Summer Internship project Report

On
COST ACCOUNTING STRATEGIES UNDER PROSPECTIVE
PAYMENT SYSTEM

Shiv Orthopedics & Trauma center

Submitted to

Institute Code – 734

Marwadi education foundation group of Institution

Under the guidance of

MR VIJAY VIKRAM DAS

Assistance professor

In partial fulfilment of the requirement of the award of the degree

of Master of business administration

Offered By

Gujarat Technological University

Ahmedabad

Prepared by:

RAJ KUMAR

Enrolment No – 217340592131

MBA (Semester 3rd), SEPTEMBER 2022

[1]
 Shiv Orthopedics & Trauma center
Submitted to: -
Institute code: 734

Marwadi Education Foundation's Group of

Institutions

Under the Guidance of

MR. VIJAY VIKARAM DAS
Assistance professor

In partial Fulfilment of the Requirement of the award of the degree of

Master of Business Administration (MBA) Offered By;

Gujarat Technological University, Ahmedabad

Prepared By:-

Raj Kumar

217340592131

MBA (Semester - III) Month & Year: Aug 2022

[2]
 Student’s Declaration

I hereby state that the "Healthcare Financing" topic: cost accounting strategies
under prospective payment system. summer internship project report for Shiv
Hospital Orthopedics & Trauma Center is the result of my own work and that
all references, if any, have been appropriately acknowledged. I am aware that if
I am found guilty of copying from another report or piece of public information
and presenting it as my own, I may be held accountable and punished by the
university, which may include receiving a "Fail" on an exam or any other
punishment the university may impose.

ENROLLMENT NO. NAME SIGNATURE

217340592071 Raj Kumar

Place: ………………………… Date: ………………………

[3]
 Date: __/__/____

Institute Certificate

This is to certify that RAJ KUMAR (21734059131), who worked on his or

her project under my supervision, is the bona fide author of the summer internship
project report titled "Healthcare finance”. I additionally attest that, to the best of
my knowledge, the work described here is not included in any other project report
or dissertation that served as the foundation for a degree or award that was
previously given to this candidate or any other candidate.

This report's plagiarism rate, which I also checked, is.........%, which is

less than the legal limit of 30%. This is accompanied by a separate plagiarism
report that is included as an HTML or PDF file.

Rating of Project Report [A/B/C/D/E]: ______

(A=Excellent; B=Good; C=Average; D=Poor; E=Worst)
(MR. VIJAY VIKARAM DAS)

Signature of the Faculty Guide/s

(Name and Designation of Guide/s)

Signature of Principal/Director with Stamp of Institute

(Name of Principal / Director)

[4]
 CERTIFICATE OF EXAMINER

This is to confirm that the project work described in this report titled " cost
accounting strategies under prospective payment system " was performed by RAJ
KUMAR (217340592131) of the Marwadi Education Foundation's Group of
Institutions & 176.
The report has either been approved or disapproved.
Comments of External Examiner:

This report is intended to fulfil a portion of the requirements for the award of the
Gujarat Technological University's Master of Business Administration (Part-
Time) degree. --------------------------
(Examiner’s Sign)
Name of Examiner:
External Examiner’s Institute Name:
External Examiner’s Institute Code:

Date:
Place: Date: __/__/____

[5]
 Company / Organization Certificate
To whom so ever it may concern

This is to confirm that RAJ KUMAR, a member of the Marwadi Education

Foundation Group of Institutions (Institute Code: 176), completed his summer
internship project report on "Healthcare finance" topic: cost accounting strategies
under prospective payment system at SHIV HOSPITAL (ADDRESS) between
August 11 and September 7, 2018.
Plagiarism Report

[6]
 PREFACE

Knowledge is one of the most important Treasures for any person. The amount
of the knowledge in this world is a doubling every five years and with the end
of the 21st century it is now expected to double every two years. So if I plan to
be in this knowledge explosion means that I would be facing with
unprecedented challenges and opportunities. How well I address that I would
depend upon, in large part on my ability to adapt to the continuing changes.
Journal work like this gave an exposure to the practical and real life experience
of the modern market

Theories don’t teach unless accompanied by the working in original situation.

This project report was carried out according to the course of MBA

Moreover in modern world practical knowledge has given more importance

than theoretical knowledge enables the student to get some experience of
management, affairs of course, theoretical knowledge is essential as a sound
base

As a part of my industrial trial training I have taken industrial visit at Shiv

Orthopedies & Trauma center. for 30 Days. I have collected various information
from Export departments.

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Company / Organization Certificate

[8]
 ACKNOWLEDGEMENT

To acknowledge my gratitude and humility to everyone, much above the level of

simplicity and into something substantial, overwhelms me. I would like to express
my gratitude to my teacher and our principal for providing me with the amazing
opportunity to do this project on the topic of healthcare finance, “cost accounting
strategies under prospective payment system” which also enabled me to
conduct extensive research and learn new information about a lot of new topics.
I sincerely appreciate them. Without the assistance and direction of my guider,
no endeavour at any level can be successfully finished.

