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MIDNAPORE CITY COLLEGE

Department of Paramedical and Allied Health Sciences
BBA in Hospital Management
Semester: II
Paper Title: HOSPITAL AND HEALTH SYSTEM
Paper Code: MI02

Syllabus:
Module:-I Definition and meaning of Health, Holistic approach to health, Basic
information relating to health, Historical development of health care system in India,
Present status of hospitals in India
Module: -II National Health policy, Goals for Health for all by 2000 AD and beyond,
Health committee and their recommendation, benefits to the Health Care systems,
Overview of Health Care delivery system.
Module: -III Definition and meaning of hospital, types of hospitals, concept of modern
hospitals and privatization in health sector, effects of globalization in healthcare, historical
development of hospitals, , Future health care system.
Module: -IV Hospital viewed as a system, Role of Hospitals, Hospital Viewed as a Social
system, Peculiarities of hospital systems.

Basic Concept of Health:

Health is a state in which our body is free from illness. It also relates to state of physical, mental
and social well-being. In other words, if someone healthy it is more than just the absence of
diseases or infirmity, likewise we can use the term to donate the condition within societies and
countries.
Definition:
According to WHO, World Health Organization, a state of complete physical, mental and
social well-being and not merely the absence of disease or infirmity.
Types of Health.
Physical Health:
It means the condition of a physical body and how suitable it is to function considering its all
parts with flexibility. It is affected by sufficient intake of nutrition, physical activity, rest, and
environment zones where the person is residing or at the place. It encourages us to take proper
care of the body in terms of strength and endurance. One should intake nutrition, a balanced
diet, and plenty of water to help achieve the body’s physical fitness.
Mental Health:
The psychological state should be maintained at an appropriate level of emotional adjustments
and the behavior being shown. Good mental health does not mean free of illness; it indicates
how the stress and relationships are managed, which could be done by instilling a sense of
confidence, optimism, acknowledgement of being oneself, performing yoga and exercises.
Social Health:

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It is the state of being friendly and interactive with others and pursuing different situations with
calmness and happiness. Strong social relations help foster communities at all levels.

HOLISTIC APPROACH TO HEALTH

That term holistic health is used many times in literature with a variety of different definition.
Holism also has its origin in the Greek word “hollows”, which mean ‘whole’. Holism it’s not
about any religious rather, it was first used in 1926 by Jan Smuts in his book “Holism and
Evolution”. The Super specialization of scientific discipline has created a mentally leading to
a myopic understanding of knowledge and compromising our ability to deal with most sweet
table problems. Although Jan Smuts used evolution as an example to Explain this concept of
holism comma this book actually became a trigger for systems thinking and complex , this
book actually became a trigger for systems thinking and complex, interdisciplinary and
integrative approaches in science.

Holistic health typically Consider the whole person’s body, mind and spirit. A holistic approach
goes beyond just eliminating symptoms. Many times holistic health is considered hour idea of
investigative approach. Holistic medicine involving traditional and complementary medicine,
we feel this is not correct. The holistic health is an approach, which modern medicine also
needs to adopt idea of investigative Approaches for health is in a way, holistic wear modern
medicine I word Veda, Yoga and traditional and complementary medicine are traditional and
complementary medicine are considered as a whole.

Ayurveda is about the Ways and Means of restoring and promoting health. The broader goal
of Ayurveda is to maintain a dynamic balance between internal and external environment.
According to Ayurveda one is considered as a healthy when body, mind and spirit are spirit are
in the state of equilibrium, comfort bliss.

BASIC INFORMATION RELATING TO HEALTH

DETERMINANTS OF HEALTH:

Health is multifactorial. The factors which influence health lie both within the individual and
externally in the society in which he or she lives. It is a truism to say that what man is and to
what diseases he may fall victim depends on a combination of two sets of factors his genetic
factors and the environmental factors to which he is exposed. These factors interact and these
interactions may be health promoting or deleterious. Thus, conceptually, the health of
individuals and whole communities may be considered to be the result of many interactions.

1.Biological Determinants:

The physical and mental traits of every human being are to some extent determined by the
nature of his genes at the moment of conception. The genetic make-up is unique in that it cannot
be altered after conception. A number of diseases are now known to be of genetic origin, e.g.,
chromosomal anomalies, errors of metabolism, mental retardation, some types of diabetes, etc.

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 The "positive health" advocated by WHO implies that a person should be able to
express as completely as possible the potentialities of his genetic heritage. This is possible only
when the person is allowed to live in healthy relationship with his environment an environment
that transforms genetic potentialities into phenotypic realities.

2. Behavioural and socio-cultural conditions:

The term "lifestyle" is rather a diffuse concept often used to denote "the way people live",
reflecting a whole range of social values, attitudes and activities. It is composed of cultural
and behavioural patterns and lifelong personal habits (e.g., smoking, alcoholism) that have
developed through processes of socialization. Lifestyles are learnt through social interaction
with parents, peer groups, friends and siblings and through school and mass media.

In developing countries such as India where traditional lifestyles still persist, risks of
illness and death are connected with lack of sanitation, poor nutrition, personal hygiene,
elementary human habits, customs and cultural patterns. It may be noted that not all lifestyle
factors are harmful. There are many that can actually promote health. Examples include
adequate nutrition, enough sleep, sufficient physical activity, etc. In short, the achievement of
optimum health demands adoption of healthy lifestyles. Health is both a consequence of an
individual's lifestyle and a factor in determining it.

3. Environment:

It was Hippocrates who first related disease to environment, e.g., climate, water, air, etc.
Centuries later, Pettenkofer in Germany revived the concept of disease environment
association.

It is an established fact that environment has a direct impact on the physical, mental
and social well-being of those living in it. The environmental factors range from housing, water
supply, psychosocial stress and family structure through social and economic support systems,
to the organization of health and social welfare services in the community. The environmental
components (physical, biological and psychological) are not water-tight compartments. They
are so inextricably linked with one another that it is realistic and fruitful to view the human
environment into when we consider the influence of environment on the health status of the
population.

4. Socio-economic conditions:

Socio-economic conditions have long been known to influence human health. For the majority
of the world's people, health status is determined primarily by their level of socio-economic
development, e.g., per capita GNP, education, nutrition, employment, housing, the political
system of the country, etc. Those of major importance are:

(i) Economic status: The economic status determines the purchasing power, standard of
living, quality of life, family size and the pattern of disease and deviant behaviour in the
community. It is also an important factor in seeking health care. Ironically, affluence may also

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be a contributory cause of illness as exemplified by the high rates of coronary heart disease,
diabetes and obesity in the upper socio-economic groups.

(ii) Education: A second major factor influencing health status is education (especially female
education). The world map of illiteracy closely coincides with the maps of poverty,
malnutrition, ill-health, high infant and child mortality rates. Studies indicate that education, to
some extent, compensates the effects of poverty on health, irrespective of the availability of
health facilities.

(iii) Occupation: The very state of being employed in productive work promotes health,
because the unemployed usually show a higher incidence of ill-health and death. For many,
loss of work may mean loss of income and status. It can cause psychological and social damage.

(iv) Political system: Health is also related to the country's political system. Often the main
obstacles to the implementation of health technologies are not technical, but rather political.
Decisions concerning resource allocation, manpower policy, choice of technology and the
degree to which health services are made available and accessible to different segments of the
society are examples of the manner in which the political system can shape community health
service.

7. Gender:

The 1990s have witnessed an increased concentration on women's issues. In 1993, the Global
Commission on Women's Health was established. The commission drew up an agenda for
action on women's health covering nutrition, reproductive health, the health consequences of
violence, ageing, lifestyle related conditions and the occupational environment. It has brought
about an increased awareness among policy-makers of women's health issues and encourages
their inclusion in all development plans as a priority.

8. Other factors:

The development of these technologies offers tremendous opportunities in providing an easy

and instant access to medical information once difficult to retrieve. It contributes to
dissemination of information worldwide, serving the needs of many physicians, health
professionals, biomedical scientists and researchers, the mass media and the public.

