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Role of Technology and Innovation in Rural
                                     Healthcare in India

                                             5



Anshul Pachouri
Senior Researcher
Institute for Competitiveness, India
E-Mail: anshul.pachouri@competitiveness.in
Rural India: A Snapshot


Definition of Rural India
                                                                s           Monthly Per Capita Consumer Expenditure - 2009-
                                                                                                                Series1,
                                                                                          Rural ( US $)           10, 21.18
The most standard and widely accepted definition is given by
Census of India in 2001 which define an area as rural area if it
fulfills the following conditions;

(1) Population density of less than 400 sq km                                                                  Series1, 2004-
(2) Atleast 75% of the male population engaged in agriculture                               Series1, 1999-       05, 12.87
(3) No presence of Municipal Corporation or Board.                                            00, 10.80

Quick Facts                                                             Series1, 1993-
                                                                           94, 6.36
Rural India – 70 % of the total Indian population

Total Rural Population :- 833 Million Individuals

Contribution to the National Savings – 33 %
                                                                   Source: Data Extracted from Key Indicators of Household Consumer Expenditure in
                                                                   India 2009-10, Ministry of Statistics, Government of India
Contribution to Total Consumption – 57%

Contribution to Total GDP – 45%                                      • The monthly household per capita consumer expenditure (MPCE)
                                                                     in rural areas has increased by more than thrice from 1993-
(Source: IBEF, NCAER and Census of India)                            2010.

                                                                     • Rural areas are going high on spending.

                                                                     • But in the actual terms, they are spending half in comparison
                                                                     to their urban counterparts.
Rural Healthcare : Opportunities

• India BoP healthcare market is estimated to be 26.5         Shortage of Series1, Radiogr Community Health Centers
                                                                          Manpower at
billion 2005 International dollars at purchasing power                      aphers, 2724
parity dollars. In 2008                                                                                                   Series1, Genera
                                                                                                                             l Medical
• The average rural population meant to be served by each                                                                  Officers, Total
                                                                                                                           Series1, 9933
health sub-center and primary health center is more than                                                                     Specialist
6000 and 36000 respectively.                                                                                              Doctors, 11361
                                                                            Series1, Paediat
                                                                              ricians, 2991
• It is estimated that nearly 1.75 millions of beds will be
required to achieve the status of 2 beds per 1000 people,                   Series1, Physici
700,000 doctors to reach one doctor per 1000 population by             Series1,ans, 2949
                                                                                Obstetr
2025. (PWC)                                                                icians &
                                                                       Gynaecologists,
•The total capital investment to reach the above targets is                  2271
                                                                         Series1, Surgeo
estimated to be US $ 80 billion approx.                                      ns, 2583

• 8% of the total expenditure of rural people on health.                                      Series1, With
                                                                  Facilities at Primary Healthcare Centers
                                                                                                    Telephone, 54.
                                                                                               Series1, With
                                                                                                          3%
                                                                                               Computer, 47.           Series1, Reach
                                                                                                    0%                   able in all
                                                                                                                          weather
                                                                  Series1, Witho                                       conditions, 92.
                                                                     ut Water                                                5%
                                                                   Series1, Witho
                                                                  supply, 12.4%
                                                                      ut electric
                                                                    supply, 14.2%                      Series1, With
                                                                                                            4-6
                                                                                    Series1, Opera      beds, 59.3%
                                                                                         tion
                                                                                    Theatre, 36.0%
                                                                                                           Series1, Labou
                                                                                                           r Room, 64.9%
Rural Healthcare: Challenges


    Rural People Challenges                   Organizational Challenges


                                             Distribution and Reach


                         Affordability
                                             Recruiting skilled manpower


                         Accessibility
                                             Tackling social issues and local beliefs (
                                             Self medication)

                         Awareness
                                             Creating awareness among the rural
                                             consumers
                     Quality of Healthcare
                           Services
                                             Changing the mindset of the rural
                                             people
Emerging Business Models

                                                                    Changing Times in Rural Healthcare
                                                 Tele-Medicine

                                                                    With the advent of time, there has been significant change
                                                   Healthcare       in the business models practiced in
                          Primary
                                                   Information      rural healthcare and each type of healthcare is served by a
                         Healthcare
                                                     Systems        particular type of business – model
                                                                    and format.
 Emerging                                         Hospitals on
                                                                    Traditional brick and mortar model      can’t   serve   the
  Trends                                            Wheels
                                                                    healthcare needs of rural people.

