Healthcare in IndiaBY:Dheeraj SrinathDon Philips bhagavantrarayaBrief Overview30-10-2014copyright (your organization) 2003The Healthcare Sector comprises ofHospitalsDiagnosticsPathologyEquipment and SuppliesMedical TourismTelemedicine, etcIt is one the prominent contributors to Indias GDP.It attracts large number of domestic as well as international playersIndia has become an attractive destination for Medical TourismClinical StudiesResearch and Development ProgramsThere is massive growth potential and scope for expansion

HealthCare : Market SizeThe HealthCare Industry is presently worth USD90.4 billionSecond largest service sector employer in the country.Provides jobs for 4.5mn people directly or indirectly.Per Capita Healthcare Expenditure USD61Healthcare Expenditure ~15% Health Insurance Penetration ~15%Government share in total healthcare expenditure 33.1%Hospital Share in Total Healthcare Expenditure 71%Hospital Beds Per Thousand Population 0.9Physicians Per Thousand Population 0.7

Indian HealthCare : Growth StoryA sudden in paradigm shift in the last five years.This shift has become visible only in the last two years.A shift from an unorganized to an organized structure.It was earlier seen only as a social sector but now there is a move towards corporatization.Apollo pioneered the trend of corporate hospitals in India.

Factors for the HealthCare boom in India6Strong Indian EconomyIncreasing options for Healthcare FinancingIncreasing Opportunities in Healthcare delivery Better Profitability (15-20% EBIDTA)Earlier Break Even (2-3 years)Medical TourismIncreasing demand from within the county

Top Health Care Companies and Hospital Chains7APOLLO LIFESUN HEALTHCARENICHOLAS PIRAMAL INDIA PVT. LTDWIPRO GE HEALTHCARESERUM INSTITUTE OF INDIA LTDCIPLACADILLA HEALTHCARERANBAXYFORTIS HEALTHCAREEmerging & Re-Emerging DiseasesPneumonia - The deadliest Acute respiratory infections (ARIs) are responsible for most deaths in the developing nations.

HIV/AIDS - Over 33 million people are living with HIV/AIDS worldwide. There is still no cure on the horizon. Worst affected is sub-Saharan Africa

Emerging & Re-Emerging Diseases(contd)Diarrhea - It imposes a heavy burden on developing countries - accounting for 1.5 billion bouts of illness a year in children under five. The burden is highest in deprived areas where there is poor sanitation, inadequate hygiene and unsafe drinking water.Tuberculosis (TB) - a disease once thought to be under control, has bounced back with a vengeance to kill 1.5 million people a year - even more when in combination with HIV/AIDS. Nearly two billion people - one-third of the world's population - have latent TB infectionEmerging & Re-Emerging Diseases(contd)Influenza - It is a greatly misunderstood disease. Each year we confront seasonal, or interpandemic influenza. Seasonal influenza kills about 250,000 to 300,000 people each year throughout the world

Measles - It is the most contagious disease known to man. It is a major childhood killer in developing countries - accounting for about 900 000 deaths a yearEmerging & Re-Emerging Diseases(contd)SARS Nearly three years ago, the world experienced another newly emerging microbea previously unknown corona virusthat caused severe acute respiratory syndrome (SARS). The SARS outbreak turned out to be a classic study in epidemiology with regard to tracking the point source, the spread, and the containment. SARS first appeared in Guangdong Province in China. It was not reported to authorities until it emerged in Hong Kong, when an index case, which traveled from Guangdong to Hong Kong, stayed at the Metropole hotel and infected at least 14 people. Those individuals did some traveling throughout the world. Within months we had an epidemic that temporarily transfixed the world and did extraordinary economic damage in Canada, China, and Hong Kong, and other countries. There were 8,098 reported cases and 774 deaths.

Indian Healthcare InfrastructureAs on December 2010, there were 335 medical colleges which were recognized by the Indian Medical Council. As on 2001, a total of 5, 39, 00 MBBS doctors were registered with the Medical council number of Physicians and specialists available is less than the estimated requirements. The current doctor population ratio is 1:1800. Though at present approximately 50000 doctors are being produced annually in the nation, but the number needs to go up.

