Dr Joy- Banerjee-At Mallya Hospital study

201

Masters in Hospital Administration Projects. 1. A study to assess the extent to which the Social

Health Insurance Schemes operational in Bangalore (Karnataka) were utilized (2008 and 2009) by the beneficiaries of the respective schemes at Mallya Hospital

2. To evaluate the efficiency and effectiveness of the website of Mallya Hospital as tool in e – marketing

From 4TH March 2010 till 7TH April 2010 Two major projects done at Mallya Hospital , Bangalore as an essential part of Final Internship, in partial fulfillment of academic requirement of Masters in Hospital Administration from Tata Institute of Social Sciences, Mumbai.

2010

Dr JOY K BANERJEE Masters In Hospital Administration

Batch 2008‐2010 Registration No. 2008HO017 EMAIL : [email protected]

Dr Joy B., MHA, TISS; ([email protected]) : final internship project :at Mallya Hospital. Page 2

PROJECT 1 : A study to assess the extent to which the Social Health

Insurance Schemes operational in Bangalore (Karnataka) were utilized (2008

and 2009) by the beneficiaries of the respective schemes at MALLYA

HOSPITAL, Bangalore.

(Project 1 in the Fourth and Final Internship as an essential part of academic

curriculum in Masters of Hospital Administration.)

From 4th March –7 th April 2010.

Study done By: DR JOY K BANERJEE Guided By : Mr NAMADEV RAO

MHA Final Yr. Manager _ Business Development

Registration No. 2008HO017

TATA INSTITUTE OF SOCIAL SCIENCES,

SCHOOL OF HEALTH SYSTEM STUDIES, MUMBAI.


ACKNOWLEDGEMENT

The successful accomplishment of any task is incomplete without acknowledging the

contributing personalities who not only assisted and inspired me but also lead to visualize

the theme of the project.

I take this opportunity to thank Dr C A K Yesudian, Dean School Of Health System Studies,

TISS, Mumbai for visiting me personally and giving essential inputs and guidelines during

the course of this project.

My word of success to MALLYA HOSPITAL, Bengaluru for granting me the permission to

undergo project work in their organization. I am extremely grateful to Mr. S. Namdev Rao

(Manager – Business Development) and all departmental staff for his expert guidance and

valuable inputs and their assistance through out the study. Also special thanks To Ms

Usharani, Manager- MRD for letting me collect the data. The success of this project is ever in

the shadow of MALLYA HOSPITAL staff.

Last but not the least I convey my heartfelt thanks to all the staff members of the various

Social Health Insurance Regional offices spread in Bengaluru who were concerned with this

project, for giving me time and all the secondary data required for the completion of this

project.

Dr Joy K Banerjee.


CONTENTS (project 1)

Page No.

1. INTRODUCTION TO THE HOSPITAL 05

2. AIMS AND OBJECTIVES 07

3. LITERATURE REVIEW 10

a. Health Care In India 10

b. Introduction To Social Insurance 12

c. Social Health Insurance 13

d. Need for Social Health Insurance 14

e. Why Social Health Insurance is Different. 15

f. Modus Operandi of Micro Insurance. 17

g. Indian Social Insurance Scenario : IRDA Tables of Reference 19

h. Social health insurance - an overview at Mallya Hospital. 23

4. METHODOLOGY and DESCRIPTION 36

5. DATA ANALYSIS and INFERENCE 39

6. RESULT 44

7. RECOMMENDATIONS 48

8. CONCLUSION 49

9. REFERENCES 50


PROJECT 1 : A study to assess the extent to which the Social Health Insurance

Schemes operational in Bangalore (Karnataka) were utilized (2008 and 2009) by the

beneficiaries of the respective schemes at Mallya Hospital.

Introduction of the hospital : MALLYA HOSPITAL

Hospital with a difference

The only name, which comes to everybody’s mind when one thinks of Hospitals in the

Central business unit of Bangalore, is none other than the well known Mallya Hospital.

Bordered by the whispering meadows of Cubbon Park on one side and the active business

establishments on the other, this Hospital stands apart with its magnificent look symbolizing

a legendary Institute.

It was on 6th June 1991 that Bhagawan Sri Sathya Sai Baba inaugurated Mallya Hospital.

Until the early 90’s there were very few Medical Institutions in Bangalore offering Quality

Healthcare. Thanks to the farsighted vision of Dr.Vijay Mallya, a 150-bedded hospital was

born in the heart of the city as an integrated, health care delivery component with all assets

that could make a hospital – its location, excellent medical equipment, moderate size and

above all some of the best Specialists.

Mallya Hospital has grown over the years with substantial increase in bed strength,

infrastructure and an assurance of quality patient care with human touch using state-of-the art

technology. The multidisciplinary approach to diagnosis and care is designed to have a

continuum of safe and high-quality care for patients – all services under one roof. Today, the

hospital is managed by Chaparral Health Services Limited with Mr.D.K.Audikesavulu,

Ex - Member of Parliament, Lok Sabha as the Managing Director and Commodore Indru

Wadhwani as the President. The group also manages Vydehi Institute of Medical Sciences

at Whitefield, which is a 1000 bedded Medical College Hospital & Research Centre. Mallya

hospital has to its credit as the first Multispeciality hospital in the country to receive the

coveted ISO-9002 certification award which has been recently upgraded to ISO 9001:2008


World standards within the reach

In line with the quality policy of the hospital, continuous up gradation of the facilities and

services is the mantra. With the bed strength increased to 219, now the hospital is able to

cater to those who seek even the most sophisticated services and treatment. Two modern OTs

have been added recently to the previous lot of five OTs. These are equipped with world-

class technology and are stainless steel with vertical laminar flows, which ensure zero

infection. The hospital is equipped with advanced MRI, 64-slice CT, iPacx - PACS

Teleradiology System, CR ‘X’ ray System, Mammography and Ultrasound equipment. The

introduction of Fresinius 4008 S Dialysis machines has further enhanced the efficiency of

the Dialysis unit. These are in addition to the earlier lot of eight dialysis machines. The

Nephrology Department carries out regular Renal Transplants.

Cutting edge technology to compliment the skills of Consultants & Surgeons to perform

Minimal invasive surgery, Total hip replacement & Total knee replacement surgery,

Arthroscopic surgery, Polytrauma care, Brain & Spine surgery have come a long way in

ensuring international standards. Capsule endoscopy, a unique procedure in detecting

gastrointestinal lesions has been an advanced method, which can trace haemorrhage even in

the small intestines, which routine procedures fail to diagnose.

The 24-hour Emergency and Trauma care services are geared to handle all kinds of

emergencies ably supported by imported hi-tech ambulances having medical and paramedical

staffs. In a way, these ambulances are literally CCUs’ on wheels.

Birthing suite – a home away from home for the joyful moments of motherhood is unique

to Mallya Hospital. This is equipped for Labor / delivery / recovery (LDR) so as to have the

convenience of staying in the same room throughout the recovery.

Health check programs

“Prevention is better than cure”. The age-old slogan is given due weightage with the various

health check up programs designed specially to have an early diagnosis of life style diseases.

The Laboratory has been accredited by NABL acknowledging the precision of the

diagnostic services.

The process towards accreditation by NABH is in progress which further ensures high quality

standards.


Mallya Hospital offers courses in DNB for Medicine, Surgery, Anesthesia and Orthopedics.

Frequent CMEs are conducted in association with various medical fraternity to exchange

updated information. Various health awareness programs including talks by specialists’ and

health check-up camps are conducted on a regular basis.

Latest in Technology

“Brillance 64 slice Cardiac CT, the non-invasive diagnostic procedure to detect coronary

artery blocks was inaugurated in the year 2007, by Dr.Mallya and has become a great boon to

thousands of cardiac patients to have an early detection of heart ailments. The installation of

Flat Panel Philips Allura X per F 10 Cath Lab is yet another feather in the cap which has

put the Dept of Cardiology to the world standards.

Departments & Facilities

Advanced Hi-tech Ambulance Service Autoanalyser, Audiometry

Angiogram Angioplasty

Biochemistry Blood Bank

Bone & Mineral Metabolism Lipid – Vascular Metabolism

CT Scan (64-slice) Cafeteria

Colour Doppler Coronary Care Unit

Coronary Bypass Surgery Computerized Stress Test

Dento-facial Orthopedics Diabetology

Diabetes Day Care Center Diabetics Health Check-up

Dialysis Day & Night Pharmacy

Electrocardiogram Endoscopy

EEG EMG

Hematology Hormone Assay (ELISA, RIA)

Health Check-ups Microbiology

Holter monitoring Intravascular Ultrasound

Joint Replacement Laparoscopic Surgery

MRI, Mammography Maxillo-Facial Surgery

Metabolism, Thyroidology Reproductive Endocrinology


Non-stitch Cataract Surgery Orthodontics

Echocardiography Interventional Radiology

Open Heart Surgery Pulmonary Function Test

Paediatric Endocrinology Neuro endocrinology

Plastic Surgery Physiotherapy

Renal Transplants Ultrasonography

Mission Statement

The Mission of Mallya Hospital is to provide quality patient care and to ensure the safety of

patients and their families and the staff of Mallya Hospital.

Quality Patient Care is the first priority of the organization. We believe that empowered

employees will maximize Quality Patient Care by balancing Patient Expectations, Patient

Needs and Available Resources.

Quality Policy

To achieve continuous improvement in providing quality patient care using state-of-the-art

technology and rendering service with human touch.

A gentle feel, even in sophistication.

“Individual care to deliver the best results – that is what we focus at every step”. With the

360-degree care, patients experience the concept of Total Quality Management. A regular

orientation program for the staff, specially aimed at giving the best of the updated care with

the usage of ultra modern equipment is conducted in which team sprit is a focus priority.

Their consultants and Nursing staff are not only just experts in their specialty; they are also

driven by the vision of quality and commitment in giving individual attention for maximum

treatment outcome.

Contact details:

Mallya Hospital No.2, Vittal Mallya Road

Bangalore – 560 001

Ph: 080 22277979 / 22277997

Fax: 080 22242326 / 22121282

Emergency Number: 080 22242325

E-mail: [email protected]

Website: www.mallyahospital.net

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AIMS & OBJECTIVES :

1. To study the overall structure of various social health insurance schemes operational in

Karnataka with specificity to Bangalore.

2. To ascertain the total number of beneficiaries of the social insurance schemes who have

availed the services offered at Mallya Hospital in past two years ie 2008 & 2009.

3. To identify the percentage of patients covered by Mallya Hospital out of the total number

of beneficiaries who took treatment in the past two years through these schemes.

4. To figure out the departments/ specialities under which these beneficiaries have been

treated at Mallya Hospital.

5. To have a comparative study between the calendar years 2008 and 2009 with regard to

the patient flow to Mallya Hospital from these social health insurance schemes

6. To asses the trend of the clinical cases which are covered by these beneficiaries at Mallya

Hospital.

7. To suggest possible ways and means so as to bring around more scheme beneficiaries

within the preview of treatment offered at Mallya Hospital.

8. To suggest additional areas localized predominantly with scheme beneficiaries to add to

the existing geographical areas.

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HEALTH CARE IN INDIA

The public sector :

The provision of public health services is divided into primary, secondary and tertiary

sectors, which reflect increasing specialisation.

In rural areas, health sub-centres form the institutional basis of primary health care. Each sub-

centre is supposed to provide essential services for up to 5,000 individuals (the actual average

in 1999 was 4,579) (Planning Commission 2001). Jointly with other institutions, they also

provide family planning and other public health programmes (e.g., hygiene and water purity

programmes) that are supposed to be carried out by paramedical personnel such as auxiliary

nurse midwives (Planning Commission 2001). In reality, however, many positions in the

137,000 sub-centres are vacant (World Bank 2001).

The sub-centres are complemented by community health workers under supervision of the

sub-centre. These community members provide essential health care on a part-time basis. A

three-month training course is supposed to enable them to perform first aid according to

traditional and allopathic principles.

