India, until recently, has seldom been known for its advanced medical technology. Foreign firms with their world-class quality tag have had an upper hand. Spurred by the demand for affordability not only in India, but also in advanced markets, many of the Indian brands have taken initiative to shed the low-tech, poor-quality tag. As a result, India today is emerging as an attractive destination for medical technology manufacturing.

Growing per capita income and adoption of new lifestyles has brought rapid changes in the healthcare services in India. Urban areas have seen the construction of state-of-the-art hospitals and associated satellite facilities. Privatization of insurance has opened new avenues. Patients from foreign shores are looking toward India for their healthcare needs and medical tourism is becoming increasingly popular. Medical equipment, pharmaceuticals, IT, telemedicine, and BPOs (medical transcription, billing, and coding) are collectively redefining the international reputation of Indian healthcare.

ROLE OF PRIVATIZATION

Privatization has been crucial in the development of Indian health services. The private sector has revamped the industry and accounts for 70 percent of the hospitals and 60 percent of the hospital beds. Funds are readily available, infrastructure and technology have improved, and political issues in public hospitals have abated. This has provided the requisite impetus to equipment and devices across segments.

Market Dynamics

The medical equipment and devices industry in India is estimated at Rs. 14,375 crore in 2009. Driven by increasing customer awareness and affordability, coupled with an increasing patient pool, the market is forecast to grow by 12 percent annually for the next five years to reach Rs. 28,370 crore in 2015.

While the ongoing recession continues to hurt businesses around the globe, the medical equipment and devices industry in India seems to have defied this trend. This may be attributed to several ongoing factors. The demand for healthcare is not dependant on the consumer discretionary spending. Healthcare is a necessity and is therefore not likely to be sacrificed. Ill health prompts people to seek medical care, irrespective of the state of the economy. An increasingly affluent and educated patient population continues to demand improved health services. Corporate hospital groups in India are responding to the demand and are building new healthcare infrastructure.

Changing Perceptions

India, until recently, has seldom been known for its advanced medical technology. An indigenous medical devices industry has been virtually non-existent. Local players have struggled to shed the low-tech, poor-quality tag. Regulatory controls were absent until 2005 and barnyard operators competed freely with bonafide local companies. Foreign firms with their world-class quality tag had an upper hand.

Spurred by the demand for affordability not just in India but also in advanced markets facing cost pressures on healthcare budgets, many of the local players are taking steps to develop low-cost, high-quality medical equipment and devices.

Small and medium enterprises (SMEs) have played a crucial role in the development of low-cost products. Because of their quick adaptability, ability to identify market niches and considerable innovative potential, these firms form an important component of the healthcare industry. Accounting for more than 50 percent of all pipeline products, they have a significant role in the future of the healthcare industry.

While SMEs are at the heart of solving dry pipeline problems and creating jobs, all innovation requires funding. Venture capital and equity offerings (IPOs) have been the traditional mainstay for start-ups. Given the turbulent financial environment, this funding has virtually dried up, adversely affecting product development activities at most small businesses. SMEs form the majority of medical device companies. Consequently, they have significant social as well as economic implications. This fact is slowly being recognized by government and industry lobbies, and has led to the introduction of several initiatives to safeguard the interests of SMEs.

MNCs are not resting on their laurels either. They have enabled to narrow down the yawning gap between the needs of the Indian market and the availability of finished products. An estimated 80 percent of India's medical technology market comprises foreign-made products.

The Indian medical technology industry has taken impressive strides domestically, witnessing growth in almost all areas of healthcare. Beyond high growth, it has demonstrated an ability to support the Indian healthcare industry through superior technologies and willingness to serve. Global medical technology companies now view India as a significant market as compared to the developed economies due to its large population base.

India, over the last five years, has been growing in the areas of electronic component manufacturing, mechanical fabrication, biotechnology, pharmaceuticals and information technology. These industries, in one way or the other, provide inputs to medical product manufacturing. As a result, India today is an attractive low cost destination for medical technology manufacturing. Philips has established a Philips Innovation Center in Bangalore Software Technology Park; much of the high-end medical equipment is developed at this world class center. Trivitron has invested in India's first-ever medical technology park in Chennai. A total investment of Rs 250 crore would be incurred in the setting up the 24-acre medical technology park which would be completed by 2012. The main drive for developing the medical park is to position India as an alternate and viable low-cost manufacturing site like China and strengthen its position in the international manufacturing map of medical technology products. Another key objective of this initiative is to bring down cost of medical technology products by around 30-50 percent over next three years and make these hi-tech products accessible and affordable to a larger under privileged section of India. Apart from this, products manufactured in the park will suit the demographic requirements of developing countries, hence improving accessibility and affordability of these products to the rural public. The Government of India has also shown deep interest in promoting such medical parks in the country.

