MSC – I YEAR – ANP

UNIT – II: HEALTH CARE DELIVERY

TOPIC: MAJOR STAKE HOLDERS IN

HEALTH CARE

MS. SHOBA.G
PROFESSOR
• At the end of the session the students will be able to
– Define stakeholders
– Enlist various types of stakeholder
– Explains the common stakeholders in health care
 HEALTH CARE SYSTEM:

• The health care system intended to provide services and

resources for better health. This system includes
hospitals, clinics, health centers, nursing homes and
special health programmed in school, industry and
community. Health system operates in the context of
socioeconomic and political framework of the country.
 STAKEHOLDER DEFINITION

• Stakeholder is a person, group, organization or

system who affects and can be affected by an
organizational l action.
• Stakeholders are those entities in the
organization’s environment that play a role in an
organization’s health and performance or that are
affected by an organizational Aaction.
 TYPES OF STAKEHOLDERS

• Accorging to availability
• According to position of work
 ACCORDING TO AVAILABILITY

• Primary stakeholders:

the primary stakeholders are those that are engaged in economic

transaction with the business.
Example: stockholders, customers and employers.
• Secondary stakeholders:

the secondary stakeholders are those who are although do not engage
in direct economic exchange business but are affected by or can affected.
Example: general public, communities, activist, business support groups
and media.
ACCORDING TO POSITION /WORK

External
stakeholders

Internal Interface
stakeholders stakeholders
 EXTERNAL STAKEHOLDERS

• A health care organization must respond to large number

of external stakeholders.
• They fall into three categories in their relationships to the
organization.
– Those that provide inputs to organization.
– Those that compete with it.

– Those that have particular special interest.

 EXTERNAL STAKEHOLDER - THOSE THAT PROVIDE
INPUTS TO ORGANIZATION

• The relationship between the organization and these

external stakeholders is a symbolic (interdependent
relationship) one, as organization depends on them for its
survival.
• Stakeholders depend on the organization to take their
outputs.
• The competitor stakeholder may be directed competitor for
• Patient (E.G. Other hospital)
 EXTERNAL STAKEHOLDER -THOSE THAT COMPETE
WITH IT

• The competitor stakeholder seeks to attract the focal

organization dependents.
• The competitor may be direct competitor for patients. (E.g.
Other hospital) or they may be competing for skilled
personnel.
• Competitor does not need one another to survive, while
co-operation between hospitals and their competitor has
increased in recent years.
 EXTERNAL STAKEHOLDER – THOSE
HAVE SPECIAL INTEREST

• These are the government regulatory agencies, private

accrediting association, professional associations, labor
union, the media and political action group.
• Because of special interest conflict most often occur.
• Compromise and, in some cases, overt collaboration
generally resolves the conflicts.
 INTERFACE STAKEHOLDERS

• Some stakeholders function on the interface between the

organization and its environment.
• The major categories of interface stakeholders include
the medical staff, the hospital board of trustees.
• The organization must provide sufficient inducements to
continue to make appropriate contribution.
• The organization may offer professional autonomy
institutional prestige or political contacts, special services
and benefits etc.
 INTERNAL STAKEHOLDERS
• Internal stakeholders almost entirely within the organization
and typically include management, professional and non
professional staff.
• Management attempts to provide internal stakeholders with
sufficient inducements to gain continual contribution
• The stakeholders determine whether the inducements are
sufficient for the contribution that they are required to make
partly on the basis of alternative contribution offer received
from competitive.
 STAKEHOLDER IN HEALTH CARE
DELIVERY SYSTEM

• Government
• Public
• Providers

• Hospital administrator and governing boards

• Non-governmental
 1. GOVERNMENT

• Many federal government health care efforts are headed

by a cabinet-level officer, the secretary for health and
human services, who runs the department of health and
human services.
• government makes budget and other planning related to
expenditure in health care.
• As the major payer, the federal government has been
active in regulating the health care industry.
 CONTI..GOVERNMENT

• Therefore, hospital have great incentive to comply with

regulations promulgated by federal government,
because they can be fined or ―decertified‖ as a provider
of care to Medicare clients if they do not.
• Government regulation is frequently opposed by the
health care industry because it often affects the health
care practitioner‘s autonomy
 GOVERNMENT At central level:
• Stakeholders at central level are cabinet minister & secretary for
health & human services who runs the department of health &
human services.
The functions are:
• Ensuring high levels of executive management performance.
• Ensuring quality of patient care.
• Ensuring financial health of the organization.
• Assuming responsibility for itself (for its efficient and effective
• performance).
• Formulating policy to guide decision making and action.
 GOVERNMENT At state level
At state level, state health directorate is responsible for
administering health care services & regulating the health
care delivery system.
The functions are:
• Integrating health care services.
• Availability of medical facilities.
• Plan health programmes & drawing policies in providing
health care.
• Provision of medicines.
 GOVERNMENT AT DISTRICT LEVEL

The district level stakeholder in health care delivery

system is deputy commissioner, MLAs of the area, civil
surgeons, senior medical officers and district public
health nurse.
 2. STAKEHOLDER - THE PUBLIC
• The public has a stake in health care from several
perspectives. As consumers of health care services or as
patients, the public is concerned with quality, cost and access
to care.
• They expect an employer to offer a wide variety of option for
health coverage that can be customized to their specific needs.
• They also look for the employs to fund the majority of cost of
health insurance.
• People are interested in receiving quality care at a reasonable
cost.
 3. STAKEHOLDER - THE PROVIDERS
• Community health care professional & Hospital health
care professional
– Physician
– Nurses
– Pharmasist
– Hospital administrator
HOSPITAL HEALTH CARE PROFESSIONAL - PHYSICIANS

• The role of physicians in the health care system is important one.

