mba - pharma healthcare que-ans

7/31/2019 MBA - Pharma Healthcare Que-Ans

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1..What is the Role of Public and Private Sector in Healthcare?

DEFINING "PUBLIC" AND "PRIVATE"

The terms public and private, although not precise, are often used as descriptors for health-

care systems. In general, public refers to government involvement, while private may referto involvement by businesses, charitable organizations or individuals. This categorization isillustrated in Table 1.

Table 1

Categories of Public and Private

Category Levels

Public Nation

Province or state

Region

Local

Private Corporate/for-profit

Smallbusiness/entrepreneurial

Charity/non-profit(paid employees orvolunteers)

Family/personal

Source: Raisa Deber etal., The Public-Private Mix in Health Care, Striking a Balance: HealthCare Systems in Canada and Elsewhere, paper commissioned by the National Forum on Health,MultiMondes, 1998, p. 433.

Although Table 1 presents the public and private sectors as separate entities, the two are oftenclosely related. For example, even when hospital services are delivered by charitableorganizations (the private sector), the responsibility to do so is typically delegated by thegovernment (the public sector). Governments frequently regulate private-sector involvement, aswith the German Sickness Funds, or they may provide additional funding, as with the substantialgovernment (public) subsidization of the U.S. health-care system, which is typically described asprivate.
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THE ROLE OF THE PUBLIC SECTOR IN HEALTH CARE

Public-sector involvement in health care dates back to 1883 when compulsory sickness insurancewas introduced in Germany for some categories of workers. This established the first model ofmandatory health-care insurance in the Western world. Almost all industrialized countries now

have health-care systems in which there is a high level of public-sectorinvolvement. Nonetheless, there is little consensus between economists about the precise rolethat the public sector should play in financing and delivering health care. Some of the argumentsfor public-sector involvement in health care include social justice, restriction of monopolies,redistribution and public goods.(3)These arguments may overlap.

The social justice argument applies to situations in which the provision of health services to oneperson is advantageous for other members of society. For example, the treatment of aninfectious disease provides a broad societal benefit. From a social standpoint, public-sectordelivery of these types of health services may be preferred to private-sector delivery becausewhen the price of a service is determined privately, it may not incorporate the positive external

social benefits of delivering it. As a result, the price may be higher when it is determinedprivately. If the price exceeds what people can afford, or are willing, to pay, they will forego thetreatment. This may have undesirable social consequences. For example, an infectious diseasemay spread to a broad segment of society.

The second argument is that government involvement in health care prevents health-careproviders from exercising a monopoly. In a health-care monopoly, the medical profession is ableto control access to training or impose restrictions on medical substitutes. This can restrict theavailability of services.

The redistribution argument asserts that public-sector involvement permits the redistribution of

funds from people who are in good health to people who are in poor health. Individuals are notequally afflicted with health problems. People with unhealthy lifestyles or dangerous jobs, forexample, have a higher risk of developing health problems. In a private insurance system, thesepeople would pay a higher premium, but in a public insurance system, the risks are pooled andeveryone pays the same premium, regardless of the risk for filing a claim. In the public model,insurance must be mandatory, otherwise those at low risk would almost certainly opt out. In theprivate model, insurance is voluntary and insurers may choose who they wish to insure. In somecases, people in poor health may have difficulty finding an insurer who is willing to coverthem. Figure 1 depicts the health-care funding, risk pooling, and insurance coverage patterns inselected countries.

The public goods argument in favour of public-sector involvement in health care suggests thathealth care is a public good in the sense that it cannot be managed by market mechanismsbecause it is impossible to exclude people who have not paid from consuming it.(4)Clean airand military defence are two other examples of public goods. There is a consensus thatgovernments have a legitimate economic role and responsibility to fund and deliver publicgoods.
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Figure 1

Funding, Risk Pooling and Insurance Coverage

Source: World Health Organization, The World Health Report 1999, WHO, 1999, p. 41.

In recent years, concerns about cost containment, quality, and accessibility to health serviceshave prompted calls for health-care reform in many countries. As a means of addressing theseconcerns, public-sector involvement in health care has decreased, permitting increased

involvement by the private sector in health care in many countries. Proponents argue thatprivate-sector involvement in health-care systems encourages greater efficiency, innovation,consumer choice, and client responsiveness.(5)However, Deber et al. argue:

Most reasons advanced in favour of allowing competing insurers or financers appear to be basedon ideology rather than evidence. The primary justification is usually based on the assumptionsthat markets promote efficiency and that competition is more responsive to innovation andpatient choice. There is good justification for these arguments when speaking of delivery, butnone when speaking of financing.(6)

Other critics argue that greater private-sector involvement will lead to inequities in access and

eroded standards of care.(7)

THE ORGANIZATION OF HEALTH-CARE SYSTEMS

In its simplest form, a health-care system contains two components: financing anddelivery. Financing refers to the generation of funds to pay for health services, while deliveryrefers to the provision of health services. Financing and delivery can be carried out in the publicsector, the private sector, or both. As such, a variety of financing and delivery options are
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available. Table 2 illustrates the possible combinations for public- and private-sectorinvolvement in financing and delivering health care, drawing on examples from the OECDcountries. A more detailed discussion of these options follows.

The precise organization of a health-care system is much more complex than Table 2

implies. Most countries use a mix of financing and delivery options from both the public and theprivate sector, although the private-sector component is typically small. As Deber et al. pointout, Virtually every country employs some combination of financing and delivery models,

relying on various public-private combinations in various sectors of the health-care system or forvarious groups of the nations population.(8)Moreover, health-care systems are dynamic;changing needs, new policy directions, and medical developments may all necessitate health-carereform. As a result, it is quite difficult to place health-care systems into static compartments.

Table 2

Private- and Public-Sector Involvement in Health Care

DELIVERYPublic Private

FINANCING

Public

Insurance and servicedelivery are handled by asingle public agency.

Norway, Sweden,Denmark, Finland

The public pays for servicesthrough taxes or social securityand the services are providedby private agencies(commercial or non-profit).

Canada, Japan, Germany,France, United Kingdom

Private

The cost is charged

directly to users (throughinsurance or out-of-pocket payments) butservices are provided inpublic facilities.

To our knowledge, nogood examples of thissystem exist.

Health care is funded by

private insurance or paid fordirectly by the patient and isprovided in private facilities.

United States

Q.2 Explain the concept ofIndian Medical Tourism

The concept of medical tourism is not a new one. The first recorded instance of medical tourismdates back thousands of years to whenGreekpilgrims traveled from all over theMediterranean
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to the small territory in theSaronic GulfcalledEpidauria. This territory was the sanctuary of thehealing godAsklepios. Epidauria became the original travel destination for medical tourism.

Spa townsandsanitariumsmay be considered an early form of medical tourism. In eighteenthcentury England, for example, patients visitedspasbecause they were places with supposedly

health-givingmineral waters, treating diseases fromgouttoliverdisorders andbronchitis.

[3]

Medical tourism (also called medical travel, health tourism or global healthcare) is a terminitially coined bytravel agenciesand themass mediato describe the rapidly-growing practice oftravelling across international borders to obtainhealth care. It also refers pejoratively to thepractice of healthcare providers travelling internationally to deliver healthcare.

[1][2]

Services typically sought by travelers include elective procedures as well as complex specializedsurgeriessuch asjoint replacement(knee/hip),cardiac surgery,dental surgery, andcosmetic

surgeries. However, virtually every type of health care, including psychiatry, alternativetreatments, convalescent care and even burial services are available.

Over 50 countries have identified medical tourism as a national industry.[3]However,accreditationand other measures of quality vary widely across the globe, and some destinationsmay become hazardous or even dangerous for medical tourists.

In the context of global health, "medical tourism" is a pejorative because during such trips healthcare providers often practice outside of their areas of expertise or hold different (i.e., lower)standards of care.[4][5]Greater numbers than ever before of student volunteers, health professionstrainees, and researchers from resource-rich countries are working temporarily and anticipating

future work in resource-starved areas.[5][6]

This emphasizes the importance of understanding thisother definition.

OR

What is Medical Tourism?

It is the term used to describe the situation of patients travelling across international borders toobtain health care. Medical tourism is also called health tourism or medical travel or globalhealth care.

Why people are travelling as medical tourists?

