+91-22-67237000 contact@hosmac.com
MEP Design for Hospitals 101

MEP Design for Hospitals 101

Satish Kamble, Managar-MEP Design at Hosmac answers questions on designing efficient MEP systems in hospitals.

Mechanical and electrical engineering are like the nerves of the hospital. When working on a green field hospital project, what is an ideal cost percentage that should be allocated to MEP?

Yes, Mechanical Electrical and Plumbing (MEP) engineering are the nerves of a hospital as after commissioning, MEP engineering is crucial in representing the performance and efficiency of the building.

Earlier, when awareness of green building was not prominent, the cost of green building construction was about 30-40 % higher as compared to traditional MEP engineering in the building. Nowadays due to awareness of green buildings and the changed perspective to reduce operating cost of the building, MEP engineering by default is designed considering basic green building measures. Hence considering that cost into mind, there is an increment in the spend by around 15-20 % with the fluctuation in cost being attributable to the green building energy rating  (i.e. Platinum, Gold, Silver etc.)

What are the latest trends in designing energy efficient systems?

  1. Use of Energy efficient MEP equipments i.e. Chillers with high COP more than 6.5, High delta T chillers to reduce energy bills
  2. Use of highly Energy efficient IE-3 motors for MEP equipment’s
  3. Use of waste heat recovery system for air and water both through energy wheels/heat pipe
  4. Water recycling to obtain zero discharge of the water
  5. Use of energy efficient heat pump for central hot water system instead of local geysers
  6. Maintaining Power factor closed to Unity to minimize power losses
  7. Use of under deck insulation of exposed area to minimize heat gain into floor below
  8. Use of low flow fixtures in plumbing engineering etc.

What can a hospital do to improve Infection Control via MEP?

There are  many measures we can follow for infection control as it is most crucial part in hospital industry; most of the infection is caused due to poor air quality which is called HAI (Hospital Acquired infection).

  1.  It is essential to maintain desired ACPH (air changes per hour) as per the latest guidelines of ASHRAE- 170 which is specifically assigned for healthcare industry. Proper ACPH helps to replace fresh air with used air and thus helps to maintain required fresh O2 level inside the hospital
  2. It is must that positive pressure is maintained inside hospital premises so that outside air infiltration can be prevented through door opening and minor leakages
  3. Use of UVGI system (Ultraviolet Germicidal Irradiation) on cooling coil and supply duct so that infection can be killed at the source only before generation due to wet surface. Growth of microorganism at the wet surface is prevented with the help of high intensity UV lights destroying Genes of Bacteria and viruses
  4. Use of double filtration ( MERV-7 as pre-filter and MERV-14 as fine filter at all air handling units to filter air particles so as to improve IAQ ( Indoor Air quality)
  5. It is essential that proper percentage of fresh air and exhaust air be maintained so that to ensure aspect of –ve and +ve pressurization is maintained as per the application.(i.e. infectious isolation rooms required –ve pressurization for TB patients whereas  protection room for BMT, hear transplant patient etc.  requires +ve pressurization).Exhaust air also has to be discharged at the highest level of the building so as not to spread infection to the other adjacent area.

How can we build resilience into hospital buildings?

Hospitals are operation 24*7. It is very essential that 100 % power back up is maintained especially in rural areas where as frequent load shedding happens. This can be done in following general manner:

  1. DG Sets are provided in multiple quantity of the demand electrical load
  2. UPS system is provided to provide power back up during the lag period of power outage and DG start for crucial areas like, OT, certain medical equipment, emergency lights etc. UPS is normally provided for 15 minutes to 30 minutes back up.
  3. These days, thermal storage is also done to store AC energy in case of power failure to reduce huge load of chiller in case of emergency.

What does electronic surveying though BIM mean?

BIM is the advanced platform for electronic surveillance for feel of reality before the project is built at actual. You can prepare actual MEP model and see for clash detection of all MEP services and resolve at model level before actual installation. Aside; there are manpower/material scheduling, project cost, energy analysis etc. which can be obtained through this BIM platform. This keeps a client well informed about the project.

