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Journal of the Academy of Hospital Administration

Customer (Patient) Service through Non-Government Health Care Organization in Calcutta Municipal Corporation Area

Author(s): Dev Malya Dutta*, Soubhatra Bandopadhyay**

Vol. 12, No. 2 (2001-07 - 2001-12)

Introduction

World resources data-sheet of 1998-1999 describes Calcutta city had a population of 4,446 thousand in 1950s, it became 11,923 thousand in 1995 and according to the same document Calcutta''s population is projected to become 17,305 thousand by 2015 A.D. The city has recorded an average annual population growth of 2.6 percent during 1970 to 1975 and 1.8 percent during 1990-1995. According to the estimates of the National Building Organization (1984) among the cities with a population of one million and above, Calcutta had the 35.4 per cent slum population.

Calcutta needs huge health care arrangement to reach the target of "Health For All". The state Government and the Calcutta Municipal Corporation obviously shoulder the main responsibility to extend health care services for the city population in general through the following institutional arrangements as described in table no.1 below.

There are three government (State) run medical colleges established within the city corporation area. It is rather needless to mention that the Government sector arrangements are rather insufficient. Further, it has been observed that Calcutta recorded 44 percent increase in growth of number of hospital beds while Mumbai recorded an increase of 137 percent since independence, which is highest rate of increase in the country. The growth of hospital facilities for per 100,000 population has varied between 5 percent in Calcutta to 27 percent in Chennai.

Table -1: Government Sector Health Care

Sl. Health Care Service Hospitals Clinics Dispensaries No Beds
1 Government Sector 25 36 10 8.499
2 Calcutta Municipal Corporation 09 29 34 164
Source : Calcutta Municipal Corporation 1977

Present Health Care Scenario in Calcutta

Government run health care organizations operating in Calcutta are over burdened with the pressure of patients. Patients waiting for a long time to see doctor is a common phenomenon. Choice of a doctor usually is a very rarely possible for general patients. Environment and hygienic conditions of the Government or Corporation run hospitals are very poor. Often lack of motivation among professional and non professional employees aggravate this situation further.

The public sector health care organizations face such types of trouble increasingly throughout the world. Flynn (1994) identified the causes as:

  1. They are not subject to discipline engendered by market;
  2. They are dominated by powerful groups, notably by professions, politicians and trade unions, and
  3. They are administered rather than managed, and so emphasize altruistic concern for humanistic objectives and safety rather than efficiency.

Non-government health care organizations are, therefore, taking the chances to explore the vast field of health care, understanding the demand of population and need in the society. In Calcutta, the non-government health sector generally extends the health care services through hospitals and nursing homes. Patients, being frustrated with the Government sector, have become increasingly dependent on non-government sector. Such demand in the society has influenced the non-government sector to increase at an enormous speed and intervene more and more in the difficult areas of medical treatment.

Researchers have identified the secret of success in the nursing home business in merchandising, which means, that these nursing homes have a product, i.e. health care, that they are proud of, a product so valuable and appealing to their residents and patients that the residents pay a price which allows the nursing homes to make a profit. By making a profit the quality nursing homes will remain in the business (Nielsen, 1991). Researchers have further observed that the nursing home business as, they must sell care, treatment, and service at a profit and, at the same time satisfy patients. If they could satisfy patients but fail to get profit they will easily be out of business. On the other hand, if they make profits but fail to satisfy patients they will soon be out of patients (Nielsen, 1991).

It has been observed that something like 80 per cent of the effectiveness of all medical treatments have never been evaluated fully and full clinical trials are not always practical, necessary, or indeed desirable. Further 20 per cent of medical treatment are hardly useful to patients (Christie, 1995).

