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INDIA’S HEALTHCARE SECTOR: Opportunities and Challenges Sign up to vote on this title
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India’s Health Sector: Opportunities and Challenges
Group Members
1) Divya Divya Kumar( Kumar(21) 21) 2) Ansu Ansu Grover( Grover(12) 12) 3) Honey(28) 4) Nishant Chhabra(6) 5) Sushant Kumar Suman(46)
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Index Introduction
1. Overview Overview of of the Indian Indian Healthcar Healthcare e Sector Sector 2. Segments Segments in Healthcar Healthcare e Sector Sector 3. Medica Medicall Infras Infrastru tructu cturerea. Curr Curren entt stat state e b. Specia Speciall Econ Economi omic c Zone Zone c. Manp Manpow ower er Stat Statis isti tics cs d. Medi Medica call Educa Educati tion on 4. Poli Policy cy Initi Initiat ativ ive e 5. Key trend trends s and and Dri Driver vers s
a. Shift Shift to lifestyle lifestyle related disease disease to drive drive higher healthcare healthcare spe b. Growing Growing Middle Middle class class and and Patient Patient Prefere Preferences nces c. Awareness Awareness towards towards Preven Preventive tive healthcar healthcare e d. Increased Increased life life expectancy expectancy and an aging aging populat population ion e. Overburden Overburdened ed health infrast infrastructu ructure re & high costs costs in the west Sign up to vote on this title
f. India’s India’s value value proposit proposition ion goes goes far beyond beyond cost; cost; qualit quality y second Useful Not useful none
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9. Hospotel Hospotels-An s-An Emerging Emerging Novel Concept Concept 10. Health Insurance: Current and Future Scenario 11. Path labs 12. Impelling Technology 13. Biotechnology Biotechnology 14. Reverse in Brain Drain 15. Mergers and Acquisitions Acquisitions 16. Key Players in the Sector 17. New Entrants/Key Foreign Players 18. Medical Infrastructure Development 19. Status of Private Investment in India’s Healthcare Sector 20. Telemedicine 21. Medical equipment 22. Insurance 23. Medical value Travel 24. Hospitals Planning and Controlling Controlling 25. Medical Textiles and Clinical Trials 26. Healthcare Outsourcing 27. Challenges to Private Investors 28. Challenges 29. Concluding Thoughts
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Introduction
Objective: - To analyze the business potential and study the major bran in the health-care sector in India. Research Design: - Descriptive research Sampling Design: - convenience sampling Data collection technique: - Internet, Journals, Newspaper and associations
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1. Overview of the Indian Healthcare Sector
The Indian healthcare delivery market is estimated at US$ 1 billion and employs over four million people, making it one of the larg service sectors in the economy today. Total national healthcare spend reached 5.2% of GDP, or US $34.9 billion in 2004 and is expected to to 5.5% of GDP or US $60.9 billion by 2009. This includes pharma pharmaceu ceutic tical als s market market,, gover governme nment nt and priva private te spendi spending. ng. Pr segmen segmentt consti constitut tutes es bulk bulk and growin growing g rapid rapidly, ly, to reach reach $38 billi billion on 2012. There are various gaps in the Indian healthcare market, which a present a vast opportunity. Good healthcare in India is in extreme sh supply. Hospitals in India are running at 80-90 per cent occupancy. W the the dema demand nd for for heal health thca care re far far exce exceed edin ing g supp supply ly,, Indi India’ a’s s heal health th industry is expected to grow by around 15 per cent a year for the next years.
There are some economic factors which make India such exciting market. Since healthcare is dependent on the people serv India’s huge population of a billion people represents a big opportun The middle income group in this vast base is also a large 300 million. In spends only 1% of its GDP on health, translating into $35 per cap France spends 10.4% and Japan 8%. A significant portion of the popula receives inadequate or no health care, specifically 25.7% below Sign up to vote on thisliving title useful poverty line and those who have only the public to rely Usefulhealth Notsystem Natio National nal Famil Family y Healt Health h Survey Survey for 2005-0 2005-06 6 estim estimate ates s 453 deaths deaths 100,00 100,000 0 women women;; higher higher than than Cambod Cambodia, ia, Bolivi Bolivia a and Botswa Botswana. na.
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Give Given n the the grow growin ing g dema demand nd,, the the emer emerge genc nce e of repu repute ted d pr player players, s, and the huge huge inves investme tment nt needs needs in the health healthcar care e sector sector recent years, there has been growing interest among foreign players non resident Indians to enter the Indian healthcare market. There is a growing interest among domestic and international financial institutio private equity funds, venture capitalists, and banks to explore investm opportunities across a wide range of segments. This study examines status and the major brands in the key segments of the healthcare sec i.e. i.e.,, in hosp hospit ital als. s. It also also anal analys yses es the the impl implic icat atio ions ns for for the the ov healthcare system.