There are many fire norms which a building has to follow as per the category of the building, height of the building and the area of plot covered. NBC-2016 is for minimum fire-fighting guidelines whereas NFPA-13, NFPA-10,IS codes etc. are widely followed for sprinklers, fire extinguishers etc. Some of the norms which are normally overlooked are:

a) Provision of smoke extraction system for floors above basement

b) Use of 2 hours fire rated doors for Electrical room, AHU room, UPS room, IT room and server room

c) Use of FRLS cables for electrical system d) use of smoke detector instead of heat detector in parking area f) not using high temperature sprinklers into kitchen area etc.

What are the factors that are critical in designing electrical systems in hospitals?

Crucial factors in designing electrical system are:

a) Optimum Electrical load estimation is crucial to design optimum transformer capacity

b) Effective earthing system especially for medical equipment and OT

c) Lightening arrestors for entire building

d) Energy efficient lighting, power factor improvement

e) Electrical safety of all equipment

List 5 Priorities for MEP Maintenance in Hospitals

One must consider the following:

a) Preventive maintenance schedule of all MEP equipment

b) Periodical maintenance schedule

c) Energy metering and careful analysis of all major power consumer contributor MEP equipment such as Chiller, Pumps, heat pump, etc.

d) Training of all the maintenance staff and enhance their skill for advanced technology and to train them in know-how of the installed system

e) Preserve of essential spare parts of the MEP equipment in advance and getting a daily stock of store items to prevent shortage during emergency and breakdown of equipment

f) Tracking on AMC/CMC of the OEMs are crucial and personal attention/witness to their service is essential from our own staff for proper care of the installed MEP system

How Green Hospital Norms have Influenced Hospital Design

How Green Hospital Norms have Influenced Hospital Design

A look into how the Indian Green Building Council (IGBC) guidelines are affecting hospital design and the upkeep of hospitals.

The Indian Green Building Council (IGBC) has laid down certain parameters and criteria which look into the effective management of resources and the overall aesthetic and hygienic conditions of hospitals. In a country overrun by poor quality infrastructure, the IGBC not only heralds a better design language but also ensures the principles of sustainability and eco-friendliness are applied on a larger scale.

Getting an IGBC certificate isn’t a hard process. Yes, there may be a few layers of bureaucratic mumbo-jumbo to it but its impact far outweighs the process. Each hospital is graded on particular criterion based on the guidelines of the IGBC. The sum total of the score within each criteria is how each hospital is scored for the IGBC certification.

According to Janhavi Bhavsar, Project Architect, HOSMAC, the IGBC certificate is a welcome relief in India’s healthcare industry. “Once you get the IGBC certificate, there are a lot of government facilities and government subsidies that are available and which can be availed. Even in terms of procuring investments, large companies and particularly international clients, are more willing to invest in commercial projects which have a golden or platinum level of IGBC certification.” she says.

So what design changes can be made to have a better IGBC green score?

“There are a lot of design elements that get altered while following the IGBC guidelines. Natural ventilation and natural lighting are key elements in raising the overall score of the hospital. In case a facade faces the hot sun then the windows can be glazed to prevent the harmful direct sunlight to come in. Another important design element is spacing and ventilation. Opening up more space and having lesser cramped areas contribute greatly to the overall IGBC score,” adds Janhavi.

She also says, “Figures state that hospitals consume the most energy among the commercial sector; it’s a place where electricity must be available 24x7, and cutting off the energy supply can have a critical effect on the functionality of the hospital in emergency situations which in turn will have a negative effect on the health of the individuals at these hospitals. In terms of lighting, using low cost LED lights is a very big boon. Metering, a technique by which one figures out how much energy is consumed by which department, helps highlight which areas of the hospitals need to be scrutinized thoroughly. Maintenance and upkeep of instruments and equipment ensures they have a longer use period and makes them more energy efficient.”

What are the pros and cons of getting an IGBC certification?

The biggest drawback in setting up an IGBC certified green building is the cost of building. The initial cost for an IGBC certified green building is higher than that of a normal hospital. However, much like a solar heater, over a course of 5-10 years, the amount that is being saved on unnecessary expenditure and energy management makes it a more viable long-term solution. In addition, Janhavi says “There’s nothing fancy that is being done or being proposed while making an IGBC certified green building. The points which contribute to the overall score can be achieved from localized technology and labour anywhere in the country. Changing our mentalities is essential. Quite a few investors look only at the initial cost and the lack of foresight has a negative effect on the overall agenda of hospitals, which is, to ensure quality health care is provided to the patients.”