In spite of their busy schedules, my guider sir: Assistant prof.mr Vijay Vikram
Das gave me several suggestions on how to make my project stand out, therefore
I would like to thank him for all of his assistance in helping me obtain various
facts, gather data, and guide me occasionally as I made this project.

THANK YOU

[9]
 ABSTRACT

 The goal of this study is to determine hospital awareness and perception.

This chapter explains how the healthcare system works and how healthcare
financing works. The chapter describes the sources and methods of
financing healthcare for various modes of healthcare delivery.

 The majority of healthcare treatments are paid for out-of-pocket by the

patients themselves. Public and private health insurance are additional
sources of finance for healthcare and funding of public medical facilities.

 This chapter provides an overview of the healthcare spending components,

as well as the necessity for and difficulties in estimating the cost of
healthcare in the nation. Learning Objective: - The reader will be able to
by the end of this chapter.

 Comprehend the intricate healthcare system. It spans both rural and urban
areas and includes various regulated and uncontrolled healthcare services.

[10]
 SUBJECT INDEX

chapters title Page

no.
1 INDUSTRY OVERVIEW
• Basic overview of the industry
• Major Players
2 Company Overview
• History
• Mission, Visions etc.
• Organizational Structure
• Product & Services
• Overview of different departments. (Marketing, Finance, HR, Account,
Production, R & D etc...)
3 SWOT Analysis
4 Introduction to topic
5 Literature review
6 Research Methodology
• Introduction
• Statement of the problem
• Research Objectives
• Scope of the study
• Research hypothesis
• Data Collection sources (Primary and secondary sources)
• Data Collection Instrument (e.g., Questionnaire)
• Sampling Design
o Population of the study
o Sample Size
o Sampling Method
• Data Analysis Design (a brief outline of tools and techniques to be used
for analysis, statistical tools and tests to be used)
• Limitations of the Project
7 Data Analysis & Interpretation
8 Findings & Suggestions
9 Annexure
 Questionnaire
10 Bibliography

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 CHAPTER -1

INDUSTRY OVERVIEW

BASIC OVERVIEW OF THE INDUSTRY

Establish: - 1 Dec 2020
Shiv Hospital
150 feet ring road, Rajkot
Orthopedic, Orthopedic surgeon, Interventional cardiology
32 Procedures
9 Doctor and 52 beds

The well-known Shiv Hospital, a multi-specialty hospital with 52 beds, is

situated on Rajkot's 150-foot Ring Road. Top doctors like Dr. Kaushal Patel
frequently visit Shiv Hospital (sports medicine specialist). Dr. Shyam Gohil
(orthopedic), Dr. Hiren S. Kothari (orthopedic surgeon), Dr. Avinash Maru
(orthopedic), Dr. Ankur Thummar (interventional cardiologist), and mpre.

Shiv Hospital has a waiting room that its patients enjoy as a patient-friendly
amenity. For example, Shiv Hospital offers Angioplasty and Stenting, Bone
Grifting, Bone Truma, Fracture Plaster, General Medical Consultation,
Reconstration and Bone Lengthening, Foot and Ankle Surgery, among other
operations and services.

The first of its type, Shiv Hospital is the top trauma and orthopedic Super
specialty clinic in Saurashtra-Kutch. The lack of a hospital offering all types of
orthopedic super specialty services under one roof in the Saurashtra region raised
concerns about the idea of such a hospital. The fact that each patient is treated by
a specialist who has spent a long time becoming trained precisely for that problem
is very advantageous to the patient. In addition, many of the issues requires a
collaborative strategy where one expert treats one issue while another expert
treats another issue.

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 Board of the director

Dr. Amish Dr. Bhavesh Dr. C.P.

Sanghvi Sachde Dr. K.P Dr. Hiren Dr.Rajesh Dr.Shyam
Rabara
Taraviya Kothari jani Gohil
M.S M.S (Patal)
M.S M.S M.S M.S
( Ortho.) (ortho.) M.S
(Ortho) (Ortho) (Ortho) (Ortho)
F.N.B (Ortho)

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 MAJOR PLAYER

 Major Player in healthcare : -

Policymake
r

Vender Patient
Major
Player in
healthcare

Payers Providers

 The Relationship between the 4ps

1. Policymakers
2. Patient
3. provider
4. payers
5. vender
 Policymaker
Policymakers set the framework for how the nation's citizens will
receive healthcare. The "minister of health" or any other legal body with
control over population health may be cited by policymakers. By merging
data from patients, providers, and payers, the policy maker creates
population level indicators that direct their health and health economic
strategies.

Policies provide responses to the following inquiries: -

1. Who is eligible for treatment?

2. What kinds of care services, how, where, and by whom are provided?
3. How are services remunerated?
4. What future healthcare challenges do we need to be ready for?

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 Patient
Everybody has practiced patience occasionally. Patients are
occasionally voters, citizens, and taxpayers. The nation's policy
framework is intended to be patient-beneficial, and policymakers
have a fiduciary duty to this population. Patients receive care from
providers and are beneficiaries of payers' services. A patient can also
want to use an electronic gadget to access information about their
care.

