By M H Ahssan
Twenty years ago, the first name that came to mind while talking of corporates in Hyderabad was the Nagarjuna Group. But that was then. It is now a downhill journey for the group whose boss K S Raju is cooling his heels in judicial custody these days.
It was a bright star that shone on the business horizon of Hyderabad in the early 1970s when the city was dominated by public sector units and there were hardly any private businesses in the reckoning. The Nagarjuna group is still synonymous with a prominent locality in the upmarket area that goes by the name Nagarjuna Hills where many of the groups offices are located. Superfluous though, employment in the group was a prize job for the youth in the state.
Founded by KVK Raju, a first generation technopreneur, the group’s first foray was into steel with Nagarjuna Steels. Then came Nagarjuna Fertilisers and Chemicals Limited (NFCL), that became the flagship company of the group which commissioned the first gas-based fertiliser plant in south India at Kakinada in 1992 and currently has a capacity to produce 12 lakh MT of urea per annum.
However, the now-beleaguered Nagarjuna Finance Ltd (NFL) was established in 1982 to foray into the financial services business. Interestingly, at one point of time it was a highly respected company. “It was a solid company with branches all over the country and at one point of time was the top financial services company in south India,” recalls an old timer. But what went wrong? “I think later, by the time they gained momentum in collecting deposits, there was heavy competition with interest rates being paid going really high. So they couldn’t service the deposits and that did it in,” explains a former senior executive of the group.
Even as the group’s chairman K S Raju is facing criminal charges for fraud at the moment, there are supporters who feel that he was surrounded by the wrong kind of people whom he trusted. They in turn misled him with their advice. But then the leader has to take responsibility for the consequences of both his right and wrong decisions. “The group’s luck ran out and many of its plans did not fructify,” quips another employee.
The group had a very good run for many years as it slowly diversified into packaging with Nagarjuna Signode and later into power and oil refining. “The group had a lot of futuristic ideas and was probably ahead of its times. In 1995, the group employed almost 40 IIM graduates, perhaps the highest in corporate India,” says the executive.
The group’s foray into oil refining saw the emergence of Nagarjuna Oil Corporation, a sixmillion metric tonnes per annum (MMTPA) petroleum refinery at Cuddalore at an estimated cost of Rs 4,790 crore. But later it sold off 20 per cent of its holdings to the Tatas.
Further, after starting Nagarjuna Power Corporation with a bang, setting up a Rs 4,300-crore, 1,015-MW, coal-fired, Nagarjuna Power Plant at Mangalore in Karnataka, the group sold a 74 per cent stake to the Hyderabad-based Lanco group two-and-half-years ago. The first company in the group, Nagarjuna Steel, has been sold off to Pennar Steels.
One wonders why such high-profile projects the group got into seemed to simply lose steam after a while necessitating selling off stakes to others. One, it reveals that the projects are fundamentally sound. If not, there wouldn’t be buyers for that. “But what’s missing is a commitment and the necessary drive to see the projects through. It’s basically lethargy.
Moreover, over the years many retired bureaucrats have been appointed in key positions as advisors and consultants. And many of them were actually a drag on the company, both financially and on its pursuit and focus. This prevented fresh and innovative ideas from being pursued for better results,” points out a senior executive who was with the group. However K S Raju now nearing 60 and presently cooling his heels in jail is responsible for these half-hearted initiatives. “In a way he lacks the drive his father had and that zeal to implement projects right to the last T,” says a former senior manager of the company.
Today, some of the group companies include a part from the flagship Nagarjuna Fertilisers and Chemicals, Nagarjuna Agri Chem, Vijayalakshmi Insecticide and Nagarjuna Agri Research Institute and of course the Nagarjuna Foundation in Kakinda.
After all the highflying growth now the group seems to be heading towards a downward path and away from its founder’s vision. It has become a pale shadow of its fine past.
WHAT DID K S RAJU DO?
K S Raju, chairman, Nagarjuna group, after his arrest on Monday was sent to 14 days of judicial custody by a city magistrate at Nampally court on Tuesday. His partner in crime is P K Madhav, who is presently President and CEO of Maytas Ltd. The charge by the police was that Nagarjuna Finance Ltd has failed to return depositors about Rs 100 crore that was due to them.
They were arrested under Section 5 of the Andhra Pradesh Protection of Depositors of Financial Establishments Act and under Sections 420 and 406 of the Indian Penal Code after scores of complaints were filed by aggrieved depositors.
Interestingly, Madhav was finance director on the board of Nagarjuna Fertilisers and Chemicals Ltd for nearly two decades during 1982-2001.
In fact, this is a culmination of a fiveyear battle wherein Raju has been fighting lawsuits filed against him by the ministry of corporate affairs through the Registrar of Companies, which moved the economic offenses court against him and other directors responsible for raising public deposits that were not returned. However, Raju has been arguing to absolve himself of the responsibility of paying the depositors. Since the group had divested its equity holding in NFL in favour of the Mumbaibased Mahalakshmi Factoring Services Ltd (MFSL) in September 2000, the onus now lies on MFSL to pay dues by way of realising receivables, he says.
As the case takes a new turn and the court takes its time to deliver its verdict on Raju and Madhav, there are different opinions. “I give Raju a clean chit as I believe he had no malafide intentions to cheat anyone. However, he had neglected the running of the company and left it to others. Moreover, people deposited their money with faith in the name of Raju and Nagarjuna Fertilisers, which enjoyed good brand equity. So, one cannot escape that responsibility,” explains a banker who was associated with the company. He adds that to say NFL and NFCL are two different companies is not entirely correct as there was an association. The fact that a PSU bank got a letter of comfort from NFCL for the bank’s exposure to NFL some years ago proves this beyond doubt, though this was not public knowledge.
But a former executive of the Nagarjuna group says, “You have not returned the hard earned money of middle class and lower middle class people. But you live in a mansion and move about in swanky cars. How do you justify all this?” he asks.
Saturday, December 20, 2008
T-varsity Can’t Afford RTI Compliance
By M H Ahssan
The Right To Information Act (RTI), intended to empower the public and bring out administrative transparency, has turned into a nightmare for the fledgling Telangana University based in Nizamabad. The authorities of the university, who have neither trained personnel nor enough funds to serve the public under the Act, are at their wits end as to how to cope with the pressure generated by genuine and motivated applicants, without attracting the contempt of the State Information Commission.
What has hit Telangana University is a recent request by two of its students, C Varadaiah and N Soundarya, who sought information related to all recruitments done in the past three years ever since the varsity was set up. Normally, a request for providing information does not pose a problem for the university as it would levy charges for the stationery and photocopying of the documents.
But the present case is posing a huge problem for the varsity. This is because as per rules, anyone who falls in the Below Poverty Line (BPL) category should be provided the information without being charged for the stationery and photocopying. All the applicant needs to do is attach a copy of his BPL ration card with his request, said officials.
It is the statistics involved in obliging this particular request by two students falling in the BPL category that has stumped the varsity officials. Varadaiah and Soundarya sought copies of notification pertaining to the recruitments done in 2006, 2007 and 2008, the applications the university received along with all enclosures including call letters sent and copies of the joining reports from the university.
Telangana University registrar K Sivasankar told HNN that the varsity had recruited only 38 teaching and five non-teaching staff during the last three-year period. “However, 1,000 applications had been received. If we have to comply with the request of these two students, we would have to provide them 24,872 pages of information,” the registrar said.
The numbers involved in this exercise has the cash-strapped university groping in the dark.“We have no funds to purchase enough stationery for photocopying nearly 25,000 pages of documents. Apart from the cost, we have no staff to do clerical work of this magnitude,” Sivasankar said. He also lamented the fact that no authority had ever trained them on matters pertaining to the RTI Act.
But that is not all. Before providing this information, the university has to seek and obtain permission from all the 1,000 applicants for the information pertaining them to be disclosed to any applicant under the RTI act. “Who will do the dispatch job? The entire university has only 5 nonteaching personnel. And where will we get the funds for the work?” he asks.
According to Sivasankar, the university has no provision to spend money for disclosing information under the RTI act. As of now, an assistant professor from the faculty of law has been designated as the PIO with an honorarium of Rs 1000. After seeing the massive work needed in putting together nearly 25,000 pages of information from various sources, the PIO is reluctant to continue to hold the responsibility, said the registrar.
And to top it all, the university should complete the process within 30 days from the date of receipt of the application.”Imagine what will happen if others also apply for the same information,” he wondered.
Meanwhile, applicant Varadaiah claimed that the information was needed to verify the irregularities allegedly committed by the authorities in the recruitment. “The university cannot abdicate its responsibility in providing information on the pretext of paucity of funds, lack of personnel and bulky nature of the work,” he insists.
The Right To Information Act (RTI), intended to empower the public and bring out administrative transparency, has turned into a nightmare for the fledgling Telangana University based in Nizamabad. The authorities of the university, who have neither trained personnel nor enough funds to serve the public under the Act, are at their wits end as to how to cope with the pressure generated by genuine and motivated applicants, without attracting the contempt of the State Information Commission.
What has hit Telangana University is a recent request by two of its students, C Varadaiah and N Soundarya, who sought information related to all recruitments done in the past three years ever since the varsity was set up. Normally, a request for providing information does not pose a problem for the university as it would levy charges for the stationery and photocopying of the documents.
But the present case is posing a huge problem for the varsity. This is because as per rules, anyone who falls in the Below Poverty Line (BPL) category should be provided the information without being charged for the stationery and photocopying. All the applicant needs to do is attach a copy of his BPL ration card with his request, said officials.
It is the statistics involved in obliging this particular request by two students falling in the BPL category that has stumped the varsity officials. Varadaiah and Soundarya sought copies of notification pertaining to the recruitments done in 2006, 2007 and 2008, the applications the university received along with all enclosures including call letters sent and copies of the joining reports from the university.
Telangana University registrar K Sivasankar told HNN that the varsity had recruited only 38 teaching and five non-teaching staff during the last three-year period. “However, 1,000 applications had been received. If we have to comply with the request of these two students, we would have to provide them 24,872 pages of information,” the registrar said.
The numbers involved in this exercise has the cash-strapped university groping in the dark.“We have no funds to purchase enough stationery for photocopying nearly 25,000 pages of documents. Apart from the cost, we have no staff to do clerical work of this magnitude,” Sivasankar said. He also lamented the fact that no authority had ever trained them on matters pertaining to the RTI Act.
But that is not all. Before providing this information, the university has to seek and obtain permission from all the 1,000 applicants for the information pertaining them to be disclosed to any applicant under the RTI act. “Who will do the dispatch job? The entire university has only 5 nonteaching personnel. And where will we get the funds for the work?” he asks.
According to Sivasankar, the university has no provision to spend money for disclosing information under the RTI act. As of now, an assistant professor from the faculty of law has been designated as the PIO with an honorarium of Rs 1000. After seeing the massive work needed in putting together nearly 25,000 pages of information from various sources, the PIO is reluctant to continue to hold the responsibility, said the registrar.
And to top it all, the university should complete the process within 30 days from the date of receipt of the application.”Imagine what will happen if others also apply for the same information,” he wondered.
Meanwhile, applicant Varadaiah claimed that the information was needed to verify the irregularities allegedly committed by the authorities in the recruitment. “The university cannot abdicate its responsibility in providing information on the pretext of paucity of funds, lack of personnel and bulky nature of the work,” he insists.
Friday, December 19, 2008
Global Meltdown Impact on Currency
By Ayesha Jabeen
The unstable financial situation in the world, growing foreign debt on US and the falling oil prices are all paving way for the collapse of dollar and it may no more remain as the world’s major currency.
Sharp decline in the value of dollar against the euro, and other major currencies of the world has become a matter of global concern, this issue is giving rise to as to how long the dollar can hold its place as the world’s major currency . Since long, the dollar has strongly occupied the world’s trade, it has been a common currency in world businesses, more than 80% of transactions from all corners of the world take place in dollars.
It is likely that the world might bid good bye to US dollar and shake hands with a new currency amero which will replace American dollar, the Canadian dollar and Mexican Peso, this news has been under covers for a while now and is slowly gaining exposure. According to American Daily 07/05/07 the collapse of American dollar and amero making its way is a sign that there is a possibility of North American Union being formed. This has been extracted from the article written by Judi McLeod, a famous journalist who operates the website Canada Free Press. According to his vision the invention of this new currency will take place stealthily and the American public will learn about it only once it is into the market.
It is predicted by many US experts that the fall of American dollar is imminent. Although, the US authorities justify its stand considering this as rumors and promise to keep the dollar floating, the latest buzz is that the US is reportedly working on a new currency and its pictures have already arrived on Russian internet.
The unstable financial situation in the world, growing foreign debt on US and the falling oil prices are all paving way for the collapse of dollar. US has highest demand for consumption in the world and largest imports when compared to exports, this created a depreciation of dollar as the outflow of dollar outdid the inflow of any other currency from exports. This led to inflation and made consumables costlier to US this is one simple reason out of many as to why the dollar is shaking up.
As the American economy is slowing down global investors are taking back to invest their money in dollars and are putting them into euros, British pounds and Japanese yen. Oil producing countries no more want to accumulate all the dollars they are getting for their oil, since it’s worth less, as a result, they are converting them into other major currencies, this is sending more dollars into currency markets, which in turn is declining the dollar’s value. For instance, Russia used to have 90 percent of its financial reserves in dollars.
It now has 45 percent in dollars, 45 percent in euros and 10 percent in British pounds as per one economic analyst who told ABC news in Feb 2008. The billions of dollars invested by China with American economy will be worthless and they may have to negotiate it with amero.
According to a report from one of the blogs on internet recently written 3 Dec 2008 by an American citizen Hal Turner, it is known that amero coins were being secretly mint at Denver Mint in September 2007. In October 2008 the US government shipped 800 billion ameros to the China Development Bank. There is a video out there placed on You Tube showing the coin and explaining the possible efforts of the government to exhaust the dollar as a currency.