2. Segments in Health Sector It comp compri rise ses s of many many segm segmen ents ts like: like: - Medi Medica call infr infras astr truc uc Medi Medica call equi equip pment ment,, Heal ealth insur surance ance,, Trai Traini nin ng and and educ educ Telemedicine, Clinical trials etc. The industry has grown at about 13 cent annually in recent years and is expected to grow at 15 per cent year over the next four to five years. How the healthcare Pie will evolve:-
2006 100%=$34.2b n 14% 5%
2012 100%=$78.6 bn
Infrastructure Medical Equipment
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1%
Clinical Trials
1%
3%
Training and Education
3%
1%
Medical Textiles
1%
6%
Medical Co Consumables
5%
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Source: The Business World, Ernst & Young Survey; June 2007
Share of tertiary care in the total healthcare market is around 20%. Market for tertiary care expected to grow at a faster rate, due to in complex in-patient ailments such as heart diseases and cancer.
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• Use of technologically technologically advanced diagnostic equipments and excellen infrastructure infrastructure are making India a medical value travel hub
Public Healthcare Infrastructure Snapshot of the healthcare market (2006) (US$) Primary Health Centres
23,000
Community Health Centres
2,935
District Hospitals
4,400
State Owned Hospitals
1,200
Source: India Chronicle: 2007, Ernst & Young Analysis
B. Special Economic Zones
Under the SEZ Act 2005 “Healthcare” has been defined as an appro service. For a sector specific zone, a hospital with minimum bed stren of 25 is stipulated and this goes up to 100 beds for a multi product S With the latest approvals, given by an inter-ministerial Board of Appro the total number of formally approved SEZ is now at 395, of which, 1 have been notified by the Law ministry.
C. Manpower Statistics • Number of Doctors - 660,801 • Number of Nurses - 1,371,121
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4. Policy Initiative National Health Policy-2002
• The National Health Policy 2002 focuses on the need for enhan fundin funding g and organ organis isati ation onal al restr restruct uctur uring ing of the natio national nal publi public c he initiatives in order to facilitate more equitable access to health facilities
• The focus is on those diseases that are principally contributing to disease burden - TB, Malaria and Blindness from the category of histor diseases and HIV/AIDS from the category of newly emerging diseases.
• Identification of specific programmes targeted at women’s health strengthening of food and drug administration, administration, in terms of both labora facilities and technical expertise.
• Greater contribution from the Central Budget for the delivery of pu health services at the state level.
5. Key Trends and Drivers A. Shif Shiftt to life lifest styl ylee-re rela late ted d dise diseas ases es to driv drive e hi healthcare spends
While rising incomes and growing literacy are likely drive higher per capita expenditures on healthcare, the shift in dise profiles from infectious to lifestyle-related diseases are expected to ra expenditures per treatment. Lifestyle-related diseases are typically m expensive to treat than infectious ones. In 2001, the average inpati cost for lifestyle-related diseases (cardiac problems, digestive issues e was US$ 658 compared to US$ 91 for infectious diseases.
Sign upto to follow vote on this titlesame patt India’s disease profile is expected the useful and dise Useful Not as in developed economies. Based on demographic trends profil profiles, es, lifes lifestyl tyle e disea diseases ses - cardio cardiovas vascul cular, ar, asthm asthma a and cancer cancer be th st im rt t ts d in atie atient nt di
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average realisation per inpatient for cardiac related treatment is m higher than for other disease segments. Hospitalisation Hospitalisation Cases, 2006
Source: Ernst & Young Analysis, Business Line: 2007
B. Growing Middle Class and Patient Preferences
Ther There e is favo favour urab able le incr increa ease se in perc percen enta tage ge of work workin ing g population from 32% in 2006 to 36% in year 2016. General awarene literacy rates and patient preferences in healthcare decisions is grow National Health Policy, 2002 has laid strong emphasis on the policy goa better engaging patients in their healthcare Sign decisions. up to vote on this title
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C. Awareness towards Preventive healthcare
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D. Increased life expectancy and an ageing population
In the domestic market, health spending will be sustained by demographic trends: increased life expectancy and an ageing populat Life expectancy, which averaged 63.3 years in 2000-04, is expected incr increa ease se to 65.1 65.1 year years s in 2005 2005-0 -09 9 and and to 66 year years s in 2006 2006-1 -10. 0. proportion of the population aged 65 years and over is also on the r and will increase from 4.7 per cent in 2000 to 5.3 per cent in 2005 and per cent in 2010. Although the rate of ageing in India is slower than developed world, the large population makes any increase significan term terms s of abso absolu lute te numb number ers, s, and and ther theref efor ore e also also in term terms s of ma potential.
