Dr Virendra Chauhan
Unit Head
Shalby Hospital

Importance Of Accreditation In Improving Efficiency, Quality, And Effectiveness Of Healthcare

On the healthcare market in India

When it comes to spending money on healthcare in India vis-à-vis any developed country in the world; the difference is huge. With the lowest government spend and public spend, as a proportion of gross domestic product (GDP), and the lowest per capita health spend – China spends 5.6 times more, and the United States of America 125 times more than India. Indians met more than 62 percent of their health expenses from their personal savings, called out-of-pocket expenses, compared with 13.4 percent in the United of States of America, 10 percent in the United Kingdom, and 54 percent in China.

India’s current infrastructure is not enough to cater to the increasing demand. In India the state and central governments do offer free treatment and free medicines at government hospitals; however, being understaffed and lacking medical instruments patients have been forced to visit private hospitals. Furthermore, in some country like the United States of America, the health insurance cover is generally comprehensive, and embraces everything from consultations for, say, a fever to hospitalization. However in India, consultation to physicians is not covered under most of the policies. Only 30 days pre-/60 days post-hospitalization are covered, depending on the terms of the policy. The other expenses are to be borne by the individual.

On budgetary allocation in healthcare

Total budgetary allocation for this year to the health ministry is `52,800 crore, an 11.5 percent rise over the `47,353 crore allocated last fiscal. Even though the central government is coming up with new schemes (National Health Protection Scheme) that can cover a large population of the country; implementation of the same will be the crucial part as existing schemes are not able to attract private hospitals. NHPS aims at providing health coverage up to `5 lakhs per family to 10 crore families in the nation. That will be accounted to more than 40 percent of country’s population. Majority of the budget this year will be spent on insurance premium rather than spending on the basic healthcare need of India like clean water, better immunization, adequate nutrition, and sanitation.

Vision for health and family welfare and challenges faced while implementing health services

Healthcare for all shall be my vision for health and family welfare. India ranks 154 of the 195 countries on the global health index. Such low ranking is due to its poor performance in managing cases of TB, diabetes, heart disease, and chronic kidney diseases. Some of the challenges include:

Paucity of trained manpower. There is a severe crisis of people who have requisite skills required by a hospital. The scarcity of manpower is most highly felt for doctors, nurses, technicians, and up to some extent administrative staff too. There are many colleges and universities offering different kinds of courses but the contents of the courses are not in sync with what hospitals require; hence staff needs to be trained and taught new skills.

Attrition rate. Attrition of hospital manpower is one of the highest in any industry. There are so many alternatives job opportunities available for nurses including jobs abroad.

Digitalization. One category of staff finds it difficult to get adjusted to the new paperless platform developed. Management faces resistance from doctors as they show lack of interest in learning new digital tools.

Hospital productivity. Healthcare costs are on the rise. Increasing utility cost and thin margins on medicines and consumables are putting pressure on hospitals to do more with less without compromising on patient safety and care.

On importance of PPP in making healthcare a success

Public private partnership (PPP) is the best model possible in the country in the healthcare sector. In the PPP model two things are very important: infrastructure and footfall. Both things can been taken care of by the government. Private players need to only manage the medical equipment and professionals. Through this model impact can be created in the society by providing affordable care. Even the private player can sustain well by doing huge volume at lower margin.

In the rural region where the government is not able to penetrate well; the PPP model can flourish like anything if the right accord can be made. It is quite cumbersome to set up the diagnostics facilities in PHC and CHC in the rural area. Private players can very well manage the show if given a chance to manage. Getting quality manpower and equipment are always constraints for a government and private players have a better edge on these things.

On areas where the government should invest to make healthcare available to everyone on the go

By introducing NHPS the government is inviting private hospitals to participate in a big way. Failing to provide competitive rates may create a bigger hurdle for the government in implementing the scheme. The patient–bed ratio is a concern in India. Majority of private hospitals in urban areas find it difficult to manage the occupancy at a healthy level. Better rates, good IT support, and timely payment can boost up the scheme and may attract more private players to engage in other national level schemes as well.

Secondly central and state government led schemes need better supervision and auditing to avoid wrong billing and misusing of scheme. Furthermore current PHC and CHC need to have better infrastructure, better equipment, and sufficient manpower to have better health coverage in rural areas. Despite increasing medical seats across the country it is difficult to provide doctors and nurses in rural areas of India.

On monitoring the quality of private healthcare

The private healthcare delivery segment is very fragmented. The major population of the country is still fulfilling their healthcare needs through PHC, CHC, private clinics, and nursing homes. In recent times the need of quality in healthcare is on the rise because of various factors like insurance, competition, and public awareness; which lead to introduction of various national and international accreditation bodies. NABH (National Accreditation Board of Hospitals and Healthcare Provider) defines hospital accreditation as self-assessment and an external peer assessment process used by healthcare organizations to accurately assess their level of performance in relation to established standards. NABH mainly focuses on patient safety, employee safety, environment safety, and community safety. In India we have roughly 80,000 hospitals in public and private sectors. From these hardly 1000 hospitals across the country have applied for NABH accreditation.

At this point of time we need a mandate from the government to go for NABH for all the hospitals across the nation: private and public. In developed countries 80 percent of hospitals have insurance schemes that have impelled the hospitals to adopt best healthcare standards. Currently the IRDAI move would drive all the hospitals to opt for entry level accreditation. It is the single most used method to improve the current standard of the hospitals. The prime goal of the accreditation is to warrant that the hospitals not only achieve evidence-based practices but also give importance to efficiency, quality, and effectiveness of healthcare.

A variety of benefits can be availed by hospitals through NABH. It provides an opportunity to get empaneled by various insurance companies and other third parties. Patients also get an opportunity to give their feedback. Biggest beneficiaries are the patients as they get the treatment by credentialed medical staff.

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