 Providers
Healthcare is operationalized by providers under the legal
framework. They look after patients' medical records and offer
healthcare services. The professionals work together on patient care
as a care team. Many suppliers own and operate their own
independent companies, which are in charge of their own finances
and day-to-day operations.

 Payers
Payers operationalize the financial aspect of the policy
framework. Payers enroll patients as beneficiaries. They make
purchases from the vendors of healthcare services on behalf of their
patient beneficiaries. They must also assume the actuarial
responsibility of ensuring the sustainability of the care programed.
They deliver reports to decision-makers.

 Vendor
Buyer Give medical supplies, medications, services, and
solutions to healthcare providers. Undoubtedly, there are other
important factors as well, such as the benefits of pharmaceuticals.

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 CHAPTER -2

COMPANY OVERVIEW

 HISTORY
Shiv Hospital is first of its kind and the best Centre for Orthopaedic Super
specialist and Trauma in Saurashtra – Kutch. The idea of such a hospital was
conceived as the Saurashtra region was lacking in hospital having all kinds of
orthopaedic super-specialist service under one roof. It is extremely beneficial to
the patient as each patient is treated by the concerned specialist who is trained
specifically for that problem for extensive years. Also, many of the problems need
a team approach where one specialist treats one problem and another specialist
treats another problem.

 Mission, Vision & Value of the Company

 Mission
Our goal is to be the best technologically advanced
orthopaedic and trauma hospital in Saurashtra. Along with an ICU
facility, it is built for complex trauma, joint replacement, spine
procedures, and arthroscopy. Visits to renowned centers for
complicated injuries and trauma with a focus on superiority in
clinical services, patient care, and healthcare infrastructure with a
strong team of experts, we will foster and provide clinical
excellence.

 Vision
We strive to be the top orthopaedic trauma and super-specialty
Centre that combines the best medical care with unwavering moral
standards and a tradition of consideration, devotion, and care. We
aspire to be a cutting-edge medical facility.

 Values
The foundation of all of our healthcare ideals will be devotion
and integrity. With our dynamic staff, the noble profession for which
it is named will continue to be NOBLE, and the hospital management
will do all reasonable efforts to promote its value-based services.
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 ORGANIZATIONAL STURUCTURE

Board of Director

Central Head

Administration

Information Therapeutic Diagnostic

Support Units
System services services

Admission Medical laboratory

Billing & Collection Surgery Units Imaging Center Supply
Health Education Intensive Care Emargency Medicine Biomedical Technology
Medicak records Maternity Cardiology Housekeeping
Physical therapy maintenance
Information System Neurology
Speech|Launguage Transportations
Human Resource
pharmacy
sports medical
Nursing
social service
Medical psychology
respiratory

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 PRODUCT & SERVICES
Goods and Services: -
It is renowned for offering excellent care in the following specialties:
general practitioners, orthopaedic physicians, dentists, ENT physicians,
psychiatrists, neurosurgeons, rheumatologists, and cosmetic surgeons.
 Arthroscopy
 Injury Surgery
 Treatment for Bone Tumors
 Surgery for Joint Replacement
 Bone fracture treatment
 Eye Lift Medical Rheumatology
 Spinal Procedures
 Surgery for Cancer
 Surgery oncology
 Orthopedics in pediatrics
 Prevention of Disease
 Laparoscopic Procedures
 Rheumatism Treatment
 Consultant Laparoscopy
 Consultant Rheumatologist
 Maxillofacial Prosthetics
 Oral and Maxillofacial Surgery

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 SERVICES AVAILABLE IN HOSPITAL
 Clinical services
Such as Internal Medicine and Critical Care, General Surgery,
Cardiology, GI Surgery and Laparoscopic Surgery, Pediatrics and
Neonatology, Bone & Joint, ENT, Ophthalmology, Anesthesia Services,
Neurology & Spine, Nephrology, Urology, Dermatology, Psychiatry,
Pathology Laboratory, and Radiology.

 Clinical support services

Including, but not limited to, laboratory services such biochemistry,
pathology, microbiology, hematology, and immunology; imagine services;
CSSD; pharmacy; dietary services; and the medical record department.

 Utility services
examples include the departments of administrative personnel, front
desk, communication, housekeeping, and biomedical waste management;
engineering services; biomedical engineering; procurement and store; and
finance.