It is without the consent of a single American citizen or authorization of congress that this new currency is being secretly printed and circulated around the world. On October 16, 2008, It was broadcast on the "Global-Europe AnticipationBulletin" that the present U.S. Dollar will be demonetized (it won't be "money" anymore) and a new currency imposed. “Old dollars" will be devalued by ninety percent (90%). This means the dollar will lose its value by 90%. News posted on 5 october 2007 on WorldNetDaily.com says that Amero may be the currency of North America in next 10 years this can boost Mexico economy to a considerable level.
But it is also true that fake amero currency has been making rounds on internet which looks much like Canadian currency, so people need to be cautious not to buy them. Whether the amero currency is going to be a reality or not still remains a topic of debate. Coming to the description of amero currency it is learnt that amero notes have no portraits of US presidents on them and resemble the Belarussian rubles.For instance, there is an image of a deer depicted on a 50-amero note, and a picture of a pyramid of Mexican Indians can be seen on a 100-amero note.
Former Mexican President Vicente Fox last year confirmed the existence of a plan to create a new currency in apprehension with President Bush, indicating it was a long term plan, he declared this in an interview on CNN's "Larry King Live”. It probably was the first time a leader of Mexico, Canada or the U.S. openly confirmed a plan for the innovation of a new currency. It is known through various news channels that the governments of the United States, Canada, and Mexico are already taking steps to implement such a currency.
This idea was first proposed in 1999 by Canadian economist Herbert G.Grubel. A book titled The Case for the amero in September 1999 was published by a senior fellow of the conservative Fraser Institute, this was the year when euro became a virtual currency. Another Canadian think-tank, the C.D. Howe Institute, advocates the formation of a shared common currency between Canada and the United States . When the report was out the nationalists groups in Canada opposed this because they viewed it as a threat by American businesses to gain access to their extensive natural resources.
Lets wait and watch what the future holds in its hand…. Dollar or amero
The unstable financial situation in the world, growing foreign debt on US and the falling oil prices are all paving way for the collapse of dollar and it may no more remain as the world’s major currency.
Sharp decline in the value of dollar against the euro, and other major currencies of the world has become a matter of global concern, this issue is giving rise to as to how long the dollar can hold its place as the world’s major currency . Since long, the dollar has strongly occupied the world’s trade, it has been a common currency in world businesses, more than 80% of transactions from all corners of the world take place in dollars.
It is likely that the world might bid good bye to US dollar and shake hands with a new currency amero which will replace American dollar, the Canadian dollar and Mexican Peso, this news has been under covers for a while now and is slowly gaining exposure. According to American Daily 07/05/07 the collapse of American dollar and amero making its way is a sign that there is a possibility of North American Union being formed. This has been extracted from the article written by Judi McLeod, a famous journalist who operates the website Canada Free Press. According to his vision the invention of this new currency will take place stealthily and the American public will learn about it only once it is into the market.
It is predicted by many US experts that the fall of American dollar is imminent. Although, the US authorities justify its stand considering this as rumors and promise to keep the dollar floating, the latest buzz is that the US is reportedly working on a new currency and its pictures have already arrived on Russian internet.
The unstable financial situation in the world, growing foreign debt on US and the falling oil prices are all paving way for the collapse of dollar. US has highest demand for consumption in the world and largest imports when compared to exports, this created a depreciation of dollar as the outflow of dollar outdid the inflow of any other currency from exports. This led to inflation and made consumables costlier to US this is one simple reason out of many as to why the dollar is shaking up.
As the American economy is slowing down global investors are taking back to invest their money in dollars and are putting them into euros, British pounds and Japanese yen. Oil producing countries no more want to accumulate all the dollars they are getting for their oil, since it’s worth less, as a result, they are converting them into other major currencies, this is sending more dollars into currency markets, which in turn is declining the dollar’s value. For instance, Russia used to have 90 percent of its financial reserves in dollars.
It now has 45 percent in dollars, 45 percent in euros and 10 percent in British pounds as per one economic analyst who told ABC news in Feb 2008. The billions of dollars invested by China with American economy will be worthless and they may have to negotiate it with amero.
According to a report from one of the blogs on internet recently written 3 Dec 2008 by an American citizen Hal Turner, it is known that amero coins were being secretly mint at Denver Mint in September 2007. In October 2008 the US government shipped 800 billion ameros to the China Development Bank. There is a video out there placed on You Tube showing the coin and explaining the possible efforts of the government to exhaust the dollar as a currency.
It is without the consent of a single American citizen or authorization of congress that this new currency is being secretly printed and circulated around the world. On October 16, 2008, It was broadcast on the "Global-Europe AnticipationBulletin" that the present U.S. Dollar will be demonetized (it won't be "money" anymore) and a new currency imposed. “Old dollars" will be devalued by ninety percent (90%). This means the dollar will lose its value by 90%. News posted on 5 october 2007 on WorldNetDaily.com says that Amero may be the currency of North America in next 10 years this can boost Mexico economy to a considerable level.
But it is also true that fake amero currency has been making rounds on internet which looks much like Canadian currency, so people need to be cautious not to buy them. Whether the amero currency is going to be a reality or not still remains a topic of debate. Coming to the description of amero currency it is learnt that amero notes have no portraits of US presidents on them and resemble the Belarussian rubles.For instance, there is an image of a deer depicted on a 50-amero note, and a picture of a pyramid of Mexican Indians can be seen on a 100-amero note.
Former Mexican President Vicente Fox last year confirmed the existence of a plan to create a new currency in apprehension with President Bush, indicating it was a long term plan, he declared this in an interview on CNN's "Larry King Live”. It probably was the first time a leader of Mexico, Canada or the U.S. openly confirmed a plan for the innovation of a new currency. It is known through various news channels that the governments of the United States, Canada, and Mexico are already taking steps to implement such a currency.
This idea was first proposed in 1999 by Canadian economist Herbert G.Grubel. A book titled The Case for the amero in September 1999 was published by a senior fellow of the conservative Fraser Institute, this was the year when euro became a virtual currency. Another Canadian think-tank, the C.D. Howe Institute, advocates the formation of a shared common currency between Canada and the United States . When the report was out the nationalists groups in Canada opposed this because they viewed it as a threat by American businesses to gain access to their extensive natural resources.
Lets wait and watch what the future holds in its hand…. Dollar or amero
Global Meltdown Impact on Currency
By Ayesha Jabeen
The unstable financial situation in the world, growing foreign debt on US and the falling oil prices are all paving way for the collapse of dollar and it may no more remain as the world’s major currency.
Sharp decline in the value of dollar against the euro, and other major currencies of the world has become a matter of global concern, this issue is giving rise to as to how long the dollar can hold its place as the world’s major currency . Since long, the dollar has strongly occupied the world’s trade, it has been a common currency in world businesses, more than 80% of transactions from all corners of the world take place in dollars.
It is likely that the world might bid good bye to US dollar and shake hands with a new currency amero which will replace American dollar, the Canadian dollar and Mexican Peso, this news has been under covers for a while now and is slowly gaining exposure. According to American Daily 07/05/07 the collapse of American dollar and amero making its way is a sign that there is a possibility of North American Union being formed. This has been extracted from the article written by Judi McLeod, a famous journalist who operates the website Canada Free Press. According to his vision the invention of this new currency will take place stealthily and the American public will learn about it only once it is into the market.
It is predicted by many US experts that the fall of American dollar is imminent. Although, the US authorities justify its stand considering this as rumors and promise to keep the dollar floating, the latest buzz is that the US is reportedly working on a new currency and its pictures have already arrived on Russian internet.
The unstable financial situation in the world, growing foreign debt on US and the falling oil prices are all paving way for the collapse of dollar. US has highest demand for consumption in the world and largest imports when compared to exports, this created a depreciation of dollar as the outflow of dollar outdid the inflow of any other currency from exports. This led to inflation and made consumables costlier to US this is one simple reason out of many as to why the dollar is shaking up.
As the American economy is slowing down global investors are taking back to invest their money in dollars and are putting them into euros, British pounds and Japanese yen. Oil producing countries no more want to accumulate all the dollars they are getting for their oil, since it’s worth less, as a result, they are converting them into other major currencies, this is sending more dollars into currency markets, which in turn is declining the dollar’s value. For instance, Russia used to have 90 percent of its financial reserves in dollars.
It now has 45 percent in dollars, 45 percent in euros and 10 percent in British pounds as per one economic analyst who told ABC news in Feb 2008. The billions of dollars invested by China with American economy will be worthless and they may have to negotiate it with amero.
According to a report from one of the blogs on internet recently written 3 Dec 2008 by an American citizen Hal Turner, it is known that amero coins were being secretly mint at Denver Mint in September 2007. In October 2008 the US government shipped 800 billion ameros to the China Development Bank. There is a video out there placed on You Tube showing the coin and explaining the possible efforts of the government to exhaust the dollar as a currency.
It is without the consent of a single American citizen or authorization of congress that this new currency is being secretly printed and circulated around the world. On October 16, 2008, It was broadcast on the "Global-Europe AnticipationBulletin" that the present U.S. Dollar will be demonetized (it won't be "money" anymore) and a new currency imposed. “Old dollars" will be devalued by ninety percent (90%). This means the dollar will lose its value by 90%. News posted on 5 october 2007 on WorldNetDaily.com says that Amero may be the currency of North America in next 10 years this can boost Mexico economy to a considerable level.
But it is also true that fake amero currency has been making rounds on internet which looks much like Canadian currency, so people need to be cautious not to buy them. Whether the amero currency is going to be a reality or not still remains a topic of debate. Coming to the description of amero currency it is learnt that amero notes have no portraits of US presidents on them and resemble the Belarussian rubles.For instance, there is an image of a deer depicted on a 50-amero note, and a picture of a pyramid of Mexican Indians can be seen on a 100-amero note.
Former Mexican President Vicente Fox last year confirmed the existence of a plan to create a new currency in apprehension with President Bush, indicating it was a long term plan, he declared this in an interview on CNN's "Larry King Live”. It probably was the first time a leader of Mexico, Canada or the U.S. openly confirmed a plan for the innovation of a new currency. It is known through various news channels that the governments of the United States, Canada, and Mexico are already taking steps to implement such a currency.
This idea was first proposed in 1999 by Canadian economist Herbert G.Grubel. A book titled The Case for the amero in September 1999 was published by a senior fellow of the conservative Fraser Institute, this was the year when euro became a virtual currency. Another Canadian think-tank, the C.D. Howe Institute, advocates the formation of a shared common currency between Canada and the United States . When the report was out the nationalists groups in Canada opposed this because they viewed it as a threat by American businesses to gain access to their extensive natural resources.
Lets wait and watch what the future holds in its hand…. Dollar or amero
The unstable financial situation in the world, growing foreign debt on US and the falling oil prices are all paving way for the collapse of dollar and it may no more remain as the world’s major currency.
Sharp decline in the value of dollar against the euro, and other major currencies of the world has become a matter of global concern, this issue is giving rise to as to how long the dollar can hold its place as the world’s major currency . Since long, the dollar has strongly occupied the world’s trade, it has been a common currency in world businesses, more than 80% of transactions from all corners of the world take place in dollars.
It is likely that the world might bid good bye to US dollar and shake hands with a new currency amero which will replace American dollar, the Canadian dollar and Mexican Peso, this news has been under covers for a while now and is slowly gaining exposure. According to American Daily 07/05/07 the collapse of American dollar and amero making its way is a sign that there is a possibility of North American Union being formed. This has been extracted from the article written by Judi McLeod, a famous journalist who operates the website Canada Free Press. According to his vision the invention of this new currency will take place stealthily and the American public will learn about it only once it is into the market.
It is predicted by many US experts that the fall of American dollar is imminent. Although, the US authorities justify its stand considering this as rumors and promise to keep the dollar floating, the latest buzz is that the US is reportedly working on a new currency and its pictures have already arrived on Russian internet.
The unstable financial situation in the world, growing foreign debt on US and the falling oil prices are all paving way for the collapse of dollar. US has highest demand for consumption in the world and largest imports when compared to exports, this created a depreciation of dollar as the outflow of dollar outdid the inflow of any other currency from exports. This led to inflation and made consumables costlier to US this is one simple reason out of many as to why the dollar is shaking up.
As the American economy is slowing down global investors are taking back to invest their money in dollars and are putting them into euros, British pounds and Japanese yen. Oil producing countries no more want to accumulate all the dollars they are getting for their oil, since it’s worth less, as a result, they are converting them into other major currencies, this is sending more dollars into currency markets, which in turn is declining the dollar’s value. For instance, Russia used to have 90 percent of its financial reserves in dollars.
It now has 45 percent in dollars, 45 percent in euros and 10 percent in British pounds as per one economic analyst who told ABC news in Feb 2008. The billions of dollars invested by China with American economy will be worthless and they may have to negotiate it with amero.
According to a report from one of the blogs on internet recently written 3 Dec 2008 by an American citizen Hal Turner, it is known that amero coins were being secretly mint at Denver Mint in September 2007. In October 2008 the US government shipped 800 billion ameros to the China Development Bank. There is a video out there placed on You Tube showing the coin and explaining the possible efforts of the government to exhaust the dollar as a currency.
It is without the consent of a single American citizen or authorization of congress that this new currency is being secretly printed and circulated around the world. On October 16, 2008, It was broadcast on the "Global-Europe AnticipationBulletin" that the present U.S. Dollar will be demonetized (it won't be "money" anymore) and a new currency imposed. “Old dollars" will be devalued by ninety percent (90%). This means the dollar will lose its value by 90%. News posted on 5 october 2007 on WorldNetDaily.com says that Amero may be the currency of North America in next 10 years this can boost Mexico economy to a considerable level.