E. Overburdened health infrastructure & high costs the West
The healthcare systems in Europe and the United States are un severe pressure; particularly the National Health Service (NHS) in the which has a long list of patients waiting for over a year for surgery. In US the health healthcar care e crisis crisis has a diffe differen rentt dimens dimensio ion. n. Aroun Around d 50 mi citizens are uninsured, with even the insured having to pay dearly treatment. treatment. Further, Further, the shortage shortage of paramedic paramedical al professi professional onals s such nurs nurses es has has aggr aggrav avat ated ed the the situ situat atio ion. n. Pati Patien ents ts from from the the US are are regularly beating a path to India, as many of their insurance compan have entered into tie-ups with private Indian hospital chains.
F. India ndia’s ’s valu value e prop propo ositi sition on goes goes far far beyon eyond d co quality second to none
Sign up vote on this titlevour Cost Cost is not not the the only only fact factor or weig weighi hing ng into Indi In dia’ a’s s favo fa ur.. Es Hospit Hospital, al, for instan instance, ce, is one of the only onl y Useful handfu handful l Not treatm treuseful atment ent fac worldwide that specialise in robotic surgery. The death rate of coron bypass patients at Escorts is 0.8 per cent. By contrast, the 1999 de
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G. Healthcare Players Now Targeting Smaller Cities
• Increasing focus on unexplored regions of India in terms of healthcare
• Growing need for improved healthcare infrastructure in tier II & III citi • Bett Better er acce access ss owin owing g to deve develo lopm pmen entt of new new nati nation onal al/i /int nter erna na airports e.g. Visakhapatnam, Nagpur
6. Holistic Wellbeing - Blend of Moder dern Traditional medicine
Hospitals and wellness centres are now looking at a comprehens Sign up to vote on this title and holistic holistic approach towards treating their patients. patients. Tie-ups of hospi hospi Useful Not useful with holistic health centres have helped combine traditional healthc knowledge and practices with the conventional system.
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B. Services Offered in Wellness Centres • Diet and Nutrition • Gym and Fitness • Yoga • Herbal Medicine • Humour therapy • Healing touch therapy • Stress Management including Relaxation, and Meditation • Acupuncture • Pranic and Crystal Healing
7. Quality Driven Approach: Accreditations
It has become an imperative for healthcare institutions in India guarantee quality healthcare healthcare to all. In India, QCI (Quality (Quality Council of In operates operates the national national accredita accreditation tion structur structure e and obtains obtains internati internati recognition for its accreditation accreditation schemes.
A. International Accreditation Bodies Present in India JCI (Joint Commission International)
• Launch Launched ed in 1999, 1999, Curren Currently tly JCI survey surveys s nearl nearly y 20,000 20,000 health health programs through a voluntary accreditation process
• The World Health Organization (WHO) designated the Joint Commiss up tosvote(on on Accr ccredi editati ation of Heal Health thca carre Org Organi aniSign zati zatio on JCA JCthis AHtitle O) and and Not useful Useful for Commission International as its Collaborating Centre Patient Safet 2005.
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• Wockhardt Hospital, Mumbai • Fortis Healthcare, Mohali
B. Accreditation Bodies in India - NABH
Launched in 2005, NABH is a constituent board of Quality Counc India, set up to establish and operate the accreditation programme healthcare organizations in India. It has standards specific to the Ind healthcare setting, major aspects being the assurance of uniform acc assessment, care of patients and protection of patient’s rights. NABH accredited Hospitals
• B.M. Birla Heart Research Centre, Kolkata • MIMS Hospital, Calicut • Max Super- Speciality Hospital, New Delhi • Max Devki Devi Heart and Vascular Institute, New Delhi • Kerala Institute of Medical Sciences, Thiruvananthapuram • Moolchand Medcity, New Delhi NABH: Accreditations to be launched
• Blood Banks • Diagnostic Centres • Dental Hospitals/Clinics Sign up to vote on this title
• Ayurveda Hospitals PG trainees in their programs
8.
Health
Cities:
The
Useful
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Evolving
Concept
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Health City
No of Beds
Area(acre)
Dr Naresh Trehan’s MediCity, Gurgaon Fortis MediCity, Gurgaon Fortis MediCity, Lucknow Apollo Health City, Hyderabad Nagpur Health City, Nagpur Chennai Health City, (Global Group) Bangal Health city, Durgapur Narayana Health City, Bangalore
1,600
93
Investment Million) 293
600-800
-
293
8 00
52
122-195
7 00
33
243
2,000
100
N.A.