                                                                    There is a need of sustainable and scalable business
                         Secondary                                  models which can cater to this potential customer base.
                                                 Tele-Medicine
                         Healthcare




                                                                   Healthcare Information Management Systems:
Telemedicine and BPO Model:
                                                                   This model also uses the ICT technologies to guide its users
A new model which is emerging today is delivering healthcare       about various good health practices.
with the help of information technology tools.
                                                                   It teaches its subscribers about the different steps they should
Companies have discovered a notion to provide doctor’s advice on   take which depend on the type of disease or health problem they
phone by using latest tele and video conferencing technologies.    encounter.
Case 1.1: Apollo Tele-Medicine

                                                                      Challenges
 Apollo Telemedicine is largest and oldest telemedicine
 network in India founded by Apollo Hospitals in 1999.                •Changing the mindset of the people towards telemedicine.
                                                                      •Winning the trust of the patients of rural areas.
 Apollo Hospitals has two concurrent businesses in rural              •Standardize the protocol of interaction between doctors and
 healthcare and telemedicine, one is under the banner of Apollo       tele-medicine center.
 Telemedicine Network Foundation and other is Apollo Reach
 Hospitals.                                                           Healthcare Delivery Model

 The company was started way back in 1983 by visionary doctor         The patients were advised from doctors from the distance
 Dr. Prathap Reddy when private healthcare was not so popular in      varying from 200 to 2800 Kms.
 India.
                                                                      The technology had enabled the telemedicine centers to scan and
                                                                      mail the X-Ray’s and other medical

 Apollo Telemedicine Networking Foundation                            The details of the patients were transferred to be multi-specialty
                                                                      hospital by using desktop software.
 First project of Telemedicine was implemented in the village
 of Aragonda in state of Andhra Pradesh by building 50 beds
 hospital connected to Apollo multi-specialty hospital of
 Chennai.

 Video conferencing tools supplied by the Indian Space Research
 Organization (ISRO) were used to make tele-medicine possible
 to reach the villages of India.

 One tele-consultation with the super specialized doctor is done at
 price of US $ 11.2-16.7 and 50 US $ if overseas consultation is
 being done.
Case 1.1: Apollo Telemedicine

ISRO                       Offering Primary and   Affordable & Quality       Managing customer           Poor Patients
                           Secondary Healthcare   health-care services in    data online                 (Subsidized)
State                      services               Tier-2 cities and rural
Governments                Tele-Medicine          areas                                                  Rich Patients

Medical
Equipment
Suppliers




                           Doctors                                           Video-conferencing
                                                                             through tele-medicine
                           Para-Medical staff                                centers

                           Diagnostic Setup
                           Medicines




Infrastructure (Hospital, Equipment, Staff)                      Fees for specialist tele consultation
Resources (Doctors, Paramedical staff)                           Fees for Primary and Secondary
Training, ICT Setup, Software                                    Healthcare Services
                                                                 Medicines
Case 1.1: Apollo Tele-Medicine


                                                                                Social Benefits
                    Social Costs
                                                           Access to quality and affordable healthcare to all, expert
       Tacking the cultural differences and creating
                                                                             opinion to the patients
                  awareness


                                                                                    Metrics
      Organization Structure & Leadership
                                                                   Number of specialists tele-consultations,
   Centralized, Technology driven, multi-skilled                                    Average
                 doctors and staff                            time taken per patient, system downtime, Cost per
                                                                  patient, quality of service, number of tests




          Results

          Today, ATNF has more than 150 tertiary hospitals which are connected to 35 specialty hospitals
          across the globe.

          Today, Apollo had done 69000 tele-consultations done by more than 100 tele-consultation
          centers setup across the globe.

          The Aragonda hospital has done more than 2000 consultations had been provided in the last
          10 years from direct video interaction with specialist doctors.
Case 1.2: Apollo Reach Hospitals

 Apollo Reach Hospitals

 In 2008, Apollo started its initiative Apollo reach hospitals to deliver low cost quality healthcare in Tier-
 2 cities, sub-urban and rural areas.