But it is also true that fake amero currency has been making rounds on internet which looks much like Canadian currency, so people need to be cautious not to buy them. Whether the amero currency is going to be a reality or not still remains a topic of debate. Coming to the description of amero currency it is learnt that amero notes have no portraits of US presidents on them and resemble the Belarussian rubles.For instance, there is an image of a deer depicted on a 50-amero note, and a picture of a pyramid of Mexican Indians can be seen on a 100-amero note.
Former Mexican President Vicente Fox last year confirmed the existence of a plan to create a new currency in apprehension with President Bush, indicating it was a long term plan, he declared this in an interview on CNN's "Larry King Live”. It probably was the first time a leader of Mexico, Canada or the U.S. openly confirmed a plan for the innovation of a new currency. It is known through various news channels that the governments of the United States, Canada, and Mexico are already taking steps to implement such a currency.
This idea was first proposed in 1999 by Canadian economist Herbert G.Grubel. A book titled The Case for the amero in September 1999 was published by a senior fellow of the conservative Fraser Institute, this was the year when euro became a virtual currency. Another Canadian think-tank, the C.D. Howe Institute, advocates the formation of a shared common currency between Canada and the United States . When the report was out the nationalists groups in Canada opposed this because they viewed it as a threat by American businesses to gain access to their extensive natural resources.
Lets wait and watch what the future holds in its hand…. Dollar or amero
Global Meltdown Impact on Currency
By Ayesha Jabeen
The unstable financial situation in the world, growing foreign debt on US and the falling oil prices are all paving way for the collapse of dollar and it may no more remain as the world’s major currency.
Sharp decline in the value of dollar against the euro, and other major currencies of the world has become a matter of global concern, this issue is giving rise to as to how long the dollar can hold its place as the world’s major currency . Since long, the dollar has strongly occupied the world’s trade, it has been a common currency in world businesses, more than 80% of transactions from all corners of the world take place in dollars.
It is likely that the world might bid good bye to US dollar and shake hands with a new currency amero which will replace American dollar, the Canadian dollar and Mexican Peso, this news has been under covers for a while now and is slowly gaining exposure. According to American Daily 07/05/07 the collapse of American dollar and amero making its way is a sign that there is a possibility of North American Union being formed. This has been extracted from the article written by Judi McLeod, a famous journalist who operates the website Canada Free Press. According to his vision the invention of this new currency will take place stealthily and the American public will learn about it only once it is into the market.
It is predicted by many US experts that the fall of American dollar is imminent. Although, the US authorities justify its stand considering this as rumors and promise to keep the dollar floating, the latest buzz is that the US is reportedly working on a new currency and its pictures have already arrived on Russian internet.
The unstable financial situation in the world, growing foreign debt on US and the falling oil prices are all paving way for the collapse of dollar. US has highest demand for consumption in the world and largest imports when compared to exports, this created a depreciation of dollar as the outflow of dollar outdid the inflow of any other currency from exports. This led to inflation and made consumables costlier to US this is one simple reason out of many as to why the dollar is shaking up.
As the American economy is slowing down global investors are taking back to invest their money in dollars and are putting them into euros, British pounds and Japanese yen. Oil producing countries no more want to accumulate all the dollars they are getting for their oil, since it’s worth less, as a result, they are converting them into other major currencies, this is sending more dollars into currency markets, which in turn is declining the dollar’s value. For instance, Russia used to have 90 percent of its financial reserves in dollars.
It now has 45 percent in dollars, 45 percent in euros and 10 percent in British pounds as per one economic analyst who told ABC news in Feb 2008. The billions of dollars invested by China with American economy will be worthless and they may have to negotiate it with amero.
According to a report from one of the blogs on internet recently written 3 Dec 2008 by an American citizen Hal Turner, it is known that amero coins were being secretly mint at Denver Mint in September 2007. In October 2008 the US government shipped 800 billion ameros to the China Development Bank. There is a video out there placed on You Tube showing the coin and explaining the possible efforts of the government to exhaust the dollar as a currency.
It is without the consent of a single American citizen or authorization of congress that this new currency is being secretly printed and circulated around the world. On October 16, 2008, It was broadcast on the "Global-Europe AnticipationBulletin" that the present U.S. Dollar will be demonetized (it won't be "money" anymore) and a new currency imposed. “Old dollars" will be devalued by ninety percent (90%). This means the dollar will lose its value by 90%. News posted on 5 october 2007 on WorldNetDaily.com says that Amero may be the currency of North America in next 10 years this can boost Mexico economy to a considerable level.
But it is also true that fake amero currency has been making rounds on internet which looks much like Canadian currency, so people need to be cautious not to buy them. Whether the amero currency is going to be a reality or not still remains a topic of debate. Coming to the description of amero currency it is learnt that amero notes have no portraits of US presidents on them and resemble the Belarussian rubles.For instance, there is an image of a deer depicted on a 50-amero note, and a picture of a pyramid of Mexican Indians can be seen on a 100-amero note.
Former Mexican President Vicente Fox last year confirmed the existence of a plan to create a new currency in apprehension with President Bush, indicating it was a long term plan, he declared this in an interview on CNN's "Larry King Live”. It probably was the first time a leader of Mexico, Canada or the U.S. openly confirmed a plan for the innovation of a new currency. It is known through various news channels that the governments of the United States, Canada, and Mexico are already taking steps to implement such a currency.
This idea was first proposed in 1999 by Canadian economist Herbert G.Grubel. A book titled The Case for the amero in September 1999 was published by a senior fellow of the conservative Fraser Institute, this was the year when euro became a virtual currency. Another Canadian think-tank, the C.D. Howe Institute, advocates the formation of a shared common currency between Canada and the United States . When the report was out the nationalists groups in Canada opposed this because they viewed it as a threat by American businesses to gain access to their extensive natural resources.
Lets wait and watch what the future holds in its hand…. Dollar or amero
The unstable financial situation in the world, growing foreign debt on US and the falling oil prices are all paving way for the collapse of dollar and it may no more remain as the world’s major currency.
Sharp decline in the value of dollar against the euro, and other major currencies of the world has become a matter of global concern, this issue is giving rise to as to how long the dollar can hold its place as the world’s major currency . Since long, the dollar has strongly occupied the world’s trade, it has been a common currency in world businesses, more than 80% of transactions from all corners of the world take place in dollars.
It is likely that the world might bid good bye to US dollar and shake hands with a new currency amero which will replace American dollar, the Canadian dollar and Mexican Peso, this news has been under covers for a while now and is slowly gaining exposure. According to American Daily 07/05/07 the collapse of American dollar and amero making its way is a sign that there is a possibility of North American Union being formed. This has been extracted from the article written by Judi McLeod, a famous journalist who operates the website Canada Free Press. According to his vision the invention of this new currency will take place stealthily and the American public will learn about it only once it is into the market.
It is predicted by many US experts that the fall of American dollar is imminent. Although, the US authorities justify its stand considering this as rumors and promise to keep the dollar floating, the latest buzz is that the US is reportedly working on a new currency and its pictures have already arrived on Russian internet.
The unstable financial situation in the world, growing foreign debt on US and the falling oil prices are all paving way for the collapse of dollar. US has highest demand for consumption in the world and largest imports when compared to exports, this created a depreciation of dollar as the outflow of dollar outdid the inflow of any other currency from exports. This led to inflation and made consumables costlier to US this is one simple reason out of many as to why the dollar is shaking up.
As the American economy is slowing down global investors are taking back to invest their money in dollars and are putting them into euros, British pounds and Japanese yen. Oil producing countries no more want to accumulate all the dollars they are getting for their oil, since it’s worth less, as a result, they are converting them into other major currencies, this is sending more dollars into currency markets, which in turn is declining the dollar’s value. For instance, Russia used to have 90 percent of its financial reserves in dollars.
It now has 45 percent in dollars, 45 percent in euros and 10 percent in British pounds as per one economic analyst who told ABC news in Feb 2008. The billions of dollars invested by China with American economy will be worthless and they may have to negotiate it with amero.
According to a report from one of the blogs on internet recently written 3 Dec 2008 by an American citizen Hal Turner, it is known that amero coins were being secretly mint at Denver Mint in September 2007. In October 2008 the US government shipped 800 billion ameros to the China Development Bank. There is a video out there placed on You Tube showing the coin and explaining the possible efforts of the government to exhaust the dollar as a currency.
It is without the consent of a single American citizen or authorization of congress that this new currency is being secretly printed and circulated around the world. On October 16, 2008, It was broadcast on the "Global-Europe AnticipationBulletin" that the present U.S. Dollar will be demonetized (it won't be "money" anymore) and a new currency imposed. “Old dollars" will be devalued by ninety percent (90%). This means the dollar will lose its value by 90%. News posted on 5 october 2007 on WorldNetDaily.com says that Amero may be the currency of North America in next 10 years this can boost Mexico economy to a considerable level.
But it is also true that fake amero currency has been making rounds on internet which looks much like Canadian currency, so people need to be cautious not to buy them. Whether the amero currency is going to be a reality or not still remains a topic of debate. Coming to the description of amero currency it is learnt that amero notes have no portraits of US presidents on them and resemble the Belarussian rubles.For instance, there is an image of a deer depicted on a 50-amero note, and a picture of a pyramid of Mexican Indians can be seen on a 100-amero note.
Former Mexican President Vicente Fox last year confirmed the existence of a plan to create a new currency in apprehension with President Bush, indicating it was a long term plan, he declared this in an interview on CNN's "Larry King Live”. It probably was the first time a leader of Mexico, Canada or the U.S. openly confirmed a plan for the innovation of a new currency. It is known through various news channels that the governments of the United States, Canada, and Mexico are already taking steps to implement such a currency.
This idea was first proposed in 1999 by Canadian economist Herbert G.Grubel. A book titled The Case for the amero in September 1999 was published by a senior fellow of the conservative Fraser Institute, this was the year when euro became a virtual currency. Another Canadian think-tank, the C.D. Howe Institute, advocates the formation of a shared common currency between Canada and the United States . When the report was out the nationalists groups in Canada opposed this because they viewed it as a threat by American businesses to gain access to their extensive natural resources.
Lets wait and watch what the future holds in its hand…. Dollar or amero
Digitising Healthcare
The in-house HIS of Mumbai's Tata Memorial Hospital is harnessing the benefits of digitisation by delivering quality cancer care. Sonal Shukla tells you how.
Information is Power—this motto holds true for Mumbai-based 560-bed Tata Memorial Hospital (TMH), a reputed name in oncology. It is truly one of the first 'digital' hospitals in India as its IT story goes back to 1985 when India was not even aware of the 'alien' world of computers. Impressively, when digitisation was itself new to the healthcare industry, TMH embarked on a pioneering path to use IT for its information management with the ND550 Supermini computer and 40 dumb terminals across the hospital-wide network and thus conceptualised its own indigenous HIS. In 1997, this small indigenous project soared with an initiative to undertake a systematic review of the existing operational systems for patient care management and hospital administration in the hospital. In the process, the hospital went on to have well-integrated Electronic Medical Record (EMR) and Electronic Financial Record (EFR) systems in place. Today, the hospital is in the process of taking this initiative one step further by web enabling the entire system and fostering the concept of e-health.
Driving need
As one of the leading cancer research institutes in India, TMH has a need to retrieve patient information in a very structured manner. "The reason we created our HIS in 1985 was to computerise normal transactions in the system and retrieve them at a later stage. We were abstracting information like registration, demographic and clinical details from the patient files and putting it on the system. However, this information collection was not on a real-time basis and this HIS outlived its utility by 1996," relates Dr Narayan HKV, Medical Superintendent. The hospital felt the need for a more robust and responding integrated enterprise system that could link with all the systems in the hospital. The requirement for digitisation in the hospital was in terms of structured workflow, enhanced patient care and satisfaction, improved management tools, effective, economic, timely and manageable data processing and improved exchange of information between care givers, patients and statutory authorities. "We wanted to establish a platform and protocol for transmitting and sharing information," Dr Narayan explains.
In this context, a review was conducted with active participation of the hospital management. The scope of the review included patient care services, materials management (purchase and stores, dispensary) and financial management. "The review yielded valuable insights into inherent lacunae which kept us short of contemporary manage-ment practices. The hospital management decided to incorporate a number of recommendations into this system re-engineering process with a tight coupling to a computerised system, resulting in EMR and EFR," reveals Dr A Mahajan, Assistant Medical Superintendent. The Hospital moved into client server architecture.
Step by Step
Since 1997, the hospital has developed a variety of modules specific to an area of operations. The hospital separately implemented modules like Patient Administration System, Diagnostic Information System, PACS, Operation Theatre Module, Clinical Information System (CIS), Radiation Oncology Information System (RIOS), Medical Oncology Information System (MOIS), ICU and Inpatient Module as a part of EMR. As a part of EFR, the hospital is in the process of implementing modules like Financial Management System, Payroll system, HRD and Personal System, Stores Module, Purchase Module, Dispensary Module and Facilities Management Systems. "The integration of the EMR and EFR will enforce all the business rules of the institution and facilitate meaningful management information for timely and purposeful decision making," claims Dr Narayan.
IT@Tata
Patient Admission System: Implemented in 1999, it is said to be the pivotal system in EMR. The implementation of this system has catered for patient care activities such as registrations, appointments and travel concessions, wait listing, admissions, transfers and discharges. This system has provided key demographic and patient status information to other modules that were installed one after the other in the Hospital. "Management information such as trends in registration, waitlists, bed occupancy, lead-time analysis for treatment and re-admission rates are important outputs of this system," Dr Mahajan reveals.
