Healthcare has become one of India’s largest sectors - both in terms of revenue and employment. Healthcare comprises hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance and medical equipment. The Indian healthcare sector is growing at a brisk pace due to its strengthening coverage, services and increasing expenditure by public as well private players.
Indian healthcare delivery system is categorised into two major components - public and private. The Government, i.e. public healthcare system comprises limited secondary and tertiary care institutions in key cities and focuses on providing basic healthcare facilities in the form of primary healthcare centres (PHCs) in rural areas. The private sector provides majority of secondary, tertiary and quaternary care institutions with a major concentration in metros, tier I and tier II cities.
India's competitive advantage lies in its large pool of well-trained medical professionals. India is also cost competitive compared to its peers in Asia and Western countries. The cost of surgery in India is about one-tenth of that in the US or Western Europe.
The overall Indian healthcare market is worth around US$ 100 billion and is expected to grow to US$ 280 billion by 2020, a Compound Annual Growth Rate (CAGR) of 22.9 per cent. Healthcare delivery, which includes hospitals, nursing homes and diagnostics centres, and pharmaceuticals, constitutes 65 per cent of the overall market. The Healthcare Information Technology (IT) market which is valued at US$ 1 billion currently is expected to grow 1.5 times by 2020.#
Deloitte Touche Tohmatsu India has predicted that with increased digital adoption, the Indian healthcare market, which is worth around US$ 100 billion, will likely grow at a CAGR of 23 per cent to US$ 280 billion by 2020.
Over 80 per cent of the antiretroviral drugs used globally to combat AIDS (Acquired Immuno Deficiency Syndrome) are supplied by Indian pharmaceutical firms^.
There is a significant scope for enhancing healthcare services considering that healthcare spending as a percentage of Gross Domestic Product (GDP) is rising. Rural India, which accounts for over 70 per cent of the population, is set to emerge as a potential demand source.
India requires 600,000 to 700,000 additional beds over the next five to six years, indicative of an investment opportunity of US$ 25-30 billion. Given this demand for capital, the number of transactions in the healthcare space is expected to witness an increase in near future. The average investment size by private equity funds in healthcare chains has already increased to US$ 20-30 million from US$ 5-15 million##.
A total of 3,598 hospitals and 25,723 dispensaries across the country offer AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy) treatment, thus ensuring availability of alternative medicine and treatment to the people.
The Indian medical tourism industry is pegged at US$ 3 billion per annum, with tourist arrivals estimated at 230,000. The Indian medical tourism industry is expected to reach US$ 6 billion by 2018, with the number of people arriving in the country for medical treatment set to double over the next four years. With greater number of hospitals getting accredited and receiving recognition, and greater awareness on the need to develop their quality to meet international standards, Kerala aims to become India's healthcare hub in five years.
The hospital and diagnostic centres attracted Foreign Direct Investment (FDI) worth US$ 3.59 billion between April 2000 and March 2016, according to data released by the Department of Industrial Policy and Promotion (DIPP).
Some of the major investments in the Indian healthcare industry are as follows:
- Cisco Systems Inc has entered into an agreement with Bengaluru-based healthcare services provider Narayana Health, to deliver affordable specialty healthcare services to patients remotely in various parts of the country using its Virtual Expertise Digital Solution.
- TPG Growth, the growth equity investment platform of TPG Global, has acquired a majority stake in Rhea Healthcare, which runs a chain of mother and child care centres under the brand Motherhood, for Rs 220 crore (US$ 33 million).
- CureFit, a healthcare platform started by has raised US$ 15 million from Accel Partners, IDG Ventures and Kalaari Capital on the day of its inception.
- Aster DM Healthcare, one of the leading healthcare group headquartered in Dubai, plans to invest Rs 600 crore (US$ 88.94 million) in various Kerala-based healthcare projects over the next three years.
- Aster DM Healthcare, a Dubai-based healthcare conglomerate, has acquired 25 per cent stake in Ramesh Hospitals, a multispecialty chain headquartered in Vijayawada, in a deal worth Rs 110 crore (US$ 16.31 million).
- AddressHealth, a primary healthcare network, has raised US$ 1.5 million in series A round of funding led by Gray Matters Capital, which will be used to expand its model of school-based neighbourhood clinics and school health programmes in Bengaluru.