1,000
46
245
50,000
800
487
5,000
100
488
Other Health City Plans in the Pipeline
• MIOT hospitals, Chennai have plans to set up a multispecialty multispecialty med city • Reliance ADAG has expressed interest inSign building up to votea on60 this acre title health in Kolkata Useful Not useful
• CMCH, Ludhiana has initiated a US$ 12.2 million MediCity projec
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rest restau aura rant nt chai chains ns are are activ activel ely y gett gettin ing g into into open openin ing g food food outl outlet et hospitals Food Majors Looking at Hospitals for their Outlets Hospital
Food major in Campus
Indraprastha Apollo Hospital, Delhi Max Healthcare, Gurgaon Max Heart And Institute, Delhi Ganga Ram Hospital, Delhi
Nathu's
10. Health Scenario
Café Coffee Day outlet Subway Outlet Chopsticks Express Outlet
Insurance:
Current
and
Fut
• Revenue attributable to insurance or Third Party Administrators (TP has grown from 2% in 2001-02 to 16% in 2005-06.
• Total credit billing has increased to 32% in 2005-06 and it is furt likely to increase to 50% by 2011-2012. • Domestic health policy premiums have shown a 47% increase in the quarter of 2006. • The The numb number er of poli polici cies es issu issued ed as Medi Medicl clai aims ms,, ESIS ESIS,, and and CGHS CGHS 4,631,534; 8,400,000 and 1,040,000 respectively.
• Volun Voluntar tary y health health insur insuranc ance e market market,, estima estimated ted at US$ 86.3 86.3 mi currently, is growing fast. Sign up to vote on this title
Useful Not useful to • Total medical insurance premium income grow to US$ 3.8 billion 2012.
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proces process s of develo developin ping g natio national nal networ networks ks - such such as Dr. Dr. Lal’s Lal’s Pat Metropolis, SRL Ranbaxy, Thyrocare, and Nicholas Piramal. Most renow path path labs labs are expand expandin ing g regio regional nally ly and forayi foraying ng into into the intern internati ati markets as well. For instance, SRL Ranbaxy Ltd has signed outsourc contracts with several UK hospitals to provide pathological services. Group with 17 labs, 550 collection centres distributed in 350 towns acr the country and seven franchisee labs is looking for both franchisees acqu acquis isit itio ions ns in all all the the majo majorr citi cities es of the the coun countr try. y. Metr Metrop opol olis is He Serv Servic ices es too too plan plans s to incr increa ease se its its coll collec ecti tion on cent centre res s and and fran franch ch systems. It currently has 13 laboratories in India and plan to open at le another 9 labs by the end of next year.
12. Impelling Technology
• Life cycles of high end medical equipments becoming shor due to high level of innovation Teleme medi dicin cine e bein being g used used by majo major r healt healthc hcar are e prov provid ider er • Tele provide quality care especially in eye, cardiac and other surgeries for rural poor in India
• Teleradiology being used to leverage the time difference advant with other developed nations IT Driven Tools and Services in Healthcare
• Hospital management systems • Decision support systems that improve diagnosis and treatment • Telemedicine and electronic record genera
13. Biotechnology Sign up to vote on this title
Indi Indian an comp compan anie ies s are are driv driven en to inno inUseful nova vati tive veNotrese reuseful sear arch ch an establishing their own niche areas: Reliance Life Sciences is planning launch genetically engineered skin; Avesthagen has won a US patent
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trials and has positioned itself to take advantage of move governments in the US and Europe to create a regulatory framework approving generic medicine.
14. Reverse in Brain Drain
The reversal of trend is encouraging. Medical professionals of Ind origin, working in other nations are willing to come back and settle India. Factors for Top Medicos to Return
• Significantly improved international grade healthcare infrastructur India • Increase in medical value travel to India • Improved salary levels, almost at par with the west
• Growing restrictions on licensing and practicing in the UK and other countries
15. Mergers and Acquisitions
M&A M&A rout route e allo allows ws heal health thca care re prov provid ider ers s with with imme immedi diat ate e recognition and an aggressive scale up in new geographies. With M new standa standards rds in health healthcar care e servic services es have have been been usher ushered ed in by corporate hospitals. Merger of smaller hospitals and nursing homes w larger healthcare entities has led to better healthcare service delivery.
• Singap Singapor ore-b e-base ased d Parkwa Parkway y Group Group Healt Healthca hcare re PTE PTE Ltd. Ltd. has has firme firme plans of acquiring tertiary care hospital projects invote Class and B citie Sign up to on thisAtitle India, especially in the South with one operational Hyderabad Not useful Useful in
• The Asian Heart Institute, Mumbai plans to invest US$ 7.32 million
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Managed Clinic Pharmacy
Apollo clinics 50 Apollo ph pharmacies 415
Insurance
Apollo Telemedicines networking foundation(ATNF) (As a TPA)
Outsourcin g (BPO)
Apollo Health Street
TeleMedicine
Over 60
Retail Pharmacy- Direct a to Patients, low capital requirement for hospital pharmacies, higher bargain power with pharmacy companies. Access to huge medical network; helps expand rea and achieve growth
-
Access to patients, medic network, and claim process
-
Caters to health Information nee of U.S. based Physician groups a hospitals
Apollo Hospitals Enterprise Ltd
• Manages a network of 41 specialty hospitals and clinics with a b capacity of over 9,000 across the country and abroad.
