According to the World Bank, India is the world’s third largest economy in purchasing parity terms. The country aspires to better the lives of more than 1.3 billion citizens and become a high-middle income country by the year 2030. More than 90 million people have escaped extreme poverty and improved their living standards between 2011-2015, mainly due to the government initiatives and robust economic growth. Due to various reasons, the growth has decelerated in the past two years. The challenges are looming large in number of areas like removing poverty, improving literacy and healthcare delivery mechanism, providing safe drinking water, 24x7 electricity, and housing for such a large population. The efforts made so far on the healthcare front is not enough to ensure good health for one and all. As per National Health Profile 2019, the per capita per year government spending on healthcare was a mere Rs 1,657 in 2017-18. Sandeep Sharma takes a look at the healthcare sector in India…
FACTS AND FIGURES
Healthcare industry in India comprises of government and private hospitals, pharmaceuticals, medical devices, clinical trials, outsourcing, telemedicine, diagnostics (imaging & pathology), medical tourism, health insurance and medical equipment/supplies. The industry is going strong and rapidly growing owing to its extensive coverage, improving service standards, and increased level of spending both by the private and public sector. According to Invest India, the Indian Healthcare industry is projected to touch US$ 372 bn by 2022. The healthcare industry in India stood as the fourth largest employer in 2017. The primary healthcare industry is currently valued at US$ 13 bn. Theshare of the organized sector is practically negligible in this case and it is fully dependent on the government spending.
The hospital industry in India, accounting for 80% of the total healthcare market, is attracting attention from both global as well as domestic players and investors. It is expected to reach US$ 132 bn by 2023 from US$ 61.8 bn in 2017; growing at a CAGR of 16-17%. The medical tourism industry in India is estimated to become a US$ 9 bn industry by 2020 from US$ 3 bn in 2017. According to Ministry of Tourism communiqué released in December, 2018, the estimated Foreign Tourist Arrivals (FTAs) in the country on Medical purpose during the years 2015, 2016 and 2017 are 2,33,918, 4,27,014 and 4,95,056 respectively. The majordestination cities for the medical tourist include Mumbai, Delhi, Chennai, Bengaluru, Kolkata, and Hyderabad.The diagnostics industry in India is currently valued at US$9 bn as per industry estimates. The sector is highly fragmented with standalone centres accounting for 45-50% and the organised ones having less than 35% share while the rest are hospital-based diagnostic centres. According to the Research and Markets new report “Indian Diagnostic Services Market Outlook 2020”, the diagnostic services market is expected to continue growing at 27.5% for next five years. This market is likely to touch INR 860 bn in revenues by 2020. The Government has taken number of proactive measures, as a result the exports have improved and the growth in Pharma sector is back on track. The Pharma industry is expected to grow at a CAGR of 15% in the near future. The Government is trying to help and push the Indian pharmaceutical sector towards becoming a global player and touch Rs. 3 lakh crore mark.The medical devices market as per industry estimates are expected to grow to US$50 billion by 2025.
SHORTAGE OF SKILLED HUMAN RESOURCE
NHP 2019 has compiled detailed health manpower availability in public sector. The total number of registered Allopathic Doctors (up to 2018) is 11, 54,686. Number of Registered allopathic doctors possessing recognized medical qualifications (under MCI Act) and registered with state medical council for the years 2017 and 2018 were 43,581 and 41,371 respectively. At present average population served by Government Allopathic Doctor is 10,926 numbers of persons served per allopathic doctor.
This ratio was 1:2000 in year 2011. Number of Dental Surgeons registered with Central/State Dental Councils of India up to 31.12.2018 was 2,54,283.There is an increasing trend in number of Dental Surgeons registered with Central/ State Dental Council of India from 2007 to 2018.Total number of registered AYUSH Doctors in India as on01.01.2018 was 7,99,879. Auxiliary Nurse Midwife (ANM) plays very important role in Health Care Delivery System in India and its changing with the times. There are total of 8,60, 927 ANM serving in the country as on 31.12.2017.