DIMENSION OF HEALTH.
There are five dimensions of health: physical, mental, emotional, spiritual, and social. These
five dimensions of health provide a full picture of health as a change in any dimension affects
the others.
Physical:
The physical dimension of health refers to the bodily aspect of health. It refers to the more
traditional definitions of health as the absence of disease and injury. Physical health ranges in
quality along a continuum where combinations of diseases such as cancer, diabetes,

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cardiovascular disease or hypertension are at one end and a person who is at optimum physical
condition (think health not fitness) is at the other.
Mental:
Mental health refers to the cognitive aspect of health. Often mental health is linked to or
includes emotional health; I want to distinguish the two. Mental health is more the functioning
of the brain, while emotional health refers to the person’s mood often connected to their
hormones. Mental health then includes many mental health issues such as Alzheimer’s and
dementia. It refers to the person’s ability to use their brain and think. This may be to solve
problems or to recall information, but the focus is on the cognitive aspect of the person.
Emotional:
Emotional health is about the person’s mood or general emotional state. It is our ability to
recognize and express feelings adequately. It relates to your self-esteem as well as your ability
control your emotions to maintain a realistic perspective on situations. The relationship
between emotional and mental health is clear and as such some illnesses relate to both, such
as: depression and anxiety.
Spiritual:
Spiritual health relates to our sense of overall purpose in life. People often find this purpose
from a belief or faith system, while others create their own purpose. A person who has purpose
to life is said to be healthier than those who don’t see a purpose to life.
Social:
The social dimension of health refers to our ability to make and maintain meaningful
relationships with others. Good social health includes not only having relationships but
behaving appropriately within them and maintaining socially acceptable standards. The basic
social unit of relationship is the family, and these relationships impact a person’s life the most.
Other key relationships are close friends, social networks, teachers, and youth leaders.

SHORT NOTE ON POSITIVE HEALTH: -

Health in the broad sense of the world does not merely mean the absence of disease or provision
of diagnostic, curative and preventive services. It also includes as embodied in the WHO
definition, a state of physical, mental and social well-being. The harmonious balance of this
state of the human individual integrated into his environment constitutes health, as defined by
WHO. The state of positive health implies the notion of "perfect functioning" of the body and
mind. It conceptualizes health biologically, as a state in which every cell and every organ is
functioning at optimum capacity and in perfect harmony with the rest of the body;
psychologically, as a state in which the individual feels a sense of perfect well-being and of
mastery over his environment, and socially, as a state in which the individual's capacities for
participation in the social system are optimal. These ideas were widely ventilated some years
ago but now appear slightly ridiculous.
Dubas said, "The concept of perfect positive health cannot become a reality because
man will never be so perfectly adapted to his environment that his life will not involve
struggles, failures and sufferings". Positive health will, therefore, always remain a mirage,
because everything in our life is subject to change. Health in this context has been described as
a potentiality the ability of an individual or a social group to modify him or itself continually,

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in the face of changing conditions of life. In working for positive health, the doctor and the
community health expert are in the same position as the gardener or farmer faced with insects,
moulds and weeds. Their work is never done.
A broader concept of health has been emerging that of improving the quality of life of
which health is an essential component. This at once brings to focus that positive health
depends not only on medical action, but on all the other economic, cultural and social factors
operating in the community.

WELLBEING
Meaning:
Well-being is a positive outcome that is meaningful for people and for many sectors of society,
because it tells us that people perceive that their lives are going well. Good living conditions
(e.g., housing, employment) are fundamental to well-being. Tracking these conditions is
important for public policy. However, many indicators that measure living conditions fail to
measure what people think and feel about their lives, such as the quality of their relationships,
their positive emotions and resilience, the realization of their potential, or their overall
satisfaction with life—i.e., their “well-being.” Well-being generally includes global judgments
of life satisfaction and feelings ranging from depression to joy.
Importance:
Well-being integrates mental health (mind) and physical health (body) resulting in more
holistic approaches to disease prevention and health promotion.
• Well-being is a valid population outcome measure beyond morbidity, mortality, and
economic status that tells us how people perceive their life is going from their own
perspective.

• Well-being is an outcome that is meaningful to the public.

• Advances in psychology, neuroscience, and measurement theory suggest that well-

being can be measured with some degree of accuracy.2, 7

• Results from cross-sectional, longitudinal and experimental studies find that well-being
is associated with1, 8:

o Self-perceived health.

o Longevity.

o Healthy behaviors.

o Mental and physical illness.

o Social connectedness.

o Productivity.

o Factors in the physical and social environment.

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 • Well-being can provide a common metric that can help policy makers shape and
compare the effects of different policies (e.g., loss of greenspace might impact well-
being more so than commercial development of an area).4, 5

• Measuring, tracking and promoting well-being can be useful for multiple stakeholders
involved in disease prevention and health promotion.

Standard of living:
The term "standard of living" refers to the usual scale of our expenditure, the goods we
consume and the services we enjoy. It includes the level of education, employment status, food,
dress, house, amusements and comforts of modern living.
A similar definition, corresponding to the above, was proposed by WHO: "Income and
occupation, standards of housing, sanitation and nutrition, the level of provision of health,
educational, recreational and other services may all be used individually as measures of socio-
economic status, and collectively as an index of the "standard of living".
Level of living:
The parallel term for standard of living used in United Nations documents is "level of
living". It consists of nine components: health, food consumption, education, occupation and
working conditions, housing, social security, clothing, recreation and leisure, and human rights.
These objective characteristics are believed to influence human well-being. It is considered
that health is the most important component of the level of living because its impairment always
means impairment of the level of living.
Quality of life:
Much has been said and written on the quality of life in recent years. It is the
"subjective" component of well-being. "Quality of life" was defined by WHO as: "the condition
of life resulting from the combination of the effects of the complete range of factors such as
those determining health, happiness (including comfort in the physical environment and a
satisfying occupation), education, social and intellectual attainments, freedom of action, justice
and freedom of expression".
Physical quality of life index (PQLI):
As things stand at present, this important concept of quality of life is difficult to define
and even more difficult to measure. Various attempts have been made to reach one composite
index from a number of health indicators. The "Physical quality of life index" is one such index.
It consolidates three indicators, viz. infant mortality, life expectancy at age one, and literacy.
These three components measure the results rather than inputs. As such they lend
themselves to international and national comparison. For each component, the performance of
individual countries is placed on a scale of 0 to 100, where 0 represents an absolutely defined
"worst" performance and 100 represents an absolutely defined "best" performance. The
composite index is calculated by averaging the three indicators, giving equal weight to each of
them. The resulting PQLI thus also is scaled

HISTORICAL DEVELOPMENT OF HEALTHCARE SYSTEM IN INDIA:

Health care is the prevention, treatment, and management of illness and the preservation of
mental and physical wellbeing through the services offered by the medical, nursing, and allied

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health professions. According to the World Health Organisation, health care embraces all the
goods and services designed to promote health, including “preventive, curative and palliative
interventions, whether directed to individuals or to populations”. The organised provision of
such services may constitute a health care system.

Health is defined as a state of complete physical, mental and social wellbeing and just
not the non-existence of disease or ailment. Health is a primary human right and has been
accorded due importance by the Constitution through Article 21. Though Article 21 stresses
upon state governments to safeguard the health and nutritional wellbeing of the people, a
central government also plays an active role in the sector. Recognizing the critical role played
by the Health Industry, the industry has been conferred with the infrastructure status under
section 10(23G) of the Income Act.

Before Independence

Conventionally health care in India has been based on voluntary work. Since ancient
times traditional practitioners of health care have contributed to the medicinal needs of society.
Acute knowledge in the medicinal properties of plants and herbs were passed on from one
generation to another to be used for treatment. The colonial rule and the dominance of the
British changed the scenario. Hospitals managed by Christian missionaries took centre stage.
Even the intellectual elite in India with their pro west bias favoured Western practices.

After Independence

Prior to independence the healthcare in India was in shambles with large number of
deaths and spread of infectious diseases. After independence the Government of India laid
stress on Primary Health Care and India has put in sustained efforts to better the health care
system across the country. The government initiative was not enough to meet the demands
from a growing population be it in primary, secondary or tertiary health care. Alternate sources
of finance were critical for the sustainability of the health sector.

Entry of Private Sector

Till about 20 years back, the private sectors venture in the health care sector consisted
of only solo practitioners, small hospitals and nursing homes. The quality of service provided
was excellent especially in the hospitals run by charitable trusts and religious foundations. In
1980's realizing that the government on its own would not be able to provide health care, the
government allowed the entry of private sector to reduce the gap between supply and demand
for healthcare. The private hospitals are managed by corporate, non-profit or charitable
organizations. The establishment of private sector has resulted in the emergence of
opportunities in terms of medical equipment, information technology in health services, BPO,
Telemedicine and medical tourism.

Large companies and affluent individuals have started five star hospitals which
dominate the space for high end market. The private sector has made tremendous progress, but

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on the flip side it is also responsible for increasing inequality in healthcare sector. The private
should be more socially relevant and efforts must be made to make private sector accessible to
the weaker section of society.

PRESENT STATUS OF HOSPITAL IN INDIA:

Now days in India as the health sector grows up the new technologies are introduced to
the hospitals. Due to the effect of globalization most of the health institutions in India adopting
modern concepts and ultra-modern concepts of hospitals.

Upgradation Done by Hospital Industry in India:

➢ Machine Learning and Analytics:

Applying the technologies described above allows Healthcare Tech organizations to
gather large amounts of data about individuals and patients. This data can be mined with
advanced Machine Learning and Analytics algorithms to identify patterns and segment
customers. Companies can develop customized, personalized offerings tailored to an individual
user’s profile using the insights thus gained.

