ftob healthcare report
TRANSCRIPT
A WIPRO THOUGHT LEADERSHIP INITIATIVE.
FORESEEING THEFUTURE OF HEALTHCAREAn explorative study for deeper insights
Prepared by Dun & Bradstreet India
Future Thought of Business: Healthcare
PrefaceThe Indian healthcare sector has witnessed unprecedented growth in the last decade. Medical value travel, diagnostics, single speciality
hospitals and day care surgical centres are some of the key segments that are expected to witness a major transformation in the years
ahead. The healthcare sector’s growth is going to be fuelled by changing socio-economic and demographic factors, rising awareness levels and
increased adoption of technology.
Exciting opportunities in the Indian Healthcare space are luring many investors towards itself. Several private equity, venture capital funds, and
multi-national healthcare companies are closely studying the Indian market for a possible foray, supported by the long-term healthy growth
prospects of the Indian economy. These increased investments would facilitate improved quality, access and affordability of healthcare services
in the country.
India has the potential to emerge as one of the most preferred destinations for medical treatment, attracting patients from across the world.
However, there exist numerous gaps and bottlenecks which are hindering the sector’s overall growth and further expansion.
The widening gap between demand and supply for healthcare services is a major cause for concern. Although large hospitals and other leading
healthcare chains are on an expansion mode, they represent a small portion of the healthcare landscape, with bulk of the private healthcare
being serviced by the unorganised sector. Adding to the woes is the shortage of trained professionals including doctors and support staff like
nurses in the country. Nonetheless, the growing Government focus, increased private sector participation and growing penetration of health
insurance augurs well for the future prospects.
Against this backdrop, Wipro Limited in association with Dun & Bradstreet brings to you The Future Thought of Business: Healthcare.
This is an endeavor to highlight the potential that the Indian healthcare sector holds in the coming decade, and to identify the gaps that need
to be bridged so as to enable the sector to exploit future opportunities. I hope you enjoy reading this report and look forward to receiving
your suggestions.
Anand Sankaran
Sr Vice President and Business Head - India, Middle East and Africa and Global Business Head - Infrastructure and Services
Wipro Limited
Executive SummaryThe Indian healthcare sector is one of the most promising sectors of the Indian economy. The strong demand for healthcare services coupled
with growing private sector interest sets the stage for the next level of growth. However, numerous challenges need to be addressed in an
urgent and effective manner to achieve this. The Future Thought of Business: Healthcare is an attempt to capture the various facets
of the Indian healthcare landscape and identify key trends that will define the sector’s changing dynamics in the coming decade. The demand
potential, the major challenges likely to be faced by the sector and the actions needed to be taken are detailed in the report.
With demand for healthcare services expected to be driven by both urban and rural markets in the coming decade, growth prospects for the
sector are bright. The increasing penetration of both private and Government health insurance schemes is expected to draw more people
under the healthcare net.
The sector is witnessing a distinct shift in disease pattern, towards the chronic segment. Rising incidences of lifestyle-related diseases are
expected to increase demand for preventive healthcare, and this phenomenon would not be restricted to the urban population. The corporate
sector would be a critical factor that will drive expansion of the preventive healthcare market.
Low-cost delivery models such as day-care surgical centres, though currently in their infancy in India, are expected to gain prominence in the
coming decade. Further, high operating costs in the metro cities and fear of over-supply will drive more healthcare companies to increase their
focus on the untapped smaller towns. The coming decade is likely to see more single speciality hospitals coming up in India’s tier II and tier III
cities. Rising incomes and awareness levels are driving demand for such speciality centres. More super speciality centres are expected to come
up in the areas of heart, cancer, eye, maternal and child care, and cosmetology.
Due to the above reasons, the Indian market is likely to attract more foreign players in the coming decade. As a result of the rising
competition and the need of healthcare players to enhance scale and geographical reach, the findings predict increased consolidation
in future.
The sector continues to battle high attrition and faces a manpower crunch, and a resulting increase in the cost of manpower resources.
More public-private initiatives are also needed to bridge the demand-supply gap in infrastructure development and medical education. On the
plus side, the healthcare sector has been witnessing a reverse ‘brain gain’ compared to the brain drain in earlier decades. This is expected to
improve the overall quality and standard of medical personnel in the country as also the quality of healthcare services.
The coming decade is also expected to see increased technology adoption among mostly private sector players, with technology becoming a
core function. The need to optimise costs and increase efficiencies will make information technology an integral part of hospital management.
Cost-effective cloud-based solutions would drive increased adoption of the hospital management information system (HMIS).
India has emerged as one of the fastest growing medical value travel destinations in the world. However, lack of coordinated efforts among
the various stakeholders is hindering this segment’s growth. Nonetheless, the market is growing strongly and in the coming decade, it would
particularly benefit from the rising cost burden of the national healthcare system in the developed economies.
Research FrameworkObjective of the StudyThe Future Thought of Business: Healthcare report aims to identify those trends likely to emerge in the coming decade that could
significantly influence the future of business in the Indian healthcare sector. This report is an initiative that thus provides the healthcare
sector with a tool to apprehend, strategise and tackle future challenges. Possible recommendations to address the issues so identified have
also been detailed in the report.
Research designThe report has been developed based on quantitative and qualitative information. Data and information collection was conducted through
secondary research and interviews with industry experts.
Methodology1. Desk research
A detailed review of relevant literature for the Indian healthcare sector was conducted at this stage.
2. Questionnaire development and industry interactions
Findings of the desk research were used to develop appropriate questionnaires for interviews. Face-to-face and telephonic interviews
were conducted with experts in the sector.
3. Collation and analysis of information
All data and information gathered through secondary research and interviews was collated and analysed for the purpose of developing
the report.
4. Report writing
Finally, the analysis, results and key findings were written in the form of the current report.
Table of contents1.................................................................Section I: Indian Healthcare Landscape
2 ................................................................................Low Government Expenditure on Health
2 ................................................................................Government Initiatives
3 ................................................................................Widening Gap between Healthcare Demand and Supply
4 ................................................................................Private Sector Gains Prominence
5 ................................................................................Industry Reaps Benefits of Increased IT Adoption
6 ................................................................................Technological Advancements Redefine Healthcare Delivery
6 ................................................................................Greater Government Involvement is the Need of the Hour
8.................................................................Section II: Future Demand Drivers
8 ................................................................................Changing Patient Profile to Generate Greater Demand for Healthcare Services
10 ..............................................................................Rise in Health Insurance Penetration to Expand Addressable Market
10 ..............................................................................Rise in Awareness and Income Levels to Drive Preventive Healthcare
11 ..............................................................................Rising Incomes and Lifestyle Diseases to Drive Urban and Rural Demand
11 ..............................................................................Government’s Changing Role as Facilitator of Healthcare Services
12 ..............................................................Section III: Emerging Trends in the Indian Healthcare Sector
12 ..............................................................................Emergence of Innovative Healthcare Delivery Models
18 ..............................................................................Technology to Become a Core Function
20 ..............................................................................Cohesive Action Needed to Tap Medical Value Travel Market
23 ..............................................................Section IV: Competitive Scenario and Strategic Focus
24 ..............................................................................Consolidation to Gather Momentum
24 ..............................................................................Threat of Over-supply in Metros to Drive Firms to Tier II and Tier III Cities
25 ..............................................................................Accreditation to Become a Necessity
26 ..............................................................................Conclusion
26 ..............................................................................The Way Forward
28 ..............................................................................References and Sources
29 ..............................................................................Acknowledgements
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Section I: Indian Healthcare LandscapeIn the four decades that followed India’s independence in 1947, its
healthcare sector was dominated by the public sector. The opening
up of the economy in the 1990s however, steadily led to the
increasing involvement of private players. In the last decade, the
sector has undergone a radical transformation and it is currently
one of the most promising sunrise sectors, in terms of growth,
revenues and employment generation.
The Indian healthcare sector mainly comprises hospitals and
nursing homes, and allied sectors such as diagnostic centres and
pathology laboratories, medical equipment, medical tourism and
medical insurance. Between April 2000 and August 2011, hospitals
and diagnostic centres attracted foreign direct investment (FDI)
inflows to the tune of US $ 1.08 billion. Today the Indian healthcare
landscape is witnessing the growing dominance of private and
corporate hospitals that provide specialised and tertiary medical
care facilities.
This unprecedented fast-paced growth is based upon several
important socio-economic factors including economic liberalisation,
changing demographics, increasing disposable incomes, rising
urbanisation, changing disease profile of the population, and
advent of an information technology (IT)-enabled environment,
among others. The Internet has emerged as an important tool for
information dissemination, boosting overall healthcare awareness
levels and increasing the demand for healthcare services. This is
markedly seen in rural areas, where increased penetration of mobile
phones and the Internet, along with mass media such as television,
is rapidly increasing awareness about various treatment options and
giving rise to demand. Further, increased and effective use of mass
media by the Government in areas of health education, HIV/AIDS
awareness programmes etc, has also helped in increasing healthcare
awareness levels among the people.
Healthcare delivery in India
Source: D&B Research
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Low Government Expenditure on HealthAs per the World Health Organization (WHO), the share of total
expenditure on health in India’s gross domestic product (GDP) stands
at a low 4.2%. The share of public expenditure in India’s GDP is a
negligible 1.1% (2008-09). A salient feature of the Indian healthcare
sector is thus the significant and growing role of the private sector
in healthcare delivery and total healthcare expenditure. The private
healthcare sector accounts for nearly 70% of total healthcare
expenditure in the country; while the contribution of government’s
expenditure in the country’s total expenditure on health is
around 30%. Even within the private expenditure, out-of-pocket
expenditure constitutes the bulk (nearly 75%).
Health Expenditure as % of GDP
Country Health expenditure as % of GDP
Government expenditure*
Private expenditure*
Bangladesh 3.3 31.4 68.6
Brazil 8.4 44.0 56.0
China 4.3 47.3 52.7
India 4.2 32.4 67.6
Indonesia 2.3 54.4 45.6
Malaysia 4.3 44.1 55.9
Singapore 3.3 34.1 65.9
Thailand 4.1 74.3 25.7
UK 8.7 82.6 17.4
USA 15.2 47.8 52.2
Global 8.5 60.5 38.4*as % of total expenditure on health; for 2008Source: World Health Statistics 2011, WHO
Government InitiativesFrom the supply perspective, making quality healthcare facilities
available to the masses remains a big challenge for policy-makers.