The 23,000 primary health care centres (PHC) are in charge of six sub-centres each. Besides

outpatient treatment, most PHCs offer inpatient treatment with four to six beds. According to

the plan, each PHC serves 30,000 people and employs one physician supported by 14 staff

members (Planning Commission 2001). Although 20% of all hospital beds in India are found

in PHCs, only 5% of all hospital days are spent in these centres (Mahal et al. 2001). Apart

from inadequate medical equipment, this gap is mainly due to personnel shortages. Nurse

positions often remain vacant due to low pay, poor career prospects, and unattractive

locations. The same is true for 28% of all physician slots (World Bank 2001). The

incumbents of filled positions are often absent from work. Inadequate pay induces many of

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them to seek a second job (Betz 2002). The budget shortcomings of the PHCs not only affect

personnel and capital goods (medical equipment, furniture, buildings), but also consumer

goods such as pharmaceuticals. The budget for outpatient treatment is short by 45%

(Ashtekar 1999).

The secondary sector of the Indian health care system consists of rural hospitals and

community health centres (CHC). Serving four PHCs, the CHC’s specialised medical

services are intended for 120,000 people (Government of Maharashtra n.d.). In 1999, 3,000

CHCs served 214,000 people each.

For several years now, there have been plans to upgrade 2,000 CHCs to the status of regional

hospitals (Planning Commission 2001).

Community health centres are supposed to have at least 30 beds, an operating theatre, a

laboratory, xray facilities, as well as a team of four medical specialists and a support staff of

21. This is another area where problems of inadequately filled positions are aggravated by

equipment shortages. According to a state survey, only a third of operating theatres are

sufficiently equipped (Planning Commission 2001).

The private sector :

India has one of the highest proportions of private health financing, almost 82%. It is ironical

that in a developing country like India with over a quarter of the population still below the

poverty line, the private sector expenditure dominates health spending. UNDP’s global

HDR 2004 ranks India with a public spending on health at 0.9 % of GDP, as 171 among the

175 countries a much lower rank than the poorer South Asian neighbours like Nepal and

Pakistan. However, due to the predominance of private expenditures, the country’s rank in

terms of private health expenditure, as a proportion of GDP, is 18 among 175 countries.

Household survey of Health Care Utilization and Expenditure (NCAER 1995) indicates that

on an average the households spend about 15 % of their income on curative health care and

this percentage in marginally higher in case of rural households.

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Both macro and micro studies on the use of healthcare services show that the poor and

other disadvantaged sections are forced to spend a higher proportion of their income on

healthcare than the better off. The burden of treatment is particularly high on them when

seeking inpatient care. The high incidence of morbidity cuts their household budget both

ways, i.e., not only do they have to spend a large amount of money and resources on medical

care but are also unable to earn during the period of illness. Only about 10% of the population

is in the organized sector and is covered by any kind of health security plans. Even those

covered, experience growing inefficiencies and low quality of service.

Health Insurance has often been suggested as an optimal solution as it minimizes the

costs for the users as well as the providers. However, the fixation of the premium is

problematic, as the low premiums require large numbers of people to enroll into the scheme,

which leads proponents to suggest compulsory insurance. The insurance companies are

reluctant to collect small amounts as transaction costs are high and they therefore, rely on

several exclusion clauses to minimize their risk….these make the policies less attractive for

the subscribers- for the very poor this could mean a choice between the next meal and an

illness which is hypothetical.

INTRODUCTION ABOUT SOCIAL INSURANCE :

In comparison to phenomenon of micro-credit which started in a big way in India in the 90s,

micro-insurance is a very recent concept. Micro-insurance, that basically refers to insurance

for the low income people, is picking up in India. A strong interest in the development of

micro-insurance in India comes from three different quarters. One is the growing evidence of

a strong positive link between health security and poverty reduction; accordingly those

involved in poverty alleviation are looking for way to address healthcare needs of the poor.

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Two, hard constraint on public budget is making the health financing specialists explore

alternative financing mechanisms such as insurance, user charges, revolving funds etc. Third,

the imposition of social and rural obligations by the insurance regulator in post-reform phase

of the Indian insurance market is necessitating insurance companies to develop products for

the low-income segment of the market. The confluence of all three forces is leading to the

development of micro-insurance India.

INTRODUCTION ABOUT SOCIAL HEALTH INSURANCE:

Although the type of risks faced by the poor such as that of death, illness, accident, old age

etc. are no different from those faced by others, the poor are more vulnerable to such risks.

Given the economic circumstance of the poor, these risks have a special significance in their

lives. These risks prevent them from breaking the vicious circle of poverty. Any poverty

alleviation strategy must, therefore, enhance the ability of the poor to deal with risks

(Holzmann and Jorgensen 2000, Siegel et al. 2001). Insurance is one of the risk management

strategies. In the past insurance as a prepaid risk managing instrument was never considered

an option for the poor. For one, the poor were considered too poor to be able to pay for

insurance, and for other, they were considered uninsurable, given the variety of risks the poor

face.

Health care in India is supposed to be funded and provided by the government.

Unfortunately, decades of under-funding have resulted in poor infrastructure, unmanned

health institutions and inadequate supply of medicines. This has naturally resulted in poor

quality of health care, resulting in patients shifting to the private sector. Today, studies show

that about 80% of all outpatients and about 50% of all inpatients seek health care from the

private sector (Raman Kutty 1996). This has obvious repercussions, the main being reduced

access to health care and high medical expenditure at the time of illness. Evidence shows that

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about 19% of the patients do not seek health care because of the high costs. And about 24%

of households who do seek health care are impoverished because of this event (Peters 2002).

This problem of access is usually redressed in other countries through an insurance

mechanism. People (or their employers) pay an annual premium towards a sickness fund that

is used to meet the health care costs of the enrolled. While this is well developed in most

OECD countries, health insurance is still at a nascent stage in India. Only about three percent

of the population are insured in one form or the other. Most of the insured are people in the

formal sector (especially civil servants and industrial workers). To overcome this problem,

some non-governmental organisations (NGOs) have instituted community health insurance

(CHI) among the poorer sections of society. These are small health insurance schemes

managed by the NGO and the local community. The numbers enrolled range from 5,000 to

50,000 and the benefits usually include hospitalisation costs (Devadasan N 2004). The main

objective of these CHIs is to enable their members to access health care with minimum costs.

However, recent developments in India, as elsewhere, have shown that not only can the poor

contribute towards their insurance but also that they are insurable as the risks they face are

predictable and there are cost-effective ways of extending insurance to them.

NEED FOR SOCIAL HEALTH INSURANCE:

The need for health insurance for the poor has arisen because illness is found to be one of the

important causes of their impoverishment. In the event of illness the poor (for whom wage

income is the predominant source) not only forgo their income but have to exhaust their

savings, borrow or run down their assets for meeting hospitalization costs. According to a

World Bank study (by Peters et al. 2002), about one-fourth of hospitalised Indians fall below

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the poverty line as a result of their hospital stays. Similarly, more than 40 percent of

hospitalised patients take loans or sell assets to pay for hospitalisation. Similarly, the baseline

survey carried out by the Centre for Population Dynamics (CPD) in 2 different districts of

Karnataka corroborated the findings of the World Bank study. In particular, CPD found that

people in those 2 districts faced significant financial barriers in seeking medical care as loans

constituted the single largest source for meeting costs of illness and hospitalization, followed

by sale of livestock (Karuna Trust 2003). Such high percentage is also noted by some

Mutually Funded Insurances (MFI) in the utilization pattern of loans advanced by them.

WHY IS SOCIAL HEALTH INSURANCE DIFFERENT :

Health insurance for the poor is different from the health insurance in general in at least 4

ways. First, in case of a poor individual, the size or the extent of insurance coverage is not a

choice variable. Individuals cannot choose coverage level at a given price or decide on the

risks against which to buy insurance, as is generally the case with health insurance. The poor

are offered an insurance package that includes price, benefits and defines the method of

paying premium and settling claims. All that they decide is whether or not to join the scheme.

In other words, insurance package only influences the purchase decision i.e., whether or not

to buy (standard) insurance package but not how much coverage to buy or what risks to

include. Price is based on community rating and not on individual rating.

Health insurance in case of the poor is generally a group contract mediated through or

managed by a nodal agency. Second, in case of health insurance for the poor, some level of

subsidy or external funding is necessary for ensuring sustainability of schemes. According to

the ILO inventory, nearly 50 percent of the schemes (i.e., 25 schemes) received a financial

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assistance to initiate their activities. A review of 10 health insurance schemes for the poor in

India also confirms this point (Ranson 2004). This gives rise to a number of issues such as:

what level of subsidy, in what form, and, to what agency?

Third, health insurance does not remove all financial barriers to access health care. Often

there are many indirect costs such as wage loss, transportation costs, incidental costs during

hospital stay and so forth. This is not to suggest that people who are not poor do not have to

bear these costs. What distinguishes the poor from non-poor is that these costs often prevent

the poor from seeking medical care. So, a careful design of scheme must try to minimise

these other financial as well as non-financial barriers. It is also suggestive, that the cost

incurred in terms of transportation to avail the healthcare needs, food and other incidental

expenses be reimbursed to the beneficiary to maximize the utility of the scheme benefits.

Indeed, a few health insurance schemes explicitly provide for wage loss to enable the poor to

seek treatment. Moreover, mechanism of premium collection and claim settlement itself can

act as a barrier to join a scheme. A flexible method of collecting premium is needed for

people who have low and fluctuating income. Similarly, prompt/direct claims settlement in

case of the poor who lack credit facility assumes special significance in case of the poor.

Fourth, designing health insurance system involves strengthening health care provision as

well. Providing health insurance is meaningless if the health facility is weak. A weak facility

dissuades individuals from joining the scheme and this also has a bearing on cost of illness.

Provision of health care of reasonable quality cannot be assumed when initiating health

insurance for the poor. Often, good quality services are not available within reasonable

distance. So initiating health insurance in case of the poor also involves strengthening the

supply side.

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To the extent health insurance helps in removing financial barrier to seeking health care, it is

desirable. However, providing insurance to the poor can be prohibitively costly. Neither

government provided nor market mediated insurance is appropriate way of providing

insurance to the poor as both these are too costly. An institutional innovation that makes

delivery of insurance cost-effective is the only way of extending insurance to the poor. This

innovation lies in finding an intermediate agency that can organise the poor and perform

some (or all) of the activities normally carried out by an insurance company. A nodal agency

generally has an intimate knowledge of the needs and priorities of the community, in which

they work and also enjoys the trust of the local people. This local knowledge is essential in

designing appropriate insurance scheme as well as appropriate delivery mechanism. In

addition, a nodal agency can mobilize external funding.

In the context of health insurance, a nodal agency performs several functions typically carried

out by an insurance company. The presence of a nodal agency results in (i) lowering of

transaction costs (ii) designing a scheme suited to the community needs, and (iii) influencing

the supply of health care.

MODUS OPERANDI /Types of Micro insurance Arrangements:

Depending on the nature of functions performed by a nodal agency, one could categorise all

micro insurance schemes into three types (Ranson 2004). Type I scheme where a nodal

agency is an intermediary between a formal insurance provider and the target community

(SEWA in Ahmedabad, ACCORD in Nilgiris are good examples of this type of schemes).

Almost all MFIs and also some NGOs perform the role of an intermediary. Type II scheme

where a Community Based Organisation (CBO) or an NGO manages the scheme in-house

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with an arrangement with a health provider (for example Tribhuvandas Foundation in

Gujarat, Yeshwani in Karnataka). Type III scheme where the health care provider itself

initiates and runs an insurance scheme (as in case of Sewagram Hospital in Maharashtra,

Voluntary Health Services (VHS) in Chennai). All these forms currently exist in the country

but only in small pockets.

(i) Transaction Costs: When providing insurance to the low-income people or

those in a low resource context, transaction costs become crucial in all types of insurance

arrangements. One of the strengths of micro insurance scheme is that such costs can be

contained. The magnitude of these costs can make the whole difference between being

able or not being able to afford insurance.

(ii) Membership Size and Risk Diversification: In micro insurance schemes in

India, the size of membership varies widely from less than one thousand to more than

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50,000 members (ILO 2003). The size of membership is crucial for diversifying health

risk by enlarging the size of risk pool. This issue becomes important when a scheme is

managed in-house by a nodal agency (Type II scheme). A large group size tends to make

the scheme viable and sustainable.

(iii) Inpatient and Outpatient Care: Ideally, both these types of care should be

available to the insured members. In case of illness the decision on whether or not the

patient needs hospitalisation should be made professionally. It should not be a function of

whether or not the patient has health insurance cover. In practice we find not many

schemes provide insurance for both types of risks. Most schemes provide for inpatient care

only.

