Indian Healthcare Sector Research Articles

Quality Assessment Using EFQM Model for Overall Excellence of Indian Health Care Sector

Quality point of reference is the main priorities of hospitals and quality assessments in hospitals is the biggest challenges which is determined by many tangible and intangible factors. The purpose of the paper is to investigate the quality assessment of hospitals in Odisha using the European Foundation for Quality Management (EFQM) model. Prior literature had focused on different sectors but less applicability of this model in the hospitals. In order to address the gap, the present research used a quantitative methodology to collect the data through a questionnaire from the healthcare professionals including doctors, hospital managers and Senior Executives in hospitals of Odisha. Random sampling was used where 87 respondents participated in this study. The results confirmed the significant contribution of the EFQM determinants in relation to each other .The results emphasis on the results of the EFQM model and it had both practical as well as academic contribution in the quality assessment in the hospitals and finally it has conclude EFQM model has played a vital role in influencing the quality assessment of hospitals.

Effect of Perceived Value on Customer Satisfaction, Loyalty and Service Quality of Selected Hospitals in Chhattisgarh

Health care sector in India has grown fast in the past few decades. The primary reason for existence of health care sector is to provide care for its patients and to satisfy their needs. Providing excellence in service is an imperative determinant for the escalation and development of health care units. The present study seeks to identify the effect of customers perceived value on customer satisfaction, loyalty and service quality of selected hospitals in the state of Chhattisgarh. With the help of 400 inpatient and outpatient sample respondent’s data were collected from ten hospitals covering four districts of Chhattisgarh. Purposive sampling technique was adopted for data collection with structured questionnaire. Structured equation modelling was performed for data analysis with the help of smart PLS v3 (trial). The study outcome revealed that the dimension customer perceived value is found to have positive effect on service quality, customer satisfaction and customer loyalty in health care sector of Chhattisgarh. Perceived value is also found to positively predict the dimension of service quality including assurance, tangibility, reliability, responsiveness and empathy.

Medical Tourism and its Scope in India

Indian healthcare sector is one of the fastest growing sectors. The growth of trade in health care services through medical tourism has led India as an affordable destination. Patients from foreign countries come to India for surgical purposes due to low cost and high quality of hospital services. The country has huge potential to grow up and also expected to grow at a compound annual growth rate of 17 percent from the year 2011 to 2020.

Impact of ‘Smart Applications of IoMT (Internet of Medical Things)’ on Health-Care Domain in India

The conventional model of the healthcare system has become obsolete now. With the evolution of the digital era, new advanced technologies and service platforms are highly in demand now. One such technology is the Internet of Medical Things (IoMT) which is a sub division of Internet of Things. It allows rapid proliferation of the information from the various interconnected devices through the help of wifi or cloud. This technology is both patient centric and organisation driven. It has become a mandatory for the organisation to implement this technology as without this, the organisations would be facing great challenges to meet the demand of the industry. This technology allows optimal service production with minimal cost investment. In this paper we will try to find out the scope and opportunities of IoMT in Indian health care sector and the impact of IoMT on increasing efficiencies of healthcare management. As statistical tools, Multiple Regression and Exploratory Factor Analysis (EFA) have been used in this study.

Better healthcare setting for better healthcare service quality

Purpose The purpose of this paper is to assess and compare different private healthcare settings based on perceived service quality in Indian context using analytical hierarchy process (AHP). The Indian private healthcare sector has been controlled by three categories of healthcare settings, namely, nursing clinics (NCs), non-corporate hospitals (NCHs) and corporate hospitals (CHs). Design/methodology/approach AHP was used to rank order of healthcare setting regarding the service quality dimensions and relative standings of every service provider with respect to its competitors. The authors collected random data from nine private hospitals situated in eastern and southern India. The authors proposed a feasible appraising approach based on AHP to decide the sustainability priority of dimensions like reliability, physical environment, empathy, efficiency, timeliness, transparency, affordability, communication, appropriateness and consistency in the Indian private healthcare industry. Findings The result demonstrates that Indian NCHs are performing better on customers’ perceived service quality, followed by CHs and NCs. The comparative performance of healthcare settings is an attempt to establish a performance ranking. Originality/value This research assesses dimensions of the service quality that need urgent attention. The results may provide insight to healthcare managers as to how they can improve their service quality in order to match customer expectation and to improve business performance.