Indian Healthcare Infrastructure(contd)By 2020, the Indian healthcare industry is estimated to be worth US$ 275.6 billion. Currently, 8 per cent of Indias GDP is spent on healthcare. India needs to spend at least US$ 80 billion more in the next five years to meet targets.Indian Healthcare Infrastructure51% of the surveyed population believes that there is considerable difference between performances of hospitals in their region. 39% of the population believes that quality of govt. hospitals is bad and 35% of population believes that the quality is just an average. 18% believes that the quality of the govt. hospitals is very bad. Only 8% believes that quality of govt. hospitals are good. Indian Healthcare Infrastructure57% of the population believes that quality of private hospitals is good and 22% of population believes that the quality is just an average. 21% believes that the quality of the private hospitals is very good.

83% of the population is of the opinion that cost of private hospital is quite expensive.

DELIVERY OF SERVICESThe place of delivery may be HomeCommunityWorkplaceAt Health Facilities.The most common way is face-to-face delivery, where care provider and patient see each other 'in the flesh'. Absentia health care is becoming more common.Over The PhoneVideo ConferencingThe InternetEmailText Messages, Or Any Other Form Of Non-face-to-face Communication.

Measures Taken to ImproveMedical practitioners to undergo knowledge and skill up gradation and recertification every five years are proposed in the Tenth Plan.Promoting Open Universities for providing continuous up gradation of medical knowledgeSetting up of Medical Grants Commission for funding new Government Medical and Dental collegesDeveloping decentralized district based health manpower planning that would meet the demands of health services, and encouraging all States to establish University of Health Sciences (UHS)

RecommendationsMore medical collegesAttract more FDI investment Student exchange programmes More special medical schemes Branding Healthcare IndustryPreserve and promote Ayurvedic Medical SystemTelemarketing and social marketingSeminars and workshop (build awareness; stop corruption)

The Health Insurance Market of IndiaNeed of Health InsuranceGovernment Hospitals: Inadequate facilities

Expensive Medicines: Diagnostic charges are beyond common mans reach.

High cost of Specialists.

Tax benefit under section 80 D of the Income Tax Act

Standard Health Insurance: FeaturesRoom and boarding expenses provided by the hospitalNursing expensesDiagnostic and medicine expensesOther Services: Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist fees, Anesthesia, blood, oxygen, operation theatre expenses, cost of surgical appliances, medicines and drugs and similar expenses.Pre-hospitalization and post hospitalization expenses subject to conditions and limits.Companies CategoryNon-Life Insurance:

Public: Companies like Oriental, National Insurance, United India, etc.Private: Companies like ICICI Lombard, Reliance, Bajaj Allianz, etc.

Specialized Health Insurance Companies:Offers Core Health Insurance services & Products only.Examples: Star Health & Allied Insurance, Apollo DKV Insurance

Life Insurance Companies: Addresses following needs:SavingPensionRetirementInvestmentPlayers are LIC and other private players

Market SegmentationWorking Class IndividualsWorking Professionals with Family.StudentsSenior CitizensSmall and Medium Enterprises/ Corporate Houses:

Product RangesIndividual Health Insurance Products (Single Person).Family Health InsuranceSenior citizen Health InsuranceIndividual Personal AccidentOverseas Travel Health InsuranceGroup Health Insurance Policy for corporate / Organization

InferencesDominance: The four state-owned general insurers, account for almost 60 per cent of the premiums written in the first nine months of this fiscal. National Insurance Company: sharp rise in premium of 54% during the period.Private players: ICICI Lombard: at top position third spot in the industry with a growth of over 70 per cent and a market share of 13.2 per cent, Star Health & Allied Insurance (Star Health) with a share of 11.5 percent.