SOCIAL HEALTH INSURANCE : INDIAN SCENARIO : Statistics.

In India out of 28 schemes that provide health insurance, 16 schemes cover only

hospitalisation expenses, 7 schemes cover only primary health care services and 5 schemes

cover both primary health and hospitalisation costs. In order to understand the amount of

beneficiaries who have availed the scheme and what is the revenue outflow thereof to the

provider, the following data will give an insight with regard to two states which have been

excelling in operating SHI schemes in India.

No. of Claims and average claim paid for 2007- 08 – by state

State Number of claims Average claim paid(Rs) Maharashtra 186883 27367 Karnataka 103462 24419 Report HR1 - Number of Records - Policies, Insured Members, Claims for 2003/04, 2004/05 & 2005/06

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The overall scenario in the country is tabulated below which is self explanatory: All the

below tables are presented in exact communication from the official IRDA document

released for the year 2008-2009.

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Process Map of availing treatment

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SOCIAL HEALTH INSURANCE - AN OVERVIEW AT MALLYA HOSPITAL:

An Analysis on the social responsibility which Mallya Hospital delivers as part of its

Corporate responsibility is echoed in the success of various social insurance schemes

operational at this hospital. Wonderfully noted that the patients who avail the treatment

benefits at this hospital are no way differentiated either in terms of identifying them or ear -

marking a separate treatment area instead they are viewed at par with the other cash paying

patients.

The details on various SHI schemes operational at Mallya Hospital are appended below:

1. AROGYA BHAGYA YOJANE: (ABY) :

Karnataka Government has introduced unique scheme called Arogya Bhagya Yojane to its

Police Personnel and their families, which was launched during June 2002. This scheme is a

self-financing scheme managed through monthly contribution from the Police Personnel

themselves & through medical reimbursement from the Government. The scheme is

administered by a Nodal Agency having expertise in Medical administration.

Evolution of ABY

• Announced on April 2nd ‘2002

• Launched on 1st Aug ‘2002

• Over 60000 Police personnel enrolled under the scheme

• Over 69 quality care hospital providers (including Govt. hospitals) are empanelled

across the state

• Scheme operated under Karnataka Police Health Welfare Trust

Contribution under ABY

• Gazetted employees shall contribute Rs.50/-

• Non Gazetted employees shall contribute Rs.40/-

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Most Revolutionary Features of the Scheme

• Most revolutionary fact pre-existing diseases no bar to avail the benefit.

• Cashless transaction across Karnataka State and complete transaction from time of

admission till discharge of the member is cashless.

• All ailments are covered as per Karnataka Govt. Medical Attendance Rules 1963.

• Implants, prosthesis and materials are excluded under Karnataka Govt. medical

Attendance Rules 1963 BUT are covered under ABY.

• Free OPD consultations and OPD investigations are as per KGT and in case particular

investigation is not listed under KGT, the network hospital shall extend 25% concession

on hospital rate.

2. EX-SERVICE CONTRIBUTORY HEALTH SCHEME (ECHS) :

Retired Armed Forces pensioners so far did not have a comprehensive medicare scheme, as

compared to and available to other Central Government employees. Interim treatment of

minor nature (garden diseases) was provided at service hospitals and MI Rooms, but often

these hospitals got overloaded.

To provide some relief, AGI (MBS) was introduced in Apr 91 and AFGIS (MIS) in 1995;

however, they covered only specific high cost surgery/treatment for a limited number of

diseases. Due to certain limitations of these schemes, it was felt necessary to formulate a

comprehensive health care scheme to cater to the needs of pensioners of the Armed Forces,

and thereby decrease the in and out patient load on service hospitals.

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Based on this noble aim, and after detailed deliberations, a comprehensive scheme has taken

shape as the Ex-Servicemen Contributory Health Scheme (ECHS), authorised vide

Government of India, Ministry of Defence letter No.22(I)/01/US/D (Res) dated 30 Dec 2002.

With the advent of this scheme, Ex-Servicemen pensioners who were only entitled for

treatment in service hospitals will now be authorized for treatment, not only in service

hospitals, but also in those civil/private hospitals which are specifically empanelled

with the Ex-Servicemen Contributory Health Scheme.

ECHS is a comprehensive medical care scheme covering all diseases including cardiac,

renal, joint replacement, cancer and many others. It provides benefits to the complete

spectrum of ESM pensioners settled in far-flung areas of the country, through a network of

227 Polyclinics (104 in Military Stations and 123 in Non Military Stations). This will, in turn,

reduce the load on Military Hospitals, since the exclusive Polyclinic facility will be located in

nominated districts and closer to Ex-Servicemen pensioners.

An important aspect of ECHS is that, it not only covers the ESM pensioner, but also family

pensioners & widows who are in receipt of pension – thereby ensuring their medical care,

even in absence of the pensioner. The twin conditions are that, prospective member must be

an Ex-Serviceman who has served in the Armed Forces of India in any rank, and be in receipt

of pension/family pension/disability pension paid by Government. The intended purpose is to

provide succour to pensioners, their wives, widows & authorized dependants & bring ECHS

in line with medical schemes applicable to Central Government employees of other

categories. Correct adherence to laid down procedures will ensure that the system is not

misused or overloaded.

Aim : To provide comprehensive, quality and timely medical care (covering all possible

diseases) to ESM pensioners and their dependants, and to widows and family pensioners in

receipt of pension, through out-patient facilities at 227 all-India Polyclinics, and in-patient

treatment through service hospitals and empanelled civil hospitals/facilities.

Contribution: All ESM pensioners are required to make a one-time contribution based on

their basic monthly pension (excluding DA). A concession has been made in respect of pre–

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31 March 2003 retirees, who can pay their contribution in three consecutive, equal yearly

instalments.

Affidavit: All ESM are required to make a declaration of their dependant children, and

changes if any, through an Affidavit. Also they have to declare that they are NOT members

of any other Govt/PSU Medical Scheme.

Dependants are defined as : Spouse, unemployed son(s) below 25 years, unemployed and

unmarried daughter(s), dependant parents whose combined income is less than Rs 1500/- pm,

and mentally/physically challenged children for life.

Procedure For Becoming Members of ECHS - (Retirees On or After 01 Apr 2003). New

Application form (ECHS Med-2003) has been introduced into service for all ranks retiring

w.e.f. 01 Apr 2003, and for whom the Scheme is compulsory. The forms have been provided

to AG/PS-4 for inclusion in the Brochure issued to Retiring officers; similar forms have also

been provided to Naval and Air Headquarters for issue to their retiring personnel. Sample

copies have also been sent to all Record Offices of the Army, through Inspectorate

of Records, to Commodore Bureau of Sailors (CABS) of Navy and to Air Force Record

Office Delhi Cantt, for PBOR. All Services will make their own arrangements for printing

and issue of forms to retiring JCOs/OR and equivalent. The new forms have been now

introduced w.e.f. 01 Jan 2004.

Record Offices will also forward these forms by post to those pensioners who have retired

between 01 Apr 03 and 31 Dec 2003, and direct them to follow the procedure of submission

given in General Instructions. In addition, those retirees whose ECHS contribution amount

has NOT been directly deducted by CDA (Pension) in their PPO, will be required to deposit

their contribution amount through MRO only, in any authorised bank. They will be required

to attach original copy of MRO as a proof of remitting their contribution.

In case this is not done, ECHS Membership is not valid.

Contribution: ECHS is a contributory scheme. On retirement, each pensioner (wef. 01 Apr

2003) will compulsorily become a member of ECHS by contributing his/her share and the

scheme would be applicable for life time.

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Similarly, Ex-Servicemen pensioners who have already retired prior to 31 Mar 2003 can

voluntarily become members, either by paying a onetime contribution or in three consecutive

yearly instalments. Contribution will be according to the table given below.

Basic Uncommuted Pension Rate of One Time Subscription

(Excluding DA & Disability)

Up to Rs. 1500/- Rs. 1,800/-

Rs. 1501 - 3000/- Rs. 4,800/-

Rs. 3001 - 5000/- Rs. 8,400/-

Rs. 5001 - 7500/- Rs. 12,000/-

Above Rs. 7500/- Rs. 18,000/-

Ex-Servicemen pensioners who make payment in three consecutive yearly instalments will be

issued an ECHS Membership Smart card with initial validity for one year only. The validity

of the card for the second and third years would be extended only after the Ex-serviceman

pensioner has paid and given proof of deposit of second and third instalments. ECHS benefits

will be extended to him/her and dependants only thereafter.

Empanelment Of Hospitals, Nursing Homes, Diagnostic Centres And Consultants

Empanelment of Govt/civil/private hospitals , Diagnostic Centres, Nursing Homes and

Consultants will be undertaken by local Station Commanders on behalf of ECHS. In the

initial stage, 275 Hospitals, Nursing Homes and Diagnostic Centres are being empanelled.

This list has been drawn from 486 (431+ 55) hospitals and Diagnostic Centres recognized by

the Central Government Health Scheme (CGHS) and the Railway Board respectively, and

approved for interim inpatient health care of ECHS members. This list of hospitals shall be

reissued once the pending procedure for ECHS empanelment is approved by GOI/MOD.

Empanelment Procedure. A Board of selected Officers will be constituted to empanel

hospitals/Nursing Homes and Diagnostic Centres in every station where ECHS Polyclinics

are located. The Board will inspect the facilities in the hospital, and record the general and

specialized services available. Board will only recommend empanelment, where the facilities

are of high quality and the rates are reasonable. Approval for empanelment will be accorded

by the Government. Thereafter a Memoranda of Agreement will be signed with the approved

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hospital/Nursing Homes and Diagnostic Centres/ Consultants, thereby empanelling the said

facility for treating ECHS patients referred by the Polyclinic.

Payment to empanelled hospitals : Payment by ECHS only, post treatment. Patient does

NOT have to pay anything (except Hospital Stoppages / Dietary charges).

Points to note :

An individual cannot become a member of two Govt/PSU Schemes –

he/she has to cancel membership of the other scheme in case opting for the ECHS. For

example, one cannot be a member of CGHS & ECHS at the same time. Nor can one be a

member of the ECHS and a PSU scheme at the same time.

Benefits of joining the ECHS:

The ECHS has brought in tremendous flexibility and empowerment for pensioners. The

major benefits are; No Cash payment to be made any where, treatment is free, the number of

diseases covered is exhaustive (and not restricted to the ten under MBS) and treatment can be

availed in MH/Civil empanelled hospital of choice of the ECHS Card holder, and there is no

upper limit for repeated treatment of the same disease/condition.

A total of 431 hospitals are empanelled for the ECHS scheme to attend to their health needs.

3. YESHASVINI HEALTH INSURANCE SCHEME.

The Yeshasvini Cooperative Farmers Health Scheme is a young but incredibly successful

micro insurance scheme in Karnataka. Having started in 2003 with 1.6 million insured right

away, it covered 2.2 million lives in its second year of operation, but in the third year it

dropped to 1.45 million members after doubling the premium. This (still) amazing success is

possible through a tight partnership with the cooperative sector enabled through the

Karnataka Department of Cooperation.

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Yeshasvini Cooperative Farmers Health Care Trust is a charitable trust governing a health

insurance scheme of the same name. The scheme was launched at the end of 2002 and

became operational in June 2003. In October 2003, the Trust was officially registered as a

charitable trust.

The Trust and its insurance scheme are based on the initiative of Dr. Devi Shetty. An expert

in cardiac surgeries and chairman of Narayana Hrudayalaya Hospital in Bangalore. Dr. Shetty

and his team developed the insurance model of Yeshasvini. Mr. A. Ramaswamy I.A.S., then

Principal Secretary in the Department of Cooperation, Government of Karnataka, then gave

concrete shape to Shetty’s idea.

Yeshasvini Trust is registered as a charitable trust eligible for tax exemptions. A charitable

trust is an institution or fund registered under the Indian Trust Act of 1851, established to

benefit a disadvantaged target group. A trust’s objective needs to be consistent with the

definition of the term “charitable purpose” which includes relief for the poor, education,

medical relief and the advancement of any other object of general public interest. The income

generated in the trust should not directly or indirectly be used for the benefit of the founder of

the trust or other specified persons. Furthermore, the property should be held exclusively for

charitable purposes.

Yeshasvini has hired Family Health Plan Limited, a TPA registered with IRDA, to administer

its scheme: FHPL has experience with self-funded schemes as it administers two schemes for

the police in Karnataka and Andhra Pradesh.

