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Starting Up Anew Hospital
Starting Up Anew Hospital
BY: Arun Mahajan 39 Pawandeep Singh 60 Vikesh Bansal 40 Kalagi Joshi 70 Sarabjit Chhina 56 Meenakshi Wasson 44 Payal Parekh 74
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TABLE OF CONTENTS Promoters Background 2. Objectives of Study 3. Healthcare in India 4. Medical Tourism Scenario 5. Health Insurance Scenario 6. Location Analysis of Pune 7. SWOT Analysis 8. Proposed Hospital Profile 9. Budgetary Considerations Expected Revenue and break even Analysis.
1.
10.
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PROMOTERS BACKGROUND
C.A. Ms Gita Patwardan an NRI presently residing in U.K. has proposed to setup a Multispeciality Hospital at NCC ground to cater to the Population of PUNE (Maharashtra)
The Group is interested in conducting a detailed exploratory market research and financial feasibility to understand the demand and supply of health care and relevant market opportunities to make a conclusion for the upcoming proposed project in Pune.
Market Research: understanding the need gap and requirement for a multi specialty hospital; assess the healthcare delivery systems of competitors, and a review of all stake holders on the lacunae and strengths.
Financial Feasibility: To derive the Project cost details, Income and Expenditure estimates, Break Even Analysis and other important projections, a comprehensive Feasibility study was done.
OBJECTIVES OF STUDY
1. To perform feasibility analysis for a hospital at the NCC ground, S.B. Road, Pune. 2. To give an estimate of budget required for the project. 3. To calculate the expected profits and the break even point for the project.
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Indian Healthcare Industry to Double in Value by 2012 Rising income levels Changing demographics Shift in disease profile from chronic to lifestyle diseases to propel the growth The health infrastructure across Indian states is projected to grow by an average of 5.8 percent per annum between 2009-2013, taking the total expenditure in 2013 to USD 14.2 billion
Of the 32 Indian states that the report considered, the six states of Maharashtra,
Rajasthan, West Bengal, Uttar Pradesh, Tamil Nadu and Andhra Pradesh are forecasted to represent approximately 50 percent of the expenditure for 2009-2013 period.
While the Indian healthcare system has grown manifold over the past few years, it has
yet not been able to keep pace with the rapid rise in the population. One example of that is the availability of hospital beds in our country against a world average of four beds per 1,000 population, India lags behind at just over 0.7 presently. There is a growing need to deal with the issues of urban healthcare infrastructure as rural to urban migration has significantly increased the demand for these services.
The Indian healthcare industry is estimated to double in value by 2012 and more than
quadruple by 2017. The main factors propelling this growth are rising income levels, changing demographics and illness profiles, with a shift from chronic to lifestyle diseases. This is likely to result in considerable infrastructure.The healthcare sector in India is undergoing a phase of reform propelled by rapid economic growth. Apart from the healthcare providers, emerging markets such as diagnostic chains and medical device manufacturers, are attracting increasing amounts of investment.
In comparison to all 32 states, Maharashtra forecasted to maintain its dominance as the state with highest cumulative healthcare infrastructure expenditure, with spend of $ 7.3 billion between 2009 - 201cture challenges and opportunities.
India's healthcare sector has been growing rapidly and estimated to be worth US$ 40 billion by 2012 Revenues from the healthcare sector account for 5.2 per cent of the GDP, making it the third largest growth segment in India. The sector's growth will be driven by the country's growing middle class, which can afford quality healthcare. .
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Growth drivers Medical Tourism Telemedicine Healthcare services outsourcing Diagnostic services Increasing awareness Medical insurance Aging population Growing urbanization Low cost treatment
Pharmaceutical companies are going online to shorten the development and approval cycle of new drugs.
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Low cost medical treatment High quality medical care Low wait time for critical treatments Fluent English speaking staff
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household in 2005 to US$ 3514 per household by 2015. In some cases, the Government is partnering with the private sector to provide coverage at a low cost. The Yashaswini Insurance scheme, launched in 2002 in Karnataka by a public-private partnership.