 24*7 services
• Emergency department services
 Pharmacy services
 Laboratory services.
 Radiology services
 Ambulance services
 Pathology service

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 Auxiliary service

CENTRAL
STERILE AND CENTRAL CENTRAL MEDICAL
SUPPLY STORE – MEDICAL RECORD
DEPARTMENT(C GENERAL & GASES DEPARTMENT
SSD) MAINTENANCE

BIO-MEDICAL PHYSIOTHERAP
ANAESTHETISTS
ENGINEERING Y

 remarks
 Services not available in Hospital
 MRI(Magnetic Resonance Imaging)

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 Management Chain

BOARD OF
DIRECTORS
CENTRE HEAD

ACC MAI
OPERATIONA CO HR. SE FRONT
OUN NT ST CU
NS DE DESK
L HEAD T
UL PA AN OR RIT DEPARTM
DEP AN E - Y PR
TA RT ENT
ART CE GE O
PHYSI RA MEN NT ME DE NE
CS O. C.M MR BIO DIO NT
NURSIN ICN OTHER T PA RA
SD T. .O. MEDI LO
G DPT. D HO /QU APY RT L INCHA
DE CAL GY
PT US ALI DEPT. ME RGE
E TY NT
MEDI KE
INC PHYSI B.M. TECH
TE HAR INC CAL MR EPI NISIA
HA OFFIC OTHE ENGI
CH GE D. NG NEE N BILLIN
RG ERS RAPIS
NIS DP R G
E T
IAN T.
OT CLINI ASSI
STA CAL TRAI STAN OPD +
AS OBSE TECHN T
FF ST NEE HELP
SIS RVER ICIAN
NUR AF DESK
TA
NT SE F TRAI
NEE
TEC
HNI TRAI
AS NEE TRAINE
CIA
TR SIS E
N
AIN TA
EE NT
ASSI
STA
NT
TR
AIN
EE

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 DESIGN OF HOSPITAL

The hospital's structure is horizontal in shape, with 2 stories and a basement.

There are primarily two primary entrances, one for regular patients and the other
for emergency cases.

Basement Canteen, store, physiotherapy, Server room, Generator area,

Electric room , Indoor Pharmacy, Staff changing room,
Ground ER Billing, laboratory, inquiry, Minor o.t , Digital X-Ray, Sonography,
Help Disk
1st floor Health check-up, OPD Reception, Consulting Rooms, VIP Lounge,
Operational Head, Procedure Room
2nd floor OPD reception, billing, Health check-up, Waiting lounge, Board Room
,Central Head, Admin Block, Account Department, TPA Desk,
3rd floor General Ward, Nursing Station, special room, Twin sharing room, Multi
Bed
4th floor Semi special AC Ward, Special AC Ward, VIP. Suite Room, VIP. Suite
Room, Nursing station
5th floor General Ward

6th floor ICU

7th floor OT,

8th floor CSSD, HR OFFICE, House keeping

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 Overview of different departments
1. Marketing
2. Finance
3. Human resource
4. Production
5. Housekeeping
6. Radiology
7. CSSD
8. ICU
9. OT
10. TMT
1) Marketing
Marketing plays an important and pervasive role in the healthcare
marketplace. Till 1980, the concept was alien to healthcare. Today, one can
witness a great deal of marketing taking place in all healthcare
organizations. It is now very common to see that virtually every hospital
places ads in newspapers and magazines to tout its facilities and services.
Hospital salaried physicians give talk shows in TVs, hold camps, deliver
popular health related lectures.
2) Finance
In healthcare organizations, managing money and risk in a way that
contributes to the achievement of the organization's financial objectives is the
main responsibility of financial management. A healthcare institution can
deliver effective healthcare to all of its patients when it has solid and well-
organized financial management policies.
 Financial Management Functions
1. Evaluation and planning
2. Long- term investment Decisions
3. Financing
4. Working capital management

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3) Human resource
Specific Human Resources Management Functions Include:
 Hiring
 Physician and Nurse Recruitment
 Employee Orientation
 Personnel Management
 Benefits & Compensation Management
 Counselling
 Claims Handling
 Training and Performance Monitoring
 Professional Development Programs
 State and Federal Regulations Education
 Work place Safety and Sanitation
 Labour Mediation
 Administration – Employee Meetings
 Staff Morale & Retention

4) Production
It can be difficult to manage the tradeoff between high resource
utilization and high flow efficiency, which is a challenge in all forms of
production. Another challenge is handling variation while delivering good
quality products on time and at an affordable cost. Due to inadequate IT
support tools, there is a situation with limited capacity and a lot of variety at
department Q84, the pediatric oncology department. The results include
increased stress for the coordinators, decreased flow efficiency, and a sense
that patient security may be compromised.

[24]
 CHAPTER -3

SWOT Analysis

S W
Strength Weakness
shiv hospital
SWOT Analysis

O T
Opportunity Threat
 Strengths include:
 A high percentage of success,
 Investments in medical technology,
 Individualized attention,
 A strong reputation,
 A prime location.

 Weakness
 A shortage of doctors;
 A gap in service regions' skills;
 Lack of marketing initiatives or a meagre marketing budget.

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 Opportunities
 Collaborate with different healthcare organization to knowledge
share;
 Develop healthcare programs and initiatives to drive more
community outreach and engagement;
 Increase patient referrals.
 Threat
 Poor food quality

[26]
 CHAPTER - 4

Introduction to topic

The creation, distribution, and utilization of financial resources within the

healthcare system are all covered under health care financing. In order to achieve
universal health coverage, it has gained more and more attention on a global scale
(UHC). Understanding the nation's healthcare financing system enables one to
identify the present health funding sources and strategies for raising additional
funds and allocating them in a way that ensures equitable and high-quality
healthcare for everyone. In order to increase access to health treatments and
decrease out-of-pocket expenses that result in disaster and poverty, it also helps
to understand processes for efficiently and fairly allocating, purchasing, and
spending money.