There are many reasons for patients to travel across the globe to get medical treatment likeAmericans travel due to high medical cost in their homeland, while Canadians travel to get ridoff their long medical waiting time, since their average medical waiting time is 9.4 weeks to gettheir treatment done. The English patients travel to other places because they cant wait fortreatment by the National Health Service or cant afford to see a physician in private practice, for
http://en.wikipedia.org/wiki/Saronic_Gulfhttp://en.wikipedia.org/wiki/Saronic_Gulfhttp://en.wikipedia.org/wiki/Saronic_Gulfhttp://en.wikipedia.org/w/index.php?title=Epidauria&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Epidauria&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Epidauria&action=edit&redlink=1http://en.wikipedia.org/wiki/Asklepioshttp://en.wikipedia.org/wiki/Asklepioshttp://en.wikipedia.org/wiki/Asklepioshttp://en.wikipedia.org/wiki/Spa_townhttp://en.wikipedia.org/wiki/Spa_townhttp://en.wikipedia.org/wiki/Sanatoriumhttp://en.wikipedia.org/wiki/Sanatoriumhttp://en.wikipedia.org/wiki/Sanatoriumhttp://en.wikipedia.org/wiki/Spa_townhttp://en.wikipedia.org/wiki/Spa_townhttp://en.wikipedia.org/wiki/Spa_townhttp://en.wikipedia.org/wiki/Mineral_waterhttp://en.wikipedia.org/wiki/Mineral_waterhttp://en.wikipedia.org/wiki/Mineral_waterhttp://en.wikipedia.org/wiki/Gouthttp://en.wikipedia.org/wiki/Gouthttp://en.wikipedia.org/wiki/Gouthttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Bronchitishttp://en.wikipedia.org/wiki/Bronchitishttp://en.wikipedia.org/wiki/Medical_tourism#cite_note-Gahlinger2008-2http://en.wikipedia.org/wiki/Medical_tourism#cite_note-Gahlinger2008-2http://en.wikipedia.org/wiki/Medical_tourism#cite_note-Gahlinger2008-2http://en.wikipedia.org/wiki/Travel_agencyhttp://en.wikipedia.org/wiki/Travel_agencyhttp://en.wikipedia.org/wiki/Travel_agencyhttp://en.wikipedia.org/wiki/Mass_mediahttp://en.wikipedia.org/wiki/Mass_mediahttp://en.wikipedia.org/wiki/Mass_mediahttp://en.wikipedia.org/wiki/Health_carehttp://en.wikipedia.org/wiki/Health_carehttp://en.wikipedia.org/wiki/Health_carehttp://en.wikipedia.org/wiki/Medical_tourism#cite_note-0http://en.wikipedia.org/wiki/Medical_tourism#cite_note-0http://en.wikipedia.org/wiki/Medical_tourism#cite_note-0http://en.wikipedia.org/wiki/Surgeryhttp://en.wikipedia.org/wiki/Surgeryhttp://en.wikipedia.org/wiki/Joint_replacementhttp://en.wikipedia.org/wiki/Joint_replacementhttp://en.wikipedia.org/wiki/Joint_replacementhttp://en.wikipedia.org/wiki/Knee_replacementhttp://en.wikipedia.org/wiki/Knee_replacementhttp://en.wikipedia.org/wiki/Hip_replacementhttp://en.wikipedia.org/wiki/Hip_replacementhttp://en.wikipedia.org/wiki/Hip_replacementhttp://en.wikipedia.org/wiki/Cardiac_surgeryhttp://en.wikipedia.org/wiki/Cardiac_surgeryhttp://en.wikipedia.org/wiki/Cardiac_surgeryhttp://en.wikipedia.org/wiki/Dental_surgeryhttp://en.wikipedia.org/wiki/Dental_surgeryhttp://en.wikipedia.org/wiki/Dental_surgeryhttp://en.wikipedia.org/wiki/Cosmetic_surgeryhttp://en.wikipedia.org/wiki/Cosmetic_surgeryhttp://en.wikipedia.org/wiki/Cosmetic_surgeryhttp://en.wikipedia.org/wiki/Cosmetic_surgeryhttp://en.wikipedia.org/wiki/Medical_tourism#cite_note-Gahlinger2008-2http://en.wikipedia.org/wiki/Medical_tourism#cite_note-Gahlinger2008-2http://en.wikipedia.org/wiki/Medical_tourism#cite_note-Gahlinger2008-2http://en.wikipedia.org/wiki/Accreditationhttp://en.wikipedia.org/wiki/Accreditationhttp://en.wikipedia.org/wiki/Medical_tourism#cite_note-3http://en.wikipedia.org/wiki/Medical_tourism#cite_note-3http://en.wikipedia.org/wiki/Medical_tourism#cite_note-3http://en.wikipedia.org/wiki/Medical_tourism#cite_note-Pinto.2C_A.D._2009-4http://en.wikipedia.org/wiki/Medical_tourism#cite_note-Pinto.2C_A.D._2009-4http://en.wikipedia.org/wiki/Medical_tourism#cite_note-Pinto.2C_A.D._2009-4http://en.wikipedia.org/wiki/Medical_tourism#cite_note-Pinto.2C_A.D._2009-4http://en.wikipedia.org/wiki/Medical_tourism#cite_note-Pinto.2C_A.D._2009-4http://en.wikipedia.org/wiki/Medical_tourism#cite_note-3http://en.wikipedia.org/wiki/Medical_tourism#cite_note-3http://en.wikipedia.org/wiki/Accreditationhttp://en.wikipedia.org/wiki/Medical_tourism#cite_note-Gahlinger2008-2http://en.wikipedia.org/wiki/Cosmetic_surgeryhttp://en.wikipedia.org/wiki/Cosmetic_surgeryhttp://en.wikipedia.org/wiki/Dental_surgeryhttp://en.wikipedia.org/wiki/Cardiac_surgeryhttp://en.wikipedia.org/wiki/Hip_replacementhttp://en.wikipedia.org/wiki/Knee_replacementhttp://en.wikipedia.org/wiki/Joint_replacementhttp://en.wikipedia.org/wiki/Surgeryhttp://en.wikipedia.org/wiki/Medical_tourism#cite_note-0http://en.wikipedia.org/wiki/Medical_tourism#cite_note-0http://en.wikipedia.org/wiki/Health_carehttp://en.wikipedia.org/wiki/Mass_mediahttp://en.wikipedia.org/wiki/Travel_agencyhttp://en.wikipedia.org/wiki/Medical_tourism#cite_note-Gahlinger2008-2http://en.wikipedia.org/wiki/Bronchitishttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Gouthttp://en.wikipedia.org/wiki/Mineral_waterhttp://en.wikipedia.org/wiki/Spa_townhttp://en.wikipedia.org/wiki/Sanatoriumhttp://en.wikipedia.org/wiki/Spa_townhttp://en.wikipedia.org/wiki/Asklepioshttp://en.wikipedia.org/w/index.php?title=Epidauria&action=edit&redlink=1http://en.wikipedia.org/wiki/Saronic_Gulf


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others either they want to combine their vocation and treatment together or non availability ofhealthcare service in their home country like in Maldives or Bangladesh.

Many countries like India, Singapore, South Africa, Malaysia, Thailand, Sri Lanka, etc., areactively promoting medical tourism.

Medical Tourism in India

India is considered the leading country promoting medical tourism and Indias National Health

Policy declares that treatment of foreign patients is legally an "export" and deemed "eligible forall fiscal incentives extended to export earnings. Super specialty hospitals played a pivotal rolein the success of Medical tourism in India.

Almost every hospital in India has NRI (non resident Indian) patients and even patients offoreign countries. High cost of treatment in the developed countries like USA and UK, has beenforcing patient from such countries to look for alternative and cost-effective destinations to get

their treatments done. Virtually every type of treatment is available in India for lower cost andshorter rehabilitation period.

According to the research done by the University of Delaware, the cost of surgery done in Indiacan be one-tenth or sometimes even less than that of what is it in the USA or western Europe.For example, a heart-valve replacement that would cost $200,000 or more in US, goes for$10,000 in India.

Q.4 What are the Legal Issues for Hospital Administrators

Biomedical Waste Management: An Infrastructural

Survey of Hospitals

Biomedical waste consists of solids, liquids, sharps, and laboratory waste that are potentiallyinfectious or dangerous and are consideredbiowaste. It must be properly managed to protect thegeneral public, specifically healthcare and sanitation workers who are regularly exposed to

biomedical waste as an occupational hazard.