• Besides the recently launched Health City in Hyderabad, plans to lau similar facilities pan India • Has Has tied tied up with with insu insure rers rs like like BU BUPA PA (UK) (UK),, Vanb Vanbre reda da (Bel (Belgi gium um Mondial (France) to direct inflow of foreign patients to India
• Joint venture with Singapore-based Parkway Group Healthcare PTE Lt
• Has tied up with Indian Oil Corporation (IOC) to set up its pharmacie the latter’s petrol stations. Sign up to vote on this title
Fortis Healthcare
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• Owns a pharmacy chain by the name of Fortis Health world and plan open 250 outlets with an investment of US$ 195 million all over India
• Has announced the signing of a definitive agreement (the “pre-IPO”) allo allotm tmen entt of 670, 670,00 000 0 equi equity ty shar shares es to VA VASC SCO O Inc. Inc. for for an inve invest st amount of US$ 2.6 million
Wockhardt Hospitals • 8 hospitals across India, of which 5 are owned • Total bed size of the group is 1,390.
• Has tie-ups and association with Harvard Medical International: U Blue Cross and Blue Shield: USA, Bupa: U.K., AEA International: Singap and others. • Plans to build 15 new multi speciality hospitals in Tier-II cities in country.
• Public-Private Partnership with the Government of Gujarat to man the 275-bed Palanpur Civil General Hospital in Gujarat • Company plans an IPO by the end of this year
Manipal Health Systems Chain consists of: • 9 primary centres at 7 rural locations • 8 secondary hospitals at urban and semi urban locations • 3 tertiary hospitals at urban and semi-urban locations. Sign up to vote on this title
• MHS is building another 600-bed multi specialty hospital in Devanah Useful Not useful Bangalore
• Joint venture with Pantaloon Retail for comprehensive retail healthc
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• Capability to perform 25 major heart surgeries and over 20 card catheterisations catheterisations a day
• Hub Hub for for tele teleca card rdio iolo logy gy netw networ orks ks with with a Join Jointt Vent Ventur ure e betw betwee ee Govern Governmen ments ts of seven seven hill hill states states and West West Bengal Bengal,, Karnat Karnataka aka He Systems and ISRO
• A 5,000-bed Health City is coming up at, Bangalore, which will comp of 10 hospitals
Max Healthcare
• MHC operates 8 healthcare centres in the National Capital Region (NC
• Bed capacity of around 765 beds and is expected to increase to 1, -1,600 beds in the next few years
• Collaborated with Singapore General Hospital in the areas of med practices, nursing, paramedical research and training • Plans to raise US$ 85.36 - 97.56 million to expand its hospital chain
Columbia Asia • First healthcare provider to enter through the FDI route • Open Opened ed the the firs firstt comm commun unit ity y heal health thcar care e mult multii-sp spec ecia ialt lty y faci facili li Bangalore • Plan Planni ning ng to inve invest st US US$ $ 15. 15. 85 mill millio ion n to set set up more more hosp hospit it Bangalore Sign up to vote on this title
• Tied-up with GE, to collaborate on a number of initiatives for creatin medical Institute of world-class standards Useful
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17. New Entrants/Key Foreign Players Artemis Health Institute
• Delhi-based Apollo Tyres has made a foray with the launch of its U 48.78 million project, Artemis Health Institute in Gurgaon
• First hospital in entire northern India to offer Image Guided Radia Therapy (IGRT) to its patients • Artemis plans to grow into a 10-hospital chain by 2012
Naresh Trehan’s MediCity
• Reputed medical professional, Dr Naresh Trehan, is promoting a U 250 million world-class integrated healthcare facility known as ‘MediCit
• Has been envisioned as a multi-disciplinary high-tech medical instit spread over 43 acres in Gurgaon • Ap Apol ollo lo woul would d exam examin ine e the the poss possib ibil ilit ity y of inve invest stin ing g in the the prop prop Medi MediCi City ty and and merg merger er of the the Medi MediCi City ty with with Ap Apol ollo lo Grou Group p may may considered in the future
Aditya Birla Memorial Hospital
• A multi-speciality hospital located at Pimpri- Chinchwad in Maharasht
• The quaternary healthcare centre with 500 bed facility is spread over acres Sign up to vote on this title
Reliance ADAG Healthcare
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• Harvard Medical International and Cleveland Clinic have entered country through joint ventures
• Pacific Healthcare Holding has opened their first hospital in Hyderaba • Park Parkwa way y Grou Group p from from Sing Singap apor ore, e, Emaa Emaarr from from the the Midd Middle le East East Prexeus Health Partners from the US have announced plans
18. Medical Infrastructure Development Development
Medical infrastructure forms the largest portion of the healthc pie. The current current bed per thousand thousand populat population ion ratio ratio for India stand stand 1.03 as against an average 4.3 of comparable countries like China, Ko and Thailand. Our analysis points out that in spite of the phenome growth in the healthcare infrastructure, we are likely to reach a bed thousand-population ratio of 1.85 and in a best-case scenario, a ratio o by 2012. Beds in excess of 1 million need to be added to reach a rati 1.85 per thousand. Out of the total about 896,500 beds will be added the private sector with a total investment of 69.7 Billion US$ (Rs 222, Crores) over the next six years. However, the gains are commensurat this capital intensive industry, since the revenues generated by priv hospitals in the year 2012 will be to the tune of US$ 35.9 Billion ( 161,440 Crores) growing at a CAGR of 15%. Despite this investment, bed to thousand population ratio would be far from comparison with ot similar developing countries Leading Real estate players are looking new business areas such as hospital properties to maximize amenitie their integrated townships.
