Les chaînes hospitalières en Inde. Quels modèles pour approcher la diffusion spatiale de ces réseaux de soins ?


[FR] Depuis les années 1980, on assiste en Inde au développement de nouveaux réseaux de soins hospitaliers privés. Parce que les groupes qui composent ce secteur très dynamique sont variés en termes de taille, de composition du capital, de stratégies d’implantation (métropolitaine, régionale, locale), l’organisation spatiale du secteur reste difficile à appréhender. À partir d’un SIG sur le système urbain indien et d’une base de données rassemblant les établissements des groupes hospitaliers, on se propose d’étudier leur diffusion spatiale. On mobilise la théorie de la percolation pour rendre compte de l’hétérogénéité du milieu de diffusion et visualiser la formation de clusters à différents niveaux du réseau urbain.

[EN] Since the 1980s, new private hospital networks are emerging in India. The spatial organisation of this dynamic sector remains difficult to analyse because of the variation in size, capitalisation and development strategies (metropolitan, regional, local) of hospital chains. Using a GIS on India’s urban system and a database presenting the hospitals controlled by hospital chains, we assess the spatial diffusion of the sector. We use percolation theory to take into account the heterogeneity of diffusion medium and to visualize the formation of clusters at different levels of India’s urban network.


Lefebvre Bertrand, Les chaînes hospitalières en Inde. Quels modèles pour approcher la diffusion spatiale de ces réseaux de soins ? in Laurent Beauguitte (coord.), 2013, Les réseaux dans le temps et dans l’espace, Paris, Actes de la deuxième journée d’études du groupe fmr (flux, matrices, réseaux), http://halshs.archives-ouvertes.fr/FMR/


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The Indian Corporate Hospitals: Touching Middle Class Lives


[EN] The main argument of this paper is that today these hospitals are one the most efficient vehicles that promote consumerism in healthcare. If we consider consumerism as an ideology, then the corporate hospital, as a place, is like the manifesto in the field of healthcare, which through place marketing, are promoting newer perspectives of health service delivery and health. These places are creating confusion among the patients by mixing different symbols and signs from the consumption society. The mythical dimension attached to the corporate hospitals is interesting as it echoes some of the values attached to consumerism and the Indian middle class. The promotion of the personal history of the founders, the location strategy or the marketing strategy can offer interesting elements to understand how healthcare has gradually being commodified in India. The final outcome of such nexus between healthcare and consumerism can be seen in the “medicity” or “health city” projects that are mushrooming in the suburbs of Delhi, Hyderabad, and Kolkata. We previously described some elements of disneyization (Bryman, 2004), like hybrid consumption, performative labour or merchandising that Bryman found to be originated from Disney theme park. The main objective is to nurture more profits for hospitals through increased synergies and theming.


Lefebvre, Bertrand (2008) « The Indian Corporate Hospitals: Touching Middle Class Lives »,in Jaffrelot, C., Van der Veer, P. (éds) Patterns of Middle Class Consumption in India and China, Sage, New Delhi, pp. 88-109



The Rebirth of the Hospital: Heterotopia and Medical Tourism in Asia

[EN] Medical tourism is giving birth to new places of care e.g., new international patient wards. Hospitals designed for foreign patients have been planned in India, Middle East and Southeast Asia. In fact, hospital architecture, design and organization are being rethought through this prism of medical tourism. These hospitals face a dilemma of trying to meet local healthcare needs as well as the expectations of a tourism industry standard. Hence we find it relevant to investigate the services such hospitals provide and precisely how the ‘new’ patients’ demands are being met. Foucault’s (1967) theoretical concept of heterotopia will be employed for analyzing the ‘distinctive experience’ of healthcare proffered in medical tourism. The whole experience emulates ‘a realized utopia’.


Bochaton, Audrey, Lefebvre, Bertrand (2008) « The Rebirth of the Hospital: Heterotopia and Medical Tourism in Asia », in Winter, T., Teo, P., Chang, T.C. (éds) Asia on Tour. Exploring the rise of Asian tourism, Routledge, New York, pp. 97-108



”Bringing World-class Healthcare to India”. The Rise of Corporate Hospitals


[EN] Corporate hospitals can be defined as private for-profit hospitals (as opposed to charitable hospitals) offering general or specialist tertiary level care (e.g. cardiac care). They are different from others hospitals because of their private corporate limited status.  Following the liberalization and economic reforms of 1991, we may suppose that corporate hospitals mushroomed all over India. Such hospitals are expanding rapidly in number especially in the metropolises such as Delhi, Kolkata, Bangalore and Hyderabad.

But more than ten years after economic reforms, they hardly tap 7 per cent of the total spendings in private healthcare (CII-McKinsey, 2002). Because of their for-profit orientation and certain misuses of public subsidies, their expansion has become controversial in a country where public hospitals and primary care facilities are in such a bad shape. With the best medical teams and the wealthiest patients fleeing from the public hospitals to these institutions reserved for elite, the gap in the delivery of quality care has surely increased. But who is responsible for this situation? The World Bank and the International Monetary Fund and their Structural Adjustment Policy? The national and local political elites who followed the prescriptions of the international agencies? The corporate hospitals and the economic powers behind these hospitals? The NRIs who came back to India with new concepts of care?

If globalization has a lot to explain on the emergence of corporate hospitals, we would like to remind of and analyse the complexity that prevailed during the birth and the development of this innovation. The interactions between local and global forces were numerous and took different channels. The birth and expansion of corporate hospitals are embedded in those channels.


Lefebvre, Bertrand (2009) « ”Bringing World-class Healthcare to India”. The Rise of Corporate Hospitals », in Vaguet, A. (éd) Indian Health Landscapes under Globalization, Manohar, New Delhi, pp. 83-99