Deepak Venkatesh Agarkhed
General Manager – Engineering, Quality, and Facilities
Sakra World Hospital

Huge Opportunities For The Healthcare Market To Grow In India

As per report from Ministry of Commerce and Industry, the Indian healthcare sector is expected to increase from USD 110 billion in 2016 to USD 372 billion in year 2022.

On the healthcare market in India vis-vis the global market

Broadly the healthcare market consists of healthcare delivery, medical devices and drugs, healthcare education, and healthcare funding. The healthcare delivery has ample opportunities to grow as Indian hospital beds per 1000 of population is 0.9 as against 4.7 for OEDC countries. Indian health expenditure as a percentage of gross domestic products in 2016 is less than 5 and there is strong need to improve like most of the developed countries wherein it is more than 10 percent. The outcome of liberalization has resulted in growing income level, greater health awareness, and improved access to insurance, increased precedence of lifestyle diseases like diabetes, obesity. These are the major factors for growth of Indian healthcare. As per report from Ministry of Commerce and Industry, the Indian healthcare sector is expected to increase from USD 110 billion in 2016 to USD 372 billion in year 2022.

The hospital industry in India stood at USD 61.79 billion in 2017 and is expected to reach USD 132.84 billion by 2023. Due to new government initiates of building AIIMS across India and steady growth of PHC and CHE, the accessibility and availability of healthcare services to the general public will increase. The private sector accounts for the major share of secondary and tertiary care, with a more widely distributed network of care facilities throughout tier I and II locations and other substantially large cities. Despite India’s relatively low per capita expenditure on healthcare to date, India’s market for medical devices is in the world’s top twenty. The global medical devices industry was estimated at USD 228 billion in 2015. The medical devices industry in India is presently valued at USD 5.2 billion and contributes 4–5 percent to the USD 110 billion Indian healthcare industry. With medical parks planned in Gujarat, Andhra Pradesh, and Maharashtra and emphasis on excellence in R&D, the medical devices industry in India is poised to cross a market size of USD 50 billion by 2025.

The Indian pharmaceutical market is the largest producer of pharmaceutical products and a leading player in the global generics market, exporting nearly 50 percent of its production. Healthcare education has improved since independence as the number of doctors (in ’000) in India increased from 61.8 to 535.2 from 1950 to 2000. The number of nurses (in ’000) in India increased from 16.55 to 565.696. Currently, India is having 387 university hospitals, 7596 public hospitals, and 7366 private hospitals for profits. With the liberalizing of government policies, up to 100 percent foreign direct investment is permitted in medical devices, hospital, pharma. In a nutshell, there are huge opportunities for the healthcare market to grow in India. Indians by nature are talented and include skilled clinicians, software engineers. With the government acting like a catalyst (Make in India projects), India can do better in the healthcare market and will be a force to reckon with in the near future in all healthcare delivery, medical devices and drugs, healthcare education. But we must pursue for excellence and nothing less to achieve our ultimate aim to be the number one global player.

On budgetary allocation in healthcare

The government budgetary allocation of `52,800 crore for health in 2018/19 is 1.15 percent of the GDP. Indian health expenditure as a percentage of gross domestic products in 2016 is less than 5 and there is a strong need to improve similar to most of the developed countries wherein it is more than 10 percent. When we see the breakup of healthcare percent in India w.r.t. GDP 3.3 percent is by private health spending and 1.4 percent by government. There is a strong need for the government to increase 2.5 percent of the GDP. The National Health Policy by the present government aims to increase healthcare spending to 2.5 percent GDP by 2025.

On budgetary allocation for the fiscal year 2018–2019 and proportion allotted for the procurement of medical equipment and devices

More than 60 percent of capital budget is allocated for medical equipment and devices.

On vision for health and family welfare and challenges faced while implementing health services

Increase in life expectancy, reduction in stress toward reduction of lifestyle associated diseases, affordable, accessible, and acceptable healthcare delivery to all with more emphasis on preventable aspects should be our vision to build physically and mentally strong young minds in future. This is more toward Government initiatives. The central government is in the process of setting up 1.5 lakh health and wellness centers under the Ayushman Bharat program. NHM aims to address the health needs of under-served rural areas. Intensified Mission Indradhanush aims  at improving the coverage of immunization in the country and reach every child under 2 years of age and all the pregnant women who have not been part of the routine immunization program. The National Nutrition Mission aims to monitor, supervise, fix targets, and guide the nutrition-related interventions across the ministries. MoHFW is planning to spend USD 148.22 million to tackle lifestyle diseases such as CVD, hypertension, obesity, and diabetes in India.

On monitoring the quality of private healthcare

In the year 2014-15, 62.42 percent of health spending was borne by citizens out of their pocket. The quality of care takes a backseat in private hospitals as maximizing the profit is their sole aim. The government should make it compulsory for each hospital to have a quality department which is led by a dedicated person (not multitasking) and reports to management/promoters directly on quality on ground. The entire hospital staff should be sensitized about patient safety and quality. Making accreditation not a choice but mandatory will help improve quality of care provided by hospitals. The government should make it mandatory for all hospitals to capture important key performance indicators like infection prevention related, patient satisfaction index as prescribed in Indian Public Health Standards (IPSG). The renewal of license to a private hospital should include these aspects so that patients will benefit.

On importance of PPP in making healthcare a success

Best practices both like reduction of waste within the process and following ethical practices, running the unit as a business through best management practices without neglecting responsibilities toward patient care will ultimately lead to PPP success.

On areas where government should invest to make healthcare available to everyone on the go

Preventive healthcare including antenatal checkups, universal healthcare through family insurance, more essential medicines under price control, and creation of more beds including the PPP model and encouraging Make in India so that Indian devices are used at a lower cost will help one and all.

On policy interventions that healthcare sector in the state needs to align with the healthcare objectives at the national level

We often find that high end equipment and infrastructure is kept unused in state-run hospitals as people in the system have vested interest to do otherwise and as a result tax payer’s money goes down the drain on account of same. The health ministry finds that over the years, the center’s share in health spending has been declining steadily w.r.t states. For 2017-18, the center was expected to fund 28 percent of the total public expenditure on health while the remaining 72 percent will come from the states. Decentralization is an answer but close monitoring of the state to use fund judiciously and milestone-based fund allocation by the center irrespective of political ideology and alignment of state health policies with the center will help the common people.

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