An Experimental Evaluation on the awareness of “Pradhan Mantri Jan Aryogya Yojna - Ayushmaan Bharat” (PMJAY-AB) Scheme among residents of Moradabad, Uttar Pradesh

Background: One of the most ambitious health insurance programme of the world was launched in September 2018 i.e. Pradhan Mantri Jan Arogya Yojana (PMJAY) popularly known as Ayushmaan Bharat. The programme aims to help the 100 million poor families of India to get the benefits of medical services for their health and take the treatment of disease which they cannot afford. This gives a chance to Shri Narendera Modi’s government to transform the health care sector of India. This paper discuss about the awareness of PMJAY-AB programme among the residents of Moradabad, Uttar Pradesh. Material & Methods: It empirical study done on the residents of Moradabad region in Uttar Pradesh by Around 150 samples were collected in which 130 samples were found correct, as they were completely filled and used as a data for analysis. This topic was taken for study to assess people awareness regarding government schemes in health care sector which is associated with hospital and health care management by applying Chi-Square Test, Analysis of Variance (ANOVA) and Pearson’s Correlation Test. The period of study was of 4 months i.e. from February 2019 to May 2019. The cluster convenient sampling method was chosen for the study. For the collection of data the Moradabad was divided into three parts:- 1. MDA- near Vivekanand Hospital, 2. Majhola, Mansarover & Budhi Vihar – near Sai Hospital and 3. Pakbara – near TMU Hospital Results & Conclusion: The study concludes that the demographic factors have some relationship, effect and correlation on PMJAY – AB awareness at Moradabad. These demographic factors gender, age, marital status, religions, education qualification, occupations & income status were tested with resident’s awareness status of PMJAY-AB by conducting descriptive analysis, chi-square test (Relationship), analysis of variance & post hoc (Effect) and correlation (Association). RELATIONSHIP: It is hereby concluded from the results obtained by applying chi-square test (cross tabulation) that except demographic variable Age groups no other variable has a significant relationship with the resident’s awareness of PMJAY - AB at Moradabad. EFFECT: It is hereby concluded from the results obtained by conducting ANOVA that age groups, education level and income-socio-economic level play role in effecting the resident’s awareness regarding PMJAY- AB at Moradabad. It is also concluded that very old people (above 60 yrs) have highest awareness of PMJAY- AB and young generation (20-30 yrs) have the lowest awareness regarding this government scheme. Further residents between age bands 31-60 yrs have moderate awareness in the Moradabad City. When it comes to education level awareness about PMJAY- AB scheme is least among under graduates and there is no difference between the Awareness of PMJAY- AB among graduates and post graduates in Moradabad. Other demographic variable does not have any effect on awareness of this government scheme in Moradabad. ASSOCIATION: It is hereby concluded from the results obtained after applying Pearson_Correlation(r) test that except age groups no other variable (education qualification and income) make any association with awareness level of PMJAYAB scheme at Moradabad.

The Merit of Private Provision of Merit Goods: Econometric Evidence From the Indian Healthcare Sector

The Merit of Private Provision of Merit Goods: Econometric Evidence From the Indian Healthcare Sector

Medical Tourism in India

In the recent era medical tourism has certain significance place in the tourism industry, In India now famous for low cost medical service with high quality medical treatment. The countries where medical tourism is being actively promoted include Greece, South Africa, Jordan, India, Malaysia, Philippines and Singapore. Recently, Indian healthcare sector shows huge advancements in fields such as technology, infrastructure, and manpower, catapulting India as one of the preferred medical destinations in the world and invariably paving path to an entirely new sector, the medical tourism industry. The medical tourism in India will touch the $8 billion mark by the end of 2020, the influx of the population that experiences a saving of close to 50 to 70 percent on medical tourism industry. Cost effectiveness is a major factor in India, because a patient can undergo any type of treatment at an extremely affordable cost without compromising the quality and other reason is of course the availability of medical visa without any hassle. The Indian government predicts that, India $17-billion-a-year healthcare industry could grow 13 per cent in each of the next six years, boosted by medical tourism, which industry watchers say is growing at 30 per cent annually. This study has been focused by the fully by secondary data, which are collected from the Indian tourism department, and also it analyze the growth percentage in Past years, it will be more helpful to medical service providers. Mainly this study’s objective was examining the foreign exchange earning option through medical tourism and analysis of annual growth of foreign tourist in India. It proves that the annual growth an efficiency of handling capacity of Indian medical the medical industry