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Roles of FHPL :

• Issuing ID cards: Each client receives an ID card with a photo after subscribing to the

scheme. In the scheme’s first two years, the cards were valid for one year only; new cards

were issued at time of renewal. To lower costs, the cards have been redesigned and can

now be used for three years. They simply need to be renewed each year. FHPL issues and

renews these cards.

• Authorising treatment: When a client seeks surgical treatment, FHPL must authorise the

surgery. The hospital and client submit a photocopy of the client’s ID card, a letter from

her/his cooperative society proving membership, receipt of premium payment (if possible)

and a form filled by the doctor describing the surgery necessary. FHPL checks the documents

and authorises the surgery.

• Preparation of claim settlement including verification: After a surgery the treating

Network Hospital submits the final documents to FHPL and claims payment for the

surgery. This claim form is accompanied by

o A photocopy of the Yeshasvini ID card

o A photocopy of the Yeshasvini receipt of premium payment

o The (original) letter proving membership in the cooperative society

o The (original) Pre-Authorisation issued by FHPL

o Operating notes

o Discharge summary

o Final Bill

o Investigation reports and prescriptions.

FHPL checks these documents and prepares the claim’s reimbursement for approval by the

Board of the Trust.

• Managing the funds: FHPL manages the funds of the scheme, but does not hold them.

• Monitoring the network hospitals and guide them: It is the duty of FHPL to check the

quality of the Network Hospitals and to make sure that all adhere to the rules set.

• Prepare reports and statistics: For every monthly meeting of the Board of the Trust, FHPL

prepares statistics on the scheme’s performance.

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To fulfil these duties, FHPL maintains an office in Bangalore with an 8 person staff. It is this

office’s main responsibility to issue the pre-authorisation for the treatment and to process the

claims. One of the persons is a medical doctor responsible for checking the medical aspects

of a requested authorisation. Additionally, FHPL also employs one coordinator for each

district.

THE CLIENTS are : The insurance scheme exclusively targets members of cooperative

societies and their dependents in Karnataka. In July 2005, there were 31,000 registered

cooperative societies in Karnataka of which about 26,000 are classified as functioning. They

are active in fields such as (agricultural) credit, cattle breeding and dairy, sericulture, textiles,

sugar planting and processing.

THE BENEFITS : The scheme covers more than 1,600 surgeries. The Trust and the health

care providers have fixed a price for each surgery, including nearly all connected costs. A

client requiring one of these surgeries can approach a network hospital—although some

special surgeries require specialised hospitals. Admission charges, bed charges in a common

ward, nursing charges, anaesthesia charges, O.T. charges, surgeon’s charges are all covered,

as well as the costs of consumables and medicines during and after the operative period, post-

operative charges and surgery related investigations. Additionally, free OPD consultations are

given to clients as well as investigations at a special rate of about 70% of the usual costs (if

not connected to surgery). Drugs prescribed in OPD need to be purchased.

The maximum coverage for a person per year is Rs. 200,000 ($4,545). This is sufficient for

two of the most expensive operations and some smaller ones. The price for surgery paid to a

network hospital is about 30% below the average price charged. In case of complications, the

treating hospital has to bear the additional cost; the scheme does not reimburse for it. It seems

to be the case that for some hospitals, the prices for some surgeries are more attractive than

for others. Some hospital managers also claim that not all prices have been discounted with

the same percentage.

The scheme does not cover inpatient admission without surgery.

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CLAIM SETTLEMENT PROCESS

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CLAIM SETTLEMENT DETAILS :

4. VAJAPAYEE ARYOGYASHREE YOJANE

The scheme is intended to benefit below poverty line (BPL) families both in urban &

rural areas of Karnataka in a phase wise manner. The pilot stage of the scheme will cover the

following five Districts of Gulbarga Division: Bidar, Bellary, Gulbarga, Koppal & Raichur.

Identification of these families will be based on BPL ration card issued by the Food and Civil

Supplies Department, Government of Karnataka. The benefit will be restricted to only five

members of a family.

Benefit package : Primarily, the Benefit Package will cover the identified tertiary care and

catastrophic diseases that are not widely treatable in all Government Hospitals/ Institutions

and are not covered under any other pre-existing health programmes.

Sum assured will be Rs.1,50,000/- on a family floater basis per year. Additional buffer of

Rs.50,000/- per year for the entire family on a case to case basis will be available.

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Cashless Transaction:

It is envisaged that for each hospitalization the transaction shall be cashless for covered

procedures. Enrolled beneficiary will go to network hospital and come out without making

any payment to the hospital subject to procedure provided under the Scheme.

Pre-Existing Diseases:

All diseases proposed under the Scheme shall be covered. A person suffering from any of the

identified disease prior to the inception of the Scheme shall also be covered.

Pre and Post Hospitalization:

The package shall cover the entire cost of treatment of patient from the date of admission to

his/her discharge from the Hospital and 10 days after discharge and complications while in

hospital making the transaction truly cashless to the patient.

Procedure for Enrolment of Hospitals:

All the Public Hospitals (District Hospitals, Government/ Private Medical Colleges) and

identified Private Hospitals/ Nursing Homes shall separately be empanelled. Private

Hospitals/ Nursing Homes meaning, any institution in Karnataka established for in-patient

surgical care and the Networked Hospital should comply with minimum criteria.

Quality of Services:

• Network Hospital agrees to provide separate and Free OPD consultation. However

there will not be any discrimination to Vajpayee Arogyashree patients vis-à-vis other

paying patients in regard to quality of services.

• Network Hospital shall agree to provide free diagnostic tests and medical treatment

required for beneficiaries irrespective of surgery.

Memorandum of Understanding (MoU) between SAS Trust with Network Hospitals:

• MoU is between the SAST and Network Hospitals

• MoU is an agreement to provide services to pre-agreed set of benefit package and at

pre-agreed PRICE.

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• MoU will consist of pre-requisites including setting up of Vajpayee Arogyashree Cell,

Broadband Connectivity and using SAST web platform for all transaction processing.

• Procedures will only be conducted on receipt of Pre-Authorization from

Implementation Support Agency/ SAS Trust

Claims Settlement:

SAS Trust shall settle the claims of the Hospitals within a set period of time after

securitization and reviewed by the Trust, afterwards claims are duly processed by the

Implementing Support Agency.

Hospitalization Period:

The period for which the insured person is admitted in the hospital as in-patient and stays

there for the sole purpose of receiving the necessary and reasonable treatment for the disease/

ailment contracted/ injuries sustained during the period of policy, the minimum period of stay

shall be for at least 24 hours.

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METHODOLOGY AND DESCRIPTION: In line with the aims and objectives of the study, it is essential to identify to what extent out

of the many social Health Insurance Schemes run at Mallya Hospital, the services were

utilized by the beneficiaries.

The methodology used is completely purposive sampling. The data required were of two

types. First, the number of beneficiaries from the four SHI schemes who availed their

treatment from Mallya Hospital in the year 2008 and 2009. Second the total number of

beneficiaries of these four SHI schemes who actually claimed their benefits especially in

Bangaluru , Karnataka. The first data required is of primary in nature and the second data is

secondary.

The data with regard to the number of patients who availed the services at Mallya Hospital

was obtained from the Medical Records Department. The present Hospital Management

Information System was installed an year back and hence the data for the total number of

beneficiaries from these 4 SHI schemes for the year 2008 and 2009 was retrieved manually.

Nevertheless with the help of the MRD Manager, the required numbers were compiled.

The data with regard to the total number of patients, who actually availed the treatment

services under the schemes which are spread across the state under various hospitals, were

collected from the Regional Offices of these SHI schemes present in Bangalore. A Prior

permission and appointment from the concerned persons was sort and a reference of the

concerned person in authority from the hospital was necessarily required before any

discussion to begin. The four offices and their locations are as follows:

• Arogya Bhagya Yojane (police) Concerned person : Ms Rashmi

Karnataka Police Health welfare trust

No.2 Nrupathunga Road,

Bangalore – 1

• ECHS polyclinic Concerned person : Mr Kumar

Command Hospital

Agram Post

Bangalore – 07

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• Yeshshawini Health Insurance (Concerned person : Mrs Bharti)

No. 45, ground floor, Millers Road,

Vasanth Nagar. Bangalore -01

• Suvarna Arogya Suraksha Trust (for BPL persons)

Vajapayee Arogyashree

Nitton Building, No. 11

Palace Road, Bangalore – 52

Since the governing policies of these SHI schemes are different due their Mission and Objectives, achieving a common parameter for data collection and analysis was not considered. Data Collection ; The data under the following parameters were collected.

1. Brief history of the Social Health Insurance Schemes. 2. Number of claims in the year 2008 and 2009 3. Approximate number of claims per month 4. Process of cash flow. 5. Eligibility Criteria

The data for the case wise / speciality distribution could not be collected from these SHI offices as they were said to be confidential. DATA IS TABULATED AS FOLLOWS: 1. Arogya Bhagya IPD cases at Mallya Hospital

JAN FEB MAR APR MAY JUN JULY AUG SEP OCT NOV DEC

2008 11 16 11 15 19 11 12 20 14 16 14 11

2009 10 18 17 18 20 17 16 9 12 17 17 12

a. Total no. of claims in the year 2008 is 7345 and for the year 2009 it was 6758.

b. On an average the no. of claims made in Bangalore city alone is 550 to 600 patients per

month. This has remained almost same in the past two years under study.

c. The speciality wise case distribution was available only for the month of November

2009.

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2. Ex-servicemen Contributory Health Scheme IPD cases at Mallya Hospital

ECHS Jan‐09

Feb‐09

Mar‐09

Apr‐09

May‐09

Jun‐09

Jul‐09

Aug‐09

Sep‐09

Oct‐09

Nov‐09

Dec‐09

male 2 2 1 1 2 1 0 0 0 0 0 0

female 0 0 1 0 0 0 0 2 0 0 0 0

Jan‐08

Feb‐08

Mar‐08

Apr‐08

May‐08

Jun‐08

Jul‐08

Aug‐08

Sep‐08

Oct‐08

Nov‐08

Dec‐08

ECHS pts 2 2 6 8 5 13 8 14 10 12 11 9

a. Total number of claims made in the year 2008 is 2446 in Bangalore city alone and for

the year 2009 it was 2130. A dip of 316 patients.

b. The number of claims per month in Bangalore city ranges between 120-210 patients at

any given month.

c. The speciality wise contribution was unavailable

3. Yeshashwini IPD patients at Mallya Hospital

The month-wise data for Yeshashwini patients was not available. However, the total

number of males and females operated in the year 2008 and 2009 are 79, 38 and 92, 28

respectively.

a. The total number of claims for the operations made in Bangalore city alone by the

beneficiaries from the nearest villages and taluks of Bangalore viz. Yelahanka,

Kanakpura, Nelmangala, Bidadi, Channapatna, Kolar (to name a few) for the year

2008 and 2009 were 1009 and 1102 respectively.

b. The speciality wise contribution for the surgeries was unavailable.

4. Vajapayee Arogya Yojane for the Below Poverty Line people is relatively new scheme

taken on board by Mallya Hospital in the year 2010 and as of now only 6 men and 1 woman

availed the facility here during the months of January and February 2010. Hence the analysis of

patients covered under this scheme is exempted from the project preview.

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DATA ANALYSIS and INTERPRETATION Arogya Bhagya Yojane: (ABY)

JAN FEB MAR APR MAY JUN JULY AUG SEP OCT NOV DEC

2008 11 16 11 15 19 11 12 20 14 16 14 11

2009 10 18 17 18 20 17 16 9 12 17 17 12 Graphical representation of the data for the year 2008 & 2009

a. Bar diagram narrating the comparative data

b.Line diagram narrating the comparative data

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Inferences :

• The total number of patients treated at Mallya Hospital in the year 2008 was 200 and in

the year 2009 was 183.

• A fall of 17 patients in the year 2009.

• Out of the 7345 patients who seeked claim in ABY in the year 2008 in Bangalore city

alone, only 200 availed it Mallya hospital.

• The percentage coverage stands to be 2.72% for the year 2008.

• Out of the 6758 patients who seeked claim in ABY in the year 2009 in Bangalore city

alone, only 183 availed it Mallya hospital.

• The percentage coverage stands to be 2.70% for the year 2009.