On the other hand, the pros massively outweigh the cons. Besides providing a more cleaner and sustainable source of health care, hospitals which are certified under the IGBC green code get various aids and benefits from the government. They are also involved in active conservation of water resources and energy resources, thereby reducing the stress on, and demand for these valuable resources. The IGBC certification also looks at the building material, site selection, planning and innovation in green designs, which not only promotes the sustenance and effective resource management of that one building, but also does its part in promoting the greater social good

What is the future of the IGBC Green certificate and what is its impact on hospitals today?

Hospitals are under no compulsion to have an IGBC certificate and even having an IGBC certificate means little when there’s a lack of conscious initiative to improve the environment from society. “Personally, I feel that the IGBC has become a business industry in itself. The certification is more for show and most builders care about following the bare minimum of rules as opposed to actually putting in some thought into the environment around them.” says Janhavi. “Although this might not be ideal, those who follow these guidelines are already playing a part in the betterment of the world around by taking energy efficiency, the green quotient and general maintenance and well-being of the institution seriously.” she concludes.

Tackling Big Healthcare Challenges with Cost Innovation

Tackling Big Healthcare Challenges with Cost Innovation

Hospitals are capital intensive organizations. What can healthcare CXOs do to achieve sustainability and profitability in the competitive healthcare market? Healthcare Executive finds out.

One of the signs of a healthy tech company is a strong balance sheet. The same could be said about a hospital; whatever be the size of the chain, it’s not a sound business model, unless it passes the radar of an auditor.

Clearly, financial mismanagement can wreak havoc for a business, especially a hospital. Controlling costs and generating revenues is a tough task.

Cardinal Rule :

Cost Structure plays an Important Role in the Financial Health of a Hospital.

While it doesn’t appear in the priority list of hospitals, the importance of cost analysis is significant. “Majority of Indian hospitals don’t do cost analysis, that’s their hamartia,” says Narendra Karkera, Director of Hosmac. Hospitals don’t come under Cost Record and Audit  rules, so many ignore it. Due to this they often transfer this cost, due to underutilization, inefficiency and wastage of resources to the consumer,” he notes.

Of course, healthcare is a highly fragmented industry, which relies heavily on manpower, technology and capital. And according to Karkera, there are two types of cost centres namely service centres and revenue centres. Revenue centres generate revenue and also incur cost. But service centers like biomedical engineering do not generate revenue. “It is important to manage service centres as they are often taken for granted. If you outsource it to a third party, it’s easier to control costs,” he adds.

Perils of a One-Size-Fits- All Price Benchmarking System

However, what’s cause for worry is how Indian hospitals have been unable, for decades now to put into motion any sort of expense cutting measures, he notes “In their pursuit of growth, hospitals often ignore how much service centers cost them. Every doctor wants the biomedical engineer to check the operation theatre before every operation. But, if it’s a chargeable service, then they won’t ask for their service every time. Similarly, many hospitals often compare themselves with other players in the market to decide their price list. However, the infrastructure cost of each hospital is different, so one cannot blindly create a pricing system based on one’s neighbour. A nursing home cannot charge as much as a tertiary care hospital because the quality of manpower, equipments etc are very different from that of a tertiary care hospital,” he concludes.

Viability versus Sustainability

Take the case of GlenEagles Global hospital. It is part of Parkway Pantai, a fully owned subsidiary of IHH Healthcare. In India, Gleneagles Global Hospitals operates a chain of multi-super specialty hospitals offering tertiary and quaternary healthcare services in Hyderabad, Chennai, Bangalore and Mumbai.

Clearly, the hospital had focused on cost and process innovation to become operationally efficient. According to Dr. Jagprag Gujral, COO of GGHviability of a hospital typically means whether a new hospital will be able to become sustainable. “The first and foremost point that makes a new hospital viable is to get the model right, which means ensuring that the intrinsic quartet – scale, specialty portfolio, total investment and expected pricing -is in line with the needs of the local demography that the hospital is going to serve. An extrinsic factor that significantly affects viability is the intensity of existing competition.”