Diagnostic Information System: Implemented during 2001-02, it has enabled the hospital to put in place diagnostic services like radio-diagnosis consisting of conventional radiography, CT, MR, mammography and ultrasound, bio-imaging unit consisting of PET-CT, pathology including surgical pathology, cytology, haemato-oncology, transfusion medicine including blood banking, diagnostic endoscopy and cardiology including ECG. With this implementation, in addition to placing the diagnostic reports on the clinician's desktop as soon as the investigations are reported, the turnaround time has been considerably reduced. "The problem of misplaced reports has almost been eliminated. MIS reports, both operational and executive, are a positive fallout of the system," says Dr Mahajan. On the other hand, the interfacing of analytical equipment like biomedical analysers and cell counters with the diagnostic information system has reduced the lead-time of reporting and has eliminated transcription errors.
Picture Archival & Communication System (PACS): Implementation of PACS was quite a challenge and that is why the hospital approached it in a phased manner. "First we started distributing the images on the hospital network as we had to change the views of clinicians who were used to seeing hard copies, and this was a total culture change for them," Dr Narayan recalls. An initiative was taken where the hospital first started archiving the images on the PACS system. This developed the capacity of archiving. The next step was to distribute the archived images over the web. Without curbing the clinicians' instincts of looking at the hard copy, the hospital made available the web based images. "We told the clinicians that they could not only look at the hard copy but could also go to the web and see the images. This is how the acceptability slowly came in," Dr Narayan explains.
Simultaneously, the hospital initiated soft copy reporting where all the radiologists were provided with workstations capable of post processing the images. Reporting on diagnostic workstations has enabled the hospital to move towards a filmless environment. In the last year, an advanced voice to text system has been installed in the hospital.
Operation Theatre Module: It has been functioning since 2003 with features like scheduling of procedures, pre-anaesthesia evaluation, pre-operative check lists, surgical procedure details, anaesthesia details and post-operative check list. "The OT module was among the first modules to be implemented in the hospital as OT itself is a single event for the patients. In addition, traditionally the surgery team is the most difficult team to convince in any hospital, as it is the busiest team. Therefore we wanted compliance from them first," says Dr Mahajan.
The implementation of this module streamlined the OT area in the hospital with real-time data capture of the information now possible and being available across the hospital. Today, the future refinement in the OT module is coming from the clinicians themselves as they want more information in a structured manner.
USP
Dr Narayan avers the system is integrated and not a collection of stand-alone systems. "One system should complement the other system and not work at cross purposes. If the stand-alone systems are not properly integrated, they will under-perform. Across the world there are very good stand-alone systems, but there is a need for a a totally integrated enterprise system which can address every aspect of hospital functionl," he opines.
The hospital has avoided this. The back-end server in the hospital is a single database. It is also said to be a completely customised system whereby every stakeholder knows his role and what he has to do. On the other hand, in bought systems, users have to learn about the systems and how to use them. "We took a conscious decision in 1998-99 since we didn't have a system which could really suit us; so the only alternative was to do it the hard way. We have customised this software in such a way that we are improving our existing work practices and incorporating them into this software," says Dr Narayan. The hospital has guarded itself from system failures with back-to-back servers and data replicators.
Vendor Selection
The HIS is developed by the Electronics Corporation of India Limited (ECIL), which is a sister organisation under the Department of Atomic Energy. ECIL provided the software programmes and has been continuously upgrading them. "We tell them what we require and how it must be structured. They do the coding and programming and domain logic are sourced from us," Dr Narayan says.
The hospital was opposed to vendors who propose a ready-made product which is a collage of different requirements. "They start off with a generic product and then try to fit in the requirements. We wanted a software vendor who could develop a software and maintain it as per our requirement. With ECIL, we found a worthy partner and our association has been reassuring," says Dr Narayan.
Challenges in the Path
The route to implementation of different modules has not been easy for the hospital. As Dr Mahajan puts it, "It was more difficult when we started in 1999 because people were new to the concept of real-time data entry and departments were very reluctant to share the data with each other."
The other major challenge was to get acceptance among the users. "The department of pathology was most concerned that the reports would get lost. It took a long time for them to be convinced and till recently they were maintaining a duplicate copy in the department." remembers Dr Narayan.
Systems had to be developed that could have acceptability for a broad spectrum of employees of the hospital at all levels. "We had to sell the concept of why we were implementing the different systems and what are the benefits to each of the stakeholders. We had to motivate people to use this system and bring in some sort of acceptability. It was and is a painstaking process," Dr Narayan admits.
Future plans
In the near future, the hospital aims to have web-enabled systems in place. This will include services like patient registration, appointments, admission wait list follow-up, cyber consultation, e-health initiative, investigations/ product requisitioning, access to EMR and tendering for materials managment. The application for web enabling has been completed and will be implemented in the near future. "Cancer is a disease which needs follow-up for the rest of the patient's life. Moreover, patients have a close association with us with more than 80 per cent of them coming from outside Mumbai. Web enabling will enable them to access their records online, download and archive them, which is not only more convenient but will also save them time and money. Similarly, doctors can access the patients' records from any location," Dr Mahajan points out.
The hospital is also mulling over the concept of e-health which combines aspects of medical informatics, public health and business with reference to health services and information delivered usually through the internet.
Information is Power—this motto holds true for Mumbai-based 560-bed Tata Memorial Hospital (TMH), a reputed name in oncology. It is truly one of the first 'digital' hospitals in India as its IT story goes back to 1985 when India was not even aware of the 'alien' world of computers. Impressively, when digitisation was itself new to the healthcare industry, TMH embarked on a pioneering path to use IT for its information management with the ND550 Supermini computer and 40 dumb terminals across the hospital-wide network and thus conceptualised its own indigenous HIS. In 1997, this small indigenous project soared with an initiative to undertake a systematic review of the existing operational systems for patient care management and hospital administration in the hospital. In the process, the hospital went on to have well-integrated Electronic Medical Record (EMR) and Electronic Financial Record (EFR) systems in place. Today, the hospital is in the process of taking this initiative one step further by web enabling the entire system and fostering the concept of e-health.
Driving need
As one of the leading cancer research institutes in India, TMH has a need to retrieve patient information in a very structured manner. "The reason we created our HIS in 1985 was to computerise normal transactions in the system and retrieve them at a later stage. We were abstracting information like registration, demographic and clinical details from the patient files and putting it on the system. However, this information collection was not on a real-time basis and this HIS outlived its utility by 1996," relates Dr Narayan HKV, Medical Superintendent. The hospital felt the need for a more robust and responding integrated enterprise system that could link with all the systems in the hospital. The requirement for digitisation in the hospital was in terms of structured workflow, enhanced patient care and satisfaction, improved management tools, effective, economic, timely and manageable data processing and improved exchange of information between care givers, patients and statutory authorities. "We wanted to establish a platform and protocol for transmitting and sharing information," Dr Narayan explains.
In this context, a review was conducted with active participation of the hospital management. The scope of the review included patient care services, materials management (purchase and stores, dispensary) and financial management. "The review yielded valuable insights into inherent lacunae which kept us short of contemporary manage-ment practices. The hospital management decided to incorporate a number of recommendations into this system re-engineering process with a tight coupling to a computerised system, resulting in EMR and EFR," reveals Dr A Mahajan, Assistant Medical Superintendent. The Hospital moved into client server architecture.
Step by Step
Since 1997, the hospital has developed a variety of modules specific to an area of operations. The hospital separately implemented modules like Patient Administration System, Diagnostic Information System, PACS, Operation Theatre Module, Clinical Information System (CIS), Radiation Oncology Information System (RIOS), Medical Oncology Information System (MOIS), ICU and Inpatient Module as a part of EMR. As a part of EFR, the hospital is in the process of implementing modules like Financial Management System, Payroll system, HRD and Personal System, Stores Module, Purchase Module, Dispensary Module and Facilities Management Systems. "The integration of the EMR and EFR will enforce all the business rules of the institution and facilitate meaningful management information for timely and purposeful decision making," claims Dr Narayan.
IT@Tata
Patient Admission System: Implemented in 1999, it is said to be the pivotal system in EMR. The implementation of this system has catered for patient care activities such as registrations, appointments and travel concessions, wait listing, admissions, transfers and discharges. This system has provided key demographic and patient status information to other modules that were installed one after the other in the Hospital. "Management information such as trends in registration, waitlists, bed occupancy, lead-time analysis for treatment and re-admission rates are important outputs of this system," Dr Mahajan reveals.
Diagnostic Information System: Implemented during 2001-02, it has enabled the hospital to put in place diagnostic services like radio-diagnosis consisting of conventional radiography, CT, MR, mammography and ultrasound, bio-imaging unit consisting of PET-CT, pathology including surgical pathology, cytology, haemato-oncology, transfusion medicine including blood banking, diagnostic endoscopy and cardiology including ECG. With this implementation, in addition to placing the diagnostic reports on the clinician's desktop as soon as the investigations are reported, the turnaround time has been considerably reduced. "The problem of misplaced reports has almost been eliminated. MIS reports, both operational and executive, are a positive fallout of the system," says Dr Mahajan. On the other hand, the interfacing of analytical equipment like biomedical analysers and cell counters with the diagnostic information system has reduced the lead-time of reporting and has eliminated transcription errors.
Picture Archival & Communication System (PACS): Implementation of PACS was quite a challenge and that is why the hospital approached it in a phased manner. "First we started distributing the images on the hospital network as we had to change the views of clinicians who were used to seeing hard copies, and this was a total culture change for them," Dr Narayan recalls. An initiative was taken where the hospital first started archiving the images on the PACS system. This developed the capacity of archiving. The next step was to distribute the archived images over the web. Without curbing the clinicians' instincts of looking at the hard copy, the hospital made available the web based images. "We told the clinicians that they could not only look at the hard copy but could also go to the web and see the images. This is how the acceptability slowly came in," Dr Narayan explains.
Simultaneously, the hospital initiated soft copy reporting where all the radiologists were provided with workstations capable of post processing the images. Reporting on diagnostic workstations has enabled the hospital to move towards a filmless environment. In the last year, an advanced voice to text system has been installed in the hospital.
Operation Theatre Module: It has been functioning since 2003 with features like scheduling of procedures, pre-anaesthesia evaluation, pre-operative check lists, surgical procedure details, anaesthesia details and post-operative check list. "The OT module was among the first modules to be implemented in the hospital as OT itself is a single event for the patients. In addition, traditionally the surgery team is the most difficult team to convince in any hospital, as it is the busiest team. Therefore we wanted compliance from them first," says Dr Mahajan.
The implementation of this module streamlined the OT area in the hospital with real-time data capture of the information now possible and being available across the hospital. Today, the future refinement in the OT module is coming from the clinicians themselves as they want more information in a structured manner.
USP
Dr Narayan avers the system is integrated and not a collection of stand-alone systems. "One system should complement the other system and not work at cross purposes. If the stand-alone systems are not properly integrated, they will under-perform. Across the world there are very good stand-alone systems, but there is a need for a a totally integrated enterprise system which can address every aspect of hospital functionl," he opines.
The hospital has avoided this. The back-end server in the hospital is a single database. It is also said to be a completely customised system whereby every stakeholder knows his role and what he has to do. On the other hand, in bought systems, users have to learn about the systems and how to use them. "We took a conscious decision in 1998-99 since we didn't have a system which could really suit us; so the only alternative was to do it the hard way. We have customised this software in such a way that we are improving our existing work practices and incorporating them into this software," says Dr Narayan. The hospital has guarded itself from system failures with back-to-back servers and data replicators.
Vendor Selection
The HIS is developed by the Electronics Corporation of India Limited (ECIL), which is a sister organisation under the Department of Atomic Energy. ECIL provided the software programmes and has been continuously upgrading them. "We tell them what we require and how it must be structured. They do the coding and programming and domain logic are sourced from us," Dr Narayan says.
The hospital was opposed to vendors who propose a ready-made product which is a collage of different requirements. "They start off with a generic product and then try to fit in the requirements. We wanted a software vendor who could develop a software and maintain it as per our requirement. With ECIL, we found a worthy partner and our association has been reassuring," says Dr Narayan.
Challenges in the Path
The route to implementation of different modules has not been easy for the hospital. As Dr Mahajan puts it, "It was more difficult when we started in 1999 because people were new to the concept of real-time data entry and departments were very reluctant to share the data with each other."
The other major challenge was to get acceptance among the users. "The department of pathology was most concerned that the reports would get lost. It took a long time for them to be convinced and till recently they were maintaining a duplicate copy in the department." remembers Dr Narayan.
Systems had to be developed that could have acceptability for a broad spectrum of employees of the hospital at all levels. "We had to sell the concept of why we were implementing the different systems and what are the benefits to each of the stakeholders. We had to motivate people to use this system and bring in some sort of acceptability. It was and is a painstaking process," Dr Narayan admits.
Future plans
In the near future, the hospital aims to have web-enabled systems in place. This will include services like patient registration, appointments, admission wait list follow-up, cyber consultation, e-health initiative, investigations/ product requisitioning, access to EMR and tendering for materials managment. The application for web enabling has been completed and will be implemented in the near future. "Cancer is a disease which needs follow-up for the rest of the patient's life. Moreover, patients have a close association with us with more than 80 per cent of them coming from outside Mumbai. Web enabling will enable them to access their records online, download and archive them, which is not only more convenient but will also save them time and money. Similarly, doctors can access the patients' records from any location," Dr Mahajan points out.
The hospital is also mulling over the concept of e-health which combines aspects of medical informatics, public health and business with reference to health services and information delivered usually through the internet.
Digitising Healthcare
The in-house HIS of Mumbai's Tata Memorial Hospital is harnessing the benefits of digitisation by delivering quality cancer care. Sonal Shukla tells you how.
