An Overview of Ambulatory Surgery
– Evolution & current position in
Healthcare delivery India
©2011. Nova Medical Centers....
“Of all the forms of inequality,
injustice in health care is the most
shocking and inhumane.”
— Dr. Martin Luther King Jr.
©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential
HealthCare ...
©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential
Healthcare ...
©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential
Current Ind...
©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential An Introduc...
©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential An Introduc...
©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential
Health Care...
©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential
Health Care...
©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential
Government’...
©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential
Healthcare ...
©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential
Healthcare ...
©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential
Taking Heal...
©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential
Taking Heal...
©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential
Why Ambulat...
©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential
Evolution o...
©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential
Ripple down...
©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential
• The Ambul...
©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential
THANK YOU
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1 mahesh reddy-evolution-and-healthcare_ncas_2011

  1. 1. An Overview of Ambulatory Surgery – Evolution & current position in Healthcare delivery India ©2011. Nova Medical Centers. Strictly private and confidential 2nd September, 2011 Dr. Mahesh Reddy MS(Orth), MCh (Orth-Liverpool), FRCS (England) Consultant Orthopedic Surgeon (Shoulder Specialist) & Executive Director, Nova Medical Centers
  2. 2. “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” — Dr. Martin Luther King Jr.
  3. 3. ©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential HealthCare In India… Three Indias… Extreme Needs Population Avg Healthcare spend per household Middle Income 325 Mn 15k High Income 19 Mn 75k Low Income 825 Mn <4k 3
  4. 4. ©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential Healthcare Delivery… HIGHS & LOWS Islands of Excellence in an Ocean of Inadequacy Jan 2010, CSIR have successfully mapped the first complete and entirely Indian genome. Medical Tourism is a $2Bn market in India 5th Gene behind brain disorder found by Indian geneticist & psychiatrist Telesurgery & Telemedicine has gained prominence for outreach to inaccessible population Success rate of cardiac bypass in India is 98.7% vs. 97.5% in the U.S. Ayurveda is the earliest school of medicine known to humans Life expectancy in India is 66 years compared to 78 years in developed countries Maternal Mortality Rate: 25 per 10,000 births vs 7 in developed countries 34 deliveries every minute… Births attended by skilled health personnel 47% vs 97% in developed countries Infant mortality rate: 70 deaths per 1,000 births Vs. 6 deaths in developed countries. 2 deaths occur every 3 minutes from Tuberculosis
  5. 5. ©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential Current Indian Health Care Scenario Infrastructure & Manpower • Total Beds - 1.37 million • But Only 50% beds functional & relevant • Hospital bed to Population ratio of 1.1 per 1,000 • World Average of 2.7 23% • 77% of the population pays out-of-pocket for healthcare. Only 23% covered by insurance (private, social etc) • Doctor to population ratio is 1 : 1,722 • World Average Ratio is 1: 715 • OT to population ratio of 1 per 100,000 77% 5 • Nurses to population ratio is 1.3 per 1,000 • World Average of 9.7
  6. 6. ©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential An Introduction | 6 Health Care Accessibility 10% of population Resides in Top 20 Cities 40% of beds 60% of beds 90% of the rest of the population
  7. 7. ©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential An Introduction | 7 Health Care Accessibility >46% of patients travel more than 100 km from small towns … to seek medical attention 67% DoctorsNurses Paramedical staff Working in Tier I cities Serious Lacuna in Tier II, III cities & rural India
  8. 8. ©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential Health Care in India... The Opportunity • The avg. household healthcare spend will increase from 7% to 10% in next decade 10% 7% • Healthcare contribution to GDP to grow from current ~4% to 5.5% of GDP Indian Healthcare Market – US$Bn 2010 2015 2020 2025 • 65 cities with 1mn+ population, 40 towns with 0.5mn+ population 8
  9. 9. ©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential Health Care delivery formats across the World 9 Canada: 70% of healthcare spend by Govt. Federally sponsored public funded medicare system with services provided by private sector US: 45% spend by the govt. 38% through the employers and 17% from private payment. UK: 90% Healthcare spend by govt. NHS completely funded by the government. Private practices to co-exist France: 80% of healthcare spend by government. Both forms of practice exist (Private & Public). Govt. refunds 70% of most healthcare costs & 100% in costly or long term ailments. Australia: 60% under government Program – Medicare (Co-exists with Private) All legal residents are entitled to government paid public hospital including treatment by private doctors