There are 20,48,979 Registered Nurses and Registered Midwives (RN & RM) and 56,469 Lady Health Visitors serving in the country as on 31.12.2017.
ESIC MULTISPECIALITY HOSPITAL IN PUNE
The All India ESIC Employees Federation plans to build two hospitals with full-fledged facilities at Pune and Kolhapur for industrial workers. The Pune facility will have a 500-bed multi-specialty hospital while the Kolhapur facility is a 200-bed multi-specialty hospital.
CAPACITY AUGMENTATION OF GOVERNMENT-RUN HOSPITALS IN NCT OF DELHI
The Government of NCT of Delhi is taking steps towards augmenting the capacity of Delhi government-run hospitals by over 120 per cent targeting a total capacity of 13,899 beds in place of the existing capacity of 11,353 beds in 38 Delhi government hospitals. The Delhi Government has recently approved the plan to construct three new government hospitals in Madipur, Hastsal and Jwalapuri areas of Delhi. A total of 1,950 beds is planned to be added on completion of the three hospitals. Two hospitals with approximately 772 and 600 beds are coming up in Burari and Ambedkar Nagar areas, A new mother and child block will be constructed at the Lal Bahadur Shastri Hospital, Khichripur with 460 beds. The project is approved by the Delhi government, and tendering has been completed. A 100 bedded hospital each in Bindapur and Siraspur is also planned.
VIKRAM PLANS CHAIN OF HOSPITALS IN BENGALURU
The Bengaluru-based Vikram Hospital plans to set up a chain of hospitals. As part of this plan, two more 150-200 bedded facilities are proposed to come up in the city of Bengaluru at an investment of Rs. 200 crore. The debt ridden hospital, was taken over by private equity player Multiples in 2015. The hospital is looking forward to rope in new investors to fund expansion project.
AYUSH HOSPITAL IN MOHALI
The state of Punjab will get its first AYUSH hospital spread across 9 acre with 50-bed capacity coming up in Zirakpur area of Mohali district. The alternative and traditional systems of medicine are gaining prominence after these are clubbed under AYUSH. These include Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homoeopathy. The Punjab government has accorded high priority to the healthcare sector by initiating the process of complete transformation of the healthcare facilities.
STRENGTHENING OF ESI HOSPITALS IN A.P.
The Government of Andhra Pradesh is keen and taking steps towards strengthening the ESI hospitals across the state so as to provide corporate level medical aid to the working class. As part of this initiative, a 100 bedded ESI hospital is planned to come up in Rajamahendravaram city in place of the existing 50 bed hospital. The approval of the Central government is received.
The work is likely to start soon. The project will be undertaken under the Naadu Needu programme.
DISTRICT HOSPITAL IN MYSURU
A 300-bed district hospital is coming up in north Mysuru in the state of Karnataka. The hospital with three-storey is likely to be handed over in December to the department of health and family welfare. The project cost is estimated to be Rs.75 crore.
As part of the CSR initiatives, corporates are also coming forward to build healthcare facilities across the country. The primary healthcare centre at Byramangala in Karnataka was upgraded by Toyota Kirloskar Motor with modern medical equipment comprising 26 diagnostic unit as part of its CSR project. The company took up this project in 2018. Apart from this, they have installed an advanced water purification unit to offer clean drinking water to the local community.
CANCER CARE UNIT IN UDAIPUR
Hospitals chain Paras Healthcare in collaboration with Udaipur-based J K Hospital plans to set up an advanced cancer care unit, additional cath lab as well as an IVF unit in the hospital located in Udaipur to offer secondary and tertiary care services.
STRENGTHENING HEALTHCARE INFRA IN J&K
The Government of India is going ahead with strengthening the healthcare infrastructure in Jammu and Kashmir region. Out of the sanctioned allocation of Rs. 900 crore under a financial assistance program for health projects in J&K, the Centre has released Rs. 836.64 crore. So far 48 out of the 144 ongoing and new health projects are completed as approved under the PrimeMinister’s Development Package (PMDP), the rest of the projects will be completed by FY2020-21.
