SUMMER TRAINNING REPORT

ON

“HEALTH INFRASTRUCTURE OF INDIA”

Submitted in Partial Fulfillment of the Requirement for the award of the degree

MASTER OF BUSINESS ADMINISTRATION

Submitted By

AJAY BHARDWAJ

ROLL NO. 12217087

Under The Guidance Of

DR. ANUPAM SHARMA

Associate Professor

MAHARISHI MARKANDESHWAR INSTITUTE OF MANAGEMENT

MAHARISHI MARKANDESHWAR (DEEMED TO BE UNIVERSITY)

MULLANA- AMBALA, HARYANA

(2022-2023)

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2
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 DECLARATION BY STUDENT

I, Mr. AJAY BHARDWAJ student of MBA belong in to MM INSITUTE OF

MANAGEMENT, MAHARISHI MARKANDESHWAR (DEEMED TO BE
UNIVERSITY), declare that this Project Report / Dissertation entitled A PROJECT
REPORT ‘HEALTH INFRASTRUCTURE OF INDIA’ is the result of project /
dissertation work done by me under the supervision of DR. ANUPAM at MMIM,
MAHARISHI MARKANDESHWAR (DEEMED TO BE UNIVERSITY). I am
submitting this Project Report / Dissertation in partial fulfillment of the requirements for
the award of the degree of MASTER OF BUSINESS ADMINSTRATIVE by the
MAHARISHI MARKANDESHWAR (DEEMED TO BE UNIVERSITY) MULLANA,
AMBALA during the academic year 2022-2023. I further declare that this project /
dissertation report or any part of it has not been submitted for award of any other Degree
/ Diploma of this University or any other University/ Institution.

(AJAY BHARDWAJ)

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 CERTIFICATE BY GUIDE

This is certify that the report of the project submitted is the outcome of the project work
entitled “HEALTH INFRASTRUCTURE OF INDIA” carried out by AJAY
BHARDWAJ bearing Roll no. 12217087 .carried by under my guidance and supervision
for the award of Degree in Master of Business Administration of Maharishi
Markandeshwar (Deemed to be) University, Mullana, Ambala, Haryana.

DR. ANUPAM SHARMA

(Associate Professor)

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 ACKNOWLEDGEMENT

This is a matter of pleasure for me to acknowledge my deep sense of gratitude to

MAHARISHI MARKANDESHWAR (DEEMED TO BE UNIVERSITY) and MM
INSTITUTE OF MANAGEMENT for giving me an opportunity to explore my abilities
via this Dissertation.

I would like to express my sincere gratitude to my guide DR. ANUPAM for her valuable
guidance and advice in completing this project report and for the whole hearted support
extended to me throughout the conduct of the study. Sir gave me lot of inputs and
suggestions to bring out the best in me.

I would like to thank ADITYA KIRTI and team for their support and guidance regarding
the project work at EJY HEALTH. In fact it is very difficult to acknowledge all the
names and nature of help and encouragement provided by them.

I am also very thankful and grateful to my friends for their support, encouragement, and
valuable suggestions for the completion of this project report.

Last but not the least, I would like to express my sincere thanks to my family members,
friends for their immense support and best wishes throughout the study and the
preparation of this report.

AJAY BHARDWAJ

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 EXECUTIVE SUMMARY

Health Infrastructure in India

1. Favourable investment environment
• Conducive policies for encouraging FDI, tax benefits, and favourable Government
policies coupled with promising growth prospects have helped the industry attract
private equity (PE), venture capitals (VCs) and foreign players.

2. Fourth-largest employer
• India climbed to the 63rd rank among 190 countries in the World Bank’s ‘Ease of
Doing Business’ rankings in 2020.
• As of 2021, the Indian healthcare sector is one of India’s largest employers as it
employs a total of 4.7 million people. The sector has generated 2.7 million additional
jobs in India between 2017-22 over 500,000 new jobs per year.
• The Asian Research and Training Institute for Skill Transfer (ARTIST) announced
plans to create around one million skilled healthcare providers by 2022.

3. Strong fundamentals and cost advantage

• Rising income levels, an ageing population, growing health awareness and a
changing attitude towards preventive healthcare is expected to boost healthcare
services demand in the future.
• The low cost of medical services has resulted in a rise in the country’s medical
tourism, attracting patients from across the world. Moreover, India has emerged as a
hub for R&D activities for international players due to its relatively low cost of
clinical research.
4. Impressive growth prospects
• The Indian healthcare sector is expected to record a three-fold rise, growing at a
CAGR of 22% between 2016–2022 to reach US$ 372 billion in 2022 from US$ 110
billion in 2016.

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 • As of 21 March, 2022, more than 181.52 crore COVID-19 vaccine doses have been
administered across the country.
• By FY22, Indian healthcare infrastructure is expected to reach US$ 349.1 billion.

Advantage India

1. Rising manpower
• Availability of a large pool of welltrained medical professionals in the country.
• The number of allopathic doctors with recognised medical qualifications (under the
I.M.C Act) registered with state medical councils/national medical council increased
to 1.27 million in July 2021, from 0.83 million in 2010.
2. Strong demand
• Rising income, greater health awareness, lifestyle diseases and increasing access to
insurance will contribute to growth.
• The healthcare sector, as of 2021, is one of India’s largest employers, employing a
total of 4.7 million people.
3. Policy and government support
• The Government aims to develop India as a global healthcare hub.
• Public health surveillance in India will further strengthen the health systems.
• In the Union Budget 2022, the government allocated Rs. 86,200.65 crore (US$
11.28 billion) to the Ministry of Health and Family Welfare (MoHFW).
• In March 2021, the Parliament passed the National Commission for Allied,
Healthcare Professions Bill 2021, which aims to create a body that will regulate and
maintain educational and service standards for healthcare professionals.
4. Attractive opportunities
• The Government of India aims to increase healthcare spending to 3% of the Gross
Domestic Product (GDP) by 2022.
• Two vaccines (Bharat Biotech's Covaxin and Oxford-AstraZeneca’s Covishield
manufactured by Serum Institute of India) – were instrumental in medically
safeguarding the Indian population and those of 100+ countries against COVID-19.

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Market overview and trends

Hospitals Pharmaceutical Diagnostics Medical equipment and supplies Medical

insurance Telemedicine Private hospitals –

It includes nursing homes and mid-tier and top-tier private hospitals. Government
hospitals –

It includes healthcare centres, district hospitals and general hospitals.

It includes manufacturing, extraction, processing, purification and packaging of chemical

materials for use as medications for humans or animals.

It comprises businesses and laboratories that offer analytical or diagnostic services,

including body fluid analysis.

It includes establishments primarily manufacturing medical equipment and supplies, e.g.

surgical, dental, orthopaedic, ophthalmologic, laboratory instruments, etc.

It includes health insurance and medical reimbursement facility, covering an individual’s

hospitalisation expenses incurred due to sickness. Telemedicine has enormous potential
in meeting the challenges of healthcare delivery to rural and remote areas besides several
other applications in education, training and management in health sector.

The healthcare market functions through five segments Source: Hospital Market – India
by Research on India Healthcare 8 Strong growth in healthcare expenditure over the
years.

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 INDEX

SR. NO. CONTENT PAGE NO.

1. INTRODUCTION 11-31

2. INDUSTRY PROFILE 32-38

3. COMPANY PROFILE 39-40

4. LITERATURE REVIEW 41-42

5. RESEARCH METHODOLOGY 43-45

6. DATA ANALYSIS AND 46-56

INTERPRETATION

7. FINDINGS AND CONCLUSION 57-58

8. SUGGESTIONS 59-61

9. REFERENCES 62

10. ANNEXURE 63-65

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 INTRODUCTION

Healthcare infrastructure in India

Strong growth in healthcare expenditure over the years Source:

▪ Healthcare has become one of India's largest sectors, both in terms of revenue and
employment. The industry is growing at a tremendous pace owing to its strengthening
coverage, service and increasing expenditure by public as well private players.

