OVERVIEW OF HEALTHCARE SYSTEM IN INDIA
Healthcare has become one of India’s largest sector, both in terms of revenue and employment. Healthcare comprises hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance and medical equipment. The Indian healthcare sector is growing at a brisk pace due to its strengthening coverage, services and increasing expenditure by public as well private players.
Indian healthcare delivery system is categorised into two major components public and private. The Government, i.e. public healthcare system, comprises limited secondary and tertiary care institutions in key cities and focuses on providing basic healthcare facilities in the form of primary healthcare centres (PHCs) in rural areas. The private sector provides majority of secondary, tertiary, and quaternary care institutions with major concentration in metros and tier I and tier II cities.
India’s competitive advantage lies in its large pool of well-trained medical professionals. India is also cost competitive compared to its peers in Asia and Western countries. The cost of surgery in India is about one-tenth of that in the US or Western Europe.
The government said that as per the projected mid-year population for 2020, the total population of the country aged 18 years and above is approximately 93 – 94 crore and as such, administering two doses to these beneficiaries would require an estimated 186 – 188 crore vaccine doses. Out of this requiremet, 51.6 crore doses will be made available for administration by July, 2021, leaving requirement of approximately 135 crore vaccine doses for complete vaccination to the eligible population..
Healthcare Infrastructure Statistics
Health infrastructure is an important indicator for understanding the health care policy and welfare mechanism in a country. Itsignifies the investment priority with regards to the creation of health care facilities. Infrastructure has been described as thebasic support for the delivery of public health activities. Effective public health actions rely upon a well-trained public healthworkforce and good and sufficient health infrastructure.
- Medical education infrastructures in the country have shown rapid growth over the past few years. The country has 529 medical colleges, 313 Dental Colleges for BDS &253 Dental Colleges for MDS. The total number of admissions for academic year 2019-20 in Medical Colleges is approx.70,000 including Government & Private Medical colleges. The Dental Colleges saw an admission of 26,960 in BDS and 6,288 in MDS in the academic year 2018-19.
- India has 1909 Institutions for ANM with an admission of 55263, 6,861 Institutions with an admission of 267,564 for Nursing and 1,682 Pharmacy Institutions with an admission of 99,145.
- There are around 21,403 rural hospitals with 265,275 beds and 4,375 urban hospitals with 448,711 beds in India.
- There are 4,035 hospitals and 27,951 dispensaries to provide Medical care facilities for Ayurveda and Naturopathy medicine under AYUSH Ministry.
- Health-care is the right of every individual. 60% of population lives in rural India. To cater the health needs of these rural populations there are 158,417 Sub Centers, 25,743 Primary Health Centers and 5,624 Community Health Centers in India.
- Total no. of licensed Blood Banks in the Country is 3,108 (approx.)..
- The country has 469 Eye Banks till January, 2019.
- The Central Government Health Scheme (CGHS) was started under the Ministry of Health and Family Welfare in 1954 with the objective of providing comprehensive medical care facilities to Central Government employees, pensioners and their dependents residing in CGHS covered cities. At present, CGHS has health facilities in 37 cities having 288Allopathic Dispensaries and 85 AYUSH Dispensaries in the Country. There are 11.413 lakh registered card holders with total 33.96 lakh number of beneficiaries.
MEDICAL TOURISM IN INDIA
India, with its ancient and modern heritage, diversities of culture and exotic destinations is always an attraction to international travellers. Medical travel offers a mix of pleasure, luxury and quality healthcare for medical patients coming to India.The estimated Foreign Tourist Arrivals (FTAs) in the country on Medical purpose during the years 2016, 2017 and 2019 are 4.27 lakh, 4.95 lakh and 6.97 lakh respectively.
India is a large market for travel and tourism. It offers a diverse portfolio of niche tourism products – cruises, adventure, medical, wellness, sports, MICE, eco-tourism, film, rural and religious tourism. India has been recognized as a destination for spiritual tourism for domestic and international tourists. In Independence speech from Red Fort, Prime Minister of India urged people to visit 15 domestic tourist destinations in India by 2022 to promote tourism. India was ranked 34th in the Travel & Tourism Competitiveness Report 2019 published by the World Economic Forum.