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Real Estate Players in Healthcare
• DLF inking a 26:74 joint venture with Fortis Healthcare for setting hospitals in its 200 acre plus integrated townships across the country an investment of around US$ 1.5 billion. The JV plans to set up a chain 200-450 bed hospitals in 31 cities in India within three to five years.
• Fortis’s Lucknow MediCity, is being set up in Ansal’s 1,500 a upcoming mega township.
• Hinduja Group and Limitless LLC, the realty arm of Dubai World, putting in about US$ 1.1 billion in their 51:49 JV to build hospitals a medicare cities Sign up to vote on this title
Not develop useful Useful to • Ambuja Realty Development Ltd (ARDL) plans a cou of feed feeder er hosp hospit ital als s in Sili Siligu guri ri (Nor (North th Beng Bengal al)) and and Bard Bardha hama man n (S Bengal Bengal)) for its sed multi multi ecialt ecialt hospi hospital tal in Kolkat Kolkat ARDL ARDL
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19. Status of Private Healthcare Sector
Investment
in
Indi
• Growth in private investment in various forms – Private equity, acquisitions, FDI, FII, NRI investment, joint ventures, ups, Venture Capital, IPOs • Segmen Segments ts attra attracti cting ng privat private e invest investmen mentt inclu include de diagno diagnosti stic c ch medical device manufactures, and hospital chains • Sign Signif ific ican antt grow growth th in Priv Privat ate e Equi Equity ty (PE) (PE) inve invest stme ment nts s in In healthcare sector – Over $448 million in PE investment in 2008. – Expected investments of $5 billion between 2008 and 2011
Examples of recent or proposed healthcare investmen (By Corporate)
• Apax Partners which picked up 12 per cent stake in Apollo Hospi Enterprise Ltd for Rs 426.40 crore • ICICI Venture making multiple healthcare investments: – Rs 40 crore in RG Stone Hospital – Rs 140 crore in Pune's Sahyadri Hospital – Rs 65 crore in Kolkata's Medica Synergie. – Rs 96 crore in Mysore’s Vikram Hospital • Sale of 25 percent stake by Narayana Sign Hrudayalaya up to vote on this Pvt. title Ltd to priv privat ate e equi equity ty arms arms of Amer Americ ican an Inte Intern rnat atio nall Grou Gr Inc. Inc. (AIG (AIG Useful Notpuseful iona oup JPMorgan for $100 million
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Recent PE Funding Deals in Healthcare Sheet Music
• Warburg Pincus’ total investment in Max Healthcare stands at U 34.15 million
• George Soros ’ fund Quantum and Blue Ridge bought 10 % in Fo Healthcare Manipal Health Health Syste Systems ms Privat Private e Limi • Manipal Limite ted d has has rise risen n over over US million of equity from IDFC Private Equity Fund
• Bangalore-based HealthCare Global Enterprises Limited (HCG) risen over US$ 10 million in equity from IDFC Private Equity Fund
Metrop opol olis is Healt Health h Serv Service ices s Ltd. Ltd. (Metro • Metr (Metropol polis) is),, India’ India’s s le corporate diagnostics chain, raised over US$ 8 million in equity from In Advantage Fund-I managed by ICICI Venture Capital.
