For a variety of reasons, surgery may be required on the heart or inside of the heart. This is commonly called Open-Heart Surgery, or Cardiac Surgery. Common reasons for cardiac surgery may include Coronary Artery Bypass Grafting (CABG), valve surgery or the repair of congenital malformations, (birth defects.) etc.
We have surely come a long way in cardiothoracic surgery, from the first successful surgery on the heart, being performed by Dr. Ludwig Rehn, Germany, in 1896 .We have gone through the dark phases of Closed Heart Surgery and Hypothermia, which were highly risky procedures, Followed by Open Heart Surgery with with Oxygenators, Controlled Cross – circulation and finally the Heart Lung Machine. And now we are performing Off-Pump Surgeries or Beating heart Surgery, Awake bypass Surgeries Redo Bypass surgeries etc. All this has resulted in a High success rate, and very few post operative complications. And this has been possible only because certain organisations have strived for Excellence in Cardiothoracic Surgery.
Wockhardt Hospitals have been a pioneer in Cardiothoracic Surgery for over 18 years now. They have a collective experience of over 30,000 Cardiothoracic surgeries. Innovators in Cardiothoracic Suregery, they have performed the first Awake Heart bypass Surgery with Aortic Valve Replacement in the world, the first Minimally Invasive Beating Heart Coronary Artery Bypass Suregery in the Australasia Region, The first Maze III procedure for the Management of Chronic Atrial Fibrilation and the first Endoscopic Radial Harvesting Procedure in India.
Continuing in the same spirit Wockhardt Hospitals Hyderabad, with its Centres at LB Nagar and King Koti have over this period of 2 years Excelled in Cardiac Surgery . Performoing Complicated Surgeries for CAD, Congenital Heart Defects, Valvular Dysfunctions, using Latest procedures life Awake Bypass Surgery, Endoscopic Radial Harvesting, Endoscopic Vein Harvesting, they have made their way into the Hearts of many. They were the first ones to Diagnose and operate on a 9 year girl for Coronary Artery Disease, This CABG performed displayed amaizing Techinical Skills.
Wockhardt Hospitals iin addition to this have also showed their Corporate Social Responsibility by being actively involved in the Child Cardiac Progmramme initiated by the Government of Andhrapradesh.
What goes into the creation of Excellence at Wockhardt Hospitals one might ask, well its simple Choosing the Best Professionals in the field, putting them in a State of the Setup with the latest Equipments, setting up protocols which are of global standardas, a Patient Centric Approach and most important Integrity.
When we look at the Healthcare scenario in India it has shown a progressive exponential growth in recent years, and this has been possible only through Pioneers like Wockhardt Hospitals, who with focussed effrots have made a difference . This is the phase for excellence not only in Heartcare but rather in Healthcare.
For Details contact:
Sudhaker Jadhav
Head Marketing
Wockhardt Hospitals
Hyderabad – India
Sudhaker.jadhav@wockhardthospitals.com
Mobile: 00919849492676
Monday, February 18, 2008
Wockhardt Hospitals- Hyderabad-India Performing Laproscopic Banding for Obese Patients
Obesity: A Disease
Obesity is emerging as a health epidemic around the world. More than 50% of the American adult population is obese. Of this group, 11 million adults suffer from severe obesity.
Obesity is an excess of total body fat, which results from caloric intake that exceeds energy usage. A measurement used to assess health risks of obesity is Body Mass Index (BMI).
The American Obesity Association reports that obese individuals have a 50-100% increased risk of death as compared to normal weight individuals, with 300,000 to 587,000 deaths each year. This substantial increase in health risks has made obesity the second leading cause of preventable death in the United States. In Childhood every growing child was told by his parents not to leave anything in the plate, but today we say eat only what is required and Please leave the extra food in the Plate. Its better to leave rather than to abuse your body.
Causes of Obesity
· The genes you inherited from your parents
· How well your body turns food into energy
· Your eating and exercising habits
· Your surroundings
· Psychological factors
Consequences of Obesity
Major health risks
· Shorter Life Expectancy
· Compared to people of normal weight, obese people have a 50% to 100% increased risk of dying prematurely
· Obese people have more risk for:
- Diabetes (type 2)- Joint problems (e.g., arthritis)- High blood pressure- Heart disease- Gallbladder problems- Certain types of cancer (breast, uterine, colon)- Digestive disorders (e.g., gastroesophageal reflux disease, or GERD)- Breathing difficulties (e.g., sleep apnea, asthma)- Psychological problems such as depression- Problems with fertility and pregnancy- Urinary Incontinence
Risks to psychological and social well being
· Negative self-image
· Social isolation
· Discrimination
Difficulties with day-to-day living
· Normal tasks become harder when you are obese, as movement is more difficult
· You tend to tire more quickly and you find yourself short of breath
· Public transport seats, telephone booths, and cars may be too small for you
· You may find it difficult to maintain personal hygiene
Treatment Options
Non-Surgical Treatment
Dieting, exercise, and medication have long been regarded as the conventional methods to achieve weight loss. Sometimes, these efforts are successful in the short term. However, for people who are morbidly obese, the results rarely last.. Recent research reveals that conventional methods of weight loss generally fail to produce permanent weight loss. Several studies have shown that patients on diets, exercise programs, or medication are able to lose approximately 10% of their body weight but tend to regain two-thirds of it within one year, and almost all of it within five years**. Another study found that less than 5% of patients in weight loss programs were able to maintain their reduced weight after five years*.
Surgical Treatment
Over the years, weight-loss surgery has proven to be a successful method for the treatment of morbid obesity surgical options have continued to evolve and is pleased to be able to offer patients
LAP-BAND surgery. This procedure is the least traumatic and the only adjustable and reversible obesity surgery available The LAP-BAND System provides a unique tool that can help you achieve and maintain significant weight loss, improve your health, and enhance your quality of life.
It induces weight loss by reducing the capacity of the stomach, which restricts the amount of food that can be consumed. Since its clinical introduction in 1993, more than 180,000 LAP-BAND procedures have been performed around the world.
Gastric Roux-En-Y Bypass
Here a small stomach pouch is created to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine). This bypass reduces the absorption of nutrients and thereby reduces the calorie intake.
Residual stomach capacity: 30-50mls
Estimated weight loss: 60-70% EWL over 2 years.
Tube Gastrectomy or Gastroplasty
This is a relatively new approach. It involves removing the lateral 2/3rds of the stomach with a stapling device. It can be done laparoscopically (keyhole surgery) but is not reversible. It basically leaves a stomach tube instead of a stomach sack.Sometimes it is offered to patients as part of a two stage Bypass operation particularly if they are super obese ( BMI>60) because it allows good weight loss until the patient gets down to a safe weight and the more radical bypass can then be offered laparoscopically when they are at a safer weight.
The residual stomach capacity is about 200mls so a generous entree should be possible.
Bilio Pancreatic Diversion BPD
These operations combines removal or exclusion of 2/3rds of the stomach along with a long intestinal bypass which significantly reduces the absorption of fat. The capacity to eat is greater than with the other operations, and the eventual weight loss is the best of all the operations but if fatty foods are overeaten e.g. a hamburger and fries then diarrhoea and foul flatus will result.
The residual stomach capacity is about 200mls so a generous entree should be possible.
The weight loss seems to be of the same order as a lap band ( 50-60% EWL) over two years but it is not adjustable.
It might also be a good option if patients have a problem with their lap band requiring revision, have already lost a lot of weight and don't want a full bypass.
Patient Outcomes
1) Mr. Venkat Ramana
Body Mass Index 38
Initial Weight: 107
Initial Associated Conditions: Varicose Veins (Non Healing Ulcer)
Weight at Present: 90
Associated Condition Status: Healed
Procedure Performed: Sleeve Gastrectomy
Contact No : 009140 – 27154263
2) Ms. Samita Rani
Body Mass Index 50
Initial Weight: 125
Initial Associated Conditions: NA
Weight at Present: 102
Associated Condition Status: NA
Procedure Performed: Gastric Bypass
Contact No : 009199496 56836
3) Ms. Bhagwathi Reddy
Body Mass Index 34
Initial Weight: 93
Initial Associated Conditions: NA
Weight at Present: 84
Associated Condition Status: NA
Procedure Performed: Gastric Banding
Contact No : 00919912277930 / 009140 - 27031201
4) Ms._____________
Body Mass Index 44
Initial Weight: 99
Initial Associated Conditions: NA
Weight at Present: 88
Associated Condition Status: NA
Procedure Performed: Gastric Bypass
For Details contact:
Sudhaker Jadhav
Head Marketing
Wockhardt Hospitals
Hyderabad
00919849492676
Sudhaker.jadhav@wockhardthospitals.com
Obesity is emerging as a health epidemic around the world. More than 50% of the American adult population is obese. Of this group, 11 million adults suffer from severe obesity.
Obesity is an excess of total body fat, which results from caloric intake that exceeds energy usage. A measurement used to assess health risks of obesity is Body Mass Index (BMI).