Total contribution by travel and tourism sector to India’s GDP is expected to increase from INR. 15,24,000 crore (US$ 234.03 billion) in 2017 to INR. 32,05,000 crore (US$ 492.21 billion) in 2028. Total earning from the Medical sector in India stood at US$28.6 billion in 2018 and is targeted to reach US$50 billion by 2022.
Around4.2 crore jobs were created in the tourism sector in India which was 8.1% of total employment in the country. According to WTTC, India ranked 3rd among 185 countries in terms of travel & tourism’s total contribution to GDP in 2018. International Tourists arrival is expected to reach 30.5 million by 2028.
Hotel & Tourism sector has receivedcumulative FDI inflows of US$12.96 billion between April 2000 and June 2019.India’s medical tourism industry could grow by 200% by 2020, hitting US$9 billion, according to Ministry of Tourism figures. As it tries to expand the industry, the country is trying to make it easier for people to come for medical reasons. It’s touting advanced facilities, skilled doctors and low-cost treatment but also traditional practices such as yoga and Ayurveda.
MAJOR HEALTHCARE ISSUES IN INDIA
- Awareness or the lack of it: How aware is the Indian population about important issues regarding their own health? Studies on awareness are many and diverse, but lacunae in awareness appear to cut across the lifespan in our country.
- Access or the lack of it: Barriers to access in the financial, organizational, social, and cultural domains can limit the utilization of services, even in places where they are “available.
- Short of Healthcare Manpower: The doctor-population ratio in India is 1:1456 against the WHO recommendation of 1:1000. India has shortage of an estimated 6 lakh doctor and 2 million nurses.
- Shortage of Healthcare Infrastructure: Issues in regard to public and private health infrastructure are different and both of them need attention but in different ways. Rural public infrastructure must remain in mainstay for wider access to health care for all without imposing undue burden on them.
In India, hospitals are mostly located in metropolitan cities, and not in rural areas or emerging cities. The current strength of hospital beds is about 7.14 lakh and another 7 lakh needs to be added in the next 10 years. Ideally, it needs to be four beds per 1,000 people, keeping in mind the sheer geographical spread of the country and the geography’s varied population density. A research study has revealed that the lack of adequate healthcare infrastructure is a prime factor denying access to patient healthcare. The study was initiated by India Health Progress to find the principle reasons which are hampering the healthcare access to Indian patients. Secured Governancestrategy designed to minimise the gap ofHealthcare infrastructure of the social sector and promote private participation in infrastructure development.The value and valuation strategy offers sophisticated funding mechanism and tailored to the economic growth and generate huge employment opportunity.
WORKING TOWARDS BUILDING A HEALTHIER INDIA
Healthcare industry in India comprises of hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance and medical equipment. The industry is growing at a tremendous pace owing to its strengthening coverage, services and increasing expenditure by public as well as private players.
Growing incidence of lifestyle diseases, rising demand for affordable healthcare delivery systems due to the increasing healthcare costs, technological advancements, the emergence of telemedicine, rapid health insurance penetration and government initiatives like e-health together with tax benefits and incentives are driving healthcare market in India.
- Current financial year, India is expected to rank amongst the top 3 healthcare markets in terms of incremental growth
- The present year, the healthcare information technology market is expected to grow 1.5 times from current US$1 billion
- By 2022, the diagnostics market is expected to grow at a CAGR of 20.4% to reach US$32 billion from US$5 billion in 2012
- Current financial year, the Indian telemedicine market is expected to grow at a Compound Annual Growth Rate (CAGR) of 20% to reach US$32 million from US$15 million
- 100% FDI is allowed under the automatic route for Greenfield projects. For investments in brownfield projects, up to 100% FDI is permitted under the government route.
Industry Marker Size
The healthcare market can increase three-fold to INR. 8.6 trillion (US$ 133.44 billion) by 2022. In Budget 2021, India’s public expenditure on healthcare stood at 1.2% as a percentage of the GDP.