• Thus it shows that the dip of patients treated at Mallya Hospital in the year 2009 in

comaprison to that of 2008 is in line with the market dynamics as is seen in the total

dip of ABY patients in the year 2009.

Since the data for speciality wise treatment was availbale only for the month of November 2009, an indept analysis of the same was done as with the details as follows. Graphical representation of the speciality wise break-up for the month of November 2009

Inferences :

• As is evident from the above graph, the surgical sepciality seems to contribute highest.

• The lowest is from Neurosurgery.

• The sample selected for analysis is too small a data and hence commenting on the same

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with regard to the most prevalent cases amongst the policemen cannot be stated.

• However, the dominance of general surgical cases cannot be ruled out by taking the above reference.

Ex servicemen Contributory Health Scheme : (ECHS)

Jan‐08

Feb‐08

Mar‐08

Apr‐08

May‐08

Jun‐08

Jul‐08

Aug‐08

Sep‐08

Oct‐08

Nov‐08

Dec‐08

ECHS pts 2 2 6 8 5 13 8 14 10 12 11 9

ECHS Jan‐09

Feb‐09

Mar‐09

Apr‐09

May‐09

Jun‐09

Jul‐09

Aug‐09

Sep‐09

Oct‐09

Nov‐09 Dec‐09

male 2 2 1 1 2 1 0 0 0 0 0 0 female 0 0 1 0 0 0 0 2 0 0 0 0

Inferences :

• The total number of ECHS beneficiaries who seek benefit has fallen in the year 2009

from the previous year. The drop amounts to 91 patients. Thus compared to last year

the percentage change with regard to the number of beneficiaries who availed

treatment in Mallya Hospital has dropped by 88.35%!

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• Out of the 2446 patients who claimed for health benefits under ECHS only 103 availed

this service from Mallya Hospital and for the year 2009, out of the 2130 claims only

12 took the services at Mallya Hospital.

• Thus Mallya Hospital has catered to 4.2 % patients in the year 2009 and 0.56% patients

in the year 2009

• On an average the patients availing their treatment in Mallya Hospital per month has

also dropped from 9 patients in 2008 to almost 1 patient in 2009. This fall is of about

88.89%

• Only 7.5% of the total ECHS beneficiaries availed health care treatment in Mallya

hospital in 2008 compared to only 0.83% patients in the year 2009 per month.

3. Yeshasvini Health Insurance Scheme: (YHI)

Inferences :

• The number of male patients who availed surgery under Yeshasvini Health Insurance

Scheme has increased by 14 patients over one year 2009 amounting to an increase by

17.45%

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• The number of female patients who availed surgery under the Yeshasvini Health

Insurance Scheme has decreased by 10 patients over one year in 2009 amounting to a

drop by 26.32%

• Thus the over all number of patients (both male and female) who availed surgery in

Mallya Hospital has increased by only 03 patients over one year. This is a rise of

about 2.56%

• Compared to the year 2008 where 11.6% beneficiaries of the Yeshasvini Health

Insurance Scheme availed surgeries at Mallya Hospital, in the year 2009 this

percentage increased by a 0.2% only. In the year 2009 11.89% beneficiaries of the

Yeshasvini Health Insurance Scheme availed surgery at Mallya Hospital.

Vajpayee Aryogyashree Yojane:

• Since it is relatively new scheme operational at Mallya Hospital it has helped only a

few beneficiaries. The data available is disproportionate to the period of study and

thus cannot be effectively analysed for performance.

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RESULT

From the above data analysis and interpretation the following conclusion is arrived at.

Mallya Hospital is located at the Heart of the city and is well known amongst all section of

the societies.

Though many hospitals with Super speciality treatment and claiming world class treatment

with cutting edge technology and gadgets have cropped up in the city, Mallya hospital has

retained its charm and also has maintained its faithful patient flow.

The Hospital has grown over the years both vertically and horizontally increasing in its

capacity and services, which itself is a proof of its ever increasing loyal patient community

base.

The hospital has not only gone ahead to enhance its patients from all the economic sections of

the society but has also found innovative ways to draw the patients to its premises for the

services.

The hospital has been effective in empanelling a number of corporate group health insurance

but has also successfully maintained profitable tie ups with many leading TPAs in the

country.

The hospital has not forgotten its corporate social responsibility as well. The result is the

number of patients who approach Mallya hospital for health care facilities from economically

challenged sections of the societies covered under various SHI.

The Hospital has held up its mission and quality standards in delivering same healing and

personal touch to both the out of pocket payment patients and the Social Health insurance

patients alike.

The hospital gives services on the first cum and get served basis without any bias to the

patient’s background.

Out of the four SHI schemes the beneficiaries of the ABY avail maximum services from this

hospital, followed by Yeshswini Health Insurance and then ECHS.

`


The drop in the ECHS patients can be a cause of concern as the fall in the number of patients

is to the extent of 88.89%.

The following comparison will elucidate further as to the extent of variations in patient

numbers within the three SHI schemes.

It is encouraging to note that there has been no significant difference in patient contribution

between the two years for both ABY and YHIS. However, exercising a word of caution at

this juncture may be apt as “no change” in ABY and YHIS numbers should not be interpreted

as highest contributors. It may be noted that as mentioned earlier, the number of patients in

these categories are very minimumal in comparison to the total beneficiaries who had availed

the services under the scheme from various other health care organizations. The total number

of IP in Mallya Hospital for the year 2008 was 3475 and for the year 2009 was 3309.

.

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The month wise breakup of the total number of patients in the year 2008 and 2009 are as

follows.

The percentage contribution of SHI patients to the IP flow for the year 2008 is 11%

The percentage contribution of SHI patients to the total IP flow for the year 2009 is 9%

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Inferences :

The inference that we can draw from the above three graphical representations are as follows.

The SHI scheme beneficiaries contributed 11% to the total IPD patients at Mallya Hospital

for the year 2008. This contribution came down to 9% in the year 2009. But in actual there

has been only a minute difference, as it is evident in the light of total number of patients in

these two years and is self explanatory of the market dynamics. Because the total number of

in patients were 3475 for the year 2008 and 3309 for the year 2009.

Thus the hospital definitely stands strong in its effort and continues to recognise and extend

its corporate social responsibility towards the economically marginalized sections of the

society.

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RECOMMENDATIONS

1. A Core team should be assigned to look into the process since the time a SHI patients

seeks information in this hospital till he/she takes treatment and is discharged.

2. This team will also keep a strong communication with the regional offices to keep the

hospital informed of the present statistics regarding the new policy holders, changes in the

policy, subsidy by the government, and various types of treatment allowed etc.

3. Word to mouth is one of the most successful agents of marketing. And since hospital is

a service based industry it becomes even more vital. In the special cases of the SHI it is

of utmost importance because the patient folk gives more preference to the experience of

their fellow community members. Therefore it should be made sure that the treatment

both clinical and in house patient freindly.

4. The hospital Business Development Team puts efforts to create centres of new revenue

generation but once the patient is brought in the responsibility has to also be shared by in

house, clinical , non clinical and para clinical staff to work towards patient satisfaction.

As the proverb goes “one happy experience is told to 5 but one bad experience is but a

forest fire”

5. Information and health camps should be organized where the SHI policy holders are in

majority. This is to create a good rapport and communication.

6. At the Front Office a person should be dedicated to handle all such SHI cases. Since he

/she will be the first point of contact inside the hospital premises, he/she should be well

accquinted with all the SHI schemes and their minute but important guidelines, policy and

procedure. This is to releave the suffering patient of the burden of formalities and quick

admission and treatment. Such service will have a huge positive impact on the minds of

the patient .

7. Excellent co ordination between TPA empanelment experts, and related departments

including Marketing, HMIS, Finance and Accounts and the MRD is must.

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CONCLUSION

One of the pioneers in containing the concept of Multi-Disciplinary, Super- speciality patient

care services at Bangalore city – Mallya Hospital is viewed even to this date as a VVIP

Hopsital. With all the latest technology in place, hospital has always focused on delivering

utmost patient care. Being centrally located, patients from various walks- of life including a

sizable amount from large business corporates avail the treatment services from Mallya

Hospital. Needless to say, almost all the Insurance companies/ TPAs are tied up with this

Hospital and the policy holders avail cash less Hospitalization facilities.

What is interesting is that, inspite of the image as a corporate luxury hospital the patients

falling even in the poorest of the poor can get access to the treatment offered at this hospital.

A host of schemes designed and run by the Central and State governements for the purpose of

imparting medical services to the under previleged is operational at this hospital. This shows

the Corporate Social Responsibility (CSR) exhibited by the institution.

Arogya Bhagya Yojane, (ABY) a Scheme run by the State government for the State Police

Force, Ex-servicemen Contributory Health Scheme (ECHS), the scheme for the retired

personnel from Defence, Yeshaswini Health Insurance Scheme (YHIS), a noval sceme for the

rural inhabitants and Vajpayee Arogyashree, for BPL card holders are some of the few Social

Health Insurance Schemes which are adopted by the hospital as its commitments towards a

healthy society.

No doubt that many of the beneficiaries did avail the services from this hospital ever since

such schemes were floated. Various acivities at different levels for educating the beneficiaries

is being held by the hospital at a rapid pace so as to arouse interest among the potential

patients for visiting the hospital. However, the analysis of the contribution of patients from

various SHIs to the total number of paients and also when compared to the total number of

beneficiaries who had availed treatment services at various Healhcare organizaions shows an

ample scope for further uilizaion of the hospital resources. Hence, the Hospital is also

suggested to enhance strategies and acivities in line with the market potential to take the

“technology to the door step” in its real sense.

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REFERENCES : First hand information from the regional offices of the SHIs under study in Bangalore.

Devadasan N . Community health insurance in India: a compilation of case studies.

Ahmedabad:FWWB.2005:Pp 62.

Devadasan N, Ranson MK, Van Damme, W., & Criel B. 2004. Community health insurance

in India: an overview. Economic and Political Weekly. 39, pp. 3179-3183.

Devadasan, N., Manoharan, S., Menon, N., Menon, S., Thekaekara, M., Thekaekara, S., &

AMS team. 2004. Accord community health insurance - Increasing access to hospital care.

Economic and Political Weekly. 39, pp. 3189-3194.

IRDA Journal Volume VII, Number 1 to 12.

Rao S. Health insurance: Concepts, issues and challenges. EPW, pages 321- 399, August

2004.

David Mark Drora, Ruth Korenb, Alexander Ostc, Erika Binnendijkd, Sukumar Vellakkale,

Marion Danisf ; Health insurance benefit packages prioritized by low-income clients in India:

Three criteria to estimate effectiveness of choice, Social Science Medicine, pages 884- 898.

2004.

Rajeev Ahuja; Working Paper No. 161; Health Insurance For The Poor In India: An

Analytical Study, Indian Council For Research On International Economic Relations ; June

2005.

Sarosh Kuruvilla, Mingwei Liu, Priti Jacob; The Karnataka Yeshasvini Health Insurance

Scheme For Rural Farmers & Peasants: Towards Comprehensive Health Insurance overage

For Karnataka?: May 2005

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Project 2 : To Evaluate the Efficiency and Effectiveness of the website of

Mallya Hospital as tool in E – Marketing

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CONTENTS (project 2)

Page No.

1. INTRODUCTION 52

a. Internet 52

b. What is “www” 54

c. Web Browser and Web Server 54

d. URL(Universal Resource Locator ) 54

e. How Internet Works 55

f. Internet to Intranet To Extranet 55

g. Varieties of Website 56

2. AIMS AND OBJECTIVES 58

3. LITERATURE REVIEW 59

a. What is marketing 59

b. Internet marketing 61

c. E-commerce and e- business 62

d. Difference between Internet marketing communication & traditional

marketing communication 63

e. Internet marketing as a tool 64

4. METHODOLOGY 66

5. DATA ANALYSIS AND INTERPRETATION 69

6. RESULT 75

7. RECOMMENDATION

8. CONCLUSION 82

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To evaluate the efficiency and effectiveness of the website of Mallya

Hospital as tool in e – marketing :

INTRODUCTION:

Since the dawn of the Internet, marketers have regarded it as a vast laboratory, launching

experiment after experiment to crack the code that generates sales and customer loyalty. Not

surprising, most have failed. Consumers adopted digital technology as they themselves saw

fit, in the process fundamentally altering the way they make purchasing decisions.

