A study on corporate social responsibility for the health care of the elderly by private health care providers of Mangalore city : A health systems research

Introduction: Private sector is the largest provider of health care services in India. But it is expensive. Self-driven corporate social responsibility (CSR) providing free or subsidised services will be useful to the elderly. There are no published data reporting the pattern or types of health care services provided to elderly by the private health care sector of India through CSR initiative. So this study was undertaken. Objectives: To know the pattern (Subsidised/free) and type (Medical, Surgical etc.,) of Health care services received by the elderly people as a part of CSR. Materials and Methods: A questionnaire based cross-sectional study conducted among all private health care providers of Mangalore city. List of all private health care providers which included various types of hospitals (corporate hospitals, multispecialty hospitals etc...) were obtained from the local chapter of Indian Medical Association. The data was collected form hospitals fulfi lling the study criteria. The data was analysed using SPSS software for windows, version 16.0. Results are presented as frequencies and proportions in appropriate tables. Results: Totally 24 hospitals had participated in this study. Most (n = 16, 66.7%) reported providing some free or subsidised services. Among them only 7 (29.2%) were providing free services like: Health check-up camps, subsidised medical and surgical treatment. However most of them did not respond to the “criteria for selecting of the elderly for such free services.” Conclusion: Most of the private hospitals in Mangalore do not provide free or subsidised health care services to the elderly through a self-driven CSR initiative.


INTRODUCTION
It has been projected that the population of elderly (60+) in India will increase from 100 million in 2013 to 198 million by 2030. [1]A clear indication that population of the elderly is going to double.Health care for the elderly has not received much attention till recent years.This is evidenced by the fact that a national programme was launched only in 2011. [1]The programme document highlights the need for comprehensive care for the elderly pertaining to preventive, promotive, curative and rehabilitative services. [1]alth care in India is provided by government and private sectors.The health care services in the government sector are free, where as in private sector it's contrary.Private health care sector is the largest provider of health care in India. [2]As per the World Bank report of 2012; the out of pocket health expenditure in India was 57.6% of the total expenditure. [3]Elderly people have fi nancial constraints for one or more of the obvious reasons like: Retirement, loss of job, disability preventing them from earning, lack of family support etc.This vulnerability may prevent them from accessing health care services or delay in seeking health care.If private health care services are either subsidised or free, then it would help the elderly in accessing the health care services.The world business council for sustainable development has defi ned corporate social responsibility (CSR) as: "The continuing commitment by business to behave ethically and contribute to economic social development while improving the quality of life of the workforce and their families as well as the local community and society at large." [4] There are no published data pertaining to health care services provided to elderly by the private health care sectors of India through CSR initiative.In this context the current study was undertaken with the following objectives: 1.To study the types of health care services (subsidised/free) received by the elderly people as a part of CSR if any. 2. To know the types of CSR activities related to geriatric care provided by private hospitals of Mangalore city.

Study area (background)
The study was conducted in Mangalore, a coastal city of Karnataka state situated in southern India.The city has a population of 5 lakhs as per 2011 census. [5]The city has 5 allopathic medical colleges.Tertiary care in this city is provided by government district Wenlock Hospital and Private Hospitals affi liated to the 5 medical colleges.The city also has numerous corporate hospitals, multi-speciality hospitals, general hospitals, private nursing homes (NHs) and polyclinics which provide various secondary and primary health care services.

Study setting
All private health care providers (corporate hospitals/hospitals attached to private medical institution/NHs/multispecialty hospitals [MSHs]) of the Mangalore city who were functioning as per the guidelines laid (Private Medical Establishment act 2007) by the Government of Karnataka state. [6]

Study design
This is a questionnaire based cross-sectional study where the following components were studied: 1. Pattern of health care services (subsidised care, free care) provided, 2. Types of elderly health care services provided, 3. Criteria for selecting elderly for availing free and or subsidised health care services.

Study units
Private health care providers which included corporate hospitals, private hospitals attached to medical institutions, MSH etc.

Inclusion criteria
1.All private health care providers (hospitals) who are providing services to the elderly.2. Those willing to participate.

Exclusion criteria
1. Speciality hospitals where a health care service to the elderly was not available (like maternity homes, children's hospitals).2. Those who did not consent for the study.

Sample size
There were totally 33 hospitals, of which 24 had consented to participate in the study.There was no sampling used as all the consenting hospitals were included.

Operational defi nitions
The various types of hospitals referred to are: 1.University hospitals/hospital attached to private medical institution (HAPMI), 2. MSH, 3. NH, 4. Specialised care hospital like dialysis care, cardiac care, eye hospital (others).
These terms were used based on the defi nitions/criteria defi ned under Karnataka state private medical establishment act. [6]

Study tools
A self-administered questionnaire was given to hospital administration authorities to collect the following components of information pertaining to various health services made available to the elderly: 1. Type of health care services provided in the hospital, 2. Benefi ciaries of health care services, 3. Types of health care services provided to the elderly, 4. Selection criteria for elderly for availing health care services through CSR, 5. Pattern (free health check-up [FHC] etc.,) of health care services provided to elderly as a part of CSR. 6. Was the hospital authority aware of CSR?