Moreover, healthcare costs have increased as compared to the past
because of the technology involved in delivering healthcare today.
Nevertheless, the Government has introduced several measures to
expand the reach of healthcare to the masses. The Government has
introduced several programmes and schemes in order to bridge the
wide gap between optimum and existing healthcare infrastructure,
with an aim to provide affordable, accessible and equitable healthcare
services. Some of the major initiatives of the Government include
the following.
National Rural Health Mission (NRHM)
The NRHM was launched throughout the country in April 2005,
with special focus on 18 states, including eight Empowered Action
Group states (Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Uttar
Pradesh, Uttaranchal, Orissa and Rajasthan); eight North-Eastern
states (Assam, Arunachal Pradesh, Manipur, Meghalaya, Mizoram,
Nagaland, Sikkim and Tripura); Jammu & Kashmir and Himachal
Pradesh, to provide accessible, affordable and quality healthcare
services to the rural population, especially the vulnerable sections.
Allocation and release of funds under the NRHM (` billion)
Note: Expenditure figures for 2009-10 & 2010-11 are provisionalSource: PIB website
Janani Suraksha Yojana (JSY)
This is a safe motherhood intervention under the NRHM being
implemented with the objective of reducing maternal and neonatal
mortality by promoting institutional delivery among pregnant poor
women. It was launched in April 2005 and is being implemented in all
states and Union Territories, with a special focus on low-performing
states. The launch of this initiative has led to a substantial increase in
institutional deliveries: the number of beneficiaries rose from 7.39
lakh in 2005-06 to about one crore in 2009-10.
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Rogi Kalyan Samitis (RKS)
Around 599 district hospitals, 4,210 community health centres
(CHC), 1,136 other hospitals, and 17,097 primary health centres
(PHCs) have their own RKSs with untied funds for improving quality
of health services.
Village Health and Sanitation Committees (VHSCs)
About 4.98 lakh villages have their own VHSCs, each of which has
been provided ` 10,000 as an untied grant per year.
Village Health and Nutrition Days
About 35 lakh Village Health and Nutrition Days were observed in
2006-07, to extend the reach of basic health services to rural areas.
This increased to 49 lakh in 2007-08, 58 lakh in 2008-09 and 58.7
lakh in 2009-10.
Mobile Medical Units
About 381 Mobile Medical Units are functional under the NRHM so far.
Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH)
Mainstreaming of AYUSH in national healthcare delivery is an
important goal under the NRHM. AYUSH services have been co-
located in 14,766 health facilities and 9,578 AYUSH doctors and
3,911 AYUSH paramedics have been added to the system.
Pradhan Mantri Swasthya Suraksha Yojana (PMSSY)
The PMSSY was launched with the twin objectives of (i) correcting
regional imbalances in the availability of affordable/reliable tertiary
healthcare services and (ii) augmenting facilities for quality medical
education in the country. The PMSSY has two components in its
first phase: (i) setting up of six AIIMS-like institutions and (ii)
upgradation of 13 existing Government medical college institutions.
The healthcare sector in India faces severe shortage of availability
of human resources. To achieve the WHO recommended norm
of 1:1,000 (doctor-population ratio) the country will require an
additional 15.4 lakh doctors. In order to increase the supply of
human resources in medical education, the Central Government has
revised the teacher-student ratio from 1:1 to 1:2. This has resulted
in approximately 4,000 additional post-graduate seats in various
disciplines in Government medical colleges from the academic
year 2010-11. To increase the number of medical colleges and
specialists, the Government has relaxed the norms in respect of
land requirement, bed strength, bed occupancy, maximum admission
capacity, and age of teaching faculty.
Widening Gap between Healthcare Demand and Supply One of the major challenges faced by the sector today is the huge
mismatch between demand and supply of resources, both in terms
of physical infrastructure and human resources especially when
compared to international standards. The density of hospital beds
per 10,000 population stands at a dismally low nine, compared
to the global average of 29. The number of physicians per 10,000
population at six is also much lower when compared to several other
developing countries. The nurse-doctor ratio in India also stands at
a low 1.2, compared to developed countries such as the US and UK
which have a nurse-physician ratio of 3.0 and 5.0 respectively.
Healthcare infrastructure status*
Country Physicians (No.)
Physicians density**
Hospital beds**
Bangladesh 43,315 3 4Brazil 329,041 17.2 24China 1,905,436 14.2 41India 660,801 6 9Indonesia 65,722 2.9 6Malaysia 25,102 9.4 18Singapore 8,323 18.3 31Thailand 18,918 3 22UK 165,317 27.4 34USA 793,648 26.7 31Global 9,171,877 14 29
*2000-2010; **per 10,000 population Source: World Health Statistics 2011, WHO
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“The quality of healthcare services rendered in India is second to none in the world. However, the physical infrastructure in the country should also match.” opines Dr Sujit Chatterjee, CEO of Dr L H Hiranandani Hospital
India has the highest number of medical colleges in the world.
There are 229 recognised medical colleges, and 71 colleges have
been permitted under Section 10A of the Indian Medical Council
Act, 1956 during 2009-10. Approximately 33,528 graduates pass
out every year from these colleges. Nevertheless, the healthcare
sector continues to face supply constraints due to an inadequate
supply of trained manpower and this in turn adversely affects the
flow, quality and cost of manpower resources.
Attracting and retaining the right talent thus continues to be a major
challenge, as the sector battles high attrition rates. This challenge
of recruiting and retaining is more acute among nurses, particularly
on account of the high demand and attractiveness of employment
opportunities in the healthcare field in the Middle East Gulf region,
Africa, etc. The brain drain to overseas markets can also be attributed
to the limited career growth opportunities available for nurses in India.
The market for medical technology in India is currently at a nascent
stage, and is characterised by high fragmentation with limited
indigenous manufacturing. The country is mostly dependant on
imports, with imports meeting nearly three-fourths of the domestic
requirement. While domestic firms primarily manufacture low-end
technology products, multinational companies mainly import high-
end medical equipment.
As per industry estimates, import duties on medical equipment are
as high as 20-30%, while the maximum life of an imported machine
is just five to seven years. Given the criticality of technologically-
advanced equipment in the healthcare sector, the limited
manufacturing capacity in the domestic market and the high import
duties act as major bottlenecks for healthcare players looking to
introduce advanced products/services.
“The attrition rate among nurses is quite high. The average tenure of a junior nurse in our hospital is about two years. Nurses in India, on an average, get three promotions in their entire service career. We are trying to create a different environment for nurses, where they become the decision makers, in an effort to retain them.” informs Dr Sujit Chatterjee, CEO of Dr L H Hiranandani Hospital
Private Sector Gains ProminenceThe private sector plays a dominant role in the delivery of healthcare
services in India. It is predominant in medical education, training,
diagnostics and technology, manufacture of pharmaceuticals, hospital
design, and in construction and management of ancillary services.
Over 75% of the human resources and advanced medical technology,
68% of all hospitals and 37% of total hospital beds in India are in the
private sector.
Further, the sector has grown rapidly in the last few years, witnessing
the emergence of several large private players and attracting huge
capital investment. The growing dominance of the private sector and
the consequent increase in competitive forces is transforming the
Indian healthcare sector from a supply driven market to a demand
driven/consumer-centric market.
“The last decade has seen a fair amount of sophistication as far as patient monitoring systems and minimal access surgeries are concerned.” opines Dr Sujit Chatterjee, CEO of Dr L H Hiranandani Hospital.
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Capital raised in the Indian healthcare sector (` crore)
Source: Handbook of Statistics on the Indian Securities Market 2010-SEBI; D&B Research
The Indian healthcare delivery system is highly fragmented, with large
number of independent, and small and medium privately-run hospitals
and healthcare centres accounting for the bulk, and a few large hospitals
accounting for the rest. The past few years have seen the emergence of
organised healthcare with several players setting up hospital chains and
creating a comprehensive healthcare delivery platform.
In India, rural and primary healthcare largely remains in the centre
and state’s domain. The private sector, which continues to strengthen
its foothold in the urban areas, is gradually increasing its focus on
tier II and tier III cities and small towns. Given the huge demand
potential, the private sector is poised to play a greater role in the
transformation of the Indian healthcare sector.
The long term prospects of the Indian healthcare sector look bright,
and much of the growth is expected to come from the private sector.
The attractiveness of the growing and under-penetrated healthcare
sector is drawing foreign players into this market, through capital
investments and technology tie-ups across various segments such as
hospitals, diagnostics, medical equipment, etc. As mentioned above,
the FDI in this sector between April 2000 and August 2011 stood
at US $ 1.08 billion. However, to meet the expected increase in
demand for healthcare services, both from domestic population
and international patients, the healthcare sector needs to scale up
considerably in terms of both availability and quality of the physical
infrastructure and human resources.
Government expenditure on health is extremely low, and as per D&B’s
estimates it is expected to remain low at a meagre 1.5% of GDP in
FY20. In such a scenario, private expenditure would have to increase
substantially to ensure overall improvement in health infrastructure.
Very high upfront investment, limited availability of quality manpower including doctors and para-medics and limited access to funding for the Indian population remain three key challenges for the Indian healthcare sector.” says Mr Rajiv Sharma, CEO of Sterling Addlife India Limited
Industry Reaps Benefits of Increased IT Adoption One of the major trends to have emerged in the Indian healthcare
sector in the last decade is increased adoption of IT in hospital
management. Healthcare providers are increasingly adopting
technology to derive various benefits, including improved patient
satisfaction (through reduced turnaround time at points of care);
enhanced patient safety (through improved decision-making);
enhanced productivity and elimination of human error (by way of
seamless integration with medical device/equipment); reduction in
operational costs (through reduction in staff needed for back-office
tasks); improved inventory management (by way of accurate demand
estimation and timely procurement and distribution of materials),
among others.