The Health Care Financing (HCF) Division supports the Union and State
Governments in the field of healthcare financing and facilitates evidence-based
decisions. The National Health Accounts Technical Secretariat (NHATS), a
branch of NHSRC, has the responsibility of institutionalizing health accounts in
India. Based on SHA-2011 criteria, the division has been creating the National
Health Account for the nation from 2013–2014, making the estimates from India
comparable to those from the rest of the globe. The World Health Organization
(WHO) also uses the NHA estimates for India in its Global Health Expenditure
Database (GHED).
Important government papers like the Economic Survey published by the
Ministry of Finance and the Survey of State Finances published by the Reserve
Bank of India also make use of the estimates. Indicators for health financing are
reported and tracked by the HCF division in accordance with the National Health
Policy of 2017, Sustainable Development Goals, and Universal Health Coverage.
The HCF team conducts research on matters pertaining to national health
financing.

[27]
 CHAPTER - 5

Review of the literature

 Factors influencing the burden of health care financing and the

distribution of health care benefits in Ghana, Tanzania and South Africa
 2012 •
 Bronwyn Harris
 Due to flat insurance rates, weak methods to exempt impoverished groups,
and insufficient prepayment financing to cover the expenses of health care
for the underprivileged, voluntary health insurance and out-of-pocket
payments are regressive.
 There are many different affordability, availability, and acceptability
hurdles that affect poorer populations the most severely. The expense of
healthcare is not the only one of these.
 To overcome these imbalances, it will be required to alter how health
services are financed, particularly by shifting away from out-of-pocket
payments and toward a greater reliance on prepayment funding systems.
However, deliberate actions are also needed to address the entire spectrum
of access obstacles.

 Progressivity of health care financing and incidence of service benefits in

Ghana
 James Akazili
 Ghana's current health care financing structure is progressive, but the
advantages of health services are favoured by the wealthy.
 Although out-of-pocket expenses make up the single largest portion of
health care spending, they are also the most regressive part of the health
finance system.
 Contributions to the national health insurance programme made by those
who work outside of the formal economy are incredibly regressive.
 A number of access constraints contribute to inequities in the distribution
of health service benefits.

[28]
 If Ghana is to reach universal coverage, it is crucial to lower out-of-pocket
expenses, figure out how to include those who work outside of the formal
economy in the national health insurance system, and actively address the
numerous access barriers to healthcare services.
 Equity in financing and use of health care in Ghana, South Africa, and
Tanzania: implications for paths to universal coverage
 2012 •
 Bertha Garshong
 Although there is currently a lot of international and domestic discussion
about universal health care coverage, there is still disagreement over the
appropriate combination of financing methods, particularly for those who
work outside of the formal economy. The equitable implications of various
finance structures and usage patterns of services are crucial topics. We
present a whole-system analysis of the equality of health-system financing
and service utilisation in Ghana, South Africa, and Tanzania, integrating
the public and private sectors.

 We charge them; otherwise we cannot run the hospital” front line

workers, clients and health financing policy implementation gaps in
Ghana
 2011 •
 Irene A Agyepong
 Providers altered the policies and procedures for implementing
exemptions, occasionally only granting partial or no exemptions. Clients
who were aware of or suspected they were entitled to an exemption did not
request it out of concern for the providers' possible reactions. The threat
that payment uncertainty and delays pose to the financial stability of their
institutions is what providers attributed to their alteration of
implementation arrangements and negative reactions.

[29]
 At the time of the study, frontline staff were not significantly altering
implementation arrangements, and insurance coverage was low. However,
the underlying objective conflicts, resource shortages, working
circumstances, and interactions between frontline employees and clients
that led to gaps in the application of the exemptions policy remained.
Therefore, there was still a chance that the health insurance policy might
run into the same operational problems as the exemptions programme.
 Health Policy and Planning
 Minding the gaps: health financing, universal health coverage and gender
 Sophie Witter
 Insufficient attention has been paid to the interaction of gender and health
financing; we call for better collaboration to fill this gap.
 While Universal Health Coverage (UHC) emphasizes equity, some groups
have higher health needs and lower financing capabilities than others; this
implies the need for progressive universalism, which puts the needs of
vulnerable groups like women and children first.
 Broad recommendations from our review include public financing of
health care services with resources mobilized from progressive taxation of
income and wealth; firm action by governments to regulate the private
health sector, especially in the area of price controls; attention to coverage
of different groups of women when implementing health financing
reforms; and social protection schemes that go beyond women from
households below the poverty line and with packages covering more than
maternal health.
 The underlying political and social determinants that undermine access for
vulnerable and marginalized groups (e.g. poor indigenous women,
adolescents) must also be tackled to achieve the broader equity and
effectiveness goals of UHC.
 Health Care Financing Reforms in India
o by Mita Choudhury
o 6 Views
o 2