NEED FOR MULTI SPECIALITY HOSPITALS 50 Doctors interviewed All facilities under one roof. Most advanced facilities. Provides Basic Facilities at a rock bottom price with the same quality. They can attract talent. Indian Healthcare Industry-Growing and Innovating High Tech Area.
Change in attitude towards healthcare.
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Hospitals in Pune
HOSPITALS Budhrani Cantonment Chest (Aundh) Dr. Ambedkar Hsp. Deen Dayal Gadikhana (Clinic) Hardikar Hospital Inlaks & Budhrani & M.N.B.Cancer Jahangir Nursing Home Joshi Hospital K.E.M. Kamala Nehru Kotbagi Krishna Gen. Hospital (Stree Clinic) Leprosy Lokmanya Hsp Mental Hsp. N.M.Wadia Cardiology Naidu Poona Hosp. & Research Center Ratna Memorial BED STRENGTH(APPROX) 200 350 100 200 150 200 780 300 100 550 350 350 150 200 250 500 60 250 150
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Ruby Hall Nursing Home ADITYA BIRLA Deena Nath Manageshkar Sasoon
Total Population( PUNE) Bed ratio (present) Total Beds Required Beds Available Bed Deficit
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P ro s ta te
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Positive Factors
81% Literate population Densely Populated 7,214/ Km Majority of High and Middle income group Good sewerage system Huge scope for further development
Population of Pune city (2009) excluding suburbs is around 33 Lacs (approx). Total bed strengths (which includes Private and Government Hospitals ) is 6000 approx. So number of beds per 1000 population is 1.8 , but according to WHO standards it should be 3. So we are short of 4000 beds in Pune. And this shortage will increase in future. IT Services sector remains a major driver of the economy and jobs created here, Pune's NRI Diaspora and first-generation of successful technology entrepreneurs are encouraging a renaissance of entrepreneurial activity. Pune is emerging as a prominent location for IT and manufacturing companies to expand. 25% of income of Pune comes from IT sector. Pune has the sixth largest metropolitan economy and the highest per capita income in the country. Additional 2,500 additional beds in 2016
Negative Factors
Reputed hospitals like Ruby Hall, Apollo Jehangir, Aditya Birla Market penetration difficult for newcomer High Real estate rates Scarcity of Trained Doctors , Specialist, Nursing staff (common problem f whole india) Congested space around hospital premises
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SWOT ANALYSIS Strengths: Pune called Oxford of East, has huge student base. Also it is hub of IT industry, thus we expect high employer base utilisation of insurance an hospital services.
Weakness: Acute shortage of skilled doctors and trained Para-medical staff and investments required to uplift the current status of the healthcare.
Opportunities: Changes in demography and socio-economic mix are altering the population's disease profile and increasing the incidence of lifestyle diseases thus increasing the demand for beds
Threats: Steep population growth with lack of proper healthcare policies, Infrastructure and accessibility to the healthcare for all is challenge in the coming days.
LAND FEASIBILITY SURVEY NCC A Land Feasibility Study is conducted to evaluate and determine the suitability of the soils relative to a parcel of land where an on-site sewage system would be used Erosion & Sediment The site is assessed according to its current erosion and sediment loss conditions and then a new plan is designed proposing a new topography for sediment control and erosion prevention. Proper Water Supply Proper Sewage System
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PROPOSED HOSPITAL
Logo: Colour: Red signifies the colour of life and the courage to deal with emotionally disturbed customers
Mission To serve and enrich the quality of life of patients suffering from diseases, through the efficient deployment of technology and human expertise, in a caring and nurturing environment with the greatest respect for human dignity and life.
Vision Bliss hospitals will strive with excellence to fulfil the needs of the community in its chosen field of medical treatment and grow to be the biggest and most respected name in quality healthcare business in the country.
