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Introduction Healthcare is delivered through both the public healthcare system and the private sector in most of the countries. The public healthcare system consists of healthcare facilities run by the central and state governments, which provide services free of cost or at subsidized rates to low-income families in rural and urban areas. The government funds allocated to healthcare sector have always been low in relation to the population of the country, for example in india in 2003 it was as low as 0. 9 per cent of the GDP. In the private sector healthcare industry, healthcare facilities are owned and run by for-profit companies and non-profit or charitable organizations. Healthcare facilities run by charitable organizations also provided services at subsidized rates or free of cost depending on the income. Analysis Initially, the government imposed high custom duties on imported medical equipment making it difficult for private individuals to set up hospitals that provided specialized care using sophisticated equipment.
As a result, there were very few privately run large hospitals but there were many small private practitioners who provided primary and secondary care. Another, limitation faced by the private sector was low penetration of medical insurance which meant that almost everyone paid out of their pocket. Therefore, many could not afford to go to private hospitals, as the fees were much higher than the governments run hospitals. Gradually, with the rising population and number of people suffering from diseases that required specialized care, together with the limited government spending on healthcare, the quality of services at government run hospitals suffered. The existing government facilities were simply not enough to cater to the burgeoning population, whether it was primary, secondary or tertiary care. The private sector investment in the healthcare industry really took off in the 1990 s after the liberalization of the economy.
The number of privately run large hospitals and non-profit and charitable hospitals began to increase. The non-profit hospitals catered to low-income families that could not afford to go to corporate hospitals even though they felt that government hospitals were not providing the best care. Even though insurance industry was opened up to private sector, the penetration of medical insurance still remained very low. In 2003, it was estimated that only 10 to 15 per cent of the Indian population were covered whether it was private health insurance or government. The innovations whether in business models, in marketing & promotion or in the use of technology, have created unique experiences for patients. Disability Today the world devotes special attention to the question of disability, striving to provide the various facilities required to ensure that every disabled person has work opportunities that will help him or her to become a productive member of society.
Various institutions are cooperating in the area for the Disabled in an integrated approach and a programme to ensure that the question of disability will be dealt with in every regard: quality of services offered, ease of procedures followed, current legislation, and standards criteria to be adopted for training and rehabilitation. The approach followed by the Lebanese Company for the Development and Reconstruction of Beirut Central District (SOLIDERE) - an approach that developed into the present Accessibility for the Disabled, a Design Manual for a Barrier Free Environment, met the requirements of the Ministry of Social Affairs, and the two parties were largely in agreement on both goals and methods of implementation. I would like to site an ideal example of an institution which is very much assessable to disabled people. Such institutions are though expensive and seem to be useless initially can be of greatest advantage in long run. It not only attracts and satisfies customers but gives insight to health business.
In physical terms, the provision of such environment can be undertaken in following complementary domains. One such accepted example is as follows: Site planning: Level of the roads, access paths & parking areas shall be described in the plan along with specification of materials. Every building should have at least one access to main entrance / exit to the disabled which shall be indicated by proper signage. This entrance shall be approached through a ramp together with stepped entry. The ramp should have a landing after every 9 Metre run and in front of the doorway. Minimum size of landing shall be 1000 X 2000 mm.
Access path / walk way: Access path from plot entry and surface parking to building entrance shall be minimum of 1800 mm. wide having even surface without any step. Slope, if any shall not have gradient greater than 5 %. Selection of floor material shall be made suitably to attract or to guide visually impaired persons (limited to floor material whose colour texture is conspicuously different from that of the surrounding floor material or the material that emit different sound to guide visually impaired persons. Finishes shall have a non-slip surface with texture traversable by a wheel chair. Curbs wherever provided should blend to common level.
