By Ashok Thapa
December 18, 2016
If one claims there is no business environment in the country, s/he might be partially true. Understood that unfavourable factors and circumstances have hit the manufacturing industry hard, yet service sector has grown abnormally. Even in the host of service sector segments, health care is the one which has not only drawn huge amount of investments but also has grown into a fully matured sector.
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Stakeholders credit the entry of private sector players for the health care industry to evolve like never before and for the value addition it has ensured as compared to efforts being made by the government sector. Such is the charm in this sector that a number of corporate house and companies have also invested in establishment of hospitals ensuring all pervasive and holistic health care service.
There is a strong presence of private sector in the domestic healthcare service industry with medical institutions like Om Hospital, B&B Hospital, Norvic Hospital, Blue Cross, Medicare Hospital, Grande International Hospital, Neuro Hospital, Vayodha Hospital, Kathmandu Medical College and Manipal Medical College, among others however, the latest wave of investments from the private sector shows that healthcare is now turning into an attractive area of investment.
"The entry of innovative, professional, educated and dynamic investors in the industry did not only help break the decade long government monopoly in the sector but also gave a sense of relief to the patients with their swift, technology-based and organised service," says Gopi Krishna Neupane, former General Secretary of Association of Private Health Institutions Nepal (APHIN) who claims that the entry and success of private medical institutes was the result of growing need of quality healthcare service and the poor performance of public health centers.
According to APHIN, there are as more than 400 hospitals including 200 from the private sector and the rest from the government. However in terms of bed capacity private hospitals along with community and cooperative based offers 14,000 beds while the government sector remains only with 7,000 beds.
The APHIN also estimates that the private health care industry has a total investment worth Rs 5-6 billion and employs as much as 15 thousand individuals directly including, 10 thousand technical and the rest non-technical. However surprisingly, despite having double bed capacity, the private along with cooperative and community based hospitals serve as much as 50 percent of the total patients while the rest are served by the government health care institutes. "It's because private hospitals do not have reach in most of the rural areas and also a huge number of Nepalis rely on government hospitals for outdoor patient department (OPD) checkups and only visit the private centers for the specialised service," says Neupane, one of the promoters of Stupa Community Hospital, Boudha.
The 'over commercialisation' illusion
Despite the private sector hospitals being accused of being too commercialised, the operators defend themselves stating that the quality comes with the cost.
According to Sandip Ranjit, Marketing Chief of Blue Cross Hospital the private sector medical services are not that expensive if compared with the swiftness in service and the delivery of quality service. "If a person comes to Kathmandu for a normal surgery in the government hospital, s/he is made to wait in queue for a month," he says, "Now calculate the cost of staying in Kathmandu along with one or two of his/her visitors. There is also at the same time risk of getting the disease getting deadlier."
He is of the version that it's better to get the 'expensive' (which is not is real sense) service than getting no service or delayed service.
Dr Rabi Shakya, Head of Department of Psychiatry at Patan Hospital claims that people have wrong perception about the hospitals and medical professionals. "The taxi that leads you to the emergency is allowed to be expensive, the canteen at hospitals are allowed to be expensive and also the fruits that a patient consumes are allowed to be hospitals then why has there been a lot of hullaballoo regarding the hospitals and doctors being expensive?," he states, "A private sector hospital has to invest tens of millions of rupees only to import equipments so that the patients could get better diagnostic system, proper care and prompt service and how could one claim that they are expensive?"
Industry insiders also claim that had there been a little support from the government even in the import of equipments, the services charge would have a lot been deducted.
Bringing in the excellence
Private sector players claim that the private hospitals have not introduced the concept of 'customer care' but also have shaped the culture of excellence in the overall medical sector. "The introduction of ultra modern equipments, expert professionals, personalized and specified services and sense of care and sympathy to the patient are the benchmarks that the private hospitals are really here to serve," says veteran doctor Anjani Kumar Jha, Immediate Past President of NMA. In his words, the private hospitals are not satisfied with the status quo of serving the patients and making immediate returns but have stayed focused to enhance and improve their service for the sustainable period of time.