“Technology is central to healthcare delivery even today, enabling greater efficiency and supporting leaner business models.” says Mr. Prabhjit Didyala, Head – Strategy, Fortis Healthcare
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Technological Advancements Redefine Healthcare DeliveryOver the past few decades, healthcare in India has increasingly
become technology-driven, whether it is the development of new
drugs/vaccines, medical devices/equipment, or even the diagnostic
techniques. The last decade witnessed a significant change in the
manner in which healthcare services are delivered, with technology
having a key role to play. For instance, technological advancements
have been made in the field of imaging with an aim to deliver faster
and more reliable diagnosis, with reduced doses, procedure time
and new interventional application. Considerable advancements
have also been made in several other areas, with introduction
of advanced technologies such as functional MRI, parallel
radio frequency transmission, automated scanning technology,
ultrasound systems with 3D/4D capabilities, digital X-ray system,
wireless and ambulatory monitoring and micro electromechanical
systems, microprocessor-based ECG equipment, home-use
devices (glucose monitors, insulin delivery devices, nebulizers and
oxygen concentrators) etc. Advances in medical technology have
improved the ability of monitoring, preventing, diagnosing,
controlling, and curing a number of growing health conditions.
“Advances in technology have made it possible to treat a lot more conditions, improve quality of healthcare, give more predictable outcomes and significantly reduce the length of stay.” informs Mr. R D Thulasiraj, Executive Director, Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System
Greater Government Involvement is the Need of the HourThe existing norms of the Government allow a five year income
tax holiday from the start of operations, for setting up hospitals
in tier II and III towns. However, considering the large investments
needed for setting up the infrastructure and the long break-even
period for hospitals in India, there is a need to have a re-look at the
existing tax breaks. Further, a fund on the lines of the Technology
Upgradation Fund Scheme (TUFS) that is presently in place for the
textile industry will encourage greater private participation mainly
in the smaller towns. According priority status to the healthcare
sector will also go a long way in enabling players to get access to
funds at lower rates of interest.
A majority (60%) of the health workers reside in urban areas, and
a majority (70%) of them are employed in the private sector. The
density of health workers per 10,000 population in rural areas
stands at a mere 11.8, as compared to 42 in urban areas. Given
the staggering gap, another area that needs greater focus is a public
private partnership model (PPP) for skill development. A PPP
arrangement which would link Government hospitals/health centres
with private medical training institutes will help in reducing the
demand-supply gap for trained healthcare personnel in India’s rural/
semi-urban areas.
The set of challenges in making available quality healthcare services
at affordable costs in rural areas is unique. Given the lower paying
capacity of the rural populace, there is a need to create lower-cost
healthcare delivery models that are suitable for this segment.
The Government has undertaken several initiatives to improve the
state of healthcare services in the country. However, access to quality
and affordable healthcare remains a distant dream, particularly for
the poor and vulnerable sections of the society. The Aadhaar, or the
Unique Identification number (UID) has the potential to become a
powerful tool for the Government, policy makers and healthcare
providers to meet some of the healthcare challenges the country
faces and deliver healthcare services more effectively, particularly
to this section. It can also help to effectively coordinate the services
offered by the various stakeholders – Government, healthcare
providers, insurance companies, among others.
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Further, given the staggering gap between demand and the current
supply, there is an urgent need to bridge the gap by way of investments
in the concerned areas. The need of the hour is to re-evaluate and
reform existing policies, especially in public health system, to match
the dynamic and changing healthcare needs. Further, there is a
dire need to encourage greater partnerships among Government,
industry and academia to improve the quality, affordability and
accessibility to healthcare services.
“Affordability being a major challenge for people to avail quality healthcare services, healthcare service providers should develop different models to serve different segments of population with different needs.” says Mr. Prabhjit Didyala, Head – Strategy, Fortis Healthcare
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Section II: Future Demand DriversToday, the healthcare sector in India is on the threshold of a major
transformation, largely fuelled by increasing spending power, a rising
aspiration for wellness, and a distinct shift in disease pattern towards
chronic diseases.
The four key factors that would drive growth of the Indian healthcare
sector in the coming decade would be:
1. changing patient profile: demographic and socio-economic factors;
2. thrust on health insurance;
3. change in disease profile; and
4. government initiatives.
On the supply side, increase in availability of healthcare centres/
hospitals will drive growth of the sector. On the demand side,
growing demand for healthcare services is expected to be driven by
rising incomes, growing propensity to spend on healthcare, a shift to
lifestyle-related diseases, and changing demographics, among others.
These are discussed in detail below.
Changing Patient Profile to Generate Greater Demand for Healthcare ServicesSome of the major demographic and socio-economic factors which
are expected to drive growth of the Indian healthcare sector in the
coming decade would be:
(a) increase in population;
(b) rise in urbanisation;
(c) increase in life expectancy;
(d) rise in personal disposable income; and
(e) an increase in literacy rate.
Increase in population and rise in urbanisation
India’s population is projected to increase from an estimated 1.1
billion in 2010 to 1.3 billion by 2020. The level of urbanisation is
projected to increase from 29.8% in 2010 to 32.1% by 2020.
Projected population of India (billion)
Source: Census of India 2001, D&B Research
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Trend of urbanisation in India
Source: Census of India 2001, D&B Research
Rise in life expectancy and per capita income
Increase in life expectancy increases demand for healthcare services.
Life expectancy in the country is projected to move upwards in the
coming decade along with a rise in personal disposable incomes.
Increasing life expectancy coupled with rising disposable income
points towards higher demand for healthcare services and increase
in the per capita expenditure on healthcare, thereby driving growth
of the healthcare sector.
Projected values of expectation of life at birth
Units: YearsSource: Census of India 2001, D&B Research
All-India per capita net national product*
Units: `; *Per capita net state domestic product at factor cost (At constant prices); Base: 2004-05Source: Reserve Bank of India website, D&B Research
“Strong growth in demand for quality healthcare in India and across the globe, corporatisation of private healthcare, and growing access to funding i.e. private health insurance would be the three major factors that will drive industry’s growth in the coming decade.” says Mr Rajiv Sharma, CEO of Sterling Addlife India Limited
Rise in literacy rates
The literacy rate in the country has increased from 64.8% in 2001 to
74% in 2011. This increase in literacy rates has improved awareness
levels, particularly about lifestyle-related diseases, thereby having a
bearing on consumption of healthcare services.
Literacy rate in India (%)
Source: Census of India, D&B Research
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“Good quality of healthcare professionals, strong processes and creating affordability would be the key factors that would drive growth in the healthcare sector in the coming decade.” says Ms Shobana Kamineni, Executive Director-New Initiatives, Apollo Hospitals Group
Rise in Health Insurance Penetration to Expand Addressable MarketThe liberalisation of the insurance industry in 2000 has resulted in
the entry of several private and international insurance companies,
and proliferation of innovative products as also distribution
channels. Some state governments have also launched health
insurance schemes targeted at specific sections of the population,
which have been successful in improving access to healthcare. Social
and community health insurance schemes have also been rolled out
in the country. However, the overall level of insurance penetration
continues to be low. In India, any form of insurance including the
Central Government Health Scheme (CGHS) and the Employees
State Insurance Scheme (ESIS), other Government sponsored
schemes and private health insurance cumulatively covered only
25% of the country’s population in 2010. And over three-fourths
of the coverage is through the Rashtriya Swasthya Bima Yojana and
other state-sponsored health insurance schemes.
The Indian health insurance landscape has seen a significant
transformation in the last three to four years since 2007; from
about 75 million people covered in 2007, the estimated number of
people covered by health insurance has surged to about 302 million.
In the coming decade, driven by rising healthcare costs and the
Government’s increased thrust on improving access to healthcare,
the penetration of health insurance is expected to increase
significantly. Further, an increasing section of the domestic workforce
is being covered by corporate health plans. India’s growing consumer
class, increasing awareness regarding insurance, and increasing
domestic savings and investments would be some of the chief factors
that would further drive market penetration of health insurance
products in the country in the coming years.
Over the last couple of years, health insurance has emerged as one
of the most promising segments within the Indian insurance sector.
Not only has there been an increase in the number and variety of
insurance products introduced, there has also been a rise in the
number of insurance companies entering into the health insurance
market. In 2009-10, the health insurance industry had underwritten
premium worth ` 80 billion, a growth of 20.7% over 2008-09. The
contribution of the health segment in total premium stood at 21.2%
in 2009-10. The Insurance Regulatory Development Authority
(IRDA) expects the health insurance segment to expand manifold
in the coming years. With gradual increase in penetration of health
insurance, healthcare is likely to become more affordable for a larger
proportion of the country’s population. Further, expansion in the
health insurance segment would also have a positive rub-off impact
on demand for health check-ups/preventive healthcare, which is a
mandatory part of health insurance coverage.
“Penetration of Government health insurance schemes will increase going forward, and we expect a lot more of our patient inflow to be driven by these Government insurance schemes.” says Mr. Prabhjit Didyala, Head – Strategy, Fortis Healthcare
Rise in Awareness and Income Levels to Drive Preventive Healthcare The Indian healthcare sector is gradually moving towards preventive
healthcare from curative healthcare. Need for preventive healthcare
is expected to become even more crucial in the coming decade due
to the rising incidences of lifestyle-related diseases. The incidence of
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lifestyle-related diseases such as diabetes and cardiovascular diseases,
and the associated risk factors such as hypertension, high cholesterol
and blood pressure, obesity etc is increasing at an alarming rate in
India. This in turn can be attributed to urbanisation and changing
corporate environment (rising stress levels and sedentary lifestyles),
among others. Moreover, this phenomenon is no longer restricted
to urban population. Since preventive steps can help prevent the
occurrence of such diseases, with rising awareness levels both
in the urban and rural areas and increasing disposable incomes,
the coming decade is expected to witness increased demand for
preventive healthcare. The corporate sector will play a critical role
in driving growth in the preventive healthcare market. In a highly
competitive corporate environment, both as part of their corporate
social responsibility as also to boost their employee efficiencies, the
coming decade is expected to witness significant increase in demand
for preventive healthcare and wellness programmes.