Lean Six Sigma for the healthcare sector: a multiple case study analysis from the Indian context

PurposeThe purpose of this paper is to explore the voice of the customer, key performance indicators, critical to quality characteristics, critical success factors, and commonly used tools and techniques for deploying the Lean Six Sigma (LSS) strategy in Indian private hospitals, with special attention to the medical records.Design/methodology/approachThe study utilizes the action research methodology to obtain a greater understanding of the use of LSS in the Indian healthcare sector. Multiple case studies were designed and successfully deployed to understand and ascertain challenges in LSS implementation. Five case studies were carried out in the Medical Records Departments (MRD) of four private hospitals in India.FindingsPatients perceive that waiting in queue harms their health, which can be rectified by addressing the cycle time of the system. The research also found that effective leadership, availability of data, involvement of cross-functional team and effective communication are critical to the success of LSS projects. In addition, control charts, cause and effect diagram, 5S, gemba, two-sample t-test, standardization, waste analysis and value stream mapping are some of the common tools used to improve healthcare systems.Research limitations/implicationsThe research was restricted to studying the impact of LSS on the workflow and resource consumption of the MRD in Indian allopathic hospitals only. The validity of the results can be improved by including more hospitals and more case studies from the healthcare sector in different countries.Originality/valueThe findings will enable researchers, academicians and practitioners to incorporate the results of the study in LSS implementation within the healthcare system to increase the likelihood of successful deployment. This will provide greater stimulus across other departments in the hospital sector for wider and broader application of LSS for creating and sustaining process improvements.

Impact of IoT Adoption on Agility and Flexibility of Healthcare Organization

This study addresses one of the most critical advents and highly sought after the technological breakthrough of today’s service sector. Internet of things has been finding relevance in today’s service sector as a significant impetus to superior service delivery and advanced service proposition to customers. Healthcare sector is also no exception. This study taking data from the Indian healthcare sector attempts to check the relationship between IoT adoption and proposed service delivery gains experienced by healthcare organizations (if any). The study based on the theoretical premises of cybernetic control theory and technology adoption model by Davis, Hypothesized that IoT adoption must positively influence flexibility and agility and in turn, flexibility positively influence readiness. The empirical evidence supports these hypotheses, and all the findings validate the propositions that healthcare organizations and the players and actors involved in healthcare consider IoT adoption as pivotal. Because the survey outcomes establish path analysis linkages through Structural equation modeling (SEM). SEM results highlight the significant positive impact of IoT adoption on flexibility and agility and in turn, even stronger association and effects of flexibility on readiness in the services offered by healthcare organizations. This study outcomes are very vital for hospital managers and upcoming healthcare practitioners as it establishes empirical evidence supporting IoT adoption as a helpful step and prominent success factor for better flexible patient care delivery and agility.

Privacy Preserving Healthcare Data using Cloud Computing

Cloud Computing is a new way of delivering computing resources and services. It is a model for on-demand network access to a shared pool of configurable computing resources like, networks, servers, storage, applications, and services that can be provided with minimal management effort or service provider interaction. The cloud model is composed of five essential characteristics, four service models, and four deployment models. Healthcare is faster growing way to adopt cloud computing. It is very important for every individual and essential for every country in the Globe. Electronic healthcare systems in the world are moving towards a more accessible, collaborative and more proactive way in reaching out to the public. The delivering of public health solutions can lead to increased efficiencies in health related data. Many nations across the globe have launched aggressive stimulus programs aimed at solving public healthcare problems in efficient way. This review article mainly focus on different ICT based infrastructure facilities available in various hospitals in India, abroad with cost effective manner using cloud computing technologies, services and this will be a best solutions for healthcare systems in rural areas. In this paper analyzed and presented about various cloud service providers, investment in healthcare, IT adoption in Indian Healthcare sector, Major benefits of Cloud-based Patient Management System [PMS], about SADA systems, Top ten cloud storage companies in healthcare and Pros and Cons of EHR systems, comparison of Indian healthcare systems with US system, and various Cloud Simulators.

Assessment of Patient Satisfaction by Physician Assistants in Super Specialty Hospital

Purpose: To assess the Patient Satisfaction of Physician Assistants in Super Specialty Hospital. Understand evolution, role and growth of physician assistant professionals in hospital. Methods: Structured questionnaires are used to collect data from 100english speaking patients who were above 18 years of age. Secondary data from the year 1960 to 2018 was analyzed which is available in internet database in English literature is taken in to account to understand the role. Survey and discussions methods are also used to get the updated data from healthcare team. Findings: PA's provide satisfactory care to their patients while being courteous and respectful, having a good understanding of the patient's problem, explaining to patients and using simple words that are nontechnical and have proven themselves to be an asset to the hospital. Conclusions: Research concluded that role of Physician Assistant can be utilized in Indian healthcare sector to compensate the deficiency of physicians in the healthcare outreach areas.

