Glocal Healthcare Systems Pvt. LtdA Messiah for rural and urban Underserved population of India.

ABSTRACTHealthcare is a necessity which is still eluding the underserved population of our country. Despite many efforts taken by the government; still our low socio-economic populace is denied of their basic right ie right for healthy living. This is where a private player like Glocal Hospitals steps in and takes the noble responsibility of providing healthcare to underserved population of the country.

BIDYUT KUMAR MANA 15XPGDM09 & Dr RAHUL S DESHPANDE 15XPGDM25Marketing of Services. Presented To: Prof Dr Nalin Jain

Table of ContentSerial No.

Topic Page No.

1 Executive Summary 22 Nature and Size of Market 33 Competitors 34 Target Segments 3-45 Target Customer Expectation 4-56 Market Strategy & Positioning Strategy 5-117 Customer relationship loyalty focus 118 Service Concepts 129 Basic Service Description 1310 Elements & Attributes of service 13-1411 Demand & Capacity Planning 14-1512 Perception 15-1713 Recommendation & Conclusion 17

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Executive Summary:

The private healthcare sector is responsible for the majority of healthcare in India. Most healthcare expenses are paid out of pocket by patients and their families, rather than through insurance. This has led many households to incur Catastrophic Health Expenditure (CHE) which can be defined as health expenditure that threats a household's capacity to maintain a basic standard of living. As per a study, over 35% of poor Indian households incur CHE which reflects the detrimental state in which Indian health care system is at the moment. With government expenditure on health as a percentage of GDP falling over the years and the rise of private health care sector, the poor are left with fewer options than before to access health care services. Private insurance is available in India, as are various through government-sponsored health insurance schemes. According to the World Bank, about 25% of India's population had some form of health insurance in 2010. A 2014 Indian government study found this to be an over-estimate, and claimed that only about 17% of India's population was insured. Public healthcare is free for those below the poverty line.

Plans are currently being formulated for the development of a universal health care system in India, which would provide universal health coverage throughout India. The National Rural Health Mission (NRHM) was launched in April 2005 by the Government of India. The goal of the NRHM was to provide effective healthcare to rural people with a focus on 18 states which have poor public health indicators and/or weak infrastructure. It has 18,000 ambulances and a workforce of 900,000 community health volunteers and 178,000 paid staff. Only 2% of doctors are in rural areas - where 68% of the population live.

This is where a private player like Glocal Hospitals steps in to solve this gruesome fact about the already strained urban and rural economic healthcare system. Glocal Healthcare is a chain of hospitals bringing state-of-the-art medical facilities and infrastructure closer to under-served India. Exclusively focusing on the health and wellness needs, Glocal provides outstanding medical services at a price point that provides maximum access to the intended audience. With a multidisciplinary team of highly skilled doctors and practitioners for world class patient care and treatment, Glocal provides secondary level healthcare, addressing 95% of the disease load in the country, constituted by 42 conditions & diseases.

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Nature and Size of Market:

Rural India contains over 68% of India's total population, and half of all residents of rural areas live below the poverty line, struggling for better and easy access to health care and services. Health issues confronted by rural people are many and diverse – from severe malaria to uncontrolled diabetes, from a badly infected wound to cancer. Postpartum maternal illness is a serious problem in resource-poor settings and contributes to maternal mortality, particularly in rural India. A study conducted in 2009 found that 43.9% of mothers reported they experienced postpartum illnesses six weeks after delivery. The hinterlands in India consist of about 650,000 villages. These villages are inhabited by about 850 million consumers making up for about 70 per cent of population and contributing around half of the country's Gross Domestic Product (GDP). Owing to a favourable changing consumption trend as well as the potential size of the market, rural India provides a large and attractive investment opportunity for private companies. India’s per capita GDP in rural regions has grown at a Compound Annual Growth Rate (CAGR) of 6.2 per cent since 2000.

Competitors:

The rural healthcare mainly was supplied and its needs were fulfilled by Government run hospitals and primary healthcare centre. Hence the major competition would be from these PHC (Primary Healthcare Centres). The dire condition of the healthcare in rural healthcare scene of India has no competition at present because there are no players in rural India except for Indian government. In this the main competition to Glocal Hospitals come from District Level hospitals, Taluka Level Cottage hospitals and rural level Primary Health Centres. This dismal state of health care in Indian rural setting attracted various international Non-Government Organisation to contribute towards providing health solutions to needy populace of India. For e.g. Bill and Melinda Foundation. Also there are others who also act as health service providers in rural and semi urban set-up like chemist from a drug store and also there are various quack practitioners operating without any valid medical education. By healthcare we mean to emphasize on the allopathic remedies and not focusing on other various branches on healthcare like Ayurvedic, Homeopathy, Unani and naturalist e.t.c hence we are considering as them as competition in some area.