➢ Smart devices:
Smartphones and smartwatches are becoming increasingly intelligent and are equipped
with sensors and technology to track various physiological bio-markers. Most smart devices
now allow users to track the number of steps walked, hours slept, body temperature and pulse
on a real-time basis. Advanced smartwatches monitor the wearer’s glucose levels, body fat,
and oxygen levels as well.

➢ Financing:
Health insurance distribution has increased significantly in the last few years and is
available on digital channels which eliminate commissions to intermediaries and agents. Over-
the-counter (OTC) drugs and prescription medicines are available to consumers at attractive
price discounts from pharmacies and healthcare-tech startups.

Insurance premium payments are possible via online payment modes like UPI, and
through loans serviced via Equated Monthly Instalments (EMIs), easing the cashflow burden
on individuals and families. Improved technology integration between insurers and healthcare
provider organizations enables faster claim processing and cashless treatment, easing cashflow
burden on individuals.

➢ Standardization:
The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) program aims to
provide free health coverage to nearly 40% of Indian households. Under this program, IRDAI
has mandated that all health insurers provide an Arogya Sanjivani Policy - a standardized health
insurance policy with a fixed sum insured and applicability terms.

➢ Telemedicine:

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 On 25-Mar-2020, the day after the announcement of the nationwide lockdown, the
MoHFW published guidelines for practicing Telemedicine – a form of doctor consultations
conducted remotely over a voice or video call. The guidelines had been under review for some
time, and the pandemic accelerated their formalization.

Hospitals and healthcare-tech startups have quickly adopted the guidelines to provide
Telemedicine solutions with a doctor network. With increased acceptance, transparency and
implementation of NHS, the adoption and usage of Telemedicine solutions is expected to
increase significantly.

➢ Enhanced plans:
Until recently, due to a combination of taxation and regulation, individual health
insurance was used only when the insured person was admitted to a hospital for treatment i.e.,
only for serious injuries or afflictions. Some insurers had attempted to offer Outpatient (OPD)
reimbursement plans, but these have not been successful.

Recently IRDAI has begun discussions on allowing health insurers to create plans that
include hospitalization cover, OPD benefits, cashless facilities at network hospitals and
discounts on medicines from pharmacies. This would address the far more common scenario
of regular outpatient consultations with doctors or purchasing medication for chronic illnesses
than being admitted into a hospital.

Outcomes of the Upgradation:

The technology, financing and regulatory developments described above have several
beneficial outcomes, and lay the path for further improvements.

1. The Telemedicine solutions being developed address the issues of capacity and access with
reasonable quality, as the expertise of highly trained medical professionals located in urban
areas becomes available to semi-urban and rural areas.

2. Regulatory transparency and standardization encourage competition among insurance

providers to make operations efficient and optimize costs, and pass on these benefits to the
customers.

3. The NHS framework combined with data from smart devices enables health insurers to
create customized plans with proper due-diligence and improved risk-management strategies
to improve their revenues and profitability.

4. The enhanced insurance plans combined with technology and financing allow health insurers
to create personalized plans for individuals who would otherwise have been regarded as
uninsurable by including appropriately priced OPD and pharmacy discount components as
benefits.

Hence, the developments described above address the pressing needs detailed earlier, and lay
the groundwork for solving the core problems plaguing healthcare in India.

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NATIONAL HEALTH POLICY 2017
Definition:
The National Health Policy (NHP) 2017 announced by the Union Government marks
the culmination of a complex process. Before the adoption of the NHP 2017, the Government
of India formulated the Draft NHP and placed it in public domain in December 2014. Following
detailed discussion with the stakeholders and State governments, the Draft National Health
Policy was further fine-tuned. It received the assent of the Central Council for Health and
Family Welfare in February 2016.
With its focus on preventive and promotive health care and universal access to quality
health care services, the NHP 2017 envisages provision of a large package of assured
comprehensive primary health care through the ‘Health and Wellness Centers’. The health care
package also includes care for major NCDs {noncommunicable diseases}, mental health,
palliative care and rehabilitative care services.
Principles of National Health Policy 2017
For the first time the NHP 2017 prescribes ten key policy principles. These are:
Professionalism,
Integrity and Ethics;
Equity;
Affordability;
Universality Patient-centered & Quality of Care;
Accountability;
Inclusive Partnerships;
Pluralism;
Decentralization;
and Dynamism and Adaptiveness
Objectives of an NHP 2017-

Under three broad components like-

1) Health status and programmed impact

i) Life expectancy and healthy life
ii) Mortality by age or cause
iii) Reduction of disease prevalence or incidence
2) health system performance
i) Coverage of health services
ii) Cross sectoral goals related to health
3) Health system strengthening
i) Health finance
ii) Health infrastructure and human resource
iii) Health management information

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Goal of NHP 2017-

➢ Increase life expectancy at birth from 67.5 to 70 by 2025.

➢ Establish regular tracking of Disability Adjusted Life Year(DALY) index as a
measure of burden disease.
➢ Reduce under five mortalities to 23 by 2025 and MMR from current levels to 100
by 2020.
➢ Reduce infant mortality rate to 28 by 2019.
➢ Achieve and maintain elimination status of leprosy by 2018, kala-azar by 2017 and
lymphatic filariasis in endemic pockets by 2017.
➢ To reduce premature mortality from cardiovascular disease, cancer, diabetes or
chronic respiratory diseases by 25% by 2025.
➢ Increase utilization of public health facilities by 50% from current levels by 2025.
➢ Antenatal care coverage to be sustained above 90% and skilled attendance at birth
above 90% by 2025.
➢ Relative reduction in prevalence of current tobacco uses by 15% by 2020 twenty
and 30% by 2025.
➢ Reduction of 40% in prevalence of stunting of under five children by 2025.
➢ Increase health expenditure by government as a percentage of GDP from the
existing of 1.15% two 2.5% by 2025.
➢ Increase state sector health spending to >8% of their budget by 2020.
➢ Ensure availability of paramedics and doctors as per Indian Public Health Standard
(IPHS) norm in high priority district by 2020.
➢ Increase community health volunteers to population ratio as per IPHS norm in high
priority districts by 2025.
➢ Ensure district level electronic database and information on health system
components by 2020.
➢ Establish federated integrated health information architecture, health information
exchanges and National Health information network by 2025.
NHP 2017 identifies coordinated action in the following seven priority areas for improving the
environment for health:
1) The Swachh Bharat Abhiyan;
2) Balanced, health diets and regular exercises;
3) Addressing tobacco, alcohol and substances abuse;
4) Yatri Suraksha – preventing death due to rail and road traffic accidents;
5) Nirbhaya Nari – action against gender violence;
6) Reduced stress and improved safety in the work place; and
7) Reducing indoor and outdoor air pollution;
The policy also articulates the need for the development of strategies and institutional
mechanisms in each of these seven areas, to create Swasth Nagrik Abhiyan – a social movement
for health. It recommends the prescription of indicators, their targets as also mechanisms for
realizing them.

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HEALTH FOR ALL BY THE YEAR 2000 AD:

In 1977 the 30th World Health Assembly resolved that the main social target in coming
decades for Governments, as for the WHO, should be ‘the attainment by all citizens of the
world by the year 2000 A.D. of a level of health that will permit them to lead a socially and
economically productive life’ (WHO, 1979). This goal got coined into a slogan Health for All
by the Year 2000 A.D. Health for all meant that every individual should have access to Primary
Health Care — a very important concept which we shall discuss later — and through it to all
levels of a comprehensive health system. A year later, in 1978, the famous Alma Ata World
Conference identified Primary Health Care as the key to the achievement of Health for all by
2000 A.D. In May 1979, the World Health Assembly endorsed the Declaration of Alma Ata
and invited Member States to formulate national policies, strategies and plans to attain this
target. One of its important guidelines was that each Member State should have a National
Health Policy (NHP).

Now, the WHO definition of health is not how health is commonly understood. Health as the
absence of disease is a negative definition. The WHO, in the Preamble to its Constitution,
defined it positively way back in 1948 and threw a challenge to community workers to
construct suitable models of health care:

Health is a state of complete physical, mental and social well-being, and not merely an absence
of disease or infirmity.

Facilities for HFA

To gear health facility development more effectively for the implementation of HFA,
there is a need to take initiatives such as:

• Developing adaptable reference plans for district health facilities;

• Training manpower for health facility development;

• Remodelling, upgrading and maintenance of facilities;

• Finding of facility development programmes: national investment planning;

• The international market of health facilities development;

• Coordination with urban and regional development authorities and with other sectors such
as housing, public works and education;

• Possibility of adaptation of certain technical approaches (Nucleus Hospital). Health care

should be based on community health standards and disease occurrence rates. It must
incorporate social life, working active life, and living culture. The facilities are to be provided
with the benefit of time and distance, with safety and amenity of environment and good access
services. Patients should be treated as close to their homes as possible in the smallest, cheapest,

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most humbly staffed and most simply equipped unit that is capable of looking after them
adequately.