“Based on published reports, it is expected that incidence of lifestyle-related diseases is expected to grow at a rate faster than infectious diseases, which would result in increase in cost per treatment.” informs Dr Naveen Nagar, Associate Vice President - Operations & Strategy, HealthCare Global Enterprises
Rising Incomes and Lifestyle Diseases to Drive Urban and Rural DemandIndia has the world’s largest population of diabetics, with an estimated
50.8 million people living with diabetes. According to estimates of
the International Diabetes Federation (IDF) for 2010, the national
prevalence of diabetes in India stands at 7.1% of the population (20-
79 years). By 2030, this figure is estimated to increase to 8.6% of the
country’s population (20-79 years), with an estimated 87.0 million
people having diabetes.
Increase in life expectancy coupled with rising income, increased
awareness, higher levels of work-related stress, more sedentary
lifestyles, and increased consumption of fast foods, tobacco and
alcohol is bringing about a distinct shift in the pattern of diseases.
Consequently, these factors have contributed to alarmingly increasing
incidences of lifestyle-related diseases such as cardiovascular
ailments, obesity, diabetes and cancer.
“Health awareness and information on the kind of treatment options available is increasing in rural areas. This is one of the key factors driving demand for healthcare services in these markets. To tap this demand, there is a need to develop lower-cost models.” says Mr. Prabhjit Didyala, Head – Strategy, Fortis Healthcare
Government’s Changing Role as Facilitator of Healthcare ServicesThe role of the Government should evolve as a facilitator for
providing healthcare services in the country. Increasing focus of
the Government on enhancing the reach of healthcare services at
affordable costs across the country could also be achieved if some of
the current norms are relaxed. Tariff-related policy measures which
could benefit healthcare providing companies include reduction of
customs duty on medical equipment/spares; reduction of excise
duties on indigenously manufactured medical equipment, drugs,
consumables, etc, allowance of higher rate of depreciation in order
to counter the high rate of obsolescence of technology and enable
the companies to generate funds for replacement, etc.
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Section III: Emerging Trends in the Indian Healthcare SectorIn the coming decade, the Indian healthcare sector will witness the
emergence of several innovative healthcare delivery models. The four
key models identified are: (i) PPP-based models (ii) day care surgical
centres (iii) single speciality hospitals and (iv) telemedicine. Further,
the role of technology will evolve to become the core of functions.
The medical value travel market is poised to register strong growth.
There trends are discussed in detail below.
Emergence of Innovative Healthcare Delivery ModelsThe coming decade is expected to witness the emergence of several
innovative healthcare delivery models that are aimed at enhancing
the reach of quality healthcare services at affordable rates. There
exists vast untapped demand in semi-urban/rural areas. However,
the existing models of healthcare delivery are unable to meet this
demand at a price which this segment of the population can afford.
Even for the non-rural segment, considering the fact that a large
proportion of private expenditure on health is out-of-pocket, the
key objective of the emerging delivery models would be to provide
quality healthcare facilities at affordable costs.
The four prominent delivery models that are likely to emerge would
be based on public-private partnerships; single speciality hospitals;
day care surgical centres and telemedicine. These are discussed in
detail in the following section.
Improved PPP Models to Bridge Demand-Supply GapThe PPP model is important for improving the healthcare scenario
in India. However, the success of this model will depend on reaching
a mutually agreed arrangement where objectives of both the parties
involved are met. While the private sector is driven largely by the
profit motive, the Government’s objective is to provide healthcare
services at affordable costs to the masses.
As far as provision of primary health is concerned, the country
faces certain key challenges in terms of coverage, accessibility,
management, and quality and availability of healthcare professionals.
Internationally, PPP models have been successful in meeting some
of these challenges. This reflects the possibility of adopting such
models in the Indian context.
Currently, Government hospitals suffer from lack of advanced
technology, inadequately skilled paramedical staff, poor/under-
utilisation of infrastructure and other resources, ineffective/
inefficient utilisation of funds, and low levels of customer satisfaction.
At the same time, the Government is striving to provide access
to affordable healthcare services to the masses through the PPP
route.
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“PPP model has an important role to play in facilitating better delivery of healthcare at a lower cost.” says Ms Shobana Kamineni, Executive Director-New Initiatives, Apollo Hospitals Group
Potential thrust areas for PPPs in the healthcare sector
Source: D&B Research
The current state of PPP mechanism suffers from several restrictions
and conditions imposed on the private player (e.g. free treatment to
be provided to certain percentage of patients; decisions involving
recruitment of doctors etc). Nevertheless, several initiatives are being
undertaken by the Government to enable a better PPP framework
and to remove the existing bottlenecks. The PPP arrangements are
being explored in areas of running of operations, management and
maintenance of Government hospitals; operation and maintenance
of mobile health vans; setting up of diagnostic centres and super
speciality hospitals; and setting up of speciality centres (e.g. cardiac
centre, nephrology centre, etc) within the Government hospitals.
Status of PPP projects in healthcare in India*
Project category Total investments (` crore) Up to ` 100 crore 315` 100-250 crore 343` 251-500 crore 275More than ` 500 crore 900Total value of contracts (` crore) 1,833
*As of July 2011Source: PPP India Database, Department of Economic Affairs, D&B Research
Data on PPP projects in India reveals that currently sectors such as
healthcare, education, railways etc account for a negligible share in the
total value of the PPP projects. Healthcare remains highly untapped,
with a share of a meagre 0.5% in the total value of existing projects.
Moreover, as can be seen from the following table, only a handful of
states have taken the initiative in building a PPP framework.
PPP projects in healthcare in India*
State Project name Status Cost (` crore)
Project type
Andhra Pradesh
Urban Slum Health Care Project
Not available (N.A.) 26.72 N.A.
Andhra Pradesh
III Haemodialysis Machines under Arogyasri Second Phase in Govt. Hospitals
Operational 0 BOOT**
Andhra Pradesh Arogya Raksha Scheme Operational 1.5 PPP
Andhra Pradesh Arogya Raksha Scheme Operational 50 PPP
Andhra Pradesh
Emergency Response Services (ERS) Operational 99 PPP
Andhra Pradesh
Rajiv Aarogyasri Community Health Insurance Scheme
Operational 900 PPP
Assam Regional Diagnostic Centre Bidding 20 Lease
Maharashtra
Indra Gandhi Government Medical College (IGGMC) Complex
Bidding 275 BOOT
MaharashtraDispensary, Vartak Nagar (RCC, G+7) 660 Sqm, by MC Thane
Construction 0.53 BOT***
Maharashtra
Primary Health Centre, Kopari, (RCC, G+3), 357.78 Sqm, by MC Thane
Construction 0.8 BOT
Maharashtra
Setting up and Running Trauma Center and Hospital, at Bopodi Pune
Construction 1 BOT
Maharashtra
Setting up and Running Trauma Centre and Hospital at Yerwada, Pune
Construction 1.5 BOT
Maharashtra
Setting up and Running Trauma Centre and Hospital at Yerwada, Pune
Construction 2.5 BOT
Punjab
Development of Hospital Building at Indrayani Nagar Pradhikaran Sector No. 1 by MC Pimpri Chinchwad
Construction 99 DBFOT****
PunjabGreenfield Super Specialty Hospital at Mohali
Construction 118 DBFOT
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PunjabPunjab Institute of Medical Sciences
Construction 225Concession BOT
Uttar Pradesh
Para medical colleges at Jhansi, Saifai
Bidding N.A. N.A.
Uttar Pradesh
State Medical colleges Kannauj, Azamgarh, Jalaun, Banda Saharanpur
Bidding N.A. N.A.
*As on January 31, 2011; **Build, own, operate, transfer; ***Build, own, transfer; ****Design, build, finance, operate, transfer.Source: PPP India Database, Department of Economic Affairs, D&B Research
Given the wide demand-supply gap in healthcare services, the coming
decade will see increased healthcare sector PPP, where the initiatives
create synergies between the strengths of the Government and the
private sector. However, the two key factors necessary to ensure
that the PPP model is profitable and is a success would be clearly
laid down growth and expansion strategies, and project objectives
and risks associated; and clear and regular communication among
the stakeholders with an aim to ensure transparency of operations.
Going forward, demand for healthcare delivery systems based on
the PPP model is likely to gain further momentum in the case of
super speciality hospitals also. This is considering the fact that setting
up such specialised centres involves high capital investment (land
etc) that can be catered to by the Government, and requires high-
level of quality care that can be provided by the private sector.
“PPP is a way forward by which healthcare providers can quickly scale up by leveraging existing public infrastructure, while bringing their own managerial expertise to the table. However, there need to be clearly defined roles for the parties involved.” opines Mr. Prabhjit Didyala, Head – Strategy, Fortis Healthcare
Day Care Surgical Centres to Gain Popularity
The concept of day care surgical centres (also known as ambulatory
surgery or outpatient surgery centres) is popular in developed
economies such as the United States of America (USA), the United
Kingdom (UK), France, etc. In India, the concept of stand-alone
day care surgical centres is currently at its infancy, but is poised to
slowly but steadily catch up. For a healthcare provider, the two chief
advantages of setting up day care surgical centres lie in the lower
cost of initial investments and lower break-even period, as compared
to a hospital. For instance, while a typical 100-bed hospital with five
operation theatres would require an initial set-up cost of about
` 120-130 crore with a break-even period of five to seven years, a
day care surgical centre could be set up at one-tenth of the cost and
have a much lower break-even time of as little as ten months.
Day care surgical centres also have much lower overhead costs as
manpower needs at day care surgical centres are about one-fourth
of a traditional 150-bed hospital, thereby keeping the operations
costs also lower. For the healthcare provider, these surgical centres
can be instrumental in increasing the availability of hospital beds
for higher margin inpatient surgeries. Further, the lower break-even
period also makes re-investment for expansion easier, as compared
to a traditional hospital. These factors are attracting the investor
community, particularly venture capitalists, into seriously looking at
investing in day care surgical centres in the country.