[30]
 This study examines public health spending in India. In particular, it
examines the type of public health spending and how it affects health
infrastructure and population health. Additionally, it covers the recent
reform initiatives that aimed to increase state-by-state spending on
healthcare through transfers for a defined purpose. Additionally, it
examines the State's financial flexibility for health care spending as well as
the stimulation and replacement effects of federal health transfers. Low
levels of public spending on healthcare, poor service quality that has a
severe impact on the population's health, a lack of emphasis on
preventative healthcare, and population dependency are all characteristics
of the Indian healthcare system.
 A lack of focus on preventative health care; and dependency of the
population, particularly the poor, on private health care providers and
consequently high OOP spending and immiseration.
 Health care financing and delivery in developing countries
o by A Maeda
o 6 Views
o 16

 This essay Although they make up 93 percent of the world's illness burden
and 84 percent of the world's population, developing nations only make up
18 percent of global income and 11 percent of global health spending.
Governments in the developing countries have significant hurdles due to a
lack of financial and administrative capabilities as well as significant
service needs. This study examines the features of health spending, health
outcomes, and health delivery systems for low-, medium-, and high-
income nation groupings and the six developing regions of the world.
 Equity in health care finance and delivery
 A Wag staff, E Van Doorslaer - Handbook of health economics
 , 2000 – Elsevier

[31]
 This essay developing nations generally the paper conducts a review of the
economics literature on equality in the financing and provision of
healthcare. Most of the time, empirical research is the main focus,
particularly when it involves global and chronological comparisons. The
idea and definition of equity are, however, briefly discussed. The empirical
portions cover the literature on equity in health care delivery (horizontal
equity in the sense of treating people in equal need identically) and equity
in health care finance (progressivity and horizontal equity of health care
financing arrangements).

[32]
 CHAPTER – 6

Research methodology

 Introduction: -
This paper Developing countries• There is insufficient data to support the
application of best practises for interventions aimed at primary health care (PHC)
system finance, which could hasten the transition to universal health coverage.
The goal of this project was to establish a stakeholder-driven research agenda on
PHC funding interventions in the Asia-Pacific region.
 Methods
 We adopted a two-stage process:
1. A systematic review of financing interventions targeting PHC service
delivery in the Asia-Pacific region was conducted to develop an evidence
gap map.
2. An electronic-Delphi (e-Delphi) exercise with key national PHC
stakeholders was undertaken to prioritise these evidence needs.
 Results
 The review includes 31 peer-reviewed papers, 8 systematic reviews, and
8 reports from the grey literature. Although there was little consistency
among studies, there was evidence that some interventions (such as the
elimination of user fees, changes in provider ownership models, and
contracting arrangements) might have an impact on PHC service access,
effectiveness, and outcomes related to out-of-pocket costs..
 The e-Delphi exercise highlighted the importance of contextual factors
and prioritised research in the areas of:
1. Interventions to limit out-of-pocket costs;
2. Financing models to enhance health system performance and maintain
PHC budgets;
3. The design of incentives to promote optimal care without unintended
consequences
4. The comparative effectiveness of different PHC service delivery strategies
using local data.

[33]
  Globalization and income inequality
The way that money is distributed both across and within nations has
been significantly impacted by globalisation. Thomas Piketty's main study
from 2014 demonstrated how capital is favoured by globalisation in
comparison to other revenue sources like labour and rent. Many countries
were lifted out of poverty by increased capital mobility, but the gains went
to the wealthy capital-owning nations. Globalization has widened income
disparity inside nations, with the highest income levels consuming a higher
proportion of the GDP. Growing inequality raises moral and political
issues, but it also has economic ramifications because, at a certain point, it
can lead to serious economic problems. For instance, if income is not taxed,
welfare and other safety nets are less effective and the economy is less
competitive.

 Research objective
1. Assessing the impact of employing healthcare funding initiatives to
lower the costs of delivering or using smoking cessation treatment
on abstinence from smoking was the main goal of this review.
2. To learn about a phenomenon or obtain fresh knowledge about it
(studies with this goal are known as exploratory or formative
research studies).
3. To appropriately represent the traits of a certain person,
circumstance, or event group (studies with this object in view are
known as descriptive research studies).
4. To determine how frequently something happens or is repeated in
relation to another thing (studies focusing on this object are known
as studies on diagnostic research).
5. To test a theory on the existence of a causal link between two
variables. The term "hypothesis-testing research studies" is used to
describe this kind of study.

 Scope of the study

 The research issues that stakeholders felt were most crucial are not
addressed in the literature. More study is required to determine how to
finance interventions and apply them widely across health systems.
Such research must be pragmatistically conducted, balancing
academic rigour with real-world needs.

[34]
  This is an open access article distributed under the terms of the Creative
Commons Attribution Non Commercial (CC BY-NC 4.0) licence,
which enables others to distribute, remix, adapt, and build upon this
work for non-commercial purposes and to licence their derivative works
under different conditions, as long as the original work is properly cited,
credit is given, any changes are noted, and the use is for non-
commercial purposes.