The national health policy echoes the WHO call for HFA and the Alma-Ata Declaration. It had
laid down specific foals in respect of the various health indicators by different dates such as
1990 and 2000 AD. Foremost among the goals to be achieved by 2000 AD are:

1. Reduction of infant mortality from the level of 125(1978) to below6 60.

2. To raise the expectation of life at birth from the level of 52 years to 64.

3. To reduce the crude death rate from the level of 14 per 1000 population to 9 per 1000.

4. To reduce the crude birth rate from the level of 33 per 1000 population to 21.

5. To achieve a net reproduction rate of one.

6. To provide potable water to the entire rural population.

HEALTH COMMITTEES:

1.BHORE COMMITTEE:

The Government of India in 1943 appointed a committee, popularly known as the

Health Survey and Development Committee (after the name of the Chairman, Sir Joseph Bhore.

Purpose of Bhore Committee –

Survey the existing position regarding the health conditions and health organization in
the country, and to make recommendations for the future development. The Committee which
had among its members some of the pioneers of public health, met regularly for 2 years and
submitted in 1946 its famous report which runs into 4 volumes. The Committee put forward,
for the first time, comprehensive proposals for the development of a national programme of
health services for the country.

Recommendation of Bhore Committee-

1. Integration of preventive and curative services at all administrative level

2. The Committee visualised the development of primary health centers in two stages:

(a) as a short-term measure, it was proposed that each primary health center in the rural

areas should cater a population of 40000 with a secondary health center to serve as a

supervisory, coordinating and referral institution.

According to Bhore committee the staffing pattern of PHC are -2 medical officers, 4 public
health nurses, 1 nurse, 4 midwives, 4 Trained dais, 2 Sanitary inspector, 2 Health assistants, 1
pharmacist,15 other class IV employees.

15
 (b)A long-term programme (also called the 3 million plan)

◦Setting up primary health units with 75-bedded hospitals for each 10,000 to

20,000 population.

◦ Secondary units with 650-bedded hospitals, again regionalized around district

hospitals with 2,500 beds.

(3) Major changes in medical education which includes 3-month's training in

preventive and social medicine to prepare "social physicians".

2.MUDALIAR COMMITTEE:

By the close of the Second Five Year Plan (1956-61), a fresh look at the health needs
and resources was called for to provide guidelines for national health planning in the context
of the Five-year Plans. In 1959, the Government of India appointed another Committee known
as "Health Survey and Planning Committee", popularly known as the Mudaliar Committee
(after the name of its Chairman, Dr. A.L. Mudaliar).

Purpose of Mudaliar Committee

◦ Survey the progress made in the field of health since submission of the Bhore Committee's
report.

◦ Make recommendations for future development and expansion of health services.

The Mudaliar Committee found the quality of services provided by the primary health canters
inadequate, and advised strengthening of the existing primary health centers before new centers
were established.

They also advised strengthening of sub divisional and district hospitals so that they may
effectively function as referral centers.

Main recommendation of Mudaliar Committee -

1)Consolidation of advances made in the first two five-year plans.

(2) strengthening of the district hospital with specialist services to serve as central base of
regional services;

(3) Regional organizations in each state between the headquarters organizations and the district
in charge of a Regional Deputy or Assistant Directors - each to supervise 2 or 3 district medical
and health officers.

4) Each primary health center not to serve more than 40,000 population.

16
(5) To improve the quality of health care provided by the primary health centers.

(6) Constitution of All India Health Service pattern of Indian Administrative services.

(7) Integration of medical and public health services as recommended by Bhore committee.

3.CHADHAH COMMITTEE:

In 1963, a committee was appointed by the Govt. of India, under the Chairmanship of
Dr. M.S.Chadah, the Director General of the Health Service.

Purpose of chadhah committee- To study the arrangement necessary for the maintenance phase
of the National Malaria Eradication Programme.

Main recommendation of Chadhah committee-

(1) Vigilance" operations in respect of the National Malaria Eradication Programme should be
the responsibility of the general Health Services i.e., primary health centresat the block level.

(2) The Committee recommended that the vigilance operation through monthly home visits
and it should be implemented through basic health workers.

(3) One basic health worker per 10,000 population were recommended. These workers were
envisaged as "multipurpose" works to look after additional duties of collection of vital statistics
and family planning, in addition to malaria vigilance.

(4) . The Family planning health assistants were to supervise 3 or 4 of these basic health
workers.

(5) At the district level, the general health services were to take the responsibility for the
maintenance phase.

4.MUKHERJI COMMITTEE,1965:

Within a couple of years of implementation of the Chadah committee's

recommendations by some states, it was realised that the basic health workers could not
function effectively as multipurpose workers. As a result, the malaria vigilance operations had
suffered and also the work of the family planning programme could not be carried out
satisfactorily. This subject came for discussion at a meeting of the Central Health Council in
1965. A Committee known as "Mukerji Committee, 1965" under the Chairmanship of Shri
Mukerji, the Secretary of Health to the Govt. of India, was appointed, to review the strategy
for the family planning programme.

Recommendation of Mukerji Committee 1965

1.The Committee recommended separate staff for the family planning programme. The family
planning assistants were to undertake family planning duties only

17
2.The basic health workers were to be utilized for purposes other than family planning.

3. Delink the malaria activities from family planning so that the latter would receive undivided
attention of its staff.

The recommendations were accepted by the Govt. of India.

5.MUKHERJI COMMITTEE,1966:

As the states were finding it difficult to take over the whole burden of the maintenance
phase of malaria and other mass programmes like family planning, small pox, leprosy,
trachoma, etc. due to paucity of funds, the matter came up for discussion at meeting of the
Central Council of Health held in Bangalore in 1966.TheCouncil recommended that these and
related questions may be examined by a committee of Health secretaries, under the
Chairmanship of the Union Health Secretary, Shri Mukerji. The Committee worked out the
details of the BASIC HEALTH SERVICE which should be provided at the block level, and
some consequential strengthening required at higher level of administration.

6.SHRIVASTAV COMMITTEE,1975:

The Govt. Of India in the Ministry of Health and Family Planning had meeting in
November 1974 to set up a 'Group on Medical Education and Support Manpower' popularly
known as Srivastav Committee.

Recommendation of Srivastav Committee 1975-

(1) creation of bands of paraprofessional and semi-professional health workers from within the
community itself (e.g., school teachers, postmasters, gram sevaks) to provide simple,
promotive, preventive and curative health services needed by the community

(2) establishment of 2 cadres of health workers, namely-multipurpose health workers and

health assistants between the community level workers and doctors at the PHC;

(3) development of a 'Referral Services Complex' by establishing proper linkages between the
PHC and higher-level referral and service centers, viz taluk/tehsil, district, regional and medical
college hospitals, and

(4) Establishment of a Medical and Health Education Commission for planning and
implementing the reforms needed in health and medical education on the lines of the University
Grants Commission.

HEALTH CARE DELIVERY SYSTEM IN INDIA

Introduction:

18
 India is a union of 28 states and 7 union territories. States are largely independent in
matters relating to the delivery of health care to the people. Each state has developed its own
system of health care delivery, independent of the Central Government. The Central
Government responsibility consists mainly of policy making, planning, guiding, assisting,
evaluating and coordinating the work of the State Health Ministries. The health system in India
has 3 main links

1. Central

2. State and

3. Local or peripheral

AT THE CENTRAL LEVEL

• The official “organs” of the health system at the national level consist of

• 1. Ministry of Health and Family Welfare

• 2. The Directorate General of Health Services

• 3. The Central Council of Health and Family Welfare

Union Ministry of Health and Family Welfare.

Union list

1. International health relations and administration of port quarantine

2. Administration of Central Institutes such as All India Institute of Hygiene and Public Health,

Kolkata.

3. Promotion of research through research centers

4. Regulation and development of medical, pharmaceutical, dental and nursing Professions

5. Establishment and maintenance of drug standards

6. Census and collection and publication of other statistical data

7. Immigration and emigration

8.Regulation of labour in the working of mines and oil fields

9. Coordination with states and with other ministries for promotion of health

Concurrent list

The functions listed under the concurrent list are the responsibility of both the union and state

governments.

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1. Prevention and extension of communicable diseases

2. Prevention of adulteration of food stuffs

3. Control of drugs and poisons

4. Vital statistics

5. Labour welfare

6. Ports other than major

7. Economic and social planning

8. Population control and Family Planning

9. Preparation of health education material for creating health awareness through Central
Health Education Bureau.

10. Collection, compilation, analysis, evaluation a dissemination of information through the

Central Bureau of Health Intelligence

11. National Medical Library

Directorate General of Health Services

Functions Of D.G.H.S-

1. International health relations and quarantine of all major ports in country and International

airport

2. Control of drug standards

3. Maintain medical store depots

4. Administration of post graduate training programmes

5. Administration of certain medical colleges in India

6. Conducting medical research through Indian Council of Medical Research

7. Central Government Health Schemes.

8. Implementation of national health programmes

9. Preparation of health education material for creating health awareness through Central
Health

Education Bureau.