One of the innovations that medical technology has seen is the development of mobile monitoring devices. It facilitates self-management of personal health and helps minimize visits to doctors and hospitals. Tele-health monitors reside in a patient's home and require a simple telephone line connection; voice prompt panels assist patients with medication adherence, appointment scheduling and transmission of: temperature, weight, blood pressure, peak flow, blood oxygen, blood sugar, cardiac and lung sounds, and ECG results. Advanced Monitors now offer virtual home visits and web access via digitized technology. This offers patients and practitioners the ability to share real-time interactive video sessions and transmit pictures of wounds or body parts for review. Once in receipt of this information, healthcare providers can offer immediate diagnosis, treatment or referral.

Mobile monitoring is increasingly complementing home tele-health, with the introduction of medical devices that transfer data via mobile phones to backend servers. Mobile phones directly capture data from medical devices via bluetooth and also provide facilities of web access for health information, video chats, photo messaging for interaction with doctors and SMS text messaging for alerts and reminders.

The latest advancement in mobile monitoring has been the introduction of Picture Archiving and Communication Systems (PACS). Through PACS, medical images in digital format may be viewed on multiple screens and shared between healthcare professionals across locations over an advanced communications system. PACS technology has been changing quite rapidly. It has already allowed clinicians to diagnose with much better accuracy. In future, with more development in algorithms and computing power, computer assisted diagnosis based on radiology data will evolve as a feasible technology and will enhance quality of diagnosis to unprecedented level.

The medical technology market may be segmented into anesthesia equipment, blood pressure monitoring and measurement equipment, cath labs, catheters, defibrillators, dialysis equipment, ECG equipment, CT scanners, endoscopes and accessories, implants and prostheses, infusion technology equipment, nebulizers, MRI equipment, neonatal and infant care equipment, nuclear medicine equipment, oxygen concentrators, patient monitoring equipment, SDB equipment and devices, ultrasound equipment, ventilators, and x-ray devices and accessories.

The anesthesia equipment market primarily constitutes anesthesia delivery machines, anesthesia ventilators and anesthesia workstations. Imported equipment and indigenous equipment are both popular. The anesthesia equipment market witnessed total sales of an estimated 4,000 machines in 2009. Of these, an estimated 300 numbers of high-end anesthesia ventilators with workstations were sold. The mid-segment anesthesia delivery machines had sales of around 500 machines. The value segment constituted the largest portion of this segment in terms of sales of around 3200 anesthesia machines.

Some significant improvements in anesthesia technology have been made in recent years, including the evolution of equipment with integrated functionalities and enhanced ventilation capabilities. Pressure support ventilation (PSV) - a process in which the ventilator automatically completes the breath in a spontaneously breathing patient is a particularly noteworthy advancement. Complete anesthesia workplace solutions (anesthesia device, gas monitoring, vaporizers, patient monitoring, and point-of-case specific IT solutions) are becoming common to ensure seamless data transfer between different components of the anesthesia workplace.

The BP monitor market may be segmented into arm, portable digital wrist type, and portable digital finger type BP monitors. The arm type BP monitors may be further segmented into conventional and digital BP monitors. In 2009, upper arm BP monitors ruled the market. With the growing trend of home monitoring and inclination toward high technology, demand for wrist BP monitors is also increasing. These BP monitors have a high degree of accuracy and appear to have a promising market in India.

Conventional mercury BP monitors are losing ground to digital BP monitors. The risk of spillage of mercury and other adverse mercury related factors in the conventional BP monitors are the prime factors for this decline.

The market for cath labs may be segmented into mobile cath labs and fixed cath labs. Although the contribution of fixed cath labs in the total market is much larger, the significance of mobile cath labs is not any less as it can easily be wheeled into a sterile environment of the OT, which enables the doctor to carry-out procedures with relative ease. With a price much lower than fixed cath labs, mobile labs have become preferred choice for cardiologists.