 Data collection (primary and secondary)

 Primary Data- data observed or collected from first-hand experience.
 Secondary Data- Published data then the collected in the previous or
by other parties.
 PRIMARY DATA
 Discussion with the different officials of the healthcare organization
 Focus group conversation
 Taken Expert opinion
 Direct surveillance
 Informal & formal conversation with superior
 SECONDARY DATA
 Use different text record and journals.
 Different kind of report and articles linked to study.
 Some of my sequence elements as related to this report.
 Web based provision from the internet.

 Data collection Instrument (e.g. Questionnaire)

1. observations
2. surveys

1. Observations:-
 By witnessing individuals and their behaviour at events or in their
natural environments, observation is one of the traditional qualitative
data collection techniques used by academics to acquire descriptive
text data. With this approach, the researcher actively participates in
observing or observing others while taking notes. In addition to writing
notes, other methods including using movies, photos, audio recordings,
and physical objects like antiques and mementos are also used.

[35]
 There are two main types of observation:-
 Convert
 Overt
 Covert:
One of the classic qualitative data collection methods used by
academics to gather descriptive text data is observation, which
involves observing people and their behavior at gatherings or in their
natural habitats. With this strategy, the researcher actively participates
in observation while keeping notes on what they see or what others are
seeing. In addition to taking notes in writing, people also use movies,
pictures, audio recordings, and actual artefacts like antiques and
keepsakes.

 Overt:

 In this method, everyone is aware that they are being watched. For
example, a researcher or an observer wants to study the wedding
rituals of a nomadic tribe. To proceed with the research, the
observer or researcher can reveal why he is attending the marriage
and even use a video camera to shoot everything around him.

 Observation is an effective qualitative data collection technique,

particularly when you want to examine an ongoing process, a given
circumstance, or a person's responses to a particular topic. Even
when you want to understand people’s behavior or their way of
interaction in a particular community or demographic, you can rely
on the observation data. Remember, if you fail to get quality data
through surveys, qualitative interviews, or group discussions, rely
on observation. It is the best and trusted qualitative data collection
method to generate qualitative data as it requires equal to no efforts
from the participants.

[36]
 2. Survey:-
Many researchers utilise qualitative surveys to gather data or to gather
specific information about a product or topic in order to generate an informed
hypothesis. Ask more open-ended questions while developing questionnaires
to gather textual or qualitative data. Such inquiries require the respondent to
write their viewpoint or opinion on a certain subject or issue. Online surveys,
in contrast to other qualitative data collection methods, offer a larger reach,
allowing you to obtain high-quality, highly reliable data from a large number
of people.

 Paper surveys:-
For gathering participant-provided qualitative data, paper
questionnaires are widely utilised. The survey consists of brief, frequently
open-ended text questions. The goal of these inquiries is to elicit from
responders as much specific information as possible in their own words.
Survey questionnaires are frequently used to gather responses from a broad
population or sample size since they are made to collect standardised data.

 Online surveys
In order to gather trustworthy online data, an online survey, also
known as a web survey, is created using well-known online survey
software and either published to a website or sent to the chosen sample
size. The responders enter their replies on computers and keyboards rather
than writing them down. The collection of qualitative data is made easier
and more seamless with the use of an online survey questionnaire.

Online surveys also have a wider audience and the respondent is not under the
interviewer's control to answer every question. One of the key advantages of online
surveys is that respondents may complete them on any platform, including desktop,
tablet, or mobile.

[37]
 Limitations of the Project
1. Lack of face to face interaction
2. Can be obstructive
3. Not suitable for every services
4. Weaker trust large number of scams
5. Issues with research samples and selection.
6. Insufficient sample size for statistical measurements.
7. Lack of previous research studies on the topic.
8. Methods/instruments/techniques used to collect the data.
9. Limited access to data.
10. Time constraint.

[38]
 CHAPTER – 7

Data Analysis and Interpretation

INTERPRETATION

We collect the survey inquiry the age group of 18-25 the highest 84.4% from
Despondence to response and another rest of age between group of 26-35 is
15.6%.

INTERPRETATION

We collect the survey inquiry the Gender of male the highest 85.9% from
Respondence to response and another gender female 14.1%.

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INTERPRETATION

We collect the survey inquiry the occupation of student the highest 84.4%
from Respondence to response and another self -employed professional is
10.9%.

INTERPRETATION

We collect the survey inquiry the Qualification of the response is the highest
masters, 43.8% from Respondence to response and another Bachelors 35.9%
and 12th is 14.1%.

[40]
INTERPRETATION

We collect the survey inquiry the marital status of the single is teg highest,
89.1% from Respondence to response and another married is 9.4%.

INTERPRETATION

We collect the survey inquiry the monthly household income of the below
50000 is the highest, 55.6% from Respondence to response and another
50000-100000 is 22.2% and 100000-150000 is 14.3% and above the 150000
is 7.9%.

[41]
INTERPRETATION

We collect the survey inquiry the healthcare coverage of yes is the highest,
73.4% from Respondence to response and another 26.6%.