▪ Between 2016–22, the market is expected to record a CAGR of 22.52%.

▪ The total industry size is estimated to reach US$ 372 billion by 2022.

▪ The e-health market size is estimated to reach US$ 10.6 billion by 2025.

▪ In November 2021, the Government of India, the Government of Meghalaya and the
World Bank signed a US$ 40 million health project for the state of Meghalaya. This
project will improve the quality of health services and strengthen the state’s capacity to
handle future health emergencies, including the COVID-19 pandemic.

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Per capita healthcare expenditure has risen at a fast pace

▪ This is due to rising income, easier access to high-quality healthcare facilities and
greater awareness of personal health and hygiene.

▪ Greater penetration of health insurance aided the rise in healthcare spending, a trend
likely to intensify in the coming decade.

▪ Economic prosperity is driving the improvement in affordability for generic drugs in the
market.

▪ In the Economic Survey of 2022, India’s public expenditure on healthcare stood at 2.1%
of GDP in 2021-22 against 1.8% in 2020- 21 and 1.3% in 2019-20. The Government is
planning to increase public health spending to 2.5% of the country's GDP by 2025

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Healthcare infrastructure has risen at a fast pace

▪ India’s medical educational infrastructure has grown rapidly in the last few decades.

▪ By FY22, Indian healthcare infrastructure is expected to reach US$ 349.1 billion.

▪ As of January 2022, the number of medical colleges in India stood at 595.

▪ The number of allopathic doctors, with recognised medical qualifications (under the
I.M.C Act), registered with state medical councils/national medical council increased to
1.27 million in July 2021, from 0.83 million in 2010

. ▪ As per information provided to the Lok Sabha by the Minister of State for Health &
Family Welfare, Dr. Bharati Pravin Pawar, the doctor population ratio in the country is
1:854, assuming 80% availability of 12.68 lakh registered allopathic doctors and 5.65
lakh AYUSH doctors.

▪ In September 2021, Union Minister for Road Transport & Highways Mr. Nitin Gadkari
expressed that the country needs at least 600 medical colleges, 50 AIIMS-like institutions
and 200 super-specialty hospitals. Also, he called for the need to replicate the
infrastructure development sector's public-private partnership model in the healthcare
sector.

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Notable trends in the Indian healthcare sector

1. Shift from communicable to lifestyle diseases

• With increasing urbanisation and problems related to modern-day living in urban

settings, currently about 50% of spending on in-patient beds is for lifestyle diseases – this
has increased the demand for specialised care. In India, lifestyle diseases have replaced
traditional health problems. • Most lifestyle diseases are caused by high cholesterol, high
blood pressure, obesity, poor diet and alcohol.

2. Expansion to Tier II and Tier III cities

• Vaatsalya Healthcare is one of the first hospital chains to start focus on tier II and tier
III cities for expansion

. • To encourage the private sector to establish hospitals in these cities, the Government
has relaxed taxes on these hospitals for the first five years.

3. Emergence of telemedicine

• Telemedicine is a fast-emerging sector in India. Virtual care - constituting teleconsult,

telepathology, teleradiology and epharmacy—is experiencing a stimulus in India. Major
hospitals (Apollo, AIIMS, Narayana Hrudayalaya) have adopted telemedicine services
and entered into a number of PPPs.

• According to a study (survey of consumers, doctors and stakeholders from pharma

companies and global EY research) by EY, in collaboration with the Indian
Pharmaceutical Alliance in September 2020, the domestic telemedicine market is
expected to reach US$ 5.5 billion by 2025.

• By September 21, 2021, the Health Ministry’s eSanjeevani telemedicine service

crossed 12 million teleconsultations since its launch, enabling patient-to-doctor
consultations, from the confines of their homes, and doctor-to-doctor consultations.

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4. Rising adoption of artificial intelligence (AI)

• Rising adoption of AI-based applications has enabled people to talk directly to doctors,
physicians, and get expertise for the best treatment.

• It is also capable of solving problems of patients, doctors, and hospitals as well as the
overall healthcare industry.

• In April 2021, Tata Trust’s initiative called India Health Fund (IHF) announced the
onboarding of two AI start-ups—TrakItNow Technologies - an IoT and AI-based
solution that is in development stage with immense potential to impact mosquito borne
diseases, and Stellar Diagnostics (SDIL).

5. Introduction of digital vaccine delivery platform

• In December 2020, a new COVID-19 vaccine delivery digital platform called ‘CoWIN’
was prepared to deliver vaccines. As a beneficiary management tool with different
modules, this user-friendly mobile app for recording vaccine data is in the process of
establishing the ‘Healthcare Workers’ database, which is in an advanced stage across all
states/UTs.

• In July 2021, India made its Covid19 vaccination platform, CoWIN, open source for all
countries. Almost 76 countries have displayed interest in leveraging the CoWIN platform
to manage their national COVID-19 vaccination drives.

6. Increasing penetration of health insurance

• In FY21, gross healthcare insurance stood at 29.5% of the overall gross direct premium
income by non-life insurers segment.

• Health insurance is gaining momentum in India. Gross direct premium income

underwritten by health insurance companies grew 13.3% YoY in FY 21 to Rs. 58,572.46
crore (US$ 7.9 billion).

• In June 2021, the government announced that the ‘Pradhan Mantri Garib Kalyan
Package (PMGKP) Insurance Scheme for Health Workers Fighting COVID-19’, which

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was launched in March 2020, has been extended for one more year. The insurance
scheme provides comprehensive personal accident cover of Rs. 50 lakh (US$ 68,189.65)
to all healthcare providers, including community health workers and private health
workers. It was drafted by the government for the care of COVID-19 patients and those
who may have come in direct contact with COVID-19 patients and were at risk of being
infected by the virus. The scheme is being implemented through New India Assurance
Company (NIACL).

7. Focus on universal immunization programmes (UIP)

• As of December 2020, under universal immunization programmes, ~1.54 lakh ANMs

(auxiliary nurse midwives) are operating as COVID-19 vaccinators. For further
expansion of vaccinators, the government plans to take collaborative effort with states
and UTs.

8. Technological initiatives

• Digital Health Knowledge Resources, Electronic Medical Record, Mobile Healthcare,

Electronic Health Record, Hospital Information System, PRACTO, Technology-enabled
care, telemedicine and Hospital Management Information Systems are some of the
technologies gaining wide acceptance in the sector.

• In June 2021, the Uttar Pradesh government announced the introduction of automatic
medicine dispensing machines to expand the primary healthcare industry and clinical
centres in the country. The state health department has been nominated to design an
action plan and install ‘Health ATMs’ walk-in medical kiosks, with combined medical
devices for basic laboratory testing, emergency offerings, cardiology, neurology,
pulmonary and gynaecology testing services that will be operated by a medical assistant
in all 75 districts of Uttar Pradesh.

• In June 2021, AstraZeneca India signed a memorandum of understanding (MoU) with

Docon Technologies, a Bengaluru-based health start-up, to digitise 1,000 clinics across
India by implementing customised electronic medical record (EMR) systems in clinics to
offer doctors access to a patient’s complete medical history.

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• In December 2021, Eka Care became the first CoWIN-approved organization in India,
through which users could book their vaccination slot, download their certificate and
even create their Health IDs.

Health community and health clubs are the organizations that are dedicated to improving
public health through providing them facilities at affordables cost.

Health communities and Clubs are effective modes for changing knowledge, attitude and
practices on environmental health issues.