Companies that understand this evolution are now carefully moving digital interactivity

toward the centre of their marketing strategies, rethinking their priorities and budgets, and

substantially reshaping their processes and skills.

McKinsey , a leader in research, which works with dozens of companies navigating this

shifting landscape, have found that the most successful digital marketers focus on managing

four core sources of value as they increase the percentage of marketing and channel spending

that is directed to digital activities. First, they coordinate their activities to engage the

consumer throughout an increasingly digital purchase journey. Second, they harness interest

in their brands by syndicating content that empowers the consumer to build his or her own

marketing identity and, in the process, to serve as a brand ambassador. Third, they recognize

the need to think like a large-scale multimedia publisher as they manage a staggering increase

in the content they create to support products, segments, channels, and promotions. Finally,

these marketers strategically plot how to gather and use the plethora of digital data now

available.

The Internet

The Internet refers to the physical network that links computers across the globe. It consists

of the infrastructure of network servers and wide-area communication links between them

that are used to hold and transport the vast amount of information on the Internet.

The recent dramatic growth in the use of the Internet has occurred because of the

development of the World Wide Web. This became a commercial proposition in 1993 after

development of the original concept by Tim Berners-Lee, a British scientist working at CERN

in Switzerland in 1989. The World Wide Web changed the Internet from a difficult-to-use

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tool for academics and technicians to an easy-to-use tool for finding information for

businesses and consumers.

What is : “www” ?

The World Wide Web is an interlinked publishing medium for displaying graphic and text

information. This information is stored on web server computers and then accessed by users

who run web browser programs, which display the information and allow users to select links

to access other web sites (the process known as ‘surfing’).

The World Wide Web (WWW) was created in 1989 by CERN physicist Tim Berners-Lee.

On 30 April 1993, CERN announced that the World Wide Web would be free to use for

anyone. Before the introduction of HTML and HTTP, other protocols such as file transfer

protocol and the gopher protocol were used to retrieve individual files from a server. These

protocols offer a simple directory structure which the user navigates and chooses files to

download. Documents were most often presented as plain text files without formatting or

were encoded in word processor formats.

Web Browsers

Browsers such as Netscape Navigator or Microsoft Internet Explorer provide an easy method

of accessing and viewing information stored as web documents on different servers.

Web Servers

Web servers are used to store the web pages accessed by web browsers. They may also

contain databases of customer or product information which can be queried and retrieved

using a browser.

Uniform (universal) Resource Locators (URL)

A web address is used to locate a web page on a web server. The technical name for web

addresses is uniform or universal resource locators (URLs). URLs can be thought of as a

standard method of addressing similar to postal or ZIP codes that make it straightforward to

find the name of a site. Commonest of them are:

1. .com represents an international company such as http://www.travelagency.com

2. .co.uk represents a company based in the UK such as http://www.thomascook.co.uk/.

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3. .ac.uk a UK based University (e.g. http://www.derby.ac.uk)

4. .org.uk or .org are not for profit organisations (e.g. www.greenpeace.org)

5. .net a network provider such as www.freeserve.net.

Web addresses are structured in a standard way as follows:

http://www.domain-name.extension/filename.html

The domain name refers to the name of the web server and is usually selected to be the same

as the name of the company and the extension will indicate its type. The extension is also

commonly known as the global top level domain (gTLD). Note that gTLDs are currently

under discussion and there are proposals for adding new types such as .store and .firm. The

‘filename.html’ part of the web address refers to an individual web page, for example

‘products.html’ for a web page summarising companies’ products. When a web address is

typed in without a filename, for example www.bt.com, the browser automatically assumes

the user is looking for the home page, which by convention is referred to as index.html.

When creating sites, it is therefore vital to name the home page index.html.

How does the Internet work :

The Internet enables communication between millions of connected computers world-wide.

Information is transmitted from client PCs whose users request services to server computers

that hold information and host business applications that deliver the services in response to

requests. As such, the Internet is a large-scale client/server system. By 2000, worldwide,

there were over 450 million users of clients accessing over 30 million web sites hosted on

servers. The client PCs within homes and businesses are connected to the Internet via local

Internet Service Providers (ISPs) who, in turn, are linked to larger ISPs with connection to

the major national and international infrastructure or backbones.

From the Internet to intranets and extranets

Intranet and extranet are two terms that have arisen in the 1990s to describe applications of

Internet technologies that do not only involve communicating with customers, but rather with

company staff (intranet) and third parties such as suppliers and distributors (extranet). While

everyone connected to the Internet can access a company Internet web site, only those who

have been given authorisation can access an intranet or extranet. It can be seen that an

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intranet is effectively a private-company Internet with access available to staff only. An

extranet permits access to trusted third parties, and the Internet provides global access.

Types of website : Organized by function, a website may be

• a personal website

• a commercial website

• a government website

• a non-profit organization website

It could be the work of an individual, a business or other organization, and is typically

dedicated to some particular topic or purpose. Any website can contain a hyperlink to any

other website, so the distinction between individual sites, as perceived by the user, may

sometimes be blurred.

Access to website :

Websites are written in, or dynamically converted to, HTML (Hyper Text Markup Language)

and are accessed using a software interface classified as a user agent. Web pages can be

viewed or otherwise accessed from a range of computer-based and Internet-enabled devices

of various sizes, including desktop computers, laptops, PDAs and cell phones.

A website is hosted on a computer system known as a web server, also called an HTTP

server, and these terms can also refer to the software that runs on these systems and that

retrieves and delivers the web pages in response to requests from the website users. Apache is

the most commonly used web server software (according to Netcraft statistics) and

Microsoft's Internet Information Server (IIS) is also commonly used.

Varieties of website :

There are many varieties of websites, each specializing in a particular type of content or use,

and they may be arbitrarily classified in any number of ways. A few such classifications

might include :

• Affiliate: enabled portal that renders not only its custom CMS but also syndicated

content from other content providers for an agreed fee. There are usually three relationship

tiers. Affiliate Agencies (e.g., Commission Junction), Advertisers (e.g., eBay) and consumer

(e.g., Yahoo!).

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• Archive site: used to preserve valuable electronic content threatened with extinction.

Two examples are: Internet Archive, which since 1996 has preserved billions of old (and

new) web pages; and Google Groups, which in early 2005 was archiving over 845,000,000

messages posted to Usenet news/discussion groups.

• Blog (web log): sites generally used to post online diaries which may include

discussion forums (e.g., blogger, Xanga).

• Brand building site: a site with the purpose of creating an experience of a brand

online. These sites usually do not sell anything, but focus on building the brand. Brand

building sites are most common for low-value, high-volume fast moving consumer goods

(FMCG).

• Community site: a site where persons with similar interests communicate with each

other, usually by chat or message boards, such as MySpace or Facebook.

• Corporate website: used to provide background information about a business,

organization, or service.

• Electronic commerce (e-commerce) site: a site offering goods and services for online

sale and enabling online transactions for such sales.

• Information site: contains content that is intended to inform visitors, but not

necessarily for commercial purposes, such as: RateMyProfessors.com, Free Internet Lexicon

and Encyclopaedia. Most government, educational and non-profit institutions have an

informational site.

• Search engine site: a site that provides general information and is intended as a

gateway or lookup for other sites. A pure example is Google, and well-known sites include

Yahoo! Search and Bing (search engine).

• Video sharing: A site that enables user to upload videos, such as YouTube and

Google Video.

Some websites may be included in one or more of these categories. For example, a business

website may promote the business's products, but may also host informative documents, such

as white papers. There are also numerous sub-categories to the ones listed above.

The above gives a background information about the history of internet, its evolutions and its

current presence and future prospects.

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AIMS & OBJECTIVES

1. To evaluate the content and usability of Mallya Hospital website.

2. To find out the effectiveness of the online customer relationship management

strategy.

3. To compare the quantum of information displayed on the website of Mallya Hospital

with other similar Corporate Hospital websites of Bangalore city.

4. To highlight the areas which are appealing in terms of the user friendliness.

5. To recommend precisely, areas of improvement through SWOT analysis.

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LITERATURE REVIEW :

The interactive nature of online marketing, both in terms of providing instant response and

eliciting responses is a unique quality of the medium. Online marketing is relatively

inexpensive when compared to the ratio of cost against the reach of the target audience.

Hospitals can reach a wide audience for a small fraction of traditional advertising budgets.

The nature of the medium allows consumers to research well before they utilize the services

of the hospital. Surfing with web is like “window shopping” and a website is a decorative

display of an organization to the world. A poor display and the audience are gone because as

someone has said, “Fingers can move a lot faster than feet!”. Here at Mallya Hospital, the

Business Development Department was instrumental in conceptualizing to completing the

entire website for the hospital. an attempt here onward is made to not only evaluate the

website but also to compare it with the other hospital websites who have their presence in

Bangalore and attempt of the website to market itself to the internet users.

What is marketing :

The definition of marketing by the Chartered Institute of Marketing is: “Marketing is the

management process responsible for identifying, anticipating and satisfying customer

requirements profitability.”

This definition emphasises the focus of marketing on the customer, while at the same time

implying a need to link to other business operations to achieve this profitability. Smith and

Chaffey (2001) note that Internet technology can be used to support these aims as follows:

• Identifying –the Internet be used for marketing research to find out customers need

and wants

• Anticipating – the Internet provides an additional channel by which customers can

access information and make purchases – understanding this demand is key to governing

resource allocation to e-marketing.

• Satisfying – a key success factor in e-marketing is achieving customer satisfaction

through the electronic channel, this raises issues such as is the site easy to use, does it

perform adequately, what is the standard of associated customer service and how are physical

products dispatched

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A broader definition of marketing has been developed by Dibb, Simkin, Pride and Ferrell

(Dibb et al., 2000): Marketing consists of individual and organisational activities that

facilitate and expedite satisfying exchange relationships in a dynamic environment through

the creation, distribution, promotion and pricing of goods, services and ideas.

The Internet and the marketing concept

In this section, the marketing concept is introduced, and then consider its relationship to more

recent concepts such as Internet marketing, e-commerce and e-business. The word marketing

has two distinct meanings in modern management practice. It describes:

1. The range of specialist marketing functions carried out within many organisations.

Such functions include market research, brand/product management, public relations and

customer service.

2. An approach or concept that can be used as the guiding philosophy for all functions

and activities of an organisation. Such a philosophy encompasses all aspects of a business.

Business strategy is guided by an organisation’s market and competitor focus and everyone in

an organisation should be required to have a customer focus in their job.

The modern marketing concept (Houston, 1986) unites these two meanings and stresses that

marketing encompasses the range of organisational functions and processes that seek to

determine the needs of target markets and deliver products and services to customers and

other key stakeholders such as employees and financial institutions. Increasingly the

importance of marketing is being recognised both as a vital function and as a guiding

management philosophy within organisations. Marketing has to be seen as the essential focus

of all activities within an organisation (Valentin, 1996). The marketing concept should lie at

the heart of the organisation, and the actions of directors, managers and employees should be

guided by its philosophy.

Modern marketing requires organisations to be committed to a market/customer orientation

(Jaworski and Kohli, 1993). All parts of the organisation should co-ordinate activities to

ensure that customer needs are met efficiently, effectively and profitably. Marketing

encompasses activities traditionally seen as the sole domain of accountants, production,

human resources management (HRM) and information technology (IT). Many of these

functions had little regard for customer considerations. Increasingly such functions are being

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reorientated, evidenced by the importance of initiatives such as Total Quality Management

(TQM), Business Process Reengineering, Just in Time (JIT) and supply chain management.

Individuals’ functional roles are undergoing change, from being solely functional to having a

greater emphasis on process.

The Internet can be applied by companies as an integral part of the modern marketing

concept since:

• It can be used to support the full range of organisational functions and processes that

deliver products and services to customers and other key stakeholders.

• It is a powerful communications medium that can act as ‘corporate glue’ that

integrates the different functional parts of the organisation.

• It facilitates information management, which is now increasingly recognised as a

critical marketing support tool to strategy formulation and implementation.

• The future role of the Internet should form part of the vision of a company since its

future impact will be significant to most businesses.

Without adequate information, organisations are at a disadvantage with respect to competitors

and the external environment. Up-to-date, timely and accessible information about the

industry, markets, new technology, competitors and customers is a critical factor in an

organisation’s ability to plan and compete in an increasingly competitive marketplace.