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It will be 300 bedded Research Hospital which will be accomplished in 3 phases Rationale: - Availability of land Availability of finances Competitors First Phase 100 beds; it will take one and half year to commence the Hospital after acquiring the land.( OCT 2009- MARCH 2010). Hospital + pharmaceutical company tie up( joint venture) Pharmaceutical company has been investing 75 crores in three phases 25 crores each year into my business. Share of Promoters invested 58 crores in phase 1. Second Phase 100 beds Third Phase 100 beds Nature of the Hospital The BLISS Hospital will be a high end hospital with the following characteristics: 250 bedded acute care tertiary healthcare facility with specialty and super specialty services Full outpatient department, inpatient department and primary care services It will have a state of the art radiology imaging centre It will be fully digitised and paperless with all clinicians and departments using an Electronic Patient Record system at all times It will provide an intimate, friendly and caring environment Its design and processes will be patientfocussed High staff to patient ratios for personalised care Providing the highest standards of cleanliness, comfort, safety and convenience State of the art medical equipment and evidence based protocols It will be staffed by selected, highlyqualified healthcare professionals to ensure highest quality practices THERAPEUTIC SPECIALITIES 1) Ortho 2) Cardiology
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3) Gynaecology 4) Paediatrics 5) ENT 6) Sex clinic/ counselling centre 7) Rehabilitation centre 8) Psychiatry 9) Dental 10) Wellness centre 11) Ophthalmology 12) Medicine 13) Surgery
SUPER SPECIALITY
1) 2) 3) 4) 5) 6) 7)
Liver Transplant and Digestive Diseases Joint Replacement Women and Child Care Trans Nasal Brain Tumor Surgery PELD Minimal Access Slipped Disk Surgery Urology and Andrology Obesity Surgery
DIAGNOSTIC SERVICESS 1 Radiology: CT scan, MRI, bone mineral densitometry, mammography, ultrasound, xray Laboratory: biochemistry, haematology, serology, microbiology, clinical pathology, histopathology Other support services 1 Endoscopy, blood bank and blood components, dialysis, noninvasive cardiology such as echo, stress testing, holter, and ECG IT Driven tools and service Hospital management system Billing Inventory Accounts management Records management
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ERP solution Telemedicine and medical informatics Decision support system that improves diagnosis and treatment Healthcare players are establishing ways to give customers easy access to pertinent information
Pharmaceutical companies are moving to speed development and delivery of new drugs
Hospital Pecularities Micro-processor based implantable in patients. CPU-driven technology supported by artificial intelligence. Robotics in OTs Robotics in Path-labs / Research. Laser Technology in surgery Instrumentation in medical and surgical practices. IT tools for net-working examination, diagnostics, treatment rooms and OTs. IT Tools along with artificial intelligence and microprocessor technologies for equipment maintenance and trouble shooting. IT tools for generation of disease specific data. USP Quality healthcare services with state of the art medical facilities under one roof Well qualified staff Excellent customer patients services Easily accessible and competitively priced. Customized designs to suit the varying needs of different customers (patients) Constant interaction with the patients and strong bonding with them Promoting healthy India
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JCI Accreditation: To stay competitive in the market According to Ernst & young report quality is the most preferred attribute for patients to choose a particular hospital To increase customer satisfaction To cater foreign patients.