20
10. Collection, compilation, analysis, evaluation and dissemination of information through the

Central Bureau of Health Intelligence

11. National Medical Library

CENTRAL COUNCIL OF HEALTH:

Functions of Central Council of Health-

1. To consider and recommend broad outlines of policy regard to matters concerning health
like

environment hygiene, nutrition and health education.

2. To make proposals for legislation relating to medical and public health matters.

3. To make recommendations to the central government regarding distribution of grants-in-aid.

AT THE STATE LEVEL

Functions of state health Director:

(1) Studies in depth the health problem and needs in the state and plans scheme to Solve them.

(2) Providing curative &preventive services.

(3) Provision for control of milk and food sanitation.

(4) Prevention of any outbreak of communicable diseases.

(5) Promotion of health education

(6) Promotion of health programmes such as school health, family planning, occupational
health

(7) Supervision of PHC

(8) Establishing training courses for health personnel

(9) Co-ordination of all health services with other minister of state such as minister of
education,

central health minister &voluntary agency

AT THE DISTRICT LEVEL:

21
There are 593 (year 2001) districts in India. Within each district, there are 6 types of

administrative areas.

1. Sub –division

2. Tehsils (Talukas)

3. Community Development Blocks

4. Municipalities and Corporations

5. Villages and

6. Panchayats

DEFINITION OF HOSPITAL:

A hospital is a healthcare facility that provides specialized medical and nursing care as well as
medical supplies to patients. The most well-known form of the hospital is the general hospital,
which usually carries an emergency department to handle urgent health issues such as fire and
accident victims, as well as medical emergencies.

WHO Definition of Hospital is an integral part of a social and medical organisation, the
functions of which arc to provide the population complete health care both curative and
preventive with out-patient services reaches out to the family in its own environment and also
to carry out training of health workers/functionaries and the bio-social research.

Other than this WHO definition, the definition given in the "Directory of Hospitals in
India, 1988" is to some extent simple and short. According to this definition. "A hospital is an
institution which is operated for the medical surgical and/or obstetrical care of in-patients and
which is treated as a hospital by the Central State Government/Local bodies or licensed by the
appropriate authority".

Function of Hospital

Below mentioned are some of the functions of hospital/hospital use: -

• Medical hospital - medical hospital includes the treatment and management of patients
by a team of doctors.

• Patient Support provides nursing, nutritional diagnostic, counselling, pharmacy, and

medical supplies, all of which are directly related to patient care.

22
 • Administrative responsibilities include carrying out the hospital's guidelines and
directives regulating the release of support services in the areas of finance, staff,
housekeeping, materials and property, laundry, protection, transportation, engineering,
and board as well as several other maintenances.

• The hospital's financial activities must be planned, guided, and coordinated.

• Patients in a hospital as well as the employees working there.

• Prepare a job and financial plan for services and initiatives, as well as funding
projections.

• To keep track of cash receipts and disbursements.

• To manage personnel development plans, procedures, and standards; to provide

guidance on policy, implementation, and administration of laws, rules, and regulations.

• The quality, efficacy, and outcomes of health services for various groups and
populations are shaped by the structure and dynamics of healthcare organizations; the
policy repercussions for future health care reform initiatives and patients in the hospital.

• Hospital operation is another major benefit of hospitals.

CLASSIFICATION OF HOSPITAL:

According to Directory of Hospitals

a) General Hospital:

All establishment permanently staffed by at least two or more medical officers, which
can offer in patient accommodation and provide active medical and nursing care for more than
one category of medical discipline (e.g., general medicine, general surgery, obstetrics,
paediatrics etc.)

b) Rural Hospital:

Hospital located in rural areas permanently staffed by at least one or more physicians,
which offer in patients’ accommodation and provide medical and nursing care for more than
one category of medical discipline (e.g., general medicine, general surgery, obstetrics,
paediatrics)

c) Specialized Hospital:

Hospital providing medical and nursing care primarily for only one discipline or a
specific disease/affection of one system (e.g., tuberculosis, eye, leprosy, orthopedic, cardiac,
mental, maternity etc.). the specialized departments, administratively attached to a general
hospital and sometimes located in an annexure or separate ward, may be excluded and their
beds should not be considered in this category or specialized hospitals.

d) Teaching Hospital:

23
 A hospital to which a college is attached for medical/dental education.

e) Isolation Hospital:

This is a hospital for the care of person suffering from infectious disease requiring
isolation of the patients.

According to Ownership and Control

Hospitals can also be classified on the basis of ownership and control.

a) Public Hospitals:

Public hospitals are those run by the Central Government, Stale Governments,
Local Bodies and public sector undertakings etc., on non-commercial lines. The
hospitals may be general hospital or' specialised hospitals or both. General hospitals are
those that provide treatment for common diseases, whereas specialised hospitals
provide treatment for specific diseases like infectious diseases, cancer, eye diseases,
psychiatric ailments. etc., General hospitals can diagnose patients suffering from
infectious diseases, but refer them to infectious disease hospitals or hospitalization as
general hospitals are not fully equipped to treat infectious disease patients.

b) Voluntary Hospitals:

Voluntary hospitals are those which arcs established and incorporated under the
Societies registration Act, 1860 or Public Trust Act. 1882 or any other appropriate Acts
of the Central or Stale Governments. They are run with public or private funds on a
non-commercial basis. No part of the profit of the voluntary hospital goes to the benefit
of any member, trustee or to any other individuals. Similarly, no member, trustee or
any other individual is entitled to a share in the distribution of any of the corporate
assets on dissolution of the registered society, A board of trustees, usually comprising
prominent members of the community and retired senior officials of the government,
manages such hospitals. The board appoints, an administrator and a medical director
Lo lull such voluntary hospitals. These hospitals spend more on patient care than what
they receive from the patients. There is of late, a trend among voluntary hospitals to
charge reasonably high fees from rich patients and very little from poor patients.
Whatever they earn from the rich patients of the private wards is spend on the patients
of general wards. However, the main source of their revenue are public and private
donations, and grants-in-aid from the Central Government, the State Governments, and
from philanthropic organisations, both national and international. Thus, voluntary
hospitals run on a 'no profit no loss' basis.

c) Private Nursing Homes:

Private nursing homes are generally owned by an individual doctor or a group

of doctors. They accept patients suffering from infirmity, advanced age, illness, injury,
chronic disability, etc., or those who are convalescing. They do not admit patients

24
 suffering from communicable diseases, drug-addiction or mental illness. These is,
however; no uniform 'definition for nursing homes. The phrase may refer to out of home
care facilities that offer a range of services similar to many found in a hospital.

d) Corporate Hospitals:

The latest concept is of corporate hospitals which are public limited companies
formed under the Companies Act. They are normally run of commercial lines. They can
be either general or specialised or both.

According to the Systems of Medicine

The hospitals in very broad terms may also be classified according to tile system of
medicine that is been practiced there. Hence the hospitals are named as: "Allopathic",
"Homoeopathic". "Ayurvedic", "Naturopathic", "Unani. and “Siddha" etc.

According to the Bed Strength

Arbitrarily the hospitals can be classified into Large, medium and small, depending
upon the number of beds available in that hospital. Roughly any hospital having more than
500 beds is a large hospital, one having the bed strength between 200 to 500 is a medium
hospital, and a hospital having less than 200 beds is a small hospital.

According to Length of Stay of Patients Hospitals call also be classified according to

the length of stay of patients. A patient usually stays for a short-term in a hospital in the
diseases like gastro-enteritis, fever etc. or may stay for long-term for the treatment of
diseases such as tuberculosis, cancer, etc. Therefore, a hospital may fall either under the
category of short-term or long-term (now known as acute and chronic-care hospitals
respectively) according to the period of stay in the hospital.

Concept of Modern Hospital

Introduction:

A hospital is now seen as not just a place for treating patients who are too ill to be treated at
home but as a part of a comprehensive system of preventive and curative medicine, as a center
for outpatient treatment and homecare services, and as an organization for health education and
training center for health workers. The modern hospital is ideally part of a regional work that
embraces hospitals of all kinds and sizes, maintaining a close and cordial relationship with
paramedical and medical services within its area.

History of Hospitals in India:

In India, hospitals have existed since ancient times. Even in the 6th century BC, during the time
of Buddha, there were a number of hospitals to look after the handicapped and the poor. The
outstanding hospitals in India at that time were those built by King Ashoka (273–232 BC). In
1639, EIC officials, Andrew Cogan and Francis Day were instrumental in establishing Fort St

25
George, christened after the patron saint of England, near a small town, Madrasapatnam on the
eastern (Coromandel) coast of India. In this fort, the first modern hospital in India was started.