 Apollo reach hospitals also extend the telemedicine network of the group which helped the people of
 the villages to get the best advice at their reach.

 Challenges

 The Apollo reach hospitals faced the critical challenge of availability of the doctors as people don’t
 want to work in smaller cities.

 Innovation in Business Model

 The Apollo reach hospitals targets both rich and poor patients in equable manner.

 The revenue comes from the high income people and affordable healthcare was provided to the
 low income people on the other side.

 The health insurance covers RSBY hospital expenses up to Rs. 30,000 ($667) for a family of five
 people.

 The transportation costs were also covered up to a maximum of Rs. 1000 ($23) including Rs. 100
 ($2.23) per visit to the hospital or doctor.

 Apollo had also signed a loan of 50 million dollars from International Finance Corporation to
 open up more reach hospitals and telemedicine center in 2010.
Case 1.1: Apollo Tele-Medicine

ISRO                    Diagnostic Tests           Affordable & Quality       Primary & Secondary      Poor Patients
                                                   health-care services in    Healthcare               (Subsidized)
State Governments       Tele-Medicine              Tier-2 cities and
                        Consultation               rural areas                Insurance Offer          Rich Patients
Medical Equipments                                                            (RSBY)
Suppliers               Primary and
                        Secondary Healthcare




                        Doctors                                               Face2Face Consultation

                        Para-Medical staff                                    Video-Conferencing

                        Diagnostic Setup




        Infrastructure (Hospital Setup, Equipment etc)            Primary and Secondary Healthcare
        Resources (Doctors, Paramedical staff)                    Money from Insurance
        Training, ICT Setup, Software                             Medicines
Case 1.2: Apollo Reach


                   Social Costs                                                   Social Benefits

      Publishing Papers to create the awareness                     Access to quality and affordable healthcare
                                                                    Inclusion of poor people (paramedical staff)




                                                                                      Metrics
       Organization Structure & Leadership
                                                                 Poor-Rich Patients Mix, Average time taken per
    Centralized, Technology driven, multi-skilled
                                                                patient, system downtime, Cost per patient, quality
                  doctors and staff
                                                                                   of service



         Results

         The inclusive business model of Apollo Hospitals had helped to reach sustainable
         revenues
         ranging from Rs 6000 ($132) to Rs. 7000 ($154) per bed.

         It is estimated that more than 1, 00,000 patients who earn less than 2$ per day had been served
         from Apollo reach hospitals.

         The group aims to open 15 more hospitals and serve more than 400,000 patients by 2015. The
         group also aims at opening 1000 telemedicine centers by the end of 2012.
Case 2: E-Health point Services

E-Health Point services is owned by HealthPoint Services India (HIS)       Healthcare Delivery Model
started its operations in 2009 in partnership in Ashoka Foundation and
Naandi Foundation in the state of Punjab.                                  Tele-medicine consultation was done by HIS urban health
                                                                           center where doctors give their advice and diagnose by
Three projects were started simultaneously at different places by          video-conferencing tools.
providing the services of tele-medicine, diagnostic services,
pharmacy and clean drinking water supply to around 10000 people.           Doctors were recruitment from local areas so that there are
                                                                           no linguistic disadvantages and they are especially
In 2011, E-Health Points (EPHs) are operational with more than 80          trained to for providing tele-consultations.
EPH centers spreading over seven districts of Punjab.
                                                                           EPH also has the facility of performing near 70 tests and
Innovation in Business Model                                               equipped with devices like digital stethoscope, blood
                                                                           pressure monitoring machine and ECG.
The services were offered with a nominal fees of less than 1$ mostly to
make it affordable for rural households.                                   The average cost of each medical test was just $1.

The subscription was given at a very nominal fees of 1.5$ per month and
gives 20 liters of clean drinking water daily which has helped in
decreasing the water-borne diseases in rural areas.