CANCER HOSPITAL IN MUZAFFARPUR
A 125-bed Homi Bhabha Cancer Hospital and Research Centre is coming up on the Sri Krishna Medical College and Hospital (SKMCH) premises in Muzaffarpur. The construction is expected to start soon. A plot of 15 acre of land has already been identified near the SKMCH.
ASTER PLANS HEALTHCARE CHAIN IN INDIA
Kochi based Aster DM Healthcare, One of the largest healthcare chains in the Middle East countries and in India, currently has 4,794 beds across 13 hospitals in India and 12 hospitals in the Middle East. The company plans to add more than 1500 beds over the next three years in India. The capacity addition will come up in Chennai, Bengaluru, and Kolhapur. They have also planned a new 600-beded multi-speciality hospital in Thiruvananthapuram. The company is looking forward towards opening more clinics as satellite centres to its hospitals in various cities. The development of a diagnostics chain is also under implementation. A central laboratory is being set up in Bengaluru in the coming months.
KOTTAPARAMBA GOVT HOSPITAL EXPANSION
Kottaparamba Government Hospital for Women and Children in Kozhikode is constructing a four-storey building block behind the existing hospital building with funds received under the National Health Mission. Apart from this a sewage treatment plant (STP) will also come up. The hospital currently has 295 beds, and the new building will add 50-bed capacity to the existing one. The project cost is Rs.10 crore.
KAUVERY HOSPITAL CHAIN EXPANSION PLANS
Chennai-based Sri Kauvery Medical Care, which runs the Kauvery Hospital chain healthcare centres in Tamil Nadu, plans to expand its footprint in the state. The hospital has raised Rs 140 crore equity capital from investment platform LGT Lightstone Aspada. The expansion plans include construction of 12-15 hospitals with a total capacity of more than 3,000 beds.
100 MULTI-SPECIALITY VETERINARY HOSPITALS
CavinKare founder-chairman CK Ranganathan plans to launch 100 multi-speciality veterinary hospitals by 2024 in cities like Mumbai, Delhi, Bengaluru, and Hyderabad. CavinKare has launched a multi-speciality veterinary hospital named ‘Sanchu Animal Hospital’ in Chennai. The hospital is set up in an area of 7200 sq ft at an investment of Rs.3 crore.
MEDICAL COLLEGE AND HOSPITAL AT NARGHOGHI
Sriram Janki Medical College and Hospital (SJMCH) is being constructed at Narghoghi village in Samastipur district spread over an area of 21 acre. The project comprises a medical college, 500-bed hospital, 655-bed hostel for medical students, and 197quarters for the resident doctors and employees. The project is estimated to cost Rs 591 crore. Out of this Rs 478 crore will be contributed by the state government while Rs 113 crore will be funded by the Centre. The construction work is estimated to complete in the next three years.
KAUVERY HOSPITAL CHAIN EXPANSION PLANS
Hospitality player Katriya Group has forayed into the healthcare industry with a new entity named SLG Hospitals. The group is building a 999-bed hospital spread over 4 acre with over 10 lakh sq ft built up area in Nizampet area of Hyderabad. The project is taken up in three phases at a cost of Rs. 350 crore. The first phase is completed with 550 bed capacity, and the entire project is targeted to complete by 2022. In addition, the project will have a 0.5 MW solar power plant, 120-room hotel, nursing and hotel management colleges, helipad for the air ambulance and health club. The hotel will be operational by March 2020.
SUPER SPECIALITY BLOCKS IN 63 GMCIs
The Government of India has sanctioned setting up of Super Speciality Blocks in 63 existing Government Medical Colleges/ Institutions (GMCIs) across the country under different phases of Pradhan Mantri Swasthya Suraksha Yojana (PMSSY). These include: 1) Siddhartha Medical College (Vijayawada) and Govt.