Definition of Modern Hospital:

According to the modern theory of hospital, a hospital should be better integrated into the
community than was previously the case. Vast buildings with forbidding exteriors now give
way to more human, more personal construction. The modern hospital became central to
healthcare in the early 20th century, such as operating rooms that enable sterile pain-free
surgery and nightingale wards that allowed modern nurses and hospitals to care for a border
population. A modern hospital is a facility that specializes in the diagnosis and treatment of
illness and injury. Hospitals provide a wide range of medical services, including emergency
care, surgery, and childbirth. They also offer a variety of other services, such as outpatient care,
diagnostic tests, and rehabilitation. Hospitals may be compared and classified in various ways:
by ownership and control, by type of service rendered, by the length of stay, by size, or by
facilities and administration provided.

I. Bed number and length of stay: Hospitals may be compared by the number of
beds they contain. Modern hospitals tend to rarely exceed 800 beds, and though
some integrated health facilities may have more beds, they often comprise multiple
geographic locations, each with several hundred beds.
II. Ownership and Control: In most countries, the government owns and operates the
hospitals. However, other forms of ownership include universities, religious groups,
public-spirited individuals and such owners. For instance, in Great Britain, the
National Health Service runs the hospitals. Alongside, a few of them are operated
by religious orders serving special groups. While, in the US, most hospitals are not
owned by government agencies.
III. Financing of Hospitals: The mechanism through which the financing of the most
modern hospitals in the world takes place also varies. It happens because some
hospitals may be not-for-profit while others are for-profit. Throughout the world,
hospital contributions are met through government contributions.
IV. Specialized Medical and Health Care Facilities: In the modern hospital, there is
also specialization for a certain type of illness. In large universities, where they
carry out postgraduate teaching, specialized health services are like a department of
general hospitals. With the changing conditions, some types of specialized
institutions have increased in number. These include mental hospitals, cancer
centers, and tuberculosis centers among others.
V. The General Hospital: These can be entities owned by communities or can be
academic health facilities. Most modern hospitals in the world admit all types of
patients, inclusive of medical and surgical cases. Their major focus is on patients
suffering from acute illness, who require short-term care.
The bed number of community general hospitals varies. They all have a professional
and medical staff that is well-organized. Along with this, they also possess basic
diagnostic equipment

26
Privatization in Health Sector

Privatization in the health sector means involvement of private sectors (i.e., private hospitals,
clinics, etc.) in health care services. It refers to the transfer of the function and ownership of
any services and assets to the private sector. It involves the direct involvement of physicians,
specialists, pharmacists, pathological laboratories, and the indirect involvement of
manufacturers of materials and technologies used in health care provision.

Reasons for Increasing Privatization in Health Sector:

The involvement of the private sector in health care services is increasing speedily. It is
competent to provide required services to the population. Here are some reasons-

I. Government is unable to provide comprehensive health care services to the people.

II. Often the services provided by the public sector don’t meet up the demand and
create chaos.
III. Low government expenditure on health leads to low-quality services.

Advantages of Privatization in the Health Sector:

Private health care providing entities have benefited the community in a satisfactory nature.
This is one of the reasons for increasing privatization in the health sector. The advantages of it
are-

I. Quality and Early Treatment: Private sectors are always people and profit-
oriented, due to which they give more priority to the services. Private hospitals are
much more systematic compared to public ones. They provide early and quality
services.
II. Wide Range of Health Services: In the case of private healthcare facilities, there
are always many options. Patients can freely choose the doctor, hospital services,
etc. Private hospitals introduce a range of health services.
III. No Political Interferences: Privatizing a government-owned hospital removes all
political interferences. Improving the efficiency of all health care services. It turns
losses into profits.
IV. Improved Facilities: New technologies have been invented and introduced.
Medical treatments had taken a huge leap in private facilities. Private sectors
provide different sophisticated services.
V. Boost to Public Sectors: Involvement of the private sector in health shares the
burden of the government. Financial burden of the government also decreases due
to private sectors in health. Competitive market of the private sector encourages the
public sector to boost up the facilities.

Disadvantages of Privatization in the Health Sector:

27
 There are also disadvantages of privatization in the health sector. It makes difficult for the
general public in achieving modern health care services. The disadvantages are-

I. Increase in expenses: Private sectors provide a variety of range of services but are
too expensive for the general public to afford. Private sector further deepens the
financial burden. Profit-seeking motives of the private sector have raised
unnecessary diagnoses and tests.
II. Market monopoly: Country where the private sector is too flourished than the
public sector can have a monopoly in the health market. Creates the unhealthy
competition. Cases of fraud are likely to increase. Private sectors are involved more
in such sectors where there is more money than demand-based services.
III. Increase in gaps: Privatization has further increased the gap in health. Private
sectors being profit oriented are more focused on the urban areas where the
population are high. This further increase gap and inequity in health services

Effects of Globalization in Healthcare

Globalization:

Globalization is the increasing interconnectedness that defines the current world. As

technology and trade have advanced, so has the ability to invest, travel, and market t o the worls
as a whole.

Globalization in healthcare system:

Globalization is changing the nature and process of human interaction across a wide range of
spheres, especially in the health care system. The emphasis of the global move is directed
towards developing countries owing to its lack of facilities and resources.

While the health inequalities between the rich and poor persist, the prospects for future health
depend increasingly on the revived processes of a comprehensive phenomenon.

Effects of Globalization in the healthcare System:

The channels through which globalization may effect on health outcomes are multiple:

I. Socioeconomic factors which affect the distribution of the global burden of disease.
II. Government’s resources and policy options to confront health problems.
III. The distinction between national and international health, which affect the
Government’s ability to prevent and control disease.
IV. The affects of expanded trade in health commodities and services, and the
implementation of patients for medicines and other changes in Intellectual Property
Rights as agreed in the WTO.
V. The relationship between poverty, health, food security and nutrition.

28
VI. The transnational movements of health risks.

Advantages of healthcare globalization for the people:

Globalization is shaping healthcare system for the betterment of future. The various advantages
are-

I. Tourism gains: Tourism is a second mechanism through which countries like Africa,
can benefit through trade liberalization in healthcare. There is a substantial flow of
medical tourists to developing countries where low cost procedures are implemented.
II. Substantial savings: Far most common men, heart surgery would seem like a
humongous cost, especially in the top hospitals. However, in many countries, for
example, this is now available at a fraction of the cost due to globalization without
compromising on the service quality.
III. Enormous healthcare potential: The gap between healthcare cost in India and the rest
of the world offers enormous potential gains through the use of healthcare vouchers for
the government run medical care system.

Globalization is impacting on World healthcare system enormously. It is helping the population

to get latest facilities in healthcare. Due to globalization of healthcare system health promotion
has also become easier. This is making people health conscious and increasing life expectancy,
and reducing other mortality rates. There are also challenges of healthcare globalization but it
shall be overcome.

HISTORICAL DEVELOPMENT OF HOSPITALS IN INDIA:

In India, hospitals have existed from ancient times. Even in 6th century BC, during the time of
Buddha, there were a number of the hospitals to look after the handicapped and the poor. The
outstanding hospitals in India at that time were those built by King Ashoka (273–232 BC).
Books written by Arabian and European travelers (around AD 600) reveal that the study of
medicine in India was in its bloom. The zeal of the native Vaidya’s for the investigation of the
Indian flora slackened for want of encouragement. The invasion of foreigners in the 10th
century AD brought with them their own physicians called Hakims. The use of the Allopathic
system of medicine commenced in the 16th century with the arrival of European missionaries.
It was during the British rule that there was progress in the construction of hospitals. Organized
medical training was started in the 19th century.

ANCIENT PERIOD

29
VEDIC PERIOD

Indus valley culture was so developed that it assimilated the Aryan culture, although the
Aryans brought their own gods and medical knowledge. The chief sources of knowledge of the
Aryan culture and medicine are the four Vedas (Rig, Sama, Yaguas, and Atharva Veda).
Atharva Veda is full of hymns and prayers, indicating ways and means to protect people against
many kinds of diseases and natural disasters. Physical and mental ingredients of positive health
were a genuine concern of people in the Vedic period as is evident from ayur Veda (16/4),
meaning that the world should be free from diseases and (everybody) should have a healthy
mind. The Ayur Veda (Ayush means life, Veda means knowledge) means science of life. How
to prolong life figures in the Ayur Veda. Traditional medicine is based on Ayur Veda. Charaka,
a court physician of King Kanishka, further developed it. Dhanwanti, the patron god of Indian
Medicine, also initiated many methods of healing and passed it to Sushruta, who was the
celebrated surgeon of his time.