Parking: For parking of vehicles of disabled people the following provisions shall be made: a) Surface parking for two Equivalent Car Spaces (ECS) shall be provided near entrance for the physically handicapped persons with maximum travel distance of 30 metre from building entrance. (b) The width of parking bay shall be minimum 3. 6 metre. (c) The information stating that the space is reserved for wheel chair users shall be conspicuously displayed. (d) Guiding floor materials shall be provided or a device which guides visually impaired persons with audible signals or other devices which serves the same purpose shall be provided. Building requirements: The specified facilities for the buildings for disabled persons shall be as follow: 1) Approach to plinth level. 2) Corridor connecting the entrance / exit for the handicapped. 3) Stair-ways. 4) Lift. 5) Toilet. 6) Drinking water. Braille signage shall be provided at the above specified facilities. Approach to Plinth Level: Ramp shall be provided with non-slip material to enter the building minimum clear width of ramp shall be 1800 mm with maximum gradient 1: 12, between top and bottom of the ramp.
Length of ramp shall not exceed 9. 00 metres having 800 mm high handrail on both sides extending 300 mm beyond the ramp. Minimum gap from the adjacent wall to the handrail shall be 50 mm. Minimum clear opening for the entrance door shall be 1000 mm. Threshold shall not be raised more than 12 mm.
For stepped approach, size of tread shall not be less than 300 mm and maximum riser shall be 150 mm. Provision of 800 mm high handrails on both sides of the stepped approach similar to the ramped approach shall be made. Corridor connecting the entrance / exit for the disabled: The corridor connecting the entrance / exit for handicapped leading directly outdoors to a place where information concerning the overall use of the specified building can be provided to visually impaired person either by a person or by signs, shall be provided as follows: a) Guiding floor materials shall be provided or devices that emit sound to guide visually impaired persons. (b) The minimum width shall be 1500 mm. (c) In case there is a difference of level, slope ways shall be provided with a slope of 1: 12. (d) Handrails shall be provided for ramps / slope ways. Stairways: Stairways with open riser & provision of nosing are not permitted in such building.
Lifts: Whenever lift is required as per bye-laws, provisions of at least one lift shall be made for the wheel chair user with the following car dimensions of lift recommended for passenger lift for 13 persons capacity by Bureau of Indian Standard. Clear internal depth 1100 mm Clear internal width 2000 mm Entrance door width 910 mm A handrail not less than 600 mm long at 900 mm above floor level shall be fixed adjacent to the control panel. The lift lobby shall be of an inside measurement of 1800 mm X 2000 or more. The Braille signage will be posted outside the lifts. Operational details of lifts shall confirm to the National Building Code (NBC) and will be the responsibility of designer as well as manufacturer. Toilets: One special WC in a set of toilet shall be provided for the use of handicapped with essential provision of washbasin near the entrance for the handicapped.
a) The minimum size shall be 1500 mm X 1750 mm. (b) Minimum clear opening of the door shall be 900 mm and the door shall swing out / sliding type. (c) Suitable arrangement for vertical / horizontal handrails with 50 mm clearance from wall shall be made in the toilet. (d) The WC seat shall be 500 mm from the floor. Refuge: An alternative to immediate evacuation of a building via staircases and / or lifts is the movement of disabled persons to areas of safety within a building. If possible, they could remain there until the fire is controlled and extinguished or until rescued by fire fighters. It is useful to have the provision of a refuge area, usually at the fire protected stair landing on each floor that can safety hold one or two wheelchairs.
Have doorways with clear opening width of 900 m and complying with Section 4. 6; and Have an alarm switch installed between 900 mm and 1200 mm from the floor level. And the analyses to same can be done as follows; TOWS Areas of Opportunity Our analysis here tries to highlight various pockets of opportunity within the healthcare sector. The key areas of opportunity within the Healthcare are: Medical Infrastructure Telemedicine Medical Equipment Medical textiles Health Insurance Clinical Trials Health services outsourcing Medical value travel Training and Education Medical infrastructure forms the largest portion of the healthcare pie. As per our analysis the current (2006) bed per thousand population ratio stands at 1. 03 as against an average 4. 3 of comparable countries like China, Korea and Thailand (2002 data). Our analysis points out that in spite of the phenomenal growth in the healthcare infrastructure, we are likely to reach a bed to thousand-population ratio of 1. 85 and in a best-case scenario, a ratio of 2 by 2012. Beds in excess of 1 million need to be added to reach a ratio of 1. 85 per thousand.