The American Obesity Association reports that obese individuals have a 50-100% increased risk of death as compared to normal weight individuals, with 300,000 to 587,000 deaths each year. This substantial increase in health risks has made obesity the second leading cause of preventable death in the United States. In Childhood every growing child was told by his parents not to leave anything in the plate, but today we say eat only what is required and Please leave the extra food in the Plate. Its better to leave rather than to abuse your body.
Causes of Obesity
· The genes you inherited from your parents
· How well your body turns food into energy
· Your eating and exercising habits
· Your surroundings
· Psychological factors
Consequences of Obesity
Major health risks
· Shorter Life Expectancy
· Compared to people of normal weight, obese people have a 50% to 100% increased risk of dying prematurely
· Obese people have more risk for:
- Diabetes (type 2)- Joint problems (e.g., arthritis)- High blood pressure- Heart disease- Gallbladder problems- Certain types of cancer (breast, uterine, colon)- Digestive disorders (e.g., gastroesophageal reflux disease, or GERD)- Breathing difficulties (e.g., sleep apnea, asthma)- Psychological problems such as depression- Problems with fertility and pregnancy- Urinary Incontinence
Risks to psychological and social well being
· Negative self-image
· Social isolation
· Discrimination
Difficulties with day-to-day living
· Normal tasks become harder when you are obese, as movement is more difficult
· You tend to tire more quickly and you find yourself short of breath
· Public transport seats, telephone booths, and cars may be too small for you
· You may find it difficult to maintain personal hygiene
Treatment Options
Non-Surgical Treatment
Dieting, exercise, and medication have long been regarded as the conventional methods to achieve weight loss. Sometimes, these efforts are successful in the short term. However, for people who are morbidly obese, the results rarely last.. Recent research reveals that conventional methods of weight loss generally fail to produce permanent weight loss. Several studies have shown that patients on diets, exercise programs, or medication are able to lose approximately 10% of their body weight but tend to regain two-thirds of it within one year, and almost all of it within five years**. Another study found that less than 5% of patients in weight loss programs were able to maintain their reduced weight after five years*.
Surgical Treatment
Over the years, weight-loss surgery has proven to be a successful method for the treatment of morbid obesity surgical options have continued to evolve and is pleased to be able to offer patients
LAP-BAND surgery. This procedure is the least traumatic and the only adjustable and reversible obesity surgery available The LAP-BAND System provides a unique tool that can help you achieve and maintain significant weight loss, improve your health, and enhance your quality of life.
It induces weight loss by reducing the capacity of the stomach, which restricts the amount of food that can be consumed. Since its clinical introduction in 1993, more than 180,000 LAP-BAND procedures have been performed around the world.
Gastric Roux-En-Y Bypass
Here a small stomach pouch is created to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine). This bypass reduces the absorption of nutrients and thereby reduces the calorie intake.
Residual stomach capacity: 30-50mls
Estimated weight loss: 60-70% EWL over 2 years.
Tube Gastrectomy or Gastroplasty
This is a relatively new approach. It involves removing the lateral 2/3rds of the stomach with a stapling device. It can be done laparoscopically (keyhole surgery) but is not reversible. It basically leaves a stomach tube instead of a stomach sack.Sometimes it is offered to patients as part of a two stage Bypass operation particularly if they are super obese ( BMI>60) because it allows good weight loss until the patient gets down to a safe weight and the more radical bypass can then be offered laparoscopically when they are at a safer weight.
The residual stomach capacity is about 200mls so a generous entree should be possible.
Bilio Pancreatic Diversion BPD
These operations combines removal or exclusion of 2/3rds of the stomach along with a long intestinal bypass which significantly reduces the absorption of fat. The capacity to eat is greater than with the other operations, and the eventual weight loss is the best of all the operations but if fatty foods are overeaten e.g. a hamburger and fries then diarrhoea and foul flatus will result.
The residual stomach capacity is about 200mls so a generous entree should be possible.
The weight loss seems to be of the same order as a lap band ( 50-60% EWL) over two years but it is not adjustable.
It might also be a good option if patients have a problem with their lap band requiring revision, have already lost a lot of weight and don't want a full bypass.
Patient Outcomes
1) Mr. Venkat Ramana
Body Mass Index 38
Initial Weight: 107
Initial Associated Conditions: Varicose Veins (Non Healing Ulcer)
Weight at Present: 90
Associated Condition Status: Healed
Procedure Performed: Sleeve Gastrectomy
Contact No : 009140 – 27154263
2) Ms. Samita Rani
Body Mass Index 50
Initial Weight: 125
Initial Associated Conditions: NA
Weight at Present: 102
Associated Condition Status: NA
Procedure Performed: Gastric Bypass
Contact No : 009199496 56836
3) Ms. Bhagwathi Reddy
Body Mass Index 34
Initial Weight: 93
Initial Associated Conditions: NA
Weight at Present: 84
Associated Condition Status: NA
Procedure Performed: Gastric Banding
Contact No : 00919912277930 / 009140 - 27031201
4) Ms._____________
Body Mass Index 44
Initial Weight: 99
Initial Associated Conditions: NA
Weight at Present: 88
Associated Condition Status: NA
Procedure Performed: Gastric Bypass
For Details contact:
Sudhaker Jadhav
Head Marketing
Wockhardt Hospitals
Hyderabad
00919849492676
Sudhaker.jadhav@wockhardthospitals.com
Thursday, February 14, 2008
WOCKHARDT HOSPITALS- HYDERABAD - INDIA NOW CATERS TO INTERNATIONAL PATIENTS. MEDICAL TOURISM ON UPSPRING
OUR VISION
Maintaining the Health of the Worlds swelling population ranks amongst the highest of social priorities and healthcare providers stand in the front line of this all-important effort. At Wockhardt Hospitals we seek to differentiate ourselves by our International perspective to deliver exceptional healthcare. We will always place our emphasis on consistently securing our patients prosperity through investing in knowledge and expertise, which creates better, lives and delivers superlative values to our patients in a uniquely personalized way.
THE INCRIDIBLE JOURNEY
Wockhardt Hospitals gives structure to a 30-year tradition of caring on a global canvas built by Wockhardt Ltd., India's 5th largest Pharmaceutical and Healthcare Company. The Institute was commissioned in 1990 with a focus to excel in the field of Cardiology and Cardiovascular Surgery. As a Hospital, all our efforts are dedicated and committed to the creation of patient value. At Wockhardt, we are convinced that a judicious blend of technology, clinical expertise and personalized care applied in the context of achieving patient satisfaction can make our pursuit of Excellence in Cardiacare highly rewarding.
THE HYDERABAD WAY
Two new generation hospitals were setup by the Wockhardt Hospitals Ltd. in Hyderabad in June 2005. The Wockhardt Heart Centre at L.B. Nagar is commissioned specifically for Cardiac Care, and the Kamineni Wockhardt Hospital at King Koti, focusing on Cardiology, Bone and Joint, Minimal Access Surgery & Critical Care. The Hospitals are Tertiary Care referral centers for the whole of Andhra Pradesh and the bordering areas of Karnataka, Maharashtra, Madhya Pradesh and Chattisgarh.
FACILITIES OFFERED AT WOCKHARDT HYDERABAD
200 Bedded hospital (king koti and LB Nagar)
30 Bedded Medical ICU
20 Bedded Surgical ICU
6 state of the art operation theatre
2 cardiac catheterization labs with latest imaging technology
Dedicated cardiac ambulance & 24hrs emergency heartline 66002200
High end Imaging (CT and MRI)
Multi specialty visiting consultants
The Kamineni Wockhardt Hospitals Hyderabad, houses the Wockhardt Heart Hospital, Wockhardt Bone and Joint Hospital, Wockhardt Minimal Access Surgery Hospital and the Wockhardt Critical care and Pain Management Clinic.
The Wockhardt Heart Hospital has a cardiac team of 26 members with a vast international collective experience. The Hospital provides Cardiac as well as Cardiothoracic Surgical care. The hospital provides completed end-to-end solutions for cardiac patients.
The Wockhardt Bone & Joint Hospital is equipped to treat all types of musculoskeletal problems ranging from Trauma surgery to Minimally Invasive Arthroscopy surgery. The hospital also specializes in surgery for joint replacements, sports medicine, ligament repair, knee surgery and physical therapy for rehabilitation.
The Wockhardt Minimal Access Surgery Hospital is equipped with the latest technology to deliver high precision surgery procedures encompassing thorax, abdomen, reproductive system, Urinary tract and joints. This not only minimizes the pain from surgical trauma but also shortens hospitalization and improves aesthetics.
The Wockhardt Pain Management Clinic deals with both acute as well as chronic pain. First the patient is evaluated for the causation of pain and then appropriate therapy is provided to him/ her. We deal with all kinds of pain including Back pain, Headache, Cervical Spondylitis, Fibromyalgias, Neuralgias, Arthritis, Post surgical Pain, Sympathetic Dystrophy etc. Complete and permanent solutions are provided.