The Evolving Neural Tissue Engineering Landscape of India.

The healthcare sector in India is witnessing unprecedented advancement. Tissue engineering has become an integral part of healthcare and medicine, particularly where treatments involve functional restoration of any injured or deceased part of the body. Not falling behind much with the progressing medical and healthcare sector of India, tissue engineering is also gaining momentum in the country. Out of several arenas of tissue engineering, India has made its mark in orthopedic and bone regeneration, cosmetic and skin regeneration, and very importantly neural regeneration. There are several articles reviewing the progress and prospects of orthopedic and skin regeneration research in India. However, there is no systematic review on progress, prospects, and pitfalls associated with neural tissue engineering in Indian context. The existing ones mainly focus on the technical advancements in the field from a global perspective. Therefore, it is worthwhile to have an organized look at the evolving neural tissue engineering landscape of India. This review will walk the readers systematically through different aspects of the topic. The review starts with an introduction to the nervous system to help readers appreciate the complexity that must be dealt with while engineering neural tissue. This is followed with a global picture of the neural tissue engineering, prominent research groups working on neural tissue engineering in India, factors that have and are currently molding the prospects of this field, and concluding with an overall perspective on present and future of neural tissue engineering in India.

Incidence of tuberculosis among HIV infected individuals on long term antiretroviral therapy in private healthcare sector in Pune, Western India

BackgroundDespite rapid scale up of antiretroviral therapy (ART), Tuberculosis (TB) remains the commonest opportunistic infection and cause of death among HIV infected individuals in resource limited settings like India. Incidence of TB in individuals on ART in private healthcare sector in India is infrequently studied.MethodsThis retrospective cohort study conducted between 1st March 2009 and 1st March 2017 aimed to evaluate rate of incident TB in individuals initiated on ART at 3 private sector ART clinics in Pune, India. Individuals more than 12 years of age with ART duration of atleast 6 months were included. Patients were classified as having prevalent TB if they had a TB episode within the year prior to ART initiation or if they developed TB within 6 months of starting ART. Individuals who were diagnosed with TB after 6 months of starting ART were classified as incident TB cases. A recurrent episode of TB after treatment completion or cure of prevalent TB was also regarded as incident TB. Patients were classified as definitive TB if Mycobacterium tuberculosis was grown in culture from a biological sample or a positive rapid molecular test. Patients were classified as probable TB if there was radiologic evidence of TB in absence of confirmatory culture or PCR.Results1904 patients with a median duration of follow up on ART of 57 (IQR = 32.0, 84.0) months were included. Of these, 182 developed incident TB (22% definitive TB, 38% recurrent cases). TB incidence at 6–12 months, 13–24 months, 25–60 months and > 60 months of ART was 24.32, 5.46, 2.54 and 0.75 cases per 100 person years respectively. Current time updated CD4 count < 500 cells/mm3 (p < 0.0001), virologic failure on ART (adjusted Hazard Ratio (aHR): 3.05 (95% CI: 2.094, 4.454), p < 0.0001) and receipt of ART without IPT (aHR: 8.24 (95% CI, 3.358, 20.204), p < 0.0001) were associated with higher risk of incident TB.ConclusionStarting ART early in treatment naïve individuals, prompt detection of virologic failure on ART and providing IPT along with ART will be useful in reducing incident TB. Efforts from private sector are crucial in achieving Sustainable Development Goals set by Government of India and attaining the vision of a TB free India.

Modelling the barriers of Health 4.0–the fourth healthcare industrial revolution in India by TISM

In healthcare industry, the phenomenon of Industry 4.0 is popular as Health 4.0 where the modern technologies are integrated with available data along with the use of artificial intelligence. The main objective of this paper is to explore the barriers of Health 4.0 application in healthcare sector in India. Fifteen barriers which can affect the adoption of Health 4.0 in the Indian healthcare sector have been identified through extensive literature review and opinions of healthcare industry and academic experts. A TISM (Total Interpretive Structural Modelling) model has been developed to extract the key barriers influencing Health 4.0 adoption which will guide the healthcare managers and decision makers to explore the effect of each barrier on other barriers as well as the degree of relationships among them. The result shows that lack of top management support, exclusive and skilled workforce requirement, inadequate maintenance support systems and political support are the major barriers as they have strong driving power. Timely action taken by the management to remove these hurdles will not only reduce the cost of medical procedures but also improve the quality of treatment so that the true potential of Health 4.0 can be utilized.