Physicians provide direct medical services to clients in variety of settings,
including offices, clinics, hospitals and freestanding centers.
• In addition, physician control 60% to 70% of hospital costs through their
decisions regarding the use of resources.
– which client to admit,

– where to admit,

– the length of stay,

– the ancillary services,

– whether to perform surgery,

– when to initiate and to discontinue treatment regimens,

– which medications to prescribe.

 HOSPITAL HEALTH CARE
PROFESSIONAL – NURSES
• An individual who provides care to clients.
• The extent of participation varies from simple patient care
tasks to the most expert professional technique necessary in
acute life threatening situations.
• The ability of nurse to function independently and making self
directed judgment will depends on his or her professional
development.
• Nurses provide a unique perspective on the health care
system. The greatest impact and the most frequently discussed
aspect of nursing has been the recurring shortage of nurses.
 HOSPITAL ADMINISTRATORS AND
GOVERNING BOARDS

• The chief executive, chief financial officer, chief nursing

officer, and governing boards of hospitals strongly
influence health care delivery in their institutions.
• In addition most hospitals are members of some
association which represents the industry‘s efforts to
influence legislation, regulation, judicial decisions, and
health policy.
NON-GOVERNMENTAL STAKEHOLDERS

• The voluntary agencies occupy an important place in community

health care system.
• These organizations directly or indirectly act as stakeholder.

• These organizations are administered by autonomous boards

which
– hold meetings,
– collect funds from private sources

– spend money for providing health services and health

education to individual, family and community.
• There are many NGO’S in India which serves to society.
 INDIAN RED CROSS SOCIETY:

• It was established in 1920 and has over 400 branches all over India.
It has been executing programme for the prevention of diseases and
promotion of health. Its activities are:
• Relief work

• Milk and medical supplies

• Armed forces

• Maternal and child welfare services

• Family planning

• Blood bank and first aid

 HINDU KUSHT NIVARAN SANGH:
• It was founded in 1950 with its headquarters in New Delhi. Its
precursor was the Indian council of British empire leprosy relief
association (B.E.L.R.A) which was dissolved in 1950.
• The work of the Sangh includes rendering of financial
assistance to various leprosy homes and clinics, health
education, training of medical worker and physiotherapists
conducting research and field investigation.
• The Sangh has branches all over India and work in close
cooperation with the government and other voluntary agencies
 INDIAN COUNCIL FOR CHILD WELFARE

• It was established in 1952. It is affiliated with international

union for child welfare.
• The services of I.C.C.W are devoted to secure for Indian
children those “opportunities and facilities, by law and
other means” which are necessary to enable them to
develop physically, mentally, morally, spiritually and
socially in a healthy and normal manner and in conditions
of freedom and dignity.
 TUBERCULOSIS ASSOCIATION OF INDIA:

• It was formed in 1939. It has branches in all states of

India.
• The activities of this association comprise organizing T.B
campaign every year to raise funds, training of doctors,
health visitors and social workers in anti-tuberculosis
work, promotion of health education conferences.
 BHARAT SEVAK SAMAJ:

• The Bharat sevak samaj which is non-political and

nonofficial organization was formed in 1952.
• One of the prime objectives of the Bharat sevak is to
help people to achieve health by their own actions and
efforts.
• The B.S.S. Has branches in all the states and nearly all
the districts. Improvement of sanitation in villages is one
of the important activities of the B.S.S.
 THE KASTUBRA MEMORIAL FUND:

• Created in the memory of Kasturba Gandhi, after her

death in 1994, the fund was raised with the main
objective of improving the status of women, especially in
the villages, through gram savikas.
THE ALL INDIA BLIND RELIEF SOCIETY:

• It was established in 1946 with a view to coordinate

different institutions working for the blind, it organizes
eye relief camps and other measures for the relief of the
blind.
 PROFESSIONAL BODIES:
• The Indian medical association, all India dental
association, the trained nurses association of India of all
men and women who are qualified in their respective
specialties and possess registerable qualifications.
• These professional bodies conduct annual conferences,
publish journals, arrange exhibitions, foster research, set
up standards of professional education and organize
relief camps during periods of natural calamities.
 BUSINESS & INDUSTRY

• As health care costs increased in mid of 1990, the influence

of business industry increased as well.
• Health insurance programmes are launched mainly through
benefit programme.
• As the cost of health care increases, insurances costs
increase as well, forcing business to assume greater
financial burden to insure employee & their dependents as
well.
• Cost for product increases accordingly.
 References
• http://www.authorstream.com/presentation/randhawakiran
23-1773521-majorstakeholders
• http://www.slideshare.net/jincy_eappen/major-
stakeholders.