We can basically work on the following tariffs:
Angiogram/Cath evaluation: 650 Dollors (4 days stay)
Angioplasty – 2400 dollors plus stent cost extra (5 days stay)
Simple Cardiac Surgeries – 8000 Dollors (10 days stay)
Complex Cardiac Surgeries – 10000 Dollors (12 days stay)
Valve Cost each about – 3000 Dollors (if required)
In operable case – 1200 Dollors (5 days stay)
Death Case – Additional 1500 Dollors (as we bury the body with all the honor in India itself)
Patient food is free of cost.
Patient Attender food would cost extra
Free accommodation to the patient attender and the nurse accompanying the patient.
Additional number of days the patient have to pay (100 dollors per day including food for the patient)
Cost Comparison
Procedure / Treatment
Wockhardt Hospitals, India ($)
USA ($)
UK (GBP)
Open HeartSurgery (CABG)
8,000
100,000
20,000
Total Knee Replacement
6,000
48,000
15,000
Hip Resurfacing
7,500
55,000
15,000
LA Hysterectomy
3,500
22,000
6,000
Lap Cholcystectomy
3,500
18,000
4,000
Spinal Decompression Fusion
7,500
60,000
32,100
Obesity Surgery (Gastric Bypass)
9,000
65,000
12,000
* Prices subject to change due to currency fluctuations or other external cost factors
For Further Details please contact:
Sudhaker Jadhav
sudhaker.jadhav@wockhardthospitals.com
Mobile: 00919849492679
Maintaining the Health of the Worlds swelling population ranks amongst the highest of social priorities and healthcare providers stand in the front line of this all-important effort. At Wockhardt Hospitals we seek to differentiate ourselves by our International perspective to deliver exceptional healthcare. We will always place our emphasis on consistently securing our patients prosperity through investing in knowledge and expertise, which creates better, lives and delivers superlative values to our patients in a uniquely personalized way.
THE INCRIDIBLE JOURNEY
Wockhardt Hospitals gives structure to a 30-year tradition of caring on a global canvas built by Wockhardt Ltd., India's 5th largest Pharmaceutical and Healthcare Company. The Institute was commissioned in 1990 with a focus to excel in the field of Cardiology and Cardiovascular Surgery. As a Hospital, all our efforts are dedicated and committed to the creation of patient value. At Wockhardt, we are convinced that a judicious blend of technology, clinical expertise and personalized care applied in the context of achieving patient satisfaction can make our pursuit of Excellence in Cardiacare highly rewarding.
THE HYDERABAD WAY
Two new generation hospitals were setup by the Wockhardt Hospitals Ltd. in Hyderabad in June 2005. The Wockhardt Heart Centre at L.B. Nagar is commissioned specifically for Cardiac Care, and the Kamineni Wockhardt Hospital at King Koti, focusing on Cardiology, Bone and Joint, Minimal Access Surgery & Critical Care. The Hospitals are Tertiary Care referral centers for the whole of Andhra Pradesh and the bordering areas of Karnataka, Maharashtra, Madhya Pradesh and Chattisgarh.
FACILITIES OFFERED AT WOCKHARDT HYDERABAD
200 Bedded hospital (king koti and LB Nagar)
30 Bedded Medical ICU
20 Bedded Surgical ICU
6 state of the art operation theatre
2 cardiac catheterization labs with latest imaging technology
Dedicated cardiac ambulance & 24hrs emergency heartline 66002200
High end Imaging (CT and MRI)
Multi specialty visiting consultants
The Kamineni Wockhardt Hospitals Hyderabad, houses the Wockhardt Heart Hospital, Wockhardt Bone and Joint Hospital, Wockhardt Minimal Access Surgery Hospital and the Wockhardt Critical care and Pain Management Clinic.
The Wockhardt Heart Hospital has a cardiac team of 26 members with a vast international collective experience. The Hospital provides Cardiac as well as Cardiothoracic Surgical care. The hospital provides completed end-to-end solutions for cardiac patients.
The Wockhardt Bone & Joint Hospital is equipped to treat all types of musculoskeletal problems ranging from Trauma surgery to Minimally Invasive Arthroscopy surgery. The hospital also specializes in surgery for joint replacements, sports medicine, ligament repair, knee surgery and physical therapy for rehabilitation.
The Wockhardt Minimal Access Surgery Hospital is equipped with the latest technology to deliver high precision surgery procedures encompassing thorax, abdomen, reproductive system, Urinary tract and joints. This not only minimizes the pain from surgical trauma but also shortens hospitalization and improves aesthetics.
The Wockhardt Pain Management Clinic deals with both acute as well as chronic pain. First the patient is evaluated for the causation of pain and then appropriate therapy is provided to him/ her. We deal with all kinds of pain including Back pain, Headache, Cervical Spondylitis, Fibromyalgias, Neuralgias, Arthritis, Post surgical Pain, Sympathetic Dystrophy etc. Complete and permanent solutions are provided.
We can basically work on the following tariffs:
Angiogram/Cath evaluation: 650 Dollors (4 days stay)
Angioplasty – 2400 dollors plus stent cost extra (5 days stay)
Simple Cardiac Surgeries – 8000 Dollors (10 days stay)
Complex Cardiac Surgeries – 10000 Dollors (12 days stay)
Valve Cost each about – 3000 Dollors (if required)
In operable case – 1200 Dollors (5 days stay)
Death Case – Additional 1500 Dollors (as we bury the body with all the honor in India itself)
Patient food is free of cost.
Patient Attender food would cost extra
Free accommodation to the patient attender and the nurse accompanying the patient.
Additional number of days the patient have to pay (100 dollors per day including food for the patient)
Cost Comparison
Procedure / Treatment
Wockhardt Hospitals, India ($)
USA ($)
UK (GBP)
Open HeartSurgery (CABG)
8,000
100,000
20,000
Total Knee Replacement
6,000
48,000
15,000
Hip Resurfacing
7,500
55,000
15,000
LA Hysterectomy
3,500
22,000
6,000
Lap Cholcystectomy
3,500
18,000
4,000
Spinal Decompression Fusion
7,500
60,000
32,100
Obesity Surgery (Gastric Bypass)
9,000
65,000
12,000
* Prices subject to change due to currency fluctuations or other external cost factors
For Further Details please contact:
Sudhaker Jadhav
sudhaker.jadhav@wockhardthospitals.com
Mobile: 00919849492679
Monday, February 11, 2008
Healthcare In India
DESTINATION INDIA
A FICCI ASSESSMENT
ON
FUTURE OF INDIAN HEALTHCARE INDUSTRY
(ESPECIALLY HOSPITAL SECTOR)
IN ASSOCIATION WITH
ERNEST & YOUNG GROUP (BASE YEAR 2006)
INDIAN INDUSTRY REVIEW:
India is now the second fastest growing major economy in the world, with a GDP growth rate of 9.2% at the end of second quarter of 20006-2007 and the third largest economy in the world as measured by purchasing power parity(PPP) , with a gross GDP of US$3.611 trillion( Rs.162495 billion).
The Indian healthcare is in the midst of a rapid transformation and has emerged as one of the largest service sector in India. Healthcare spending in India is expected to rise by 15% per annum. As per our estimate healthcare spending could contribute to 6.1% of GDP in 2012 and employ around 9 million people.
SHIFT FROM SOCIALIZED TO PRIVATE PROVIDERS:
The majority of healthcare services in India is provided by the private sector and also the facilities provided by them are rated higher on quality indicators. In fact the private health sector in India is one of the largest in the world: 80% of the all qualifieddoctors, 75% of the dispensaries and 60% of the hospitals in India belongs to private sector. Only 23.5% of the urban residents and 30.6% of the rural residents choose to visit a government health facility as their main source of healthcare services. Government expenditures on he healthcare has been declining and is around 0.9% of the GDP The average of the developing countries as a whole is around 3% of GDP and for high income countries , 5% of GDP.
A majority of Indians trust private healthcare despite the average cost being higher at US$4.3(Rs. 193.50) than the US$2.7(Rs.121.50)it costs at government owned healthcare agencies. According to World Bank study 79% of all OPD care among the poor is provided by the private sector. Clearly it is the poor quality of care provided by the public health system, which compels people to use costlier private facilities.
BOOMING ECONOMY AND HIGH LITERACY RATE:
Healthcare spending is on an upward track partly due to the fact that as nations becomes wealthier, consumers want more and more and is willing to pay spend more on healthcare (about half a percent increase in the healthcare cost for each percent increase in wealth).According to a , fitness and wellbeing accorded an aspiration status and the highest growth in healthcare is recorded in healthcare when the families move from middle income to rich. The growth in affluence of over 300 million strong middle income consumers is creating demand for higher standards of healthcare The top 33% income earners in India accounted for 75% of total private expenditure on healthcare in 2004.