Sustainability on the other hand is dependent on the ability of a hospital to become the healthcare provider of choice to those who avail its services, while keeping operational efficiency high. The ability of a hospital to create a brand pull, at least in its neighbourhood, is very important. There are two components that create a brand pull for a hospital. One is to become known as an institution of high ethical and clinical standards, and the other is patient centricity which entails a fine balance between empathy and professionalism. Last but not the least, it is important to function with high operational efficiency to keep costs under control, although in the Indian context most of the hospitals have this feature well entrenched in their management philosophy.

Average Length of Stay

But then why do some hospitals accumulate so much debt? “Occupancy is central to a hospital’s functioning because in addition to being a financial metric, low occupancy is also a fundamental question regarding usefulness of the hospital. Average length of stay is a good parameter to optimize because on the one hand it allows patients to not have to spend more time in hospital than required, and on the other hand it also allows the hospital to use its beds optimally thereby staying financially healthy even at relatively lower prices. Net revenue per patient isn’t a very important metric in isolation because depending on the case, revenue can vary widely. Capital Expenditure invested per bed is an indirect metric hence not very useful, although total CE invested is important, and as mentioned previously it forms a part of the intrinsic quartet for evaluating a new hospital,” says Gujral.

Don’t set up your hospital in an already

Overcrowded Market

And of course, some hospitals make poor location choices. “One of the most common strategic mistakes is to set up a hospital in an overcrowded market like Delhi, Mumbai or Bangalore,” says PL Mehta, Managing Director of Neotia Healthcare Limited.

He also notes that several hospitals face a competitive future in which a growing number of organizations seek to serve the growing middle class market. The increase in delivery infrastructure requires an increase in healthcare professionals and supply has been inadequate. This has created even greater competition among hospitals. Labor shortages might also bid up the hospital’s labor costs, which already account for 40 percent of hospital’s cost structure. High attrition rate also threatens the efficacy of several low cost SOPs developed by hospitals.

“A hospital needs to ensure itself a steady supply of clinicians and nurses by diversifying into clinical  and research activities. In order to achieve sustainability, it’s important to minimize the expenditure on manpower, by avoiding employment models,” he says.

Balancing Price, Quality and Service

So, what is the real test of a hospital’s business model? Siddharth Ranjan, former CFO of Kalinga Hospital, points out that a sound business model ensures viability and sustainability in the long run. “The business model of a for profit hospital which intends to reach out to most patients in its geographic area would be different from one which want to attract discerning corporate clientele. Factors like average length of stay, occupancy rate, net revenue per patient, CE invested Per Bed Day capacity affect the viability of a project. Each hospital, whether for profit or not should constantly review these benchmarks and take prompt corrective measures whenever required. However, what’s singularly most important is creating and maintaining trust amongst the target audience . Unfortunately there are few hospital in our area which pass this litmus test,” he adds.

Factors Hospitals Should Focus On

Ranjan points out that hospitals should focus on hygiene, quality para-medical staff,  right kind of medicos / doctors suitable to the adopted business model and corporate philosophy, weeding out the black sheep and aggressively update technology to keep it sustainable.

Technology obsolescence, in addition to the generally high setup cost, also continues to be a challenge for Indian healthcare sector because many of the equipment are expensive or imported. “For most setups in India the wish to always have the cutting edge technology may spell doom. For example a 1.5 tesla machine could still suffice today if the target audience is cost sensitive. Replacing a 1.5 tesla machine with 3 tesla machine to remain up to date may very adversely affect cash flow and thereby lead towards bankruptcy for many Indian hospitals operating in smaller towns. It’s better to have a documented approach regarding adopting and updating/ replacing ageing equipment,” adds Ranjan.

Cloud Nine

on how it solved its Cost Challenges

There is also a reasoned mature way out. Rohit MA, cofounder of Cloud Nine recalls that during initial days, everyone was sceptical about the business model. “We had incorporated all the features of a nursing home and a corporate hospital in to our model. The fact that we have delivered more than 1000 babies in the last ten years is a proof of our viability,” he adds. Rohit explains that CloudNine had deliberately kept the model simple. “ We are a single-specialty hospital with only private rooms. And the average length of stay is 3 days. Our units have 2 OTs and 2 labour delivery rooms for 30-40 beds. Using this configuration, we do 6-8 deliveries in a day. This is due to our focus on high efficiency.”