Information is Power—this motto holds true for Mumbai-based 560-bed Tata Memorial Hospital (TMH), a reputed name in oncology. It is truly one of the first 'digital' hospitals in India as its IT story goes back to 1985 when India was not even aware of the 'alien' world of computers. Impressively, when digitisation was itself new to the healthcare industry, TMH embarked on a pioneering path to use IT for its information management with the ND550 Supermini computer and 40 dumb terminals across the hospital-wide network and thus conceptualised its own indigenous HIS. In 1997, this small indigenous project soared with an initiative to undertake a systematic review of the existing operational systems for patient care management and hospital administration in the hospital. In the process, the hospital went on to have well-integrated Electronic Medical Record (EMR) and Electronic Financial Record (EFR) systems in place. Today, the hospital is in the process of taking this initiative one step further by web enabling the entire system and fostering the concept of e-health.
Driving need
As one of the leading cancer research institutes in India, TMH has a need to retrieve patient information in a very structured manner. "The reason we created our HIS in 1985 was to computerise normal transactions in the system and retrieve them at a later stage. We were abstracting information like registration, demographic and clinical details from the patient files and putting it on the system. However, this information collection was not on a real-time basis and this HIS outlived its utility by 1996," relates Dr Narayan HKV, Medical Superintendent. The hospital felt the need for a more robust and responding integrated enterprise system that could link with all the systems in the hospital. The requirement for digitisation in the hospital was in terms of structured workflow, enhanced patient care and satisfaction, improved management tools, effective, economic, timely and manageable data processing and improved exchange of information between care givers, patients and statutory authorities. "We wanted to establish a platform and protocol for transmitting and sharing information," Dr Narayan explains.
In this context, a review was conducted with active participation of the hospital management. The scope of the review included patient care services, materials management (purchase and stores, dispensary) and financial management. "The review yielded valuable insights into inherent lacunae which kept us short of contemporary manage-ment practices. The hospital management decided to incorporate a number of recommendations into this system re-engineering process with a tight coupling to a computerised system, resulting in EMR and EFR," reveals Dr A Mahajan, Assistant Medical Superintendent. The Hospital moved into client server architecture.
Step by Step
Since 1997, the hospital has developed a variety of modules specific to an area of operations. The hospital separately implemented modules like Patient Administration System, Diagnostic Information System, PACS, Operation Theatre Module, Clinical Information System (CIS), Radiation Oncology Information System (RIOS), Medical Oncology Information System (MOIS), ICU and Inpatient Module as a part of EMR. As a part of EFR, the hospital is in the process of implementing modules like Financial Management System, Payroll system, HRD and Personal System, Stores Module, Purchase Module, Dispensary Module and Facilities Management Systems. "The integration of the EMR and EFR will enforce all the business rules of the institution and facilitate meaningful management information for timely and purposeful decision making," claims Dr Narayan.
IT@Tata
Patient Admission System: Implemented in 1999, it is said to be the pivotal system in EMR. The implementation of this system has catered for patient care activities such as registrations, appointments and travel concessions, wait listing, admissions, transfers and discharges. This system has provided key demographic and patient status information to other modules that were installed one after the other in the Hospital. "Management information such as trends in registration, waitlists, bed occupancy, lead-time analysis for treatment and re-admission rates are important outputs of this system," Dr Mahajan reveals.
Diagnostic Information System: Implemented during 2001-02, it has enabled the hospital to put in place diagnostic services like radio-diagnosis consisting of conventional radiography, CT, MR, mammography and ultrasound, bio-imaging unit consisting of PET-CT, pathology including surgical pathology, cytology, haemato-oncology, transfusion medicine including blood banking, diagnostic endoscopy and cardiology including ECG. With this implementation, in addition to placing the diagnostic reports on the clinician's desktop as soon as the investigations are reported, the turnaround time has been considerably reduced. "The problem of misplaced reports has almost been eliminated. MIS reports, both operational and executive, are a positive fallout of the system," says Dr Mahajan. On the other hand, the interfacing of analytical equipment like biomedical analysers and cell counters with the diagnostic information system has reduced the lead-time of reporting and has eliminated transcription errors.
Picture Archival & Communication System (PACS): Implementation of PACS was quite a challenge and that is why the hospital approached it in a phased manner. "First we started distributing the images on the hospital network as we had to change the views of clinicians who were used to seeing hard copies, and this was a total culture change for them," Dr Narayan recalls. An initiative was taken where the hospital first started archiving the images on the PACS system. This developed the capacity of archiving. The next step was to distribute the archived images over the web. Without curbing the clinicians' instincts of looking at the hard copy, the hospital made available the web based images. "We told the clinicians that they could not only look at the hard copy but could also go to the web and see the images. This is how the acceptability slowly came in," Dr Narayan explains.
Simultaneously, the hospital initiated soft copy reporting where all the radiologists were provided with workstations capable of post processing the images. Reporting on diagnostic workstations has enabled the hospital to move towards a filmless environment. In the last year, an advanced voice to text system has been installed in the hospital.
Operation Theatre Module: It has been functioning since 2003 with features like scheduling of procedures, pre-anaesthesia evaluation, pre-operative check lists, surgical procedure details, anaesthesia details and post-operative check list. "The OT module was among the first modules to be implemented in the hospital as OT itself is a single event for the patients. In addition, traditionally the surgery team is the most difficult team to convince in any hospital, as it is the busiest team. Therefore we wanted compliance from them first," says Dr Mahajan.
The implementation of this module streamlined the OT area in the hospital with real-time data capture of the information now possible and being available across the hospital. Today, the future refinement in the OT module is coming from the clinicians themselves as they want more information in a structured manner.
USP
Dr Narayan avers the system is integrated and not a collection of stand-alone systems. "One system should complement the other system and not work at cross purposes. If the stand-alone systems are not properly integrated, they will under-perform. Across the world there are very good stand-alone systems, but there is a need for a a totally integrated enterprise system which can address every aspect of hospital functionl," he opines.
The hospital has avoided this. The back-end server in the hospital is a single database. It is also said to be a completely customised system whereby every stakeholder knows his role and what he has to do. On the other hand, in bought systems, users have to learn about the systems and how to use them. "We took a conscious decision in 1998-99 since we didn't have a system which could really suit us; so the only alternative was to do it the hard way. We have customised this software in such a way that we are improving our existing work practices and incorporating them into this software," says Dr Narayan. The hospital has guarded itself from system failures with back-to-back servers and data replicators.
Vendor Selection
The HIS is developed by the Electronics Corporation of India Limited (ECIL), which is a sister organisation under the Department of Atomic Energy. ECIL provided the software programmes and has been continuously upgrading them. "We tell them what we require and how it must be structured. They do the coding and programming and domain logic are sourced from us," Dr Narayan says.
The hospital was opposed to vendors who propose a ready-made product which is a collage of different requirements. "They start off with a generic product and then try to fit in the requirements. We wanted a software vendor who could develop a software and maintain it as per our requirement. With ECIL, we found a worthy partner and our association has been reassuring," says Dr Narayan.
Challenges in the Path
The route to implementation of different modules has not been easy for the hospital. As Dr Mahajan puts it, "It was more difficult when we started in 1999 because people were new to the concept of real-time data entry and departments were very reluctant to share the data with each other."
The other major challenge was to get acceptance among the users. "The department of pathology was most concerned that the reports would get lost. It took a long time for them to be convinced and till recently they were maintaining a duplicate copy in the department." remembers Dr Narayan.
Systems had to be developed that could have acceptability for a broad spectrum of employees of the hospital at all levels. "We had to sell the concept of why we were implementing the different systems and what are the benefits to each of the stakeholders. We had to motivate people to use this system and bring in some sort of acceptability. It was and is a painstaking process," Dr Narayan admits.
Future plans
In the near future, the hospital aims to have web-enabled systems in place. This will include services like patient registration, appointments, admission wait list follow-up, cyber consultation, e-health initiative, investigations/ product requisitioning, access to EMR and tendering for materials managment. The application for web enabling has been completed and will be implemented in the near future. "Cancer is a disease which needs follow-up for the rest of the patient's life. Moreover, patients have a close association with us with more than 80 per cent of them coming from outside Mumbai. Web enabling will enable them to access their records online, download and archive them, which is not only more convenient but will also save them time and money. Similarly, doctors can access the patients' records from any location," Dr Mahajan points out.
The hospital is also mulling over the concept of e-health which combines aspects of medical informatics, public health and business with reference to health services and information delivered usually through the internet.
Information is Power—this motto holds true for Mumbai-based 560-bed Tata Memorial Hospital (TMH), a reputed name in oncology. It is truly one of the first 'digital' hospitals in India as its IT story goes back to 1985 when India was not even aware of the 'alien' world of computers. Impressively, when digitisation was itself new to the healthcare industry, TMH embarked on a pioneering path to use IT for its information management with the ND550 Supermini computer and 40 dumb terminals across the hospital-wide network and thus conceptualised its own indigenous HIS. In 1997, this small indigenous project soared with an initiative to undertake a systematic review of the existing operational systems for patient care management and hospital administration in the hospital. In the process, the hospital went on to have well-integrated Electronic Medical Record (EMR) and Electronic Financial Record (EFR) systems in place. Today, the hospital is in the process of taking this initiative one step further by web enabling the entire system and fostering the concept of e-health.
Driving need
As one of the leading cancer research institutes in India, TMH has a need to retrieve patient information in a very structured manner. "The reason we created our HIS in 1985 was to computerise normal transactions in the system and retrieve them at a later stage. We were abstracting information like registration, demographic and clinical details from the patient files and putting it on the system. However, this information collection was not on a real-time basis and this HIS outlived its utility by 1996," relates Dr Narayan HKV, Medical Superintendent. The hospital felt the need for a more robust and responding integrated enterprise system that could link with all the systems in the hospital. The requirement for digitisation in the hospital was in terms of structured workflow, enhanced patient care and satisfaction, improved management tools, effective, economic, timely and manageable data processing and improved exchange of information between care givers, patients and statutory authorities. "We wanted to establish a platform and protocol for transmitting and sharing information," Dr Narayan explains.
In this context, a review was conducted with active participation of the hospital management. The scope of the review included patient care services, materials management (purchase and stores, dispensary) and financial management. "The review yielded valuable insights into inherent lacunae which kept us short of contemporary manage-ment practices. The hospital management decided to incorporate a number of recommendations into this system re-engineering process with a tight coupling to a computerised system, resulting in EMR and EFR," reveals Dr A Mahajan, Assistant Medical Superintendent. The Hospital moved into client server architecture.
Step by Step
Since 1997, the hospital has developed a variety of modules specific to an area of operations. The hospital separately implemented modules like Patient Administration System, Diagnostic Information System, PACS, Operation Theatre Module, Clinical Information System (CIS), Radiation Oncology Information System (RIOS), Medical Oncology Information System (MOIS), ICU and Inpatient Module as a part of EMR. As a part of EFR, the hospital is in the process of implementing modules like Financial Management System, Payroll system, HRD and Personal System, Stores Module, Purchase Module, Dispensary Module and Facilities Management Systems. "The integration of the EMR and EFR will enforce all the business rules of the institution and facilitate meaningful management information for timely and purposeful decision making," claims Dr Narayan.
IT@Tata
Patient Admission System: Implemented in 1999, it is said to be the pivotal system in EMR. The implementation of this system has catered for patient care activities such as registrations, appointments and travel concessions, wait listing, admissions, transfers and discharges. This system has provided key demographic and patient status information to other modules that were installed one after the other in the Hospital. "Management information such as trends in registration, waitlists, bed occupancy, lead-time analysis for treatment and re-admission rates are important outputs of this system," Dr Mahajan reveals.
Diagnostic Information System: Implemented during 2001-02, it has enabled the hospital to put in place diagnostic services like radio-diagnosis consisting of conventional radiography, CT, MR, mammography and ultrasound, bio-imaging unit consisting of PET-CT, pathology including surgical pathology, cytology, haemato-oncology, transfusion medicine including blood banking, diagnostic endoscopy and cardiology including ECG. With this implementation, in addition to placing the diagnostic reports on the clinician's desktop as soon as the investigations are reported, the turnaround time has been considerably reduced. "The problem of misplaced reports has almost been eliminated. MIS reports, both operational and executive, are a positive fallout of the system," says Dr Mahajan. On the other hand, the interfacing of analytical equipment like biomedical analysers and cell counters with the diagnostic information system has reduced the lead-time of reporting and has eliminated transcription errors.
Picture Archival & Communication System (PACS): Implementation of PACS was quite a challenge and that is why the hospital approached it in a phased manner. "First we started distributing the images on the hospital network as we had to change the views of clinicians who were used to seeing hard copies, and this was a total culture change for them," Dr Narayan recalls. An initiative was taken where the hospital first started archiving the images on the PACS system. This developed the capacity of archiving. The next step was to distribute the archived images over the web. Without curbing the clinicians' instincts of looking at the hard copy, the hospital made available the web based images. "We told the clinicians that they could not only look at the hard copy but could also go to the web and see the images. This is how the acceptability slowly came in," Dr Narayan explains.
Simultaneously, the hospital initiated soft copy reporting where all the radiologists were provided with workstations capable of post processing the images. Reporting on diagnostic workstations has enabled the hospital to move towards a filmless environment. In the last year, an advanced voice to text system has been installed in the hospital.
Operation Theatre Module: It has been functioning since 2003 with features like scheduling of procedures, pre-anaesthesia evaluation, pre-operative check lists, surgical procedure details, anaesthesia details and post-operative check list. "The OT module was among the first modules to be implemented in the hospital as OT itself is a single event for the patients. In addition, traditionally the surgery team is the most difficult team to convince in any hospital, as it is the busiest team. Therefore we wanted compliance from them first," says Dr Mahajan.
The implementation of this module streamlined the OT area in the hospital with real-time data capture of the information now possible and being available across the hospital. Today, the future refinement in the OT module is coming from the clinicians themselves as they want more information in a structured manner.