THE BUDDHIST PERIOD (563–477 BC)

Lord Buddha himself took very keen interest in supporting the science of medicine. However,
Indian surgery received a setback during this period because of the doctrine of Ahinsa. Lord
Buddha used to attend to the sick himself. To look after the sick was treated as a noble cause.
During the course of his travel for propagating Buddhism, Buddha created Buddhist Viharas
(monasteries) in different places, and in all the Viharas, care of the sick and medical education
was given special attention.

MEDIEVAL PERIOD

Post-Buddha And Muslim Period

Emperor Ashoka established many hospitals throughout the country. With the advent of
Muslim rule from the 10th century onwards, middle east physicians trained in the Unani system
created their impact. The main impact was curative approach. Emperor Akbar (1555–1605),
during his period, encouraged the amalgamation of the Unani and Ayurvedic systems. The
most significant achievement was the translation of medical texts in Arabic, then into Persian
and later into Urdu. The impact of Muslim dominance was very apparent. It started declining
after the Portuguese conquered Goa in 1510.

Christianity And Medical Care

Hospitals became an integrated part of church and monasteries. Medicine was treated as a
religious practice, and all missionaries like nuns and monks used to be trained to take care of
the sick. Between AD 1100–1300 as many as 19,000 hospitals were founded in Europe to cater
to those suffering from war injuries and diseases.

During 1300–1800, although the knowledge of medicine was broadened, care in

hospitals was not of high standard. Crowding and infection were prevalent in hospitals till the
middle of the 19th century. Florence Nightingale revolutionized the working of hospitals and
this was the beginning of the era of ‘Better Patient Care’.

30
Modern Period of Medicine

The Portuguese founded the Royal Hospital in Goa between 1510 and 1515, and later the
Jesuits introduced basic general medical training programme at the hospital. In 1842 this was
converted into school of medicine and surgery.

Although the Portuguese first brought modern medicine to India, it was the French and
the British who later established the first hospitals in 1664 and 1668, respectively. The first
medical school was started in Calcutta, followed by Madras in 1846. Along with the spread of
British rule over the country, local government encouraged establishment of dispensaries at
sub-division and district level. At provincial levels the hospitals were converted into teaching
hospitals attached to medical colleges. In 1885, there were 1250 hospitals and dispensaries in
British India.

Slow progress continued, and on the eve of independence there were 7400 hospitals and
dispensaries in the country with 1,13,000 beds, that is, a bed population ratio of 0.24 per 1000
population. There were 47,000 doctors and 7000 nurses, 19 medical schools, and 28 medical
colleges in the country at that time. In 1943, the Government of India appointed a committee
called the Health Survey and Development Committee headed by Sir Joseph Bhore and having
nineteen other members. This is the only authentic record depicting hospital development and
health care system in pre-independence India, that is, before 1947. The report was submitted
in 1946. The report recommended upgrading of medical care in various forms, such as medical
relief in the form of primary health center at the village level, secondary health center at sub-
division level (Taluka level), and district hospitals at district headquarters, with all the specialist
services. It was anticipated that the bed population ratio could rise to 1.3 per 1000 population
in 10 years and to 5.6 in 25 years.

Post-Independent India

India became an independent nation in 1947 after remaining under foreign domination for more
than 150 years. The economic, social, religious, and political exploitation during this period
was beyond comprehension. On one side independence brought delight and joy but on the other
hand it faced problems like population explosion, retarded economic development, mass
illiteracy, and multilingual problems, etc. The Government of India set up the Planning
Commission in 1950 to prepare a plan for the most effective and balanced utilization of the
country’s resources. In all plan periods, health had a separate allocation, but it always received
a low priority. Health being a state subject led to every state having its own plan. However, the
main thrust of Centre was to start the community development programme and national
extension movement. The community development programme pledged itself towards self-
help. The concept of democratic decentralization adopted by the government theoretically
shifted the responsibility for health to the people themselves, through the Panchayat raj system.
In actual practice it was a failure, except for the opening of 725 Primary Health Centers, and
some effect on control of communicable disease.

In course of time, when the government found that recommendations of Bhore

Committee (1946) were too ambitious, it set up The Health Survey and Planning Committee,

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popularly known as Mudaliar Committee, in 1959. This Committee was set up with the
following aims:

1. To assess the progress in the field of medical relief and public health service since the
submission of the Bhore Committee report.

2. To review the progress of First and Second Five Year Plans (Health Projects).

3. To formulate recommendations for the future plan of Health Development in the Country.
The Health Survey and Planning Committee submitted its report in 1961. This report was
submitted some 15 years after the Bhore Committee, 10 years after the introduction of
programmed systematic development in the form of Five-Year Plans. The result of systematic
approach towards health care development programme has paid dividends in the field of control
of epidemic diseases such as plague, cholera, malaria, and eradication of smallpox.

FUTURE HEALTHCARE SYSTEM

Definition:
Healthcare has undergone a significant paradigm shift as a result of the confluence of these
various technologies, which exponentially increases the impact. With the help of a variety of
cutting-edge technologies, such as telemedicine, electronic medical records, home-based care
transitioning from hospital-based care, drone technology, genome sequencing, digital tools,
and artificial intelligence (AI), the healthcare sector has been transforming drastically.

Future Hospitals:
Tomorrow’s hospitals will no doubt rely more on robotics and digital technologies. Many of
the physical and mental tasks that doctors perform today will be automated via hardware,
software, and combinations of both. That will leave hospitals with more space in addition to
the space already being freed up through telemedicine and remote healthcare, which reduce the
need for patient visits.
Developing Characteristics of Future Health Care System:
• Care at Home may deliver more value and higher-quality care:
The biggest paradigm shift will be the transition from care that is predominantly provided
in hospitals and towards care that is provided at home. Innovative tools like ultra-wideband
radar technology, non-invasive sensors integrated into living environments to monitor
everyday activities, and handheld gadgets that let doctors remotely monitor ECG, pulse
oximetry, and IR skin temperature, among other things, will make this possible. In this
situation, hospitals can serve as a command center for tracking patient health as well as a
primary location for operations.
• Growing investment in the digital health market:
The pandemic highlighted the need for real-time, error-free data as well as for a healthcare
system that is technologically capable of doing so. If used wisely, artificial intelligence

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 (AI), machine learning, robotic process automation (RPA), big data analytics, block chain
technology, cloud computing, and quantum computing can completely alter the healthcare
system and elevate it to a high standard.
It can help in gaining helpful information for real-time decision-making without placing
stress on the healthcare environment.
• Growth in virtual care:
Electronic Medical Records have been a huge help in India as telehealth continues to
expand quickly. EMRs have been helpful since they can be accessed whenever needed,
which is important because the majority of patients seek a second opinion from a different
specialist.
Telehealth is a revolutionary method of communication and access to care for people and
medical professionals. Beyond episodic treatment, telehealth will continue to expand into
the management of chronic illnesses and specialty care, including mental health services.
• Internet of Things (IoT):
The influence of IOTs on the healthcare industry is enormous. The healthcare sector is
evolving globally to become a well-coordinated, user-centric, and more effective system.
The advancing technology of IoT is propelling revolutionary and life-improving solutions
throughout the healthcare industry. IoT accelerates process automation, and the benefits are
unlimited.
• Harnessing the power of drone technology:
By ensuring the timely and cost-effective conveyance of medical supplies and test samples,
drones are helping to increase access to high-quality healthcare. Drones are helpful in
overcoming connectivity issues because they can transfer items like life-saving drugs,
emergency supplies, and prescriptions to remote areas like Tier2/Tier3/Tier4 cities and
villages.
• Genome sequencing:
The accessibility of cutting-edge genome sequencing technologies like NovaSeq 6000 will
be particularly beneficial because the government has not yet implemented a widespread
screening programme for genetic disorders or rare diseases. The NovaSeq 6000 technology
provides high throughput speed and flexibility for research that require the fast and
economical processing of enormous amounts of data.
• Nanotechnology:
Ever-smaller wearable devices that can monitor our vital signs are becoming common, but
at a nanoscale, we could implant them into our bodies. Nano devices could capture
incredibly detailed data from deep within us, enabling doctors to personalize treatment.
Indeed, innovators in the field are working on this already: Proteus Digital Health, for
instance, an Anglo-American firm named after the Fantastic Voyage submarine, has
developed ingestible sensors that fit inside pills and report in real-time from within body.
Looking to the future, it’s critical that the healthcare sector maintain its attention on a single
objective: making sure that everyone, regardless of circumstances, has access to high
quality and affordable healthcare. This will become a reality thanks to advanced technology
that has been rendered even more potent by expanded mobility.

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HOSPITAL VIEWED AS A SYSTEM

A hospital can be variously described as a factory, an office building, a hotel, an eating

establishment, a medical care agency, a social service institution and a business organisation.
In fact, it is all of these in one, and more. Sometimes it is run by business means but not
necessarily for business ends. This complex character of the hospital has fascinated social
scientists as well as lay people.

