Healthcare Industry in India

Introduction

Healthcare has become one of India’s largest sector, 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 major concentration in metros and 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.

As of September 30, 2021, >89 crore COVID-19 vaccine doses have been administered across the country.

Market Size

The healthcare market can increase three-fold to Rs. 8.6 trillion (US$ 133.44 billion) by 2022. In Budget 2021, India’s public expenditure on healthcare stood at 1.2% as a percentage of the GDP.

A growing middle-class, coupled with rising burden of new diseases, are boosting the demand for health insurance coverage. With increasing demand for affordable and quality healthcare, penetration of health insurance is poised to expand in the coming years. In FY21, gross direct premium income underwritten by health insurance companies grew 13.3% YoY to Rs. 58,572.46 crore (US$ 7.9 billion). The health segment has a 29.5% share in the total gross written premiums earned in the country. Recent developments. Indian medical tourism market was valued at US$ 2.89 billion in 2020 and is expected to reach US$ 13.42 billion by 2026.

Between April 2000 and June 2021, FDI inflows for drugs and pharmaceuticals sector stood at US$ 18.12 billion, according to the data released by Department for Promotion of Industry and Internal Trade (DPIIT). Some of the recent initiatives in the Indian healthcare industry are as follows:

• By September 21, 2021, the Health Ministry’s eSanjeevani telemedicine service crossed 12 million teleconsultations since its launch, enabling patient-to-doctor consultations, from the confines of their homes, and doctor-to-doctor consultations.
• In September 2021, Biological E. Ltd. announced that it is expected to launch its vaccine against coronavirus in October 2021.
• In September 2021, Russian-made COVID-19 vaccine, Sputnik Light received permission for Phase 3 trials in India.
• In September 2021, Phase 2 trials of India's first intranasal vaccine, against COVID-19, that is being developed by Bharat Biotech in conjunction with Washington University School of Medicine in St Louis, the US, commenced At Prakhar Hospital in Kanpur.
• In September 2021, Biocon Biologics Limited, a subsidiary of Biocon, announced a strategic alliance with Serum Institute Life Sciences, a subsidiary of Serum Institute of India (SII). The alliance is expected to strengthen India's position as a global vaccine and biologics manufacturing powerhouse.
• As of September 2021, >76,663 Ayushman Bharat-Health and Wellness Centres (AB-HWCs) were operationalised in India.
• In July 2021, India made its Covid-19 vaccination platform, CoWIN, open source for all countries. Almost 76 countries have displayed interest in leveraging the CoWIN platform to manage their national COVID-19 vaccination drives.
• As of July 2021, Biological E. Ltd, is conducting Phase-III trials for its Corbevax vaccine. The company is expected to apply for an ‘Emergency Use License’ by August end and supply 300 million doses to the Government of India by December 2021.
• In July 2021, the Indian government granted Sanofi and GSK approvals to conduct late-stage clinical trials of their protein-based vaccines.
• In July 2021, the Ministry of Tourism established the ‘National Medical & Wellness Tourism Board’ to promote the Medical and Wellness Tourism in India.
• In July 2021, the Union Cabinet approved continuation of the National Ayush Mission, responsible for the development of traditional medicines in India, as a centrally sponsored scheme until 2026.
• In July 2021, the Union Cabinet approved the MoU between India and Denmark on cooperation in health and medicine. The agreement will focus on joint initiatives and technology development in the health sector with the aim of improving public health status of the populations of both countries.
• In June 2021, PharmEasy acquired a majority stake in Thyrocare Technologies, a diagnostics chain, to diversify and bolster its testing business.
• In June 2021, AstraZeneca India signed a memorandum of understanding (MoU) with Docon Technologies, a Bengaluru-based health start-up, to digitise 1,000 clinics across India by implementing customised electronic medical record (EMR) systems in clinics to offer doctors access to a patient’s complete medical history.
• In April 2021, Tata Digital infused Rs. 100 crore (US$ 13.45 million) debt in 1mg, the online medicine start-up, and was in the final stages of acquiring a controlling stake in the company.
• In April 2021, the Ministry of Ayush and Council of Scientific & Industrial Research completed multi-centre clinical trial of a AYUSH 64 (a medicine) and found it useful for treatment of mild-to-moderate COVID-19 infections.
• By March 2021, India exported more vaccines than it had administered to its citizens—60 million doses had been dispatched to 76 countries, while 52 million doses had been administered to Indian citizens. Apart from vaccines, drugs indicated for Covid-19 treatment too witnessed an uptrend in exports. For example, Remdesivir exports doubled in March 2021 to $14.8 million from $5.75 million in February 2021
• In March 2021, Union Health Minister Harsh Vardhan informed the Rajya Sabha that 157 medical colleges are under various stages of implementation across India. Of this, 58 colleges are in the first phase of implementation, 24 in the second phase and 75 are in the third phase.
• In June 2021, gross written premiums of health insurance companies in the non-life insurance sector increased by 32.25% YoY (for the FY period up to August 2021) to Rs. 30,192.30 crore (US$ 4.04 billion), driven by rising demand for health insurance products amid the COVID-19 pandemic.
• In March 2021, Virchow Biotech, a Hyderabad-based firm, and the Russian Direct Investment Fund (RDIF) announced a collaboration to manufacture up to 200 million doses of the Sputnik V vaccine in India.