Better imaging capabilities, which are less user dependent, saving features are available in cath labs. The market for cath labs is shifting from standard IITV detection and camera to flat panel detectors. The emerging trends and technologies are the specialized cardiac centers mushrooming in smaller towns. The hybrid or cath labs for minimal invasive procedures, 3D imaging for electrophysiology procedures, and needle guidance procedures are gaining popularity.

The catheters market may be divided into urological catheters, coronary catheters, intravenous catheters, oximetry catheters, thermodilution catheters, suction catheters, and wound drainage catheters. Although, catheters have widespread applications, their major uses are in the areas of urology, cardiology, and intravenous/infusion therapy. Catheters are used worldwide for several processes involving the administration or drainage of fluids from the body.

Catheters may be constructed with the help of materials such as silicone rubber, latex, teflon, and thermoplastic elastomers. Silicone is becoming highly preferable because it offers several advantages as it is relatively inert and does not react with the body fluids and medications that come in contact with it. Silicone catheters are soft and tissue friendly and offer complete patient comfort. Thermoplastic elastomers or thermoplastic rubbers are also widely preferred for construction of catheters. A thermoplastic material offers both thermoplastic and elastomeric properties and hence has advantages of rubber as well as plastic material.

The market for defibrillators may be broadly segmented into external defibrillators and implantable cardiovascular defibrillators (ICDs). External defibrillators are available as monophasic, biphasic, and automated external defibrillators (AED). The biphasic defibrillator is gradually becoming the technology of choice. Implantable cardioverter defibrillator (ICD), a battery powered device placed under skin beneath the collarbone, is also gaining wide acceptance among cardiologists.

Hemodialysis and peritoneal dialysis are common treatments for dialysis. Hemodialysis accounts for about 90 percent of dialysis therapies. Peritoneal dialysis is a form of home based dialysis treatment. Hemodialysis also may be a home based dialysis and is separate from the hemodialysis performed at the clinics. The home dialysis, which is still a niche segment, is getting attention and experiencing growth, due to the technological advances and the convenience associated with it.

The ECG market is seeing a shift toward advanced technologies. Telemedicine is also an emerging trend as doctors are now opting for sending the data electronically to treat patients located at remote places. Microprocessor based systems have overtaken the conventional systems as they provide accurate ECG. With added features like vector-cardiography, interpretation, and measurement of ECG it has superseded the conventional ECG market.

Technology-wise the endoscopy market may be segmented into invasive and minimally invasive endoscopes. The hottest market of endoscopes for the minimally invasive surgery segment are ENT, women's health, and to a lesser degree general surgery. Owing to escalating opportunities and demand for minimally invasive endoscopy surgery (MIES) procedures, several medical equipment manufacturers are focusing on developing products that are capable of offering minimally invasive surgeries. Orthopedic surgery will also be a huge contributor in the minimally invasive market in the near future.

The market for infusion pumps may be segmented into syringe infusion pumps and volumetric infusion pumps. Market of infusion pumps will be boosted by the increase in number of ICU, ICCU, CCU, NICU, and PICU. Dual pump is the latest development which is becoming popular besides the infusion pumps with single pump.

The MRI equipment market may broadly be segmented into closed (or supercon) equipment and open (or permanent magnet) equipment. On the basis of equipment specification, the MRI equipment market may be segmented broadly into low-field (<0.5 Tesla "T") equipment, mid-field (1.5T) equipment, and high-field (3T) equipment. With the ever increasing demand for patient comfort, the need for replacing conventional closed MRI systems with their open counterparts has intensified. Since many technology developers are taking to the concept of open systems with higher field strength, physicians are able to conduct faster, hassle-free scans that also provide better image quality and often, higher accuracy.

The market for nebulizers may be segmented into compressor based conventional nebulizers, piston based portable handheld nebulizers, and ultrasonic nebulizers, with the latter being the latest development. The introduction of portable compressor nebulizers has provided a boost to the nebulizers market, which was staggering due to the maturity of the conventional compressor nebulizers and the high pricing of ultrasound nebulizers. In meeting patients' need for portability at competitive prices, portable compressor nebulizers are likely to gain momentum due to high growth projections in the bronchodilator/corticosteroid combination therapies market.