Biomedical waste differs from other types ofhazardous waste, such asindustrial waste, in that itcomes from biological sources or is used in the diagnosis, prevention, or treatment of diseases.Common producers of biomedical waste includehospitals,health clinics,nursing homes,medical researchlaboratories, offices ofphysicians,dentists, andveterinarians,home health care,andfuneral homes.
http://en.wikipedia.org/wiki/Biowastehttp://en.wikipedia.org/wiki/Biowastehttp://en.wikipedia.org/wiki/Biowastehttp://en.wikipedia.org/wiki/Hazardous_wastehttp://en.wikipedia.org/wiki/Hazardous_wastehttp://en.wikipedia.org/wiki/Hazardous_wastehttp://en.wikipedia.org/wiki/Industrial_wastehttp://en.wikipedia.org/wiki/Industrial_wastehttp://en.wikipedia.org/wiki/Industrial_wastehttp://en.wikipedia.org/wiki/Hospitalhttp://en.wikipedia.org/wiki/Hospitalhttp://en.wikipedia.org/wiki/Hospitalhttp://en.wikipedia.org/wiki/Health_clinichttp://en.wikipedia.org/wiki/Health_clinichttp://en.wikipedia.org/wiki/Health_clinichttp://en.wikipedia.org/wiki/Nursing_homehttp://en.wikipedia.org/wiki/Nursing_homehttp://en.wikipedia.org/wiki/Nursing_homehttp://en.wikipedia.org/wiki/Medical_researchhttp://en.wikipedia.org/wiki/Laboratorieshttp://en.wikipedia.org/wiki/Laboratorieshttp://en.wikipedia.org/wiki/Laboratorieshttp://en.wikipedia.org/wiki/Physicianhttp://en.wikipedia.org/wiki/Physicianhttp://en.wikipedia.org/wiki/Physicianhttp://en.wikipedia.org/wiki/Dentisthttp://en.wikipedia.org/wiki/Dentisthttp://en.wikipedia.org/wiki/Dentisthttp://en.wikipedia.org/wiki/Veterinarianhttp://en.wikipedia.org/wiki/Veterinarianhttp://en.wikipedia.org/wiki/Veterinarianhttp://en.wikipedia.org/wiki/Home_health_carehttp://en.wikipedia.org/wiki/Home_health_carehttp://en.wikipedia.org/wiki/Home_health_carehttp://en.wikipedia.org/wiki/Funeral_homehttp://en.wikipedia.org/wiki/Funeral_homehttp://en.wikipedia.org/wiki/Funeral_homehttp://en.wikipedia.org/wiki/Funeral_homehttp://en.wikipedia.org/wiki/Home_health_carehttp://en.wikipedia.org/wiki/Veterinarianhttp://en.wikipedia.org/wiki/Dentisthttp://en.wikipedia.org/wiki/Physicianhttp://en.wikipedia.org/wiki/Laboratorieshttp://en.wikipedia.org/wiki/Medical_researchhttp://en.wikipedia.org/wiki/Nursing_homehttp://en.wikipedia.org/wiki/Health_clinichttp://en.wikipedia.org/wiki/Hospitalhttp://en.wikipedia.org/wiki/Industrial_wastehttp://en.wikipedia.org/wiki/Hazardous_wastehttp://en.wikipedia.org/wiki/Biowaste


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Components

The following is a list of materials that are generally considered biomedical waste:

Solids

Cathetersand tubes[1]

Disposablegowns,masks,[1]

andscrubs

Disposable tools, such as somescalpelsand surgical staplers

Medical gloves[1][2]

Surgical suturesandstaples

Wound dressings[1]

Liquids

Blood[1][2]

Body fluids and tissues[1][2] Cell,organ,

[1]andtissue[1]cultures

Sharps

Blades, such asrazororscalpelblades[1][2]

Lancets[1][3]

Materials made of glass, such ascuvettesandslides[1][2]

Metalstylets

Needles[1][2]

Plasticpipettesand tips[1][2]

Syringes[2]

Laboratory waste

Animal carcasses[1][2]

Hazardous chemicals with biological components[2]

Media[2]

Medicinal plants

Radioactivematerial with biological components[2]

Supernatants[2]

Syringes

Biomedical Waste Management

Sorting of medical wastes in hospital.At the site where it is generated, biomedical waste is placedin specially-labelled bags and containers for removal by biomedical waste transporters. Otherforms of waste should not be mixed with biomedical waste as different rules apply to thetreatment of different types of waste.
http://en.wikipedia.org/wiki/Cathetershttp://en.wikipedia.org/wiki/Cathetershttp://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Hospital_gownhttp://en.wikipedia.org/wiki/Hospital_gownhttp://en.wikipedia.org/wiki/Hospital_gownhttp://en.wikipedia.org/wiki/Mask#Medicalhttp://en.wikipedia.org/wiki/Mask#Medicalhttp://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Scrubs_%28clothing%29http://en.wikipedia.org/wiki/Scrubs_%28clothing%29http://en.wikipedia.org/wiki/Scrubs_%28clothing%29http://en.wikipedia.org/wiki/Scalpelhttp://en.wikipedia.org/wiki/Scalpelhttp://en.wikipedia.org/wiki/Scalpelhttp://en.wikipedia.org/wiki/Medical_gloveshttp://en.wikipedia.org/wiki/Medical_gloveshttp://en.wikipedia.org/wiki/Biomedical_waste#cite_note-MIT-1http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-MIT-1http://en.wikipedia.org/wiki/Surgical_suturehttp://en.wikipedia.org/wiki/Surgical_suturehttp://en.wikipedia.org/wiki/Surgical_staplehttp://en.wikipedia.org/wiki/Surgical_staplehttp://en.wikipedia.org/wiki/Surgical_staplehttp://en.wikipedia.org/wiki/Dressing_%28medical%29http://en.wikipedia.org/wiki/Dressing_%28medical%29http://en.wikipedia.org/wiki/Dressing_%28medical%29http://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Biomedical_waste#cite_note-MIT-1http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-MIT-1http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Cell_culturehttp://en.wikipedia.org/wiki/Cell_culturehttp://en.wikipedia.org/wiki/Organ_culturehttp://en.wikipedia.org/wiki/Organ_culturehttp://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Tissue_culturehttp://en.wikipedia.org/wiki/Tissue_culturehttp://en.wikipedia.org/wiki/Tissue_culturehttp://en.wikipedia.org/wiki/Tissue_culturehttp://en.wikipedia.org/wiki/Razorhttp://en.wikipedia.org/wiki/Razorhttp://en.wikipedia.org/wiki/Razorhttp://en.wikipedia.org/wiki/Scalpelhttp://en.wikipedia.org/wiki/Scalpelhttp://en.wikipedia.org/wiki/Scalpelhttp://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Cuvettehttp://en.wikipedia.org/wiki/Cuvettehttp://en.wikipedia.org/wiki/Cuvettehttp://en.wikipedia.org/wiki/Microscope_slidehttp://en.wikipedia.org/wiki/Microscope_slidehttp://en.wikipedia.org/wiki/Microscope_slidehttp://en.wikipedia.org/wiki/Biomedical_waste#cite_note-MIT-1http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-MIT-1http://en.wiktionary.org/wiki/stylethttp://en.wiktionary.org/wiki/stylethttp://en.wiktionary.org/wiki/stylethttp://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Pipettehttp://en.wikipedia.org/wiki/Pipettehttp://en.wikipedia.org/wiki/Pipettehttp://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Syringehttp://en.wikipedia.org/wiki/Syringehttp://en.wikipedia.org/wiki/Syringehttp://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-MIT-1http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-MIT-1http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-MIT-1http://en.wikipedia.org/wiki/Growth_mediumhttp://en.wikipedia.org/wiki/Growth_mediumhttp://en.wikipedia.org/wiki/Growth_mediumhttp://en.wikipedia.org/wiki/Medicinal_plantshttp://en.wikipedia.org/wiki/Medicinal_plantshttp://en.wikipedia.org/wiki/Radioactivehttp://en.wikipedia.org/wiki/Radioactivehttp://en.wikipedia.org/wiki/Biomedical_waste#cite_note-MIT-1http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-MIT-1http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-MIT-1http://en.wikipedia.org/wiki/Supernatanthttp://en.wikipedia.org/wiki/Supernatanthttp://en.wikipedia.org/wiki/Supernatanthttp://en.wikipedia.org/wiki/Supernatanthttp://en.wikipedia.org/wiki/Supernatanthttp://en.wikipedia.org/wiki/Biomedical_waste#cite_note-MIT-1http://en.wikipedia.org/wiki/Radioactivehttp://en.wikipedia.org/wiki/Medicinal_plantshttp://en.wikipedia.org/wiki/Growth_mediumhttp://en.wikipedia.org/wiki/Growth_mediumhttp://en.wikipedia.org/wiki/Biomedical_waste#cite_note-MIT-1http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Syringehttp://en.wikipedia.org/wiki/Syringehttp://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Pipettehttp://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wiktionary.org/wiki/stylethttp://en.wikipedia.org/wiki/Biomedical_waste#cite_note-MIT-1http://en.wikipedia.org/wiki/Microscope_slidehttp://en.wikipedia.org/wiki/Microscope_slidehttp://en.wikipedia.org/wiki/Cuvettehttp://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Scalpelhttp://en.wikipedia.org/wiki/Razorhttp://en.wikipedia.org/wiki/Tissue_culturehttp://en.wikipedia.org/wiki/Tissue_culturehttp://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Organ_culturehttp://en.wikipedia.org/wiki/Cell_culturehttp://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-MIT-1http://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Dressing_%28medical%29http://en.wikipedia.org/wiki/Dressing_%28medical%29http://en.wikipedia.org/wiki/Surgical_staplehttp://en.wikipedia.org/wiki/Surgical_suturehttp://en.wikipedia.org/wiki/Biomedical_waste#cite_note-MIT-1http://en.wikipedia.org/wiki/Medical_gloveshttp://en.wikipedia.org/wiki/Medical_gloveshttp://en.wikipedia.org/wiki/Scalpelhttp://en.wikipedia.org/wiki/Scrubs_%28clothing%29http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Mask#Medicalhttp://en.wikipedia.org/wiki/Hospital_gownhttp://en.wikipedia.org/wiki/Biomedical_waste#cite_note-ME-0http://en.wikipedia.org/wiki/Catheters


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Household biomedical waste usually consists of needles and syringes from drugs administered athome (such asinsulin), soiledwound dressings, disposable gloves, and bedsheets or other clothsthat have come into contact with bodily fluids.