Some facts and figure

Number of Hospitals and Doctors

Government Hospitals- 25778

Private Hospital- 43000

1301,319 allopathic doctors registered with state medical council and the national
medical commission as of November 2021

The Indian medical education system has been able to pull through a major turnaround
and has been successfully able to double the numbers of MBBS graduate positions during
recent decades. With more than 479 medical schools, India has reached the capacity of an
annual intake of 67,218 MBBS students at medical colleges regulated by the Medical
Council of India. Additionally, India produces medical graduates in the “traditional
Indian system of medicine,” regulated through Central Council for Indian Medicine.
Considering the number of registered medical practitioners of both modern medicine
(MBBS) and traditional medicine (AYUSH), India has already achieved the World
Health Organization recommended doctor to population ratio of 1:1,000 the “Golden
Finishing Line” in the year 2018 by most conservative estimates. It is indeed a matter of
jubilation and celebration! Now, the time has come to critically analyze the whole
premise of doctor–population ratio and its value. Public health experts and policy makers
now need to move forward from the fixation and excuse of scarcity of doctors. There is
an urgent need to focus on augmenting the fiscal capacity as well as development of

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infrastructure both in public and private health sectors toward addressing pressing
healthcare needs of the growing population. It is also an opportunity to call for change in
the public health discourse in India in the background of aspirations of attaining
sustainable development goals by 2030.

Background

India is one of the fastest growing economies in the world and the second most populous
country. In spite of rapid development achieved in other fields, the performance when
judged on healthcare parameters remains poor. One of the dominant discourses in the
public health domain within context of provision of Universal Health Coverage is the
shortage of adequate number of qualified medical doctors and other healthcare
professionals in India. World Health Organization (WHO) has promulgated desirable
doctor–population ratio as 1:1,000. Yet, over 44% of WHO Member States reported less
than one physician per 1,000 population. Responding to this challenge, there has been a
major thrust on increasing the capacity of graduate training programs (MBBS) at medical
institutions across India. India has two systems of qualified, professionally trained, and
registered medical doctors. The first one is the system of modern medicine introduced
nearly 200 years back during British colonial rule and the other one is a system of
traditional Indian system of medicine, previously neglected but now patronized and
streamlined by the Government of India. The system of modern medicine is largely
regulated by the Medical Council of India (MCI) and governed under Ministry of Health
and Family Welfare, whereas traditional medicine AYUSH (Ayurveda, Yoga, Unani,
Siddha, and Homeopathy) is regulated through Central Council for Indian Medicine
(CCIM). The traditional Indian system of medicine is governed under an independent
ministry of AYUSH of Government of India.

MBBS Doctors: Doctors of Modern Medicine

The Lok Sabha (Parliament) was informed by Minister of State for Health that as per
information provided by the MCI, there were a total of 10,22,859 MBBS (Modern
Medicine) doctors registered with the MCI or State Medical Councils as on March 31,
2017. After considering attrition, it gives a doctor (modern medicine) and population

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ratio of 0.77:1,000 as per current population estimate of 1.33 billion. The minister also
said that emphasis of the government was to increase the number of doctors in the
country to improve the doctor population ratio. Comparable figures in other countries are
as follows: Australia, 3.374:1,000; Brazil, 1.852:1,000; China, 1.49:1,000; France,
3.227:1,000; Germany, 4.125:1,000; Russia, 3.306:1,000; USA, 2.554:1,000;
Afghanistan, 0.304:1,000; Bangladesh, 0.389:1,000; and Pakistan, 0.806:1,000.
Currently, India hosts a total of 479 medical colleges with an annual intake of 67,218
MBBS students. About 12,870 MBBS student positions have been added only in the last
3 years.

AYUSH: Doctors of Traditional Indian System of Medicine

Apart from MBBS doctors, that is, graduates from the medical colleges teaching modern
medicine, there is a spectrum of graduate healthcare providers trained in the traditional
Indian systems of medicine. The government has recognized those trained in the
traditional system with equivalent status in public funded healthcare delivery system;
these graduates are also routinely employed by private sector. Department of AYUSH is
a governmental body in India entrusted with education and research in Ayurveda, Yoga,
Naturopathy, Unani, Siddha, Homoeopathy, Sowa-rigpa, and other Indigenous Medicine
systems. The department was created in March 1995 as the Department of Indian
Systems of Medicine and Homoeopathy (ISM & H). AYUSH received its current name
in March 2003. That time it was operated under the Ministry of Health and Family
Welfare. An independent Ministry of AYUSH was formed on November 9, 2014 by
elevation of the Department of AYUSH. Apart from 297 existing Ayurveda-Siddha-
Unani Colleges, under CCIM Act, 1970, there is ambitious plan to establish 47 new
colleges proposed Ayurveda (42, 3,200 seats) in undergraduate (BAMS) courses, Unani
(4, 260 seats) in undergraduate (BUMS) course, and Siddha (1, 100 seats) in
undergraduate (BSMS) course. Also, there are plans to increase undergraduate admission
capacity by 800 BAMS seats in the existing 32 Ayurveda colleges and 94 BUMS seats in
existing 4 Unani Colleges. These training programs are contributing to the accumulating
pool of traditional medical doctors by approximately 10,000/year. In total, there were

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7,44,563 AYUSH registered graduates as of January 1, 2015, which by 2017 expected to
be 7.6 lac approximately.

WHO Recommended Standard Already Achieved (2018)

With minimum age for entry at 17 years and course duration of 5.6 years, Indian medical
graduates are licensed to practice medicine by the age of 25 years. Recently, the central
and a number of state governments have increased the retirement age of doctors from 60
to 65 years. MCI had officially notified in 2010, 70 years as retirement age for medical
teachers. Indian medical graduates serve Indian population for 50 long years as “healers,”
“teachers,” and “preachers” by enjoying good health as compared with general
population.In the hard count now during 2017, 1.33 billion of Indian population is being
served by 1.8 million registered medical graduates. So, the ratio is 1.34 doctor for 1,000
Indian citizens as of 2017. This means that India has already reached WHO norm of
1:1,000 doctor population ratio even considering the most conservative estimates
including stringent attrition criteria.

India to Achieve Adequate Numbers of MBBS by 2024

The Indian medical education system has been able to pull through a major turnaround
and successfully able to double the numbers of MBBS (modern medicine) positions
during recent decades.

Further, with an annual intake of 67,218 MBBS students within next 5 years, the system
will add 4,70,526 MBBS doctors (from 2017) to a total of 14,93,385 by 2024 even if no
new college campuses are setup with more MBBS admissions. On the other hand, India's
population has been projected as 1,447,560,463 by 2024. So, by 2024, the doctor–
population ratio is expected to be around 1.03 per 1000 population. It is clear that India
will reach WHO standard of 1:1,000 doctor (only modern medicine)–population ratio
within next 7 years by the current demographic trend, a year before India's 75th
independence anniversary.

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How Many Doctors do India Needs Actually?

According the Rural Health Statistics released by government of India The total number
of posts sanctioned at PHC in India only 34,068 about half of the current number of
MBBS doctors produced annually. The shortfall is miniscule as compared with the
capacity. As a matter of fact, there are very few sanctioned positions of doctors employed
in public healthcare delivery system, given the Indian population and high morbidity
levels. Apparently, there is over supply of MBBS doctors for whom there is no jobs in
public sector. The private healthcare industry is largely urban based, hospital centric, and
specialty driven and therefore does not have capacity or need to employ basic MBBS
doctors. As it becomes clear now, there has been a continued apathy toward employing
medical practitioners in the public healthcare delivery system, more specifically in the
primary care and community-based domain. Could this be inadvertent? This appears to
be a system design where by population has to travel long distances to urban cities in
order to even avail basic medical facilities.