Rich households (the top 8%) paid US$578 per treatment (rs.26010) and hospitalization in 2004., three times the average of US$191(rs.8595).
The true might of the Indian population had so far been dwarfed by lack of capacity to pay &the concentration of the rich in very few urban townships. However, that is changing.
The proportion of households in the low –income group has declined significantly and the “great Indian middle class” has come out of age. Added to this is the mushrooming of for greater numbers of urban centers, where demand far outstrips the supply f quality care.
Expansion of rich and the middle income groups:
33% in 2004
49% in 2010
SHIFT TO LIFESTYLE –RELATED DISEASE: PROPALLANT FOR HEALTHCARE SPENDS:
Lifestyle diseases are typically more expensive to treat than infectious one .According to a survey carried out by Earnest and Young in 2006, we compared expenditures for inpatient treatment in 18 hospitals across 5 major cities, the average spend on lifestyle diseases is Rs. 40,500 per inpatient treatment, while that on infectious disease it is Rs. 5,5209 (we compared expenditures for inpatient treatment in 18 tertiary care hospitals) .
India’s disease profile is expected to follow the same pattern as in developed economics. Based on the demographic trend and disease profile lifestyle diseases – cardiovascular, asthma and cancer has become the most important segment, and the inpatient spending is expected to rise from 39% to nearly 50% of the total healthcare as compared to 62% in the US. In the inpatient market , the share of infectious diseases is expected to decline from 19% in 2004 to 16% in 2008.
2006
2012
CVS
1.6 million
2.1 million
Spend share of the IPD cardiac treatment
16%
19%
IPD cardiac care market
Rs. 12,200 crores
Rs, 30,100 crores
EASIER FINANCING IN ACAPITAL INTENSIVE INDUSTRY:
High growth rates in a capital intensive industry has inevitably stemmed from innovative financing solutions. The Indian healthcare industry has gone through entire cycle of financing from government funded socialized system to privately funded mom and pop shops (small nursing homes) to NRI &FI. funded enterprises, and now for the past 10 yrs, financial markets. When Schroder, a PE fund invested in Apollo Hospitals in 1996, nobody noticed. Investors blinked at least once at PE funding of Max Healthcare by Warburg Pincus , but we believe that private placement by Quantam Funds ( Jeorge Soros) in Fortis Healthcare is a watershed which opens new vistas for foreign investments to flow in.
Another route which is underutilized is effective utilization of the debt capacity. According to a study by Earnest and Young (2006) the top tertiary care hospitals in the country reveal that the average Debt Equity ratio is 0.93 which shows that the industry is not highly levered. Debt capacity which exists in the industry is not being utilized. Therefore, the expansion of the industry can be funded by debt which has the advantage of lower cost of the capital and also which increases the value of the organization. Considering that the aforementioned investment is justified by the latent demand existing in the industry, investors should seriously reconsider being risk averse vis-a-vis investment in the healthcare sector. “Risk sharing” by forging foreign partnerships across industries is another unbanked sector. which is likely to promote increasing investments , assisting he industry to grow at a rate of 15%.
INCREASING LIFE EXPECTANCY:
Age wise population distribution:
1991(%)
2001(%)
2010(%)
0-14
36
35
29
15-54
55
55
59
>=55
9
10
12
The correlation between the life expectancy and the increase in the healthcare spending:
Particulars
2004
2005
2006
2007
2008
2009
Life expectancy(years)
64
64.3
64.7
65.1
65.4
65.8
Healthcare spending(Rs billion)
1582
1763
1967
2216
2463
27771
Healthcare spending(US$ bn )
34.9
40.4
45.7
52.1
56
60.9
Healthcare spending(% of GDP)
5.2
5.3
5.3
5.4
5.4
5.5
Healthcare spending(US$ per hand)
32
37
41
46
49
53
RECOGNITION OF GOVERNMENT AS A PRIORITY SECTION:
The UPA govt. has recently announced from0.0.9% of GDP to 2% of GDP within the next 5years and has proposed the increase in the education cess from 2% to 4% to finance the same. Recently enacted tariff and non tariff measures are set to stimulate in market development in the healthcare sector allowing more hospitals to offer critical care services .Some of them are:
Reduction in import duty on medical equipments from 25% to 5.1%.
Depreciation limit on such equipment rose to 40% from 25%, to encourage medical equipment imports.
Customs duty reduced to 8% from 16% for medical, surgical, veterinary and dental furniture.
Customs duty on as many as25medical equipments which include X-ray, goniometry, and teletherapy stimulator machine has been reduced to 5%.
The government has announced income tax exemption under section 80 1B of the income tax act for first 5 years to hospitals (with 100 beds or more) set up in the rural areas.
Crutches, wheel chairs, walking frames, artificial limb set for the disabled will be fully exempt from customs duty. Ambulances used by all hospitals will now be eligible for concessional duty.
US456 million will be earmarked for the HIV/AIDS control programme through the use of primary health centers, prevention of drug abuse etc.
SLICING THE HEALTHCARE PIE:
DATA OF 2006
100%= US$34.2 BILLION (Rs. 153,330 Crores)
Sector name
Percentage of expenditures
Infrastructure
14%
Pharmaceuticals
17%
Medical value travel
1%
Training and education
3%
Medical equipment
6%
Health insurance
2%
Independent path laboratories
3%
Medical textiles
1%
Bed revenues
35%
Health outsourcing
11%
Clinical trials
6%
Medical consumables
6%
DATA PROJECTION FOR 2012
100%=US$78.6 BILLION
(Rs. 353, 700 Crores)
Sector name
Percentage of expenditures
Infrastructure
14%
Pharmaceuticals
15%
Medical value travel
2%
Training and education
3%
Medical equipment
6%
Health insurance
5%
Independent path laboratories
3%
Medical textiles
1%
Bed revenues
36%
Health outsourcing
9%
Clinical trials
6%
Medical consumables
5%
MEDICAL INFRASTRUCTURE:
TOP LINE FACTS:
Size-(US$4803 M) 2006
Size-(US$10975 M) 2012
Growth-14.5%
PRESENT DETAIL (2002)
Doctors -500,000
Hospitals- 15,393
Beds-875,000
PHCs-23,000
Sub centers-132,000
Projection for 2012:
Doctors- 12, 00,000(to reach doctor to thousand population ratio of 1).
Hospitals-19201
Beds-2,231,400
Despite an extensive public healthcare infrastructure
The % of private sector in projected increase number of beds will be approximately 88%.The revenues currently generated by the private hospitals (all inclusive) are US$15.51 BILLION and is likely to increase to US$ 35.87 BILLION by the year 2012 at a CAGR of 15%.
We feel that the industry should target a stronger growth and aim at achieving a bed to thousand population of 1.98 .This would require a total number of investments of US$88 BILLION and the resultant revenues from private beds would be us438.8 billion.
We believe that an increasing % of patients will prefer private hospitals over the next 6 years, which bodes well for the industry, creating a demand supply gap, leading to increased bed occupancy ratios. However the key differentiator is going to be managing higher revenues per bed by adding value added services and translating that into higher EBITDA margins by aggressively controlling costs.
A significant % of these investments are likely to come from non-core healthcare providers. A number of innovative model is likely to develop in land and development leasing and management contracts. We believe that one such model can be generated by the entry of Real estate players in the medical infrastructure development. These players have the expertise in infrastructure developments and management, they could forge a successful and mutually beneficial industry.
GAP ANALYSIS:
Current state(2006)
2012(expected)
2012(best case)
Population
1.1 billion
1.2 billion
Bed to 1000 population ratio
1.03
1.85
2.0
Number of beds
1222654
2231442
2370827
Government
593454
651814
661890
Private
683108
1579628
1708983
Investment required
$77.9 billion
Rs.350550 crores)
88.8 billion
(Rs.399600 crores)
Government(2006-20012)
$8.2 billion
(Rs.36,900 crores)
$9 billion(Rs.40500 crores)
Private(2006-20012)
$69.7 billion
(Rs.313650 crores)
$79.8 billion
(Rs.359100crores)
Revenues(private hospitals)
$15.51billion
(Rs. 69, 795 crores)
$35.9 million
(Rs. 161,550 crores)
$38.8billion
(Rs. 174600 crores)
PUBLIC PRIVATE PARTNERSHIP IN MEDICAL INFRASTRUCTURE:
Low spending by the Indian government on healthcare compared to other developing economies, coupled with huge deficits in beds makes a compelling case for PPP in infrastructure development. Though the past experiences by the government, by providing free land for exchange of free beds have been les than successful, there failure can largely be attributed to lack of appropriate alignment by incentives inadequate monitoring mechanism and les than comprehensive MOU.
The government has a strong base of preventive infrastructure in terms of PHCs; sub centers etc, but still has a long way to go in terms building and staffing hospitals. With 0.12% of the GDP being spent on infrastructure development and more on operating these facilities, there is just no enough money to bridge the gap. We believe that the government will have to think bolder & more innovative modes of partnership to spur economic turn around envisioned and reach bed to thousand population ratios of 2.