For the patient, such centres offer not only convenience, but also
cost-effectiveness as it eliminates stay and the associated expenses.
Further, advancements in medical technology have made performing
minimally invasive surgical procedures and faster post-operative
recovery possible. Considering the fact that today 75% of private
expenditure on health is out-of-pocket and there is also growing
patient preference for shorter hospital stays, this phenomenon is
likely to gain popularity.
With the cost of treatment and surgeries at day care surgical centres
being much lower than in the corporate and established hospitals,
this concept has become popular in advanced nations such as USA,
where over 70% of the surgeries are conducted at day care surgical
centres. The first ambulatory surgery centre was opened in the US
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in 1970. Presently, about 20 million surgeries are performed every
year in more than 5,000 ambulatory surgery centres across the
US. The common procedures performed in these centres include
ophthalmology, gastroenterology, orthopedic, ENT (ear, nose &
throat), gynaecology, and plastic surgery.
Apart from cost containment, decompression of busy hospital
beds and lesser incidence of hospital-acquired infections (because
of recovery at home) are some of the other benefits of such out-
patient surgery centres. Given the high healthcare costs in India
and restricted affordability of a large proportion of the population,
coupled with mounting pressure on healthcare companies to
contain costs and improve operational efficiencies, this low-cost
delivery model is emerging as a win-win situation not just for
the healthcare providers and consumers, but also for insurance
companies and business organisations providing insurance facilities
to their employees. In the coming years, day care surgical centres
would play a critical role in addressing issues of accessibility and
affordability.
Rising Incomes and Awareness Levels to Drive Demand for Single Speciality Hospitals
Single speciality hospitals are a comparatively new but rapidly
growing segment in India. HealthCare Global Enterprises (oncology),
Care Hospitals (cardiology), Vasan Eye Care and Aravind Eye Care
(ophthalmology) are some of the leading super speciality hospital
chains in India. The success of single speciality centres is encouraging
more healthcare players to venture into this segment and the
existing companies to expand operations. Among the segments, the
coming decade is expected to see more super speciality centres
being set up in the areas of heart, cancer, eye, maternal and child care,
and cosmetology. Rising incomes and increasing health awareness
is driving demand for such speciality centres. Currently, speciality
hospitals are largely present in metros and tier I cities. Going
forward, these centres are expected to spread their wings into the
huge untapped opportunities to offer these services in India’s tier II
and III cities and smaller towns.
On the one hand, there is demand for quality and specialised
healthcare services in smaller towns, since it saves time and money
spent in travelling to bigger cities for treatment. On the other
hand, lower rentals and manpower costs associated with smaller
towns enable healthcare companies to offer services at lower rates
compared to those offered by them in the big cities. Healthcare
players who have set up speciality centres in tier II and tier III
cities also attract patients from neighbouring small towns, thereby
enabling them to effectively play the volume game and offer services
at affordable costs. In the coming decade, this trend of hospitals
offering treatments in one therapeutic segment is likely to gather
pace, indicating a maturing healthcare sector in the country.
Single speciality hospitals focus on one segment, providing end-
to-end services and personalised care in one core area. Such
hospitals require less manpower, equipment and infrastructure, and
are easier to operate and manage. Furthermore, in an increasingly
competitive market environment, the higher margins enjoyed by uni-
speciality hospitals vis-à-vis multi-speciality hospitals, on account of
better economies of scale and cost optimisation, is increasing the
attractiveness of this segment. However, given the increasing number
of super speciality centres mushrooming across the country, the
shortage of experienced personnel, medical professionals and other
paramedical staff could become acute.
The expected increase in the number of single speciality hospitals in
the country would have a positive impact on the medical technology/
medical equipment market. Several global companies are already
closely watching the Indian market to set up operations here, which
in turn is expected to fuel competition in this segment.
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“Single speciality hospitals enjoy higher profit margins than multi-speciality hospitals by optimising resources and leveraging economies of scale.” says Mr. R D Thulasiraj, Executive Director, Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System
Telemedicine - Taking Healthcare to Rural India
About 70% of India’s population is in rural India and a vast majority
of the rural areas lack basic healthcare amenities such as hospitals,
trained medical personnel, diagnostic laboratories, medical equipment,
etc. A person living in a remote area has to travel 100 kilometres
on an average to avail the nearest healthcare facility. Further, only
one-fourth of India’s specialist physicians reside in semi-urban
areas, and less than 5% live in rural areas. Moreover, the inadequate
health infrastructure, including shortage of doctors and paramedical
professionals is severely restricting delivery of healthcare services
in the rural areas.
Given the demand-supply mismatch, particularly when medical
experts are usually unwilling to practice in rural areas, telemedicine
has the potential to improve access to medical experts, specialised
medical information, diagnostic tools and consultations.
With the rapid penetration of wireless technology, in the coming
decade, initiatives such as telemedicine, mobile healthcare etc
are expected to revolutionise the manner in which healthcare is
delivered. Tele-health initiatives were introduced in India about
a decade ago and their growth has been slow but steady. The
coming decade is expected to witness a major transformation in
healthcare delivery in rural areas, driven by technology, particularly
telemedicine. Convergence of healthcare with emerging technologies
will lay the stepping stone in improving the quality of healthcare at
affordable costs to the rural populace.
“Challenges of healthcare delivery in rural areas are different from those in big cities. While accessibility is a major issue in rural areas, in big cities huge variations in quality of healthcare delivery is a major issue.” says Mr. Prabhjit Didyala, Head – Strategy, Fortis Healthcare
Over the years, bottlenecks in the growth of telemedicine in India
have not been many in terms of connectivity, but are greater in
terms of availability of trained manpower to run operations in the
rural areas. Further, lack of common standards that govern medical
information and legal issues related to medical advice provided via
tele-conferencing, etc are also major impediments to the growth
of telemedicine in India. Integrating tele-health into the healthcare
delivery system will go a long way in furthering the Government’s
aim of increasing access to healthcare facilities among the rural
population.
Case Study - The ISRO’s Telemedicine Programme
The Initiative
The Indian Space Research Organisation’s (ISRO) telemedicine pilot project
was started in 2001 to make telemedicine accessible to the population at the
grassroots. This initiative was launched under the GRAMSAT (rural satellite)
programme, in co-ordination with various system providers such as Infinium,
Apollo, OTRI, BEL-VEPRO, TeleVital, etc. The telemedicine facility connects
remote district hospitals/health centres with super speciality hospitals in
cities, through the INSAT satellites for providing expert consultation to the
needy and underserved population.
The valuable experience gained during the initial pilot projects encouraged
ISRO to undertake further endeavours to enable speciality healthcare
delivery to the rural populace. The focus has been to introduce satellite
communications-based telemedicine technology in various parts of the
country through pilot projects.
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The Technology
The telemedicine system consists of customised hardware and software
at both the patient and specialist doctor’s end, with some of the diagnostic
equipment such as ECG, X-Ray, and pathology microscope/camera provided
at the patient end. They are connected through a Very Small Aperture
Terminal (VSAT) system and controlled by the Network Hub Station of
the ISRO. Through a telemedicine system consisting of simple computer
with communication systems, the medical images and other information
pertaining to the patients can be sent to the specialist doctors, either in
advance or on a real time basis through the satellite link in the form of
digital data packets. These packets are received at the specialist centre, the
images and other information reconstructed so that the specialist doctor can
study the data, diagnose, interact with the patient and suggest the appropriate
treatment during a video conference with the patient end.
The Telemedicine Network
Presently, the ISRO’s telemedicine network has enabled 382 hospitals
with telemedicine facility. As of now 306 remote/rural/district hospital/
health centres and 16 mobile telemedicine units are connected to 60
super speciality hospitals located in major cities. About 1.5 lakh patients
are getting the benefits of telemedicine every year.
The ISRO’s Telemedicine Network Growth Story
Note: Remote refers to remote hospitals and speciality refers to speciality hospitalsSource: Website of Asia-Pacific Regional Space Agency Forum, D&B Research
Thrust Areas
The ISRO’s telemedicine initiatives are aimed at providing telemedicine
technology and connectivity in the following areas:
• remote/rural hospital and super speciality hospital for teleconsultation,
treatment and training of doctors and paramedics;
• continuing medical education (CME) between medical colleges and post
graduate medical institutions/hospitals;
• mobile telemedicine units (MTU) for rural health camps, especially in the
areas of ophthalmology and community health;
• disaster management support and relief; and
• integrating with village resource centres/information kiosks.
Achievements
• The ISRO has successfully linked hospitals and healthcare centres in
remote rural areas with speciality hospitals in cities through INSAT
satellites. Thus, connectivity between patients at remote end and the
specialist doctors at urban centres has been effectively established.
• Remote areas such as Kargil and Leh in North India, offshore islands
of Andaman and Nicobar and Lakshwadeep, and some of the interior
parts of Orissa, Karnataka, Kerala, Chattisgarh, Jammu & Kashmir, the
North-Eastern states of India and some tribal districts in certain other
states now have access to speciality healthcare from some of the major
speciality hospitals in the country.
• The ISRO’s CME efforts provide doctors at rural healthcare centres
with an opportunity to upgrade their medical knowledge and skills
through interactions with experts at the speciality hospitals through
satellite-based tele-link. The CME programme has been integrated
with the tele-education programme by linking some of the medical
institutions with the speciality hospitals and research centres.
• The MTUs consist of medical equipment along with telemedicine
hardware, software and VSAT system mounted in a bus/van establishing
a mobile telemedicine centre at any place. The key areas of mobile
telemedicine applications are in the field of tele-ophthalmology and
community health. Under mobile tele-ophthalmology, rural eye camps
are conducted and the rural population undergoes eye screening for
cataract, glaucoma and diabetic retinopathy. Under the community
health programme, MTUs are useful not only for disease prevention
but also for health promotion in terms of running awareness camps and
teaching hygienic practices.
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• The ISRO’s telemedicine facilities at three hospitals – GB Pant Hospital,
Indian Naval Hospital Ship (INHS) Dhanvantari at Port Blair, Andaman
Island and Bishop Richardson Hospital at Car Nicobar along with an
ISRO Gramasat Network at eight islands was effectively used during post
tsunami disaster relief work for the benefit of the remote population
of the Andaman and Nicobar islands. More such telemedicine centres
are being planned at the primary health centres of various islands of
Andaman and Nicobar.