Current Public Health Interventions and Debates Based on the Premise of Low
Doctor–Population Ratio – A Critical Review

Arguments based on the premise of low doctor–population ratio have been used for
launching several public health interventions, more specifically in the areas of human
resource development. As per the facts presented in this paper, India has already reached
WHO norm of 1:1000 doctor–population ratio. The health system has moved from “not
available” to “available but not engaged” status or “available but maldistributed and
inefficient.” Few of the prominent interventions and current debates within the domain of
public health are enlisted in. Many of these interventions are not evidence based and
appear to be implemented with haste. Few proposed solutions have direct implications on
the legal framework of pharmaceutical retail regulation and contribute to emerging global
issues such as antibiotics resistance. Health care is heavily politicized from global to local
levels. With huge financial resources at stake, it is indeed time to critically review the
existing public health debates and interventions. As of now and for the future, public

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health interventions based on the erroneous assumption of scarcity of qualified doctors
are likely to address misplaced priorities.

Call for Paradigm Shift in Public Health Discourse in India

It is not clear who floated this idea of WHO standard of doctor-population ratio and how
it impacts the population-based healthcare intervention outcomes. But, it is popularly
quoted by public health experts and appears more frequently in mainstream media.

A country credited with successful Mars Mission definitely has resources and technical
capacity to transform age-old crumbling health care delivery system. However, there is a
tremendous tension within healthcare policy initiatives. Public health policy should serve
public interest or promote trillion dollar healthcare/pharmaceutical industry? Public
health policy should address local national health priorities and should align to achieve
global goals or serve a select few stakeholders and consumers? Public health policy
should address the long-term strategy toward addressing pressing population needs by
strengthening the general health system or should meet the priorities set by international
donors? Public health policy should address health care as a social and human right issue
or it should facilitate achievement of priorities determined by market forces?

Ultimately, the mainstream politics of the day would define the future direction of public
health initiatives in India. However, we call for a paradigm shift in the public health
discourse in India and propose a new priority setting listed in . Low doctor–population
ratio is no longer a valid argument for maintaining status.

India’s doctor-population ratio is 1:834, assuming 80 per cent availability of registered

allopathic doctors and 565,000 Ayurvedic, Unani, Siddha and homeopathic doctors,
Mansukh Mandaviya, Union minister of health and family welfare told the Rajya Sabha
April 5, 2022.

Treatment in hospitals

Government Hospitals –free of cost or minimum charges

Private Hospitals –Expensive

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Differences between Private Hospitals and Public Hospitals

Definition

Private hospitals are hospitals managed and funded by an individual or a group of people.
On the other hand, public hospitals are hospitals fully managed and funded by the state.

Quality of service

Private hospitals provide quality healthcare services. On the other hand, public hospitals
do not provide quality health care services due to budget constraints.

Waiting time

While private hospitals have short or no waiting periods, public hospitals have long
waiting periods due to a large number of patients being served.

Doctor to patient ratio

The doctor to patient ratio in private hospitals is high. On the contrary, public hospitals
have a low doctor to patient ratio.

Affordability

While private hospitals are not easily affordable, public hospitals are affordable to most
patients.

Target patients

Due to the high costs of services offered, private hospitals attract affluent patients. On the
other hand, due to its affordability, public hospitals attract less affluent patients.

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Effectiveness of treatment

Government – not much good

Private – Treatment is better than government but more costly

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Approachable

Upper class- private

Upper middle class- private

Middle class-Government

Lower class –Only government

Population of India

Total 138 crores

Upper class-6%

Upper middle class- 18%

Middle class-35%

Lower class- 41%

Living Standard

Indian rural Population - 90 Crores, which is more than 50%

Number of required doctors

In the hard count now during 2017, 1.33 billion of Indian population is being served by
1.8 million registered medical graduates. So, the ratio is 1.34 doctor for 1,000 Indian
citizens as of 2017.

Government Budget

86,000 crore (2021-2022)

89251 crore(2021-2022)

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India Health Budget

In her Budget speech on February 1, Minister of Finance Nirmala Sitharaman announced

that India will build an open platform for the national health ecosystem, which will
contain digital registries of health providers and facilities, unique health identities,
consent framework and unique access to health facilities.

Another notable announcement was the National Tele Mental Health Programme, which
includes building a network of 23 tele-centres for mental health counselling and care,
with the National Institute of Mental Health and Neurosciences (Nimhans) in Bengaluru
being the nodal centre, and the International Institute of Information Technology-
Bangalore (IIITB) providing technology support.

That apart, the Budget speech did not announce any specific provisions for the health
care sector, for which experts have been stating, for many years now and particularly in
the wake of the Covid-19 pandemic, the ideal spending on health care should be at least
2.5-3 percent of the Gross Domestic Product (GDP).

“Usually, Budget figures are announced in the Speech. This time, they departed from
this tradition. The actual allocation to the health ministry has gone up only marginally,”
says K Srinath Reddy, president, Public Health Foundation of India (PHFI). The Budget
Estimates last year for the Ministry of Health and Family Welfare (MoHFW) stood at Rs
71,269 crore, which were revised to Rs 82,921 crore. The Budget Estimates for the
MoHFW this year are Rs 83,000 crore. This is only for the Union health ministry and
does not include other allocations towards Ayush, health research, and so on.

Reddy adds that there has been some focus on the social determinants of health, like
water, sanitation and housing. The finance minister announced that 8.7 crore households
have been covered under the ‘Har Ghar, Nal Se Jal’ programme to provide direct tap-
water access, and Rs60,000 has been allocated to cover 3.8 crore households in FY23.

“I was underwhelmed by the Budget,” says Meena Ganesh, MD, co-founder and
chairperson of Portea Medical, a home health care company. “Over the last couple of

26
years, the government has spent a lot on vaccination and Covid-19 management, but the
fact of the matter is that the fundamental health care system for the country needs
significant higher investment, be it for taking care of people with chronic diseases or for
elders. I did not see any specific mention of that.”

According to her, while the focus on mental health is a step in the right direction, one
needs to wait and watch how this will be implemented in a way that it goes beyond cities
to the corners of the country, because there are challenges around providing
teleconsultation access to people, and ensuring they are comfortable and willing to speak
over a digital health helpline. “It is not just money for clinical purposes, but also helping
people get comfortable with opening up about their mental health issues,” she says.

Last year, the government had announced a five-year-plan to improve health

infrastructure and strengthen health surveillance, and they might have chosen not to
reiterate it this time, says Hitesh Sharma, tax partner and life science sector leader, EY
India, adding that the actual overall health spends by the central government has only
gone up marginally. From an overall (not just for MoHFW) budgeted and revised
estimate of Rs 74,602 crore and Rs 85,915 crore last year to a budgeted estimate of Rs
86,606 crore this year. “The only thing I saw as an aberration from last year was the
vaccination spends. From a Rs 35,000 crore budgeted estimate and Rs 39,000 crore
revised estimate, it has been reduced to Rs 5,000 crore,” says Sharma. One can interpret

27
this in three ways, according to him. One, perhaps according to the government, Covid-
19 is to become endemic; two, they might want everyone to incur their own costs; or
three, the Centre might want the states to focus more on this, since health, after all, is a
state subject.
Reddy too believes that with the ongoing progress of Covid vaccinations and
precautionary doses, the government might have considered the reduced allocations
sufficient. “In Covid times, they have come up with special packages. So they may feel
that right now it is difficult to anticipate requirement, and they may reserve the right to
make special allocations if there is a further problem,” he says. “I think right now, the
assumption seems to be that Budgetary need for vaccination is not that high and they
seem to be going slow on that.”

Reddy, however, believes that the National Health Mission should have got a lot more
focus. The Budget estimates have only seen a marginal increase, from Rs37,130 crore last
year to Rs37,800 crore this year. “The Budget needed particular focus on how to improve
urban health, apart from rural health, which still needs a lot of strengthening. Urban
primary health care has not been given a boost, and urban primary health care mission
has been largely unaddressed as a priority,” he says.