[3]Disposing of these materials with regular

household garbage putswaste collectorsat risk for injury and infection especially from sharps asthey can easily puncture a standard household garbage bag. Many communities have programs in

place for the disposal of household biomedical waste. Some waste treatment facilities also havemail-in disposal programs. Biomedical waste treatment facilities are licensed by the localgoverning body which maintains laws regarding the operation of these facilities. The laws ensurethat the general public is protected from contamination of air, soil,groundwater, or municipalwater supply. One company,BioMedical Technology Solutions, Inc., offers a green alternativeto haul-away services for disposal of biomedical waste. The Company's desktop unit, theDemolizer II, is the only patented, portable, and self-contained system able to process bothsharps and typical red bag biomedical waste onsite. Upon processing the biomedical waste in theunit, all regulatory paperwork is printed from the system and the waste is able to be disposed ofas common trash.

Protection from Biomedical Waste

Wash your hands with soap and warm water after handling biomedical waste. Also, wash allareas of your body with soap and water that you think may have come into contact withbiomedical waste, even if you are not sure your body actually touched the biomedical waste.

Keep all sores and cuts covered. Immediately replace wet bandages with clean, dry bandages. Wear disposable latex gloves when handling biomedical waste. Discard the gloves

immediately after use. Wear an apron or another type of cover to protect your clothes from contact with the

waste. If your clothes become soiled, put on fresh clothes, and take a shower, if possible. Launder or throw away clothes soiled with biomedical waste. Promptly clean and disinfect soiled, hard-surfaced floors by using a germicidal or bleach

solution and mopping up with paper towels. Clean soiled carpets. First blot up as much of the spill as possible with paper towels and

put the soiled paper towels in a plastic lined, leak-proof container. Then try one of thefollowing:

Steam clean the carpet with an extraction method. Scrub the carpet with germicidal rug shampoo and a brush. Soak the brush used for

scrubbing in a disinfectant solution and rinse the brush. Let the carpet dry, and thenvacuum it.

Never handle syringes, needles, or lancets with your hands. Use a towel, shovel, and/orbroom and a dustpan to pick up these sharp objects. Dispose of them in a plastic soda popbottle with a cap. Tape down the bottle cap. Then throw the bottle in the trash.

OR
http://en.wikipedia.org/wiki/Insulinhttp://en.wikipedia.org/wiki/Insulinhttp://en.wikipedia.org/wiki/Insulinhttp://en.wikipedia.org/wiki/Dressing_%28medical%29http://en.wikipedia.org/wiki/Dressing_%28medical%29http://en.wikipedia.org/wiki/Dressing_%28medical%29http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-FL-2http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-FL-2http://en.wikipedia.org/wiki/Biomedical_waste#cite_note-FL-2http://en.wikipedia.org/wiki/Waste_collectorhttp://en.wikipedia.org/wiki/Waste_collectorhttp://en.wikipedia.org/wiki/Waste_collectorhttp://www.bmtscorp.com/http://www.bmtscorp.com/http://www.bmtscorp.com/http://bmtscorp.com/brochures.htmhttp://bmtscorp.com/brochures.htmhttp://bmtscorp.com/brochures.htmhttp://www.bmtscorp.com/http://en.wikipedia.org/wiki/Waste_collectorhttp://en.wikipedia.org/wiki/Biomedical_waste#cite_note-FL-2http://en.wikipedia.org/wiki/Dressing_%28medical%29http://en.wikipedia.org/wiki/Insulin


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Introduction

Hospital is one of the complex institutions which isfrequented by people from every walk of life in thesociety without any distinction between age, sex, raceand religion. This is over and above the normal inhabitantsof hospital i.e patients and staff. All of them producewaste which is increasing in its amount and type due toadvances in scientific knowledge and is creating itsimpact [1]. The hospital waste, in addition to the risk forpatients and personnel who handle these wastes posesa threat to public health and environment [2]. Keepingin view inappropriate biomedical waste management,

the Ministry of Environment and Forests notified theBiomedical Waste (management and handling) Rules,1998 in July 1998. In accordance with these Rules (Rule4), it is the duty of every occupier i.e a person whohas the control over the institution and or its premises,to take all steps to ensure that waste generated ishandled without any adverse effect to human health andenvironment. The hospitals, nursing homes, clinic,dispensary, animal house, pathological lab etc., aretherefore required to set in place the biological wastetreatment facilities. It is however not incumbent thatevery institution has to have its own waste treatment

facility. The rules also envisage that common facility orany other facilities can be used for waste treatment.However it is incumbent on the occupier to ensure thatthe waste is treated within a period of 48 hours.

Biomedical Waste Management Process

Handling, segregation, mutilation, disinfection, storage,transportation and final disposal are vital steps for safeand scientific management of biomedial waste in anyestablishment [3]. The key to minimisation and effectivemanagement of biomedical waste is segregation(separation) and identification of the waste. The mostappropriate way of identifying the categories ofbiomedical waste is by sorting the waste into colourcoded plastic bags or containers. Biomedical waste

MJAFI, Vol. 60, No. 4, 2004

380 Rao et al

incineration, autoclave, hydroclave or microwave.

Cost of Biomedical Waste Management


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The cost of construction, operation and maintenanceof system for managing biomedical waste represents asignificant part of overall budget of a hospital if the BMWhandling rules 1998 have to be implemented in their truespirit. Govt of India in its pilot project for hospital wastemanagement in Govt hospitals has estimated Rs.85 lakh

as capital cost in 1000 bedded super speciality teachinghospital which includes on site final disposal of BMW.Two types of costs are required to be incurred byhospitals for BMW mgt, internal and external. Internalcost is the cost for segregation, mutilation, disinfection,internal storage and transportation including hidden costof protective equipment. External cost involves off sitetransport of waste, treatment and final disposal [5].

Recommendations1. After analysing the results of the study it was feltthat there is an urgent need to standardise the

infrastructural requirement so that hospitals followingBMW handling rules meticulously do not suffer additionalcosts.2. Hospitals having defunct / defective incineratorsshould be made to utilise central incineration facility asefforts of Govt are towards reducing the number ofincinerators in cities to prevent rise in air pollution.3. Small health care establishments in city which havestill not registered with central facility should beencouraged to register thereby bringing down theoperating cost of contractor and decrease the cost ofincineration per kg.

4. Govt hospitals which at present are totally left ontheir own, should be brought into net of rigorous checkingas far as BMW management is concerned and a corpusgrant can be allotted to them to improve theirinfrastructural requirements for which provision existsin Govt of India Rules.5. Community is utilising the services of hospitals and

by Polluter Pays principle, it needs to contribute inbuilding infrastructure for BMW mgt. This contributioncan be in the form of assistance in sharing the cost ofconsumables and capital cost of BMW mgt byMunicipality, State Govt, Public bodies and Voluntary

bodies like Rotary Club etc.28250 32800 36500

Q.4 What are the Legal Issues for Hospital Administrators

Definition


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Hospital administration is a phrase used to describe those professionals who choose to be a partof upper management in organized hospitals.

Hospital administrators spend a significant amount of time addressing legal issues including contracts,

partnerships, joint ventures, joint operating agreements, group purchasing, and management contracts.

There are multiple skills needed for effective hospital administration. Knowledge of basic leadership

skills and organizational management is required along with an understanding of organizational culture,

i.e., the unwritten rules that determine how an organization operates as a separate system. The hospital

administrator provides leadership and strategic directions within the organization to insure continuity

and targeted growth over time. People-skills is a phrase used to describe someone who interacts

positively with others at all levels. Administrators use people-skills along with an effective

communication style to deal with issues in human resources, negotiation, and conflict resolution. Ability

to interact positively with the Board of Directors/Trustees, the varied specialty physician groups, allied

health care providers, paid staff in general, and the public is essential. Intermixed with the above skills,

an administrator uses marketing expertise to ensure that the organization is meeting its market share inproviding care. Administrators often interact with patients and families to determine if the organization

is meeting patient/family expectations. Also, the administrator must be concerned with maintaining a

positive image for the organization and must be able to maintain effective public relations within the

community.

Q.5 Explain the Marketing of Hospital services

Hospital marketing is a specialized field that deals with connecting patients, physicians, and hospitals in

mutual relationships.

HOSPITAL MARKETING MIX

PRODUCT

A product is a set of attributes assembled in an identifiable form. The product is the centralcomponent of any marketing mix. The product component of the marketing mix deals witha variety of issues relating to development, presentation and management of the product

which is to be offered to the market place. It covers issues such as service package, coreservices and peripherals, managing service offering and developing service offering.

