Dr Rajesh B. Dhirawani
Managing Director
Jabalpur Hospital & Research, Jabalpur

Future of healthcare industry in India

Healthcare has become one of India’s largest sectors–both in terms of revenue and employment. Healthcare does not only include the hospitals and nursing homes, but also has medical devices industries, clinical trials, out sourcing services like medical transcription, telemedicine, medical tourism, health insurance and medical equipment trading, servicing, and manufacturing. The Indian healthcare sector is growing with a fast pace owing to the strengthening of coverage, services, and increasing expenditure by public as well as private sectors.

Indian healthcare industry comprises of two major categories–public and private. The government or public sector has a limited number of secondary and tertiary care centers, particularly in key cities, and focuses on providing basic healthcare facilities in the form of PHCs in rural areas. In bigger cities, the government has teaching institutions and medical colleges as well as civil hospitals, mostly in Tier-I and Tier-II cities, though some of the state governments are moving ahead by opening up more teaching medical colleges and hospitals in Tier-III cities along with super specialty services.

The private sector provides majority of secondary, tertiary, and quaternary care institutions with a major concentration in metros, Tier-I and Tier-II cities.

India’s competitive advantage lies in its large number of well-trained and highly qualified medical professionals, and also India is cost-effective compared to its counterparts in Asian and Western countries. The cost of treatment in India is about one-tenth of that in the US or in some of the European countries.

India ranks 145 among 195 countries in terms of quality and accessibility of healthcare.

On Indian healthcare
Owing to the large population of India, there is enormous growth of Indian healthcare since the last two decades. The healthcare market is poised grow three-folds to Rs 8.6 trillion (USD 133.44 billion) by 2022.

Indian medical tourism market is also growing rapidly at the rate of 18 percent per year, and is expected to reach USD 9 billion by 2022. Expenditure on healthcare services is also increasing and the government is also spending considerable percentage of GDP on healthcare services. The government’s expenditure on health sector has grown to 1.4 percent in FY18 from 1.2 percent in FY14.

Health insurance sector is also gaining popularity in India. The gross direct premium income has grown at 14.70 percent, i.e., up to Rs 42,328.18 crore (USD 6.06 billion) in FY20 (up to January 2020).

Budget allocation
Some of the major initiatives taken by the Government of India in the health sector are:

  • Nutrition-related program worth Rs 35,600 crore, Rs 69,000 crore outlay for health sector worth inclusive of Rs 64,000 crore for PMJAY in the Union Budget 2020-21;
  • The government aims to increase healthcare services by spending up to 3 percent of the GDP by 2022;
  • The Government of India has launched Pradhan Mantri Jan Arogya Yojana (PMJAY) to provide health insurance worth Rs 500,000 (USD 7124.54) to over 100 million families every year in August 2018. The Government of India has approved Ayushman Bharat National Health Protection Mission as a centrally sponsored scheme contributed by both the center and the state governments; and
  • The Government of India has launched Mission Indradhanush with the aim of improving the coverage of immunization in the country.

On MedTech market
India has high potential for medical devices and equipment industries. India’s healthcare industry is one of fastest-growing sector among the private players also, and is likely to reach around USD 280 billion by the end of this year. The tremendous amount of capital investment is done and more investments are expected in the coming year, particularly in high-end diagnostic services. Indian population is becoming more concerned toward their health upkeep.

Indian health sector is much diversified, and has opportunity in every segment including providers, payers, and medical technology. The hospital industry in India is forecasted to increase to Rs 8.6 trillion (USD 132.84 billion) by fiscal year 2022 from Rs 4 trillion (USD 61.79 billion) in FY2017, with the growth of 16.17 percent. This all will happen in the coming years, driven by rising incomes, greater health awareness, lifestyle diseases, and increasing access to insurance.

My vision is to increase the life expectancy and to improve the physical quality of life of people of our region. Some imperatives are:

  • Provide quality healthcare at affordable cost;
  • Provide preventive and curative healthcare; and
  • Developing human resources for health by training. medical personnel, nurses, and paramedical staff.

On importance of public-private partnership
Public-private partnership in health sector for playing innovative role in financing and providing healthcare services to underserved section of population is particularly critical in the Indian context.

There are various PPP modules, viz., contracting management of primary health centers, community health centers, management of super specialty hospitals, management of CT scan/MRI diagnostics, financing for institutional delivery and infant care, community-based health insurance, mobile health clinics, and development of telemedicine and telehealth centers.

This will help in accessing the private sector finance as well as higher-efficiency advantages in terms of better management of funds with transparency at reduced cost of procurement by bargaining medical equipment and other supplies. It also will help in enforcement and monitoring of work force to reduce the cost of running the health organizations.

On impact of COVID-19 pandemic
Fast tracking of implementation of health emergencies during COVID-19 period has been done within the National Disaster Management plan which includes:

  • Establishment of early warning system;
  • Role of various agencies for emergency management;
  • Management of essential medical supplies, such as vaccines, antibiotics, etc.;
  • Establishment of adequate decontamination and infection-control system;
  • Provision for more critical care ICUs and isolation wards with pressure control and lamellar flow system;
  • Adequate PPE for health workers;
  • Upgradation of earmarked hospitals to cope with the emergencies;
  • Mobile telehealth services and mobile hospitals;
  • Special healthcare and laboratory facilities; and
  • Establishing quarantine facilities.
  • Community awareness toward hygiene will have positive impact that will benefit the hand hygiene producing units, face masks, and disinfectant manufacturers. Awareness to keep healthy will increase the patient load on doctors and laboratories. At the same time, a percentage of patients will avoid going to clinics and hospitals until and unless there is dire emergency;
  • Gaps in care of patients of other ailments, especially chronic diseases in the short term, can lead to long-term burden on healthcare, which will help in further growth of the healthcare industry in future;
  • Strengthening of government infrastructure and PPP modules over next few years, but in near terms will see a major realignment;
  • Internalization of pharma supply chain and Make in India focus for medical equipment, medical devices, etc., will take place, which will reduce the import of these items drastically, and local manufacturers will develop the skills to start manufacturing these goods;
  • Medical tourism will see a down trend, at least in the short term; and
  • There will be increased use of technology, telemedicine, training of primary health workers and mobile hospitals will take place.

Nevertheless, a recession still poses a challenge to healthcare workers and institutions. It all depends on how long COVID-19 spread continues.

Thus, as we face this humongous challenge and focus on sailing through with minimum damage to human lives, there are opportunities to be unraveled for improvement in the healthcare scenario in our country.

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