According to Ganesh, while the Budget is more of just an indication of the intent to
create a digital health ecosystem, how the government will actually get health workers to
be part of it and get patients to share their health records is yet to be seen, because
digitisation is a “very large transformation exercise”, she says.

The consent framework that Sitharaman mentioned, Ganesh explains, will be the most
fundamental building block of this digital ecosystem. “For the first time, we are looking
at patients owning their data, rather than hospitals and health care workers owning
patients’ health records. For the first time we are saying the patients will have control in
terms of tracking and sharing their records, as and when they think it is appropriate,” she
says.
Sharma believes that one of the biggest things missing in the Budget was support for
creation of health care infrastructure by the private sector, like providing incentives or

28
focusing on innovations. “Vaccines have only taught us that innovation is a must,
because we do not know how things will move. But they [the government] really did not
think of research, innovation or infrastructure for private sector in the Budget. The
industry has been asking for it, and that was a miss.

Health NGOs in India

In 2020, GuideStar India (GSI) had more than 10,000 verified NGOs and more than
1,600 certified NGOs on its portal.

The outreach activity is the main health activity for more than 60% of NGOs functioning
primarily in health sector.

Addressing disparities in access to health care

Rural and small cities where per capita income is less, unavailability of hospitals and
shortage of doctors occur, healthcare inequalities may be extremely pronounced. Such
populations are at high risk of exposure to extreme poverty, drug abuse, and several other
risks to human health and life. If a regional health system that takes into account the
particular features of the community is set in order to meet unmet needs, the general level
of service of the community can be dramatically increased.

Minimizing costs to health care

Social health is an important part in health policy reforms aimed at lowering public
spending on healthcare. Public health services work within a model of patient-centered
treatment, including patients in decisions regarding care. This model helps physicians to
direct patients away from expensive visits to the emergency department to discourage
relapses.

Establishing public health centers and programs

In public health efforts such as the war against the drug crisis and the halting of the HIV
epidemic and the ongoing Covid19 pandemic, community health services have become
vital tools. The holistic model of health treatment helps physicians to manage and avoid a
variety of disorders simultaneously.
29
Under NHM high focus states can spend upto 33% and other States upto 25% of
their NHM funds on infrastructure.

• The population Norms for setting up of public health facilities are as under :

Sub Centre: 1 per 5,000 population in general areas and 1 per 3,000 population in
difficult/tribal and hilly areas

Primary Health Centre: 1 per 30,000 population in general areas and 1 per 20,000
population in difficult/tribal and hilly areas

Community Health Centre: 1 per 1,20,000 population in general areas and 1 per 80,000
population in difficult/tribal and hilly areas.

• A new norm has also been adopted for setting up a SHC based on ‘time to care’ within
30 minutes by walk from a habitation has been adopted for selected district of hilly and
Desert areas.

• It has also been decided to strengthen Sub-Health Centres based on 'time to care' within
minutes by walk from habitations has been adopted in selected districts of hilly States and
desert areas.

• As per the Rural Health Statistics (RHS) 2020, as on 31.3.2020 the status of public
health facilities function in the Country is as under:

1,57,921 Sub Centers (SCs),

30,813 Primary Health Centers (PHCs),

5,649 Community Health Centers (CHCs),

1193 Sub-divisional Hospitals (SDHs) & 810 Districts Hospitals (DH) in the country

• There is a shortfall of 46140 SCs (24%), 9231 PHCs (29%) and 3002 CHCs (38%)
across the country as per the Rural Health Statistics (RHS) 2020.

30
• First Referral Units (FRU) provides comprehensive obstetric care services including
like cesarean section, newborn care, emergency care of sick children, full range
of family planning services, safe abortion services treatment of STI/RTI availability of
blood storage unit and referral transport services. Number of FRUs has increased
significantly from 940 in 2005 to 2996 in 2020 (upto 31.12.2020).

31
 INDUSTRY PROFILE
Introduction

Healthcare has become one of India’s largest sectors, both in terms of revenue and
employment. Healthcare comprises hospitals, medical devices, clinical trials,
outsourcing, telemedicine, medical tourism, health insurance and medical equipment. The
Indian healthcare sector is growing at a brisk pace due to its strengthening coverage,
services, and increasing expenditure by public as well private players.

India’s healthcare delivery system is categorised into two major components - public and
private. The government, i.e. public healthcare system, comprises limited secondary and
tertiary care institutions in key cities and focuses on providing basic healthcare facilities
in the form of primary healthcare centres (PHCs) in rural areas. The private sector
provides majority of secondary, tertiary, and quaternary care institutions with major
concentration in metros, tier-I and tier-II cities.

India's competitive advantage lies in its large pool of well-trained medical professionals.
India is also cost competitive compared to its peers in Asia and western countries. The
cost of surgery in India is about one-tenth of that in the US or Western Europe. The low
cost of medical services has resulted in a rise in the country’s medical tourism, attracting
patients from across the world. Moreover, India has emerged as a hub for R&D activities
for international players due to its relatively low cost of clinical research.

Market size

The Indian healthcare sector is expected to record a three-fold rise, growing at a CAGR
of 22% between 2016–22 to reach US$ 372 billion in 2022 from US$ 110 billion in 2016.
By FY22, Indian healthcare infrastructure is expected to reach US$ 349.1 billion.

In the Economic Survey of 2022, India’s public expenditure on healthcare stood at 2.1%
of GDP in 2021-22 against 1.8% in 2020-21 and 1.3% in 2019-20.

32
In FY22, premiums underwritten by health insurance companies grew to Rs. 73,582.13
crore (US$ 9.21 billion). The health segment has a 33.33% share in the total gross written
premiums earned in the country.

The Indian medical tourism market was valued at US$ 2.89 billion in 2020 and is
expected to reach US$ 13.42 billion by 2026. According to India Tourism Statistics at a
Glance 2020 report, close to 697,300 foreign tourists came for medical treatment in India
in FY19. India has been ranked 10th in the Medical Tourism Index (MTI) for 2020-21
out of 46 destinations by the Medical Tourism Association.

The e-health market size is estimated to reach US$ 10.6 billion by 2025.

As per information provided to the Lok Sabha by the Minister of Health & Family
Welfare, Dr. Bharati Pravin Pawar, the doctor population ratio in the country is 1:854,
assuming 80% availability of 12.68 lakh registered allopathic doctors and 5.65 lakh
AYUSH doctors.

Investments/ developments

Between April 2000-March 2022, FDI inflows for drugs and pharmaceuticals sector
stood at US$ 19.41 billion, according to the data released by Department for Promotion
of Industry and Internal Trade (DPIIT). FDI inflows in sectors such as hospitals and
diagnostic centres and medical and surgical appliances stood at US$ 7.93 billion and US$
2.41 billion, respectively. Some of the recent developments in the Indian healthcare
industry are as follows:

As of August 23, 2022, more than 210.31 crore COVID-19 vaccine doses have been
administered across the country.

As of August 8, 2022, India has exported 24.24 crore vaccine doses.

In August 2022, Edelweiss General Insurance partnered with the Ministry of Health,
Government of India, to help Indians generate their Ayushman Bharat Health Account
(ABHA) number.

33
The healthcare and pharmaceutical sector in India had M&A activity worth US$ 4.32
billion in the first half of 2022.

As of July 2022, the number medical colleges in India stood at 612.

In July 2022, the Indian Council of Medical Research (ICMR) released standard
treatment guidelines for 51 common illnesses across 11 specialties to assist doctors,
particularly in rural regions, in diagnosing, treating, or referring patients in time for
improved treatment outcomes.