Out of the total about 896, 500 beds will be added by the private sector with a total investment of 69. 7 Billion US$ over the next six years. However, the gains are commensurate in this capital intensive industry, since the revenues generated by private hospitals in the year 2012 will be to the tune of US$ 35. 9 Billion growing at a CAGR of 15 %. Despite this investment, the bed to thousand population ratio would be far from comparison with other similar developing countries. Telemedicine is another exciting opportunity, which allows even the interiors to access quality healthcare and at the same time, according to the model proposed by us, significantly improves the productivity of medical personnel.
In a country of over 1. 1 Billion people, the Healthcare system will have to innovate to double the utilization of its existing resources just to reach a stage at which comparable developing countries were in 2002. Telemedicine in our opinion is one such innovative technology, if used effectively it can double utilization of scarce human resources. We believe that it is difficult to make standalone telemedicine models feasible but if telemedicine models are integrated in a Healthcare model, such models can become viable. One important reason is that Telemedicine shall increase the patient base, which in turn will increase occupancy rates of hospitals in the integrated telemedicine model. The biggest challenge for the healthcare industry today is an acute shortage of trained personnel, ranging from doctors, nurses, technicians and even healthcare administrators.
We foresee a shortfall of over 450, 000 doctors in the year 2012. Such challenges present an opportunity for both domestic and foreign players in the form of training & education. Our analysis shows the foreign players can enter the market to take a two-fold advantage. One, they also get a piece of the booming education sector and two, they can source some of the talent for their own countries as human resources shortage in healthcare will be a global phenomenon. Medical equipment forms another promising opportunity within healthcare. Our analysis pegs the medical equipment industry at US$ 2. 17 billion in 2006 growing at 15 % per year and will reach US$ 4. 97 billion by 2012 Currently over 65 % of the medical equipments are imported and thus is a key area for forging partnerships across borders.
Engineering excellence, cost-effective labor, increasing emphasis on intellectual property rights and most importantly a fast growing domestic market makes AMERICA an ideal manufacturing base. Growth in medical infrastructure will be accompanied by demand for associated products and services. One such important industry is medical textiles, which shall almost double to a US$ 753 Million industry by 2012 from the current US$ 405 Million. Medical value travel has finally come of age and is poised to grow at 22 % annually. With hospitals moving in for quality accreditations like JCI, NABH & ISO and tie-ups between insurance players and hospitals, this sector has the potential to be a latent growth driver. A percentage of high end beds will provide treatment to medical tourists and the estimated value of the industry will reach US$ 1. 48 billion by 2012 from its current size of US$ 450 Million.
Our analysis points towards the need for stronger partnerships in healthcare, between the government and private sector. Even a realistic targets of 1. 85 beds per thousand population by 2012 needs an investment of US$ 77. 9 Billion, the government and private players need to focus on their core competencies / responsibilities and work together to reduce inefficiencies and complement each others effort. References Adaptive Environments Center, Inc. and Barrier Free Environments, Inc. , "The Americans with Disabilities Act Checklist for Readily Achievable Barrier Removal. " USA, 31 March 1992. 12 pages. American National Standards Institute. American National Standard for Buildings and Facilities: Providing Accessibility and Usability for Physically Handicapped People.
New York, 1986. 84 pages. Beckman, Mats. Building for Everyone. Stockholm, Ministry of Housing and Physical Planning, 1976. 108 pages.
The Canadian Paraplegic Association, Manitoba Division. Access: A Guide for Architects and Designers. Second Edition, Manitoba, Canada, the Canadian Paraplegic Association, Manitoba Division, 1989. Opportunities in Healthcare: FICCI Health services Division, 2007 Health Planning: A Systematic Approach By Herbert Harvey Hyman Green et al. Health Policy Plan... 1988; 3: 80 - 82 Health Services Planning; Thomas, Richard K. 2 nd ed. , 2003, 320 The Demography of Health and Health Care; Pol, L.
G. , Thomas, R. K. , 2001 An Introduction to Health Planning in Developing Countries; Andrew Green, 2003
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Research essay sample on Low Income Families Visually Impaired
