LGBT folks, activists, and even a few medical professionals have claimed that some healthcare providers themselves are transphobic and homophobic, and remain largely uninformed about non-standard sexual orientation and gender identity issues. It is a given that healthcare should to be discrimination-free. We speak to some healthcare leaders to further explore the ground reality.
Out of the LGBT, lesbians, gays and bisexuals probably face less discrimination as against the transgenders. When you go to a hospital, say for a fever, you don’t necessarily have to disclose your sexual orientation. If he/she has depression, he/she disclose it to a psychiatrist/psychologist. Whereas for transgenders, just based on their appearance, people might discriminate. I think it is very necessary to have a transgender category in the registration and admission forms of hospital to acknowledge them.
Although hospitals do not have any LGBT- specific policies, we strictly treat everybody equally at our hospital. Not a single doctor have ever complained about LGBT patients or refused treatment to them. If they are averse to treating any patient based on their sexual orientation, he/she will be made to leave the hospital that very day. Our hospital has done surrogacy for gays and lesbians couples; we have never faced any problems.
There are no specific healthcare policies for LGBT community. However, as a hospital policy we don’t discriminate. We get many transgenders patients. We have a Anti-retroviral therapy centre at the hospital where many HIV-positive transgenders are admitted and no one discriminates, not the doctor, nor the non-LGBT patients. We have never received any complaints till date.
There are no specific LGBT-related policies or framework for hospitals. Ideally, we should not refuse them treatment. They are humans too. However, if doctors refuse to treat them, there is little the hospital can do. I have never come across a transgender patient in my career. In my personal view, we should not refuse medical care to anyone.
We treat members of LGBT community equally. We have gender reassignment surgery available at our hospital. We have done 62 full gender reassignment surgeries. There is a set protocol and policy.
As a reconstructive neurologist, I have done a great deal of reconstructive work on the Hijra community in my early days.This sensitized me to transgender issues and I educated myself on gender reconstructive surgery. In 2009, our hospital started gender reassignment surgery ,and in 2010, it established Mumbai’s first gender reassignment clinic. At our hospital, we look forward to providing them private, comfortable and safe space and improve their quality of life. We sensitized our staff to the LGBT community and our management has been extremely supportive of this initiative. All staff, from the sweeper to the healthcare providers to the management need to be on the same page too when it comes to treating them fairly and equally.As a member of World Professional Association for Transgender Health, I look at how to extend the best healthcare practices to this community. India needs to be sensitised to the situation!
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. According to Karkera, there are two types of cost centers namely – service centers and revenue centers. Revenue centers generate revenue and also incur cost. But service centers like biomedical engineering do not generate revenue. “It is important to manage service centers 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 centres 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 neighbor. 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. The hospital had focused on cost and process innovation to become operationally efficient. According to Dr. Jagprag Gujral, COO of GGH,viability 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 .”
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 Setup your hospital in an overcrowded market :
“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.
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”