What is Internet marketing?

Internet marketing or Internet-based marketing can be defined as the use of the Internet and

related digital technologies to achieve marketing objectives and support the modern

marketing concept. These technologies include the Internet media and other digital media

such as wireless mobile media, cable and satellite. In practice, Internet marketing will include

the use of a company web site in conjunction with online promotional techniques such as

search engines, banner advertising, direct e-mail and links or services from other web sites to

acquire new customers and provide services to existing customers that help develop the

customer relationship. However, for Internet marketing to be successful there is a necessity of

integration with traditional media such as Print and TV. Thus internet marketing is defined

as “The application of the Internet and related digital technologies in conjunction with

traditional communications to achieve marketing objectives.” whereas e – marketing is

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defined as “Achieving marketing objectives through use of electronic communications

technology”

E-commerce and E-business

The terms e-commerce and e-business are often used in a similar context to Internet

marketing, but there are significant differences it and does matter, since managers within an

organisation require a consistent understanding of the opportunities to enable their

organisation to have a cohesive strategy to best utilise new technology.

Electronic commerce (E-commerce) is often thought to simply refer to buying and selling

using the Internet; people immediately think of consumer retail purchases from companies

such as Amazon. However, e-commerce involves much more than electronically mediated

financial transactions between organisations and customers. Many commentators now refer to

e-commerce as both financial and informational electronically mediated transactions between

an organization and any third-party it deals with (Chaffey, 2002). By this definition, non

financial transactions such as customer enquiries and support are also considered to be part of

e-commerce. Kalakota and Whinston (1997) refer to a range of different perspectives for

ecommerce:

• A communications perspective – the delivery of information, products/services or

payment by electronic means.

• A business process perspective – the application of technology towards the

automation of business transactions and workflows.

• A service perspective – enabling cost cutting at the same time as increasing the speed

and quality of service delivery.

• An online perspective – the buying and selling of products and information online.

Zwass (1998) uses a broad definition of e-commerce noting the significance of information

transfer. He refers to it as “the sharing of business information, maintaining business

relationships, and conducting business transactions by means of telecommunications

networks”.

Thus e commerce is “All financial and informational electronically mediated exchanges

between an organisation and its external stakeholders.”

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E-business is defined by IBM (www.ibm.com/e-business), who was one of the first suppliers

to coin the term: e-business, as “The transformation of key business processes through the

use of Internet technologies.”

Difference between Internet Marketing Communications from Traditional

Marketing Communications

Internet marketing differs from conventional marketing communications because of the

digital medium used for communications. The Internet and other digital media such as digital

television, satellite and mobile phones create new forms and models for information

exchange. A useful summary of the differences between these new media and traditional

media has been developed by McDonald and Wilson (1999) which they describe as the ’6Is

of the e-marketing. mix’ . Note that these can be used as a strategic analysis tool, but they are

not used in this context here. The 6Is are useful since they highlight factors that apply to

practical aspects of Internet marketing such as personalisation, direct response and marketing

research, but also strategic issues of industry restructuring and integrated channel

communications.

1. Interactivity. It has the following characteristics :

a. the customer initiates contact;

b. the customer is seeking information (pull);

c. it is a high intensity medium – the marketer will have 100 per cent of the

individual’ s attention when he or she is viewing a web site.

d. a company can gather and store the response of the individual.

e. individual needs of the customer can be addressed and taken into account in future

dialogues.

2. Intelligence : The Internet can be used as a relatively low cost method of collecting

marketing research, particularly about customer perceptions of products and services. The

Internet can be used to create two-way feedback which does not usually occur in other

media.

3. Individualization : unlike traditional media where the same message tends to be

broadcast to everyone. The process of tailoring is also referred to as personalisation and is

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an important aspect of achieving customer relationship management online.

Personalisation is often achieved through extranets which are set up with key accounts to

manage the buying and after-sales processes. Every customer who accesses their system

is profiled according to their area of product interest and information describing their role

in the buying unit. When they next visit the site information will be displayed relevant to

their product interest, for example office products and promotions if this is what was

selected. This is an example of what is known as mass customisation where generic

customer information is supplied for particular segments i.e. the information is not unique

to individuals, but to those with a common interest.

4. Integration : there is a huge scope for integrated marketing communication. It is two way

i.e. from organization to customer and from customer to organization. The more the

interactivity the more beneficial it is for the organization.

5. Industry restructuring : The removal of intermediaries such as distributors or brokers

that formerly linked a company to its customers (Disintermediation) and The creation of

new intermediaries between customers and suppliers providing services such as supplier

search and product evaluation (Reintermediation) are restructuring the industries of both

the product and service based types.

6. Independence of location : Electronic media also introduce the possibility to increase the

reach of company communications to the global market. This gives opportunities to sell

into international markets that may not have been previously possible.

Internet as a marketing tool:

The Internet can potentially be used to achieve each of the four strategic directions as

follows:

1. Market penetration. The Internet can be used to sell more existing products into

existing markets. This can be achieved by using the power of the Internet for advertising

products to increase awareness of products and the profile of a company amongst potential

customers in an existing market. This is a relatively conservative use of the Internet.

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2. Market development. Here the Internet is used to sell into new markets, taking

advantage of the low cost of advertising internationally without the necessity for a supporting

sales infrastructure in the customers’ country. This is a relatively conservative use of the

Internet, but it does require the overcoming of the barriers to becoming an exporter or

operating in a greater number of countries.

3. Product development. New products or services are developed which can be

delivered by the Internet. These are typically information products such as market reports

which can be purchased using electronic commerce. This is innovative use of the Internet.

4. Diversification. In this sector, new products are developed which are sold into new

markets.

Therefore from the above discussion it is very evident that as an organization, whether it be

health care(pull) or hospitality (push) one cannot ignore the new age media- the internet and

the internet marketing as an important platform to improve the business. Because internet is

not only a media of expression but it has become a multi directional two way interaction

system to communicate. And website is not only the face but a virtual and dynamic front face

and first impression of an organization one cannot afford to ignore it.

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METHODOLOGY

Website address of Mallya Hospital www.mallyahospital.net is subjected for evaluation in

line with the aims and objectives detailed earlier. The homepage of Mallya Hospital website

is pictured below.

The content and usability evaluation was carried out by a pre-tested evaluation checklist. The

checklist developed has two broad subscales:

Content evaluation:

The components of content evaluation are as follows:

1. Authority – Presence of name of the author and the credentials

2. Currency – Relating to posting and revision dates on the site

3. Information- Stability of information, copyright status and restrictions on use

4. Scope – Scope of topics and criteria for selection of topics

5. Audience – Identification of intended audience and content appropriateness for audience

6. Value – Quality of information and ease of access

7. Accuracy – Citations, absence of errors, factual information etc

8. Advertising – Commercial sites able to advertise their core competencies

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Usability evaluation:

1. Navigation – Site map, help section, screen layout, page titles etc

2. Speed - Graphics and server availability

3. Access – Dead links, registration fees etc.

The total score obtained for the two subscales can be a maximum of 10. There is negative

marking in many components. The checklist categorises the quality of the website in terms of

the score obtained as follows:

0-25 – Poor

26-50 – Weak

51-60 – Average

61-70 – Good

71-80 – Excellent

81-100 – Outstanding.

The scores obtained by each of the hospital website is tabulated in the data analysis and

interpretation chapter with graphical representation.

Content proofing of the website was done to find out the standardization of content on the

website, locating any gross errors in the content and to identify if any significant content was

missing. The popularity of the website could not be judged from any internal source as the

website does not possess a visitor clock. Hence the popularity could only be judged based on

the results of website statistics found on a web tracker site alexa.com.

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The popularity of the website among net users can be judged by three parameters defined by

the web tracker site. They are as follows:

1. Reach - It measures the number of users. Reach is typically expressed as the percentage of

all Internet users who visit a given site.

2. Traffic Rank – The rank generated in comparison with the traffic popularity of other

websites.

3. Page Views - It measures the number of pages viewed by site visitors. Multiple page views

of the same page made by the same user on the same day are counted only once. The page

views per user numbers are the average numbers of unique pages viewed per user per day by

the visitors to the site.

4. Ghost shopping : The effectiveness of customer relationship management strategy was

assessed by “ghost shopping”. Also known as "Mystery Shopping, it serves to evaluate the

customer service for any company that deals with customer satisfaction. Ghost shopping

helps in evaluating the service provided by the hospital's channel members to its customers.

From this information a hospital can understand whether it is meeting, or failing to meet, it's

customer's needs. Ghost shoppers are everyday people who are visiting stores as anonymous

customers, and in the process helping these stores to better understand how they can meet

customers' needs. I visited Mallya Hospital site and posted the following query to their

patient service centre. Request a quote

“I am a male of 60 years of age suffering from chronic hypertension and diabetes. I have a

long history of alcohol consumption and a irregular life style owing to the demanding nature

of my profession. I have complaints of Acute Renal Failure and Chronic Hepatitis as

diagnosed by doctors here in Sri Lanka.

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DATA ANALYSIS and INTERPRETATION

Ghost shopping: inference received is as follows,

• The query form did not have the required compulsory fields such as uploading of the

soft copies of the previous treatment details.

• The reply was received much after 24 hours, no automated confirmation received on

the mail id provided.

• Details of room facility and other services were not provided.

The same query was sent to two other hospitals:

◦ Apollo Hospital, Bangalore

◦ Fortis Hospital, Bangalore

• The reply received from Apollo, was concise and professional. It contained minutes

details like application of foreign exchange rates. It also had links for stay and other

details that might be required during the visit.

• An automated reply stating a ticket ID no. as well as the contact details was received

instantaneously from Fortis Hospitals, clearly reflecting the degree of professionalism

followed!

On the Google Search Engine when the following hospitals were entered the number of web

r references obtained for each were as follows :

Results 1 - 10 of about 399,000 for Mallya Hospital, Bangalore. (0.14 seconds)

Results 1 - 10 of about 908,000 for Sagar Hospital Bangalore. (0.29 seconds)

Results 1 - 10 of about 76,300 for Appolo Hospital Bangalore. (0.36 seconds)

Results 1 - 10 of about 510,000 for Fortis Hospital, Bangalore. (0.21 seconds)

Results 1 - 10 of about 26,600 for Narayana Hrudayalaya Bangalore. (0.08 seconds)

Results 1 - 10 of about 5,640,000 for Columbia Asia Hospital Bangalore. (0.34 seconds)

Results 1 - 10 of about 98,600 for Manipal Hospital Bangalore. (0.24 seconds)

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The graphical representation of the above details is as

below:

Inference : Mallya Hospital stands 4th in the total number of references in terms of website

search on the Google search engine.

The above snap short from the actual site explains the percentage distribution of the

keywords which leads to the actual selection of the Mallya hospital website link. It is found

that 33.71% of the successful search is contributed by the key word “mallya hospital”. less

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than 1.8% is contributed by the name of the leading physicians who render their clinical

expertise at Mallya hospital.

Further comparison of these 7 hospitals websites were done with the help of (1998, P. F.

Anderson, Nancy Allee, Steve Grove, Sara Hill.) on the following parameters :

1. Aesthetic sense

2. Visual appeal

3. Information

4. Audience

5. Content / clarity

6. Update of website

7. Online response

8. No. of hits.

9. Usability

10. Advertising

Mallya Hospital

NH Hospital

Manipal Hospital

Sagar Hospital

Apollo Hospital

Collumbia Asia hospital

Wockhardt Hospital

Aesthetic Sense

8 4 5 7 6 5 4

Advertising 7 8 5 4 8 3 7

Audience 3 9 5 6 8 7 8

Content Clarity

8 8 7 8 7 7 7

Information 8 6 5 7 6 4 6

No.Of Hits 6 8 5 7 9 6 5

Online Response

3 6 5 6 7 5 3

Update Of Website

Visual Appeal

8 6 6 5 5 4 6

Usability 7 5 6 6 7 4 6

The above is a tabulation of the scores obtained on the ten parameters.

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Inference :

Mallya Hospital scores for the Aesthetic Sense, Advertising Presentation, Content Clarity,

Information , Visual Appeal has been 8, 7, 8, 8 and 8 respectively, which in sum total stands highest

when compared to the scores obtained by other hospital websites. Mallya hospital has been marked

in black for visibility contrast in this project.

Mallya hospital has poor scores on the audience, number of hits the website has, online responses

and update of website.