He also points out that innovation has been key to the success of the brand. “We had adopted cluster model consciously. It helped us to attract talented physicians as well as administrators. It also helps us to pool resources and use them at multiple locations.

He also  admits that there has been challenges too. “We have an asset light model and usually don’t buy land or buildings. However, initially our focus was on distance between the patient and the hospital. However, in cities like Bangalore, one need to be more conscious about time, rather than distance. Because pregnancy is like emergency care and you can travel only 3-4 kilometers in 40 minutes in cities like Bangalore. We had to rework our strategy based on this understanding and it helped us to improve access,” he concludes.

At a time, when other industries can find a way around high operating cost, what can private hospitals do? Healthcare can clearly take a leaf out of sectors like IT in the last couple of years, several IT companies have streamlined their financial planning. The first step in this direction will be to set clear norms for cash outflow.  The second step will be to hire competent hospital administrators with more than five years of experience and not fresh MHAs. In addition, independent studies need to be taken up on the expenditure of each unit of a hospital, to help managements take informed decisions. Else, the coffers of the hospitals will soon become empty.

Criminalizing ‘Cut Practice’ : A Welcome Move

Criminalizing ‘Cut Practice’ : A Welcome Move

To curb ‘cut practice’ in healthcare, Maharashtra, very recently, came out with a draft bill for The Prevention of Cut Practices in Healthcare Services Act, 2017 that promises harsh penalties for all medical practitioners involved in the practice of giving or receiving of cuts/ commissions. It states that “any healthcare service provider found guilty of involvement in cut practice shall he liable to be punished with simple imprisonment up to 5 years, or a fine of 50,000, or both.

This will additionally draw a suspension of 3 months from the respective council.” The draft proposes that if such an offence comes to light, the Anti-Corruption Bureau will be the authority that will Commenting on this welcome move, Dr. Vivek Desai, Managing Director, Hosmac India Private Limited, says, “Cut practices must go because it increases the overall cost to the patient. For example, if someone refers a cardiac case to a cardiology surgeon, that person is almost seeking 20-30 percent of the overall bill of the patient. If a patient spends INR1 lakh, then IN20,000-30,000 is paid out as referral fees. This is unnecessary. Why should a person be paid for referring? It is an unethical practice. In India, it is not just the doctors, who are referring patients; from ambulance drivers to porters at Mumbai railway station are involved in this process of filtering out patients, recommending hospitals to them, and getting a ‘cut.’ Ultimately, the hospital will charge the ‘cut’ amount to the patient increasing the overall treatment cost. Currently, this has only come out in Maharashtra but should go pan-India. It is a step in the right direction and should have been done a long time ago.

“Cut practices must go because it increases the overall cost to the patient”.

line

The reason why it does not happen in other countries, particularly the developed nations like the UK and the USA, is because there is a concept called ‘gatekeeper’ i.e. a person cannot come to a referral system by oneself. The patient is referred by a general physician, who is part of the insurance chain. The GP will first see the patient and then decide whether he/she needs specialist intervention. Hence, a referral fee is out of the question.”

Citing how Kokilaben Dhirubhai Ambani Hospital tried to overcome this unethical practice, he explains, “The hospitals appointed GPs as their channel partners. The patient first see the GP for which they are charged a minimal visitation fee of about INR1000 and only then they are referred to specialists. This is a legitimate practice rather than a back door entry to an INR1 lakh procedure for which the person who refers gets a cut of 20-30 percent.”

Best Practices in Mental Health Facility Design

Best Practices in Mental Health Facility Design

A mental health facility should be designed with an aim to create a space where patients are well cared for, rehabilitation and reintegration is encouraged and one that imparts awareness, education and training to family members who act as care takers, writes Hosmac architects.