Such PPP models need to innovate on:
Land subsidy by the government to make the hospital projects more feasible (land costs alone are 15% of the investment figures mentioned).
Outsourcing management to existing government facility to private players.
Higher utilization of existing secondary and tertiary care facilities by using a facilities sharing model. Several of such partnerships have been successful n India and developing countries all over the world.
Management by PHCs by corporate house with significant presence in Tamil Nadu.
Management of PHCs by SEWA (non profit organization in Gujarat.)
Transfer of management of 300 hospitals in USA from govt. to private between 1955 and 1985.
Use of private financing by UK govt. to decrease its capital expenditure.
Management of public hospitals by private providers with compulsory treatment for patients funded by the government at a negotiated price in Brazil and South Africa.
Outsourcing of cleaning, maintenance and waste management of 82 hospitals by the Karnataka government.
Outsourcing of major technology services in major teaching hospitals in Tamil nadu and diagnostic services of teaching hospitals in Uttar Pradesh.
These models need to be encouraged in areas of medial colleges, nursing colleges and also training institutes for paramedics and technicians. We further feel that the people who need the medical infrastructure the most should be given preference. The government values its senior officers and policy makers as much as the corporate sector values its top management and therefore their healthcare needs could be outsourced to the private providers in conjunction with an insurance provider, at a premium lesser than the cost of treating them today. A broader policyon this concept should be formulated so that government infrastructure can be better utilized by the poor and hae needy.
MEDICAL EQUIPMENTS
The medical equipment device market is becoming too big to ignore. It is full of opportunities for investments in high quality, specialized medical equipment Foreign participation is required specially in high –tech devices that account for 45 -55% of the entire market. Most Indian healthcare institutes use foreign medical equipments for the purpose of surgery, diagnosis of cancer and medical imaging.
MEDICAL TEXTILE
CLASSIFICATION of MEDICAL TEXTILE
Surgical
Extracorporeal
Healthcare & hygiene
Implantable:
Soft tissues,
Cardiovascular
Artificial kidney, liver, lung
Bedding,
gowns,
clothes,
wipes
Non implantable:
bandages , wounds dressing and plasters
THE FOLLOWING SUMS UP THE POTENTIAL IN THE MEDICAL TEXTILE MARKET:
INR 14.5 BILLION(2003-2004)
Growth -11%
Total beds added in the next six years:-1.8 million
Total private beds -1.3 million
Low cost production in India
Market will grow to INR23.3 billion by 2008(11% sustainable growth)
India has always been dependent on imported textile products for surgical and extra corporeal applications. Unorganized sectors of manufacturers have been catering largely to the third and the biggest segment of healthcare and hygiene products. Again MNCs like Johnson and Johnson, Smith and Nephew, Kimberly Clark, and Beiersdorf are the major players as they manufacture special types of bandages and wound care products, compared to the simple ones made by the Indian companies. With the Indian healthcare industry undergoing major expansion, the medical textile market too is poised for a boom.
Sensing this many more foreign players are expected to enter the fray Paul Hartmann of Germany set up its base in India last year with its wholly owned subsidiary Karl Otto Braun (KOB) in Coembatore. With an investment of around US$10 m (Rs. 450 MILLION) ,Hartmann plans to export 75% of its production while the remaining 255 would be marketed locally. The Coembatore unit has been a complete EOU for KOB for many years. But now the company has decided to tap the Indian market too as it offers great opportunity.
Hence this sector presents a wide array of opportunities for the foreign investors as well as the domestic players to mine.
HEALTHCARE SERVICES OUTSOURCING:
Business, insurance companies and even state law makers are now starting to eye the potential savings of outsourcing health from world’s richest country to the developing world. Its one of the many ways in which the world is flattening. Many companies se4e it as the natural extension of the competition they have faced in other aspects of their business.
Growth
11%
2006
US$3700M
2012
US$7400M
India is becoming the major hub for healthcare process outsourcing. The reasons are:
The availability of low cost and reliable high bandwidth communication for both voice and data.
The internet technology revolution that enables shared processing of transactions and locations across locations and time zone.
The availability of a very large labor cost arbitrage across countries with US, UK, Germany and Japan on the high cost band and countries like India, Philippines, South Africa , China etc. on the other end.
English speaking workforce
The lack of interference and strong tax incentives provided by the Indian government to promote the ITES and BPO sector.
Strong competitive pressures and needs of corporations in US, UK, to look at ways to cut costs and reduce overheads and establishment size. Outsourcing to Indian healthcare BPOs results in cost savings in tune of 20-30%.
The types of services provided by the healthcare BPOs in India include:
Data capture: include reporting of diagnostic tests and radiology reporting.
Documentation: data coding, medical transcription, billing and data migration
Commercial: invoicing, disbursal, expense reporting, procurement, cash management, general ledger and receivable management.
Administration: claims processing, adjudication, mailroom services and records management.
Human resources: employee assistance, training and payroll.
Customer care: dispatch and activation services, technical support companies are further involved in various functions such as converting existing data to HIPPA format( health insurance, portability and accountability act),US, administrative functions, billing and coding, processing forms including scanning the written documents, conver6ting them into an electronic format and sending them back. BPOs are further involved in claims forms processing for health insurance companies.
The Indian companies which are already providing services in these segment are:
Company
No of people
Processes
Vision Health Source
600
Billing, claims adjudication
Hinduja TMT
500
Claims adjudication
Cbay
500
Transcription, coding, billing
Lapix
300+
Medical billing
Datamatics
300
Transcription, forms processing
Ajuba
250+
Coding, billing, revenue cycle management, insurance eligibility certification.
Combat Technologies
250+
Transcription, coding
Tranquility
225
Billing, receivables analysis for pharmacies
Affiliated Computer Service
200
Medical billing
Apollo Health Street
150
Claims adjudication, billing, coding
Ideal Solutions
45
Dental claims forms processing
Outsourcing of pathology & laboratory tests by foreign hospital chain is another huge opportunity, because the high cost differential in India. A thyroid blood profile test costs anywhere from US$30-50(Rs.1350-2250) in the US, the same can be analyzed by Indian companies for less than US$5(Rs.225) per patient. The outsourcing opportunity from UK alone is about 450 million pounds or US$800 million. (Rs.36 billion). Chennai based Metropolis Lab has inked a partnership with a US based consortium to bid for outsourced pathology works from the NHS of UK. Metropolis would be investing approximately US$1 million (Rs. 45 million) on technology up-gradation on its Mumbai lab for handling outsourcing jobs.
The global demand for radiology services is growing rapidly while the supply of radiologists is not growing in tandem. Such professionals are in short supply the world over. For instance, reports claim that one in every seven radiology position is vacant in the UK. On the other hand in India there is a relative abundance. By outsourcing teleradiology in India, overseas hospitals can be assured of competent and trained professionals, time zone advantage, skill set availability, HIPPA mandates adhered to and year-round, round the clock services. Patients can be diagnosed and treated at any time of the day, with a diagnosis provided from across the globe within 30 minutes. It is cost effective to the overseas hospitals as the need to recruit night shift personnel is minimized. According to one estimate around 50% of the 6000 of the odd hospitals in the US still do not have the technology for tele-radiology, and this presents a huge potential market to be trapped.
MEDICAL VALUE TRAVEL
India presents first world treatment at the third world cost:
On an average a complicated surgical procedure can be done at 1/10thof the cost in India . There is a huge price differential.
Sx
US$
US(Rs)
UK(US$)
UK(Rs.)
Thailand(US$)
Thailand (Rs.)
India(US$)
India(Rs.)
Bone marrow transplant
250000
11250000
292470
13161150
62500
2812500
30000
1350000
Liver transplant
300000
13500000
77992
3509640
75000
3375000
40000
1800000
Open heart surgery
100000
4500000
41725.72
1877657.4
14250
641250
4400
198000
Hip replacement
55000
2475000
46990.18
2114558.
6900
310500
4500
202500
Knee surgery
48000
2160000
50109.86
2254943.7
7000
315000
4500
202500
hysterectomy
22000
990000
23007.64
1035343.8
2012
90540
511
22995
INDIA’S VALUE PROPPOSITION GOES FAR BEYOND COST: THE QUALITY IS SECOND TO NONE:
Indian doctors are recognized the world over and the comparable success rate. Escorts hospital, for instances, one of the only handful of treatment facility worldwide that specialize in robotic surgery. The death rate of CABG surgery is 0.8%,. By contrast the 1999 death rate of the same procedure at New York –Presbyterian Hospital was 2.35% according to a study by the health department.