20. Telemedicine
• Oppor Opportun tuniti ities es to integr integrate ate teleme telemedic dicine ine into into health healthcar care e to incre incre patient base, productivity, and enable cost effective delivery • Invest Investmen mentt opport opportuni uniti ties es for settin setting g up teleme telemedic dicin ine e centr centres es hospitals, create networks of hospitals and clinics in different parts of country Medical education, training, research
• Opportunities due to shortage of trained personnel- doctors, nurs technicians, healthcare administrators administrators – 1.27 1.27 doct doctor ors s (all (all kind kinds) s) and and 0.5 0.5 doct doctor ors s (all (allop opat athi hic) c) per per thou thou persons in India compared to world average of 1.5 (2006) Sign up to vote on this title
Not useful Usefulto – 0.9 nurses per thousand persons compared world average of (2006)
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4.97 billion (Rs 22,396 Cr) by 2012 Currently over 65% of the med equipments are imported and thus is a key area for forging partnersh across borders. Engineering excellence, cost-effective labour, increas emphas emphasis is on intell intellect ectual ual proper property ty right rights s and most most import important antly ly a growing domestic market makes India an ideal manufacturing base.
• As bulk of medical equipment is currently imported in opportunities opportunities for: Philips, s, GE, – Foreign companies to set up manufacturing base (Philip Siemens)
– Joint ventures and licensing agreements between Indian and fore Sign up to vote on this title companies (Wipro-GE)
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– Outs Outsou ourc rcin ing g engi engine neer erin ing g desi design gn and and skil skille led d serv servic ices es for for me equipment manufacturing and testing to Indian companies
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While the global orders will be placed through Siemens, it be serviced out of India once the regulatory approvals are in place. T Goa plant will now operate as a global production hub. The facility export products to about 30 countries and is targeting export growth about 45-50 per cent. Siemens currently exports four models from In and will increase increase the product product portfoli portfolio o to 8-10 models models by the end of fiscal. The main focus will be on X-ray systems and it will also undert all all glob global al R&D R&D acti activi viti ties es for for this this prod produc uctt segm segmen entt in this this unit unit company’s medical solutions division currently generates sales of ab US$ 111.1 million for it in India.
22. Health insurance
Growing demand for high quality health care has led to grow demand for health insurance. More number of insurers are promot insurance policies that provide comprehensive health coverage. Mult channels, including banks are being used to sell group and individ health insurance policies. Three factors have changed the face of medical insurance market:-
- Privatization in 2000 ending the monopoly of the pub sector. - Introduction of Third Party Administrators (TPAs) by
Insurance Regulatory and Development Authority in 2002 has made medical insurance segment more attractive through provision of cash hospitalisation hospitalisation facility.
- Third, the ‘detariffing’ of general insurance from January 2007 has also been a growth booster for the industry.
Insurance companies are in consultation with NABH to identifyhospi Sign up to vote cashless on this title claims. and diagnostic centres that will be allowed to process Not sect sector or is Pote Potent ntia iall lly y larg large e as pene penetr trat atio ion n Useful is less less than thuseful an 12% 12% of population but growing.
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23. Medical Value Travel
• Medi Medica call valu value e trav travel el is one one of the the most most lucr lucrat ativ ive e segm segmen ents ts of healthcare sector and is expected to grow into a US$1.5 billion industry 2010
• Potential to contribute US$ 1.2 - 2.4 billion additional revenue for market tertiary hospitals by 2012, and will account for 3-5% of the t healthcare delivery market
• In 2006-07, India was able to attract approximately 150,000 patient the country, up from 10,000 patients about five years ago
• With an annual growth rate of 30 percent, India is already inching clo to Singapore and Thailand, which are established medical care hubs t attract millions of medical tourists a year
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• The The Mini Minist stry ry of Tour Touris ism m (MOT) MOT),, Gove Govern rnme ment nt of Indi India a has has fu enhanced the Mvisa and MXvisa (Medical Visa) by extending it to th
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• Major hospital chains are now hiring hospital planning consultancy fi for a better and faster scale up of their facilities
• Established firms provide services ranging from a one stop solution; n and emerging players prefer to work on few specialised areas • Need for a statutory body to monitor hospital planning planning firms Key Hospital Planning Consulting Firms In India
• Hosmac, Mumbai • Medicontrivers India Pvt. Ltd, Mumbai • Ace Vision Health Consultant Pvt. Ltd, Jaipur • Professional Health Planners, New Delhi • Hospic, Mumbai • H-PAMCO, New Delhi • KSA Technopak, New Delhi • NOUS Hospital Consultancy (P) Ltd, New Delhi • Apollo Hospital Enterprise Ltd, Chennai • Total Hospital Solutions, Jaipur • Dr. Kamle’s Prescription
25. Medical Textiles and Clinical Trials Medical Textiles
Sign up toUS$ vote on500 this title Indian market for medical textiles is worth million; glo Useful Not useful market is worth US$ 8.2 billion. Growth inmedical infrastructure wil accompanied by demand for associated products and services. One s important industry is medical textiles. India’s market for medical text