Technology to Become a Core FunctionConsidering the limited availability and access to proper healthcare
facilities in rural areas and increasing customer expectation of better
facilities and improved services in urban markets, in the coming
decade, technology will be a game changer in the manner in which
healthcare services will be delivered. While Government hospitals
are showing some interest in adopting IT solutions, the private sector
would be the major driving force behind technology adoption in the
Indian healthcare segment. To optimise costs and effectively manage
operations, IT solutions will become an integral part of process
management, patient care and the management information system
(MIS) in hospitals. With the health insurance sector poised for major
growth in the coming decade, increasing demand from this sector for
more efficient systems for storage and retrieval of information will
put pressure on hospitals and other healthcare providers to imbibe
technology to modernise existing infrastructure.
The convergence of healthcare with upcoming technologies such
as cloud computing and wireless technologies will play a key role
in improving accessibility and meeting the challenge of manpower
shortage. The coming years are expected to witness greater
deployment of tools such as telemedicine, teleradiology, hospital
information systems (HIS)/hospital management information systems
(HMIS), online or electronic medical records (EMR), etc.
Electronic record keeping is the first step towards automation. The
majority of Government hospitals are rooted in manual processes.
Nonetheless, the overall Indian healthcare delivery mechanism is
taking baby steps towards automation and deploying various hospital
informatics and management solutions. The healthcare sector is
poised to embrace cloud computing in a big way in the coming
decade. Cost-effective cloud-based solutions are expected to drive
increased adoption of HMIS and EMRs. The various benefits that
can be derived, such as easy accessibility irrespective of geographical
location, fewer errors, fast response in times of emergencies, patient
convenience, among others, would drive increased adoption.
To drive improved efficiencies, more hospitals are likely to seek
automation for their workforce management, administration, finance,
billing, patient records and pharmacies. On the back of growing
popularity of digitisation in hospitals, market penetration of picture
archiving and communication systems (PACS) is likely to increase
further in the coming years. With India expected to experience a
major shortage of radiologists over the next five to ten years, the
need and utilisation of teleradiology is expected to increase rapidly.
Though PPPs have yet to take off, they are expected to gather steam
in the coming decade which will also see an increased demand for
transparency and accountability among the stakeholders. This in turn,
will increase the demand for IT-enabled systems such as HIS and
related IT infrastructure, EMRs etc. Even in the case of public health,
maintaining and consolidating important data from Government and
rural hospitals and integrating several systems will drive demand for
greater automation in healthcare services in the coming years.
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The exhibit below indicates the factors that will drive demand for
increased technology adoption going forward.
Drivers for technology adoption
Source: D&B Research
Healthcare companies will also increasingly invest on adopting
technology in a bigger way to attract the huge foreign patient pool,
which is looking for best options of high-quality healthcare services
at affordable costs. The role of technology would evolve from that
of a support function to become the core function; for example
in the areas of minimally invasive surgery, laparoscopic and robotic
surgeries, etc.
However, the road to greater technology adoption is not going to
be without its share of challenges. Currently, the IT budget for Indian
hospitals does not exceed 10% of their revenues, substantially lower
than allocation on IT in hospitals in the West. Moreover, despite the
long-term gains in efficiencies and costs that can be achieved, the initial
high capital investments may act as impediments for organisations
looking to invest in advanced technology products/services. Further,
lack of in-house IT expertise, lack of standards, reluctance/resistance
of staff, inadequate support from the IT vendors, etc are some of
the bottlenecks that will have to be effectively dealt with in this
direction.
Project Panchdeep – Wipro’s IT-enablement initiative for the ESICThe Employees’ State Insurance Corporation (ESIC) partnered with Wipro
Limited to establish an IT eco-system in line with its complex requirement
of developing an infrastructure network for delivering medical care
services. The initiative, Project Panchdeep, is India’s largest e-governance
project to transform the manner in which 15 million industrial and service
labourers receive healthcare and social security protection. The task at
hand was to turnaround an ailing manual system into a state-of-the-art
automated and integrated medical environment powered by information
technology, covering 2,220 sites across India and roll out of over 20 million
bio-metric identity cards and a database of over 50 million fingerprints.
“ESIC’s nationwide citizen health record created for over 50 million
citizens, enables better healthcare services anytime anywhere for them
across 144 hospitals and 1,400 dispensaries. This initiative exemplifies how
technology will enable healthcare and social security services to reach and
benefit society in the future.” says Mr Prasenjit Lahiri, General Manager,
ESIC Account- Wipro Infotech.
The Wipro solution runs on an integrated fabric that seamlessly
orchestrates the real-time IT delivery needed by one of the world’s
largest e-governance projects. The transformation has enabled the ESIC to
reduce turnaround time and operational costs; shorten claim processing
time; improve employee productivity and operation co-ordination across
functional departments; and also made it possible for the insured person
to avail medical services at any ESIC facility across India.
“Digitalisation of beneficiary data and the issue of bio-metric identity
cards is a critical element of ESIC’s strategy going forward. I am sure that
it will be a great step to serving the beneficiaries in a better way.” says Mr
Mallikarjun Kharge, Union Minister of Labour & Employment.
Major benefits derived
a) Identification, authentication and verification of insured persons and
issue of 20 million biometric cards. This provided the users with a digital
identity and a convenient access to healthcare facility anywhere in India
b) A unified information system automated all ESIC processes (internal and
external). This system provides a single view of all data to improve efficiency,
transparency and accountability across ESIC and the eco system
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for medical procedure, among others. Apart from modern medical
procedures, India also offers varied holistic and wellness medicinal
services such as Yoga, Ayurveda, Meditation, Naturopathy etc.
“There is a reverse brain gain taking place, which is very positive for Indian medical tourism. Every new hospital coming up in the country today has half the doctors who have worked abroad for many years.” says Mr. Pradeep Thukral, Executive Director, Indian Medical Travel Association
India attracts about 50-60% of its foreign patients from the
neighbouring countries such as Bangladesh, Pakistan, Nepal and Sri
Lanka, with the remaining significant share of patients coming from
Africa and the Middle East. In the Asian medical tourism market,
India faces competition from Thailand, Singapore, Malaysia and
Philippines. While Thailand is more popular for cosmetic surgeries
and dental treatments, India and Singapore specialise in complex
medical procedures.
Procedure-wise composition of foreign patients (%)
Source: ‘A Study of Problems and Challenges Faced by Medical Tourists Visiting India’, Ministry of Tourism, Govt. of India; D&B Research
The Government is taking some initiatives to boost medical tourism
in India by way of a market development assistance scheme, and
other marketing activities (overseas road shows, etc). However, for
India to cash in on the high demand for out-patient procedures
c) A web-based medical information system enabled a seamless online
registration of employers including online filing of documents. The
system is also enabled with online payment mechanism between
banks, financial institutions and ESIC
d) ESIC offices are now powered with state-of-the-art voice and video-
conferencing equipment, making it a future-ready workplace
e) Establishment of a Central Data Centre and Disaster Recovery Centre
and instalment of centralised hardware is ensuring an integrated and a
secured information retrieval system.
Project Panchdeep: Thrust areas
Source: Wipro Limited; D&B Research
Cohesive Action Needed to Tap Medical Value Travel Market As per the International Trade Commission in Geneva, the global
medical tourism market could grow into a US $ 188 billion business
by 2013. Although currently India has a marginal share in the world
medical tourism (or medical value travel) business, it has emerged
as one of the fastest growing medical travel destinations in Asia.
According to industry estimates, every year 400,000 to 500,000
foreign patients come to India, with the nation’s medical value
travel market growing at a rate of 20-30% annually. Currently
India receives patients from over 50 countries across the world.
The growing significance of this segment is largely driven by India’s
low-cost advantage; emergence of several large private players;
perceived quality of clinical component (competence of doctors and
paramedical staff, procedure and infrastructure); and less waiting time
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such as cosmetic surgeries and dental treatments, concerted efforts
by all the concerned stakeholders are needed to be taken to offer
tourist-friendly experience to the international patient. At a policy
level, there is a need to have more tourist-friendly initiatives (e.g. a
simpler visa regime), while on the other hand, there is an urgent need
to build up infrastructure. An image building exercise to improve
the perception about India among foreign patients could also be
facilitated by the Government.
Notwithstanding the high value proposition of foreign patients,
many Indian hospitals are not motivated enough to tap international
patients. This is not because they do not meet the required standards,
but because they already enjoy high demand from domestic patients
and are running at full capacities. Further, there is also an urgent
need to set up large number of hotels and provide accommodation
facilities at lower rates. Countries such as Thailand enjoy an edge
due to a large hospital base and their competitive tourism industry,
where food and lodging during recuperation would be less expensive,
as compared to India.
“The number of foreign patients coming to India every year is expected to more than double in the next 10 years.” says Ms Shobana Kamineni, Executive Director-New Initiatives, Apollo Hospitals Group
SWOT Analysis: Medical Tourism in India
Strengths Weaknesses
World class healthcare services at a fraction of the cost incurred in western countries
Low healthcare manpower-to-population ratio as compared to global norms
Little or no waiting for treatmentGeneral infrastructure in the country is not impressive; shortage of hotel rooms
Equipped with latest medical technology & equipment, and quality clinical infrastructure
Lesser number of hospitals are accredited
India attracts foreign patients for high value medical procedures such as heart surgeries, nephrology, oncology, orthopaedics, joint replacement, etc
Lack of coordinated efforts at Government level to promote medical tourism
Highly skilled and competent doctors Government regulations on issuance of medical visas
Skilled paramedical staff Lack of proper regulatory system for hospitals
English-speaking medical personnel
Poor coordination among various stakeholders (healthcare players, insurance companies, Government, tourism and hospitality companies)
Opportunities Threats
Rising cost burden of national healthcare system in developed countries; rising ageing population in countries such as US, UK etc
Competition from tourism-friendly neighbouring countries (Thailand, Singapore, Malaysia etc)
Inadequate medical care facilities in other South Asian countries; and in the African continent and the Middle East (Iran, Iraq, Oman, etc.)