Government Initiatives

Some of the major initiatives taken by the Government of India to promote Indian healthcare industry are as follows:

• In September 2021, Prime Minister Mr. Narendra Modi while speaking at the global COVID-19 summit said that India has shared its vaccine production with 95 countries and the UN peacekeepers. He also stated that India will supply COVID-19 vaccines to other countries after increased production.
• In September 2021, Prime Minister Mr. Narendra Modi launched the Ayushman Bharat Digital Mission. The mission will connect the digital health solutions of hospitals across the country with each other. Under this, every citizen will now get a digital health ID and their health record will be digitally protected.
• In September 2021, Telangana government in a joint initiative with World Economic Forum, NITI Aayog and HealthNet Global (Apollo Hospitals) launched ‘Medicine from the Sky’ project. The project will pave the way for drone delivery of life saving medicines and jabs in far-flung regions of the country.
• According to a spokesperson, the Indian government is planning to introduce a credit incentive programme worth Rs. 500 billion (US$ 6.8 billion) to boost the country’s healthcare infrastructure. The programme will allow firms to leverage the fund to expand hospital capacity or medical supplies with the government acting as a guarantor and strengthen COVID-19-related health infrastructure in smaller towns.
• In June 2021, the Union Cabinet was apprised of an MoU that was signed between Indian Council of Medical Research (ICMR), India and the Department of Medical Research (DMR), Ministry of Health and Sports of Myanmar in February 2020. The objective of this MoU was to build on the health research relationship in topics of mutual research between India and Myanmar.
• In June 2021, the Union Ministry of Health and Family Welfare, in partnership with UNICEF, held a capacity building workshop for media professionals and health correspondents in Northeastern states on the current COVID-19 situation in India, the need to bust myths regarding COVID-19 vaccines & vaccination and reinforce the importance of COVID-19 Appropriate Behaviour (CAB).
• In June 2021, Bolo Indya, a domestic social live streaming platform, partnered with the Ministry of AYUSH to improve awareness for traditional Indian methods of medicines and care such as siddha, yoga, unani and ayurveda to boost healthy living among citizens. Through this partnership, >10 million citizens will be covered in the next 12 months.
• In June 2021, West Bengal proposed for six new medical colleges in the state, nine new medical colleges became operational in Uttar Pradesh, Telangana approved six medical colleges in the state and Punjab announced establishment of four new medical colleges in the state.
• In June 2021, the Uttar Pradesh government announced to introduce automatic medicine dispensing machine to expand the primary healthcare industry and clinical centres in the country. The state health department has been nominated to design an action plan and install ‘Health ATMs’ walk-in medical kiosks, with combined medical devices for basic laboratory testing, emergency offerings, cardiology, neurology, pulmonary and gynaecology testing services that will be operated by a medical assistant in all 75 districts of Uttar Pradesh.
• In June 2021, the government invited bids for using drones to deliver COVID-19 vaccines and drugs to remote and difficult-to-reach areas to ensure last-mile coverage in select locations of the country.
• As of May 2021, 11.9 lakh Health IDs have been generated and 3,106 doctors and 1,490 facilities have registered on the National Digital Health Mission (NDHM) platform.