This is to mention here that health work is atypical of other forms of contemporary industry because it is a growth industry (Morton-Cooper & Bamford, 1997). As demand for health care increases and as improvements in medical technology make intervention possible, theories of employment, management and professionalization will need to be revised to remain consistent with those changes (Walby et al. 1994). It is now claimed that our awe or science and technology has had consequences for the power of professional and that its consequences have negatively influenced the value and definition of health care (Hawthorne & Yurkovich, 1995). Patients satisfaction studies which are purported to build on the concept of consumer sovereignty (and are therefore perceived as product of orientation to consumerism) are methodologically complex and open to multiple interpretations (Batchelor et al. 1994; Morton-Cooper & Damford, 1997).

In this regard an attempt has been made to conduct a descriptive study of the patients'' view towards non-government health care organizations operating in the Calcutta Municipal Corporation area in respect to the health care services received by them as indoor patients.

Objectives

The objective of this exercise is to study patients'' opinion regarding service rendered by the non-government health care organizations operating in the Calcutta Municipal Corporation area.

Methodology and Procedure of the study

1. There are 301 non-government health care organizations, scattered disproportionately throughout the Calcutta Municipal Corporation area.

2. The Calcutta Municipal Corporation area has been divided into five zones as North, South, Central, East and West. Number of non-government health care organizations operating in each zone have been shown in the table No.2.

Table 2: Zones Division of NGHCO Operating in the Calcutta Municipal Coopertion Area

Classified Zones No. of NGHCO
North 62
South 66
Central 72
East 47
West 54
Total CMC area 301

3. Proportionate random sampling has been used to select the representative sample unit from Non-Government Health Care Organisations for the purpose of the present study as shown in the table No.3

Table 3; Representative Sample Unit

Classified Zones No. of NGHCO
North 09
South 11
Central 13
East 09
West 09
Total CMC area 50

4. Four patients from each sample unit non-government health care organization, i.e. nursing homes or hospitals have been randomly selected. Therefore, the study is based on the responses of 200 patients belonging to the Calcutta Municipal Corporation area.

Findings of the Study

Age distribution of the Patients

It has been observed from the patients record book available with every organization that the age group of most of the patients seeking for indoor treatment is between 35 years to 65 years. The present study, following the same trend, classified the patients as shown in the table below:

The table shows that out of total 200 (100%) patients, 96 (48%) belong to the age group of 55-64 years which is the eldest and largest age group. 64(32%) patients belong to the age group of 45-54 years and represents the medium age group, and lastly, 40(20%) patients belong to the age group of 35 to 44 years and may be considered as the youngest age group for the purpose of the study.

Table 4: Age Distribution of the Patients

Age of patients 35-44 45-54 55-64 Total
No. of patients 40(20%) 64(32%) 96(48%) 200(100%)

Reasons for Selection on Non-Government Health Care Organizations

Patients belong every age group have been asked why they selected that particular health care organization, i.e. that particular private home or hospital for their medical treatment? Table No. 5 describe it as follows:

Doctor's Referral

The main reason for patients selecting a particular non-government health care organization has been found in the patients'' own consulting doctors'' referral. In a total of 200 (100%) patients, 187 93.5%) considered it as the major reason. It includes 38 (95%) response of 35-44 years age group patients, 58 (93.75%) response of 45-54 age group patients and 91 (94.79%) response of 55-64 age group patient. Patients from all the age group are mostly referred by their doctors.

Easy Accessibility

Easy accessibility of patients due to less formality in the organizations and consulting doctors'' reference has been the second major cause for patients choice with 138 (69%) of total response. Through patients in the age group 35-44 and 45-54 supported this reasons with 34 (85%) and 56 (87.5%) responses respectively, patients in the age group of 55-64 years gave only 48 (50%) response in support to this issue in respect to the selection of non-government health care organization.

Social Reputation

Patients in the younger age group of 35-44 years supported social reputation as an important reason for their selection of a private nursing home or hospital and 37 (92.5%) of them believe so. 47 (73.43%) patients in the age group of 45-54 years and 50 (52.98%) patients in the age group of 55-64 found it as cause.