USP
Dr Narayan avers the system is integrated and not a collection of stand-alone systems. "One system should complement the other system and not work at cross purposes. If the stand-alone systems are not properly integrated, they will under-perform. Across the world there are very good stand-alone systems, but there is a need for a a totally integrated enterprise system which can address every aspect of hospital functionl," he opines.
The hospital has avoided this. The back-end server in the hospital is a single database. It is also said to be a completely customised system whereby every stakeholder knows his role and what he has to do. On the other hand, in bought systems, users have to learn about the systems and how to use them. "We took a conscious decision in 1998-99 since we didn't have a system which could really suit us; so the only alternative was to do it the hard way. We have customised this software in such a way that we are improving our existing work practices and incorporating them into this software," says Dr Narayan. The hospital has guarded itself from system failures with back-to-back servers and data replicators.
Vendor Selection
The HIS is developed by the Electronics Corporation of India Limited (ECIL), which is a sister organisation under the Department of Atomic Energy. ECIL provided the software programmes and has been continuously upgrading them. "We tell them what we require and how it must be structured. They do the coding and programming and domain logic are sourced from us," Dr Narayan says.
The hospital was opposed to vendors who propose a ready-made product which is a collage of different requirements. "They start off with a generic product and then try to fit in the requirements. We wanted a software vendor who could develop a software and maintain it as per our requirement. With ECIL, we found a worthy partner and our association has been reassuring," says Dr Narayan.
Challenges in the Path
The route to implementation of different modules has not been easy for the hospital. As Dr Mahajan puts it, "It was more difficult when we started in 1999 because people were new to the concept of real-time data entry and departments were very reluctant to share the data with each other."
The other major challenge was to get acceptance among the users. "The department of pathology was most concerned that the reports would get lost. It took a long time for them to be convinced and till recently they were maintaining a duplicate copy in the department." remembers Dr Narayan.
Systems had to be developed that could have acceptability for a broad spectrum of employees of the hospital at all levels. "We had to sell the concept of why we were implementing the different systems and what are the benefits to each of the stakeholders. We had to motivate people to use this system and bring in some sort of acceptability. It was and is a painstaking process," Dr Narayan admits.
Future plans
In the near future, the hospital aims to have web-enabled systems in place. This will include services like patient registration, appointments, admission wait list follow-up, cyber consultation, e-health initiative, investigations/ product requisitioning, access to EMR and tendering for materials managment. The application for web enabling has been completed and will be implemented in the near future. "Cancer is a disease which needs follow-up for the rest of the patient's life. Moreover, patients have a close association with us with more than 80 per cent of them coming from outside Mumbai. Web enabling will enable them to access their records online, download and archive them, which is not only more convenient but will also save them time and money. Similarly, doctors can access the patients' records from any location," Dr Mahajan points out.
The hospital is also mulling over the concept of e-health which combines aspects of medical informatics, public health and business with reference to health services and information delivered usually through the internet.
Feeling the Meltdown Heat?
By M H Ahssan
The Indian healthcare industry, perceived to be insulated from the vagaries of the economy, is also facing the heat of recent global economic events. However, it isn't all bad news, as HNN discover the insight of the industry.
When 1,900 hundred employees of the Indian aviation industry across various cities were suddenly sacked, ground reality hit hard. Pink slips, job cuts, reducing salaries, cost-cutting, ever escalating inflation rates — the times are indeed tough for the average man faced with global economic meltdown. Cut to healthcare and the so-called 'recession- proof' or 'insulated' healthcare industry is also feeling the ripples.
Insulated from the Economy
Most analysts believe that the healthcare industry is relatively insulated from the current economic crisis. The industry should be able to weather the current economic storm because healthcare is a necessity and is therefore not likely to be sacrificed, unlike luxuries like certain consumer goods or services. Ill health always prompts people to seek medical care, irrespective of the state of the economy. As Suyash Borar, COO, BM Birla Heart and Research Centre, Kolkata, points out, "When someone needs cardiac care, they would not worry about recession or market conditions.
In fact, due to rise in stress levels, the need for immediate healthcare would escalate further." However, many experts are still in the wait and watch mode. "Healthcare is a recession-proof industry and hence the impact is limited in this segment. Having said that, one cannot overlook the fact that the nature of this slowdown is due to a financial crisis which can impact all sectors, including healthcare, at the corporate level," avers Dimple Sanghi, Executive Director, IndiVision India Partners— a private equity fund of Future Capital Holdings, which invested in Hyderabad-based Global Hospitals through convertibles.
Vishal Bali, CEO and MD, Wockhardt Hospitals Group, says, "We will have to wait for the future to see how and where the financial funding and banking process takes us."
However, the ‘insulated’ healthcare industry is also facing the heat. The impact is mainly noticed in a funds crunch in new projects or expansion plans. Reportedly, many hospital groups have either postponed or put their expansion plans on hold. "Except for ones which are 75 per cent complete, projects have definitely slowed down," observes an expert.
"The new hospital projects coming up will definitely be affected because of the liquidity crunch in the market, as debt funding has become more expensive," opines Anupam Verma, CEO, DM Healthcare, a healthcare-specific PE firm. The anticipated liquidity crunch is making banks cautious about lending to newer ventures. Thus, the impact of this on the hospital segment is a likely slowing down of the expansion projects that were being vigorously pursued in the last few years. Analysts say groups who are dependent on debt funding are already feeling the heat. Dr Vivek Desai, MD of HOSMAC India, a leading hospital consultancy firm concurs, "Those who were planning higher debt equity ratios to fund the project will perhaps delay the commencement date till interest rates soften."
Says Murali Nair, Partner, E&Y, "In the next six months, there will be a slowdown in new projects as the overall sentiments are irrationally pessimistic. However, considering that the GDP is expected to grow at 7 per cent, which is a good growth, and the fact that we have predominantly a sick care system, this is only a temporary aberration arising out of irrational paranoia and will correct itself in the next 12-18 months."
Reportedly, a corporate group focussing on cardiology has delayed its Kolkata projects and the recruited employees have been shifted to Delhi. The Manipal Group, too, has slowed down expansion of projects due to the liquidity crunch. Dr Ranjan Pai, CEO, Manipal Education and Medical Group, claims, "There has been no real impact other than fund availability for expansion. Hence expansion capital will be constrained."
Dr Lal Pathlabs, a leading diagnostic chain, has preferred to decelerate a little and deferred some of its new satellite clinic projects. Dr OP Manchanda, CEO, Dr Lal Pathlabs, reveals, "We have cut down on our tele-radiology or satellite projects. However, as far as our expansion plans go, we haven't really halted any project." It is a similar story at Care Group of Hospitals, which has planned a major pan-India expansion spree. "We are a little cautious. The valuation for acquiring a new business is decreasing, as the economy is slowing down," says Kasi Raju, COO, Care Group of Hospitals.
No Prescription
As the economic meltdown is claiming more jobs, those with no health insurance are increasingly likely to stop filling their regular prescriptions, reduce their visits to the physicians or even stop seeking tests as preventive measures. Jumana Barnagarwala, Head, Healthcare Consulting, Datamonitor, illustrates, "This was evidenced when Pfizer blamed a 13 per cent decline in the sales of its best-selling drug Lipitor in the US on financially-affected patients not filling their prescriptions."
Will Charity Stop?
The most profound effect of the economic slowdown in healthcare has been the drying up of charity funding for some hospitals. Dr Aravind Srinivasan, Administrator, Aravind Eye Care Systems, Madurai, admits, "Our CSR activities have also been affected. While earlier there was a lot of free disposable investment available in terms of charity, the emotional investment is drying out, for survival itself is now doubtful."
However, Col Manesh Masand, CEO, Jaslok Hospital, a trust hospital in Mumbai, differs, "Why should charity decline? It will not and there is no need to worry about sustaining the current model." Dr George Chandy, Director, CMC, Vellore also insists that there has been no impact whatsoever of the global economic meltdown on charity work.
Tighten your Belts
Though the Indian healthcare industry has not seen job cuts so far, HR procurement has slowed down and in some cases organisations have put a freeze on recruitment except for positions which are absolutely critical or in line with strategy. Apollo Hospitals Group is a case in point. It has already taken certain steps to soften the blow of global meltdown by restructuring its internal cost framework and bringing in operational efficiency. The Group has restricted its recruitment.
Says Dr K Prabakar, VP, HR, Apollo Hospitals Group, "Unit heads have to justify requirements for replacements and all new recruitments will have to go through clear sanctions for the next six months." The Group is banking upon multi tasking of human resource at the second level like managers and supervisors. It has cut down on travel expenditure unless very essential. "We are doing most of our management review meetings through video conferencing rather than travelling," shares Dr Prabakar.
Beckman Coulter, leading manufacturer of clinical diagnostics equipment, has gone for a recruitment freeze, at least for the next year. The company has also cut down on overseas travel, and internal travel is very controlled. Dr SP Chandrashekar, Managing Director, Beckman Coulter India, elaborates, "As a multinational, for some of our internal marketing activities we had proposed to get foreign brand ambassadors to speak. This did not happen as we have cut down on foreign travel in India-specific activities."
Becton Dickinson & Co has also tightened its cost-intensive measures. Says Ram Sharma, Managing Director, Becton Dickinson & Co, "Typically, we are being 'smart' in how we spend. In the current situation when the investment in less, we maintain our capex and look at areas of waste-reduction. It is not really cost-cautiousness. It has just made us focused. During boom-time, if we want to do 10 things we may end up doing all 10, but now, maybe we will do only three. We focus on functioning efficiently. When it comes to travel, we ensure that we book our flights early so that we are able to get the best rates." At its plants, BD is regularly mapping its productivity and thus discovering areas of waste-reduction to enhance its productivity. It is also trying to delay unnecessary expenses without affecting customer services.
While some say it's a correction phase, others feel that it's a consolidation phase. Nevertheless, the fact is that healthcare companies have started 'trimming the fat.' Cost-cutting is a regular and consistent occurrence, except now they are sensitive to the market conditions. Dr Pai avers, "There have been no salary cuts and no job cuts in Manipal. However, we have asked our people to travel less and only if absolutely necessary."
IT has a Problem
Another segment which is in for some tough times, according to reports, is Healthcare IT (HIT) since these companies are dependent on VC funding which is drying up. This is likely to lead to greater consolidation among the smaller players. Those HIT companies that are targeting physician practice are likely to be wiped out because physicians will not consider buying IT solutions when there are no patients to manage.
Seema Gupta, Managing Director, ARYA Hospital Management Solutions, muses, "For every new equipment or IT implementation, hospitals are asking for RoI. We have to prove our RoI for even the smallest thing." Larger HIT companies with existing big clients will have to be satisfied with service and maintenance earnings on products already sold.
Barnagarwala believes that internet-based and consumer-facing HIT companies that provide healthcare solutions may do well because they are essentially dependent on advertising revenues for their sustenance (for example a medical portal like WebMD's advertising revenue for Q3-2008 was reported to have risen substantially compared to last year). "In the US, software outsourcing services will come down temporarily similar to any other outsourcing services —but will definitely improve in the long term given the cost benefits," assures Chandrasekar Kandasamy, Managing Director, ePlanet Ventures, a global VC firm that has announced an investment of $5.5 million in Trivitron.
Not Life or Death
Experts say there will be a negative impact on consumer spending but only related to discretionary part of healthcare services like cosmetic and allied surgeries rather than the necessary part which includes cardiac or neurological disease treatment. Opines Daljit Singh, President, Operations and Strategy, Fortis Healthcare, "The only area of care delivery which may slow down somewhat is the arena of 'elective non-life threatening surgeries' which could be deferred to better times."
Dollar Tours
Experts view the global meltdown as a considerable threat to the booming medical tourism industry in India. Verma, who is also the Vice President of the Medical Tourism Council of Maharashtra, feels that as a consequence of recession many people in the West will no longer be able to afford insurance, and thus medical tourism will also take a beating as people will try and prioritise their healthcare needs and wait for economic conditions to get better. However, Dr Hari Prasad, CEO, Apollo Hospitals, Hyderabad feels that medical tourism will not have any negative impact on Indian healthcare. "We believe that there will be no impact in the Indian environment and on the global platform, the impact will be positive. With the dollar strengthening against the rupee we see more patients coming into the country for advanced healthcare," he predicts.
Overseas Effects
The New York Times in its report 'Hospitals see drop in Paying Patients' points out that healthcare is no longer recession-proof, and any medical care that can be delayed will be delayed. The article goes on to say, "some patients without insurance seem to be deferring treatments like knee replacement, hernia repair and weight-loss surgeries— the kind of procedures that are among the most lucrative to hospitals. Just as consumers are hesitant to make any sort of big financial decision right now, some patients may feel too financially insecure to take time off work or spend what could be thousands of dollars in out-of-pocket expenses for elective treatments."
In fact, Florida-based non-profit organisation, Shands HealthCare, cited poor economy and lower patient demand while announcing that it would shut down one of its eight hospitals and move patients and staff to its nearby facilities. According to news reports, the 367-bed Gainesville hospital that is closing lost $12 million last year.
In the US, in 62 per cent of hospitals admissions are almost flat to down by two to three per cent. The patients lost are the lucrative paying customers. At the same time, with many job losses the number of uninsured is rising, resulting in huge losses.
The Good News
Realistic real estate: The current slump in real estate prices due to the battered market is good news for healthcare. Srinivasan of Arvind Eye posits, "As real estate prices have corrected, now we can probably think about newer projects. We can negotiate better. Now land is available at a more reasonable rate." Raju of Care Group echoes, "Real estate prices had shot up abnormally and now they have reached a reasonable value."