A growing middle-class, coupled with rising burden of new diseases, are boosting the demand for health insurance coverage. With increasing demand for affordable and quality healthcare, penetration of health insurance is poised to expand in the coming years. In FY21, gross written premiums in the health segment grew at 13.7% YoY to INR. 58,584.36 crore (US$ 8.00 billion). The health segment has a 29.5% share in the total gross written premiums earned in the country.
- The hospital industry in India, accounting for 80% of the total healthcare market, is witnessing a huge investor demand from both global as well as domestic investors. The hospital industry is expected to reach US$132 billion by 2023 from US$61.8 billion in 2017; growing at a CAGR of 16-17%.
- The Indian Medical Tourism market is expected to grow from its current size of US$3 billion to US$7-8 billion by upcoming financial year.
- The diagnostics industry in India is currently valued at INR. 86,000 crore (US$11.41 billion). The share of organized sector is almost 25% in this segment (15% in labs and 10% in radiology).
- The primary care industry is currently valued at US$13 billion. The share of organized sector is practically negligible in this case.
Between April 2000 and December 2020, FDI inflows for drugs and pharmaceuticals sector stood at US$ 17.74 billion, according to the data released by Department for Promotion of Industry and Internal Trade (DPIIT). Some of the recent initiatives in the Indian healthcare industry are as follows:
- In April 2021, Tata Digital infused Rs. 100 crore (US$ 13.45 million) debt in 1mg, the online medicine start-up, and was in the final stages of acquiring a controlling stake in the company.
- In April 2021, the Ministry of Ayush and Council of Scientific & Industrial Research completed multi-centre clinical trial of a AYUSH 64 (a medicine) and found it useful for treatment of mild-to-moderate COVID-19 infections.
- By March 2021, India exported more vaccines than it had administered to its citizens—60 million doses had been dispatched to 76 countries, while 52 million doses had been administered to Indian citizens. Apart from vaccines, drugs indicated for COVID-19 treatment too witnessed an uptrend in exports.
- In March 2021, Union Health Minister informed the Rajya Sabha that 157 medical colleges are under various stages of implementation across India. Of this, 58 colleges are in the first phase of implementation, 24 in the second phase and 75 are in the third phase.
- In March 2021, gross written premiums of health insurance companies in the non-life insurance sector increased by 41% YoY to Rs. 2,185.05 crore (US$ 294 million), driven by rising demand for health insurance products amid COVID-19 surge.
- On March 17, 2021, the Health Ministry’s eSanjeevani telemedicine service crossed 3 million (30 lakh) teleconsultations since its launch, enabling patient-to-doctor consultations from the confines of their home, and doctor-to-doctor consultations.
- In March 2021, Virchow Biotech, a Hyderabad-based firm, and the Russian Direct Investment Fund (RDIF) announced a collaboration to manufacture up to 200 million doses of the Sputnik V vaccine in India.
- In February 2021, India approved the commercial supply of 24 million doses of COVID-19 vaccines to 25 countries, more than 2x the 10.5 million vaccines exported in January 2021. Through this, seven countries, including Brazil, Morocco, and South Africa, were sent >~10 million doses on a commercial basis.
The covid pandemic has conclusively proved that the traditional brick and mortar method of healthcare delivery alone is no longer tenable, and we must urgently adopt a hybrid model of healthcare delivery system which includes Digital Health. The Indian healthcare scenario is dominated by fragmented, undigitized health data despite availability of technology. The Covid 19 Pandemic has ushered urgency and dependency on relevant data for managing health to provide comprehensive healthcare. To address the massive challenge of providing universal healthcare in the Indian subcontinent, it’s imperative to create a long-term virtual health strategy integrating online and in-person healthcare when and where it’s needed.
The covid pandemic enabled the explosion of telehealth and telemedicine technology as it became the perfect solution to the industry’s problem. This solution ensured that patients could consult their doctors online from the comfort of their homes thus also protecting themselves from the devastating pandemic. Most of the corporates also adopted the work from home culture as it was unsafe to venture out during the height of the pandemic. Thus, telemedicine became the preferred option for patients to consult their doctors except in cases of emergencies or surgeries where they had travel to the hospital. Most corporates are now beginning to realise the benefits of a hybrid workforce, those attending onsite office work and those who work from home (WFH) as it leads to reduced costs and an increase in productivity. The healthcare industry has also realised this and began to adopt various methods of remote patient monitoring using wearable gadgets and other medtech devices to cater to the increased WFH workforce.