Target Segments:

Healthcare in India is the major concern issue for the whole population and a special concern for those who have limited resources at their disposal. Till date healthcare is the only areas which can push families into poverty because the government doesn’t provide any healthcare directly like in some other western developed nations (USA Obama Care). Thus the maximum spending which happens at presently in India on healthcare is through out of pocket payment thus further depleting already constraint monetary resources of the poor population of the country. The vision set by the Glocal Healthcare leaders was to provide comprehensive primary and secondary healthcare in medically underserved areas,

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using a rational, technology based standardized platform. Glocal stands for Global Quality, Delivered at local level. As the organization’s mission statement suggest it has been established for the benefit for the medically under privileged population of our country. Our society is segmented on the basis of socio economic state of the populace into, affluent society, ultra higher income group, upper middle class, middle class, lower middle class, lower class and below poverty line individuals. Thus the achieved target segment for Glocal Healthcare is Lower class, below poverty line and the upper lower class population. At the same time Glocal through geographic segmentation has focused onto three primary target segments i.e. Rural India, urban India and semi urban. Thus the segmentation and targeting done by Glocal healthcare is the combination of both Socio Economics and Geographical. Covering a population of about 5 lakh within a 14km radius, each of the hospitals is equipped with 24 hours emergency services, out-patient and in-patient departments, technologically advanced operation theatres, labour rooms and minor injury units. Patients are offered a wide range of health check-up packages, specialized medical treatments and facilities that are delivered with the promise of quality.

Target Customer Expectation:

Customer expectation is not much difference from urban & rural population in India. As we know customer expectation is depend on several factors which are included of knowledge about product or service, communication, education, income, socio cultural interface. In the case of healthcare service in India’s majority of age belong to 45-61 who need most healthcare service in India. The education level of in rural population minimum class eight standard to master degree level but majority of education level belong 12 th standard in rural India. However, there is significant change in terms of education as well as income level, therefore expectation also changing among rural population about health care service. In rural are income another factor of customer expectation, in general rural population income drive from 2000-30000/month and majority population income less than 6000/month. The dominant family size in rural population 4-6 and most important factor earning member in rural population is one. The level of expectation low compare to urban population. They need basic facility of healthcare service with competitive price which can affordable to their income level. The rural patient expectation is treatment oriented which included of reliability of service, responsiveness of quire and all other service need be under one roof.

Customer expectation from rural hospital are given below.

Physical Aspect-Hospital should located in a place the maximum people can reached easily through all types of transportation. The hospital physical layout should be customer convenience during course of treatment.

Reliability- Rural patient believe on reliability from hospital as well as doctor which means customer expect that all information rightly inform to the patient & their relative right & first time.

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Empathy & Responsiveness- The rural customer expect from the hospital that they should empathized & responsiveness to the patient relative as well as patient. The rural patent are not have enough knowledge about heath care therefore they faced lots difficulty during their treatment.

Cost- The most important factor is cost of treatment, as we know the rural population income level is very low the cost should be affordable to the customer, otherwise they will not able take the service.

Market Strategy (Marketing 4 P concepts at Glocal Hospitals) and Positioning Glocal Healthcare for the target segment:

Promotional Strategy:

Glocal Hospital has used the four p concepts of marketing mix to very efficient use. The nature of the selected target segment proofed beneficial for Glocal’s marketing strategy as said by the CEO Glocal Healthcare Mr Shahbat Azmi. As the company focused on the rural and urban under privileged section of the society by providing them primary and secondary healthcare facilities which were absent in those areas or were under lot of constraints previously so the launch of Glocal Hospitals was immediate success than excepted initially. Glocal put-on lot of efforts initially to make everyone aware that a new alternative for the healthcare is available other than government run facilities. Which included out of home advertising, health-camps organized by Glocal Hospitals, in some instances fleet advertising was done on some auto rickshaws and buses. The major impact of the marketing strategy adopted by Glocal was seen through the health awareness camps in rural interiors of West Bengal and in semi urban areas of Kolkata. As health is more serious issue the personal contact program organized by Glocal was much more important in propagating its values and motives behind establishing such an organization through emphasizing on the patient awareness abut he/her health and their health of their family members.