- PurpleHealth.com, a digital health and wellness platform, which aims to provide a seamless interface to consumers to choose medical practitioners, has raised US$ 100,000 from technology investor Katabole Technology Venture.
- Versante Software Technologies, an Indian subsidiary of US-based IT consulting and software engineering services company Versante Technologies LLC, is in the process of raising US$ 1 million in its first round of external funding by March 2016, the proceeds of which would be used for initial promotion, and pan-India marketing and distribution of hand-held and portable patient care devices.
- Abraaj Group, a Dubai based Private Equity (PE) investor, is set to buy a majority stake in an Indian firm Quality CARE India Ltd, which runs CARE Hospitals.
- Qatar-based Non-resident Indian’s (NRI) including medical professionals and businessmen, are planning to set up a huge world-class healthcare project in Kochi worth Rs 1,300 crore (US$ 192.71 million)
- American multinational technology and consulting corporation, IBM has announced that Manipal Hospitals’ corporate and teaching facilities will adopt ‘Watson for Oncology’, a cognitive computing platform trained by Memorial Sloan-Kettering that analyses data to identify evidence-based treatment options, helping oncologists to provide cancer patients with individualised healthcare.
- Apollo Hospitals Enterprise (AHEL) plans to add another 2,000 beds over the next two financial years, at a cost of around Rs 1,500 crore (US$ 222.36 million).
- Malaysia-based IHH Healthcare Berhad has agreed to buy 73.4 per cent stake in Global Hospitals Group, India's fourth-largest healthcare network, for Rs 1,284 crore US$ 192.84 million.
- Temasek Holdings Pte Limited acquired the entire 17.74 per cent stake of Punj Lloyd Limited in Global Health Private Limited, which owns and operates the Medanta Super Specialty Hospital in Gurgaon.
- CDC, a UK based development finance institution, invested US$ 48 million in Narayana Hrudayalaya, a multi-speciality healthcare provider. With this investment, Narayana Health will expand affordable treatment in eastern, central and western India.
- Apollo Health and Lifestyle Limited (AHLL), a wholly-owned subsidiary of Apollo Hospitals Enterprise, acquired Nova Specialty Hospitals at an estimated cost of Rs 135-145 crore (US$ 20-21 million).
- IHH Healthcare Berhad acquired a controlling 51 per cent equity stake in Hyderabad-based Continental Hospitals Limited for about approximately US$ 45.4 million.
- Sanofi-Synthelabo (India) Limited invested Rs 90 crore (US$ 13.34 million) in Apollo Sugar Clinics Limited (ASCL), a unit of its subsidiary Apollo Health and Lifestyle Limited.
- Carlyle Group acquired a stake in Metropolis Healthcare Limited, an operator of pathology laboratories in India, for an undisclosed sum.
- San Francisco-based Fitbit Inc., a fitness-tracking device maker, has launched its fitness wristbands across 300 towns in India and expects the country to be among its top five markets in next two years.
- Home healthcare service provider Portea Medical has raised Rs 247 crore (US$ 36.62 million) in Series-B funding from investors including Accel Partners, International Finance Corporation, Qualcomm Ventures and Ventureast.
- Practo Technologies Pvt. Ltd, India’s largest online doctor discovery company, has acquired hospital information management solution provider Insta Health Solutions for US$ 12 million which will help Practo get access to more than 500 hospitals across 15 countries.
- Attune Technologies Private Limited, a Chennai-based healthcare technology firm, has raised US$ 10 million in a Series B funding from Qualcomm Ventures and Norwest Venture Partners in order to expand its digital healthcare solutions from the current 200 hospitals and laboratories to 25,000 such facilities globally.
- Pluss, a Gurgaon based on-demand medicine and healthcare products delivery service start-up, has raised US$ 1 million in pre-Series A funding from IDG Ventures, India; M & S partners, Singapore and Powerhouse Ventures, US. The company would use the funding to upgrade its technology and expand presence in five cities.
India's universal health plan that aims to offer guaranteed benefits to a sixth of the world's population will cost an estimated Rs 1.6 trillion (US$ 23.72 billion) over the next four years.