The medicines were given to patients by licensed pharmacy available at
EPH and are sold at a discount of up to 50% on the listed prices and
directly procured from channel partners of the companies to get the cost
advantage.
Case 2: E-Health point Services
Ashoka                     Pharmacy                     Affordable & Quality      Primary Healthcare      Poor Patients
Foundation                                              health-care services in
                           Tele-Medicine                rural areas               Clean Water             Rich Patients
Naandi                     Consultation
Foundation                 Providing Clean Water

Government
of Punjab




                          Doctors                                                 Video-Conferencing
                                                                                  EPH Centers
                          Video-conferencing
                          Setup
                          Center Staff




 Infrastructure (Tele-medicine center, Equipment etc)
 Resources (Doctors, Staff)                                           Tele-medicine Fees, Medicine revenues and Clean
 Training, ICT Setup, Software                                        water subscription
Case 2: E-Health point Services


                 Social Costs                                                   Social Benefits

   Organizing awareness and information sessions             Access to quality and affordable healthcare to the poor



                                                                                    Metrics
         Organization Structure & Leadership
                                                                  Number of Patients, Average time taken per
                                                                 patient, system downtime, Medicine sales and
      Collaborative, Inclusive, Technology driven
                                                                       water subscription, service quality




          Results

          EHP has done about 29000 tele consultations, 15000 diagnoses and 35000 prescriptions have
          been given since its inception to September, 2011. T

          he impact and wider reach of EHP at bottom of the pyramid can be understood by the way
          that it has around 3,50,000 daily users of clean water in rural areas.
Case 3: Piramal E-Swasthya

Piramal E-Swasthya was started in 2008 as a social healthcare            Healthcare Delivery Model
initiative of   well    established pharmaceutical company Piramal
Healthcare in collaboration with Dean Nitin Nohria of Harvard Business
School.
                                                                                  • Patient comes to the Piramal Swasthya
Innovation in the Business Model
                                                                                    Sahayaka (Health Worker) for treatment

E-Swasthya doesn’t charge any consultation fee from the patients, they
just charge the expense of the medicines.
                                                                                  • Health Worker tell the symptom to the call
The medicines were made available to the health workers for selling to              center executive
the patients to generate instant revenues.

The marketing was done in a very effective manner to engage the
rural people and BoP households through regular messages, drug                    • Call center executive feeds the symptoms
remainders and publication of articles on telemedicine.                             as input into clinical decision support
                                                                                    system
Challenges

The patients are not ready to buy all medicines as prescribed or                  • Clinical Decision Support displays the
just don’t complete the full course of medicine.                                    recommended prescription based on
                                                                                    various algorithms
Recruit the motivated health workers which can take the model to the
next level.
                                                                                  • Doctor validates the prescription and if
To address this challenge, E-Swasthya has launched pilot project with               required talk to the patient
Government of Rajasthan to recruit ASHA (Female Government Health
workers).
Case 3: Piramal E-Swasthya

Government of               Pharmacy               Affordable & Quality     Primary Healthcare   Poor Patients
Rajasthan                                          health-care services
                            Tele-Medicine          in rural areas           Health worker        Rich Patients
Tata Consultancy
Services                    Selling Water
                            purification tablets
Vision Spring               and
                            reading glasses
Aquatabs




                           Doctors                                         Video-Conferencing
                           Health workers
                           Call center                                     Health worker
                           Clinical Support
                           Systems




 Infrastructure (Call center)                                    Medicine revenues
 Resources (Doctors, Call center Staff, Health
 worker)
 Training, ICT Setup, Clinical Support System
Case 3: Piramal E-Swasthya


                   Social Costs                                                       Social Benefits

    Awareness through publishing newspaper articles               Access to quality and affordable healthcare to the poor



                                                                                         Metrics
          Organization Structure & Leadership
                                                                       Number of Patients, Average time taken per
                                                                      patient, system downtime, Medicine sales and,
             Innovative Technology driven
                                                                                      service quality




  Results

  E-Swasthya has treated 40,000 patients through several pilot projects which were deployed .

  E-Swasthya gets on an average 1.2 patients per health worker per day in 50 operational villages.

  To cover all the costs including the operational, technological and personnel and make the model financial
  sustainable in the long run, it is required to achieve 1.7 patients per health worker per day on an
  average for 1000 villages. The figure is quite achievable as already many villages have witnessed more
  than 3 patients per health worker per day.
Conclusion

Tele-medicine has emerged as a sustainable business which can cater the healthcare needs of the rural
people and bottom of pyramid.

Tele-medicine is extremely helpful in primary and secondary healthcare, however more advancements
are required to replicate the model for tertiary healthcare in rural areas.

The use of information & communication has removed the distribution and geographical challenges in
delivering the primary and secondary healthcare in rural areas.

