hospital.

OTHER CHALLENGES FACED BY THE HOSPITAL SECTOR: Long gestation period for new hospital projects. Issues regarding medical records maintenance. Huge operating costs on procedures.