Hospitals today offer the following services:

1. Emergency services Emergency services and care at most of the hospitals is unique

and advanced. The hospitals have state-of-the-art ambulances. The CCU's on Wheelsunder supervision by medical and para-medical staff. There is hi-tech telecommunicationavailable to a patient in an emergency at any given time.

2. Ambulance services Hi-tech ambulances linked by state-of-the-arttelecommunications are fully equipped with doctors that are available to render medical


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attention and assistance in case of emergencies at the patient's doorstep.

3. Diagnostic services Modern Hospitals are multi-speiality and multi-disciplinary, thatcan handle any kind of ailment, they offer a wide range of facilities for instance, Oncology,

Orthopedics, Neurology, Plastic surgery and so on.

4. Pharmacy services

Most of the hospitals also have a pharmacy which is open 24hours. It caters to the needs not only of the inpatients and outpatients, but also patients

from other hospitals who require emergency drugs.

5. Causality services Causality service includes a 24 hrs. causality department, which

attends to the accident or emergency cases.

Apart from the above mentioned services, hospital also offers "Health Diagnosis

Programme" which is a complete, comprehensive, periodic health check up offered for busyexecutives, professionals, business persons and so on. The health diagnosis programmecomprises of the following:

1. Master health check up

2. Executive Health check up

3. Diabetics health check ups etc.,

Generally, the service offering in a hospital comprises of the following levels:

1. Core level it comprises of the basic treatment facilities and services offered by thehospital like diagnostic services, emergency services, casuality services etc.

2. Expected level it comprises of cleanliness and hygiene levels maintained in the hospital.

3. Augmented level

it comprises of dress code for staff, air conditioning of the hospital,use of state of art technology, services of renowned consultants.

Or

NOW YOU MUST PROFILE THE MARKET SEGMENT BY CUSTOMERS

Market needs should be interpreted very broadly, in terms far broader than only product characteristics.

Customers and prospects may differ also in their needs for information, re-assurance, technical support,

service, distribution, and a host of other benefits that are part of their purchase.

1. MARKET SIZE FOR EACH PRODUCT

It is difficult to see how marketing can be properly planned unless the relationship of the company's

product sales to the total market sales is known.


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2. COMPETITIVE STRUCTURE FOR EACH PRODUCT

The competitive structure also effects the opportunity to force a change in market structure, this

information is vital.

3. MARKET TRENDS FOR EACH PRODUCT

This is the most important of all information, which is needed to assess the opportunities for increased

profits. There are three critical areas to review:

(A) MARKET TREND:

1.IS THE MARKET GROWING RAPIDLY?

This should provide the change for good profits

on growing sales.

2.IS THE MARKET STATIC?

This is often highly competitive, with

corresponding low profit margins.

3.IS THE MARKET DECLINING?

This, again, is often highly competitive, with

correspondingly low profit margins, is not only

due to competition but also due to higher

overheads on a smaller volume.

(B) PRODUCT SERVICE VOLUME TREND:

1. IS THE SERVICE VOLUME AT THE DEVELOPMENT STAGE? Accelerate the sales, exploit this stage and

increase the profit level.

2.IS THE SALES VOLUME AT THE GROWTH STAGE?


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Stretch this stage of the product cycle through

proper promotions.

3.IS THE SALES VOLUME AT THE MATURITY LEVEL?

Stretch this stage by innovation of the product

or extending into a new market.

4.IS THIS SERVICE VOLUME AT THE DECLINING LEVEL? This stage needs complete rethinking - product,

market, channel and sales operation.

(C) PRODUCT UNIT PROFIT TREND

Unit contribution trend has different structure. It normally peaks-out before the end of the "growth"

stage of the product life cycle and then drops rapidly. This "change point" in the curve is the most

important point of the life cycle to identify.

Q.6 Describe about role Hospital Administrators in legal matters

Role of hospital administrators in legal matters

Though all hospital administrators are not qualified legal persons

yet they are supposed to possess sufficient knowledge of the Indian Laws

to be able to take decisions on legal matters. For example, if he wants to

terminate a contract with the contractor who is building a particular

portion of the hospital building he needs to have knowledge of the

Nigerian Contract Act. Similarly, if he wants to terminate services of an

employee, he should know the provisions of the Industrial EmploymentStanding Orders Act, the Industrial Disputes Act and the principles of

natural justice. No doubt he is briefed by the law officer of his hospital

before he takes decision on any legal matter, but he is still required to

have some knowledge of the laws. Secondly, all hospitals cannot afford


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to engage full time law officers or retain part time legal advisors. It is the

hospital administrator who keeps the reign of legal kingdom in his hand

in small and medium size hospitals and decides all matters rightly or

wrongly on the basis of his knowledge and common sense. Thirdly, the

hospitals are no longer immune to legal suits due to reinduction of the

Industrial Disputes Act, 1947 and application of the Consumer Protection

Act, 1986. These acts have made employees as well as patients more

conscious about their rights and privileges and they expect better working

conditions and services from the hospital administrator. Thus the hospital

administrator has crucial role to play in legal matters these days.

CEOs vision to improve hospital services

What does a hospital employee want from his job? Money, security

and career development can be high on the list for most of them, but

Mike Rudd, Logistics Director at Bulmers, says that what really

motivates employees is sharing the CEOs vision. Though it sounds odd,

with the new world of independent and short stay of personnel, it is true.

The CEO should communicate his vision about the hospitals as well as

involve the employees at every step. They should be invited to give their

views and discuss how they would work towards the vision. It would be

easy to say that such as activity is nothing more than a paper exercise, but

it can be very productive and useful because each individuals job

contributes towards achieving the vision. The process should entail

remaining firmly focused on the CEOs vision in conversations and

meetings. Thus, one can defuse difficult situations very quickly by

understanding where the personnel are, why they are there and where

they need to go next so that everyone in the hospital begins to work in a


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better way and the vision of the CEO becomes the vision of each and

every employee of the hospital.

The focus should be on people first and always on caring rather

than managing. The following approach works in good as well as bad

times:

1. Share the vision with high and low personnel leaving no place for

suspicion.

2. Share even confidential information, personal hopes and fears to

create a common vision and promote trust.

3. Seize every opportunity such as open doors, management by

walking around, networks etc. to make a point, emphasize values,

disseminate information, share your experience, express interest

and show your care and concern.

4. Recognize performance and contribution of your personnel.

5. Use incentive programmes whose main objective is not

compensation but recognition.

Q.7 Write about the Classification of hospitals

CLASSIFICATION OF HOSPITALS AND OTHER HEALTH FACILITIES

1. Government or Private

1.1. Government operated and maintained partially or wholly by the national,provincial, city or municipal government, or other political unit; or by anydepartment, division, board or agency thereof.1.2. Private privately owned, established and operated with funds through donation,principal, investment, or other means, by any individual, corporation, association,or organization.2. General or Special2.1. General provides services for all types of deformity, disease, illness or injury.


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2.2. Special primarily engaged in the provision of specific clinical care andmanagement. A primary care hospital, secondary care hospital, tertiary carehospital, or infirmary, may provide special clinical service(s).3. Service Capability3.1. Primary Care Hospital3.1.1. Non-departmentalized hospital that provides clinical care andmanagement on the prevalent diseases in the locality3.1.2. Clinical services include general medicine, pediatrics, obstetrics andgynecology, surgery and anesthesia3.1.3. Provides appropriate administrative and ancillary services (clinicallaboratory, radiology, pharmacy)3.1.4. Provides nursing care for patients who require intermediate, moderateand partial category of supervised care for 24 hours or longer3.2. Secondary Care Hospital3.2.1. Departmentalized hospital that provides clinical care and managementon the prevalent diseases in the locality, as well as particular forms oftreatment, surgical procedure and intensive care

3.2.2. Clinical services provided in the Primary Care Hospital, as well asspecialty clinical care3.2.3. Provides appropriate administrative and ancillary services (clinicallaboratory, radiology, pharmacy)3.2.4. Nursing care provided in the Primary Care Hospital, as well as totaland intensive skilled care3.3. Tertiary Care Hospital3.3.1. Teaching and training hospital that provides clinical care andmanagement on the prevalent diseases in the locality, as well asspecialized and sub-specialized forms of treatment, surgical procedureand intensive care3.3.2. Clinical services provided in the Secondary Care Hospital, as well as

sub-specialty clinical care3.3.3. Provides appropriate administrative and ancillary services (clinicallaboratory, radiology, pharmacy)3.3.4. Nursing care provided in the Secondary Care Hospital, as well ascontinuous and highly specialized critical care

3.4. Infirmary a health facility that provides emergency treatment and care to thesick and injured, as well as clinical care and management to mothers andnewborn babies.3.5. Birthing Home a health facility that provides maternity service on pre-natal andpost-natal care, normal spontaneous delivery, and care of newborn babies.