Increasing demand from medical tourists from non-English speaking countries
Increase in ‘brain gain’ of medical personnel to India
Source: D&B Research
“Traditionally India has been attracting patients from neighbouring countries, and presently there is a boom in demand from Africa and the Middle East. Going forward, rise in ageing population and increasing healthcare costs would bring more patients from the developed economies of Europe and Americas.” informs Mr. Pradeep Thukral, Executive Director, Indian Medical Travel Association
In the coming decade, the trend of foreign patients from developed
economies travelling to India for medical treatment is expected
to gather momentum. The demand would be driven by changing
demographics of the population in these countries. An ageing
population and increase in life expectancy would increase demand
for healthcare. At the same time, inability of the national healthcare
systems in these nations to meet the expected rise in demand for
healthcare and their worsening economic condition would result in
long waiting lists and high costs. Economic slowdown in the developed
22
economies coupled with loss of jobs and medical insurance is also
expected to give a boost to Indian medical tourism market going
forward. With a large majority of the foreign patients coming for
medical treatment to India being self-financed/not covered by social
security/health insurance, the low-cost advantage enjoyed by India
could augur well for further growth of medical tourism.
In such a scenario, the number of foreign patients seeking healthcare
facilities in countries such as India, Thailand, Singapore, etc, which offer
treatment at costs which are much lower compared to advanced
economies, are equipped with latest medical technology, and offer
services that match international quality standards, is set to see a
significant increase. Within the Asian sub-continent, there exists
tremendous potential for India to cash in on its low-cost advantage
vis-à-vis its Asian counterparts such as Singapore and Thailand, where
treatment costs are higher by as much as two to three times and
50-80%, respectively.
Although currently foreign patients comprise only a small
proportion (10-20%) of their total patient base (with domestic
patients accounting for the rest), several private healthcare players
are aggressively focusing on attracting foreign patients. This is on
account of the vast differential in the average per patient revenue
(in-patient) between a domestic patient (US$ 3,000) and a foreign
patient (US$ 7,000-8,000) for high-end treatments such as heart
surgery/knee replacement/cancer treatment, which acts as icing
on the cake for these companies. Most private healthcare players
catering to international patients have a separate department to
cater to this category of patients. Medical tourism facilitators in
the country offer attractive healthcare packages to foreign tourists
visiting India for medical treatments/wellness. Catering to foreign
patients helps healthcare companies in improving their financial
viability, as foreign patients usually seek high-value medical treatment
in India. This explains the increasing focus of companies to cater to
this higher-margin segment.
Improvement in the overall quality of treatment and care offered in
India at competitive rates, coupled with overall increase in awareness
levels, is resulting in several foreign patients who earlier went to
Thailand or Singapore, coming to India (e.g. African patients).
Another encouraging trend witnessed in the Indian context is the
brain gain. A large number of non-resident Indian (NRI) doctors
and other medical personnel are returning to India in view of the
huge growth opportunities in the Indian healthcare sector. In the
coming years, this trend will help in further raising the overall quality
of medical care services in India.
Accreditation, compliance with quality expectations along with
reduced medical costs and access to latest medical technology will
be the key demand drivers for medical value travel in the coming
decade.
The Indian medical tourism market is still at a nascent stage. The
huge potential from the Indian medical tourism business is reiterated
by the fact that while a foreign tourist coming to India spends an
average US $ 3,000, a foreign patient coming to India spends on
an average at least US $ 6,000-7,000. Further, currently medical
tourism in India is confined to just 10-12 big cities. India can leverage
the huge opportunity in medical tourism provided concerted and
coordinated efforts are taken by all the concerned stakeholders.
There is also greater need for accreditation of hospitals to build up
the perception of quality among foreign tourists.
“Manpower crunch is a constant battle for healthcare companies. Nonetheless, the reverse brain gain is benefitting the sector, with overall competency levels going up.” informs Mr. R D Thulasiraj, Executive Director, Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System
23
Section IV: Competitive Scenario and Strategic FocusThe most dominant feature of the Indian healthcare sector is the
wide demand-supply gap in healthcare services. While the prime
concern of the Government is to increase access and affordability of
healthcare services, the private healthcare sector accounts for bulk
of the total healthcare expenditure in the country. Private healthcare
delivery is highly fragmented, with the bulk of private healthcare
being serviced by the unorganised sector. However, this market is
witnessing increasing corporatisation in healthcare delivery.
The overall healthcare delivery market in the country is at a nascent
stage, characterised by high demand and growth potential. However,
competitive intensity seems to be increasing, particularly in the
metros and big cities. The capital-intensive nature of the healthcare
industry, with long gestation period and constant need to invest
in new/upcoming technologies puts pressure on profit margins of
healthcare players.
The larger established players enjoy the first mover advantage with
accumulation of sizeable hospital assets on land acquired at historical
prices, and have internal cash flows to take care of expansion plans.
For the new entrants, the rising real estate prices have created
high entry barriers. This is leading to several healthcare companies
increasing their attention to the tier II and III cities and small towns
to enhance their presence. However, successful entry into these
smaller markets characterised by comparatively lower affordability
would necessitate development of new and innovative healthcare
delivery models.
Growing demand for healthcare services and emergence of large
established private players is encouraging several foreign players
as also non-resident Indians to enter the Indian healthcare sector.
This rapidly growing sector is also attracting growing interest
from several private equity funds and venture capitalists, banks,
and domestic and international financial institutions to explore
investment opportunities across the healthcare value chain.
The entry of more number of players, increasing corporatisation
and foreign funding is expected to have several positive implications
for the healthcare sector, such as improvement in overall physical
infrastructure, technology, delivery systems and processes, and
overall quality of healthcare, thereby boosting further growth and
development of the sector.
In the coming decade, the strategies to be adopted by the healthcare
players would be aimed at enhancing market presence and entering
untapped markets; reducing costs and improving productivity; achieving
improved economies of scale; providing better customer service;
capital investment, including investment in infrastructure and IT;
24
introduction of new products/services, and mergers and acquisitions.
The three core areas of strategic actions likely to be undertaken by
healthcare players in the coming decade are discussed below.
Consolidation to Gather MomentumGiven the cruciality of economies of scale for the success of hospitals,
several private hospitals are likely to adopt the consolidation route in
the coming years. The need for consolidation/mergers and acquisitions
(M&As) would also be driven by the fact that demand exceeds supply
and entry of more players has increased competition and need to
widen geographical reach and healthcare delivery capabilities. Further,
considering the high costs involved in setting up hospitals and the long
gestation period, M&As would be a faster way of expanding operations.
Consolidation activities in the overall healthcare sector in the coming
years would also be driven by the objective of large healthcare
companies to become integrated healthcare service providers.
Within the healthcare sector, the diagnostics and pathology
laboratory segment is witnessing increasing competition since the
last few years with the advent of large pathology laboratory chains
and entry of foreign health insurance companies. Emergence of
these large chains with pan-India presence is posing a threat to and
eating into the market shares of the large number of small pathology
labs that have mushroomed across the country in recent years. In
the coming decade, rising awareness levels among consumers,
particularly towards preventive healthcare, and increasing income
levels of the middle class consumers is likely to increase demand
for pathology labs with emphasis on quality, standards and accuracy
of test results; thereby posing threat of existence to the small
unorganised players. Further, given the huge untapped potential in
the health insurance market, these organised players are optimistic
on the long-term future prospects of the diagnostics market and are
hence likely to adopt the consolidation route to enhance scale and
penetration.
“The market is likely to see increasing competition which will lead to some level of consolidation. We may see entry of major international healthcare players in the Indian market and also more focus on quality healthcare and efficient deployment of capital.” says Mr Rajiv Sharma, CEO of Sterling Addlife India Limited
Threat of Over-supply in Metros to Drive Firms to Tier II and Tier III Cities With competition in the healthcare sector becoming fiercer in the
metro cities, healthcare players have started to pay attention to the
demand for healthcare services in India’s tier II and tier III cities. The
entry of several new players in the Indian healthcare sector and the
likely entry of foreign players in the coming years are likely to create
a situation of over-supply in the metro cities. Further, high costs of
land in the larger cities is restricting expansion plans of healthcare
players, including diagnostics companies, which are now looking
at tapping the large untapped demand from the smaller towns.
The lower upfront costs and break-even period as compared to
setting up healthcare facilities in a metro city is expected to increase
penetration of healthcare services in the tier II and tier III cities in
the coming years.
However, given the profile of the customers in these smaller
markets, healthcare players would adopt a differential business
model, which could be in terms of smaller hospitals (i.e. less number
of beds); investing in less expensive medical equipment (without
compromising on quality), etc. Considering the lower affordability of
consumers from smaller towns, healthcare companies would thereby
adopt a low-cost model in which the patients would be required to
travel to the nearest big city only for the high-end services. In fact,
by establishing a presence in the smaller towns, healthcare players
can ensure flow of referral patients from these areas to their main
hospitals in the big city.
25
“Healthcare players are interested in tapping the tier II and tier III cities due to the growing opportunities in these markets and indirectly reducing the cost of care to the patient by taking it to their doorstep.” says Dr Naveen Nagar, Associate Vice President - Operations & Strategy, HealthCare Global Enterprises
Accreditation to Become a NecessityRise in income levels and awareness would increase demand for
quality healthcare services. With the healthcare market increasingly
becoming customer centric, high quality standards would ensure
greater consumer satisfaction. Further, to cash in on the rising demand
for healthcare services from foreign patients, more healthcare
players in India are likely to get accreditation from national as well
as international accreditation agencies.
Moreover, entry of new and foreign players would further push up
need for ensuring quality healthcare services among existing players.
In such a scenario, healthcare players would use accreditation as
an important differentiating tool amidst increase in competition
levels. Accreditation also has a critical role to play in regulating
the healthcare industry, upgrading the quality environment of the
healthcare organisations and for ensuring reach of quality healthcare
to the rural masses. Although currently there is no mandatory
requirement for an accreditation, in the coming decade, in a
dynamically changing healthcare landscape, accreditation is expected
to become a necessity.