Floor Wise Design: Basement: 10 OPDs Diagnostics, Lab Ground Floor: Lord Ganesh Temple Reception, ADT department Billing Department Blood Bank Cafeteria Children Play Area Emergency Department Admin Department ATM machine
Library Third Floor: General Ward Delux- Rooms Suite Fourth Floor: Tele-Medecine Department Conference Hall Yoga Area Ayurvedic Department ESTIMATED MANPOWER
Nurses in the Hospital Nurses in I.C.U 12 Nurses in S.C.C.U Nurses in I.C.C.U Nurses in N.I.C.U Nurses in Special ward Nurses in Deluxe ward Nurses in Double ward Nurses in Single ward Nurses in General ward Nurses in Day care Nurses in Operation Theatre Nurses in OPD Nurses in Casualty ward Nurses in Labour Room Total Nurses in the Hospital(Including 30% of Relievers) 9 0 7 12 4 7 19 8 4 5 7 7 1 90
Department of Laboratory Medicine Section Head 1 Number of Technicians for fairly 6 automated lab Number of Technicians manual/fairly 9 automated lab Senoir Technicians 1 Total Technicians Relievers Attendants for Automated Lab Relievers for Attendants Reception cum Clerk Relievers for Clerks Department of Imaging Sciences Section Head 1 Number of Technicians for routine 2 X-rays, Special procedures like myelography
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10 3 6 0 1 0
Physiotherapy Department Physiotherapists 1 Physiotherapists 0 Aide/Junior Trainee Senior 0 Physiotherapists Total 1 Physiotherapists Pharmacy Department Pharmacists for 1 Indoor Issues Pharmacists for OPD 2 Issues Junior Pharmacists 0 Senior Pharmacist 0 Pharmcy Aide 0 Chief Pharmacist 1 Total Staff in 4 Pharmacy General Maintainence Manpower required 9 Relievers 3 Total Staff in General 12 Maintanence Security Department Security guards (Including gateways 5 & Special areas) Relievers 2 Security Supervisor 5 Total Staff in Security 12 Department Sterile Supply Department Technician required 3 including Relievers Supervisor shift 1 Total Staff in 4 Sterile Department Laundary Department Laundry Opeartor 5 Laundry Orderly / 2 Assistant
barium investigations, HSG etc. Relievers Department of Ultra Sound Number of Technicians Attendants for Ultra Sound Releivers
2 4 1
Department of ECG & 2D ECHO Technicians with Echo Relievers Special Services Blood Bank Health Check Up X-Ray Infection Control Nurse Nurse Clinical Specialist Total staff - special services 5 2 0 1 0 1 1 3
Food Service Department Dietician Cook Cook Helper Dishwasher/Attendant Storekeeper Total Staff in Food Service 1 3 3 3 1 11
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Housekeeping Department Staff in Housekeeping Total Housekeeping Staff : (Including 30% Relievers) Total Manpower required in Hospital 315 :
COMPETITOR ANALYSIS:-
Deenanath mangeshkar Hospital Department of medical genetics Clinical Genetics Cytogenetics Molecular genetics Metabolic genetics Ayurveda/ Panchkarma Homeopathy Dentistry Clear vision clinic Voice clinic Obesity clinic Cardiology Neurology Kidney transplant Cancer treatment IVF centre Neuro Trauma Unit
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Ruby Hall Clinic Accident and Trauma Care Accupressure Clinic Anaesthesiology Button Hole Surgery for Gall Bladder removal Blood Bank Cancer Center with facilities for Radiotherapy, Surgical Oncology and Chemotherapy Cardiac Center Chest Medicine Corneal Transplants with Eye Bank facility Day Care Center Dental Center with laboratory and facilities for Maxillo Facial Surgery and Dental Implants Dermatology Eleven well equipped Operation Theatres including separate Operation Theatres for cardiac and neurosurgery Endocrinology and Diabetology ENT Department Gynaecology and Obstetrics Department with labour rooms I.C.U. / C.C.U. / P.I.C.U. / N.I.C.U. Intensive Care Unit for trauma and other cases Lithotripsy and Urology including Nd : YAG Surgical Laser Mobile 'C' Arm Units Neonatalogy for highly specialized infant care and Neonatal Surgery Neurology and Neurosurgery Ophthalmic Laser & Automated Perimetry Ophthalmology with facilities for radial keratotomy Orthopaedic Department Orthopaedics, Rheumatology and Physiotherapy Paediatric Intensive Care Unit Paediatrics , Paediatric Surgery and Paediatric Urology Physiotherapy Post Operative Recovery Room for Cardiac, Renal and Neurosurgical cases Psychiatry Radiation Synovectomy Reconstructive Plastic Surgery Renal Dialysis Unit Respiratory Care Unit for patients needing acute respiratory care facilities Speech Therapy with a Child Guidance Clinic Vascular Surgery Video-endoscopic Surgeries
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MARKETING STRATEGIES Communication mix The aim of this exercise is to establish the brand in the minds of the customers so well that it becomes the first name that customers recall whenever discussing or thinking about healthcare. The product would be heavily advertised before launching and then we would involve in extensive sales promotion. The communication strategy of promoting and advertising the brand is as follows: 1. Magazines o Health o General o Lifestyle 2. Newspaper ads 3. Hoardings across various places in cities 4. Advertisements in local television shows 5. Sponsoring school events 6. Organising awareness camps and visiting schools 7. Mobile marketing Public Relations and Publicity We have chosen newspapers and magazines because of wide range of our target audience. Magazines and newspapers are always in the eye amongst public. Magazines are read for a period of a month, which brings more attention to an advertisement. We plan to advertise in National and local newspapers Health Magazines We further plan to utilise the non personal communications such as photographs, films and tapes showcasing the facilities of our hospital and the advantages that the local population will have by getting themselves treated at a world class hospital as compared to the local nursing homes. Advertising 1. Internet: We would place display ads and interstitials on websites like makemytrip.com. This would target the customers who frequently visit such sites for planning their travel. Also we plan to place our advertisements on yellow pages.