3.6. Acute-Chronic Psychiatric Care Facility a health facility that provides medicalservice, nursing care, pharmacological treatment and psychosocial interventionfor mentally ill patients.3.7. Custodial Psychiatric Care Facility a health facility that provides long-termcare, including basic human services such as food and shelter, to chronicmentally ill patients.


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Q.8 Describe the Health Committees recommendations

2 A. C. Beal, M. M. Doty, S. E. Hernandez, K. K. Shea, and K. Davis, Closing the Divide: How Medical HomesPromote Equity in Health Care: Results From The Commonwealth Fund 2006 Health Care Quality Survey (New

York: The Commonwealth Fund, June 2007).

Recommendation 1: Promote population-based approaches

The Health Equities Committee recommends an on-going, substantial investment inpublic health activities that will prevent disease and promote the health of Oregonians.Culturally-specific approaches to disease prevention and health promotion must be partof this investment.

Recommendation 2: Strengthen the relationship between health-focused Community-BasedOrganizations and the health care delivery system.

The Health Equities Committee recommends designing a contracting mechanism that

will empower primary care clinics who primarily serve vulnerable populations to buildfinancial agreements with health-focused community-based organizations that provideculturally-specific health promotion and disease management services.

Recognizing that not every organization providing an integrated health home is focused onserving vulnerable populations, an alternative to renewable contracts should exist that willenable a provider to purchase community-based and/or culturally-specific services.

The Health Equities Committee recommends that high-value community-based healthpromotion, disease prevention, and chronic disease management services be eligible fordirect reimbursement. Accountable Health Plans must reimburse a broader range ofhealth professionals including, but not limited to, Community Health Workers, and a

broader range of services including, but not limited to, peer-led disease managementsupport groups in culturally-specific programs to maximize the health and function ofindividuals, families, and communities.

Recommendation 3: Develop programs to incentivize healthy personal decision-makingHEALTH EQUITIES COMMITTEE FINAL REPORT 9


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The Health Equities Committee recommends that the state create a Wellness Account forindividuals participating in the Oregon Health Fund program who receive a subsidy.

The state would deposit money in the Wellness Account based on completion of wellnessactivities. Monies accrued in the account could be used towards program cost-sharing

expenses such as premiums and co-pays, or towards non-covered wellness activities, suchas gym memberships or yoga classes. Financial incentives would encourage individuals toengage in activities that promote health, such as participating in a smoking-cessationprogram, getting recommended tests and procedures, and chronic disease managementactivities.The Wellness Account is modeled after Enhanced Benefit Accounts (EBAs) that are

currently being implemented in several state Medicaid programs.

Q.10 Explain Patient and CPA, 1986,

THE CONSUMER PROTECTION ACT, 1986(68 of 1986)[24th December, 198"6)An Act to provide for better protection of the interests of consumers and for that purposeto make provision for the establishment of consumer councils and other authorities forthe

settlement of consumers' disputes and for matters connected therewith.BE it enacted by Parliament in the Thirty-seventh Year of the Republic of India asfollows:-CHAPTER IPRELIMINARY1. Short title, extent, commencement and application.--( I) This Act may be calledtheConsumer Protection Act, 1986.(2) It extends to the whole of India except the State of Jammu and Kashmir.(3) It shall come into force on such date I as the Central Government may, bynotification, appoint and different dates may be appointed for different States and for

differentprovisions of this Act.(4) Save as otherwise expressly provided by the Central Government by notification,this

Act shall apply to all goods and services.2. Definitions.--(I) In this Act, unless the context otherwise requires,-2[(a)"appropriate laboratory" means a laboratory or organisation-(i) recognised by the Central Government;


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(ii) recognised by a State Government, subject to such guidelines as may beprescribed by the Central Government in this behalf; or(iii) any such laboratory or organisation established by or under any law for the timebeing in force, which is maintained, financed or aided by the Central Governmentor a State Government for carrying out analysis or test of any goods with a view

to determining whether such goods suffer from any defect; ]3[(aa) "branch office" means-(i) any establishment described as a branch by the opposite party; or(ii) any establishment carrying on either the same or substantially the same activity asthat carried on by the head office of the establishment;]

__________________1. The provisions of Chapters I, II and IV of this Act have come into force in the whole of India except the State ofJammu andKashmir on 15-4-1987: vide Notification No. S.O. 390 (E), dated 15th April, 1987, published in the Gazette of India,1987,Extra., Pt. II, Sec. 3 (ii). The provisions of Chapter III of this Act have come into force in the whole of India except theState ofJammu and Kashmir on 1-7-1987: vide Notification, No. S.O. 568(E), dated 10th June, 1987, published in the Gazette

of India,1987, Extra., Pt. II, Sec. 3(ii).2. .Subs. by Act 50 of 1993, sec. 2 (w.e.f. 18-6-1993).3. .Ins. by Act 50 of 1993, sec. 2 (w.e.f. 18-6-1993).3

(b) "complainant" means-(i) a consumer; or(ii) any voluntary consumer association registered under the Companies Act,1956 (1of 1956) or under any other law for the time being in force; or(iii) the Central Government or any State Government; .1[(iv) one or more consumers, where there are numerous consumershaving the same interest;](v) in case of death of a consumer, his legal heir or representative ;)who or which makes a complaint;(c) "complaint" means any allegation in writing made by a complainant that-2[(i) an unfair trade practice or a restrictive trade practice has been adopted by (anytraderor service provider ;](ii) 2[the goods bought by him or agreed to be bought by him] suffer from one or moredefects;(iii)2[the services hired or availed of or agreed to be hired or availed of by him] sufferfrom deficiency in any respect;(iv) a trader or the service provider, as the case may be, has charged for the goods orforthe services mentioned in the complaint, a price in excess of the price-(a) Fixed by or under any law for the time being in force;(b) displayed on the goods or any package containing such goods;(c) displayed on the price list exhibited by him by or under any law for the time being inforce;(d) agreed between the parties;)3[(V) goods which will be hazardous to life and safety when used, are being-offered for


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sale to the public-(a) in contravention of any standard relating to safety of such goods as required to becomplied with, by or under any law for the time being in force;(b) if the trader could have known with due diligence that the goods so offered areunsafe

to the public;)(vi) services which are hazardous or likely to be hazardous to life and safety of thepublic when used, are being offered by the service provider which such person couldhaveknown with due diligence to be injurious to life and safety;)with a view to obtaining any relief provided by or under this Act;.(d) "consumer" means any person who-(i) buys any goods for a consideration which has been paid or promised or partlypaid and partly promised, or under any system of deferred payment and includesany user of such goods other than the person who buys such goods for

consideration paid or promised or partly paid or partly promised, or under anysystem of deferred payment when such use is made with the approval of suchperson, but does not include a person who obtains such goods for resale or for anycommercial purpose; or(ii) 4[hires or avails of] any services for a consideration which has been paid orpromised or partly paid and partly promised, or under any system of deferredpayment and includes any beneficiary of such services other than the person who4[hires or avails of] the services for consideration paid or promised, or partly paidand partly promised, or under any system of deferred payment,

_________________1. Ins.byAct50ofI993,sec.2(w.e.f.18-6-1993).2. Subs. by Act 50 of 1993, sec. 2 (w.e.f. 18-6-1993).

3. Ins. by Act 50 of 1993, sec. 2 (w.e.f. 18-6-1993). ,,!4. Subs. by Act 50 of 1993, sec. 2 (w.e.f. 18-6-1993). ~., S

when such services are availed of with the approval of the first mentioned person; (butdoes not include a person who avails of such services of any commercial purpose;)1[Explanation.-For the purposes of sub-clause (i), "commercial purpose" does notincludeuse by a consumer of goods bought and used by him exclusively for the purpose ofearning hislivelihood, by means of self-employment;](e) "consumer dispute" means a dispute where the person against whom a complainthas

been made, denies or disputes the allegations contained in the complaint;(f) "defect" means any fault, imperfection or shortcoming in the quality, quantity,potency,purity or standard which is required to be maintained by or under any law for the timebeingin force or 2[under any contract, express or implied or] as is claimed by the trader in anymanner whatsoever in relation to any goods;


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(g) "deficiency" means any fault, imperfection, shortcoming or inadequacy in the quality,natureand manner of performance which is required to be maintained by or under any law forthetime being in force or has been undertaken to be performed by a person in pursuance of

acontract or otherwise in relation to any service;(h) "District Forum" means a Consumer Disputes Redressal Forum established underclause (a)of section 9;(i) "goods" means goods as defined in the Sale of Goods Act, 1930; (3 of 1930);(j) "manufacturer" means a person who--(i) makes or manufactures any goods or parts thereof; or(iii) does not make or manufacture any goods but assembles parts thereof made ormanufactured by others; or(iv) puts or causes to be put his own mark on any goods made or manufactured by any

other manufacturer ;)3[(jj) "member" includes the President and a member of the National Commission or aStateCommission or a District Forum, as the case may be;}(k) "National Commission" means the National Consumer Disputes RedressalCommissionestablished under clause (c) of section 9;(1) "notification" means a notification published in the Official Gazette;(m) "person" includes,-(i) a firm whether registered or not;