NUTRACEUTICALS MARKET

Dietary supplements

To fill nutritional deficiencies in food

To prevent diseases

SegmentationFunctional foods

Functional beverages

Mineral supplementsChallenges

Lack of awareness

Lack of Trust among People

Lack of regulations

Expensive Products Major CompaniesAmway India-NUTRILITEHerb life

Distribution channel: Multi-level Marketing

MEDICAL TOURISMMEDICAL TOURISMMedical tourism is the rapidly growing practice of traveling across international borders to obtain health care.Typically include elective procedures as well as complex specialized surgeries such as joint replacement (knee/hip), cardiac surgery, dental surgery, and cosmetic surgeries. But very type of health care, including psychiatry, alternative treatments, convalescent care and even burial services are available.Over 50 countries have identified medical tourism as a national industry.Accreditation and other measures of quality vary widely across the globe, and there are risks and ethical issues that make this method of accessing medical care controversial. ADVANTAGES OF INDIAQuality and experience of doctors and surgeons

Most doctors and nurses are fluent in English

Latest medical equipments

Quality of nurses

Low cost

COMPETITIONThailand, Singapore, Malaysia and Philippines are the major competitorsThailand is more popular for cosmetic surgery.In complex procedures Singapore has a technology advantage. Cost in Thailand is also less than SingaporeThe Malaysian government is aggressively promoting medical tourism.

AYURVEDATotal worth $1bnLess than a dozen major playersDabur India LtdSri Baidyanath Ayurvedic Bhawan LtdZandu Pharmaceuticals WorksThe Himalaya Drug CompanyCharak Pharmaceuticals Vicco LaboratoriesThe Emami GroupAimil Pharmaceuticals Ltd

STATUS OF AYURVEDA IN INDIA

Number of registered medical practitioners: 366,812Number of dispensaries: 22,100Number of hospitals: 2,189Number of hospital beds: 33,145Number of teaching institutions (undergraduate): 187Number of upgraded postgraduate departments: 51Number of specialties in postgraduate medical training: 16Number of pharmacies manufacturing Ayurvedic medicines: 8,400

SURGICAL EQUIPMENTSWorld market growing at a rate of 6% from 2010Market is highly price sensitive.Good network of distribution channelsPowered Instruments :- 47% of the total marketNon-Powered Surgical Instruments:- blades, scissors etcWound Closure Devices:- staplers, wound closure strips etcTheIndianpharmaceutical industryis the world's second-largest by volume.

India's bio-tech industry clocked a 17 percent growth with revenues of Rs.137 billion ($3 billion) in the 2009-10 financial year .

Bio-Pharmaceutical was the biggest contributor generating 60 percent of the industry's growth at Rs. 8,829/- crore, followed by bio-services at Rs.2,639/- crore and bio-agri at Rs.1,936 crore.

Pharmaceuticals in India37Service Marketing 7 PsPRODUCT

Both intangible and tangible, seeking to satisfy the new wants and demands of the consumer.Service products of the hospitals normally have the following featuresQuality LevelAccessoriesPackaging (Bundling) like offering full health checkup.Product lineBrand name

PRICE

The government uses price controls to ensure that vital drugs are affordable to the Indian population. It is an ongoing challenge to balance the commercial interests with the broader social objective.

Service Marketing 7 PsService Marketing 7 PsPLACE

The number of public health facilities also is inadequate. For instance, India needs 74,150 community health centres per million population but has less than half that number. Telemedicinethe remote diagnosis, monitoring and treatment of patients via videoconferencing or the Internet. Telemedicine is a fast-emerging trend in India, supported by exponential growth in the countrys information and communications technology (ICT) sector, and plummeting telecom costs.Many hospitals have developed public-private partnerships (PPPs), among them Apollo, AIIMS, Narayana Hridayalaya, Aravind Hospitals and Sankara Nethralaya for Telemedicine

Service Marketing 7 PsPROMOTION

Word-of-mouth plays an very important role in promotion of hospitals. Either advertisement or PR or sometimes both. Print media like Newspapers, Magazines Journals and Periodicals.Hoardings and wall writings near the markets and recreation centers. CSR activities to create awareness among the people.Ex. Aids awareness camp, Blood donation camps etc.

Service Marketing 7 PsPEOPLE

Internal customers of the hospitals which includes doctors, nurses, supporting staff etc. Patients

Service Marketing 7 PsPROCESS

Different tasks that are performed by the hospital. Communication within the setup. Experts and specialists of different disciplines Quick and healthy service under all situations from the staff.

Service Marketing 7 PsPHYSICAL EVIDENCE

Physical evidence can be in the form of smart buildings, logos, mascots etc. Proper diagnosis and cure of the problem. Diagnostic equipment used in the hospitals.