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(Glocal Team holding a press conference as a part of its publicity campaign)

(Glocal Team for a Health-camp in rural interiors)

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(Glocal Health Centre in village)

(By inviting Hon. President of India Shri Pranab Mukharjee Glocal increased eyeballs on it)

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(Glocal with its affordable Healthcare Solutions and serene atmosphere needed for healthcare delivery created a place on its own in Bengal’s rural and urban poor healthcare scenario)

Numerous press release were done prior to start of functioning of its first Sonamukhi hospital in Bankura district of West Bengal. The main focus was on public relations rather than an advertising blitz-Krieg, hence number of KOLs i.e. key opinion leaders were involved in the campaign. The seriousness and responsible nature of the industry demanded that the marketing campaign of Glocal should make people aware of importance of health and make them aware they are there to solve their any health related problem at an extremely affordable rate and that their motive is to serve people in society not to be a hospital which solely focuses on the profit making. This was the marketing goal of the Glocal to position itself as a healthcare destination which cares for the needy segment of the society, which addresses their healthcare needs at a cost which they can afford to pay without any compromise in the healthcare delivery quality by the use of the latest technology in its hospital delivery mechanisms. Glocal also associated its name with government run schemes for the rural and poor urban population so being visible with the government Glocal tried and created a valuable image in patients mind. Thus Glocal Hospital through the use of integrated marketing communications like electronic mass media television, radio, print media local newspapers (Bengali newspapers like Anand Bazaar Patrika, Vartamaan Patrika and Pratidin), out of home advertising and through extensive public relations have succeeded in developing an image of a caring, affordable and quality destination for populations’ healthcare needs.

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Integrated Marketing communications and Marketing Mix used by Glocal Hospitals

Pricing Strategy:

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Pricing strategy options for Glocal Hospitals

Through the above figure we see that Glocal Hospitals have focused or rather decided their pricing strategy based on or as per the customer segment it is trying to target. The hospital flows a Penetrative pricing strategy.

Understand Value: Value is low price.

Therefore the hospital has synchronic-pricing & penetrative pricing.

Determine Demand based on competition and offerings:

Extremely High Demand among the lower socio-economic strata of the society in West Bengal. For a root canal treatment in lower socio-economic strata of Kolkata.

Total Population of Kolkata Approx. 20 million. Total Populations in lower class of society: 1.2Million (60% of 2mil). People with severe dental root infection: 30 lacs (25% of 1.2 mil). People who to us for the root canal treatment surgery: 15 lacs (50% of 30 Lacs)

Estimated Cost, revenue and life time value:

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Cost of carrying out the root canal surgery including the dental surgeon’s fees, materials and various other factors: Rs 60/-

The cost of undergoing the surgery: Rs 200/- Net Profit behind each surgery: Rs 140/-

Therefore revenue earned: 15 Lac X 140 Rs = Rs 21 Crore.

With good quality service we expect the life time customer value of the patient to be very high.

Establish a Pricing structure:

The pricing structure of Glocal Hospital is lower level.

Set final price of the root canal surgery at Glocal hospital: Rs 200/-

Customer relationship loyalty focus:

Today healthcare market become very competitive to the world especially in rural area because the rural customer are very price sensitive and at same time they need better service from the private hospital. Rural customer are shifting due to unsatisfactory customer service from government/public hospital. To meet the customer expectation & to provide the better quality service the Glocal Hospital they have adopt several strategy which are follows as efficient outreach, effective case coordination and flexible case management.

Outreach customer relationship Process: To reach the maximum customer they focused on targeted patient population by providing local heath campaign, educating the patient health & wellness, prompting service offer and improving the communication with patient, physician and community relation.

Active Patient Coordination process: They have developed systemic coordination with the doctor, hospital internal department & other health care service provider. Patient coordination management process by using specialized CRM software service. The CRM facilities the service which are as follows:

Patient Information Management- which basically provide the individual patient current health assistance information, pre & post treatment communication, Online & offline appointment management.

Providing doctor information & other knowledge information. Patient referral management information.

Customer Feedback: To make strong relationship with patient they have customer feedback policy which enable to learn about the customer satisfaction & customer expectation improvement.

24 hours hotline telephone Service: They have dedicated customer call Centre which has been providing all telephonic response to the customer.

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Service Concepts:

The service concept adopted by Glocal healthcare is one of kind and has a potential to revolutionize the mechanism of healthcare delivery for needy population of India in villages and urban centres. The model which adopted by Glocal is no frills model, as its sole focus is on the primary and secondary healthcare delivery. It focuses on the commonly occurring conditions which can handled by minimum complicated equipment and a team of doctors efficient to handle wide array of disease conditions with help required from medical experts as when needed. For this they tied up with the government schemes such as Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) and Rashtriya Swathya Bima Yojana (RSBY). They have established state of the art hospital through the funding received from venture capital firms like world famous Sequoia Capital and Elevar Equity. In which they have successfully integrated delivery mechanism with information technology and have successfully introduced novel health delivery mechanisms such telemedicine and digital radiography thus reducing the dependency on the radiology technical staff to the minimum. Thus with state of vision, objectives, sense of purpose with the assistance of technology Glocal Healthcare is trying change the future of low cost healthcare delivery in India.