The neonatal and infant care equipment market may be segmented into incubators, phototherapy warmers, and dedicated neonatal ventilators. Incubators create a mother's womb-like environment and are hence preferred over warmers that provide basic heat required by the infant. However, sales of incubators are primarily restricted to urban areas or the larger hospitals. High-end warmers have brought a revolutionary change in the neonatal and infant care market segment. The high-end warmers integrate several features including CPAP, weighing scale, pulse oximeter into one unit. This helps the caretakers monitor the infant and also saves space. At the same time LED phototherapy units are also gaining popularity.

The market for nuclear medicine equipment in India may be broadly segmented into positron emission tomography (PET) scanners, gamma cameras, and radioisotopes. Single photon emission computed tomography (SPECT) gamma cameras used in nuclear medicine represent the largest portion of the market for new and used equipment in this field, followed distantly by new PET/CT and SPECT/CT systems. Standalone PET is finding limited usage. There is a strong trend toward higher-end diagnostic SPECT/CT-6 slice to 16 slices.

The market for oxygen concentrators may be segmented into fixed oxygen concentrators and portable oxygen concentrators. The portable oxygen concentrators segment may further be categorized into extremely lightweight concentrators (weighing approximately 5 kg), lightweight oxygen concentrators (weighing around 14-15 kg), and other portable oxygen concentrators. Portable oxygen concentrators have made it possible to provide a reliable source of oxygen at all times, even when away from an AC adaptor. Most battery-powered portable oxygen concentrators can deliver at least 1 liter per minute (LPM) of oxygen.

Novel technologies in patient monitoring are emerging to meet the increasing demands of an ageing population, decreasing healthcare resources, and an emphasis on reducing hospital stays. The central station patient monitoring market has been evolving rapidly in the recent years, with central stations' integration into the hospital clinical information systems (CIS), LIS, and HIS. The growth of this market is directly associated with the growth of bedside and telemetry monitoring. The latest advancement in wireless monitoring has been the introduction of Picture Archiving and Communication Systems (PACS). Through PACS, medical images in digital format may be viewed on multiple screens and shared between healthcare professionals across locations over an advanced communications system.

The market for sleep therapy and diagnostic equipment and devices may be segmented into CPAP (continuous positive airway pressure) devices and NIV-BiPAP (bi-level positive airway pressure) devices. In the sleep diagnostic market there is a growing trend toward home diagnostics devices. A take-home test is about 35 percent cheaper to administer and also allows the patient the comfort of sleeping in his own bed.

B&W stand-alone ultra sound system is almost vanishing from the market and is fast being replaced by high, mid and low-end color doppler systems. Although the high-end color doppler ultrasound equipment are gaining ground, mid- and low-end color doppler ultrasound equipment accounted for the majority share in the total color doppler ultrasound segment. The trend toward miniaturization and quick adoption of hand-carried ultrasound equipment is fueling the growth. The new technologies like fusion imaging, contrast imaging, and elastography are also becoming increasingly popular.

The Indian market for ventilators may broadly be segmented into high-end ventilators, mid-end ventilators, and low-end ventilators. Based on application, the market may be segmented into adult, pediatric, neonatal, non-invasive ventilators, portable ventilators, transport ventilators, and disposables. However, there is a high demand for portable and common ventilators that can be used among all the age groups.

The X-ray market in India may broadly be segmented into X-ray imaging equipment and X-ray film processors. X-ray imaging equipment segment may further be segmented into X-ray cardiovascular angiography equipment, X-ray general radiography equipment, X-ray mammography equipment, X-ray radiography and fluoroscopy equipment, dental X-ray equipment, and mobile X-ray equipment. The X-ray imaging equipment market is witnessing a major shift from analog to digital radiography. The main reason for this shift is the distortion-free imaging capability provided by digital technology, moreover digital X-rays often look sharper and cleaner than the analog version. At the same time, from two pulse x-ray generators the market is moving towards high-frequency x-ray generators.

The IVD industry constitutes around 14 percent of the total medical equipment and devices industry and is poised to deliver 15 percent growth rate over the couple of years. Advances in human genomics, bioinformatics, miniaturization, and microelectronics often blended with information and computer technology have also led to a growth spurt in the market for in vitro diagnostic (IVD) tests.