__________________1. Ins. by Act 50 of 1993, sec. 2 (w.e.f. 18-6-1993).

2. Ins. by Act 50 of 1993, sec. 2 (w.e.f. 18-6-1993).3. Ins. by Act 50 of 1993, sec. 2 (w.e.f. 18-6-1993).

(ii) a Hindu undivided family;(iii) a co-operative society;(iv) every other association of persons whether registered under the SocietiesRegistration Act, 1860 (21 of 1860) or not;(n) "prescribed" means prescribed by rules made by the State Government, or as the,case maybe, by the Central Government under this Act;1[(nn) "regulation means the regulations made by the National Commission under this

Act;)

(nnn) restrictive trade practice means a trade practice which tends to bring aboutmanipulationof price or its conditions of delivery or to affect flow of supplies in the market relating togoodsor services in such a manner as to impose on the consumers unjustified costs orrestrictions andshall include;


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(a) delay beyond the period agreed to by a trader in supply of such goods or inproviding theservices which has led or is likely to lead to rise in the price;(b) any trade practice which requires a consumer to buy, hire or avail of any goods or,as the

case may be, services as condition precedent to buying, hiring or availing of othergoods orservices;).(0) "service" means service of any description which is made available to potential(users andincludes the provision of facilities in connection with banking, financing insurance,transport,processing, supply of electrical or other energy, board or lodging or both, 2[housingconstruction] entertainment, amusement or the purveying of news or other information,but does

not include the rendering of any service free of charge or under a contract of personalservice;(oo) spurious goods & services mean such goods and services which are claimed tobegenuine but they are actually not so;)(p) "State Commission" means a Consumer Disputes Redressal Commissionestablished in aState under clause (b) of section 9;(q) "trader" in relation to any goods means a person who sells or distributes any goodsfor saleand includes the manufacturer thereof, and where such goods are sold or distributed inpackageform, includes the packer thereof;3[( r) "unfair trade practice" means a trade practice which, for the purpose of promotingthe sale,use or supply of any goods or for the provision of any service, adopts any unfair methodorunfair or deceptive practice including any of the following practices, namely;-(1) the practice of making any statement, whether orally or in writing or by visiblerepresentation which,-(i) falsely represents that the goods are of a particular standard, quality, quantity, grade,composition, style or model;(ii) falsely represents that the services are of a particular standard, quality or grade;(jii) falsely represents any re-built, second-hand, renovated, reconditioned or old goodsasnew goods;(iv) represents that the goods or services have sponsorship, approval, performance,characteristics, accessories, uses or benefits which such goods or services do not have;(v) represents that the seller or the supplier has a sponsorship or approval or affiliationwhich such seller or supplier does not have;


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(vi)makes a false or misleading representation concerning the need for, or theusefulnessof, any goods or services;

____________________1. Ins. byAct50ofI993,sec. 2 (w.e.f. 18-6-1993).2. Ins. .by Act 50 of 1993, sec. 2 (w.e.f. 18-6-1993). '..u .,

3. Subs. by Act 50 of 1993, sec. 2 (w.e.f. 18-6-1993).

(vii) gives to the public any warranty or guarantee of the performance, efficacyor length of life of a product or of any goods that is not based on an adequate or propertestthereof:Provided that where a defence is raised to the effect that such warranty or guarantee isbased on adequate or proper test, the burden of proof of such defence shall lie on thepersonraising such defence;(viii) makes to the public a representation in a form that purports to be-(i) a warranty or guarantee of a product or of any goods or services; or

(ii) a promise to replace, maintain or repair an article or any part thereof or to repeat orcontinue a service until it has achieved a specifiedresult,if such purported warranty or guarantee or promise is materially misleading or if there isnoreasonable prospect that such warranty, guarantee or promise will be carried out;(ix) materially misleads the public concerning the price at which a product or likeproducts orgoods or services, have been or 'are, ordinarily sold or provided, and, for this purpose, arepresentation as to price shall be deemed to refer to the price at which the product orgoods or

services has or have been sold by sellers or provided by suppliers generally. in therelevantmarket unless it is clearly specified to be .the price at which the product has been soldor serviceshave been provided by the person by whom or on whose behalf the representation ismade;(x) gives false or misleading facts disparaging the goods, services or trade of anotherperson.Explanation.-For the purposes of clause (1), a statement that is-(a) expressed on an article offered or displayed for sale, or on its wrapper or container;or

(b) expressed on anything attached to, inserted in, or accompanying, anarticle offered or displayed for sale, or on anything on which the article is mounted fordisplay orsale; or(c) contained in or on anything that is sold, sent, delivered, transmitted or in any othermanner whatsoever made available to a member of the public,shall be deemed to be a statement made to the public by, and only by, the person whohad


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caused the statement to be so expressed, made or contained;(2) permits the publication of any advertisement whether in any newspaper orotherwise, for thesale or supply at a bargain price, of goods or services that are not intended to beoffered for sale

or supply at the bargain price, or for a period that is, and in quantities that are,reasonable, havingregard to the nature of the market in which the business is carried on, the nature andsize ofbusiness, and the nature of the advertisement.Explanation.-For the purpose of clause (2), "bargaining price" means-(a) a price that is stated in any advertisement to be a bargain price, by referenceto an ordinary price or otherwise, or(b) a price that a person who reads, hears or sees the advertisement, would reasonablyunderstand to be a bargain price having regard to the prices at which the productadvertised or like products are ordinarily sold;

(3) permits-(a) the offering of gifts, prizes or other items with the intention of not providing themas offered or creating impression that something is being given or offered free ofcharge when it is fully or partly covered by the amount charged ,in the transactionas a whole;the conduct of any contest, lottery, game of chance or skill, for the purpose ofpromoting,directly or indirectly, the sale, use or supply of any product or any business interest;(3A) withholding from the participants of any scheme offering gifts, prices or other itemsfree ofcharge on its closure the information about final results of the scheme.Explanation : for the purpose of this sub clause, the participants of a scheme shall bedeemed tohave been informed of the final results of the scheme where such results are within areasonabletime published, prominently in the same newspaper in which the scheme was originallyadvertised;)(4) permits the sale or supply of goods intended to be used, or are of a kind likely to beused, byconsumers, knowing or having reason to believe that the goods do not comply with thestandardsprescribed by competent authority relating to performance, composition, contents,design,constructions, finishing or packaging as are necessary to prevent or reduce the risk ofinjury tothe person using the goods;(5) permits the hoarding or destruction of goods, or refuses to sell the goods or to makethemavailable for sale or to provide any service, if such hoarding or destruction or refusalraises or


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tends to raise or is intended to raise, the cost of those or other similar goods orservices.](6) Manufacture of spurious goods or offering such goods for sale or adopting deceptivepractices in the provision of services;)(2) Any reference in this Act to any other Act or provision thereof which is not in force in

anyarea to which this Act applies shall be construed to have a reference to thecorresponding Act orprovision thereof in force in such area.

Q.1 Mention the Objectives, of NATIONAL HEALTH POLICY 2002

OBJECTIVES

The main objective of this policy is to achieve an acceptable standardof good health amongst the general population of the country. The

approach would be to increase access to the decentralized public

health system by establishing new infrastructure in deficient areas, and

by upgrading the infrastructure in the existing institutions. Overriding

importance would be given to ensuring a more equitable access to

health services across the social and geographical expanse of the

country. Emphasis will be given to increasing the aggregate public

health investment through a substantially increased contribution by theCentral Government. It is expected that this initiative will strengthen the

capacity of the public health administration at the State level to render

effective service delivery. The contribution of the private sector in

providing health services would be much enhanced, particularly for

the population group which can afford to pay for services. Primacy will

be given to preventive and first-line curative initiatives at the primary

health level through increased sectoral share of allocation. Emphasis

will be laid on rational use of drugs within the allopathic system.Increased access to tried and tested systems of traditional medicine

will be ensured. Within these broad objectives, NHP-2002 will endeavour

to achieve the time-bound goals mentioned in Box-IV.