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Specific departments; preventive, curative and rehabilitational services; instant diagnosis and treatment; honest referrals, telemedicine, and others are the biggest schemes offered by the private hospitals, according to the investors.
"The fact they are not a short term business and they are staying for the longer period of time is the testament that the private hospitals want to improve themselves and achieve excellence," says senior Dr Bhagwan Koirala. He also opines that the private sector financing in healthcare industry has played an important role in the overall transformation of the country’s healthcare system that has a relatively short history in Nepal while the entry of private sector players in healthcare industry has made the sector more competitive, professional and organised.
“Gone are the days when patients had to visit at least three government hospitals for diagnosing even a simple illness due to lack of bed, defunct diagnostic machines and lack of care,” Neupane argues, “Private sector hospitals have established themselves as single-window service centres.” He further adds that the private hospitals have also enabled diagnosis and treatment of almost 95 percent of serious ailments within the country itself.
Health may be the sector where the biggest chuck of the government's budget goes every year (and with no solid output), the consolidated efforts from private sector groups, be it from a segment of professionals or big investors, the sector is becoming more competitive, trust-worthy and ever growing for the last two decades. Be it through the establishment of local clinics, medium level medical centres or mega hospital projects, private sector players have not only bring in significant amount of money, but also have brought quality and professionalism along with the innovative technology.
For the last half decade, there has been a remarkable growth in the number of private sector hospitals that is today a major source of healthcare service provider.
There are stakeholders who however impose conspiracy theory and claim that the growing investments in this sector are due to because of the safe playing ground it offers. "There are promoters of some hospitals who also treat the healthcare business as a safe ground for private sector investment," claims a health professional, according to whom there is no trade unionism in this sector, hospital are not bound to pay donations to political parties akin to other industrialists and that healthcare is among the few businesses where credit is not allowed, making it a safe game to play.
Lack of research
Despite coming a long way, country's health care has not been able to give proper attention towards the research and development affairs which otherwise might push sector up with likelihood to make the country a hub for medical tourism. Dr Shakya believes that the country has its own traditional healing and medicinal systems which might be a huge avenue of the research and study. "New and new researches have focused in their traditional healing systems which also have bore immense results," he says, "We have failed in this part bitterly."
There are others like Dr Shakya who share that Nepal adopts others' diagnostic and treatment system and this is why the country has to wait for longer period of time when there is the emergency of new diseases. "If we can venture into the research and studies of our own local and traditional diagnostic and healing system, we might be able to share the knowledge to the world," says Dr Pradeep Pandey, a Medical Consultant for Alka Hospital.
Promoters however out rule the prospect of discovering and developing the local knowledge blaming the lack of resources. "This is the thing which is to be supported by the government," adds Neupane, "We the private sector do not have that resource on our own while research is a long and expensive stuff."
"Today, Nepal has multidisciplinary and multi-specialty hospitals that cater to all kinds of patients and diseases"
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Dr Chakra Raj Pandey
Medical Director, Grande International Hospital
How has Nepal’s healthcare industry evolved over the years?
In the past, Nepal had its own indigenous system of medicine. As it adopted Western medicine and allopathic solutions, Nepal has migrated to a more efficient and modern health care system.
The last five decades have seen a significant rise in the number of hospitals and dispensaries in Nepal, with growing opportunities for both non-governmental and private organisations to enter the healthcare sector.
Today, Nepal has multidisciplinary and multi-specialty hospitals that cater to all kinds of patients and diseases. There are hospitals that are equipped with world-class infrastructure, equipment, and technology, along with teams of highly-talented and trained doctors who can perform surgeries that range from renal transplants to hip and knee replacements. Grande International Hospital is a good example of the evolution of healthcare in Nepal—with 35 specialties along with a team of world-class doctors and support staff, backed up by state-of-the-art equipment and technology.
The status of healthcare in Nepal is rapidly developing. The private sector is one the rise, striving to offer high-quality complex treatments at affordable costs. As Nepal incorporates better and evolved medical technology and training at lower costs of service, it is beginning to open the door for medical tourism.