The IVD market may be segmented into biochemistry instruments and reagents, blood gas and electrolyte instruments and reagents, coagulation instruments and reagents, hematology instruments and reagents, immunochemistry instruments and reagents, microbiology instruments and reagents, molecular diagnostics instruments and reagents, and urinalysis instruments and reagents.

In the biochemistry instruments and reagents market, reagents accounted for major 65 percent and instruments accounted for the rest. It continues to be an industry where high-value instruments are offered on a complimentary basis and subsequently regular sale of reagents for closed systems are made. Biochemistry instruments may be segmented into fully-automated and semi-automated analyzers. Fully-automated analyzers had a total sale of 970 units, whereas, semi-automated analyzers had a total sale of 9600 units. The open reagents commanded 60 percent of the market share. Although semi-automated analyzers have large presence in the market, fully-automated analyzers are fast gaining accessibility to laboratories and research centers. As lab automation continues to evolve, the drive for smaller, faster, and more-accessible devices is increasing. Completely integrated fully automated systems have gained impetus across all segments of the industry for different types of end users ranging from small labs to multi-specialty hospitals. Besides accuracy, precision, and simplicity of operation, the customers prefer an open system that permits them to choose the reagents thus dissuading the usage of exclusive reagents in closed system analyzers.

The blood gas and electrolyte analyzer market may be segmented into blood gas analyzers, electrolyte analyzers, combination systems, and reagents. The combined systems are required for critical care areas whereas the standalone blood gas and electrolyte analyzer systems find more relevance in laboratories and diagnostic centers. The key feature of interest in this segment is that analyzers are suitable for point-of-care (POC) testing. Unlike most in-vitro diagnostic tests, which are completed in centralized laboratories, blood gas and electrolyte measurements are performed near patients, directly at the POC.

The coagulation instruments and reagent market in India may be segmented into fully automated analyzers, semi-automated analyzers, and coagulation reagents. The current generation fully-automated coagulation analyzers offer broad range of features like primary tube sampling, automatic rerun, dilution capabilities, and chromogenic and immunologic methodologies. Manufacturers of coagulation diagnostic devices have introduced point-of-sales (POS) testing laboratories to ensure quick turn-around-times and better patient care. These kits are catching on rapidly in the market, with even laboratories switching over to high-volume automated analyzers to maintain patient satisfaction.

The market for hematology instruments and reagents may be segmented into fully automated analyzers, 3-part differential hematology analyzers, 5-part differential hematology analyzers, semi-automated analyzers, and hematology reagents. There is a growing preference toward opting for high throughput 5-part differential hematology analyzers. Completely integrated fully automated systems, which combine hematology, biochemistry, and immunochemistry analysis in a single system, have gained impetus across all segments of the industry.

The market for immunochemistry may be categorized into chemiluminescence (CLI) analyzers, radioimmunoassay (RIA) analyzers, immunofluorescence (IFA) analyzers, enzyme-linked immunosorbent assay (Elisa instruments), and reagents. Automation seems to be the buzzword in this segment.

The microbiology market may ideally be categorized into clinical microbiology instruments, industrial microbiology instruments, and reagents. Antimicrobial susceptibility testing methods have shortened the traditional 18-24 hour bacterial incubation period to four hours, while enzyme testing for beta lactamase now takes only a few minutes. The number of automated techniques currently applied to microbiology is small, but is growing rapidly. Polarizing fluorescence, utilizing the principle of fluorescence immunoassay, can now accurately determine antibiotic levels in less than two minutes. Other developments include the use of the limulus assay lysate test for endotoxins, measurement of bacterial ATP by bioluminescence, rapid detection of bacterial antigens, toxins, and antibodies by coagulation techniques and enzyme immunoassay.

The market for urinalysis instruments and reagents may broadly be segmented into fully automated analyzers, semi-automated analyzers, and urinalysis reagents (test strips). The market is witnessing a paradigm shift as laboratories begin to move from manual methods to modern automated urinanalysis systems. The adoption of rapid, automated instruments allows technicians to accurately screen for the presence of bacteria in approximately two minutes.