When you think of psychiatric hospital, it won’t be surprising if leather restraints, straightjackets, isolation rooms, barred window, big white corridors with flickering lights and shock therapy pop up in your head. Books and movies, too have portrayed “mental hospitals” in similar light, like a nuthouse or lunatic asylum— the intimidating Oregon State Hospital in One Flew over the Cuckoo’s Nest, the restraint beds and chains in the fictional bestseller The Girl with the Dragon Tattoo, the unforgiving Arkham Asylum in Batman Begins, and who can forget Hannibal Lecter’s eerie cell in Silence of the Lamb. Point being, such hospitals are generally considered negative; a dull space where people are detained rather than healed; a jail-like place with wide corridors. Although practices in patient treatment have evolved, the image of exclusion and imprisonment persists.

The possibility of architecture acting as a catalyst to bring a change to this clichéd mindset has drawn attention to an important question: can architecture contribute to the fight against prejudice and stigma? It is a significant mediator that transmits the real and current picture of psychiatric institutions to society. Should its architectural design be such that it gives a hotel-like atmosphere, where the patients feels they will be cared for? Or, should it be such that the patient realises he/she is in a hospital setting? Should contact with the society be encouraged or should patients feel protected in a well-designed space, considering their physical and mental needs?

Mental health facility design is a critical component of patient care. The design tremendously impacts planning of healthcare systems in these facilities. The staff, the services that are offered and its efficiency, as well as expectations and perception patients have about themselves, are largely based on facility design. Its design impacts users at different levels of building interface that include architectural and interior design. Architectural considerations include introduction to the facility, building aesthetics, accessibility, inclusions of nature in built form and physical access to these spaces, the layout and configuration of space. The interior design considerations include furniture, flooring, wall colour, texture, trim, use of artwork and other aesthetic features. Recommendation of the WHO on psychiatric services and architecture from 1959 states that familiarity with places and persons increases the patient’s sense of security.

Arch EnvironmentA mental hospital differentiates from its counterparts by the quality of interactive spaces. An individual suffering from mental issues like depression secludes himself/herself in a shell. Hence, it is important for this individual to interact with doctors and others. Healer-patient relation contributes to an important treatment process and their interaction should not be limited to treatment room. It is through designing these spaces tactfully that one can initiate interaction outside treatment room.

Adults, who are used to controlling their lives and being autonomous, come into a system in which every detail of their daily routine is prescribed, thus making them completely dependent. Therefore it is very important to provide each patient with an opportunity to control his/her immediate environment as much as possible. This may include the level of lighting, type of music, seating options, and also access to kitchen facilities, where snacks or meals can be prepared by patients themselves. A patient’s sense of competence is encouraged when spaces are easy to find, without asking for help .

Building layout should be simple with obvious travel paths and clear signage, so that visitors and patients do not need to ask for help. It should also support the feeling of security. Openings and access to plants that change with the seasons, as well as the availability of clocks, provide decor and information as part of the daily activities, and allow for orientation in time.

 

 

Some important questions to consider include:

  • How to respect privacy of a patient in his/her room and simultaneously create a secured space maintaining good visibility, with no hiding spots?
  • How to allow the patient to communicate with the external environment (to benefit from the city) with the window being locked?

Each hospital management must decide which of the factors are most important to them. For e.g. using electronic security systems; patients can be given a small bracelet that they can wear around their wrists granting them seamless access to different areas of the facility based on their privilege level.

An individual room should be comfortable, have mixed spaces  and allow for sufficient movement. Furthermore it should encourage interactions by creating an area for small groups of people. The patient will gradually gain confidence to use spaces that are designed to accommodate even more number of people in one central setting, mimicking the life they will eventually have in the community.

Create a secure access to outdoors so that patients can enjoy sunshine and fresh air as this is an important aspect of the healing process. Emphasis on incorporating natural light and exterior views generates a positive influence on mental well-being. These outdoor spaces should be designed for the specific needs of those dealing with mental or psychological challenges. At the same time, it is crucial for such facilities to be secured. Creating an opportunity for individuals to relate on a spiritual level supports treatment and including it in the design concepts is recommended.

Psychiatric facilities and treatment ideologies are subject to quick and frequent changes. Practices have evolved considerably in the last decades, and options for patients have to be adapted constantly. Therapy rooms, in particular, have to be built in a flexible and multi-purpose way.  This allows not only for different activities in the same space, but also prevents unnecessarily quick obsolescence.