In July 2022, the National Pharmaceutical Pricing Authority (NPPA) fixed the retail
prices for 84 drug formulations, including those used for the treatment of diabetes,
headache, and high blood pressure.

In March 2022, Hyderabad-based pharmaceutical company Biological E applied for

emergency use authorisation (EUA) for its Covid-19 vaccine Corbevax for the 5-12 year
age group.

In January 2022, Phase 3 trials commenced of India's first intranasal vaccine against
COVID-19 that is being developed by Bharat Biotech, in conjunction with the
Washington University School of Medicine in St Louis, the US.

Startup Healthify Me, with a total user base of 30 million people, is adding half a million
new users every month and crossed US$ 40 million ARR in January 2022.

The number of policies issued to women in FY21 stood at 93 lakh, with one out of every
three life insurance policies in FY21 sold to a woman.

In December 2021, Eka Care became the first CoWIN-approved organization in India,
through which users could book their vaccination slot, download their certificate and
even create their Health IDs.

As of November 18, 2021, 80,136 Ayushman Bharat-Health and Wellness Centres (AB-
HWCs) are operational in India.

34
As of November 18, 2021, 638 e-Hospitals are established across India as part of the
central government's ‘Digital India’ initiative.

In November 2021, Aster DM Healthcare announced that it is planning Rs. 900 crore
(US$ 120.97 million) capital expenditure over the next three years to expand its presence
in India, as it looks at increasing the share of revenue from the country to 40% of the total
revenue by 2025.

In September 2021, Russian-made COVID-19 vaccine, Sputnik Light received

permission for Phase 3 trials in India.

In September 2021, Biocon Biologics Limited, a subsidiary of Biocon, announced a

strategic alliance with Serum Institute Life Sciences, a subsidiary of Serum Institute of
India (SII). The alliance is expected to strengthen India's position as a global vaccine and
biologics manufacturing powerhouse.

Government initiatives

Some of the major initiatives taken by the Government of India to promote the Indian
healthcare industry are as follows:

In the Union Budget 2022-23:

Rs. 86,200.65 crore (US$ 11.28 billion) was allocated to the Ministry of Health and
Family Welfare (MoHFW).

Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) was allocated Rs. 10,000 crore
(US$ 1.31 billion)

Human Resources for Health and Medical Education was allotted Rs. 7,500 crore (US$
982.91 million).

National Health Mission was allotted Rs. 37,000 crore (US$ 4.84 billion).

Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) was allotted Rs.
6,412 crore (US$ 840.32 million).

35
The Government of India approved continuation of ‘National Health Mission’ with a
budget of Rs. 37,000 crore (US$ 4.85 billion).

Rs. 5,156 crore (US$ 675.72 million) was allocated to the newly announced PM-ABHIM
to strengthen India’s health infrastructure and improve the country’s primary, secondary
and tertiary care services.

In July 2022, the World Bank approved a US$ 1 billion loan towards India's Pradhan
Mantri-Ayushman Bharat Health Infrastructure Mission.

In May 2022, the Union Government approved grants for five new medical colleges in
Gujarat with a grant of Rs. 190 crore (US$ 23.78 million) each. These colleges will come
up in Navsari, Porbandar, Rajpipla, Godhra and Morbi.

In November 2021, the Government of India, the Government of Meghalaya and the
World Bank signed a US$ 40-million health project for the state of Meghalaya. Project
will improve the quality of health services and strengthen the state’s capacity to handle
future health emergencies, including the COVID-19 pandemic.

In September 2021, Prime Minister Mr. Narendra Modi launched the Ayushman Bharat
Digital Mission. The mission will connect the digital health solutions of hospitals across
the country with each other. Under this, every citizen will now get a digital health ID and
their health record will be digitally protected.

In September 2021, the Telangana government, in a joint initiative with World Economic
Forum, NITI Aayog and HealthNet Global (Apollo Hospitals), launched ‘Medicine from
the Sky’ project. The project will pave the way for drone delivery of life saving
medicines and jabs in far-flung regions of the country.

According to a spokesperson, the Indian government is planning to introduce a credit

incentive programme worth Rs. 500 billion (US$ 6.8 billion) to boost the country’s
healthcare infrastructure. The programme will allow firms to leverage the fund to expand
hospital capacity or medical supplies with the government acting as a guarantor and
strengthen COVID-19-related health infrastructure in smaller towns.

36
In July 2021, the Ministry of Tourism established the ‘National Medical & Wellness
Tourism Board’ to promote the medical and wellness tourism in India.

In July 2021, the Union Cabinet approved continuation of the National Ayush Mission,
responsible for the development of traditional medicines in India, as a centrally
sponsored scheme until 2026.

In July 2021, the Union Cabinet approved the MoU between India and Denmark on
cooperation in health and medicine. The agreement will focus on joint initiatives and
technology development in the health sector, with the aim of improving public health
status of the population of both countries.

In June 2021, the Ministry of Health and Family Welfare, in partnership with UNICEF,
held a capacity building workshop for media professionals and health correspondents in
Northeastern states on the current COVID-19 situation in India, to bust myths regarding
COVID-19 vaccines & vaccination and reinforce the importance of COVID-19
Appropriate Behaviour (CAB).

Road ahead

India’s healthcare sector is extremely diversified and is full of opportunities in every

segment, which includes providers, payers, and medical technology. With the increase in
the competition, businesses are looking to explore the latest dynamics and trends which
will have a positive impact on their business. The hospital industry in India is forecast to
increase to Rs. 8.6 trillion (US$ 132.84 billion) by FY22 from Rs. 4 trillion (US$ 61.79
billion) in FY17 at a CAGR of 16–17%.

India is a land full of opportunities for players in the medical devices industry. The
country has also become one of the leading destinations for high-end diagnostic services
with tremendous capital investment for advanced diagnostic facilities, thus catering to a
greater proportion of the population. Besides, Indian medical service consumers have
become more conscious towards their healthcare upkeep. Rising income levels, an ageing
population, growing health awareness and a changing attitude towards preventive
healthcare is expected to boost healthcare services demand in the future. Greater

37
penetration of health insurance aided the rise in healthcare spending, a trend likely to
intensify in the coming decade.

The Government aims to develop India as a global healthcare hub, and is planning to
increase public health spending to 2.5% of the country's GDP by 2025.

38
 COMPANY PROFILE

EJY Health
EJY Health strive for innovation in the medical sector through a network of hospitals
offering quality health care and minimize the amount of unnecessary medical
expenses.

Industry
Hospitals and Health Care

Company size
2-10 employees

Founded
2021

Founder and CEO

Aditya kirti

Specialties
Health Community, Health Club's, Hospitals, Medical & Health, Healthcare
Services, Health Learning, and Health Advice

39
 Headquarters
Bihar, India, IN

Vision: “Optimal health across the lifespan for the populations we serve.”

Mission: “Promote, protect and improve the lifelong health of individuals and
communities through the effective use of data, evidence-based prevention strategies,
leadership, advocacy, partnerships, and the promotion of health equity.”

Community health refers to simple health services that are delivered by laymen
outside hospitals and clinics. Community health volunteers and community health
workers are the main practitioners and they work with Primary Care Providers to
facilitate entry into, exit from and utilization of the formal health system by community
members.

Community health volunteers are members of the local community who have
considerable knowledge of the health services available to the community and are used to
identify and link beneficiaries or those in need and the registered providers. Community
health workers (Community health assistants and Community health officers) are
employees who do not necessarily come from the local community but have vocational,
professional or academic qualifications which enable them to provide training,
supervisory, administrative, teaching and research services in community health
departments

40
 LITERATURE REVIEW

Chahal and Kumari ,2011 examined the three dynamics of customer relationship
management (CRM), namely, SQ,CS and customer loyalty in the healthcare sector
through indoor patients’ judgment. Based on data analysis, the direct effect of CRM
dynamics, i.e physical environment quality and interaction quality on SQ and their
ultimate effect on CS and CL is found to be significant. However, the model fit values
came out poor.