Management science defines a system as “a collection of component subsystem which,

operating together, perform a set of operations in accomplishment of defined objectives.” A
system is viewed as anything formed of parts placed together or adjusted into a cohesive whole.
Every system is therefore a part of a large system and has its own subsystem.

A system is construed as having inputs which undergo certain processing and get
transformed into output, the output itself in turn sending feedback to the input and the process,
which can be altered to achieve still better output. A system is therefore a continuous and
dynamic phenomenon

Transformation of matter, energy or information produce the output by two processes,

viz. decision process, i.e., the process of deciding what to do, how best to do it, when to do it
and so on, and action process, i.e. the process of putting the above decisions in action.

ROLE OF HOSPITAL:

Changing and advancing technology with commitment to professional developments has

brought great changes in the organisational structure of the hospitals. To keep pace with the
changing environment and purpose, the role assigned to hospital administrator has changed
considerably.

Hence, the hospital administrator's role in the future will include:

• Understanding the health system operating in the country.

• Awareness of the fact that decisions on planning and programming will be taken outside
the four walls of the hospital. Types of services to be provided will depend on the
community and regional councils.

• Greater involvement of the public and professional experts in the hospital affairs.

• Dealing with conflicting demands of the hospital board staff, clientele, and community.

• Need for practical resilience.

Today the modern hospital administrator has to strike a balance between inside
management activities and outside communicator. Maintaining a positive relationship and
effective. Communication with hospitals clinicians is an internal duty. The administrator has

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to provide feedback to the management board so that they can be assured that the hospital
activities are consistent with the hospital mission.

Administrators are always under pressure to keep pace with changing times. They must
develop new skills and apply old skills to new situations. The administrator also has a major
role in educating the community about hospital matters, this role is particularly important as
consumers clamor about rising hospital costs.

The most effective administrators are visionaries. Modern hospital administrators time
and activities have changed greatly. Marketing public relations, medical staff relations and
strategic planning are some of the key activities in which they are now involved. Some areas
in which hospital effectiveness is being questioned and the influence of administrator in these
areas include: I) Costs and financing of operations 2) Sharing of power for decision making 3)
Organisational structure 4) Manpower utilisation 5) Patient care

Manpower Utilization –

Through job analysis, the skills, jobs and the knowledge required to perform existing tasks, can
be identified. This can result in a clustering of tasks into related skill and knowledge activities.
Job pathways can then be designed so that changes in output and technology can be handled
by re-arranging job structures and selecting appropriate job specifications for as

Patient Care-

The responsiveness of hospital employees can be increased by establishment of units in which

patient complaints are recorded and chronic offenders identified by confronting employees and
their supervisors with written transcripts concerning unresponsiveness, or by confronting them
with complaints and their representatives, the administrator may influence the behaviour of the
employees. Continued motivation and training of employees will have favourable influence on
their role performance.

Costs and Financing Operations-

The administrator's influence on cost, control is, at least potentially, most importantly exercised
in the budgeting process. The administrator has greater influence over expenditures for new
programmes and facilities. Substantial cost savings or increased, efficiency, however, can
probably be realised through reallocation of existing budgets, and better correlation of budgets
to unit performance and not merely to historical cost levels. Performance budgeting assumes
some quantifiable output at some given level of quality.

Cost control is seen as a legitimate administrative function by medical staff. As a

representative of the organisation as a whole, the administrator is seen a likely mediator
between conflicting demands and interests.

Sharing of Power –

The problems of the administrator increase with the number of bargaining units and the number
of the unions in any one hospital. Negotiating with unions on an inter hospital basis may result

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in individual hospitals securing the most expert representatives and is not being -'whipsawed"
by unions.

Organisational Structure-

Structure refers to the organisation of tasks or task groups in units, of units in the organisation
as a whole. The administrator can influence the development and implementation of formal
programme of coordination.

Because of increased specialization, changing technology, and increased expectation of

consumers and employees the hospitals require increased coordination and organisational
adaptability. The administrator's expertise is that of an integrator structuring the perceptions
among producers, and between producers and consumers, so that chain can be affected without
destroying organisational integration. The administrator requires authority appropriate to this
responsibility.

HOSPITAL AS A SOCIAL SYSTEM

Sociologists have considered hospital as a social system based on bureaucracy, hierarchy and
superordination subordination. A hospital manifests characteristic of a bureaucratic
organisation with dual lines of authority, viz. Administrative and Professional. In teaching
hospitals and in some others, many professionals at the lower and middle level (interns, junior
resident, senior residents, registrar) are transitory, while as in others, all medical professionals
are permanent with tenured positions and non-transferable jobs. In order to continue in an
orderly fashion, every social system has to fulfil the functional needs of that system, viz. the
need for pattern maintenance, the need for adaptation, for goal attainment and integration.

In a hospital system, the patients’ needs determine the interactions within the system.
When a patient is cured and discharged, in his or her place a new patient is admitted. This new
patient also demands all the attention and skills of doctors, nurses and others, thus, forcing the
essential and separative components into immediate action, repeatedly as each patient is
admitted. Free upward and lateral communication is an important characteristic of any system.

So far as communication within the hospital system is concerned, in fact there is

considerable restriction in communication among people in the hospital. Doctors communicate
freely with doctors, nurses with nurses and patients with each other (if not too ill) and with
their relatives, but there is little communication between these groups at the non-formal level.

In the course of interaction among the various units of a hospital social system, tensions
and conflicts emerge. These strains have to be dealt with effectively if the system is to function
properly. The system has to develop mechanisms of tension management to cope with such
strains.

Integration deals with the problem of morale and solidarity in the hospital social system.
Morale is necessary both for integration as well as pattern maintenance. Integration has to be

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achieved at the micro level. It involves the development of loyalty to the system, to its other
members and the values for which the system stands.

Need for pattern maintenance acts as a barrier to upward or lateral mobility of the staff.
One occupational group cannot be promoted to the other group, e.g., laboratory technician
cannot become nurse and nurses cannot become doctors.

In general, there is a trend in bureaucratisation of hospitals, in which hospitals are seen

to work towards achieving their goals through reliance upon such structural devices as systems
of division of labour, an elaborate hierarchy of authority, formal channels of communication,
and sets of policies, rules and regulations.

The two lines of authority (viz. administrative and professional) come into conflict,
because each group has a different set of values. One is concerned with the maintenance of
organisation and the other with providing medical expertise. This leads to interpersonal stress.
A system that operates through multiple subordination subjects the subordinates to multiple
orders which are often inconsistent with one another.

As a component part of health system, the first task of the hospital is to reach people
all the time at a cost the community can afford. The concept of hospital as the centre of
preventive medicine has enlarged its role enormously. The primary task of the hospitals is the
provision of medical care to a community. However, the hospital has two other important roles
to fulfil—to be a centre for the education of all types of health workers, doctors, nurses,
midwives and technicians and for the health education of the people.

The growing realisation of the thin line of distinction between health and disease, the
important relationship between social and material environment, its effects on the individual’s
physical and mental well-being, the increasing demands for a better standard of living and
health awareness of the people have all had a significant effect on hospital system and the trend
of services provided by hospitals.

PECULIARITIES OF HOSPITAL

The Special Needs or the Peculiarity of a Hospital –

The hospital as social institution facilitates interaction of a wide spectrum of the society
from ' varied cultural and socio-economic stratum. The hospital is a media, through which the
scientific technological innovation of Medical Sciences is put into operation and practiced for
healthful living of the community. The peculiarities of a hospital as an organisation are:

a) The product of the hospital is 'service' which cannot be qualified in any economic terms and
no objective criteria can be laid down to evaluate the standard of services.

b) 'The service in the hospital is always personalised, professional and directly rendered by the
medical, nursing and other specialised personnel according to the needs and requirement of
each case or client. As such the hospital service cannot be mechanised. Standardized or pre-

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planned to meet the specific need. The hospital service is a term work rather than an individual
service.

c) The hospital service is-normally emergent in nature and no two situations are similar needing
the same treatment. So, the Hospital Administration cannot always be preplanned in micro
level implementation, with straightjacket formula. It is more often in management by crisis
than management by objective.

d) The wide spectrum of people involved in the hospital activity ranges from the highly skilled
professional to the man who may not have visited a school. Therefore, the management of this
varied group of people calls for a balanced psychosocial approach. Role of Hospitals

e) The dual control by way of professional authority and the executive authority in the Hospital
invariably leads to management conflict which is a peculiar situation every hospital
administrator has to face in the day-to-day operation.

f) Of late the hospital being treated as industry for profit as well for maximization of the output
with minimal input has led to application of management tools and techniques for its
administration.

In view of this peculiar nature the hospital administration is a multidisciplinary approach. It is

an art of application of the principles of public administration, behavioural science and the
modern management skill, in the milieu of scientific medicine to observe the objectives of the
hospitals.

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