Service Blue Print of Glocal Hospitals:

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Basic Service Description:

General Medicine- Its branch of all medicine which provide all kind medicinal service & it’s an important healthcare institution.

Pediatrics & Neonatology- Institution have specialize department of pediatric & neonatology which are most important rural hospital because there so many child disease are followed in rural population.

24 Hour Emergency & Laboratory- This are most important service in rural healthcare because in night due to unavailability of emergency service number patient lose their life.

Critical Care – ICU & NICU are one of the advanced service which Glocal providing in rural hospital.

24 Hour Radiology& Pharmacy- its enable to provide urgent solution to the patent but it was not available earlier.

General Surgery- The institute of have general surgery department which are most demanded surgery in rural healthcare.

The others service included of Gynecology, Obstetrics, Ophthalmology, Dental, Dialysis and EEG.

Elements & Attributes of service.

Zero-based approach- It means common disease which are responsible for 90% of complicated disease occurrence.

Cost-As rural population spending ability is low compare to urban population, therefore cost of treatment will very low.

Standardization- In rural health treatment procedure basically driven by individual doctor decision, but Glocal approach will be standardized protocol based model which will be ensuring high quality of healthcare service & will help to reduce the human error.

Technology driven delivery model- Glocal model extensively focus on technology to ensure service operations can be lean across both the clinical and administrative aspects of healthcare delivery. Example like Digital Hospital—100% Paperless & Wi-Fi Enabled, Electronic Health Records and Tele-medicine.

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Technology Driven Service Approach.

Demand & Capacity Planning:

Hospital presently functioning with 100 inpatient bed which situated in district town in in Birbhum, west Bengal. Conversation with hospital operation manager, he told us that Hospital currently 90 to 95 bed underutilization and bed occupancy rate near 30 to 40 percent. Hospital have capacity to manage 20% of higher capacity of demand for in patient service. All though hospital is function last two years the demand is very fluctuant and cannot predict easily.

Emergency Department- In emergency department presently 15 bed is available. In case of more patient come to emergency department more than the capacity. Hospital have standard process to find out severity of patient problem and if found that patient is in normal condition then emergency team provide the initial treatment go for discharge. However, if the patient found that severity index not normal then patient directly send to concern department of inpatient department or ICU. If the patient is over than the capacity hospital authority directly transfer to other hospital after initial treatment in emergency. Its serious issue for the hospital it can be predict accurately and patient sometimes intended to send back from the emergency.

Radiology Department- In this department capacity management is the major issue and challenge to the hospital authority. However, manage the unpredicted demand they have standard policy to help them to manage which are given below.

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Evidience Based Medicine

Standarized Dignostic Protocol

Protocal based Medical Treatment

Standardize Mechanism of

outcome

Service Execillance Mechanism

Patient Feedback Mechanism

Managing prior schedule for which already given the time slot. Reconfirmation taken from the patient before one day of procedure. If any change in schedule prior inform to the individual patient. Hospital focus on which is most emergency in the case of unpredicted demand. Hospital policy always focus on current patient should be any kind of miss management.

The operation manager frankly told us there is hard and fast rules to manage the over capacity. Over capacity management cannot match with particular theory or specialized tools and it’s about human life & strong emotion.

Surgery Department- Hospital have 3 operation theatre one of them big OT and other two is medium sized. Generally one OT dedicated for emergency OT which available 24 hours and others two are schedule OT. Surgery department coordinator manage the schedule all the OT. Schedule OT generally confirmed by the doctor prior at least 2-3 days before. Before day of surgery patient need confirmed and same time treated surgeon also have to confirm. If the both of them not able to confirm it will take as cancel for the selected date and new schedule will be prepared for schedule OT list and confirmation send to individual doctor & patient party. In case of emergency of over capacity of surgery schedule the consultation with doctors and schedule meeting on basis patient seriousness priority.

Perception:

The perception of the healthcare service different from urban & rural population. In case of urban population they are more knowledgeable about the service quality like doctor & staff cooperation, hygiene, empathy, and way of service delivery to the patients. In rural population most common factors perception are empathy, reliability & tangibility. Perception of quality of healthcare service significantly high among rural population. The various study on customer perception founded that perception healthcare service depend different traits of attribute which are mostly influence on customer perception like age, personal income, education & knowledge.

