title: Hub and spoke model: making rural healthcare in India affordable, available and accessible.
abstract: BACKGROUND
  Quality health care should be within everyone's reach, especially in a developing country. While India has the largest private health sector in the world, only one-fifth of healthcare expenditure is publically financed; it is mostly an out-of-pocket expense. About 70% of Indians live in rural areas making about $3 per day, and a major portion of that goes towards food and shelter and, thus, not towards health care. Transportation facilities in rural India are poor, making access to medical facilities difficult, and infrastructure facilities are minimal, making the available medical care insufficient. The challenge presented to India was to provide health care that was accessible, available and affordable to people in rural areas and the low-income bracket.
  
  
  OBJECTIVE
  The intent of this article is to determine whether the hub and spoke model (HSM), when implemented in the healthcare industry, can expand the market reach and increase profits while reducing costs of operations for organizations and, thereby, cost to customers. This article also discusses the importance of information and communications technologies (ICT) in the HSM approach, which the handful of published articles in this topic have failed to discuss. This article opts for an exploratory study, including review of published literature, web articles, viewpoints of industry experts, published journals, and in-depth interviews. This article will discuss how and why the HSM works in India's healthcare industry while isolating its strengths and weaknesses, and analyzing the impact of India's success. India's HSM implementation has become a paramount example of an acceptable model that, while exceeding the needs and expectations of its patients, is cost-effective and has obtained operational and health-driven results. Despite being an emerging nation, India takes the top spot in terms of affordability of ICT as well as for having the highest number of computer-literate graduates and healthcare workers in the world. These factors further aid the implementation of HSM in India, thereby proving the model as a stable operational environment that is saving costs in a financially challenged nation.
  
  
  CONCLUSIONS
  HSM has an innovative architecture that emphasizes optimal utilization of scarce healthcare resources in rural areas. HSM demonstrates that medical care can be provided to even the most rural areas while still utilizing modern procedures and equipment at a much more nominal cost to the end user. It also eliminates the need for unnecessary travel, and keeps costs low to medical facilities and patients alike. The model has the potential to create and sustain thousands of local jobs, both direct and indirect. The hope is that the review of the impact of the HSM in Indian health care will result in inquiries of a similar nature in the future.
authors.affiliation: British Computer Society, Swindon, UK. cindbad@gmail.com.
authors.forename: Srichand
authors.initials: S
authors.lastname: Devarakonda
mesh_terms: D002391:Catchment Area, Health; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration*; D006301:Health Services Needs and Demand / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007194:India / Q000453:epidemiology; D017146:Models, Organizational; D015397:Program Evaluation; D017150:Public Sector / Q000191:economics / Q000458:organization & administration*; D012040:Regional Health Planning / Q000458:organization & administration; D019035:Rural Health Services / Q000191:economics / Q000458:organization & administration*; D012424:Rural Population / Q000706:statistics & numerical data*
keywords: Asia; Education; Management/Administration; Medical; Nursing; Primary Health Care; Public Health; Researcher