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Working Papers | 2006

Costing of HIV/AIDS Intervention of Providing Antiretroviral Therapy

Bhat Ramesh and Saha Somen

India's initiative to provide structured antiretroviral therapy has raised hope among people living with HIV/AIDS to lead a more productive life. However, from a programme perspective, providing structured antiretroviral therapy has got high cost implications and there are ethical issues related to the provision of second line therapy in case of drug failure. To date, evidences on the cost implications of running ART programmes are mostly from developed and African countries. The current study attempts to work out the cost implications of running the public funded ART centre in the state of Gujarat. Data on cost and patient load were collected through actual field visits to the centre. Using incremental cost approach the cost of providing ART therapy to a patient works out to be Rs. 668 per month. These calculations are based on provision of first line therapy only. Using this costing and assuming a provision of second line therapy for 16 per cent of the cases, we estimate that India will need financial provision of Rs. 454 crore to Rs. 1342 crore for a period of five years under different scenarios to successfully implement the programme. Note: For softcopy of this paper, please contact the author - email: rbhat@iima.ac.in

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Working Papers | 2006

Commitment of State Health Officials: Identifying Factors and Scope for Improvement

Sunil Kumar Maheshwari, Bhat Ramesh, and Saha Somen

Commitment, competencies and skills of people working in the health sector has significant impact on sector performance and its reform process. The current paper is a part of broader multi state studies carried out by the authors in India. The paper attempts to analyse the commitment of state health officials and its implications for human resource practices in Gujarat. The study suggests Gujarat, as compared to other states of India, have achieved significant progress in ensuring commitment of its health officials. However, the state needs to invest progressively and in a proactive manner towards improving the leadership quality, supervision skills and autonomy at workplace to improve and sustain the motivation of its health officials. Improving motivation for the health staffs also involves issues related to infrastructure, involvement, supervision and monitoring, continuous medical education and training, human resource planning, smooth reporting process, administration and audit requirements and prioritisation and synchronisation of health programmes. In order to achieve this, two sets of strategies for reforms are suggested. One relates to short term achievable reforms and other relates to long-term research based actions.

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Working Papers | 2006

Financial Health of Private Sector Hospitals in India

Bhat Ramesh

Hospitals are an important component of the healthcare delivery system. Over the years, India has experienced a significant increase in the number of hospital beds to meet the growing health demands of its population. Most of this growth has been experienced in the small sized private hospital sector (popularly known as nursing homes in India). The corporate hospital sector, however, has not exhibited similar growth though private expenditures on medical and health care in real terms have grown at 10 per cent per annum and government of India initiating number of policy reforms after 1991 aimed at attracting more capital to hospital sector. This experience has something to do with the financial health and risks, as these are critical determinants in attracting private capital. Using the financial balance sheets and profit and loss account data of 128 hospitals in India, this paper examines the financial health of hospitals in the private sector. Based on 26 key financial ratios, the paper empirically identifies relevant dimensions of financial health of hospitals. These dimensions are: profitability, financial structure, overall efficiency, cost structure, profit appropriation, technology advancement, credit management, fixed asset intensity, liquidity and current assets efficiency. It then discusses the implications of the findings. Because of lower profitability, lower financial efficiencies and less understood economies of scale, the risks in the health sector are likely to remain high. Other risk factors are the geographic pull factor, long gestation periods, a highly fragmented sector and inadequacy of standards. In this scenario, new investment in the health sector will remain resource dependent on subsidised channels of funding and will be sensitive to the out-of-pocket payment of fees, which still remains the main channel of revenues of these hospitals.

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Working Papers | 2005

On the Optimal Staffing of Surgeons and Efficient Scheduling of Surgeries at a High-Volume Eye Hospital

Desai Tejas A

It is well-known that the demand for services at many if not all hospitals is variable over a given year such that the demand is significantly higher in some months compared to the rest of the months in any given year. This is especially true for surgical departments at many hospitals. Therefore, it is a challenge to staff the surgical departments in such a way that the demand for surgeries throughout a year is met without creating significant over- or under-staffing at any point in a given year. In other words, an optimal level of staffing is sought so that the staff is not significantly over- or under- utilized at any point in a given year. In this paper, we consider an algorithmic approach of arriving at such an optimal level of staffing given some practical constraints. We apply this approach to the surgery department of the paying section of the Aravind Eye Hospital in Madurai, India.

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Working Papers | 2005

A Study of Dew Water Yields on Galvanized Iron Roof in Kothara (North-West India)

Girja Sharan, Beysens D, and Milimouk I

In order to determine what amount of dew water can be collected without much investment during the dry season (October -May) in north - west India, a study was performed on plain, un-insulated, corrugated galvanized iron roofs that are common in this rural region. Between October 1, 2004 and May 31, 2005, the cumulative dew yield on a 18 m2 double - sloped (30°) test roof was 113.5 L. The west side gave 35 % higher water yield than the east side. The use of thermal insulation and more IR radiative materials would have increased this yield by 40 % (160 L). An analysis of dew events is made with meteorological data. It shows that the variable relative humidity is the most important parameter, which in turn is strongly correlated with the average wind direction with respect to monsoon direction. The cumulative dew water yield (6.3 mm) remains modest when compared with the average rain fall (300 mm). But dew occurs far more frequently than rain and it forms precisely during the dry season when water is most scarce.