Success rate of CABG(US): 97.5%
Success rate of CABG(India): 98.5%
COUNTRY WISE BREAKUP OF MEDICAL TOURISTS IN INDIA:
(Apollo Indraprastha Hospitals. New Delhi)
Country
% of medical tourists
SAARC region
25%
UK, US, Canada
22%
Gulf and Middle East
23%
Others
10%
The healthcare systems in Europe & US are under severe pressure, particularly the NHS at UK, which has a long list of patients waiting for over a year for surgery. In the US healthcare crisis has different dimension. Around 50 million citizens are uninsured, with even the insured having to pay dearly for treatment. Further the shortage of paramedical professionals such as nurses has aggravated the situation. So the hospitals can tie up with the top hospitals in India offering promoting medical tourism and send the excess patients there and in a way promote their own brand in India.
High rewards for promoting medical tourism for the government:
Medical tourism/ value travel has rewards for al the stake holders of the country. Contrary to the notion of only private players benefiting from medical value travel, our analysis show that the government has a lot to gain from it as well.
MEDICAL VALUE TRAVEL PUSHES UP THE QUALITY OF HEALTHCAREIN INDIA:
Medical value travel has already demonstrated the sea change in infrastructure it has brought in, primarily patients from developing countries will accept nothing less than care & infrastructure available in their country. This has changed the way the Indian citizens views the healthcare although such changes are predominantly in urban areas right now.
It can be deducted that such changes will trickle into the villages as well. Where people used to have accept the level of care available, now they demand the best possible care. In addition to high quality in he healthcare system this also brings in the accountability in the healthcare system. This combined with the health insurance in India; best quality healthcare will be universally accessible and affordable to the common Indians.
TOURISM AND EMPLOYMENT WILL GET AN EXTRA BOOST
WIN-WIN SITUATION AS THE HEALTHCARE COMPANIES ALSO BENEFITS.
IT IS ALL ABOT QUALITY NOW:
Advantage of certification or assessment of quality
Makes the organization quality driven
Provides measurable parameters
Removes ambiguity in operations and increases efficiency
Builds patient confidence and credibility
Limitations of ISO certification:
1. ISO is more documentation oriented and hence a certification does not ascertain level of implementation.
2. ISO is a certification where the examinee pays the examiner to get the certificate. Since ISO certification can be awarded by several bodies a market of sorts has been created for this certification where several certifiers are competing. This induces a conflict of interest in the system as the interest of the certifier is certifying and there is no incentive to deny certification.
3. ISO does not involve customers, so it shows a limited view of quality.
WE WOULD CLASSIFY HOSPITALS AS:
Hospital category
Characteristics
Quality accreditation required to be adopted
Group1
Govt. hospitals with no benchmarks and processes documented
Private hospitals with no benchmarks and processes documented
ISO certifications
Group2
hospitals with some documented process, either govt. or private
ISO certifications
Group 3
Hospitals with documented standard processes
NABH/JCI certification
Group 4
Hospitals with documented processes, best practices, quality evaluation process and bet in the class benchmarks
Continuous performance improvement
HEALTH INSURANCE
Health insurance is a rapidly growing market in India. The number of lives covered under health plans has increased from 4-5 millions about six years ago to over 12 million today.(2006). Yet a miniscule proportion of Indian population is insured while a vast market is waiting to be tapped.
As per our analysis health insurance has a fantastic top line growth potential. Premiums grew at 133% for private players and 47% for the industry as a whole ( in Q1of 2006).
Current annual premiums collected
US$711 MILLION(RS. 3199 CR)
Projected annual premiums collected
US$3.8 BILLION(RS. 17100CR)
growth
32%
A FICCI ASSESSMENT
ON
FUTURE OF INDIAN HEALTHCARE INDUSTRY
(ESPECIALLY HOSPITAL SECTOR)
IN ASSOCIATION WITH
ERNEST & YOUNG GROUP (BASE YEAR 2006)
INDIAN INDUSTRY REVIEW:
India is now the second fastest growing major economy in the world, with a GDP growth rate of 9.2% at the end of second quarter of 20006-2007 and the third largest economy in the world as measured by purchasing power parity(PPP) , with a gross GDP of US$3.611 trillion( Rs.162495 billion).
The Indian healthcare is in the midst of a rapid transformation and has emerged as one of the largest service sector in India. Healthcare spending in India is expected to rise by 15% per annum. As per our estimate healthcare spending could contribute to 6.1% of GDP in 2012 and employ around 9 million people.
SHIFT FROM SOCIALIZED TO PRIVATE PROVIDERS:
The majority of healthcare services in India is provided by the private sector and also the facilities provided by them are rated higher on quality indicators. In fact the private health sector in India is one of the largest in the world: 80% of the all qualifieddoctors, 75% of the dispensaries and 60% of the hospitals in India belongs to private sector. Only 23.5% of the urban residents and 30.6% of the rural residents choose to visit a government health facility as their main source of healthcare services. Government expenditures on he healthcare has been declining and is around 0.9% of the GDP The average of the developing countries as a whole is around 3% of GDP and for high income countries , 5% of GDP.
A majority of Indians trust private healthcare despite the average cost being higher at US$4.3(Rs. 193.50) than the US$2.7(Rs.121.50)it costs at government owned healthcare agencies. According to World Bank study 79% of all OPD care among the poor is provided by the private sector. Clearly it is the poor quality of care provided by the public health system, which compels people to use costlier private facilities.
BOOMING ECONOMY AND HIGH LITERACY RATE:
Healthcare spending is on an upward track partly due to the fact that as nations becomes wealthier, consumers want more and more and is willing to pay spend more on healthcare (about half a percent increase in the healthcare cost for each percent increase in wealth).According to a , fitness and wellbeing accorded an aspiration status and the highest growth in healthcare is recorded in healthcare when the families move from middle income to rich. The growth in affluence of over 300 million strong middle income consumers is creating demand for higher standards of healthcare The top 33% income earners in India accounted for 75% of total private expenditure on healthcare in 2004.
Rich households (the top 8%) paid US$578 per treatment (rs.26010) and hospitalization in 2004., three times the average of US$191(rs.8595).
The true might of the Indian population had so far been dwarfed by lack of capacity to pay &the concentration of the rich in very few urban townships. However, that is changing.
The proportion of households in the low –income group has declined significantly and the “great Indian middle class” has come out of age. Added to this is the mushrooming of for greater numbers of urban centers, where demand far outstrips the supply f quality care.
Expansion of rich and the middle income groups:
33% in 2004
49% in 2010
SHIFT TO LIFESTYLE –RELATED DISEASE: PROPALLANT FOR HEALTHCARE SPENDS:
Lifestyle diseases are typically more expensive to treat than infectious one .According to a survey carried out by Earnest and Young in 2006, we compared expenditures for inpatient treatment in 18 hospitals across 5 major cities, the average spend on lifestyle diseases is Rs. 40,500 per inpatient treatment, while that on infectious disease it is Rs. 5,5209 (we compared expenditures for inpatient treatment in 18 tertiary care hospitals) .
India’s disease profile is expected to follow the same pattern as in developed economics. Based on the demographic trend and disease profile lifestyle diseases – cardiovascular, asthma and cancer has become the most important segment, and the inpatient spending is expected to rise from 39% to nearly 50% of the total healthcare as compared to 62% in the US. In the inpatient market , the share of infectious diseases is expected to decline from 19% in 2004 to 16% in 2008.
2006
2012
CVS
1.6 million
2.1 million
Spend share of the IPD cardiac treatment
16%
19%
IPD cardiac care market
Rs. 12,200 crores
Rs, 30,100 crores
EASIER FINANCING IN ACAPITAL INTENSIVE INDUSTRY:
High growth rates in a capital intensive industry has inevitably stemmed from innovative financing solutions. The Indian healthcare industry has gone through entire cycle of financing from government funded socialized system to privately funded mom and pop shops (small nursing homes) to NRI &FI. funded enterprises, and now for the past 10 yrs, financial markets. When Schroder, a PE fund invested in Apollo Hospitals in 1996, nobody noticed. Investors blinked at least once at PE funding of Max Healthcare by Warburg Pincus , but we believe that private placement by Quantam Funds ( Jeorge Soros) in Fortis Healthcare is a watershed which opens new vistas for foreign investments to flow in.
Another route which is underutilized is effective utilization of the debt capacity. According to a study by Earnest and Young (2006) the top tertiary care hospitals in the country reveal that the average Debt Equity ratio is 0.93 which shows that the industry is not highly levered. Debt capacity which exists in the industry is not being utilized. Therefore, the expansion of the industry can be funded by debt which has the advantage of lower cost of the capital and also which increases the value of the organization. Considering that the aforementioned investment is justified by the latent demand existing in the industry, investors should seriously reconsider being risk averse vis-a-vis investment in the healthcare sector. “Risk sharing” by forging foreign partnerships across industries is another unbanked sector. which is likely to promote increasing investments , assisting he industry to grow at a rate of 15%.