The medical disposables and consumables may broadly be segmented into surgical devices, syringes and tubings, tongue depressor, medical textiles, medical thermometer, blood sugar meter, coronary stents, knee and hip implant device, pacemakers, and needles. Pacemakers and coronary stents are two of the major contributors in the medical devices market. Orthopedics is one of the largest and fastest-growing segments with the surge in implant market.

Consistent technological advancements have led to the development of modern syringes, which offer several advantages and are used for a variety of medical applications. With the emergence of plastic syringes, the design of the syringes has improved, costs have reduced, and safety enhanced. Disposable syringes seem to be the most popular segment.

Tubings used for medical applications may be manufactured from a variety of materials such as silicone and plastics, including thermoplastics. Plastic tubing has evolved as a result of advances in co-extrusion technology which aids in the development of products that include special formulations and offer unique combinations of desired properties such as strength, flexibility, a high gas-barrier rating and lubricity.

Technological advances in blood sugar meter have made it possible to use smaller and thinner integrated circuit boards. Blood glucose meters now come with more functions, smaller in size, downloadable memory, and may deliver results in few seconds with samples in microliters.

The recent outbreak of pandemics like swine flu has spurred the biomedical textiles industry. Surgical masks, gowns, and other protective devices are being designed to offer better protection. Disposable textiles that provide protection against the spread of HIV, bird flu, and swine flu have also been introduced. Disposable dresses and surgical gowns are equipped with disposable- head caps, face masks with bacteria filters, water-repellant surgical gowns with full sleeves and elastic cuffs interlining with polyvinyl chloride (PVC) aprons, plastic gloves, PVC shoe covers and safety goggles - which are useful in OTs and clinical autopsies.

The laboratory and research equipment industry is a rapidly growing sector. It encompasses several diverse disciplines united by a common goal of development of novel therapeutic agents. This segment includes the instruments used in separation, purification, and analysis of biomolecules in drug discovery and diagnostics. The key growth driver is drug discovery research, which itself follows the increased demand for newer drugs and therapies, worldwide. Moreover, the end of the human genome project has marked revolutions in genomics and proteomics, thus enhancing global research on genes, proteins, and related biomolecules.

The laboratory and research equipment market may be segmented into DNA sequencers, electrophoresis instruments, flow cytometers, gas chromatography systems, homogenizers, HPLC systems, ion exchangers, liquid handling systems, mass spectrometers, microarray systems, microscopes, and thermal cyclers.

The market for DNA sequencing in India may be segmented into manual and automated DNA sequencers, and consumables. As traditional methods of manual DNA sequencing utilize radioactive isotopes to label the DNA which incur high cost in consumables, the manual sequencers are gradually exiting the market. The use of automatic sequencers, on the other hand, in drug discovery has expanded beyond simply decoding genomes to understanding cellular messages in the hopes of developing novel drug compounds.

The Indian flow cytometer market may be segmented into analyzers, cell sorters, and consumables. Cell sorters may further be segmented into high-end, mid-end, and low-end cell sorters. The growth of the flow cytometer market largely depends on the development of smaller, low-cost instrumentation, and the availability of better and effective reagents.

HPLC is one of the dynamic markets in the analytical instruments industry. The market may be segmented into two broad categories: integrated systems and modular systems. The market for HPLC may further be categorized as analytical HPLC, ion chromatography, preparative HPLC, and LC MS. Ion chromatography has also found wide applications in pharmaceutical and biotechnology laboratories. LC MS is the fastest growing technique fuelled by the explosive growth in clinical trials, pharmacokinetics, and drug metabolism studies.

The market for liquid handling systems may be segmented into micro-quantity liquid handling equipment that includes pipettes (single channel fixed volume, single channel variable volume, and multi-channel variable volume), macro-quantity liquid handling equipment that includes pipette controllers, bottle top dispensers, and digital burettes, and fully automated dispensers that essentially comprise fully automated liquid handling workstations. Liquid handlers that use syringe-based or positive displacement methods continue to be the workhorses of the automated liquid handlers market. There has been a major evolution in microplate handlers. They offer increased functionality and convenience. In addition to plates, recent microplate handling devices deliver greater efficiency. The users prefer pipettes with ergonomics, light weight, and plunger action and well-balanced feel, design is a key attribute. Pipettes with rugged look are also being accepted as they look sturdy and durable.