  10. 10. ©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential Government’s Struggle in Healthcare Delivery in India 10 • Poorly equipped & managed hospitals and delivery centers • Staffed inadequately • Sub-standard consumables, antibiotics & paracetamol being used
  11. 11. ©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential Healthcare roadmap for India… learning's from developed nations 11 Government Private • All Healthcare delivery in the hands of private players • Tiered approach to healthcare delivery… ensure rural inclusivity • Caters to all specialties including super specialties • Simplify healthcare insurance process… One Procedure One Rate • Innovative delivery models • Centers of Excellence (AIIMS, Kidwai, NIMHANS) • Research Institutes • Regulatory / Monitoring Bodies • Medical Colleges • Provide Medical Insurance • Provide preventive healthcare and provide basic amenities PPP • Private Partnership in current government hospitals
  12. 12. ©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential Healthcare Space is already witnessing new delivery formats New horizons for healthcare delivery would be that provide: • Lower cost • Addressing untapped markets • Improved CapEx leverage Innovative business models 12 • Greater operating efficiency • Enhanced patience experience • Ambulatory Surgery Centers • Single Specialist Hospitals / Chain • Hub & Spoke • Diagnostic clinics • Primary care networks • End-of-life Care Centres • Ambulatory Surgery Centers • Single Specialist Hospitals / Chain • Hub & Spoke • Diagnostic clinics • Primary care networks
  13. 13. ©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential Taking Healthcare to the People • For a few Villages – Primary Health Care Centre (PHC) – one for a few villages • Consulting • Basic diagnostics • Tests • Small procedures The Ideal Model How Lacunae will be filled… • Villages – Outreach Clinics • A consulting room • Minimal diagnostics 13
  14. 14. ©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential Taking Healthcare to the People The Ideal Model How Lacunae will be filled… • Towns - Ambulatory Surgery Centers – One in a town • Ambulatory Surgery Centers (ASC) or day / short stay surgery centers have following facilities: a. Surgical procedures that can result in discharge within 2 – 72 hours. b. Operating Theatres c. OPD Suites for Consultation d. Pre Op & Post Op beds e. Lab, Radiology & Pharmacy facilities f. Preventive Health check g. Specialized Clinics • Over 70% of all surgeries & nearly 1,400 procedures can be performed in a ASC • ASC’s can handle all non-critical surgeries 14
  15. 15. ©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential Why Ambulatory Surgery Centers? • Minimally invasive surgical techniques • Cost savings: • Treatment - 20-25% • Stay, travel – 25-30% • No scheduling delays as each center has 4 – 5 operating theatres • High quality cost effective alternative to traditional tertiary care • Hospital Acquired Infection can be significantly reduced • Increases bed to patient ratio & OT to patient ratio X 15
  16. 16. ©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential Evolution of ASC’s in India Basic ENT procedures performed in day surgery Till 2000 2000 – 2008 2009 2011 & beyond Basic ENT & Ophthal procedures. Advent of MIS India’s 1st multi specialty chain of ASC’s launched – Nova Medical Centers… to launch 25 centers in 4 years Hospital majors trying to catch up. Robotic surgery kicks off. ASC’s still very nascent in India… huge potential to make a substantial difference in healthcare delivery 16
  17. 17. ©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential Ripple down Effect of the ASC Delivery Model ASC’s Tier I Cities Tertiary Hospital Doctors visit once a week Clinical Training Quality Assurance Tier II & III Cities Doctors visit once a week Clinical Training Quality Assurance Critical Care Critical Care Rural Areas / Villages Outreach Clinics Primary Healthcare Centers (PHC’s) • ASC’s will act as GAP fillers and are easy to set up • ASC’s can be set up at 10% of the cost of a 100 bed hospital • Lower cost of set up and running translates to lower cost of healthcare in the hands of the patient • Better healthcare access to patients… in rural and Tier II & III cities Feeder
  18. 18. ©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential • The Ambulatory Surgery Centers are a 30 yr old concept in the West Ambulatory Surgery Center (ASC)… The Potential and Vital Cog in the Delivery Model • US has nearly 6,000 such centers doing 22mn+ surgeries annually • India has the potential to accommodate 15,000 such centers • ASC’s are the vital cog for • Effective, World Class, High Quality and Affordable Healthcare 18
  19. 19. ©2011.NovaMedicalCenters.Strictlyprivateandconfidential©2011.NovaMedicalCenters.Strictlyprivateandconfidential THANK YOU 19
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