INCREASING LIFE EXPECTANCY:
Age wise population distribution:
1991(%)
2001(%)
2010(%)
0-14
36
35
29
15-54
55
55
59
>=55
9
10
12
The correlation between the life expectancy and the increase in the healthcare spending:
Particulars
2004
2005
2006
2007
2008
2009
Life expectancy(years)
64
64.3
64.7
65.1
65.4
65.8
Healthcare spending(Rs billion)
1582
1763
1967
2216
2463
27771
Healthcare spending(US$ bn )
34.9
40.4
45.7
52.1
56
60.9
Healthcare spending(% of GDP)
5.2
5.3
5.3
5.4
5.4
5.5
Healthcare spending(US$ per hand)
32
37
41
46
49
53
RECOGNITION OF GOVERNMENT AS A PRIORITY SECTION:
The UPA govt. has recently announced from0.0.9% of GDP to 2% of GDP within the next 5years and has proposed the increase in the education cess from 2% to 4% to finance the same. Recently enacted tariff and non tariff measures are set to stimulate in market development in the healthcare sector allowing more hospitals to offer critical care services .Some of them are:
Reduction in import duty on medical equipments from 25% to 5.1%.
Depreciation limit on such equipment rose to 40% from 25%, to encourage medical equipment imports.
Customs duty reduced to 8% from 16% for medical, surgical, veterinary and dental furniture.
Customs duty on as many as25medical equipments which include X-ray, goniometry, and teletherapy stimulator machine has been reduced to 5%.
The government has announced income tax exemption under section 80 1B of the income tax act for first 5 years to hospitals (with 100 beds or more) set up in the rural areas.
Crutches, wheel chairs, walking frames, artificial limb set for the disabled will be fully exempt from customs duty. Ambulances used by all hospitals will now be eligible for concessional duty.
US456 million will be earmarked for the HIV/AIDS control programme through the use of primary health centers, prevention of drug abuse etc.
SLICING THE HEALTHCARE PIE:
DATA OF 2006
100%= US$34.2 BILLION (Rs. 153,330 Crores)
Sector name
Percentage of expenditures
Infrastructure
14%
Pharmaceuticals
17%
Medical value travel
1%
Training and education
3%
Medical equipment
6%
Health insurance
2%
Independent path laboratories
3%
Medical textiles
1%
Bed revenues
35%
Health outsourcing
11%
Clinical trials
6%
Medical consumables
6%
DATA PROJECTION FOR 2012
100%=US$78.6 BILLION
(Rs. 353, 700 Crores)
Sector name
Percentage of expenditures
Infrastructure
14%
Pharmaceuticals
15%
Medical value travel
2%
Training and education
3%
Medical equipment
6%
Health insurance
5%
Independent path laboratories
3%
Medical textiles
1%
Bed revenues
36%
Health outsourcing
9%
Clinical trials
6%
Medical consumables
5%
MEDICAL INFRASTRUCTURE:
TOP LINE FACTS:
Size-(US$4803 M) 2006
Size-(US$10975 M) 2012
Growth-14.5%
PRESENT DETAIL (2002)
Doctors -500,000
Hospitals- 15,393
Beds-875,000
PHCs-23,000
Sub centers-132,000
Projection for 2012:
Doctors- 12, 00,000(to reach doctor to thousand population ratio of 1).
Hospitals-19201
Beds-2,231,400
Despite an extensive public healthcare infrastructure
The % of private sector in projected increase number of beds will be approximately 88%.The revenues currently generated by the private hospitals (all inclusive) are US$15.51 BILLION and is likely to increase to US$ 35.87 BILLION by the year 2012 at a CAGR of 15%.
We feel that the industry should target a stronger growth and aim at achieving a bed to thousand population of 1.98 .This would require a total number of investments of US$88 BILLION and the resultant revenues from private beds would be us438.8 billion.
We believe that an increasing % of patients will prefer private hospitals over the next 6 years, which bodes well for the industry, creating a demand supply gap, leading to increased bed occupancy ratios. However the key differentiator is going to be managing higher revenues per bed by adding value added services and translating that into higher EBITDA margins by aggressively controlling costs.
A significant % of these investments are likely to come from non-core healthcare providers. A number of innovative model is likely to develop in land and development leasing and management contracts. We believe that one such model can be generated by the entry of Real estate players in the medical infrastructure development. These players have the expertise in infrastructure developments and management, they could forge a successful and mutually beneficial industry.
GAP ANALYSIS:
Current state(2006)
2012(expected)
2012(best case)
Population
1.1 billion
1.2 billion
Bed to 1000 population ratio
1.03
1.85
2.0
Number of beds
1222654
2231442
2370827
Government
593454
651814
661890
Private
683108
1579628
1708983
Investment required
$77.9 billion
Rs.350550 crores)
88.8 billion
(Rs.399600 crores)
Government(2006-20012)
$8.2 billion
(Rs.36,900 crores)
$9 billion(Rs.40500 crores)
Private(2006-20012)
$69.7 billion
(Rs.313650 crores)
$79.8 billion
(Rs.359100crores)
Revenues(private hospitals)
$15.51billion
(Rs. 69, 795 crores)
$35.9 million
(Rs. 161,550 crores)
$38.8billion
(Rs. 174600 crores)
PUBLIC PRIVATE PARTNERSHIP IN MEDICAL INFRASTRUCTURE:
Low spending by the Indian government on healthcare compared to other developing economies, coupled with huge deficits in beds makes a compelling case for PPP in infrastructure development. Though the past experiences by the government, by providing free land for exchange of free beds have been les than successful, there failure can largely be attributed to lack of appropriate alignment by incentives inadequate monitoring mechanism and les than comprehensive MOU.
The government has a strong base of preventive infrastructure in terms of PHCs; sub centers etc, but still has a long way to go in terms building and staffing hospitals. With 0.12% of the GDP being spent on infrastructure development and more on operating these facilities, there is just no enough money to bridge the gap. We believe that the government will have to think bolder & more innovative modes of partnership to spur economic turn around envisioned and reach bed to thousand population ratios of 2.
Such PPP models need to innovate on:
Land subsidy by the government to make the hospital projects more feasible (land costs alone are 15% of the investment figures mentioned).
Outsourcing management to existing government facility to private players.
Higher utilization of existing secondary and tertiary care facilities by using a facilities sharing model. Several of such partnerships have been successful n India and developing countries all over the world.
Management by PHCs by corporate house with significant presence in Tamil Nadu.
Management of PHCs by SEWA (non profit organization in Gujarat.)
Transfer of management of 300 hospitals in USA from govt. to private between 1955 and 1985.
Use of private financing by UK govt. to decrease its capital expenditure.
Management of public hospitals by private providers with compulsory treatment for patients funded by the government at a negotiated price in Brazil and South Africa.
Outsourcing of cleaning, maintenance and waste management of 82 hospitals by the Karnataka government.
Outsourcing of major technology services in major teaching hospitals in Tamil nadu and diagnostic services of teaching hospitals in Uttar Pradesh.
These models need to be encouraged in areas of medial colleges, nursing colleges and also training institutes for paramedics and technicians. We further feel that the people who need the medical infrastructure the most should be given preference. The government values its senior officers and policy makers as much as the corporate sector values its top management and therefore their healthcare needs could be outsourced to the private providers in conjunction with an insurance provider, at a premium lesser than the cost of treating them today. A broader policyon this concept should be formulated so that government infrastructure can be better utilized by the poor and hae needy.
MEDICAL EQUIPMENTS
The medical equipment device market is becoming too big to ignore. It is full of opportunities for investments in high quality, specialized medical equipment Foreign participation is required specially in high –tech devices that account for 45 -55% of the entire market. Most Indian healthcare institutes use foreign medical equipments for the purpose of surgery, diagnosis of cancer and medical imaging.
MEDICAL TEXTILE
CLASSIFICATION of MEDICAL TEXTILE
Surgical
Extracorporeal
Healthcare & hygiene
Implantable:
Soft tissues,
Cardiovascular
Artificial kidney, liver, lung
Bedding,
gowns,
clothes,
wipes
Non implantable:
bandages , wounds dressing and plasters
THE FOLLOWING SUMS UP THE POTENTIAL IN THE MEDICAL TEXTILE MARKET:
INR 14.5 BILLION(2003-2004)
Growth -11%
Total beds added in the next six years:-1.8 million
Total private beds -1.3 million
Low cost production in India
Market will grow to INR23.3 billion by 2008(11% sustainable growth)
India has always been dependent on imported textile products for surgical and extra corporeal applications. Unorganized sectors of manufacturers have been catering largely to the third and the biggest segment of healthcare and hygiene products. Again MNCs like Johnson and Johnson, Smith and Nephew, Kimberly Clark, and Beiersdorf are the major players as they manufacture special types of bandages and wound care products, compared to the simple ones made by the Indian companies. With the Indian healthcare industry undergoing major expansion, the medical textile market too is poised for a boom.
Sensing this many more foreign players are expected to enter the fray Paul Hartmann of Germany set up its base in India last year with its wholly owned subsidiary Karl Otto Braun (KOB) in Coembatore. With an investment of around US$10 m (Rs. 450 MILLION) ,Hartmann plans to export 75% of its production while the remaining 255 would be marketed locally. The Coembatore unit has been a complete EOU for KOB for many years. But now the company has decided to tap the Indian market too as it offers great opportunity.