No Greener Pastures: On the positive side, the economic slowdown has resulted in reduced attrition. This is because the paying capacity of other verticals has reduced, and, healthcare has emerged as a 'safer' option. Says Ankush Gupta, Manager, HR, PD Hinduja Hospital, Mumbai, "Uncertainty leads to dilemmas, leading in turn to difficulty and delay in decision making for job seekers. Job hoppers who generally show great confidence in changing jobs are also very cautious, and they are also looking for information like years of existence in the business, reserves and surpluses, and the long-term and short-term strategies of the organisation."
Singh too feels that a positive effect will be reduction in attrition. "The impact will be better for the 'non medical' cadre as compared to the medical cadre," he says. However, Dr Prabakar of Apollo begs to differ. "We track the attrition rate on a month-to-month basis and have identified no drastic change in the attrition of nursing staff and junior doctors who still prefer exploring markets like the Middle East."
Still bullish: Despite the poor sentiment, PE firms seem keener on healthcare now than ever before. What makes PE funds bullish about this sector is that healthcare is not dependent upon the market sensex. Dr Alok Aggarwal, Chairman, Evalueserve Inc, explains, "PE funds are bullish on healthcare or biotech sector, because per se it is definitely less risky and with the rising incidence of chronic diseases, it will indeed mean that healthcare would be in demand." "PEs are looking at healthcare investments in a serious way as the industry has good potential to grow and gives steady returns," Dr Desai of HOSMAC shares.
Better Bargain: Across the spectrum, bargains will be harder. "If you charge it at a higher rate you need to prove its valuation. If you don't, people won't pay you a premium. In fact, this is a great time to increase focus on the customer. We would also look for acquiring new businesses where somebody has vacated that area so that we can keep those customers forever," Sharma of Bector Dickinson reveals.
Giffen Good Situation for Health Insurance?
One of the sectors which is perceived to feel the maximum brunt is insurance. As Barnagarwala explains, "Health insurance companies are affected adversely by this crisis because of their inability to raise prices in a declining market even as the costs of drugs and healthcare services continue to rise, further compounded by the reduction in the usage of healthcare services by those insured or those losing health insurance benefits due to increasing lay-offs."
Many corporates, predominantly top-notch IT companies and BPOs, are reducing the health insurance coverage for their employees, following a sharp increase in premium rates. Some corporates have also removed parents of employees from their group insurance scheme, restricting the benefit only to the staff. IT companies, which have conventionally offered substantial health covers for their staff as a human resource incentive, are now choosing to cut costs by initiating a co-payment structure (where an employee has to partly bear the cost) or by doing away with the cover altogether. Says an expert, "People will not take insurance, or will pay smaller premiums. Less pay in insurance would obviously mean a setback to an industry which is growing by almost 40 per cent per year."
However, some experts argue that this industry would not be affected as much because insurance penetration in this country is low. Another reason for the impact not to be felt is that most contracts are annual and hence if the recession continues until the next fiscal year, then contracts would probably be terminated. B Madhavan, CEO, MediAssist, a TPA, believes, "While other insurance is directly dependent on the economic conditions, that is not the case with healthcare. While it is indirect, the effect would mean cutting down of corporate spending on healthcare. The tendency to spend on healthcare would probably be less. Also, instead of 100 per cent reimbursement as earlier, corporates may reduce it to 80-90 per cent with 10-20 per cent payment by the employee."
"The impact of recession is yet to be felt in healthcare insurance. It is expected to be felt if the recession continues for a longer period, around a year. While IT companies have already started cutting employee welfare benefits, insurance healthcare is one of the least affected ones as it is primarily need-based," Madhavan reasons.
Deepak Mendiratta, MD, Health and Insurance Integrated, has a different view about how the healthcare insurance sector will score in the midst of global meltdown. He believes that the concept of Giffen goods will make the healthcare insurance more attractive now. This is a concept in economics in which people consume more as price rises, violating the law of demand. "In the Giffen good situation, cheaper close substitutes are not available. Because of the lack of substitutes, the income effect dominates, leading people to buy more of the good, even as its price rises. Similarly, in the matured economy the price of health insurance will also rise because the price of the healthcare is rising. The rise in healthcare prices means that insurance companies have to shell out more money. As a result, the pool available to them is less profitable. In addition, as the healthcare cost rises, the individual realises that it is riskier not to be covered by health insurance any longer," Mendiratta explains.
The Impact on Medical Equipment
The lack of liquidity may affect the market for medical devices (particularly those that are very expensive) because hospitals may not wish to commit large funds which could be better utilised in creating patient-pull. However, the effect hasn't percolated yet as most medical equipment companies deny feeling any recession blues.
K Mohanlal, Managing Director, Esaote India, a leading manufacturer of ultrasound imaging, insists, "We have not seen the impact yet. But if this recession period continues then there will be some impact in this industry." However, the company does admit to strategically changing its growth plans wherein it will now focus on cost-sensitive products instead of high-end products. "As we have been growing by almost 30 per cent per year, probably there will be a drop of 10 per cent. However, this is not merely because of recession, but because of Indian consumer needs. Nevertheless, subconsciously it has made us more focused about targeting lower premium products," he adds.
Maquet also denies any dramatic change, but does admit delays in sales of its new projects. Says Ashim Purohit, CEO, Maquet, "Though there is no immediate setback on our sales at the moment, we definitely foresee delays in some projects. However, it is likely to be a passing phase. Knowing the grit and determination of the Indian industry, it's not hard to visualise an even stronger rebound. But for sure, it's going to be a different marketplace from now on." For being seemingly unaffected by the current tide, Michael Rieder, Getinge Medical Systems, Vice President, Sales and Marketing, reasons, "Maquet is interacting with acute care hospitals on a global scale with more than 30 subsidiaries and over 200 distributors. We do see a high potential for growth for medical device companies, especially in emerging markets, such as India. In addition, we have established ourselves in new market segments. By honouring our origins in surgical infrastructure, we develop Maquet systematically into a therapeutic medical company."
According to Dr SP Chandrashekar, Managing Director, Beckman Coulter India, there has been a negative impact as some hospitals are postponing their decisions to buy capital equipment. Experts feel that healthcare companies that are not likely to be affected greatly are those that deal in inexpensive devices and supplies that are used in hospitals. "For example, high profit gains for the last quarter were reported by Becton Dickinson & Co and Baxter International Inc, and they even increased their full-year earnings estimates. That is because Baxter sells drugs for treatment of blood and immune disorders, while Becton Dickinson specialises in syringes and surgical tools which are considered essentials in a hospital," says Barnagarwala.
The medical technology market was billed to be worth about $2.7 billion in 2006 and is likely to cross $10 billion by 2012 with a growth rate of over 20 per cent. It is estimated that over 85 per cent of medical devices and equipment are imported and the market is primarily dominated by MNCs. Most MNCs currently source their products from China through OEM arrangements, joint ventures or own manufacturing facilities. With the Indian software and hardware strengths, and the overall increase in prices in China, India could become a potential alternate sourcing centre for such MNCs.
"We continue to be bullish on the healthcare industry - especially the medical technology space. With the costs of imports going up, we believe that a number of domestic companies would evolve, as Indian consumers would look for low-cost devices / equipment. We also believe that there could be consolidation of smaller players through acquisition by larger players who have a strong sales, distribution and support network. Foreign companies would also look to acquire smaller niche companies for product diversification and lower pricing advantages," believes Kandasamy of ePlanet Ventures.
Given the rise in the value of the dollar, the cost of purchases is expected to increase, which may increase the capital expenditure or the margins of companies engaged in healthcare. "The opportunities for the Indian healthcare manufacturing industry will increase, as more companies like Trivitron would get into local manufacturing of devices or equipment," Kandasamy argues.
Rays of Light
According to Kandasamy, "With reference to the domestic market, healthcare expenditure will continue to grow— though the estimates of US$67.5 billion by 2012 may decrease nominally. CROs and CMOs will continue to grow in the long term, though they may have a temporary setback, due to general recession in the economy." He adds, "While the growth will definitely be there, there will be a decline in growth percentages due to general recession. However, as in the Indian telecom industry, where a number of domestic players evolved due to cost advantages, we believe this could happen in the healthcare space."
Nair believes that this is an excellent opportunity for Indian healthcare industry players to come together and exploit the opportunity of drawing overseas patients-where there is true recession-through targeted marketing initiatives. Like the NASSCOM for IT, healthcare needs to adopt a collaborative approach to win the overseas market, he says.
So while the dark clouds of meltdown might be obscuring the sunrise industry right now, rays of light are peeping through around the edges.
The Indian healthcare industry, perceived to be insulated from the vagaries of the economy, is also facing the heat of recent global economic events. However, it isn't all bad news, as HNN discover the insight of the industry.
When 1,900 hundred employees of the Indian aviation industry across various cities were suddenly sacked, ground reality hit hard. Pink slips, job cuts, reducing salaries, cost-cutting, ever escalating inflation rates — the times are indeed tough for the average man faced with global economic meltdown. Cut to healthcare and the so-called 'recession- proof' or 'insulated' healthcare industry is also feeling the ripples.
Insulated from the Economy
Most analysts believe that the healthcare industry is relatively insulated from the current economic crisis. The industry should be able to weather the current economic storm because healthcare is a necessity and is therefore not likely to be sacrificed, unlike luxuries like certain consumer goods or services. Ill health always prompts people to seek medical care, irrespective of the state of the economy. As Suyash Borar, COO, BM Birla Heart and Research Centre, Kolkata, points out, "When someone needs cardiac care, they would not worry about recession or market conditions.
In fact, due to rise in stress levels, the need for immediate healthcare would escalate further." However, many experts are still in the wait and watch mode. "Healthcare is a recession-proof industry and hence the impact is limited in this segment. Having said that, one cannot overlook the fact that the nature of this slowdown is due to a financial crisis which can impact all sectors, including healthcare, at the corporate level," avers Dimple Sanghi, Executive Director, IndiVision India Partners— a private equity fund of Future Capital Holdings, which invested in Hyderabad-based Global Hospitals through convertibles.
Vishal Bali, CEO and MD, Wockhardt Hospitals Group, says, "We will have to wait for the future to see how and where the financial funding and banking process takes us."
However, the ‘insulated’ healthcare industry is also facing the heat. The impact is mainly noticed in a funds crunch in new projects or expansion plans. Reportedly, many hospital groups have either postponed or put their expansion plans on hold. "Except for ones which are 75 per cent complete, projects have definitely slowed down," observes an expert.
"The new hospital projects coming up will definitely be affected because of the liquidity crunch in the market, as debt funding has become more expensive," opines Anupam Verma, CEO, DM Healthcare, a healthcare-specific PE firm. The anticipated liquidity crunch is making banks cautious about lending to newer ventures. Thus, the impact of this on the hospital segment is a likely slowing down of the expansion projects that were being vigorously pursued in the last few years. Analysts say groups who are dependent on debt funding are already feeling the heat. Dr Vivek Desai, MD of HOSMAC India, a leading hospital consultancy firm concurs, "Those who were planning higher debt equity ratios to fund the project will perhaps delay the commencement date till interest rates soften."
Says Murali Nair, Partner, E&Y, "In the next six months, there will be a slowdown in new projects as the overall sentiments are irrationally pessimistic. However, considering that the GDP is expected to grow at 7 per cent, which is a good growth, and the fact that we have predominantly a sick care system, this is only a temporary aberration arising out of irrational paranoia and will correct itself in the next 12-18 months."
Reportedly, a corporate group focussing on cardiology has delayed its Kolkata projects and the recruited employees have been shifted to Delhi. The Manipal Group, too, has slowed down expansion of projects due to the liquidity crunch. Dr Ranjan Pai, CEO, Manipal Education and Medical Group, claims, "There has been no real impact other than fund availability for expansion. Hence expansion capital will be constrained."
Dr Lal Pathlabs, a leading diagnostic chain, has preferred to decelerate a little and deferred some of its new satellite clinic projects. Dr OP Manchanda, CEO, Dr Lal Pathlabs, reveals, "We have cut down on our tele-radiology or satellite projects. However, as far as our expansion plans go, we haven't really halted any project." It is a similar story at Care Group of Hospitals, which has planned a major pan-India expansion spree. "We are a little cautious. The valuation for acquiring a new business is decreasing, as the economy is slowing down," says Kasi Raju, COO, Care Group of Hospitals.
No Prescription
As the economic meltdown is claiming more jobs, those with no health insurance are increasingly likely to stop filling their regular prescriptions, reduce their visits to the physicians or even stop seeking tests as preventive measures. Jumana Barnagarwala, Head, Healthcare Consulting, Datamonitor, illustrates, "This was evidenced when Pfizer blamed a 13 per cent decline in the sales of its best-selling drug Lipitor in the US on financially-affected patients not filling their prescriptions."
Will Charity Stop?
The most profound effect of the economic slowdown in healthcare has been the drying up of charity funding for some hospitals. Dr Aravind Srinivasan, Administrator, Aravind Eye Care Systems, Madurai, admits, "Our CSR activities have also been affected. While earlier there was a lot of free disposable investment available in terms of charity, the emotional investment is drying out, for survival itself is now doubtful."
However, Col Manesh Masand, CEO, Jaslok Hospital, a trust hospital in Mumbai, differs, "Why should charity decline? It will not and there is no need to worry about sustaining the current model." Dr George Chandy, Director, CMC, Vellore also insists that there has been no impact whatsoever of the global economic meltdown on charity work.
Tighten your Belts
Though the Indian healthcare industry has not seen job cuts so far, HR procurement has slowed down and in some cases organisations have put a freeze on recruitment except for positions which are absolutely critical or in line with strategy. Apollo Hospitals Group is a case in point. It has already taken certain steps to soften the blow of global meltdown by restructuring its internal cost framework and bringing in operational efficiency. The Group has restricted its recruitment.