26
The Indian healthcare sector is on the threshold of a major
transformation. In the coming decade, the changing dynamics of the
sector would be characterised by rise in demand for healthcare
services at affordable costs; increased investments, both in terms of
infrastructure and technology; and expansion of market, particularly
in the tier II and tier III cities and towns. Apart from the traditional
demand drivers such as rising incomes and urbanisation, factors like
increase in penetration of health insurance schemes, Government
initiatives, increased awareness levels and changing disease pattern
would play a critical role in driving demand. However, widening gap
between demand and supply of healthcare services would remain a
major challenge for all stakeholders. Concerted efforts are needed
to be taken by all the stakeholders to ensure availability of quality
and affordable healthcare services to the Indian population.
Conclusion
The Way ForwardThere is a need for the Government’s role to evolve from a provider
to that of a facilitator in extending healthcare services. Presently
healthcare accounts for a negligible share in the existing PPP projects
in the country. Given the low public health expenditure in the
country, greater efforts need to be taken to foster more PPP-based
initiatives for building healthcare infrastructure, particularly in the
rural areas. PPP framework in the area of medical education would
help in addressing the severe manpower shortage in the sector.
Providing incentives and subsidies would attract greater private
sector participation. A fund on the lines of the TUFS for the textiles
industry will encourage greater private participation in the healthcare
sector, particularly in the smaller towns.
Affordability being a major bottleneck among the vulnerable section
of the society, the public and private sector should come together
to develop sustainable low-cost delivery models. To increase
accessibility of healthcare services in the far flung areas, more PPP
initiatives would help in addressing this challenge. Telemedicine
has a critical role to play in improving access to medical experts,
specialised medical information, diagnostic tools and consultations
for the rural populace.
Providing concessions on land would help the healthcare companies
in substantially reducing their costs, as they continue to grapple
with rising costs. Reducing the customs duty on imported medical
equipment would also them in saving cost. At the same time,
encouraging domestic production of medical equipment would bring
down acquisition costs for healthcare players and reduce the sector’s
high dependence on imports. Indigenised local production would
also help in bringing down overall costs of healthcare delivery.
Technology is poised to be a game changer in the manner in which
healthcare services will be delivered in the coming decade. Greater
deployment of technology will address the challenge of rising costs
of healthcare companies by automating routine administrative
functions and improve overall productivity levels. More importantly,
increased IT adoption will enable improved diagnosis, and more
accurate clinical decisions and treatment, thereby improving the
overall quality of services delivered.
To exploit the immense potential of the medical value travel
business, there is a need for the Government to facilitate greater
brand building initiatives (through overseas road shows, seminars,
conferences etc) in conjunction with healthcare providers, third
party administrators and other concerned stakeholders. Cohesive
action is also needed to offer tourist-friendly experience to the
international patient looking for high-value out-patient procedures
(e.g. dental treatment, cosmetic surgery). Relaxing the existing visa
27
norms and making it easier to access all the relevant information
(regarding hospitals, treatment options, charges, accommodation
etc) using different medium (Internet, published reports, magazines,
etc) would also go a long way in attracting more foreign patients
into the country.
While awareness levels have improved, increased use of information
and communication technology will go a long way in bringing more
people under the healthcare net, thereby increasing demand for
healthcare services. Insurance is the way forward towards expanding
reach of healthcare services across the nation.
Demand for healthcare is expected to remain strong in the coming
years. However, there is a need for healthcare providers to increase
thrust on developing innovative healthcare delivery models to
increase access/reach and affordability. To achieve this, there needs
to be greater partnerships between healthcare companies, medical
equipment providers and insurance companies, with the Government
playing an enabling role. To achieve sustainable and long term
growth of the Indian healthcare sector, collaborative action among
all concerned stakeholders, with clear and common objectives of
increasing accessibility and affordability is the way forward.
28
References & SourcesWorking Paper “Policy for India’s Services Sector”, Department of
Economic Affairs
“Improving Health and Education Service Delivery in India through
Public-Private Partnerships”, Govt. of India
Medical Council of India documents
Reserve Bank of India documents
Planning Commission documents
Industry interactions
Ministry of Tourism
Confederation of Indian Industries
Economic Survey, 2010-11
The National Medical Journal of India
Report of Task Force on Medical Education for the National Rural Health
Mission, Ministry of Health and Family Welfare
Handbook of Statistics on the Indian Securities Market 2010-SEBI
Census of India Reports
Annual Reports of Healthcare Companies
National Health Profile of India, 2010
World Health Statistics 2011, WHO
Annual Report of Ministry of Health & Family Welfare, 2010
Annual Report of Medical Council of India, 2009-10
Websites:
www.pib.nic.in
www.irda.gov.in
www.finmin.nic.in
www.dipp.nic.in
www.medicalbuyer.co.in
www.modernmedicare.co.in
www.novamedicalcenters.com
www.aprsaf.org
www.ibef.org
www.indianhealthcare.in
www.pppindiadatabase.com
www.expresshealthcare.in
www.expresscomputeronline.com
www.worlddiabetesfoundation.org
www.indiabudget.nic.in
www.nlm.nic.in
www.medind.nic.in
www.openmed.nic.in
www.ehealthonline.org
www.whoindia.org
www.upppc.org
www.decu.gov.in
www.idf.org
www.isro.org
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AcknowledgementsWe would like to thank the following experts for sharing their insights during the preparation of this report:
Dr Naveen NagarAssociate Vice President - Operations & Strategy, HealthCare Global Enterprises
Dr Naveen Nagar is an ENT Surgeon and a management professional in the healthcare sector with over 15 years of
experience. He is currently Associate Vice President - Operations & Strategy at HealthCare Global Enterprises (HCG)
- South Asia’s largest network of cancer hospitals.
Mr Prabhjit Singh DidyalaHead – Strategy, Fortis Healthcare
Mr Prabhjit Didyala is focused on Corporate Strategy, Medium Term Planning for Hospital Medical Programs, Incubation
of ideas around various focus areas for the Company, and Program managing complex change management projects.
Prior to joining Fortis, Mr. Didyala has worked for The Boston Consulting Group in India, E.I. DuPont in Shanghai, for
Accenture (then Andersen Consulting) in India and at Tata Cummins. He is a Mechanical Engineer (from BIT Mesra) and
an MBA (from IIM Lucknow), and a gold medalist at both places.
Mr Pradeep ThukralExecutive Director – Indian Medical Travel Association (IMTA)
Mr Pradeep Thukral is Executive Director of the IMTA - a non-profit organisation that brings together leading players
in the Indian Medical Tourism industry like JCI, NABH accredited hospitals, healthcare & wellness service providers,
facilitators and specialised travel companies and aims to make India the leading global healthcare destination. Prior
to joining the IMTA, he was Group Head - International Marketing, Apollo Hospitals and before that he was with
Wockhardt Hospitals Group in India, where he successfully set up its International Marketing function from the scratch.
He is presently working closely with India’s Ministry of Tourism and in the past has served on the task force constituted
by the CII and the Indian Ministry of Tourism to suggest a strategy for promoting medical tourism to India.
30
Mr Rajiv SharmaCEO - Sterling Addlife India Limited
Mr Rajiv Sharma is a B.E. (Mechanical) from PEC Chandigarh and a postgraduate in management from IIM, Ahmedabad.
He has a career spanning 16 years across various functions ranging from sales & marketing to consulting and M&A.
Under his leadership, from a single hospital in Ahmedabad, Sterling Hospitals has emerged to be the largest and dominant
chain of corporate hospitals in Gujarat with 5 operational hospitals in all major cities in Gujarat, with close to 1,000
beds under management. Rajiv Sharma is an eminent speaker on various healthcare issues and is a member of healthcare
committee of FICCI – Gujarat.
Ms Shobana KamineniExecutive Director – New Initiatives, Apollo Hospitals Group
Ms Shobana Kamineni has a degree in Economics and 20 years of experience in the healthcare industry. She is part of the
founding family of the Apollo Hospitals Group, which is Asia’s largest healthcare provider and the world’s 4th largest ‘For
Profit’ hospital with 8,500 tertiary & secondary care beds, Health BPO, 75 Clinics, Pharmacies, Educational Institutions,
Research, Insurance, Wellness spas, and Health Media. As Executive Director of New Initiatives, Ms Kamineni is currently
involved with the pharmaceutical retailing – 1,200 pharmacies, supply chain management, Clinical Trials, Research and
the Apollo Group’s foray into Health Insurance.
Dr Sujit ChatterjeeCEO - Dr L H Hiranandani Hospital
Dr Sujit Chatterjee, M.D. (Obs. & Gyn.) is the CEO of Dr L H Hiranandani Hospital since inception. The hospital is a
240 bedded super-speciality hospital located in Mumbai. Dr Sujit Chatterjee’s areas of specialisation are Obstetrics and
Gynaecology & Gynac Oncology. He has published papers in various scientific journals and has won awards for the
best scientific presentation. He led the Hiranandani Group to arguably the first Public Private Partnership in healthcare
with Navi Mumbai Municipal Corporation. Dr Chatterjee is involved in Corporate Health Strategy planning and also
interacting with other healthcare companies to help forge joint ventures.
Mr R D ThulasirajExecutive Director - Lions Aravind Institute of Community Ophthalmology (LAICO), Aravind Eye Care System
Mr R D Thulasiraj, an IIM Calcutta graduate, has been working in the field of eye care for over 25 years. He is part of the
leadership team that built Aravind into the world’s largest provider of eye care. In 1992, he shifted his focus to capacity
building, training and consultancy by setting up the LAICO which by 2010, had worked with over 260 hospitals across
the globe. He has served as an Advisor on several national and international bodies, and has been actively involved in
several research activities, both clinical and operations research. He has been a Technical Advisor to India’s National
Programme for the Control of Blindness and to the WHO. For the past five years, Mr Thulasiraj has been representing
eye care at the World Economic Forum as Davos.
31
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