INTERPRETATION

We collect the survey inquiry the spending patterns of the spend much then
income is the highest,43..% from Respondence to response and another little
less then income is 28.3% and spent about equal to income is 18.3% and spend
a little more than income is 10 %.

[42]
INTERPRETATION

We collect the survey inquiry the healthcare coverage of yes is the highest,
54.7% from Respondence to response and another I am not sure is 23.4% and
no is 21.9%.

INTERPRETATION

We collect the survey inquiry the financial health of yes is the highest, 67.2%
from Respondence to response and another 26.6%.

[43]
INTERPRETATION

We collect the survey inquiry the pay of health services of yes is the highest,
71.9% from Respondence to response and another 20.3%.

INTERPRETATION

We collect the survey inquiry the long term health care of service of all and
home is equal, 40.6% from Respondence to response and community is
12.5% and institutional is 6.3%.

[44]
INTERPRETATION

We collect the survey inquiry the investment capital of saving is the highest
45.3% from Respondence to response and another rest of salary 34.4% and
investment income is20.3%.

INTERPRETATION

We collect the survey inquiry the spent on the general treatment of hospital,
below 300000 is the highest 68.8% from Respondence to response and another
rest 500000 is 23.4%.

[45]
INTERPRETATION

We collect the survey inquiry the payment system would you prefer of the
cash is highest 54.7% from Respondence to response and another rest of cash
less is 28.1% and other is 9.4 %.

[46]
 CHAPTER – 8

Findings & Suggestions

Searches were conducted in important electronic databases as Medline,

Embase, Scopus, Global Health, CinAHL, EconLit, and Business Source
Premier. Additionally, we looked through the grey literature, more specifically
the websites of reputable groups that advocate health care finance. Only studies
that explicitly used financing incidence analysis (FIA) or benefit incidence
analysis (BIA) as methodology were included. The various sources yielded a total
of 64 records. 24 were deemed eligible for inclusion after the entire texts of 64
references were evaluated against the selection criteria. In addition to nine studies
from the Asia-Pacific area, two from Latin America, and one from the Middle
East, 12 of the 24 studies came from India. The evidence suggests that both sub-
Saharan Africa and the Asia-Pacific region have progressive financing and a pro-
rich distribution of total health benefits. The bulk of the time, the hospital level
services help the wealthy while the primary health care level benefits the less
fortunate. A few Asian nations, including Thailand, Malaysia, and Sri Lanka, still
maintain a progressive finance system and pro-poor distribution of health
benefits.

 Conclusion:-

This systematic review's studies show that health care financing in LMICs
benefits the wealthy more than the poor while also placing a greater financial
burden on the wealthy. Primary healthcare appears to benefit the poor, which
suggests that increasing funding for these services and removing obstacles to care
can improve equity. The overall findings indicate that there are barriers to
enhancing the poor's access to health care, and this must be addressed if universal
health coverage is to become a reality.

[47]
 CHAPTER – 9

Annexure

 Annexure – Questionnaire
 Age:-
 *
 18-25
 26-35
 36-45
 Above the

 Gender :-
 *
 Male
 Female
 Prefer not

 Occupation :-
 *
 Student
 Self-Empl
 Self-Empl
 Salaried

 Qualification :-
 *
 10th
 12th
 Bachlors
 Masters
 Other

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 Marital Status :-
 *
 Singal
 Married
 Divorced
 Widowed

 What is your monthly Household income? (In thousand)

 below Rs
 Rs 50.1to 1
 Rs 100.1 t
 Above the

 Have you been able to obtain healthcare coverage?

 *
 yes
 no

 Over the past, how would you describe your spending patterns related to
income and expenses?
 spend mu
 spend a lit
 spend abo
 spend a lit

 Have you been able to obtain healthcare coverage?

 *
 yes
 no
 I am not s

 Do you think that financial health is useful lens through which to think
of finances?
 *
 yes
 No
 I am not s

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 Are people willing to pay for health services?
 *
 Yes
 No
 I am not s

 Long term health care service are usually found in a (n) --------- setting?
 *
 home
 communi
 institution
 all of thes

 What is the source of your investment Capital?

 *
 salary
 saving
 investmen

 How would you like to spent on a general treatment of hospital

 *
 Below 300
 500000
 800000
 Above 100

 which type of payment system would you more prefer:-

 *
 cash
 cash less

[50]
 CHAPTER – 9

Bibliography
 https://doi.org/10.1371/journal.pone.0152866

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of health care benefits in Ghana, Tanzania and South Africa

2. Progressivity of health care financing and incidence of service benefits in

Ghana

3. Equity in financing and use of health care in Ghana, South Africa, and
Tanzania: implications for paths to universal coverage

4. We charge them; otherwise we cannot run the hospital” front line workers,
clients and health financing policy implementation gaps in Ghana

5. Equity in health care finance and delivery

6. Minding the gaps: health financing, universal health coverage and gender

7. Equity in financing and use of health care in Ghana, South Africa, and
Tanzania: implications for paths to universal coverage

8. Progressivity of health care financing and incidence of service benefits in

Ghana

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