Better Expectation

32 (80%) in the age group of 35 to 44 years, 35 (54.68%) in the age group of 45-54 and 28 (29.16%) in the age group of 55-64 years, which in total 95 (47.5%) patients selected their nursing home or hospital in the hope of getting better care than provided by other sectors like Government or Corporation etc. Notably, here appears a considerable difference in opinion among the patients to youngest and eldest age groups.

Table No. 5: Why Patients Selected This Private Nursing Home/Hospital?

Age Group 35-44 45-54 55-64 Total
  N=40(%) N=64(%) N=96(%) N=200(%)
Reason for Selection
Consulting Doctors Referred 38 (95%) 58 (93.75%) 91 (94.79%) 187 (93.5%)
Easy Accessibility 34 (85.5%) 56 (87.75%) 48 (50%) 138 (69%)
Reputation in Society 37 (92.5%) 47 (73.43%) 50 (52.08%) 134 (67%)
Better Expectations 32 (80%) 35 (54.68%) 28 (29.16%) 95 (47.5%)
Satisfactory Environment 33 (82.5%) 37 (57.80%) 22 (22.9%) 92 (46%)
Reasonable Price 19 (47.5%) 37 (57.8%) 23 (23.92%) 79 (39.5%)
Attracted by Advertisement 26 (65%) 35 (54.68%) 17 (10.09%) 78 (39%)
Employers Selection 20 (50%) 26) (40.62% 21 (21.87%) 67 (33.5%)
Insurance Co. Preferred 05 (12.5%) 05 (7.81%) 03 (3.12%) 13 (6.5%)

Satisfactory Environment

Patients in eldest age group 55-64 years did not substantially support the environment cause and only 22(22.9%) of them revealed the same. While 33 (82.5%) and 37 (57.80%) patients respectively from the youngest (35-44) and medium (45-54) age group favoured this issue. In average 92 (46%) patients felt the environment of private nursing homes or hospitals were satisfactory.

Reasonable Price

79 (39.5%) in total of which 19 (47.5%), 37 (57.80%) and 23 (23.92%) patients respectively in the age group of 35-44, 45-54 and 55-64 years opined in favour of cost of care issue. Interestingly patients in the middle age group took the lead with 37 (57.8%) response in this issue.

Attracted by Advertisements

Youngest age group patients 26(65%) selected their nursing home or hospital due to the influence of the media for their personal medical care. Middle age group patients (45-54 years) gave a moderate view with 35 (54.68%) response while the issue has been less effective with 17 (17.09%) patients in the age group of 55-64 years.

Employers Selection and Health Care Insurance

Among patients in the age group of 35-44 years 50% i.e. 20 has selected the nursing homes or hospitals due to the norms set by their employers and 40.62% i.e. 26 in the age group of 34-54 had the same cause. In the cases of only 21 (21.87%) patients in the age group of 55-64 years, employers selection was a reason. While health care insurance, through still not so popular, is gaining ground gradually with 05 (12.5%), 05 (7.8%) and 0.3 (3.12%) patients respectively in the age group of 35-44, 45-54, and 55-64 years for selection of their respective nursing homes or hospitals.

Problems with non-Government Health Care

Though patients selected their respective private health care organization independently and because of the influence of different factors, they faced a lot of problems when approached for treatment or initiation of an effective treatment by that organization. Table no. 6, described it thoroughly.

Waiting Time

Waiting for meeting a doctor or beginning of an immediate treatment in a private nursing home or hospitals has been emerged as the main problem encountered by most of the patients, numbering 127 (63.5%), 22(55%), 40 (62.5%) and 65 (67.7%) patients respectively in the age group of 35-44, 45-54 and 55-64 years responded in this regard. Patients in the eldest age group have been affected mostly.

Communication with Professionals

Patients numbering 112 (56%) argues that they faced the problem in making proper communication with their doctors, nurses, etc. while undergoing medical treatment in a private nursing home or hospital. Patients in every age group encountered the same problem in an almost equal manner in average with response numbering 22 (55%), 36 (56.25%) and 54 (58.33%) according to their order of age group.