ICT has significantly reduced both the infrastructure and operating cost for delivering the quality
healthcare services to rural areas.

Tele-medicine has been used as market development tool by the companies to create a new market for
getting an expert doctor advice without meeting him in personal.

The emerging business models looks very promising but it’s very early to comment on their long term
scalability and sustainability. The next 2-3 years will actually show clearer picture of the future of tele-
medicine in India.

The treatment of the poor segment at cheap and affordable price is a huge social capital created by these
business models.

By giving treatment to the poor segment and people in rural areas, these business models are contributing in
the inclusive growth of India full filling the dream of “healthcare to all”.
Recommendations

Government hospitals should be converted into public private partnership models to make them more profitable and effective in
delivering the healthcare.

Companies need to make tele-medicine as their core activity rather than a side activity. They need to offer full basket of healthcare
services in order to make their business models more sustainable and scalable.

There is also a need of more advanced healthcare information management system like Nokia health tools. Healthcare information
systems can play a crucial role in preventive healthcare and creating the awareness about healthcare with the increasing penetration of
mobile phones in rural India.

The government need to give adequate subsidies and tax benefits to the companies operating in rural healthcare to make their
business models more scalable which can enhance the reach of tele medicine to different parts of the country.

It is very important that bigger companies should enter the market the tele-medicine and rural healthcare industry to develop the
market and make it more scalable and sustainable.
Role of technology and innovation in rural healthcare in India

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Role of technology and innovation in rural healthcare in India