Secured Governance is a novel strategy that consists in promoting infrastructure (Healthcare HUB) development that integrated with all key supporting sectors such as transport, power, telecom, banking, education etc.This is not new. We all know when development takes place there is valuation in property. Who benefits from this? More often than not it is incidental and taken advantage off by land and property sharks. Imagine a model where this valuation can be ploughed back into the project and benefit the people around. First the development cost of the Healthcare HUB is reduced and can be at negligible cost to the government if carefully planned. Next the population sees it as benefitting them and so they participate more enthusiastically, helping with early completion of the project rather than being an impediment.The strategy provides a genericpathway to capture a part of the increasedvalue by investment made by private stakeholders and helps repayment of loan for infrastructure (HUB) development. This mechanism helps to bridge the gap of healthcare population ratio drastically.
Indianeeds to be becoming a major international HUB for the global healthcare industry. It is already home to the world’s largest medical tourism zone. The HUBs would stimulateprivate investment in new developments from domestic and international players, Research & Development in medical field, advanced technology zone including global University for Healthcare sector and its focus on becoming a global medical tourism HUB. The HUB of a diverse healthcare economy that includes the life sciences and a digital health cluster that leverages the strong private investment/venture capital landscape, major academic medical centers, institutions of higher learning and a highly skilled and educated workforce to meet the shortage of healthcare workers in India. Around 700+ Mini medical HUBs with 50 bed facilities and more than 10,000 nano medical HUBs need to be developed in all the districts of India. Rural people could get easy access in this healthcare mini HUB. There could be a strong commitment from both the public and private sectors. Players from both sides are working together and investing to continue building an ecosystem that fuels innovation in the life sciences and digital health industries. The healthcare innovations and unprecedented public-private support could boost the healthcare economy in Indiaand lead the sustainable economic growth.
We know that nations need a healthy population to prosper. Stepping up investment in public healthcare is pivotal to sustaining India’s economic growth. India needs to invest more in public healthcare and build a robust health delivery system in all aspects, including infrastructure and human resources,with special focus on rural areas also. It is necessary to take swiftly advance and accelerate progress towards proper public health and effective response to achievesustainable development Goals, especially the health goal.
The General Government Hospitals and primary healthcare centres are in the heart of Urban and semi urban area of India.All these infrastructures and buildings are important existing assets of India that may impact on values. The influence area of public hospitals stimulates long-term growth of value. Local government need to allow additional Floor Space Index (FSI) for Government and private hospitals. With additional FSI, these healthcare administrators could aim for better utilisation of the space and that leads to open avenue of sustainable revenue to the management. The additional revenue could meet around 60% of healthcare maintenance expense and other new infrastructure development.
The battle is like third world war between Covid-19 virus and mankind.The smallest viruses are most elusive and invisible enemy on earth — which has superior intelligence that surpasses human intelligence in many ways.The wild viruses are marching on like wildfire across the world, killing increasing number of people mercilessly at an alarming rate. Surely,we need strategic approaches that can produce expected success in terms of curtailing the spread of the COVID – 19 and reducing the number of deaths without causing an economic downturn or total collapse of the country’s economy.
In this context our country needs to be boost investment in healthcare sector to meet efficient health response and service. The insufficient funding allocation of government on healthcare sector and high out-of-pocket expenditure cannot meet all the demands and needs of the virus infected population. Secured Governancea novel strategy designed to minimise the gap ofHealthcare infrastructure and services of the social sector and promote private participation in infrastructure development.The value and valuation strategy offers sophisticated funding mechanism and tailored to the economic growth and generate huge employment opportunity.
Dr. P. Sekhar,
Global Smart Cities Panel,
Lifeline Group of Hospitals and Director,
an Indo US Healthcare system provider