Table No. 6: Problems Faced by the Patients to Approach Non-Government Organizations for Treatment

Age Group 35-44 45-54 55-64 Total
Problems n=40 % n=64 % n=96 % n=200 100%
Waiting times 22 (55%) 40 (62.5%) 65 (67.7%) 127) (63.5%
Communication with Professionals 22 (55%) 36 (56.25%) 54 (58.335) 112 (56%)
Com. With non-prof.staff 17 (42.5%) 26 (42.18%) 43 (44.79%) 86 (43%)
Finance 14 (35%) 26 (42.18) 38 (39.58%) 78 (39%)
Choice of Doctors 9 (22.5%) 21 (38.88%) 38 (39.58%) 68 (34%)
Transport 11 (21.5%) 19 (29.68%) 34 (35.4%) 64 (32%)

Communication with Staff

Communication with nonprofessional supporting staff has also been an area of difficulty to the total 86 (43%) patient. 43 (44.79%), 26 (42.18%) and 17(42.5%) is the order of patients respectively in the age group of 55-64, 45-54 and 35-44 who encountered this problem with private nursing homes or hospitals in this Calcutta Corporation area.

Finance

It is certain that patients opting for service from non-government health sector have to pay more than the government sector. Possibly due to this cause patients'' response in respect to their financial difficulty did not came top of the list of factors but obviously has been an area of concern with 78 (39%) responses in total. Patients in the middle age group of 45-54 years numbering 26 (42.18%) confronted with this problem most. Followed by 38 (39.58%) patients in 55-64 years and 14 (35%) patients in the age group of 35-44 years.

Choices of Doctors

Choice of doctors to whom patients would depend to get proper treatment in non-government sector has been considered as a problems almost for 21 (38.88%) and 38 (39.58%) patients respectively in the age group of 45-54 years and 55-64 years. 9 (22.5%) patients in the age group of 35-44 years faced the same problems which account for in total 68 (34%) patients problem.

Transport

11 (21.5%), 19 (29.68%) and 34 (35.4%) patients respectively in the age group of 35-44, 45-54 and 55-64 years mentioned transport as a problem. In total 64 (32%) patients faced this problems while approached for their medical treatment from a non-government health care organization, i.e. from private nursing homes or hospitals.

Fulfilment of patients expectations

Patients covered under this study has been asked whether they have received expected medical care from their respective non-government health care organization? The table number 7 clarifies the patients'' responses in this regard. 25 (62.5%) patient in the youngest age group of 35-44 years received expected care as may be seen in the table and has been emerged as the largest group of patients who got expected medical care from non-government health care organizations. This age group patients numbering 61 (15%) has also been the largest group who posses an indifferent attitude. However, 9 (22.5%) of them denied about getting expected care.

Patients in the group of 45-54 years have certainly given an interesting picture. 36 (56.25%) patients considered that service received from non-government health care organizations has fulfilled their expectations while nearly a half of them i.e. (29.68%) patients clearly expressed their negative options and again nearly a half of this respondents, i.e., 9(14.06%) have revealed indifference in this regard.

Eldest age group (55-64 years) patients represents the smallest percentage, i.e., 49 (51.04%) in terms of getting the expected medical treatment from private nursing homes or hospitals. This group, again, represents the highest percentage, i.e. 37 (38.54%) patients who were annoyed with the health care services extended by such organizations. Eventually, only 10.41% i.e. 10 patients in this group had an indifferent attitude regarding the health care services received by them.

Therefore, the study reveals that even if the patients who opted to go for health care treatment in non-government sector, only a little above half of them, i.e., 110 (55%) have received expected medical care. A little above one third, i.e. 65 (32.5%) patients gave a clearly negative response and the rests i.e., 25 (12.5%) remained indifferent by the non-government health care organizations operating in the Calcutta Municipal Corporations area.