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Promotion activities 1. Hoardings: Visual hoardings to be placed on prime locations of the city to increase visibility among masses. Also we would place hoardings in high density residential areas, industrial areas and on city outskirts. 2. Camps: Blood donation camps and free check up camps would be arranged in schools and colleges. 3. Event Sponsorships: We would try to grab attention of the prospects by sponsoring events such as cultural events, sports events etc. We can even organize marathons. 4. Advertisements to be placed on local and short route buses. Sales Promotion 1. Tie up with Insurance companies for devising various insurance cover plans. 2. Tie ups with corporate and educational institutions for annual health contracts. Special packages for economically backward patients, senior citizens, maternity package, annual health check up package, package for diabetic patients, physiotherapy package etc. Future Plan We have devised a plan which would be followed in case of future expansions. We are planning to implement a Hub and Spoke model which will help us in expanding our services to areas where we cannot currently reach due to infrastructure related issues. Issues like transportation, electricity, public sanitation facilities available in smaller towns and villages currently dont allow us to open our super speciality hospitals in these areas. Even if these are ignored, there would be problems finding good doctors and other hospital staff who would be willingly ready to work in such areas. To circumvent these issues, we have come up with this model.
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As shown in the above diagram, we will have our fully equipped super speciality hospital in the cities (Tier 2) built and working successfully as envisioned in the current expansion plan. But we would not be able to provide quality health care to smaller towns where a good number of people reside and are in need of such facilities. This would also form a part of our Corporate Social Responsibility whereby we will go one step further than just providing free care in our hospitals by reserving 10% of our capacity for such cases. Here we will establish small nursing homes with minimal facilities and having interns and other less qualified staff (but competent enough to handle minor issues like flu, fever, basic orthopaedic and other basic services). These staff would be able to give proper diagnostic facility to the villagers and to the small town people and if they feel that the patient has some major disease, he/she will refer that patient to the nearest HUB where the person would be treated at subsidised cost (the exact amount of subsidy that would be provided can only be decided on regional basis). We would be cross subsidising such activities with the retained earnings from our business. These plans, would however, can be implemented only after we have attained a certain minimum level of competence and profitability which could take us few years.
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PROJECT ESTIMATION
Civil Cost
240,000,000
Plumbing Cost
30,000,000
Electrical Cost
60,000,000
78,000,000
Miscellaneous Cost
6,400,000
Grand Total
414,400,000
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BUDGETARY CONSIDERATIONS
Amount budgeted (Rs.) 1. Land cost 15000 Sq.Ft / * 1000 *12 2. Equipment planning Rs. 20,00,00,000 Amount expenditure (Rs.)