  • 1. Role of Technology and Innovation in Rural Healthcare in India 5 Anshul Pachouri Senior Researcher Institute for Competitiveness, India E-Mail: anshul.pachouri@competitiveness.in
  • 2. Rural India: A Snapshot Definition of Rural India s Monthly Per Capita Consumer Expenditure - 2009- Series1, Rural ( US $) 10, 21.18 The most standard and widely accepted definition is given by Census of India in 2001 which define an area as rural area if it fulfills the following conditions; (1) Population density of less than 400 sq km Series1, 2004- (2) Atleast 75% of the male population engaged in agriculture Series1, 1999- 05, 12.87 (3) No presence of Municipal Corporation or Board. 00, 10.80 Quick Facts Series1, 1993- 94, 6.36 Rural India – 70 % of the total Indian population Total Rural Population :- 833 Million Individuals Contribution to the National Savings – 33 % Source: Data Extracted from Key Indicators of Household Consumer Expenditure in India 2009-10, Ministry of Statistics, Government of India Contribution to Total Consumption – 57% Contribution to Total GDP – 45% • The monthly household per capita consumer expenditure (MPCE) in rural areas has increased by more than thrice from 1993- (Source: IBEF, NCAER and Census of India) 2010. • Rural areas are going high on spending. • But in the actual terms, they are spending half in comparison to their urban counterparts.
  • 3. Rural Healthcare : Opportunities • India BoP healthcare market is estimated to be 26.5 Shortage of Series1, Radiogr Community Health Centers Manpower at billion 2005 International dollars at purchasing power aphers, 2724 parity dollars. In 2008 Series1, Genera l Medical • The average rural population meant to be served by each Officers, Total Series1, 9933 health sub-center and primary health center is more than Specialist 6000 and 36000 respectively. Doctors, 11361 Series1, Paediat ricians, 2991 • It is estimated that nearly 1.75 millions of beds will be required to achieve the status of 2 beds per 1000 people, Series1, Physici 700,000 doctors to reach one doctor per 1000 population by Series1,ans, 2949 Obstetr 2025. (PWC) icians & Gynaecologists, •The total capital investment to reach the above targets is 2271 Series1, Surgeo estimated to be US $ 80 billion approx. ns, 2583 • 8% of the total expenditure of rural people on health. Series1, With Facilities at Primary Healthcare Centers Telephone, 54. Series1, With 3% Computer, 47. Series1, Reach 0% able in all weather Series1, Witho conditions, 92. ut Water 5% Series1, Witho supply, 12.4% ut electric supply, 14.2% Series1, With 4-6 Series1, Opera beds, 59.3% tion Theatre, 36.0% Series1, Labou r Room, 64.9%
  • 4. Rural Healthcare: Challenges Rural People Challenges Organizational Challenges Distribution and Reach Affordability Recruiting skilled manpower Accessibility Tackling social issues and local beliefs ( Self medication) Awareness Creating awareness among the rural consumers Quality of Healthcare Services Changing the mindset of the rural people
  • 5. Emerging Business Models Changing Times in Rural Healthcare Tele-Medicine With the advent of time, there has been significant change Healthcare in the business models practiced in Primary Information rural healthcare and each type of healthcare is served by a Healthcare Systems particular type of business – model and format. Emerging Hospitals on Traditional brick and mortar model can’t serve the Trends Wheels healthcare needs of rural people. There is a need of sustainable and scalable business Secondary models which can cater to this potential customer base. Tele-Medicine Healthcare Healthcare Information Management Systems: Telemedicine and BPO Model: This model also uses the ICT technologies to guide its users A new model which is emerging today is delivering healthcare about various good health practices. with the help of information technology tools. It teaches its subscribers about the different steps they should Companies have discovered a notion to provide doctor’s advice on take which depend on the type of disease or health problem they phone by using latest tele and video conferencing technologies. encounter.
  • 6. Case 1.1: Apollo Tele-Medicine Challenges Apollo Telemedicine is largest and oldest telemedicine network in India founded by Apollo Hospitals in 1999. •Changing the mindset of the people towards telemedicine. •Winning the trust of the patients of rural areas. Apollo Hospitals has two concurrent businesses in rural •Standardize the protocol of interaction between doctors and healthcare and telemedicine, one is under the banner of Apollo tele-medicine center. Telemedicine Network Foundation and other is Apollo Reach Hospitals. Healthcare Delivery Model The company was started way back in 1983 by visionary doctor The patients were advised from doctors from the distance Dr. Prathap Reddy when private healthcare was not so popular in varying from 200 to 2800 Kms. India. The technology had enabled the telemedicine centers to scan and mail the X-Ray’s and other medical Apollo Telemedicine Networking Foundation The details of the patients were transferred to be multi-specialty hospital by using desktop software. First project of Telemedicine was implemented in the village of Aragonda in state of Andhra Pradesh by building 50 beds hospital connected to Apollo multi-specialty hospital of Chennai. Video conferencing tools supplied by the Indian Space Research Organization (ISRO) were used to make tele-medicine possible to reach the villages of India. One tele-consultation with the super specialized doctor is done at price of US $ 11.2-16.7 and 50 US $ if overseas consultation is being done.