Suggestions for improvement

Understanding the problem areas faced by the patients and as a consequence, considerable low rate of response in the fulfillment of patients'' expectation resulted from the service delivery. All the patients were further requested to give their suggestions for improvement of service delivery system of the non-government health care organizations. Patients suggestions has been systematically categorized in the following Table No.8

Table No. 7: Whether patient Got Expected Medical Care?

Age Group 35-44 45-54 55-64 Total
Response n=40 % n=64 % n=96 % n=200 100%
Yes 25 (62.5%) 36 (56.25%) 49 (51.04%) 110 (55%)
No 9 (22.5%) 19 (29.68%) 37 (38.54%) 65 (32.5%)
Indifferent 6 (15%) 9 (14.06%) 10 (10.41%) 25 (12.5%)
Total 40 (100%) 64) (100%) 96 (100%) 200 (200%)

1. Justified use of Tests and Medical Technology

Prolonging the treatment with different tests in the name of investigation by the medical practitioners has been the main area of concern for non-government health sector. Increasing the cost of health care by the intervention of newly introduced technology further add to this. Considering this issue 144 (72%) patients suggested justified use of medical tests and technological intervention relevant for the appropriate diseases. Eldest age group patients (55-64 years) happened to be the worst affected and therefore 82 (85.4%) of them suggested that these issues as the main area to be improved followed by middle age group 45-54 years 39 (60.73%) patients and younger age group 35-44 years 23 (57.5%) respondents.

2. Better Infrastructural Facility

Occasionally these organizations start functioning without having proper infrastructual arrangements. Patients as customer in the elder age group felt most uncomfortable and 71 (73.95%) of them suggested for improvement. 42 (56.62%) in the age group of 45-54 years and 14 (35%) in the age group of 34-44 years suggested infrastructural improvement for better delivery through non-government organization and this a total of 127 (63.5%) respondents made suggestions for infrastructural improvement.

3. Better Bedside Manner

This means affectionate and sympathetic behaviour of the care providers towards the patients when they are undergoing a medical or surgical treatment 73 (76.04%) patients in the age group of 55-64 years, 29 patients (43.31%) in the age group of 45-54 years and 8 (20) patients in the age group of 35-44 years suggested this. Usually patients in the eldest age group felt it a dire need for the non-government health care providers followed by the middle and younger age group patients. Thus 110 (55%) patients in total suggested change in regard to this issue.

Table No. 8: Patients suggestions for Improvement of Non-Government Health Care Services

Age Group   35-44 45-54 55-64 Total
Suggestions   N=40(%) N=64(%) N=96(%) n=200(%)
1. Justified use of tests and medical technology 23 39 82 114
    (57.5%) (60.93%) (85.41%) (72%)
2. Better in infrastructural facility 14 33 69 127
    (35%) (51.56%) (69.33%) (63.5%)
3. Better auxiliary service 11 33 69 113
    (27.5%) (51.56%) (69.33%) (56.5%)
4. Better bedside manner 08 29 73 113
    (20%) (45.31%) (76.04%) (56.5%)
5. Cost minimization 17 21 73 111
    (42.5%) (32.63%) (76.04%) (55.5%)
6. Less waiting time 28 29 53 110
    (70%) (45.31%) (55.2%) (55%)
7. Easy Administrative process

13 23 49 85
    (32.5%) (35.93%) (51.04%) (42.5%)

4. Better Auxiliary Services

There is strong need to increase and extend quality auxiliary services like food, laundry, bed conditions, waiting room facilities, etc., for the satisfaction of patients parties. 69 (69.33%) patients in the age group of 55-64 years and 33 (51.56%) patients in the group of 45-54 years suggested this. 11 (27.5%) patients in the age group of 33-44 years suggested better auxiliary services by the non-government health care organizations for better patient (customer) care.

5. Cost Minimization

The cost of care is always a matter of concern for patients, specially that received from the non-government organizations. The eldest age group patients numbering 73 (76.04%) felt the cost of care is high and suggested for minimization. 17 (42.5%) in the age group of 35-44 years and 21 (32.63%) in the age group of 45-54 years patients also suggested cost reduction. In total, 111 (55.5%) patients felt that the cost was high and suggested a reduction 28 (70%) suggested arrangements for less waiting time.