Just in time elements extraction and prioritization for health care unit using decision making approach

PurposeThe purpose of this paper is to identify and prioritize prime just-in-time (JIT) elements in Indian healthcare sector based on the degree of importance and difficulty. This facilitates the implementation of JIT philosophy in healthcare services without any failure as well as provides quality services to patients at low cost.Design/methodology/approachJIT elements related to health care services have been sorted out from comprehensive literature survey. Moreover, important and difficult JIT elements have been ranked on the basis of score obtained by the quantitative method using statistical tools. Furthermore, validation and prioritization of important JIT elements based on the degree of importance have been computed using the analytical hierarchy process (AHP) and best worst method (BWM).FindingsThe present work provides important, difficult and easy to implement JIT elements in healthcare services. Besides, this work justifies the application of decision-making tool (AHP, BWM) for the prioritization of JIT elements in the health care sector.Practical implicationsThe present study develops a deep understanding of JIT concepts in health care services. Furthermore, it motivates professionals for implementing JIT in healthcare services with healthy situation for both hospital and supplier.Social implicationsThe present work is beneficial for all the dimensions of sustainable development (social, economic and environmental). The implementation of JIT with a proper understanding of its elements results in an improved patient care, lesser cost of healthcare delivery, time and better management of associated medical items. This work also facilitates the proper management of inventory items together with the reduction in various Lean wastes with the proper implementation of JIT in healthcare. The reduction in various associated wastes leads to cleaner surrounding and lesser environmental degradation.Originality/valueThis paper outlines the need of a robust JIT approach in the healthcare sector for quality services. The efficacy of JIT, AHP and BWM has been explored to find out critical elements for successful JIT implementation in health care.

Tuberculosis treatment in the private healthcare sector in India: an analysis of recent trends and volumes using drug sales data

BackgroundThere is a pressing need for systematic approaches for monitoring how much TB treatment is ongoing in the private sector in India: both to cast light on the true scale of the problem, and to help monitor the progress of interventions currently being planned to address this problem.MethodsWe used commercially available data on the sales of rifampicin-containing drugs in the private sector, adjusted for data coverage and indication of use. We examined temporal, statewise trends in volumes (patient-months) of TB treatment from 2013 to 2016. We additionally analysed the proportion of drugs that were sold in combination packaging (designed to simplify TB treatment), or as loose pills.ResultsDrug sales suggest a steady trend of TB treatment dispensed by the private sector, from 18.4 million patient-months (95% CI 17.3–20.5) in 2013 to 16.8 patient-months (95% CI 15.5–19.0) in 2016. Overall, seven of 29 states in India accounted for more than 70% of national-level TB treatment volumes, including Uttar Pradesh, Maharashtra and Bihar. The overwhelming majority of TB treatment was dispensed not as loose pills, but in combination packaging with other TB drugs, accounting for over 96% of private sector TB treatment in 2017.ConclusionsOur findings suggest consistent levels of TB treatment in the private sector over the past 4 years, while highlighting specific states that should be prioritized for intervention. Drug sales data can be helpful for monitoring a system as large, disorganised and opaque as India’s private sector.

The effect of health insurance on hospitalization: Identification of adverse selection, moral hazard and the vulnerable population in the Indian healthcare market

