‘Though Karnataka and Maharashtra lead in patient care, people will prefer Kashmir if better facilities are provided Chairman of National Board of Quality Promotion, Associate Vice President, Head - Wockhardt Hospitals, Mumbai, member International Society for Quality Assurance in Health Care (ISQA) Dr Ravindra Karanjekar in conversation with Rising Kashmir Staffers Baba Umar and Hakeem Irfan says Kashmir is ideal for medical tourism as climate, hospitality, environment are all there.
Q: What is the status of health sector in India?
A: In India healthcare infrastructure is not supportive in terms of number of hospitals, beds, man power management. Also people don't have quality perspective in vital area like health. They don’t understand quality as important driver for standardization of health sector. In USA patient stay is only 3-4 days and in UK it is floating. For quality we need five beds per medical students. But today in India, on an average, patient stays in a hospital for 9 to 10 days on an average. If the stay is reduced say by only one day using proper pre-operative investigation in OPDs, transfer in time, and investigation by the doctors on time, it will give India 96,000 more beds a day and if it is lowered by two beds that means an increase of 1,80,000 beds. Right now there are 9 lakh beds in India and by just the quality care, 20 percent of beds can be increased.
Q: And which State meets best standards in terms of patient care?
A: Well Kerala is having about 230 nursing colleges, Karnataka has 210 and in Maharashtra we have 50 such colleges. So these are the States which are doing well in maintaining the best patient care. But again if we look at all India level, we have only 17 percent of Doctors, 28 percent Nurses, Ayurvedic doctors are 17 percent, but skilled technicians in the higher areas doesn’t even make up to 1percent. These people have to be created for a better patient care. And you need colleges to produce them. Overall we are witnessing poor administration but again if we delve further our existing infrastructure can bear the load of 40percent more staff but then the infrastructure needs to be upgraded. And unequal distribution of the resources in the health sector has to be taken care of too.
Q: And where does Kashmir stand in this ladder?
A: Kashmir is just above the middle rung. It has the appropriate environment available but proper training is missing. Infrastructure is not good in Kashmir but there is scope for improvement. Moving near the first five positions should be the aim. Though Karnataka and Maharashtra are in lead, people will prefer Kashmir if better facilities are provided to patients. Scenic beauty will do rest of the job. It is very poor as of now. There is a need of regulating and improving the private sector. There are prospective plans for areas in Singapore and USA. A particular area is marked and a limited number of medical institutes are constructed with all facilities. Then they regularly have to comply and report on certain parameters. If any setup is below normal, then all the privileges are withdrawn and they are not allowed to operate. Kashmir has the chance to come in the first five as it is a tiny state. Over all education is the key for such an attempt.
Q: What would be average bed revenue and annual earnings?
A: A 300 bed private hospital should earn around Rs 150 crore a year in any State within three years of its start. It must be, however, Joint Commission International (JCI) or National Accreditation Board for Hospitals & Healthcare providers (NABH) accredited. It is possible. At cent percent capacity utilization it can grow to Rs 850 crores. Knee joint problems and back ache is common in Kashmir. Knee joint replacement will cost around Rs 2.5 lakh in Delhi or Mumbai. If government negotiates with the concerned authorities and subsidy is provided for patients, this sector will boom here. Besides, doctors who want to specialize in a particular area should get a scholarship. Exchange of doctors should take place which will help in the overall improvement in the system.
Q: Which according to you are high revenue generating fields?
A: Joints are the most lucrative, next to that is heart, eyes and obstetrics and gynecology. My chairman will tell me why you are telling secrets. Single bed revenue in a secondary level hospital can be Rs 20-25 lakh a year. In a tertiary level hospital it is Rs 50-60 lakh a year. You can possibly concentrate on the patients who move outside the State and pay lakhs for treatment. Out of 60 lakh population of the Valley, you will manage to get several hundred patients.
Q: What is the investment needed for a tertiary or secondary level hospital?
A: The minimum viable hospital has 300 to 400 beds. See there are two ratios in which a hospital is divided. Manpower ratio and space ratio. Both are like 60:40. But revenue-wise it will be 60:40. Without land, Rs 100 crores are required for a tertiary level hospital and some Rs 40 to 50 crore for the secondary level hospital. The profitability is around 10-15 percent. I can tell you that an ICU bed can earn you around Rs 40 lakh a year while as a Ward bed can generate you Rs 4 lakh a year. It is a good revenue earning area.
Q: And employment potential?
A: For every patient you need to offer 4 – 4.5 employees. Again it may depend on what sort of ICU or wards you are offering. I feel that setting up of ICU's is also lucrative. Kashmir has negligible quality ICU's. In Kashmir, critical care is commercially very viable and even trauma centre has much greater requirements. But investment is very high. Areas like Cosmetic surgery, breast augmentation in a multi stage procedure is feasible for the State. Ophthalmic, Cosmetic surgery in bone and joints, fat removal and other areas are also very feasible to start in the State. But one needs to follow the short term and long term goals that are to be set for the change in the overall system.
Q: Can government play any role in meeting these requirements?
Government has a big role to play. See in the urban areas you have 10 beds against 1 bed in rural areas. Likewise the medical facility is available after every 16 kilometers while as it is only 1 km in cities. Government should offer incentives and encourage privatization in this area.