The Aesthetic sense comprises of many features including colour combination, presentation,

information displayed, usage of the given space, and presentation and formal look of the website.

Mallya hospital stands tall in this eligibility criterion.

The Advertising presentation comprises of contact details, both office hours and emergency,

address on each of the web page, contact us, about us and details about the services and facilities

provided by the hospital. Mallya Hospital stands higher as it not only suffices the requirements but

also goes a way ahead in displaying the charges of the Many health check ups that it provides to its

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clients. Further more it has a unique request a quote column on the website which responds with the

approximate amount of expenses to be incurred once the patient feeds his /her details on the pre

defined format.

Content clarity proves to be a double edged sword for Mallya Hospital for the reason that the

Mallya Hospital website provides enough information on its services and facilities. However, it is to

be noted that the content is not only exhaustive but in a way it is over loaded. The font size is

difficult to read and moreover the important contents are not highlighted and hyperlinked. From a

user point of view it is felt that the required information could be exhibited more in the homepage

so that the accessibility towards the contents is more user friendly than the present system which

warrants extensive search in the various hyperlinks.

Information given in the Mallya website is complete in its structure but not in its functions.

Though the information regarding the ISO 9000:2001 and some other features like appointments of

the doctors is not updated the other information have made a genuine attempt to cover all the

features. The one vertical which is missing to convey information is the insurance and Corporate

TPA cell. Remaining this, all other verticals are covered. Only few of the sub - headings in these

verticals are not covered. The clarity of information is relevant and to the point. It conveys to the

first timer not only the services rendered in the hospital but also informs about the latest inclusions

of world class equipments in use.

Visual appeal of the website is sublime, crisp and appealing. It is well organised and space

utilization has been better than other hospitals website. The absence of visual tour is a drawback

which needs to be addressed. The colour combinations, the spacing of the sub headings, the hyper

link response whenever the cursor moves over the heading is professional.

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From the above scores, Mallya Hospital website stands rank 4th.

The graphical representation of the scores obtained by each of the hospital website on the ten

evaluation parameter is as below.

Inference : The details for the update frequency of the website for each was not available and

thus the column remains empty for all the hospital websites in the bar graph as above.

As it is evident from the bar graph represent that Mallya Hospital scores well above the

average in six out of the ten parameters. These are explained as above. It is to be looked into

that the four areas in which Mallya Hospital has scored less are the areas of interactive

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response. Owing to poor response to the clients and incomplete sub headings under few of the

vital headings like the super specialities and mismatch of the sub headings it has received low

popularity from the side of the web users.

Thus the score obtained by Mallya hospital puts in the category of average. The remaining all

other hospitals too score within the range of 51-60 and thus stand in the same category of the

“average”. Apollo hospital happens to just touch the line of “good” category by a score of 61.

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RESULT

The content and usability evaluation showed that the site does well in terms of usability i.e.

the technical and design aspects. From the interpretation described earlier it is extremely

encouraging to note the following positive aspects of the website of the Mallya Hospital:

• The homepage of the Mallya Hospital has a good visual appeal and excels in the

utilization of the available space.

• The mixture of home colour (cyan blue 80%) along with the conspicuous visibility of

logo speaks volumes on the branding.

• “Request a Quote” is one of the most appreciated hyperlink which was not found in

any of the other Hospital websites. This “Request a Quote” on being selected puts

forth to the requester a self fill e- form asking the personal and medical details owing

to the disease or other enquires as wanted. Followed by a complete submission of the

form, a response to the client will be generated and sent by mail.

• It also has a choose a column under “how may I help u” section. This section helps

you to further look into the individual requirement of the client whose requirement is

focused, is searching for something significant or does not have the time to go

through (browse) entire website.

• News and Events is another interesting section with the intention to update the surfer

with the latest happening in the Healthcare and at Mallya Hospital in particular.

• The website also posts a unique feature called the site map and the direction map.

This is directly hyperlinked to the Google search map to help the interested client find

his way till the Mallya Hospital.

• The colour combinations are soothing in its visual appeal and are very formal.

• The hospital logo, the hospital main building picture, the patients being treated and

the special facilities available within the hospital are all present on the homepage with

the help of a slide show.

• There is ample information given about the conception, past glory and present

magnanimity of the hospital.

• The headings and subheadings which are displayed once the cursor moves over a

particular topic are fast and are in alphabetical order.

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• All the topics which concern clinical, Para- clinical and in patient and out patient

department as well as the healthy person’s health queries are well documented and

put under appropriate headings.

• Once the hyperlinks are clicked, it opens the desired page. This requested page has

only limited hyperlinks which are to homepage, to previous page and to other limited

co related links concerning the subject matter.

• The hyperlinks don’t mismatch with the windows that pop up other than at few

clinically related areas.

• The content under every sub-heading is apt and gives clear information about the

activities in the Hospital, but that information which couldn’t be provided should have

avoided a mention and leaving a blank space underneath.

• Emergency number and address along with the hospital logo is found on every

window which pops up on being clicked.

• It is the only website amongst the ones compared to come forward to not only

explicitly detail every test under their health check ups but also goes ahead to price

tag them along with other routine diagnostic check-ups.

• A detailed list of the consultants along with their OPD timings under various

specialities helps the user to navigate towards scheduling his appointments.

• A total description with regards to the admission formalities is detailed along with the

rules and regulations governing the same, which enables all planned admissions to be

administratively smooth.

However, the site is graded lower in terms of lack of certain vital information as detailed

below:

• Virtual tour of hospital – To market the infrastructure and ambience of the hospital

• Visitor clock – To track the statistics internally and to generate trends

• Search engine – To act as a source of information for its audience by linking to key

search engines

• Visitation policy – For the convenience of relatives and visitors in the hospital

• FAQ’S for procedures & Information on common diseases - As part of health

education for its audience

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• Online appointment system – For the convenience of outpatients

• Interactive and informative health tips – To attract the audience repeatedly to the

website

• The international patient care information is very limited and needs to be upgraded.

The hospital provides a host of facilities and services especially for international

patients but has not mentioned it on the website. The site also does not mention the

anticipated cost of treatment for various procedures in India. This information would

make it amply clear that India is the cheapest destination in India for most procedures.

• The information about the other portals of the hospital like the supportive services, the

administrative departments are completely ignored.

• There is no automated alert system for the questions asked through any forms of

cellular services.

• Testimonials: The complete experience of the patient in his own words should be

present on the site.

Preferably videos of patient taken at the time of their discharge describing their entire

experience should be uploaded for audiences.

• The content proofing revealed the following key findings:

• There was no standardization of content as the webpage of each department appeared

to be very different from the other. The content did not appear to be of the same site.

• Each webpage was incoherent from the other.

• The content was found to be inadequate as the information provided was very

Superficial.

The ghost shopping exposed the poor customer relationship strategy of the hospital. The

following points need to be taken care of in future to ensure successful online customer

relationships:

• Is there a template for reoccurring questions?

• Does the patient receive a standard response acknowledging the enquiry?

• What is the committed turnaround time of an enquiry?

• How many enquiries are received in a month?

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• Does management automatically get a report of a query?

• Does the patient service centre automatically check back with the patient after not

• hearing from them in three days?

• What is the process for closing a lead?

• What happens to expired leads?

These questions as suggested are answers to many of the links which have been overlooked

while framing the marketing strategy for Mallya hospital.

Last but not the least the best way to devise a marketing tool is as said by Manager Mr

Namadev Rao is “ put yourself in the shoes of the consumer, the client and the patient and

try to look through his eyes what would you expect in that situation!”

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RECOMMENDATIONS

• A website in present world of technology is much more than just a window of

information for organizations. It has involved as a whole new entity reflecting the

organization in the virtual world and being the first point of impression for the

organization. Thus a regular update and a face lift is a must.

• The information content of the website and the presentation should be a reflection of

top class hospitality, user friendliness and hassle free browsing with high level of

accuracy to the details provided. These things are the essentials ingredients for

success of website.

• The time has gone when website just use to provide superficial information. Website,

due to internet and e marketing has evolved into an essential tool of online marketing.

So as a hospital not only Mallya Hospital website should promote itself but rope in

clients by displaying its array of services for which it is known for.

• The best way to grab more clients is to put them through the following maze.

o A hyperlink to “know your health checklist”

o Asking them to leave their email ids and date of birth and other details

o Free registration for availing discounts on the health check ups and diagnostic

tests.

o Online appointment system for the patients and doctor’s availability.

o Uploading the results of the test on the net for the patients to view on

submission of their individual password provided by the hospital.

o Helping them glide through the health insurance plans and treatment facility.

o Special discount to working couples, bringing parents for diagnostic tests etc.

• Also the hospital has to do aggressive online marketing by sending direct link to

social websites and events of health and family awareness.

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• Most importantly responding to the browsers need aptly and carrying the word

forward.

• At Mallya hospital it should be an approach acquired by all to regularly visit the

hospital website and leave blog about their good experiences in the hospital in their

entire work experience.

• A dedicated column of testimonial from the patients is also highly recommended.

• Especially for the corporate tie ups and the clients the hospital website should be able

to send them regular emails wishing them on their birthday, asking them of their

wellbeing and also sending them mails about the updates in hospital and its services.

• The website can go a step further by sending SMS to the patients and their bystanders

about the availability of doctors , their report collections and benefits of availing

diagnostic tests.

• The wonderful thing about e marketing is that it is reasonable , has a global impact

and at the same time is easy to learn and use. Thus at the end as technology is

evolving so should we. For aim is not to be technological giants but to use this

technology to the best in attaining patient satisfaction and providing world class

quality treatment which is the mission of the hospital.

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CONCLUSION

Internet marketing refers to the use of Internet technologies, combined with traditional media,

to achieve marketing objectives. E-marketing has a broader perspective and implies the use

of other technologies such as databases and approaches such as customer relationship

management. Electronic commerce refers to both electronically mediated financial and

informational transactions.

Sell-side e-commerce involves all electronic business transactions between an organization

and its customers, while buy-side e-commerce involves transactions between an

organization and its suppliers.

Electronic business is a broader term referring to how technology can benefit all internal

business processes and interactions with third parties. This includes buy-side and sell-side

ecommerce and the internal value-chain.

E-commerce transactions include Business-to-Business (B2B), Business-to-Consumer

transactions (B2C), Consumer-to-consumer (C2C) and Consumer-to-business (C2B).

The Internet is used to develop existing markets through enabling an additional

communications and/or sales channel with potential customers. It can be used to develop new

international markets with a reduced need for new sales offices and agents. Organization /

hospitals / companies can provide new services and possibly products using the Internet. The

Internet can support the full range of marketing functions and in doing so can help reduce

costs, facilitate communication within and between organisations and improve customer

service.

Interaction with customers, suppliers and distributors occurs across the Internet. If access is

restricted to favoured third parties this is known as an extranet. If Internet technologies are

used to facilitate internal company communications this is known as an intranet – a private

company internet.

Therefore it is important for Mallya Hospital to understand how visitors are likely to become

aware of their web site and how efficient Mallya Hospital is at converting this interest to

visits and actions. Online and offline promotion techniques are used to capture new visitors

and on-site communications are used to convert visitors to action.

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Though Mallya hospital stands 4th in rank there is ample space for its improvement in the

area of online marketing and website interactivity.

Because the marketing benefits the Internet confers are advantageous both to the large

corporation and to the small and medium-sized enterprise. These include:

• a new medium for advertising and Public Relation;

• a new channel for distributing services;

• opportunities for expansion into new markets;

• new ways of enhancing customer service and patient care;

• new ways of cost cutting and enhancing productivity.

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REFERENCES :

1. E-Marketing: The Way Forward, Stay ahead of the pack, maintain a healthy bottom

line, and increase marketing’s value to your firm by harnessing your corporate

knowledge for e-Marketing.; By Richard Nelson, CPSM

2. www.alexa.com

3. How to use Twitter as Part of your Hospital Online Marketing strategy; Supplement

to Hospital Online Marketing Education.

4. Strategic Marketing Management: Building a Foundation for Your Future; by Allen F.

Wysocki and Ferdinand F. Wirth

5. www.mallyahospital.net

6. www.appollohospital.com

7. www.sagarhospitals.com

8. www.columbiaasia.com

9. www.narayanahaospitals.com

10. www.Fortishospitals.com

11. Business development department of Mallya hospital.