• In May 2021, Defense Minister Mr. Rajnath Singh launched ‘Services e-Health Assistance & Tele-consultation (SeHAT)’ OPD portal to provide telemedicine services to armed forces personnel and veterans.
• On May 12, 2021, the Drugs Controller General of India (DCGI), accepted recommendation of Subject Expert Committee (SEC) and accorded permission to conduct the Phase II/III clinical trials of Covaxin (COVID vaccine) for the age group of 2-18 years to its manufacturer, Bharat Biotech Ltd.
• On May 17, 2021, the Defence Ministry launched the first batch of anti-COVID drug, 2-deoxy-D-glucose (2-DG) that was developed by the Institute of Nuclear Medicine and Allied Sciences (INMAS), a lab of Defence Research and Development Organisation (DRDO), along with Dr. Reddy’s Laboratories (DRL), Hyderabad.
• In May 2021, the government announced its plan to ramp up supply and availability of Amphotericin-B, the anti-fungal drug, for treatment of the ‘Black Fungus’ disease. It has also given the license to five manufactures to produce the drug within the country.
• In March 2021, various states and UTs started implementation of the ‘Intensified Mission Indradhanush 3.0’—a campaign aimed to reach those children and pregnant women who were missed out or have been left out of the routine immunisation programme due to the COVID-19 pandemic. This is aimed to accelerate the full immunisation of children and pregnant women through a mission mode intervention.
• In March 2021, the Parliament passed the National Commission for Allied, Healthcare Professions Bill 2021, which aims to create a body that will regulate and maintain educational and service standards for healthcare professionals.
• In the Union Budget 2021, investment in health infrastructure expanded 2.37x, or 137% YoY; the total health sector allocation for FY22 stood at Rs. 223,846 crore (US$ 30.70 billion).
• The government announced Rs. 64,180 crore (US$ 8.80 billion) outlay for the healthcare sector over six years in the Union Budget 2021-22 to strengthen the existing ‘National Health Mission’ by developing capacities of primary, secondary and tertiary care, healthcare systems and institutions for detection and cure of new & emerging diseases.
• In Union Budget 2021-22, the government announced its plans to launch ‘Mission Poshan 2.0’ to merge ‘Supplementary Nutrition Programme’ with ‘Poshan Abhiyan’ (Nutrition Mission) in order to improve nutritional outcomes across 112 aspirational districts.
• The Government of India approved continuation of ‘National Health Mission’ with a budget of Rs. 37,130 crore (US$ 5.10 billion) under the Union Budget 2021-22.
• In the Union Budget 2021, the Ministry of AYUSH was allocated Rs. 2,970 crore (US$ 407.84 million), up from Rs. 2,122 crore (US$ 291.39 million).

Road Ahead

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.

Indian healthcare sector is much diversified and is full of opportunities in every segment, which includes providers, payers, and medical technology. With the increase in the competition, businesses are looking to explore for the latest dynamics and trends which will have positive impact on their business. The hospital industry in India is forecast to increase to Rs. 8.6 trillion (US$ 132.84 billion) by FY22 from Rs. 4 trillion (US$ 61.79 billion) in FY17 at a CAGR of 16–17%.

The Government of India is planning to increase public health spending to 2.5% of the country's GDP by 2025.

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.

Note: Conversion rate used for September 2021 is Rs. 1 = US$ 0.01371

References: Department for Promotion of Industry and Internal Trade (DPIIT), RNCOS Reports, Media Reports, Press Information Bureau (PIB), Union Budget 2021-22

Disclaimer: This information has been collected through secondary research and IBEF is not responsible for any errors in the same.