Says Dr K Prabakar, VP, HR, Apollo Hospitals Group, "Unit heads have to justify requirements for replacements and all new recruitments will have to go through clear sanctions for the next six months." The Group is banking upon multi tasking of human resource at the second level like managers and supervisors. It has cut down on travel expenditure unless very essential. "We are doing most of our management review meetings through video conferencing rather than travelling," shares Dr Prabakar.
Beckman Coulter, leading manufacturer of clinical diagnostics equipment, has gone for a recruitment freeze, at least for the next year. The company has also cut down on overseas travel, and internal travel is very controlled. Dr SP Chandrashekar, Managing Director, Beckman Coulter India, elaborates, "As a multinational, for some of our internal marketing activities we had proposed to get foreign brand ambassadors to speak. This did not happen as we have cut down on foreign travel in India-specific activities."
Becton Dickinson & Co has also tightened its cost-intensive measures. Says Ram Sharma, Managing Director, Becton Dickinson & Co, "Typically, we are being 'smart' in how we spend. In the current situation when the investment in less, we maintain our capex and look at areas of waste-reduction. It is not really cost-cautiousness. It has just made us focused. During boom-time, if we want to do 10 things we may end up doing all 10, but now, maybe we will do only three. We focus on functioning efficiently. When it comes to travel, we ensure that we book our flights early so that we are able to get the best rates." At its plants, BD is regularly mapping its productivity and thus discovering areas of waste-reduction to enhance its productivity. It is also trying to delay unnecessary expenses without affecting customer services.
While some say it's a correction phase, others feel that it's a consolidation phase. Nevertheless, the fact is that healthcare companies have started 'trimming the fat.' Cost-cutting is a regular and consistent occurrence, except now they are sensitive to the market conditions. Dr Pai avers, "There have been no salary cuts and no job cuts in Manipal. However, we have asked our people to travel less and only if absolutely necessary."
IT has a Problem
Another segment which is in for some tough times, according to reports, is Healthcare IT (HIT) since these companies are dependent on VC funding which is drying up. This is likely to lead to greater consolidation among the smaller players. Those HIT companies that are targeting physician practice are likely to be wiped out because physicians will not consider buying IT solutions when there are no patients to manage.
Seema Gupta, Managing Director, ARYA Hospital Management Solutions, muses, "For every new equipment or IT implementation, hospitals are asking for RoI. We have to prove our RoI for even the smallest thing." Larger HIT companies with existing big clients will have to be satisfied with service and maintenance earnings on products already sold.
Barnagarwala believes that internet-based and consumer-facing HIT companies that provide healthcare solutions may do well because they are essentially dependent on advertising revenues for their sustenance (for example a medical portal like WebMD's advertising revenue for Q3-2008 was reported to have risen substantially compared to last year). "In the US, software outsourcing services will come down temporarily similar to any other outsourcing services —but will definitely improve in the long term given the cost benefits," assures Chandrasekar Kandasamy, Managing Director, ePlanet Ventures, a global VC firm that has announced an investment of $5.5 million in Trivitron.
Not Life or Death
Experts say there will be a negative impact on consumer spending but only related to discretionary part of healthcare services like cosmetic and allied surgeries rather than the necessary part which includes cardiac or neurological disease treatment. Opines Daljit Singh, President, Operations and Strategy, Fortis Healthcare, "The only area of care delivery which may slow down somewhat is the arena of 'elective non-life threatening surgeries' which could be deferred to better times."
Dollar Tours
Experts view the global meltdown as a considerable threat to the booming medical tourism industry in India. Verma, who is also the Vice President of the Medical Tourism Council of Maharashtra, feels that as a consequence of recession many people in the West will no longer be able to afford insurance, and thus medical tourism will also take a beating as people will try and prioritise their healthcare needs and wait for economic conditions to get better. However, Dr Hari Prasad, CEO, Apollo Hospitals, Hyderabad feels that medical tourism will not have any negative impact on Indian healthcare. "We believe that there will be no impact in the Indian environment and on the global platform, the impact will be positive. With the dollar strengthening against the rupee we see more patients coming into the country for advanced healthcare," he predicts.
Overseas Effects
The New York Times in its report 'Hospitals see drop in Paying Patients' points out that healthcare is no longer recession-proof, and any medical care that can be delayed will be delayed. The article goes on to say, "some patients without insurance seem to be deferring treatments like knee replacement, hernia repair and weight-loss surgeries— the kind of procedures that are among the most lucrative to hospitals. Just as consumers are hesitant to make any sort of big financial decision right now, some patients may feel too financially insecure to take time off work or spend what could be thousands of dollars in out-of-pocket expenses for elective treatments."
In fact, Florida-based non-profit organisation, Shands HealthCare, cited poor economy and lower patient demand while announcing that it would shut down one of its eight hospitals and move patients and staff to its nearby facilities. According to news reports, the 367-bed Gainesville hospital that is closing lost $12 million last year.
In the US, in 62 per cent of hospitals admissions are almost flat to down by two to three per cent. The patients lost are the lucrative paying customers. At the same time, with many job losses the number of uninsured is rising, resulting in huge losses.
The Good News
Realistic real estate: The current slump in real estate prices due to the battered market is good news for healthcare. Srinivasan of Arvind Eye posits, "As real estate prices have corrected, now we can probably think about newer projects. We can negotiate better. Now land is available at a more reasonable rate." Raju of Care Group echoes, "Real estate prices had shot up abnormally and now they have reached a reasonable value."
No Greener Pastures: On the positive side, the economic slowdown has resulted in reduced attrition. This is because the paying capacity of other verticals has reduced, and, healthcare has emerged as a 'safer' option. Says Ankush Gupta, Manager, HR, PD Hinduja Hospital, Mumbai, "Uncertainty leads to dilemmas, leading in turn to difficulty and delay in decision making for job seekers. Job hoppers who generally show great confidence in changing jobs are also very cautious, and they are also looking for information like years of existence in the business, reserves and surpluses, and the long-term and short-term strategies of the organisation."
Singh too feels that a positive effect will be reduction in attrition. "The impact will be better for the 'non medical' cadre as compared to the medical cadre," he says. However, Dr Prabakar of Apollo begs to differ. "We track the attrition rate on a month-to-month basis and have identified no drastic change in the attrition of nursing staff and junior doctors who still prefer exploring markets like the Middle East."
Still bullish: Despite the poor sentiment, PE firms seem keener on healthcare now than ever before. What makes PE funds bullish about this sector is that healthcare is not dependent upon the market sensex. Dr Alok Aggarwal, Chairman, Evalueserve Inc, explains, "PE funds are bullish on healthcare or biotech sector, because per se it is definitely less risky and with the rising incidence of chronic diseases, it will indeed mean that healthcare would be in demand." "PEs are looking at healthcare investments in a serious way as the industry has good potential to grow and gives steady returns," Dr Desai of HOSMAC shares.
Better Bargain: Across the spectrum, bargains will be harder. "If you charge it at a higher rate you need to prove its valuation. If you don't, people won't pay you a premium. In fact, this is a great time to increase focus on the customer. We would also look for acquiring new businesses where somebody has vacated that area so that we can keep those customers forever," Sharma of Bector Dickinson reveals.
Giffen Good Situation for Health Insurance?
One of the sectors which is perceived to feel the maximum brunt is insurance. As Barnagarwala explains, "Health insurance companies are affected adversely by this crisis because of their inability to raise prices in a declining market even as the costs of drugs and healthcare services continue to rise, further compounded by the reduction in the usage of healthcare services by those insured or those losing health insurance benefits due to increasing lay-offs."
Many corporates, predominantly top-notch IT companies and BPOs, are reducing the health insurance coverage for their employees, following a sharp increase in premium rates. Some corporates have also removed parents of employees from their group insurance scheme, restricting the benefit only to the staff. IT companies, which have conventionally offered substantial health covers for their staff as a human resource incentive, are now choosing to cut costs by initiating a co-payment structure (where an employee has to partly bear the cost) or by doing away with the cover altogether. Says an expert, "People will not take insurance, or will pay smaller premiums. Less pay in insurance would obviously mean a setback to an industry which is growing by almost 40 per cent per year."
However, some experts argue that this industry would not be affected as much because insurance penetration in this country is low. Another reason for the impact not to be felt is that most contracts are annual and hence if the recession continues until the next fiscal year, then contracts would probably be terminated. B Madhavan, CEO, MediAssist, a TPA, believes, "While other insurance is directly dependent on the economic conditions, that is not the case with healthcare. While it is indirect, the effect would mean cutting down of corporate spending on healthcare. The tendency to spend on healthcare would probably be less. Also, instead of 100 per cent reimbursement as earlier, corporates may reduce it to 80-90 per cent with 10-20 per cent payment by the employee."
"The impact of recession is yet to be felt in healthcare insurance. It is expected to be felt if the recession continues for a longer period, around a year. While IT companies have already started cutting employee welfare benefits, insurance healthcare is one of the least affected ones as it is primarily need-based," Madhavan reasons.
Deepak Mendiratta, MD, Health and Insurance Integrated, has a different view about how the healthcare insurance sector will score in the midst of global meltdown. He believes that the concept of Giffen goods will make the healthcare insurance more attractive now. This is a concept in economics in which people consume more as price rises, violating the law of demand. "In the Giffen good situation, cheaper close substitutes are not available. Because of the lack of substitutes, the income effect dominates, leading people to buy more of the good, even as its price rises. Similarly, in the matured economy the price of health insurance will also rise because the price of the healthcare is rising. The rise in healthcare prices means that insurance companies have to shell out more money. As a result, the pool available to them is less profitable. In addition, as the healthcare cost rises, the individual realises that it is riskier not to be covered by health insurance any longer," Mendiratta explains.
The Impact on Medical Equipment
The lack of liquidity may affect the market for medical devices (particularly those that are very expensive) because hospitals may not wish to commit large funds which could be better utilised in creating patient-pull. However, the effect hasn't percolated yet as most medical equipment companies deny feeling any recession blues.
K Mohanlal, Managing Director, Esaote India, a leading manufacturer of ultrasound imaging, insists, "We have not seen the impact yet. But if this recession period continues then there will be some impact in this industry." However, the company does admit to strategically changing its growth plans wherein it will now focus on cost-sensitive products instead of high-end products. "As we have been growing by almost 30 per cent per year, probably there will be a drop of 10 per cent. However, this is not merely because of recession, but because of Indian consumer needs. Nevertheless, subconsciously it has made us more focused about targeting lower premium products," he adds.
Maquet also denies any dramatic change, but does admit delays in sales of its new projects. Says Ashim Purohit, CEO, Maquet, "Though there is no immediate setback on our sales at the moment, we definitely foresee delays in some projects. However, it is likely to be a passing phase. Knowing the grit and determination of the Indian industry, it's not hard to visualise an even stronger rebound. But for sure, it's going to be a different marketplace from now on." For being seemingly unaffected by the current tide, Michael Rieder, Getinge Medical Systems, Vice President, Sales and Marketing, reasons, "Maquet is interacting with acute care hospitals on a global scale with more than 30 subsidiaries and over 200 distributors. We do see a high potential for growth for medical device companies, especially in emerging markets, such as India. In addition, we have established ourselves in new market segments. By honouring our origins in surgical infrastructure, we develop Maquet systematically into a therapeutic medical company."
According to Dr SP Chandrashekar, Managing Director, Beckman Coulter India, there has been a negative impact as some hospitals are postponing their decisions to buy capital equipment. Experts feel that healthcare companies that are not likely to be affected greatly are those that deal in inexpensive devices and supplies that are used in hospitals. "For example, high profit gains for the last quarter were reported by Becton Dickinson & Co and Baxter International Inc, and they even increased their full-year earnings estimates. That is because Baxter sells drugs for treatment of blood and immune disorders, while Becton Dickinson specialises in syringes and surgical tools which are considered essentials in a hospital," says Barnagarwala.
The medical technology market was billed to be worth about $2.7 billion in 2006 and is likely to cross $10 billion by 2012 with a growth rate of over 20 per cent. It is estimated that over 85 per cent of medical devices and equipment are imported and the market is primarily dominated by MNCs. Most MNCs currently source their products from China through OEM arrangements, joint ventures or own manufacturing facilities. With the Indian software and hardware strengths, and the overall increase in prices in China, India could become a potential alternate sourcing centre for such MNCs.
"We continue to be bullish on the healthcare industry - especially the medical technology space. With the costs of imports going up, we believe that a number of domestic companies would evolve, as Indian consumers would look for low-cost devices / equipment. We also believe that there could be consolidation of smaller players through acquisition by larger players who have a strong sales, distribution and support network. Foreign companies would also look to acquire smaller niche companies for product diversification and lower pricing advantages," believes Kandasamy of ePlanet Ventures.
Given the rise in the value of the dollar, the cost of purchases is expected to increase, which may increase the capital expenditure or the margins of companies engaged in healthcare. "The opportunities for the Indian healthcare manufacturing industry will increase, as more companies like Trivitron would get into local manufacturing of devices or equipment," Kandasamy argues.
Rays of Light
According to Kandasamy, "With reference to the domestic market, healthcare expenditure will continue to grow— though the estimates of US$67.5 billion by 2012 may decrease nominally. CROs and CMOs will continue to grow in the long term, though they may have a temporary setback, due to general recession in the economy." He adds, "While the growth will definitely be there, there will be a decline in growth percentages due to general recession. However, as in the Indian telecom industry, where a number of domestic players evolved due to cost advantages, we believe this could happen in the healthcare space."
Nair believes that this is an excellent opportunity for Indian healthcare industry players to come together and exploit the opportunity of drawing overseas patients-where there is true recession-through targeted marketing initiatives. Like the NASSCOM for IT, healthcare needs to adopt a collaborative approach to win the overseas market, he says.
So while the dark clouds of meltdown might be obscuring the sunrise industry right now, rays of light are peeping through around the edges.
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