Over the summer months of 2022, I volunteered as a Clinic Medical Assistant for three weeks from June 20 to July 11 at Guru Ka Langar Eye Hospital in Chandigarh, a northern city in India between the states of Punjab and Haryana. Guru Ka Langar Eye Hospital is a charitable hospital; they offer healthcare services to the general public free of cost. They are a branch of a larger organization, Sri Guru Granth Sahib Sewa Society, a registered not-for-profit in Chandigarh. Sri Guru Granth Sahib Sewa Society was founded in 1997 and has grown to 20 executive members and over 65 doctors in the last 25 years.  They also have five healthcare centers in Chandigarh, including hospitals, clinics, and a pharmacy. The preeminent purpose of the organization is to provide quality healthcare to the impoverished population of India through Sewa, a Sikh concept of selfless service, hence the term charitable hospital. 

Guru Ka Langar Eye Hospital offers the following services free of cost: cataract screening, cataract surgery, retina screening, vitrectomy, cornea transplants, lazy eye surgery, glaucoma surgery, squint surgery, oculoplastic surgery, and pediatric ophthalmology services. They also provide access to glasses and contact lenses free of cost and medicines for an affordable price. As part of the Sri Guru Granth Sahib Sewa Society, the hospital also contains its affiliate medical lab, Tera Hi Tera. All types of blood tests are performed for prices significantly lower than their average market price in India. 

My role as a Clinic Medical Assistant was to assist the nurses and expedite the process of patients before their visitation with a doctor. I took patients' blood pressure and random blood samples before their screening and surgery. I also worked in the Tera Hi Tera Lab, where I learned the procedure of drawing blood. I registered patient information and clinical test reports in both the general hospital and lab. 

The charitable hospital health system is entirely self-sufficient. The Sri Guru Granth Sahib Sewa Society has never taken a grant for any of their healthcare centers, and they keep no profits for themselves. The organization as a whole adopts a non-profit funding model, and individual hospitals themselves, such as Guru Ka Langar Eye Hospital, build upon that. 

The Sri Guru Granth Sahib Sewa Society is the larger non-profit organization that Guru Ka Langar Eye Hospital is a part of. Beginning in 1997, the organization opened its first hospital in Chandigarh, India, and in the last 25, they have grown to five healthcare centers around the Chandigarh area. Each of these hospitals was funded for through a trust organization. 

The Sri Guru Granth Sahib Sewa Society follows the Heartfelt Connector funding model. This model creates a structured way for people who feel connected to a cause to support, generally resulting in a large group of individual donors. In our case, the Sri Guru Granth Sahib Sewa Society has a group of over 1,000 families that donate a portion of their monthly income. From there, the organization allocates the money to each of its respective hospitals for operational costs. When the organization has enough money conserved to launch a new project (i.e., a new charitable hospital), they subsidize their new branch, following the franchise model. 

Proceeding down the executive branches, each hospital of the Sri Guru Granth Sahib Sewa Society follows its supplemental funding model. For this discussion, I will present the particulars of Guru Ka Langar Eye Hospital. 

Independently, Guru Ka Langar Eye Hospital follows the Beneficiary Builder funding model. This model relies on donations from previous hospital beneficiaries to accrue funding. However, the total financing of this model will not all cover the hospital's costs. The rest of the funding comes from the previously mentioned Heartfelt Connector funding model of the Sri Guru Granth Sahib Sewa Society. 

As an operational business entirely funded by donations, one can imagine that the costs of the business are not exorbitant. The cost structure of the charitable hospital (Guru Ka Langar Eye Hospital) will be discussed in the following paragraphs. 

The fixed costs of the charitable hospital include your general expenditures associated with a hospital: employee salaries and benefits, building maintenance, utilities, and equipment. 

All employees not members of the Sri Guru Granth Sahib Sewa Society are entitled to a full salary, albeit slightly lower than their occupation’s mean salary. What pulls employees to work at Guru Ka Langar Eye Hospital is the freedom of working to their style as opposed to a rigid, regulation-set system.

The hierarchical organization of a charitable hospital is not as bureaucratic as a government-funded or private hospital, so there is less supervision and more flexibility in working time and schedule. There are still rules and standards that must be met to prevent malpractice and improper patient care. Still, many of the regulations that we see in the American Health System are not present in the charitable hospital system. Because of this, employees enjoy a more flexible work arrangement and are content with a lower mean salary.

Some employees at Guru Ka Langar Eye Hospital also work for free, embodying the concept of Sewa. When interviewing those employees, the demographics and rationale were consistent. All employees mentioned that they were retired workers and had little-to-no family at home, and volunteering at Guru Ka Langar Eye Hospital gave them a purpose and something to bring them out of their isolation.

The other fixed costs, building maintenance, utilities, and equipment, are traditional expenses expected with any other business. Guru Ka Langar Eye Hospital pays rent for their leasing, pays for electricity and water bills, and pays for the medical equipment they use. Some equipment, however, is also donated from larger government-funded or private hospitals. Other resources, such as glasses, are often recycled rather than bought. 

The variable costs of the charitable hospital include the delivery of blood samples to a medical lab and the supply of medications. 

The Tera Hi Tera lab of the Sri Guru Granth Sahib Sewa Society conducts medical lab tests at Guru Ka Langar Eye Hospital, but they do not have the proper facilities actually to test the blood samples. The delivery costs may vary depending on the number of samples they must send daily.

Guru Ka Langar Eye Hospital also offers medications that the doctors may prescribe, such as eye drops, for a cost-effective price. The number of medications the hospital may need to order also varies depending on the number of patients and their diagnoses. 

Guru Ka Langar Eye Hospital segments the consumer market based on demographics. From a World Bank study in April 2022, roughly 10% of India’s population, 140 million people, is deemed in “poverty” and can consequently not afford quality healthcare. The target consumers are individuals that cannot afford government-funded or private practice services. 

To attract consumers, Guru Ka Langar Eye Hospital operates using only inbound marketing strategies. They attract consumers through social media marketing, primarily on their websites, FaceBook pages, and WhatsApp group messaging. People around the city, neighboring states, and much of northern India view these online advertisements and learn about Guru Ka Langar Eye Hospital. 

The other inherent marketing strategy of Guru Ka Langar Eye Hospital is word-of-mouth marketing. When an individual from a distant city or village comes to Guru Ka Langar Eye Hospital and receives quality healthcare for free, they will return to their city or village and tell their community about it. Through this, a large population will learn about a hospital where they don’t have to pay an excessive fee to visit a doctor and be galvanized to go there for their eye complications. 

Because of the high population density in India, social media marketing and word-of-mouth marketing are incredibly influential. Guru Ka Langar Eye Hospital sees more than 100 new patients daily. These patients come from all over northern India, such as neighboring states Himachal Pradesh, Uttarakhand, and Rajasthan. 

The unique value proposition of Guru Ka Langar Eye Hospital is that they can provide quality healthcare from medical professionals for FREE and AFFORDABLE RATES. This is the optimum service for the impoverished and elderly/disabled population, who otherwise would not be able to afford government-funded or private practice healthcare. These other healthcare providers would lose money if they offer such services at low rates, but because of Guru Ka Langar Eye Hospital’s exceptional business model, they can.

Overall, the efficiency and cost-effectiveness of the Guru Ka Langar Eye Hospital and the Sri Guru Granth Sahib Sewa Society make the notion of a charitable hospital so remarkable. Few charitable hospitals exist in the United States, and those that do operate very differently. The United States Health System should take from the charitable hospital model outlined in this article and improve their healthcare practices.