  • 7. Case 1.1: Apollo Telemedicine ISRO Offering Primary and Affordable & Quality Managing customer Poor Patients Secondary Healthcare health-care services in data online (Subsidized) State services Tier-2 cities and rural Governments Tele-Medicine areas Rich Patients Medical Equipment Suppliers Doctors Video-conferencing through tele-medicine Para-Medical staff centers Diagnostic Setup Medicines Infrastructure (Hospital, Equipment, Staff) Fees for specialist tele consultation Resources (Doctors, Paramedical staff) Fees for Primary and Secondary Training, ICT Setup, Software Healthcare Services Medicines
  • 8. Case 1.1: Apollo Tele-Medicine Social Benefits Social Costs Access to quality and affordable healthcare to all, expert Tacking the cultural differences and creating opinion to the patients awareness Metrics Organization Structure & Leadership Number of specialists tele-consultations, Centralized, Technology driven, multi-skilled Average doctors and staff time taken per patient, system downtime, Cost per patient, quality of service, number of tests Results Today, ATNF has more than 150 tertiary hospitals which are connected to 35 specialty hospitals across the globe. Today, Apollo had done 69000 tele-consultations done by more than 100 tele-consultation centers setup across the globe. The Aragonda hospital has done more than 2000 consultations had been provided in the last 10 years from direct video interaction with specialist doctors.
  • 9. Case 1.2: Apollo Reach Hospitals Apollo Reach Hospitals In 2008, Apollo started its initiative Apollo reach hospitals to deliver low cost quality healthcare in Tier- 2 cities, sub-urban and rural areas. Apollo reach hospitals also extend the telemedicine network of the group which helped the people of the villages to get the best advice at their reach. Challenges The Apollo reach hospitals faced the critical challenge of availability of the doctors as people don’t want to work in smaller cities. Innovation in Business Model The Apollo reach hospitals targets both rich and poor patients in equable manner. The revenue comes from the high income people and affordable healthcare was provided to the low income people on the other side. The health insurance covers RSBY hospital expenses up to Rs. 30,000 ($667) for a family of five people. The transportation costs were also covered up to a maximum of Rs. 1000 ($23) including Rs. 100 ($2.23) per visit to the hospital or doctor. Apollo had also signed a loan of 50 million dollars from International Finance Corporation to open up more reach hospitals and telemedicine center in 2010.
  • 10. Case 1.1: Apollo Tele-Medicine ISRO Diagnostic Tests Affordable & Quality Primary & Secondary Poor Patients health-care services in Healthcare (Subsidized) State Governments Tele-Medicine Tier-2 cities and Consultation rural areas Insurance Offer Rich Patients Medical Equipments (RSBY) Suppliers Primary and Secondary Healthcare Doctors Face2Face Consultation Para-Medical staff Video-Conferencing Diagnostic Setup Infrastructure (Hospital Setup, Equipment etc) Primary and Secondary Healthcare Resources (Doctors, Paramedical staff) Money from Insurance Training, ICT Setup, Software Medicines
  • 11. Case 1.2: Apollo Reach Social Costs Social Benefits Publishing Papers to create the awareness Access to quality and affordable healthcare Inclusion of poor people (paramedical staff) Metrics Organization Structure & Leadership Poor-Rich Patients Mix, Average time taken per Centralized, Technology driven, multi-skilled patient, system downtime, Cost per patient, quality doctors and staff of service Results The inclusive business model of Apollo Hospitals had helped to reach sustainable revenues ranging from Rs 6000 ($132) to Rs. 7000 ($154) per bed. It is estimated that more than 1, 00,000 patients who earn less than 2$ per day had been served from Apollo reach hospitals. The group aims to open 15 more hospitals and serve more than 400,000 patients by 2015. The group also aims at opening 1000 telemedicine centers by the end of 2012.
  • 12. Case 2: E-Health point Services E-Health Point services is owned by HealthPoint Services India (HIS) Healthcare Delivery Model started its operations in 2009 in partnership in Ashoka Foundation and Naandi Foundation in the state of Punjab. Tele-medicine consultation was done by HIS urban health center where doctors give their advice and diagnose by Three projects were started simultaneously at different places by video-conferencing tools. providing the services of tele-medicine, diagnostic services, pharmacy and clean drinking water supply to around 10000 people. Doctors were recruitment from local areas so that there are no linguistic disadvantages and they are especially In 2011, E-Health Points (EPHs) are operational with more than 80 trained to for providing tele-consultations. EPH centers spreading over seven districts of Punjab. EPH also has the facility of performing near 70 tests and Innovation in Business Model equipped with devices like digital stethoscope, blood pressure monitoring machine and ECG. The services were offered with a nominal fees of less than 1$ mostly to make it affordable for rural households. The average cost of each medical test was just $1. The subscription was given at a very nominal fees of 1.5$ per month and gives 20 liters of clean drinking water daily which has helped in decreasing the water-borne diseases in rural areas. The medicines were given to patients by licensed pharmacy available at EPH and are sold at a discount of up to 50% on the listed prices and directly procured from channel partners of the companies to get the cost advantage.
  • 13. Case 2: E-Health point Services Ashoka Pharmacy Affordable & Quality Primary Healthcare Poor Patients Foundation health-care services in Tele-Medicine rural areas Clean Water Rich Patients Naandi Consultation Foundation Providing Clean Water Government of Punjab Doctors Video-Conferencing EPH Centers Video-conferencing Setup Center Staff Infrastructure (Tele-medicine center, Equipment etc) Resources (Doctors, Staff) Tele-medicine Fees, Medicine revenues and Clean Training, ICT Setup, Software water subscription