When they looking for service from private hospital & there perception becoming high because the rural patient are habituated with free treatment from government hospital. The different perception rural population has given below.

The hospital physical facility like waiting are, diagnostic are, intensive care units, wards and toilets are suppose be well equipped with cleanness.

Availability required medication within affordable cost. Availability of ambulance service within minimal cost which help to make affordable. Hospital whatever promotional offer activities mention in brochure it should be

same when customer avail the service. There should not be any hidden cost during avail the service because rural

population have money constraint therefore, any kind of extra cost will unaffordable to them.

Hospital should provide error medical & medical record service.

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In government hospital Doctor maximum time not entertain to patient & there relative for any kind quire, therefore patient & relative never make comfortable with government hospital service. Hence, patient are paying for service therefore doctor & other hospital staff must response to patient as well as relative.

Hospital must inform to patient & their relative during admission & treatment process & discharge follow-up activities which make comfortable to the customer.

Employee of the hospital must empathize & response to individual patient quire & update information.

It’s very tough assignment to meet customer’s expectation with multidisciplinary medical service in rural health care service. However to meet customer expectation the Glocal hospital they have service excellence policy will ensure the customer expectation of rural population.

The hospital committed give value of money by spending of every customer which will ensuring to the customer low cost of service.

Hospital is located within certain range of locality therefore ancillary cost has reduce to the customer.

Effective customer feedback mechanism help to identify the customer needs & expectation.

They have learning & skill development initiative activities which help to ensure the quality of service.

Rural employment help to decrease the cost of service as result the service quality meet the customer requirement.

Hospital extensively using the updated technology which has been ensuring the better service to the customer.

Standardize protocol base treatment & service policy helping to increase the customer expectation.

“A medical doctor & former civil servant, Dr Sabahat Azim founded Glocal Healthcare Systems in 2010 with ambitious plans to offer affordable healthcare services at scale in the unserved parts of urban, semi-urban & rural India. Glocal successfully implemented five hospitals in West Bengal within two years. All hospitals have broken even financially & rapid scaling of volumes is playing a role in their sustainability. Their hospitals break even in 8 months on average, significantly much lesser time than the industry standard. By end-January2013, the hospitals had treated 77,834 patients, conducted 3,452 surgeries and till end-December 2012, had managed 274 childbirths & 2,505 emergencies including trauma & accident cases.”

- India Infrastructure Report 2013-14: The Road to Universal Health Coverage, IDFC Foundation, 2014 pp. 86-87; http://www.idfc.com/pdf/report/2013-14/IIR-2013-14.pdf

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“Setting up standardized diagnosis & management protocol for the 42 diseases that 95 percent of the population suffered from, helped Glocal streamline its focus area, adding clarity in requirement analysis & design of hospitals. “ -22nd January 2014, KPMG www.kpmg.com/global/en/issuesandinsights

“Each hospital in Glocal has 100 beds, 20 operation theatres, ICU, delivery suite, neo-natal care unit, pharmacy, pathology & radiology. And each Glocal hospital serves 5 lakh people living in a radius of 15km from the hospital.” - Oct 31, by Aparajita Gupta, The Times of India http://timesofindia.indiatimes.com/city/mumbai/Doctor-at-heart/articleshow/17026344.cms

Recommendations & Conclusion:

Glocal Hospitals is doing fabulous job in healthcare delivery for the underserved population of West Bengal. They have done everything to formulate a successful business model which can deliver the affordable low cost health service simultaneously generate profits. Nobody is perfect even God did not create universe in perfect fashion He is still trying to figure out and so is Glocal Hospital. We are sure that it will be a highly successful business model in low cost affordable healthcare which will further inspire many entrepreneurs across the country to venture into the noble field of healthcare. As a part of our contribution to the Glocal Hospitals initiative of health for all we would like to make few suggestions to them:

1 Try to strength the emergency department

2 Try to bring in more efficiency in handling medical consumables ie inventory management needs improvement.

3 More motivation for the doctors and specialist so that they continue to work for the hospitals.

4 Patient catering services need some improvement regarding the menu served.

5 Increase in public awareness program regarding various preventable diseases through which attaining more publicity.

6 More efficiency in patient turnaround time.

Over all Glocal Hospitals have been immensely successful in developing the healthcare system for the low socio-economic strata of the society in West Bengal’s rural, urban and semi urban areas. The model which they have established is to look out for and is the need of the hour in India’s context. Indian are a burgeoning young enthusiastic population with hunger our bellies for growth and development and the last thing which should come in between our progress and development is poor health. Thus hospitals like Glocal will soon become backbone of the Indian Economy.

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