Hence this sector presents a wide array of opportunities for the foreign investors as well as the domestic players to mine.
HEALTHCARE SERVICES OUTSOURCING:
Business, insurance companies and even state law makers are now starting to eye the potential savings of outsourcing health from world’s richest country to the developing world. Its one of the many ways in which the world is flattening. Many companies se4e it as the natural extension of the competition they have faced in other aspects of their business.
Growth
11%
2006
US$3700M
2012
US$7400M
India is becoming the major hub for healthcare process outsourcing. The reasons are:
The availability of low cost and reliable high bandwidth communication for both voice and data.
The internet technology revolution that enables shared processing of transactions and locations across locations and time zone.
The availability of a very large labor cost arbitrage across countries with US, UK, Germany and Japan on the high cost band and countries like India, Philippines, South Africa , China etc. on the other end.
English speaking workforce
The lack of interference and strong tax incentives provided by the Indian government to promote the ITES and BPO sector.
Strong competitive pressures and needs of corporations in US, UK, to look at ways to cut costs and reduce overheads and establishment size. Outsourcing to Indian healthcare BPOs results in cost savings in tune of 20-30%.
The types of services provided by the healthcare BPOs in India include:
Data capture: include reporting of diagnostic tests and radiology reporting.
Documentation: data coding, medical transcription, billing and data migration
Commercial: invoicing, disbursal, expense reporting, procurement, cash management, general ledger and receivable management.
Administration: claims processing, adjudication, mailroom services and records management.
Human resources: employee assistance, training and payroll.
Customer care: dispatch and activation services, technical support companies are further involved in various functions such as converting existing data to HIPPA format( health insurance, portability and accountability act),US, administrative functions, billing and coding, processing forms including scanning the written documents, conver6ting them into an electronic format and sending them back. BPOs are further involved in claims forms processing for health insurance companies.
The Indian companies which are already providing services in these segment are:
Company
No of people
Processes
Vision Health Source
600
Billing, claims adjudication
Hinduja TMT
500
Claims adjudication
Cbay
500
Transcription, coding, billing
Lapix
300+
Medical billing
Datamatics
300
Transcription, forms processing
Ajuba
250+
Coding, billing, revenue cycle management, insurance eligibility certification.
Combat Technologies
250+
Transcription, coding
Tranquility
225
Billing, receivables analysis for pharmacies
Affiliated Computer Service
200
Medical billing
Apollo Health Street
150
Claims adjudication, billing, coding
Ideal Solutions
45
Dental claims forms processing
Outsourcing of pathology & laboratory tests by foreign hospital chain is another huge opportunity, because the high cost differential in India. A thyroid blood profile test costs anywhere from US$30-50(Rs.1350-2250) in the US, the same can be analyzed by Indian companies for less than US$5(Rs.225) per patient. The outsourcing opportunity from UK alone is about 450 million pounds or US$800 million. (Rs.36 billion). Chennai based Metropolis Lab has inked a partnership with a US based consortium to bid for outsourced pathology works from the NHS of UK. Metropolis would be investing approximately US$1 million (Rs. 45 million) on technology up-gradation on its Mumbai lab for handling outsourcing jobs.
The global demand for radiology services is growing rapidly while the supply of radiologists is not growing in tandem. Such professionals are in short supply the world over. For instance, reports claim that one in every seven radiology position is vacant in the UK. On the other hand in India there is a relative abundance. By outsourcing teleradiology in India, overseas hospitals can be assured of competent and trained professionals, time zone advantage, skill set availability, HIPPA mandates adhered to and year-round, round the clock services. Patients can be diagnosed and treated at any time of the day, with a diagnosis provided from across the globe within 30 minutes. It is cost effective to the overseas hospitals as the need to recruit night shift personnel is minimized. According to one estimate around 50% of the 6000 of the odd hospitals in the US still do not have the technology for tele-radiology, and this presents a huge potential market to be trapped.
MEDICAL VALUE TRAVEL
India presents first world treatment at the third world cost:
On an average a complicated surgical procedure can be done at 1/10thof the cost in India . There is a huge price differential.
Sx
US$
US(Rs)
UK(US$)
UK(Rs.)
Thailand(US$)
Thailand (Rs.)
India(US$)
India(Rs.)
Bone marrow transplant
250000
11250000
292470
13161150
62500
2812500
30000
1350000
Liver transplant
300000
13500000
77992
3509640
75000
3375000
40000
1800000
Open heart surgery
100000
4500000
41725.72
1877657.4
14250
641250
4400
198000
Hip replacement
55000
2475000
46990.18
2114558.
6900
310500
4500
202500
Knee surgery
48000
2160000
50109.86
2254943.7
7000
315000
4500
202500
hysterectomy
22000
990000
23007.64
1035343.8
2012
90540
511
22995
INDIA’S VALUE PROPPOSITION GOES FAR BEYOND COST: THE QUALITY IS SECOND TO NONE:
Indian doctors are recognized the world over and the comparable success rate. Escorts hospital, for instances, one of the only handful of treatment facility worldwide that specialize in robotic surgery. The death rate of CABG surgery is 0.8%,. By contrast the 1999 death rate of the same procedure at New York –Presbyterian Hospital was 2.35% according to a study by the health department.
Success rate of CABG(US): 97.5%
Success rate of CABG(India): 98.5%
COUNTRY WISE BREAKUP OF MEDICAL TOURISTS IN INDIA:
(Apollo Indraprastha Hospitals. New Delhi)
Country
% of medical tourists
SAARC region
25%
UK, US, Canada
22%
Gulf and Middle East
23%
Others
10%
The healthcare systems in Europe & US are under severe pressure, particularly the NHS at UK, which has a long list of patients waiting for over a year for surgery. In the US healthcare crisis has different dimension. Around 50 million citizens are uninsured, with even the insured having to pay dearly for treatment. Further the shortage of paramedical professionals such as nurses has aggravated the situation. So the hospitals can tie up with the top hospitals in India offering promoting medical tourism and send the excess patients there and in a way promote their own brand in India.
High rewards for promoting medical tourism for the government:
Medical tourism/ value travel has rewards for al the stake holders of the country. Contrary to the notion of only private players benefiting from medical value travel, our analysis show that the government has a lot to gain from it as well.
MEDICAL VALUE TRAVEL PUSHES UP THE QUALITY OF HEALTHCAREIN INDIA:
Medical value travel has already demonstrated the sea change in infrastructure it has brought in, primarily patients from developing countries will accept nothing less than care & infrastructure available in their country. This has changed the way the Indian citizens views the healthcare although such changes are predominantly in urban areas right now.
It can be deducted that such changes will trickle into the villages as well. Where people used to have accept the level of care available, now they demand the best possible care. In addition to high quality in he healthcare system this also brings in the accountability in the healthcare system. This combined with the health insurance in India; best quality healthcare will be universally accessible and affordable to the common Indians.
TOURISM AND EMPLOYMENT WILL GET AN EXTRA BOOST
WIN-WIN SITUATION AS THE HEALTHCARE COMPANIES ALSO BENEFITS.
IT IS ALL ABOT QUALITY NOW:
Advantage of certification or assessment of quality
Makes the organization quality driven
Provides measurable parameters
Removes ambiguity in operations and increases efficiency
Builds patient confidence and credibility
Limitations of ISO certification:
1. ISO is more documentation oriented and hence a certification does not ascertain level of implementation.
2. ISO is a certification where the examinee pays the examiner to get the certificate. Since ISO certification can be awarded by several bodies a market of sorts has been created for this certification where several certifiers are competing. This induces a conflict of interest in the system as the interest of the certifier is certifying and there is no incentive to deny certification.
3. ISO does not involve customers, so it shows a limited view of quality.
WE WOULD CLASSIFY HOSPITALS AS:
Hospital category
Characteristics
Quality accreditation required to be adopted
Group1
Govt. hospitals with no benchmarks and processes documented
Private hospitals with no benchmarks and processes documented
ISO certifications
Group2
hospitals with some documented process, either govt. or private
ISO certifications
Group 3
Hospitals with documented standard processes
NABH/JCI certification
Group 4
Hospitals with documented processes, best practices, quality evaluation process and bet in the class benchmarks
Continuous performance improvement
HEALTH INSURANCE
Health insurance is a rapidly growing market in India. The number of lives covered under health plans has increased from 4-5 millions about six years ago to over 12 million today.(2006). Yet a miniscule proportion of Indian population is insured while a vast market is waiting to be tapped.
As per our analysis health insurance has a fantastic top line growth potential. Premiums grew at 133% for private players and 47% for the industry as a whole ( in Q1of 2006).
Current annual premiums collected
US$711 MILLION(RS. 3199 CR)
Projected annual premiums collected
US$3.8 BILLION(RS. 17100CR)
growth
32%
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