Mass spectrometry (MS) is fast becoming an indispensable field for medical professionals. MS systems are being used for clinical and diagnostics purposes. This trend has been strengthened by the improved robustness and speed of LC separation systems, achievable lower MS detection limits and the ability of MS software to automatically handle complicated acquisition schemes in real time as well as the analysis of very large data file numbers. Proteomics has traditionally been synonymous with 2D gels but is increasingly shifting to the use of gel-free systems and liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS).

The market for microarray systems may be segmented into open microarray systems (including microarray platforms and spotters), closed microarray systems, and consumables. There has been constant demand from consumers for standardized and integrated solutions. In keeping with this, vendors are offering solutions that incorporate multiple products such as arrayers, readers, software, slides, and content. New solutions are integrating a scanner, software, and hybridization equipment.

Blood banking is a cornerstone of emergency and surgical medicine and is dependent on the clinical laboratory for ensuring the safe use of blood and its components. There is constant pressure on the blood bank for meeting the high demand of blood. Availability of adequate blood supply is an important parameter which many times decide the course of a treatment. And, with the ever present gap between demand and supply, its efficient collection and management holds significance. The importance of blood safety cannot be underemphasized, either. Procuring latest equipment, improving their standards by opting for the best available technology, and striving hard to increase the donation capacity are a few initiatives taken by the Indian blood banking sector. Accreditation mechanism is also providing a format for blood banks towards improvement in blood safety. One of the most important aspects of accreditation is to continue checking performance by way of participation in External Quality Assessment Schemes (EQAS)/Proficiency Testing. This mechanism provides an opportunity to blood banks to compare its results with other blood banks. The National Accreditation Board for Hospitals and Healthcare Providers (NABH) has started its own EQAS with the able support of a group of pathologists, immunohematologists, and doctors involved in blood banking. Many blood banks have enrolled in this program and are making use of outcomes in correcting and improving their processes. The total blood banking market may be segmented into blood collection monitors, blood donor couches, blood tube sealers, plasma thawing and cryoprecipitate baths, blood bank centrifuges, platelet agitators, blood storage bags, blood bank refrigerators and low temperature freezers, and blood cell separators.

The automation of laboratories has driven the market toward new developments. Companies are forming strategic alliances with software and computer firms to combine automatic handlers and analyzers with their products, thus reducing human intervention. Product improvement, driven primarily by the fear of disease, includes modifications like centrifuge shields to prevent inadvertent splattering of blood, refined blood bag design to simplify technologist use and patient connection, and simplified labeling. Blood donor couches are now making way for blood donor stations with facilities for complete donor care. Blood collection monitors are incorporating advanced features including multiple-donor management, pre-installed fully-automated system for more control on the quality of blood collections, and donor health while donating. Online blood collection monitoring helps in effective data management system and enables better way to trace quality of blood collection.

Apheresis being an essential aspect of blood banking and cell separation systems, is not only restricted to SDP (single donor platelets), but is extensively used in different clinical settings including therapeutic plasma exchange, antibody depletion, and peripheral stem cell collection. Leukoreduction (LR) is also making inroads in Indian blood banking industry. In blood banks in metro, presence of leukoreduction up to LOG 3/LOG 4 can be seen. Inclusion of nucleic acid testing (NAT) in transfusion guidelines is already in process as India has high rate of sero-positivity of HIV, HCV, and HBV. Another significant development is the introduction of platelet bacterial contamination test. Verax PGD, a rapid point-of-care test, can be performed in lesser than 30 minutes and is designed for use in hospitals, cancer centers and other sites of care as a safeguard prior to transfusion.

Hospitals and health centers need equipment and utilities for a seamless and hygienic delivery of treatment. Ambulances, hospital hygiene and disinfection products, lighting equipment, medical furniture, medical robotics, physiotherapy/orthopedic technology, pneumatic tube systems, and telemedicine equipment constitutes major assistive equipment. Other utilities include audio and television equipment, cooling solutions, communication and information technology, facility management solutions, premises and building technology, UPS system, and water purification systems. Though the market for these essential solutions for hospitals are increasing, health centers still need to attach more importance to the utility of these equipment.