Some of the major initiatives taken by the Government of India to promote Indian healthcare industry are as follows:
- The government has announced that 3,000 Jan Aushadhi Stores (JAS) will be opened under Pradhan Mantri Jan Aushadhi Yojana (PMJAY) across the country by the end of March 2017.
- The Ministry of Science & Technology has launched the innovative and indigenously developed fecal incontinence management system ‘Qora', which was developed by M/s. Consure Medical under Department of Biotechnology (DBT), Ministry of Science & Technology supported Bio design Programme.
- The Union Cabinet has approved signing of an agreement with the World Health Organisation (WHO) under which WHO will develop technical documents on traditional medicines which is expected to lead to better acceptance of Indian systems of medicines at an international level.
- The NITI Aayog (National Institute for Transforming India) seeks to bring reforms in India’s public health system like outsourcing primary healthcare to private doctors and promoting competition between government and private hospitals at the secondary level.
- Provisions made in the Union Budget 2016-17:
- National Dialysis Services Programme to be initiated to provide dialysis services in all district hospitals to accommodate the increasing demand for dialysis session
- A new health protection scheme for health-cover up to Rs 1 lakh (US$ 1,504) per family.
- Setting up 3,000 medical stores across the country to provide quality medicines at affordable prices.
- Senior citizens will get additional healthcare cover of Rs 30,000 (US$ 441) under the new scheme
- Pradhan Mantri Jan Aushadhi Yojana to be strengthened, 3000 generic drug store to be opened
- Government of West Bengal has introduced G1 Digital Dispensary, which aims to provide people from rural areas access to primary healthcare services.
- A unique initiative for healthcare 'Sehat' (Social Endeavour for Health and Telemedicine) has been launched at a government run Common Service Centre (CSC) to empower rural citizens by providing access to information, knowledge, skills and other services in various sectors through the intervention of digital technologies and fulfilling the vision of a ‘Digital India’.
- India and Sweden celebrated five years of Memorandum of Understanding (MoU). The cooperation in healthcare between India and Sweden will help in filling gaps in research and innovative technology to aid provisioning of quality healthcare.
- Mr J P Nadda, Union Minister for Health & Family Welfare, Government of India has launched the National Deworming initiative aimed to protect more than 24 crore children in the ages of 1-19 years from intestinal worms, on the eve of the National Deworming Day.
- Under the National Health Assurance Mission, Prime Minister Mr Narendra Modi's government would provide all citizens with free drugs and diagnostic treatment, as well as insurance cover to treat serious ailments.
- All the government hospitals in Andhra Pradesh would get a facelift with a cost of Rs 45 crore (US$ 6.67 million), besides the establishment of 1,000 generic medical shops across the State in the next few months.
- ission Indradhanush launched by Mr JP Nadda aims to immunise children against seven vaccine preventable diseases namely diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and hepatitis B by 2020. Government has set a target of 95 per cent immunisation cover by end of 2016.
- The E-health initiative, which is a part of Digital India drive launched by Prime Minister Mr Narendra Modi, aims at providing effective and economical healthcare services to all citizens. The programme aims to make use of technology and portals to facilitate people maintain health records and book online appointments with various departments of different hospitals using eKYC data of Aadhaar number.
India is a land full of opportunities for players in the medical devices industry. The country has also become one of the leading destinations for high-end diagnostic services with tremendous capital investment for advanced diagnostic facilities, thus catering to a greater proportion of population. Besides, Indian medical service consumers have become more conscious towards their healthcare upkeep.
India's competitive advantage also lies in the increased success rate of Indian companies in getting Abbreviated New Drug Application (ANDA) approvals. India also offers vast opportunities in R&D as well as medical tourism. To sum up, there are vast opportunities for investment in healthcare infrastructure in both urban and rural India.
Exchange Rate Used: INR 1 = US$ 0.0149 as on September 27, 2016
References: Department of Industrial Policy and Promotion (DIPP), RNCOS Reports, Media Reports, Press Information Bureau (PIB), Union Budget 2016-17
Note: # - as per National Association of Software and Services Companies (NASSCOM), ## - as per PriceWaterHouseCoopers, ^ - According to Mr J P Nadda, Minister of Health and Family Welfare