Abstract The Indian healthcare sector is growing at a rapid pace; nevertheless, inequality in healthcare consumption and catastrophic healthcare expenditure is also increasing at an alarming rate. In addition to socioeconomic differences, poor healthcare infrastructure, and inadequate risk-pooling mechanisms; asymmetric information in the healthcare market is also a potential contributor to this inequity and increasing costs. The consequences of information asymmetry are adverse selection (AS) and moral hazard (MH). AS occurs if people with health risks (high-risk individuals) are more prone to buying health insurance as compared to low-risk individuals. MH occurs when insured individuals are more likely to use healthcare than the uninsured individuals, inflating insurance premiums and medical care costs. Empirically, AS and MH lead to endogeneity due to unobserved heterogeneity. In practice, endogeneity is often addressed by using the instrumental variable estimation technique; however, this approach suffers from identification problems. Therefore, in this paper, we use an instrument-free semi-parametric copula regression technique to examine how health insurance status affects hospitalization using a sample of individuals from a large nationally representative survey for India. Our results suggest the presence of AS and potential MH in the Indian healthcare market. We observe that chronically ill individuals are probable sources of AS, which leads to possible MH. A spline regression analysis suggests nonlinearity in health insurance choice and healthcare utilization across age, education, family size, and household consumption expenditure. We find chronically ill women in India exhibit less insurance coverage and lower hospital care usage. We also identify the vulnerable groups, such as older adults and rural residents, who have low insurance participation and high healthcare consumption. Our results indicate toward the need for evidence-based health care policy to manage the healthcare system and support the disadvantaged population of India.

A fuzzy interpretive structural modeling approach for evaluating the factors affecting lean implementation in Indian healthcare industry

Purpose Lean concept is implemented in healthcare organizations, as it deals with improvement processes so that best services may be provided to the patients and competitive advantage may be achieved. The purpose of this paper is to evaluate the important factors which influence implementation of lean principles in the healthcare industry. Design/methodology/approach The factors influencing lean implementation in the healthcare industry have been determined through literature review and results of a survey where questionnaires were distributed among 325 healthcare professionals. Fuzzy Interpretive Structural Modeling (FISM) approach has been used to analyze the interrelationships among these factors. A FISM model has been developed to extract the key factors influencing lean implementation. Findings Results of the survey and model show that lean leadership, professional organizational culture and teamwork and interdepartmental cooperation are the top level factors. Clarity of organizational vision, communication of goals and results, follow up and evaluations are the factors with strong driving as well as strong dependence power. Even a slight action taken on these factors will have a significant impact on other factors. Practical implications The healthcare professionals and managers can acquire information from the drive power dependence matrix so that they can thoroughly understand the relative importance, interdependencies and relationships among these factors. The model will help in determining the hierarchy of various actions and activities which may be taken by the management for managing the factors that remarkably affect the lean management in hospitals. Social implications In this paper, only 15 variables appropriate for the Indian healthcare industry have been identified. The model developed in the present research has not been validated statistically which can be done by structural equation modeling (SEM). Originality/value Though there are various studies which depict that lean principles have been implemented successfully in various industries, there are few studies specifying the application of lean principles in healthcare sector in India. This paper is an attempt to identify various factors which are important for application of Lean concept in the healthcare sector.

Assessing tuberculosis control priorities in high-burden settings: a modelling approach

In the context of WHO's End TB strategy, there is a need to focus future control efforts on those interventions and innovations that would be most effective in accelerating declines in tuberculosis burden. Using a modelling approach to link the tuberculosis care cascade to transmission, we aimed to identify which improvements in the cascade would yield the greatest effect on incidence and mortality. We engaged with national tuberculosis programmes in three country settings (India, Kenya, and Moldova) as illustrative examples of settings with a large private sector (India), a high HIV burden (Kenya), and a high burden of multidrug resistance (Moldova). We collated WHO country burden estimates, routine surveillance data, and tuberculosis prevalence surveys from 2011 (for India) and 2016 (for Kenya). Linking the tuberculosis care cascade to tuberculosis transmission using a mathematical model with Bayesian melding in each setting, we examined which cascade shortfalls would have the greatest effect on incidence and mortality, and how the cascade could be used to monitor future control efforts. Modelling suggests that combined measures to strengthen the care cascade could reduce cumulative tuberculosis incidence by 38% (95% Bayesian credible intervals 27-43) in India, 31% (25-41) in Kenya, and 27% (17-41) in Moldova between 2018 and 2035. For both incidence and mortality, modelling suggests that the most important cascade losses are the proportion of patients visiting the private health-care sector in India, missed diagnosis in health-care settings in Kenya, and drug sensitivity testing in Moldova. In all settings, the most influential delay is the interval before a patient's first presentation for care. In future interventions, the proportion of individuals with tuberculosis who are on high-quality treatment could offer a more robust monitoring tool than routine notifications of tuberculosis. Linked to transmission, the care cascade can be valuable, not only for improving patient outcomes but also in identifying and monitoring programmatic priorities to reduce tuberculosis incidence and mortality. US Agency for International Development, Stop TB Partnership, UK Medical Research Council, and Department for International Development.