Ambulances have been the first step to help a patient in need of emergency care. In 2009, there was an estimated sale of 1450 ambulances - 200 basic life support ambulances, 1150 advanced life support, and 100 cardiac care / mobile OT ambulances. Unlike some advanced countries, where there are dedicated lanes for ambulances, such vehicles have to share the crowded road space in Indian cities. It is therefore essential that the ambulance vehicles in India are equipped with life support systems. An ambulance is not just a vehicle but it needs to be a mini-hospital, equipped with communication facilities such as video-conferencing and also life support systems and equipment. Air ambulance is a new trend which has started to gain popularity in India. Apollo, for instance, has already started its air ambulance service.

Hospital pneumatic tube systems offer unique solutions for automation in healthcare logistics, materials transportation, and supply chain. From two-way travel to connecting multiple workstations, PTS has seen several modifications. Today, the system comes with various facilities like selection of priority, adjusting the speed, shutting-down a workstation, tracking the canister, and so on. An alarm system is equipped to indicate the arrival of a sample into the lab. PTS comes as a solution to meet the challenges of growing demand and high cost of labor. Several leading hospitals in India have adopted this system and there are several more to be brought under this influence - a market for manufacturers indeed.

Challenges

An effective regulatory system is the need of the hour! Healthcare facilities have yet to reach the Indian masses. Illegal imports and sub-standard equipment continue to command an appreciable market share.

Indian laws seem to encourage trading and levy higher duties on raw materials than on finished goods. Medical technology is capital intensive, but Indian products sell in the value segment. Enforcement for registration of firms is weak and leads to undercutting by the low-quality products from dubious firms.

The US Food and Drug Administration is developing a new set of guidelines that will set tougher scientific standards for data from tests on humans that makers of medical devices submit when seeking approval of their products. The USFDA may urge medical device makers to use more sharply defined targets to measure the success of clinical trials. The agency may also urge medical device makers to more closely follow patients enrolled in such trials to determine whether the targets are met. This will make procedures stringent for the manufacturers, and Indian market will indirectly benefit from this.

The healthcare delivery system is under tremendous pressure to identify and commercialize simple medical solutions quickly to lower costs, control infections, reduce liability and eliminate preventable errors. This demand along with the trend toward more user-friendly home health care products will spur the demand for innovative medical devices.

Opportunities

Medical tourism in India has emerged as one of the fastest growing segments. The high cost of treatment in the developed countries, has been edging patients to look for alternative and cost-effective destinations, including India. Though the Indian medical tourism industry is presently at a nascent stage, it is expected to generate revenue of Rs. 8000 crore by 2012. The number of medical tourists is anticipated to grow at a CAGR of over 19 percent and reach 1.1 million by 2012. Factors such as the low cost, scale, and range of treatment provided in India differentiate it from other medical tourism destinations.

Moreover, the growth in India's medical tourism market will be a boon for several associated industries, including hospital, medical equipment and devices, and pharmaceutical industry. In addition to the modern medicine, indigenous or traditional medical practitioners are providing their services across the country. There are around 726,000 registered practitioners catering to the needs of traditional Indian healthcare. Indian hotels are also entering the wellness services market by tying up with professional organizations in a range of wellness fields and offering spas and ayurvedic massages.

To tap the market and provide effective healthcare solutions, newer models of business such as public private partnership (PPP) and service based models need to be explored. Domestic manufacturing for certain equipment would lead to significant reduction in costs, which would in turn provide incentives to delivery centers and medical technology to penetrate the masses. An additional ray of hope for the industry would be the introduction of a special Act for regulation of medical devices in India by Union Health Ministry to bring them at par with global standards. Considering the rapid increase in demand for healthcare services that have forced the government to rethink upon the delivery model, the government is now ready to think out-of-the-box and proactively involve the private sector to increase the reach of healthcare services. The forthcoming budget 2010 is yet another opportunity to push the healthcare sector into a higher growth trajectory. Research and innovation can play a crucial role. The government will need to step in and provide adequate incentives and recognition. Long-term tax breaks could extend well into the next decade. Customs duties on the import of raw materials for life saving formulations, devices, and equipment would need to be drastically reduced or abolished. Fiscal stimulus will ensure healthcare costs in India are within the reach of the common people. There is a need to create initiatives at the level of Central government to spur private participation in tier II and tier III cities, to ensure cost-effective healthcare for all classes of society in India.