Globalization is driving changes in healthcare through factors like changing demographics, integrated economies, technology, and geopolitical changes. This is impacting India through opportunities in areas like clinical process outsourcing, medical tourism, and IT services for healthcare organizations in other countries. Managing healthcare delivery and IT across geographic and cultural boundaries presents challenges around privacy, security, productivity and control.

1. Globalization of Healthcare Saji Salam MD,MBA Chairman, Health Level Seven(HL7) India Healthcare Trends, Boston 2005

2. Agenda Globalization of Healthcare Impact on India Managing IT in a global care delivery model

3. Availability of Quality Care elsewhere Increasing Cost & Complexity in Administering Care Shortage on Manpower Globalization of Healthcare :Key drivers Changing demographics Integrated economies Technology Geopolitical changes

4. Way forward? Shortage of critical manpower Business process and IT outsourcing Demographic changes in US Requires more healthcare professionals,drives remote care Increasing Cost of care Global delivery of care Technology enabled remote care Clinical process outsourcing-Teleradiology, telenursing Integrated Economies Drives epidemic monitoring systems Geopolitical Changes Global network of bioterror surveillance systems Drug recalls such as Vioxx Global Adverse Events reporting

5. Key driver - Critical shortage in human resources Jonathan Sunshine, Ph.D., ACR's senior director for research and lead author of the study, says he's not sure why there are fewer vacancies in the radiology job market. "A lot of people are breathing more readily, but few feel the problem is definitely resolved," he says. AAMC officials said schools need to start planning now to prevent the shortages that at least two studies have predicted. One forecast, by Richard Cooper, MD, director of the Medical College of Wisconsin's Health Policy Institute, expects a shortage of 200,000 physicians by 2020. Another study by Ed Salsberg, for the Council of Graduate Medical Education, projects an 85,000-physician shortfall by 2020.

6. Globalization –Impact on India

7. IT services 15- 20 vendors 8000 -10,000 professionals serving US market Payors Providers HIT Vendors Revenue $ 500 million revenues 300+ HL7 professionals

8. Clinical Process outsourcing Clinical trial services Tele radiology services Telepathology Clinical laboratory Services Telenursing Revenue $ 25 - 50 million

9. Source: IDC $ 28 Billion $ 41 Billion BPO market - Break up by Vertical ( $28B in 2002 – $41B in 2006)

10. Business Process outsourcing Billing and coding services Claims processing services Accounts Receivables $ 100 million

11. Medical Tourism Hip replacement surgery Coronary bypass surgery Dental treatments

12. Managing IT in a global care delivery model

13. Critical decision – to outsource vs in-house Skills Training Cost of Ownership Productivity Quality

15. Outsourcing - challenges for IT Managers Challenges Privacy and security Geographically distributed teams Managing across cultures Managing across time zones Perceived loss of control

16. Offshore : Challenges

17. Q& A contact :saji.salam@cognizant.com