References:

  1. Mental Health Facilities Design Guide. (Dec 2010) Published by department of Veteran’s Affairs
  2. Part 2.1 (On the handling of mentally ill)
  3. The Architecture of Hospitals by CorWagenaar
  4. WHO, Psychiatric services and architecture. : Pg 26

www.wbdg.org (whole building design guide)

Union Budget 2017-18: Healthcare Industry Speaks Out

Union Budget 2017-18: Healthcare Industry Speaks Out

While public healthcare spending remains largely status-quo in Union Budget 2017, the Finance Minister Mr. Arun Jaitley declared a number of commendable initiatives to boost maternal, child and preventive health, improve medical education and infrastructure, eliminate epidemic diseases and promote use of generic medicines, among others. Let’s hear what healthcare experts have to say about the latest budget announcement.

Dr. Vivek Desai, Managing Director, Hosmac India Pvt. Ltd.

From healthcare industry perspective, budget is not bad. Overall outlay increased by 24% to 47,500 CR  which is almost 2.2% of GDP. It is not clear how this money will be spent but outcome oriented administration by this government should ensure proper usage like upgrading 150,000 sub centres to Wellness centres. Giving health insurance coverage of 100,000/- to the BPL patients with a top up of 30,000/- for senior is welcome and will encourage hospitalisation amongst the poor without waiting till critical stage. There would be some indirect benefits like the Digi Gaon allocation of 10,000 cr will help 150,000 gram panchayats to get broad band connectivity which will help bring telemedicine to their door steps. Money saved by lower tax regime will help people spend more on much needed health insurance. Lowering of taxes for MSME sector from 30% to 25% will also benefit smaller hospitals, diagnostic centres, nursing home sector. Addition on 5000 PG seats and two new AIIMS is step in right direction to make super specialty care as the focus. There is announcement about lowering cost of making medical devices in India though details are still awaited. As always, missing point is granting of Infrastructure status to healthcare to get better tax incentives and softer funding options, which is disappointing. Overall a pragmatic budget which will help stimulate growth.

Vishal Bali, Chairman & Co-founder, Medwell Ventures.

The much awaited Union Budget 2017-18  on the back of demonetisation has a balanced approach to the healthcare sector. A 27% increase in outlay for healthcare is a positive move by the finance minister but still misses the 2% of GDP healthcare spend by the Govt. The reduction in the cost of life-saving drugs and widening the availability of essential drugs is also in the right direction. The announcement of 5000 new PG seats in medicine should have been backed by significant reforms and policy change in medical education.The budget is once again silent on giving boost to healthcare infrastructure. Like low cost housing, healthcare should have been given infrastructure status.This budget is at best incremental for the healthcare sector and once again misses the much needed reformist attention.

Dr. Vikram Shah, CMD, Shalby Limited

All in all a positive budget with focused approach on improving lives of a billion plus population. Higher allocation to healthcare and healthcare infrastructure, initiative for tele-medicine and addressing concern of shortage of healthcare professional will ensure better healthcare index. Gujarat is fortunate to get the bonanza of an All India Institute of Medical Science. Allowing private hospitals to start Diplomate of National Board courses (DNB) and ensuring adequate availability of specialist doctors to strengthen the secondary and tertiary levels of health care and target of creating additional 5,000 post graduate seats will help address the issue of shortage of healthcare professionals. The move to convert 1.5 lakh health sub-centres to Health Wellness Centres will definitely give a big boost to Health for All.

Anjan Bose, Secretary General, NATHEALTH

Budget clearly focuses on improving healthcare access for the less privileged and on “preventive & wellness” both of which are very encouraging. Target of transforming 1.5 lakh health sub-centres into health and wellness centres is in line with the need of the hour for the Indian citizens.

Dr. Kaushik Murali, President – Medical Administration, Sankara Eye Foundation

Healthcare was among the 10 focus areas of the budget. They appear to have consolidated on schemes announced earlier. The visible allocation has been to maternal and child health and primary health care, an impetus with healthcare having infra status or to spur device manufacturing is not immediately evident. In the long term, programs on skilling, sanitation could improve overall healthcare. With most healthcare being out of pocket MNREGA allocation may also help increase access.