Yeoh, 2011 contributed to the literature on emerging multinationals by studying the

internationalization strategies of two established companies in the Indian pharmaceutical
industry; Ranbaxy and Wockhaedt. The internationalization patterns of Ranbaxy and
Wockhardt suggest that the mainstream internationalization models are more effective in
explaining exploratory learning.

Aagja and Garg (2010) measured perceived service quality of public hospitals. A
reliable and valid scale called public hospital SQ was developed to measure the five
dimensions of hospital SQ: admission, medical service,overall service, discharge process
and social responsibility.

Shailendra Kumar (Kumar S. , 2016) in his working paper clearly explained How
public health care services failed toprovide health for all and private sector was
promoted and even facilitated to provide health care services to people but failed due
to base on profitability, hence created merely inequality and misallocation in
spreading of infrastructure facilities in all areas.

Isabelle Joumard and Ankit Kumar (Kumar I. J., 2015) found in their study that
health care system in India is a mix of private and public providers and there is a great
shortage of health care staff in populous and rural states of north. They suggest that
longest gains in health status will come from preventive measures. Improving living
conditions and lifestyle habits would have greatest impact as total sanitation campaign
(Swachh Bharat Mission) has high effect on reducing young deaths and development

41
disorders in later stage of life. Likewise, better use of drugs would improve quality
of health care and reduce out of pocket expenditure.

Chandrakant Lahariya(Lahariya, 2018) discussed health service infrastructure,

health education infrastructure and human resources available for health in India
and the challenges in this area. It comes out with conclusion that India‟s vast rural
health infrastructure has the capacity and potential to deliver more services than
currently it providing. The need is to strengthen them and enable with input mix of
facilities, supplies and human resources based upon real time information system.

Kumar and Gupta (Gupta, 2012) discussed the present scenario of health care
facilities and personnel. They suggested a model health care plan which devolves
around preparing a long-term strategy for qualitative as well as quantitative
improvements in India‟s health care infrastructure by focusing on workforce capacity
and competency, information and data systems and organizational capacity. They
suggest government to take an integrated approach with a decentralized structure based
on district level with the help of local people and local level institutions like Panchayats.

42
 RESEARCH METHODOLOGY

Objectives of study

•To analyze the people’s satisfaction levels with Healthcare services in India.

•To analyze the various factors affecting people’s satisfaction.

•To study the satisfaction level of people for the hospital services.

• To examine the importance given by people to their public or private hospitals.

A Study on healthcare infrastructure in India, A study analysis and determine growth,

development and know about the preparation of India for future.

This report is based on primary as well as secondary data, however primary data
collection was given more importance as it is overhearing factor in attitude studies.
Secondary data is only used for the reference. Research has been done by primary data
collection and primary data has been collected by interacting with various people. The
secondary data has been collected through various Newspapers and websites.

Primary data

A primary source provides direct or firsthand evidence about an event, object, person, or
work of art. Primary sources include historical and legal experiments, statistical data,
pieces of creative writing, audio and video recordings, speeches, and art objects. The
primary sources of collection is Questionnaire from which we get to know the perception
of people about healthcare infrastructure in India. As well as secondary data, however
primary data collection was given more importance as it is overhearing factor in attitude
studies. Common sources of secondary data government departments, organizational
records, research purposes, Newspaper and websites.

43
Research Design: The research is based on Descriptive research; Descriptive research is
used to obtain information from people about Indian healthcare infrastructure. For that
Questionnaire was prepared to collect the information.

Sample Area: Research is conducted on Indian healthcare infrastructure where sample

area is not limited data has been collected from different part of India by circulating
online questionnaire.

Sample Size: A sample of 80 respondents was chosen for know the health structure of
India. The sampling type was a probability sampling based on systematic random
sampling.

Altogether 120 online questionnaire was circulated but unfortunately 80 responses came
out of it. The scores of individual items are summated to produce a total score for the
respondent. The higher the respondents score, the more favorable is the attitude. After
recollecting the questionnaire which was a very tough job to carry out interpreted it and
jotted down the queries and complaints welling up in my mind.

Data Collection Method: Survey was done with questionnaire which could aptly help in
eliciting the essential information from the respondents.

The Duration of the Study

The study was carried out for a period of 45 days from 01/07/2022 to 14/08/2022.

Limitations of the Study

1. As far as the limitation of the project is concerned, I faced many a problem and
adversities in course of my project duration.

2. The people hesitate to disclose the true facts in order to secure their privacy

3. It is very time consuming process.

4. Samples are not true representative of the total workforce.

44
5. Difficulty in getting information from secondary sources.

6. Because of the size of the sample, the population of India is large. Therefore it
was very tough on my part to conduct the survey by going to them personally.

7. It was also very disappointing for me at times when the feedback given by the
people were below expectation.

8. The lack of cooperation by the people to which the responsibility of handling the
questionnaire was given was one of the most important factors which leaded to de
motivation and exhortation.

45
 DATA ANALYSIS AND INTERPRETATION

1. Family Annual Income.

80 Responses

Income

7
19
Below 3 Lakhs

3-7 Lakhs
26
7-10 Lakhs

Above 10 Lakhs
28

Interpretation:

Out of 80 respondents 28 respondents are who, who have income is between 3 to 7 lakhs
, 26 respondents have income between 7 to 10 lakhs, 7 have income more than 10 lakhs
and 19 respondents have income below 3 lakhs, which means most of the responses have
family annual income of 3lakhs to 10 lakhs. They are common people of the nation.

46
 2. Where do you live?

80 Responses

Areas

39 Urban area

41 Rural area

Interpretation:

Out of 80 respondents 41 respondents are living in rural are and 39 living in urban area.
Number of responses are from both urban area and rural area, which is approximately
equal.

47
 3. Do you have any Health Insurance?

80 Responses

Health Insurance

40 40 Yes No

Interpretation:

Out of 80 respondents 40 respondents have health insurance and 40 do not have. Half of
the people have Health insurance other wouldn’t.

48
 4. Hospitals with bed facilities are available in your location?

80 Response

Hospital

12

Yes No

68

Interpretation:

Out of 80 respondents 60 respondents said that they have hospitals with bed facilities are
available in their location. Most of the people saying that they have nearby hospitals with
bed facilities, where they can go in case of emergency.

49
 5. Which hospital you prefer for the treatment?

80 Responses

Hospital

17

Private Hospital

Government Hospital
18 45
doesn't matter to you

Interpretation:

Most of the people prefer private hospital for the treatment, There is less number of the
people who are prefer government hospitals and for some people it does not matter
either it is private or government hospital.

50
 6. Which hospital have good facilities?

80 Responses

Good facilities

5
15

Government hospital
Private Hospitals
Same facilities

60

Interpretation:

Most of the people are saying that private hospitals have good facilities as compare to
government hospitals and they prefer to go in private hospitals for the treatment.

51
 7. Government hospitals are using new technologies for the treatment.

80 Responses

New technologies

18

Agree

Neutral

Disagree

53

Interpretation:

Most of the people answered neutral to this question, they are not completely agreed with
that government hospitals are using new technologies for the treatment.

52
 8. Taking treatment in Private hospitals are more expensive than
Government Hospitals?

80 Responses

Expensive

Right
Wrong
Same cost

80

Interpretation:

All people are saying that Taking treatment in Private hospitals are more expensive
than Government Hospitals.

53
 9. Which treatment you prefer?

80 Responses

Treatment

Allopathy
16
Ayurveda

Homopathy

56

Interpretation:

Most of the people prefer Allopathic treatment for the fast recovery than the Ayurveda
and Homopathy.

54
 10. Is waiting period in government hospitals is more than private hospitals.