How do you compare the private healthcare industry with the public?
The government runs a uniform healthcare programme that is intended to reach the masses. As far as the private sector is concerned, it complements the already-existing public service with even more advanced and sophisticated care facilities. Much needed public health programmes such as health education, vaccinations and maternal health, among others are taken care of by the government, reaching all 75 districts. This has created a structure for healthcare as well as for the medical education of doctors, nurses, and technicians. The government’s role in healthcare is central and cannot be undermined.
However, once the primary and secondary needs—such as primary healthcare facilities, medical education, and training—are fulfilled, our attention must turn to illnesses that are equally severe and complicated and that require a multidisciplinary approach, founded on high-end resources, whether it is complex medicines, sophisticated experience and knowledge, or consumables. This is where the private sector comes in. The mushrooming of private healthcare institutions throughout the country is in response to the needs of the people. The private sector is hence capitalising, out of necessity, on a platform that the government has created. The public and the private sectors are hence complementary to each other, and subsequently synergistic.
Big corporate tycoons and health professionals have been venturing into the healthcare sector. What value addition has this created?
If anything, this has given the healthcare sector a much-required boost in terms of providing state-of-the-art facilities. Understandably, any hospital that incorporates high-end equipment and infrastructure into its system will also bear huge costs. Nepali entrepreneurs have ventured into diverse businesses and projects throughout the world, returning not only with significant wealth but also with a global outlook and expertise to build world-class infrastructure in the healthcare sector. Health professionals are similarly driven by their zeal to help the Nepali population and beyond, capitalising on this social and economic opportunity to create medical services that accommodate and, indeed, exceed the needs of the country. Such investments are intended and motivated by a desire to give back to community, even if they may appear as commercial ventures at first sight.
Despite such healthcare development in Nepal, millions of rupees still flow out of the country in medical tourism, especially from leaders and politicians. What do you make of this trend?
Nepali healthcare has not reached its maximum, and there are certainly some conditions that we simply cannot offer treatment for. Furthermore, there are better and newer methods of treatment being offered in developed countries. If someone must travel abroad for better healthcare, then they will. This is why medical tourism is still so prominent from Nepal.
How do you view the future of the private healthcare industry?
Both government and private, community, or non-governmental and cooperative hospitals have been established in most major urban settlements in Nepal, and their primary intention is to provide health services to the general public.
There are 301 private hospitals in Nepal, among which 67 are located in the Kathmandu Valley, compared to 123 government hospitals under the Ministry of Health and Population, demonstrating a vast gap between private and government hospitals. Hence the private healthcare industry has a prominent role in contributing to the healthcare in Nepal, and to the healthcare economy.
Inpatient medical activities at private hospitals are chiefly directed and carried out under the direct supervision of medical doctors and include services of medical and paramedical staff, laboratory services and technical facilities, radiology and anesthesiology, emergency room services, surgical procedures and concomitant infrastructure, pharmaceutical services, and family planning centers, among others.
Health is a need, and that is that. There are increasingly new methods of identifying and treating disease, more and more techniques for surgery. There are new gadgets, newer knowledge, better technology, and better talent. The private healthcare industry has to constantly update itself with global healthcare trends and practices in order to improve its services for the Nepali population. More and more doctors and scientists need to be trained in the best medical schools. The future is evolving, and so is the private sector. It continues to bring in new treatment, techniques, and talent.
- Comparatively cheaper
- Special expertise
- Multi-disciplinary approach
- Wide reach of hospitals and health-posts across the country
- Relatively cheaper drugs
- Prompt surgeries – less time in waiting list
- Less waiting time for consultation
- Rising consciousness among stakeholders in regards to importance of health
- Availability of improved, educated and skilled manpower
- Potential to be a medical tourism destination
- Technological enhancement]
- International collaboration
- Increased sense of diversity and specialisation
- Bad infrastructure
- Referring physician access
- Total patient-care
- Lack of government subsidy/support
- Less number of specialists
- Poor health insurance/welfare programmes
- Lack of research
- Lack of specialisation and sluggish technological advancement
- Higher tax
- Lack of trust