Echo Colour Doppler Ventilator: 3 Cardiac Monitor (NIBP) 30 Defibrillator: 5 TMT-2 Central Line Oxygen ECG Machine : 10 Pulse Oxymetre : 5 Centralized Monitor Infusion Pump : 10 Pace Maker : 05 Computerized System X-Ray :3 Cardiac Fowler Bed IITV USG : 2 Pathology Equipments Other material & Medicines CT scan MRI CSSD Lab Ambulance@ Rs.500000/*4
Communication System@ Rs.2000000/1 IT system
Total
3. Hospital Furniture
Civil Cost
Rs. 18, 00,000 Rs. 24, 00,000 Rs. 30, 00,000 Rs. 10, 00,000 Rs. 03, 00,000 Rs. 02, 00,000 Rs. 01, 00,000 Rs. 01,00,000 Rs. 01, 00,000 Rs. 03, 00,000 Rs. 02,50,000 Rs. 02,00,000 Rs. 09,00,000 Rs. 07,50,000 Rs. 08,00,000 Rs. 8,00,000 Rs. 15,00,000 Rs. 02,00,000 Rs. 1,00,00,000 Rs. 1,50,00,000 Rs. 1,50,00,000 Rs. 2,00,00,000 Rs. 20,00,000 Rs. 20,00,000 Rs. 1,00,00,000 Rs. 7,40,00,000 Rs. 4,50,00,000 Rs. 24,00,00,000
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Plumbing Cost Electrical Cost Air conditioning Cost Miscellaneous Cost Total
Miscellaneous Total Budget Amount budgeted(Monthly) (Rs.) 1. Salaries NURSES @ Rs. 7000/ *90 Physiotherapist @ 30000/*1 Pharmacist @ 12000/* 4 Maintenance staff @ 6000/* 12 Security staff- outsourced Technicians @ 7000/*63 Housekeeping -outsourced dietary services @ 5000/ * 11 Administrative Heads @ 70000 /* 7 Med.Supr. Assit.Med. Supr.@ 40000/ * 6 CEO Administrations @ 20000 /* 12 Admin Others @ 8000 /*20 consultants @ 70000 /* 15 Surgeons' Visit @20000 / *7 Rs. 60,000 Rs. 30,000 Rs. 48,000 Rs. 72,000 Rs. 50,000 Rs. 44,100 Rs. 50,000 Rs. 55,000 Rs. 4,90,000 Rs. 1,50,000 Rs. 24,000 Rs. 2,00,000 Rs. 2,40,000 Rs. 2,00,000 Rs. 1,05,000 Rs. 1,40,000
Rs. 3,00,00,000 Rs. 6,00,00,000 Rs. 7,80,00,000 Rs. 64,00,000 Rs. 41,44,00,000 Rs. 1,00,00,000 Rs. 74,34,00,000
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Disaster budget
Rs. 20,00,000
Rs. 3,00,00,000
Rs. 31,500
Rs. 3,78,000
Other expenses
Rs. 6,00,000
Rs. 72,00,000
TOTAL
Rs. 6,67,47,200
OPD patients(20 patients* 30 days * 10 OPD ) IPD patients( 4 patients * 30 days ) surgery(70 surgeries per month )
Rs. 30,00,000
2 3
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4 5 6 7 8 9 10 11
Pharmacy( OPD) Pharmacy( IPD) USG( 20usg * 30 days ) Xray(15 Xrays * 30 days ) CT (50 CT per month ) lab tests( 100 OPD tests * 30 days) lab tests( 50 IPD tests * 30 days) ECG ( 100 ECG * 30 days ) Rs. 700 Rs. 400 Rs. 2,200 Rs. 500 Rs. 800 Rs. 200
Rs. 30,00,000 Rs. 12,00,000 Rs. 4,20,000 Rs. 1,80,000 Rs. 1,10,000 Rs. 15,00,000 Rs. 12,00,000 Rs. 6,00,000
Rs. 3,60,00,000 Rs. 1,44,00,000 Rs. 50,40,000 Rs. 16,20,000 Rs. 13,20,000 Rs. 1,80,00,000 Rs. 1,44,00,000 Rs. 72,00,000
TOTAL
Rs. 2,21,10,000
Rs. 26,47,80,00 0
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* = Increase in revenue is observed because of increase in no. of patients. # = increase in expenditure is observed because of inflation ## = Profit before interest and Tax
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