Medical College (Anantapur) in A.P. 2) Guwahati Medical College, and Assam Medical College (Dibrugarh) in Assam. 3) Srikrishna Medical College (Muzaffarpur) Govt. Medical College (Darbhanga), Patna Medical College & Hospital, Government Medical College (Bhagalpur), Government Medical College ( Gaya), and IGIMS (Patna) in Bihar. 4) Government Medical College(Bilaspur), and Government Medical College (Jagdalpur) in Chhattisgarh. 5) Goa Medical College (Panaji) in Goa. 6) PDU Govt. Medical College (Rajkot), Government Medical College ( Surat), and Government Medical College (Bhavnagar) in Gujarat. 7) Government Medical College (Tanda), and Indira Gandhi Govt. Medical College (Shimla). 8) Government Medical College (Jammu) in J&K 9) Rajendra Institute of Medical Sciences (RIMS) (Ranchi), Patliputra Medical College (Dhanbad) in Jharkhand. 10) Bangalore Medical College, Karnataka Institute of Medical Sciences (Hubli) in Karnataka. 11) Medical College, (Thiruvananthapuram), Kozhikode Medical College, SCTIMST ( Trivandrum) in Kerala. 12) Govt. Medical College (Rewa), Netaji Subhash Chandra Bose Medical College (Jabalpur), GR Medical College (Gwalior), Government Medical College (Indore) in M.P. 13) Govt. Medical College (Aurangabad), Govt. Medical College, (Latur), Govt. Medical College (Akola), Shri Vasantrao Naik Govt. Medical College (Yavatmal). 14) MKCG Medical College ( Behrampur), VSS Medical College (Burla), Government Medical College (Cuttack) in Odisha 15) Government Medical College (Amritsar), Govt. Medical College (Patiala) in Punjab. 16) SP Medical College (Bikaner), RNT Medical College (Udaipur), Govt. Medical College (Kota), and Government Medical College (Jaipur) in Rajasthan. 17) Government Medical College (Salem), Thanjavur Medical College, and Tirunelveli Medical College inTamil Nadu. 18) Nizam Institute of Medical Sciences (Hyderabad), Rajiv Gandhi Institute of Medical Sciences (Adilabad), Kakatiya Medical College (Warangal) in Telangana. 19) Agartala Govt. Medical College in Tripura 20) SGPGIMS (Lucknow), Govt. Medical College (Jhansi), Govt. Medical College (Gorakhpur), MLN Medical College (Allahabad), LLR Medical College (Meerut), Government Medical College (Agra), Government Medical College (Kanpur), SS B at Institute of Medical Sciences, BHU (Varanasi) in U.P. 20) Kolkata Medical College, Kolkata, BS Medical College (Bankura), and North Bengal Medical College (Darjeeling) in West Bengal.
India is regarded as a leader in the production and supply of high-quality generic medicines to the world. The Centre is encouraging the growth and development of Indian Pharmaceutical and Medical Device Industry and attracting foreign capital through the programme like ‘Make in India’.
The Government is leaving no stone unturned to improve the affordability and sustainability of the healthcare delivery mechanism in India. As per the ‘National Health Profile 2019 (NHP 2019)’, the cost of medical treatment has been on rise in India and it has led to inequity in access to health care services. India spends only 1.28% of its GDP (2017-18 BE) as public expenditure on health. The Per capita public expenditure on health in nominal terms has went up from Rs 621 in 2009-10 to Rs 1657 in 2017-18. The Centre:State share in total public expenditure on health was 37:63 in 2017-18. To fill the gaps in the healthcare delivery mechanism and give timely and effective support to the poor and deprived sections of the society, the Government of India has launched Ayushman Bharat Mission- National Health Protection Mission or Pradhan Mantri Jan Arogya Yojana (PMJAY). This programme is considered to be the world’s largest health scheme which was announced in the Union Budget 2018-19. It is the latest initiative in expanding the health insurance net and targets 10 crore poor and deprived rural population. The Mission aims to provide a cover of Rs.5 lakh per family per year for secondary and tertiary care procedures.
As per the National Health Profile 2019, the country currently spends just 1.28 per cent of its GDP as public expenditure on health. The basic or the primary healthcare needs adequate budgetary support from the Government. The healthcare sector in India is growing rapidly and attracting attention of the global and domestic investors. The potential is huge and is attracting lot of private-sector participation. According to IBEF, the hospital industry in India is forecasted 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 per cent.