Sam Santhosh, Founder and Chairman, MedGenome

It’s a welcome step to reach and penetrate remote areas with limited healthcare access. Building an efficient healthcare system seems to be high on the agenda for the present government. By increasing the additional 5000 post-graduate seats per annum the government has shown its intent to transform healthcare. Its determination to eradicate diseases like Kala Azar, Filariasis, leprosy, measles and tuberculosis and bring down infant and maternal mortality rates is really applaudable. Assimilating disease information to senior citizen’s Aadhar card is a good way to understand the disease demographics.

Suresh Ramu, CEO & Co-Founder, Cytecare Hospitals

While not a lot of focus was given to the private healthcare sector, we feel that reducing costs of life-saving drugs will help hospitals make cancer treatment more affordable and cost-effective for the total life cycle of the patient treatment. This, in turn, will reduce total cost for patients to access quality healthcare. While the government has mentioned increasing access to healthcare for rural India, we hope that they will also focus on setting up specialty hospitals in villages. The 5% reduction in tax for small and medium enterprises will decrease some tax burden on players who are just establishing their business.

Dr. Dharminder Nagar, MD, Paras Healthcare

The most notable announcement on the healthcare front has been that of two new AIIMS. Given the need for expanding the reach of public healthcare, we need an AIIMS in every state. The pledge to eliminate tuberculosis by 2020 seems an ambitious target but it is a highly imperative one. Ensuring availability of drugs and medical devices at reasonable prices will help a large number of patients avail of critical health facilities. However the most notable step is decreasing a tax component of the people earning between Rs 2.5- Rs 5 lacs. This highlights that they shall have more spending power and we hope that in the wave of fitness and prevention, people will not ignore or postpone health checks and shall opt for diagnostic care.

Rajat Goel, Co-founder & CEO- Eye-Q Super Speciality Eye Hospitals

Improving healthcare and medical facilities for the poor and underprivileged was high on the agenda. The proposal to amend Drug and Cosmetics Rules to ensure availability of drugs at reasonable prices will be hugely beneficial to the people. The most significant announcement for healthcare is the conversion of 1.5 lakh health sub-centres to Health Wellness Centres. Proposed action plans to eliminate Kala Azar and Filariasis, leprosy, measles, TB, bring down MMR, and introduce DNB courses in hospitals were encouraging. The budget also laid emphasis on enhancing the medical education in the country. However, aid towards research and development, corporate tax cut, withdrawal of service tax on health insurance and exemption of input service tax on support services found no mention in the budget. in the space also went missing.

J. Sudhir Pai, ED & CEO, Vikram Hospital, Bangalore

Much awaited budget has been satisfactory for the healthcare sector. Infrastructure plans in healthcare and measures to help poor by bringing down costs and providing health cards for senior citizen are commendable. Encouraging private hospital to conduct DNB programs will help to improve the quality of healthcare. New rules regarding medical devices to be formulated will aim at helping investments into these sectors and bring down cost of the devices. Also plan of 1.5 lakh healthcare wellness centres will help in treatment and prevention of diseases. Amendments to drugs control act to bring down prices of medicines will help patients financially. With the reduction in tax rates to individuals earning upto 5 Lakhs and corporates with revenue of Rs. 50 crore is appreciable.

Suresh Sugavanam, Vice President and Managing Director, UL South Asia.

The proposal by the Government to formulate new regulations for medical devices is a welcome move. India is one of the fastest growing markets for healthcare in the world; and it is important that the country starts to design and manufacture medical devices that are best in class and follow international standards in quality and compliance. This will not only ensure patient safety but also make the domestic industry globally competitive.

K.G. Krishnamoorthy Rao, Future Generali India Insurance

Union budget 2017 majorly focused on the importance of digital payments across sectors including hospitals. This will encourage people to pay insurance premium through digital mode. Additionally, it will direct customers to open e-insurance accounts and also help us to settle claims through digital mode. The tax reduction for individuals with income upto Rs 5 lakh will give an opportunity to young tax payers to buy Health Insurance from an early age for themselves and parents. FM’s proposal to amend drug rules to ensure drugs and medical devises are available at affordable prices will definitely lighten the burden on pockets of individuals.