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• National Centre for Clinical Trials has been established at Tata Memo Hospital
• A Clinical Research in Cancer (TMC) is one of the avowed objective the Tata Memorial Centre and Department of Atomic Energy (DAE) funded cancer cen (DAEFCC)
26. Healthcare Outsourcing
India has an estimated share of 65 % in the global IT services shori shoring ng segment segment and around around 46 % of the global global BPO market. market. Med services outsourcing outsourcing from the US has seen a CAGR of 150% in the last years. years. Indian Indian service service providers providers accounted accounted for US$ 115 million million wort outsourcing and off shoring services during 2005-2006. India’s large p of skilled IT manpower and the fast growing broadband connectivity secure networks provide robust infrastructure for IT-enabled healthc services
Fact Factor ors s maki making ng Indi India a the the pref prefer erre red d dest destin inat atio ion n Healthcare outsourcing • HIPAA-compliant processes • AAPC trained medical coders
• Thorough understanding of US medical coding and billing procedu and processes, including government regulations • Software applications to streamline workflow • A college-educated, trained and experienced operations team Healthcare BPO Services
• Medical Coding
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- Teleradiology - Medical Transcription Transcription
- Patient Record Management and EMR (Electronic Medical Recor
27. Challenges to Private Investors
• Although private investments growing in various segments of healthc sector, longer term, direct investment not as forthcoming as PE, IPO, based investments. • Regulatory, infrastructural, human-resource, and other constraints affecting direct investments. • Prim Primar ary y stud study y cond conduc ucte ted d in 2007 2007 (fun (funde ded d by WHO WHO and and Mini Minist st Health Health)) on “Fore “Foreig ign n Invest Investmen mentt in Hospi Hospital tals: s: Statu Status s and Impli Implicat cat illus illustra trates tes a range range of chall challeng enges es affect affecting ing organi organic c inves investme tments nts in Indian hospitals segment.
Findings hospitals
on
foreign
investment
in
Ind
• Regulatory environment very liberal for foreign investment in hospita
– Since January 2000 up to 100 percent FDI allowed under automatic ro in hospitals in India
• Regulatory environment for other forms of foreign financing quite libe – FIIs FIIs and and priv privat ate e equi equity ty fund fundin ing g conditions
Sign up to vote on this title perm permit itte ted d unde underr FDI, FDI, with with
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– FIIs and private equity funds can individually purchase up to 10%
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• Non-debt based foreign financing present via: – Private equity (funds) with stakes of 15-26% – Development agencies – Investment arms of foreign government • Around 50% of financing via long term domestic borrowing
28. Challenges External constraints • Heal Health thca care re unde underg rgoi oing ng refo reform rm and and inte intern rnal al prob proble lems ms in over over economies. • Number of potential players who could invest is limited. • Requ Requir irem emen entt of loca locali lize zed d and and in-d in-dep epth th know knowle ledg dge e of host host co market. • Difficulties in setting up individually as an overseas investor • Difficulties in establishing establishing and maintaining maintaining joint ventures • Competing destinations • Lowe Lowerr attr attrac acti tive vene ness ss of Indi India a as an inve invest stme ment nt dest destin inat atio ion n du perceptions of red-tape, lack of policy clarity, lack of transparency, problems of efficiency
Domestic constraints Sign up to vote on this title
• Initial and post establishment related operational adversely af Useful issues Not useful returns to investment in hospitals in India
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• Profits of 13% or less after several years – Depreciation of assets – High interest costs of debt financing – Margins squeezed by very high operating costs
29. Concluding Thoughts
If we want both organic and inorganic investments in the healthc sector, we need to look beyond investment-specific and capital mar policies to the the larger ecosystem ecosystem and make it supportive supportive for investors. need need tran transp spar aren entt regu regula lato tory ry fram framew ewor orks ks and and bett better er inst instit itut ut gove govern rnan ance ce.. Most Most impo import rtan antl tly, y, we need need heal health th to be a core core focu focu government policy. Some vital issues to address are standards, pend legislati ation, investment in human capital, setting up na councils/regulatory bodies, accreditation, insurance etc. Policy framew needs to recognize spinoffs from a facilitative investment environmen terms of improving access to healthcare, exploiting domestic and glo opport opportuni uniti ties es in emerg emerging ing segmen segments ts and and synerg synergies ies across across segme segme Private sector must also look at healthcare from more than a commer per perspec specti tive ve.. Our anal nalysi ysis poin oints tow toward ards the the need eed for for stro stro partnerships in healthcare, between the government and private sec Even a realistic targets of 1.85 beds per thousand population by 2 needs needs an invest investmen mentt of US$ 77.9 77.9 Bill Billion ion,, the gover governme nment nt and pr players need to focus on their core competencies/ responsibilities work work togeth together er to reduce reduce ineffi inefficie cienci ncies es and comple complemen mentt each each oth effort.
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