Pretesting and instrument development
This was pretested on some hospitals outside the city limits to assess the feasibility of its use.Some changes were made to suit our circumstances like: 1. Questions pertaining to types of services were reframed, more types or options for the services provided etc., 2. Questions pertaining to selection criteria were reframed.

Data collection
The study protocol was approved by the Institutional Ethics and Research committee.To get representative sample a list of Private health care providers (corporate hospitals/private hospitals attached to medical institutions/MSHs/NHs) were obtained from the local chapter of Indian Medical Association, Mangalore.The hospitals which fi lled the study criteria were approached for data collection.A "Consent form" along with "Study Information Sheet" was enclosed along with the study tool.The medical superintendent's/hospital administrators or chiefs were given the questionnaire.Additionally any queries were verbally clarifi ed.The fi lled questionnaires were collected and analysed.

Statistical (data) analysis
Data thus entered were analysed using Statistical package for social sciences (SPSS) for windows, version 16.0.Chicago, SPSS Inc. Results were expressed as frequencies and proportions in appropriate tables.
Most (n = 16, 66.7%) of them reported to provide some free or subsidised services.Only 7 (29.2%)provided FHC camps, in addition to providing subsidised/free care for the elderly.The type of services provided to elderly (subsidised or free) is presented in Table 1.The nature of services provided are shown in Table 2.
However most of them did not respond to write clearly, the criteria for selecting of the elderly for availing free or subsidised health care services as shown in Table 3.The "others" refered to in Table 3 included the following: 1.Those elderly patients who were willing to be a participant for the research study, 2. Those who would volunteer to be a case for academic discussion.
Only 50% of the hospital authorities answered "yes" to the question "Have you heard about term CSR?"

Access to free or subsidised health care service
Our study showed, only 7 (29.2%)hospitals in Mangalore were providing subsidised health care service to the elderly via CSR initiative.However there are no published data pertaining to private health sector providing health care services to the elderly through CSR Initiative in India.Rashtriya Swasthya Bima Yojana (RSBY) a health insurance scheme for the below poverty line families, helps elderly in India to avail benefi t of free health care services in the private sector. [8]But this scheme provides cover benefi t with an annual limit of Rupees 30,000 only (approximately 500 US$). [8]But most of the chronic morbidities requiring hospitalisation during old age like cardiac surgeries, complications of diabetes, cancer treatments would cross the annual limit of RSBY.Old people belonging to middle income class cannot avail benefi ts under this scheme. [9]This means certain proportion of old people belonging to low income group along with middle income group cannot access the specialised health care services for the conditions mentioned above.Besides, some of these services are not available in government hospitals.In countries such as Canada, Germany and United States of America it is mandatory for most of the population including elderly to have a compulsory access to health insurance either provided by government through tax deduction laws or by the private insurance agencies. [10]About 84% of the citizens in United States of America are covered with health insurance whereas the rest are supported by the charity organizations and the private health care providers through a charity programmes. [10]so the elderly have better health care options as compared to our setting.So provision of free/ subsidized care as a part of CSR would make it accessible to elderly.
Private Health sector in India is not only the largest, but also expensive apart from being most deregulated one. [2]There is an urgent need for the Government to frame policies and issue guidelines to facilitate or motivate the private sector to provide free/ subsidised care as a part of CSR.

Criteria for selecting elderly for providing free or subsidised care
It is evident from the study that, clear selection criteria were not followed in most of the hospitals.Majority of the hospitals failed to respond when asked about the same.Selection was found to be mainly on personal discretion.As a possible result of these situations, elderly are left with no choice other than to depend on government hospital where speciality services may not be available.Thus any legislation or policy formed by the government in this regard should clearly defi ne the criteria for the selecting elderly in providing free or subsidised health care.

Limitation of the study
Considering feasibility, hospitals (private health care providers) situated in Mangalore city were only considered.There could be certain amount of response bias on the part of the hospitals inspite of assurance of anonymity.

CONCLUSION
Most of the private hospitals in Mangalore do not provide free or subsidised health care services to the elderly through a self-driven CSR initiative, inspite of their availability.Although a subsidised care to elderly was provided in 7 (29.2%)hospitals, but there are no clearly defi ned criteria when it comes to selecting elderly for availing the subsidised health care.
[7]   International Journal of Medicine and Public Health | Apr-Jun 2015 | Vol 5 | Issue 2

Table 1 : Type of health care services (subsidised or free) provided in the hospitals (n = 24) for the elderly
*Subsidised health care service, BP = Blood pressure International Journal of Medicine and Public Health | Apr-Jun 2015 | Vol 5 | Issue 2

Table 3 : Selection criteria in elderly for availing (free/subsidised) health care services
How to cite this article: Pai US, Harsha Kumar HN.A study on corporate social responsibility for the health care of the elderly by private health care providers of Mangalore city: A health systems research.Int J Med Public Health 2015;5:157-60.Source of Support: Nil, Confl ict of Interest: None declared.