  • 14. Case 2: E-Health point Services Social Costs Social Benefits Organizing awareness and information sessions Access to quality and affordable healthcare to the poor Metrics Organization Structure & Leadership Number of Patients, Average time taken per patient, system downtime, Medicine sales and Collaborative, Inclusive, Technology driven water subscription, service quality Results EHP has done about 29000 tele consultations, 15000 diagnoses and 35000 prescriptions have been given since its inception to September, 2011. T he impact and wider reach of EHP at bottom of the pyramid can be understood by the way that it has around 3,50,000 daily users of clean water in rural areas.
  • 15. Case 3: Piramal E-Swasthya Piramal E-Swasthya was started in 2008 as a social healthcare Healthcare Delivery Model initiative of well established pharmaceutical company Piramal Healthcare in collaboration with Dean Nitin Nohria of Harvard Business School. • Patient comes to the Piramal Swasthya Innovation in the Business Model Sahayaka (Health Worker) for treatment E-Swasthya doesn’t charge any consultation fee from the patients, they just charge the expense of the medicines. • Health Worker tell the symptom to the call The medicines were made available to the health workers for selling to center executive the patients to generate instant revenues. The marketing was done in a very effective manner to engage the rural people and BoP households through regular messages, drug • Call center executive feeds the symptoms remainders and publication of articles on telemedicine. as input into clinical decision support system Challenges The patients are not ready to buy all medicines as prescribed or • Clinical Decision Support displays the just don’t complete the full course of medicine. recommended prescription based on various algorithms Recruit the motivated health workers which can take the model to the next level. • Doctor validates the prescription and if To address this challenge, E-Swasthya has launched pilot project with required talk to the patient Government of Rajasthan to recruit ASHA (Female Government Health workers).
  • 16. Case 3: Piramal E-Swasthya Government of Pharmacy Affordable & Quality Primary Healthcare Poor Patients Rajasthan health-care services Tele-Medicine in rural areas Health worker Rich Patients Tata Consultancy Services Selling Water purification tablets Vision Spring and reading glasses Aquatabs Doctors Video-Conferencing Health workers Call center Health worker Clinical Support Systems Infrastructure (Call center) Medicine revenues Resources (Doctors, Call center Staff, Health worker) Training, ICT Setup, Clinical Support System
  • 17. Case 3: Piramal E-Swasthya Social Costs Social Benefits Awareness through publishing newspaper articles Access to quality and affordable healthcare to the poor Metrics Organization Structure & Leadership Number of Patients, Average time taken per patient, system downtime, Medicine sales and, Innovative Technology driven service quality Results E-Swasthya has treated 40,000 patients through several pilot projects which were deployed . E-Swasthya gets on an average 1.2 patients per health worker per day in 50 operational villages. To cover all the costs including the operational, technological and personnel and make the model financial sustainable in the long run, it is required to achieve 1.7 patients per health worker per day on an average for 1000 villages. The figure is quite achievable as already many villages have witnessed more than 3 patients per health worker per day.
  • 18. Conclusion Tele-medicine has emerged as a sustainable business which can cater the healthcare needs of the rural people and bottom of pyramid. Tele-medicine is extremely helpful in primary and secondary healthcare, however more advancements are required to replicate the model for tertiary healthcare in rural areas. The use of information & communication has removed the distribution and geographical challenges in delivering the primary and secondary healthcare in rural areas. ICT has significantly reduced both the infrastructure and operating cost for delivering the quality healthcare services to rural areas. Tele-medicine has been used as market development tool by the companies to create a new market for getting an expert doctor advice without meeting him in personal. The emerging business models looks very promising but it’s very early to comment on their long term scalability and sustainability. The next 2-3 years will actually show clearer picture of the future of tele- medicine in India. The treatment of the poor segment at cheap and affordable price is a huge social capital created by these business models. By giving treatment to the poor segment and people in rural areas, these business models are contributing in the inclusive growth of India full filling the dream of “healthcare to all”.
  • 19. Recommendations Government hospitals should be converted into public private partnership models to make them more profitable and effective in delivering the healthcare. Companies need to make tele-medicine as their core activity rather than a side activity. They need to offer full basket of healthcare services in order to make their business models more sustainable and scalable. There is also a need of more advanced healthcare information management system like Nokia health tools. Healthcare information systems can play a crucial role in preventive healthcare and creating the awareness about healthcare with the increasing penetration of mobile phones in rural India. The government need to give adequate subsidies and tax benefits to the companies operating in rural healthcare to make their business models more scalable which can enhance the reach of tele medicine to different parts of the country. It is very important that bigger companies should enter the market the tele-medicine and rural healthcare industry to develop the market and make it more scalable and sustainable.