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Working Papers | 2005

Corporate Brand Image: Antecedents, Mediating Role and Impact on Stakeholder Expectations

Prathap Oburai, Moorthi Y L R, Basalingappa Anita, Kok Wai Chew, and Baker Michael J

Corporate identity and image are shaped by the entirety of perceptions of a variety of stakeholders, both existing and potential ones, such as customers, suppliers, employees, general public, opinion makers, and government officials. Our study is an empirical investigation of corporate brand image and impact on one such stakeholder group made up of prospective employees. A large multinational, a technical and scientific research firm, a major recruiter of graduates from campuses of reputable universities across the nation was chosen as the subject. This paper develops and tests a path model of the antecedent factors affecting corporate brand image and specific expectations that stakeholders may have of a corporate brand. Based on a thorough literature review, a corporate brand image model that treated as antecedents the four constructs, awareness of organisation's products, perceptions about culture, personality of the focal firm, and general expectations was proposed. Specific expectations that respondents may have about working with the firm was modeled to be influenced by the corporate brand image of the firm surveyed and also by the mentioned four antecedent constructs. The model is fitted to empirical data obtained from a national sample of 368 respondents using LISREL 8.5 methodology, and strong support was found for five, partial support for two of the nine hypotheses tested. Substantial evidence can be seen for the mediating role of corporate brand image in shaping specific expectations that stakeholders have from the corporate brand. Practical significance and managerial implications for marketing investments and organisational performance are detailed.

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Working Papers | 2005

Fuzzy Transfer Pricing World: On the Analysis of Transfer Pricing with Fuzzy Logic Techniques

Tucha Thomas and Brem Markus

The arm's length analysis of international transfer prices of multinational firms lacks sound methodological approach of the so-called function and risk analysis. In practice, such analyses are descriptive. Derived from Zadeh's mathematical theory of fuzzy sets, this paper investigates a quantitative approach to identify the function and risk pattern of related parties of multinational companies. We illustrate our fuzzy logic approach with a simple case.

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Working Papers | 2005

Recommendations of the Task Force on Revival of the Co-operative Credit Structure: Implementation Issues

Sriram M S

The Task Force on Revival of Rural Co-operative Credit Institutions (Vaidyanathan Committee) submitted its final report in February 2005 and there have been a few meetings with the state governments to work out the modalities of the implementation of the report. This paper lists out the issues that are involved in implementing this ambitious financial package of Rs.15,000 crores. It first brings out the historic circumstances under which the co-operative form of organisation came into being, its peculiarities and the principles under which co-operatives operate. The paper then puts the recommendations of the committee in the framework of the principles. Basically we argue that the major issues that would affect the implementation of the recommendation stem out from how in the negotiation between the center and the states some compromises may have to be worked out and the possible implications of the compromises. The observations are based on the recent negotiations and also on the past performance of the sector. The other issues that are raised relate to the logistics of implementation, its endurance over the long run, and concludes with a discussion on the conditions under which the recommendations could effectively work.

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Working Papers | 2005

Globalization, Multinationals and Tax Base Allocation: Advance Pricing Agreements as Shifts in International Taxation?

Brem Markus

This paper elaborates on the emergence of so-called Advance Pricing Agreements (APA) in international taxation and corresponding APA programs in individual countries. It refers to how globalizing business processes trigger governance change on the nation state level regarding the identification and allocation of the tax base of multinational companies. The introduction of APA programs and the generation of APAs are considered to be an example of such governance change. On the basis of a governance choice model, the paper seeks to identify factors which might explain variation in the evolution of national APA programs and the implementation of individual APAs between the taxpayer and the tax authorities. Differences in institutions, economic conditions, and the actors involved are important in explaining variation across countries. Note: For softcopy of this paper, please contact the author - email: markus.brem@gmx.de

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Working Papers | 2005

Classification of Pathological Stage of Prostate Cancer Patients Using Penalized Splines

Mukhopadhyay Pushpal, Maiti Tapabrata, and Tathagata Bandyopadhyay

We propose a penalized splines based method to predict the pathological stage of localized prostate cancer. A combination of prostate specific antigen, Gleason histological score, and clinical stage from a cohort study of 834 prostate cancer patients are used to build the penalized splines model. It turns out that the proposed methodology results in improved prediction of pathological stage compared to usual logistic regression after removing a few outliers. The improvement is shown to be statistically significant. Receiver operating characteristic curve is drawn and we show that the increase in area under the ROC curve over the commonly used logistic regression based classification method is also statistically significant.

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