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Box-IV: Goals to be achieved by 2000-2015Eradic ate Polio and Yaws 2005Eliminate Leprosy 2005Eliminate Kala Azar 2010Eliminate Lymphatic

Filariasis2015Ac hieve Zero level growthof HIV/AIDS2007Reduc e Mortality by 50%on ac c ount of TB, Malariaand Other Vec tor andWater Borne diseases2010Reduc e Prevalenc e of

Blindness to 0.5%2010Reduc e IMR to 30/ 1000And MMR to 100/ Lakh2010Inc rease utilization ofpublic health fac ilities fromc urrent Level of 75%2010Establish an integratedsystem of surveillanc e,National Health Ac c ountsand Health Statistic s.2005Inc rease healthexpenditure byGovernment as a % ofGDP from the existing 0.9 %to 2.0%2010Inc rease share of Centralgrants to Constitute atleast 25% of total healthspending2010Inc rease State Sec torHealth spending from 5.5%to 7% of the budgetFurther inc rease to 8%


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20052010

Q.2 What are the Functions of hospital,

FUNCTIONS OF THE HOSPITALHospital administration functions can be classified into three broad categories:1. Medical - which involves the treatment and management of patients through the staffofphysicians.2. Patient Support - which relates directly to patient care and includes nursing, dietarydiagnostic, therapy, pharmacy and laboratory services.3. Administrative - which concerns the execution of policies and directions of thehospital governing discharge of support services in the area of finance, personnel,materials and property, housekeeping, laundry, security, transport, engineering andboardand the maintenance.MAJOR FUNCTIONS OF THE ADMINISTRATIVE SERVICE1. Provide service related to accounting, billing, budget, cashiering, housekeeping,laundry, personnel, property and supply, security, transport, engineering, andmaintenance; and2. Render support services to hospital care providers, clients, other government, andprivate agencies, and professional groups.

Q.3 Write about Hospital Ethics.

Medical ethics is a system of moral principles that apply values and judgments to the practice ofmedicine. As a scholarly discipline, medical ethics encompasses its practical application inclinical settings as well as work on its history, philosophy, theology, and sociology.

Q.4 Mention the Health Committees appointed by Government

I mentioned that there are now eight different UN committees of governmentappointedindependent experts, serviced by the UN Office of the High Commissioner

for Human Rights, reviewing statespolicies and practices across a wide range of

issues. Two deserve special mention because they are key to womens and childrens

health.The Child Rights Committee reviews implementation of the Convention on the Rights
http://en.wikipedia.org/wiki/Medicinehttp://en.wikipedia.org/wiki/Medicinehttp://en.wikipedia.org/wiki/Medicine


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of the Child that all countries in the world have signed up to (all countries bar two).

And the Womens Rights Committee reviews implementation of the Convention on

the Elimination of all form of Discrimination against Women that 186 countries haveagreed to be bound by. Because of their subject matter - and because they are almostuniversally ratifiedwe should use, and build upon, these international commitments

in our work. Frankly, it would look very strange if we didnt.

Of course, international independent accountability arrangements are not confined tothe UN Office of the High Commissioner for Human Rights.For decades, ILO committees of independent experts have reviewed whether or notcountries are complying with their obligations under a wide-range of labour-relatedinternational instruments and recommendations. The ILO understandsrecommendations to be agreed guidelines for national action.UNESCO also has procedures to review whether or not countries are conforming to anumber of international instruments and recommendations falling within its mandate.Because one international instrument (relating to the terms and conditions of teachingstaff) is relevant to both their mandates, the ILO and UNESCO have established a

joint committee of twelve independent expertssix appointed by the ILO and six byUNESCOto review countriesconduct on this issue.

UNESCO also has a joint expert group with the UN Committee on Economic, Socialand Cultural Rights. In other words, here you have a UN specialised agency joiningwith a UN human rights treaty-body to consider the right to education.Established in 1993, the World Bank Inspection Panel consists of three independentexperts who determine whether or not the Bank is complying with its own policiesand procedures, which are intended to ensure that Bank-financed operations providesocial and environmental benefits and avoid harm to people and the environment.UNFPA has recently established an independent External Advisory Panel to help the

Executive Director and senior management ensure that they are meeting UNFPAs

goals and targets. I have the honour to serve on this Panelwe call ourselves criticalfriends of UNFPA.Of course, WHO also has independent panels of experts to assist with its work, suchas the independent Technical Steering Committee that, for some years, has reviewedand advised the Department of Child and Adolescent Health and Development.Recently, in light of the H1N1 pandemic, WHO established the expert ReviewCommittee anticipated by the International Health Regulations (2005). While the5WHO Framework Convention on Tobacco Control does not establish an independentreview body, it is instructive for present purposes because it sets up a processwhereby governments report, every few years, on implementation of their

commitments under the Convention.There are numerous other diverse examples and I am not holding up any of them asmodels to be slavishly followed. Nonetheless, they confirm that independent expertreviews are commonplace within the United Nations.While some of these independent arrangements are designed to ensure thatinternational agencies are effective and do as they said they would, others aredesigned to check whether or not governments are keeping their internationalcommitments.


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Q.5 Explain the Challenges to Hospital Administration

FIVE CHALLENGES FOR HEALTHCARE LEADERS

1. Sustaining the organization's viability and mission in the face of growing resource needs

and reimbursement constraints

Most healthcare organizations are faced with an aging population, growing numbers of

uninsured and underinsured persons, the need for costly technology, and other

pressures that require greater resources. At the same time, both governmental and

private payers are constraining reimbursement, and most organizations' income from

investments has been affected adversely by events over the past three years. Twenty-

five of the 29 responding CEOs believed these factors represent a problem for

healthcare executives, governance, and clinical leaders who are responsible for

maintaining their organizations' viability and mission and for responding to their

communities' needs. In February, PriceWaterhouseCoopers (2003) published a report,

entitled "Cost of Caring: Key Drivers of Growth in Spending on Hospital Care," that

informs us of the impact of these factors on hospitals. To a considerable degree,

however, the same factors affect all providers of healthcare services and, at least

indirectly, all health-related firms.

2. Meeting the multifaceted workforce crisis that exists throughout the country

Twenty-two of the 29 responding CEOs identified workforce issues as a principal

challenge. Their deep concerns mirror the position taken by many healthcare

organizations, including the American Hospital Association, that the healthcare industry

is in the midst of a real workforce crisis. This crisis is not simply about the short supply

of workers, although we are experiencing significant shortages of nursing personnel,

certain physician specialists, and other professional caregivers. Other dimensions of the

workforce crisis include:

* changes in the skill mix to meet new service requirements,

* high levels of dissatisfaction expressed by many nurses and other employees abouttheir work situation, and

* the tremendous need for care continuity in a period where recruitment is difficult and

turnover is high.

All of these elements affect the cost and quality of care. A study prepared by the VHA


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(Voluntary Hospitals of America [2003]), entitled "The Business Case for Workforce

Stability," found that the average annual turnover rate in hospitals is nearly 21 percent.

The study also documents the adverse effects of high turnover rates on cost per

discharge, severity-adjusted length of stay, return on assets, and other quality and cost

variables. This is a report worth reading. It paints a sobering picture. The CEOs know

that our problems have no easy solutions and that we have to address their root causes,

not just their symptoms.

3. Ensuring patient safety and good clinical outcomes; reducing variability in quality and

costs; and demonstrating positive impact on the health status of individuals, families,

and communities

Over the past decade or so, there had been little evidence to indicate that managed

care programs have had a positive impact on improving access to and quality of

healthcare services or containing healthcare costs. The Institute of Medicine (IOM)

reports--Crossing the Quality Chasm and To Err Is Human--and other studies have

described serious problems and defects in the U.S. healthcare system. As does the IOM,

the CEOs I spoke to agreed that we need to provide care that is safe, effective, patient

centered, timely, efficient, and equitable. But they understand clearly that we are a long

way from fulfilling these six aims.

Pioneering work at the University of Michigan, Dartmouth College, and elsewhere has

revealed the startling variability in levels of healthcare utilization, quality, and cost from

community to community. In the early 1980s, John Griffith of the University of Michigan

acquainted me and colleagues at the Sisters of Mercy Health Corporation with data on

the large variation in use rates among Michigan communities where the Sisters of Mercy

operated healthcare facilities. I recall our early efforts, which were far less than

adequate, to understand the underlying reasons for the variations and to do something

about them. A new study by Elliot Fisher and colleagues (2003) at Dartmouth, entitled

"The Implications of Regional Variations in Medicare Spending-Part I: The Content,

Quality, and Accessibility of Care" (as quoted in the Wall Street Journal [2003]) speaks

graphically of this variation:

The federal Medicare Program spends about 60% more for health care for beneficiaries

in White Plains, N.Y. and Detroit than it does in Rochester, N.Y. and Grand Rapids,

Michigan. Yet the quality of care delivered to patients living in 'high-spending'

communities is no better and in some cases worse than what people in low-spending

communities get ... a large fraction of medical care is devoted to services that neither

improve health nor quality of care.

Both healthcare leaders and the public at large are feeling a growing discomfort with

the performance, the impact, and the cost of our nation's healthcare system. Closing the


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gaps and achieving measurable improvements are great mandates for executive,

clinical, and governance leaders. It is a challenge for us in the academic community as

well.

4. Redesigning systems and processes, building new operating models, and overcoming

both technical and cultural obstacles along the way

Various reports, including those by the IOM, have illustrated the importance of

assessing and redesigning systems and processes to bring about improvements in

patient safety, quality outcomes, and costs. Crossing the Quality Chasm strongly

recommends "the systematic identification of priority areas for improvement" (IOM

2001). Subsequent IOM report

mba - pharma healthcare que-ans

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