80 Responses

17

Yes No

63

Interpretation:

Most of the people are saying that waiting period in government hospitals is more than
private hospitals, But some are saying waiting period in government hospitals is not
more than private hospitals now a days.

55
 11. What you think is India's Healthcare infrastructure is developing and
Indian government is doing best for their people?

80 Responses

Yes NO

71

Interpretation:

Approximately 90% of people are saying that India's Healthcare infrastructure is

developing and Indian government is doing best for their people.

56
 FINDINGS

 People from common family approaches to Government hospitals.

 Private hospital provides better facilities for the treatment than government
hospitals.

 Government doing best for betterment for the nation.

 NGOs playing the role to health infrastructure of India.

 In India there is enough Doctors as per WHO.

 India has capability and quality in healthcare industry.

 People prefer private hospitals over the public hospitals.

 Private hospitals charge more.

 Nowadays Government hospitals are using new technologies.

57
 CONCLUSION

As per this report we can conclude that people prefer private hospitals for good treatment
as compared to government hospitals. And the reason for it is waiting period in
government hospital is more and facilities in government hospital are not much better
than private hospitals. People who have lack of family income they mostly prefer for
treatment in government hospitals. But government is also working on improvement the
infrastructure and facilities in government hospitals. WHO also appraise the contribution
of Indian health care sector towards the world in pandemics situation. Government
hospitals plays measure role in Indian health sector which we know well in 2020 and
2021 time of covid19, government hospitals did well and research also states that Indian
health care infrastructure is much better than other countries and still it is improving.

Health communities are helping people to get good treatment in hospitals by minimizing
their cost and deliver the best care for them and EJY Health is one of them.

58
 SUGGESTIONS

1. Suitable physical environment: In health facilities, water, energy, sanitation,

hand hygiene, and waste disposal centers ought to all be practical, dependable,
and safe. To provide for seclusion and facilitate the provision of quality services,
the area must be planned, arranged, and maintained. Medicines, supplies, and
equipment must all be insufficient supply at the facilities.
2. Well-trained and motivated Health Workers: All labor and delivery
departments of the hospital should have enough competent, well-trained staff and
qualified birth attendants on hand 24 hours a day to handle the expected
workload. Low social regard, low pay, long working hours, insufficient staffing,
and a lack of fully functional facility surroundings are all common hurdles to
midwifery personnel providing appropriate care. Focusing on professional
education and health workforce management that draws on midwives’
experiences is critical.
3. Concentrate on the Patients: The amount to which patients’ wants and
expectations are met is a key indicator of quality. Services that are tailored to
patients and their community’s needs and expectations Include:
 Systems that affect patient accessibility
 Evidence-based health-care provision
 Patients’ well-being
 Encouragement of patient participation
 Care coordination with other aspects of the healthcare system
 Cultural competence, which includes assessing patients’ health literacy and
patient-centered care.
 Communication and treatment that is linguistically appropriate.
4. Decentralizing public health services: Decentralization of financial resources
has increased the efficiency of health care. Major policy decisions on
decentralizing human resource management, increasing budgetary allocation, and
increasing community participation in decision-making are needed.

59
 In India, in the mid-1990s, the trend of decentralization of health care began to
take shape. In 1999, systemic changes in all of the Indian states called for the
transfer of administrative and financial duties for the management of healthcare
facilities to the district level. Some of these measures were eventually included in
the National Rural Health Mission (NRHM), which was started in 2005.
5. Infrastructural development: Infrastructure is a critical component in achieving
the core goal of improving the quality of treatment and welfare for all patients, as
well as a positive experience with the healthcare system. Simultaneously, the
healthcare system and its personnel must promote population-wide health
promotion, prevention, and self-care.
The goal is to provide better, quicker, and less expensive healthcare by promoting
and supporting fundamental processes and utilizing technology to enable flexible
and adaptable delivery. This is accomplished via the establishment of
organizational systems aimed at providing high-quality, long-term, patient-
centered services, with both planned and unscheduled care coordinated such that
none has an influence on the other.
6. Improving the doctor-population ratio: In the next ten years, India aims to
build 200 new medical institutions to satisfy a projected 600,000 doctor deficit. In
2017, 1.8 million registered medical graduates are serving 1.33 billion Indians,
according to a rigorous count. As of 2017, the ratio was 1.34 doctors per 1,000
Indian populations.
7. Increasing the number of Medical Colleges: In recent decades, the Indian
medical school system has been able to make a significant turnaround,
successfully doubling the number of MBBS graduate (modern medicine training)
posts. With over 479 medical schools, India can now accommodate 67,218 MBBS
students per year in medical colleges governed by the Medical Council of India.
India also generates medical graduates who are trained in the “traditional Indian
system of medicine,” which is governed by the Central Council for Indian
Medicine.
8. Increasing the number of Hospitals: The major feature of a hospital is to
provide a short-time period to take care of humans who’ve severe fitness troubles

60
as a result of an injury, disease, or genetic abnormality. Hospitals treat patients
with acute and chronic health problems 24 hours a day, seven days a week by
bringing together a multidisciplinary team of doctors, a skilled nursing staff, a
wide range of medical technicians, health care managers, and specialized
equipment. Emergency treatment, planned procedures, labor and delivery
services, diagnostic tests, lab work, and patient education are all available at many
hospitals. Patients may get inpatient or outpatient care from a hospital, depending
on their medical condition.

61
 REFERENCES
 EJY Health booklet
 Faisal Talib (2015), Service Quality in Healthcare Establishments, International
Journal of Behavioural and Healthcare Research , Vol 05, Issue 01,pp 01-24
 Jack Alexender “Financial Planning & Analysis and Performance Management”
Wiley
 Kothari C.R- “Research Methodology” New age international publishers
 Ministry Of Health & Family Welfare Retrieved From https://main.mohfw.gov.in
 Vij Dimpal (2019) , Health Care Infrastructure in India: Need for Reallocation
and Regulation , Research review international journal of multidisciplinary, Vol.
04, Issue 03, pp289-296
 World Health Organization retrieved from https://www.who.int/

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 ANNEXURE
Questionnaire

https://docs.google.com/forms/d/e/1FAIpQLSfazIc76lwKOjvfa3FLod8fG3xEQNmeGqc
bnghxFbDEX7JEzQ/viewform?usp=sf_link

Study on Healthcare infrastructure of India

I am Ajay Bhardwaj student of MBA(Finance and International Business)at Maharishi

Markandeshwar Deemed to be University, Mullana, Ambala. And presently I am doing a
project on "Healthcare infrastructure of India" I request you as kindly fill the
questionnaire below and assure you that the data generated shall be kept confidentially.

1. Name

2. Family Annual Income.

 Below 3 Lakhs
 3 - 7 Lakhs
 7 - 10 lakhs
 Above 10 lakhs

3. Where do you live?

 Rural area
 Urban area

4. Do you have any Health Insurance?

 Yes
 No

63
5. Hospitals with bed facilities are available in your location?
 Yes
 No

6. Which hospital you prefer for the treatment?

 Government Hospital
 Private Hospital
 doesn't matter to you

7. Which hospital do have good facilities?

 Government Hospital
 Private Hospital
 Both giving similarly Facilities

8. Government hospitals are using new technologies for the treatment.

 Agree
 Neutral
 Disagree

9. Taking treatment in Private hospitals are more expensive than Government

Hospitals?
 Right
 Wrong
 Same cost of treatment

10. Which treatment you prefer?

 Allopathic (Modern Medicine)
 Ayurveda (Traditional Indian System)
 Homeopathy

64
11. Is waiting period in government hospitals is more than private hospitals.
 Yes
 No

12. What you think is India's Healthcare infrastructure is developing and Indian
government is doing best for their people?
 Yes
 No

65