6. Waiting time

Eldest age group patients (55-64 years) numbering 53 (55.2%) and middle age group patients (29 (45.3%) suggested to make the waiting time less. In average 110 (55%) patients suggested to make the waiting time less for making the services of private nursing homes or hospitals more effective.

7. Easy Administrative Procedure

There is further need to make the administrative procedure more easy in respect to the non-government health care organization operating in the city corporation area. 49 (51.04%), 23 (35.94%) and 13 (32.5%) patients respectively in the age group of 55-64 years, 45-54 years and 35-44 years suggested this point. It accounts for 85 (42.5%) patients response in total.

Gist of the Findings

Referral Doctors as Influencers

The discussion above reveals that most of the patients, 187 (93.5%) opted to seek personal medical care from a non-government health care organization i.e. nursing homes or hospitals being privately managed, by the influence of their own consulting doctors and who are perhaps attached to those organization. So the choice made by most of the patients is not solely their own choice and even though some other factors influenced them as shown in the table no.5. It further clarifies that professional service reputation of organizations in the city did not play as the most influential cause.

Customer Satisfaction need to strengthened

Though patients were referred by their consulting doctors they still had to wait for a long time to see their doctor(s) or getting effective treatment in the non-government health care organizations functioning in the Calcutta Corporation area.

Patient - professional - staff relationship

The triad of professional - patient and staff relationship as felt by the patient also put the non-government health care organizations'' efforts for satisfactory services in vain. Cordial relationship mutual understanding and cooperation between the members of this triad should exist.

Infrastructure and auxiliary service area

As has been observed by the patients undergoing medical treatment, deficiency in required infrastructure of the non-government health care organization in the city corporation area is matter of serious concern. Patients further identified the need to extend better auxiliary services by these organizations as they are paying much higher charges for their treatment than the government sector.

Conclusion

In the twenty first century the growth possibility of health care industry will be the highest one. Obviously non-government sector along with the Government sector will play the most significant role for extending health care services. The recently announced development policy by the government will further stimulate the growth of the private sector, especially in the area of urban health care for the entire population of ever section of the society. Patients in the urban area obviously prefer those organizations where they would get better return of their money in terms of health care to be received both from the government as well as non-government sectors.

Therefore, to survive in the competitive environment these non-government health care organizations, i.e, private nursing homes or hospitals should adopt a strategy to create a balance between customer (patient) satisfaction and profit making. Any imbalance in this may have an adverse effect on the health care sector in future not only in the Calcutta Municipal Corporation area but also in other urban areas of India.

References

  1. Batchelor C. Ownes, D.J., Read, M. & Bloor, M. (1994) "Patient Satisfaction Studies Methodology, Management and Consumer Evolution" International Journal of Health Care Quality Assurance, Volume 7, Number 7.
  2. Christie, B. (1995) "Tried, Not Tested" The Scotsman. 1st November.
  3. Howthorne, D.L. & Yorkovitch, N.J. (1995) "Science, Technology Caring and the Professions: are they compatible"- Journal of Advance Nursing. Volume 21.
  4. Morton-Cooper, A. & Bamford, M. (Ed.) (1997) "Excellence in Health Care Management" Oxford, Blackwell Science.
  5. Nielsen G. (1991) "The concept that Revolutionized Nursing Home Marketing" in Long R.E. (ed.) The Crisis in Health Care. The Reference Shelf. Volume 63, Number 1, New York, H.W. Wilson.
  6. Walby, S., Greenwell, J. Mackay, L., & Soathill, K. (1994) "Medicine and Nursing Professions in a Changing Health Service " London, Sage

* Dev Malya Dutta Reader, Former Head Department of Business Administration, Burdwan University
* Sri Soubhatra Bandopadhyaya, Project Officer, P.E.R.C. and Ph.D. Research Scholar, Burdwan University.

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