+ All Categories
Home > Health & Medicine > Grant thornton healthcare east

Grant thornton healthcare east

Date post: 14-Jul-2015
Category:
Upload: misbah-hussain
View: 364 times
Download: 13 times
Share this document with a friend
Popular Tags:
48
9th Healthcare East on “Creating smart hospitals, developing smart facilities to fit in smart patients” 20 September 2014 Kolkata The Eastern Highway Progressing towards smarter health for all
Transcript
Page 1: Grant thornton   healthcare east

9th Healthcare East on “Creating smart hospitals, developing smart facilities to fit in smart patients”

20 September 2014

Kolkata

The Eastern Highway – Progressing towards smarter health for all

Page 2: Grant thornton   healthcare east

2 CII-Grant Thornton

The Healthcare industry 04

The East India story 10

News-wise 19

Deal space and funding mechanisms 23

Conclusions and recommendations 31

Appendices 35

Contact us 47

Contents

Page 3: Grant thornton   healthcare east

It‟s robust times for the Indian healthcare sector as

it evolves from being a provider of trained

manpower to the rest of the world to a provider of

world-class care. So much so that India is poised

to become a preeminent Asian nation in the

business and has begun to pique interest from

larger international strategic operators.

Things look bright for the sector over the next few

years. More and more people are warming up to

the idea of health insurance (private as well as

state-funded). This can mean only one thing:

further penetration of affordable healthcare across

the country. Further shots in the arm will come

from fiscal benefits, technological advancements

and policy changes. It‟s an environment tailor-

made for India to hone its global competitive edge

in the healthcare sector.

Areas of concern remain, though. The demand for

healthcare delivery and services remains healthy,

but marred by wide inter-regional disparities. Rural

India is particularly underserved. Nowhere is it

better demonstrated than in the eastern half of our

country. There is a huge surge in the number of

new hospitals and diagnostic centers in the region

as well as in the flow of investment to cities such

as Kolkata, Bhubaneswar and Ranchi. Yet the lack

of infrastructure and skilled workforce are clogging

up the growth trajectory.

In this paper, we seek to map the current state of

affairs in the healthcare delivery space in the

eastern states, explore recent trends in the sector,

identify key areas requiring immediate action and

offer recommendations that can ensure equitable

access and quality healthcare to all.

Foreword

CII-Grant Thornton 3

Page 4: Grant thornton   healthcare east

The Healthcare

industry:

An overview

Page 5: Grant thornton   healthcare east

Government of India has articulated a

reform oriented agenda to kick start the

economy and attract foreign investment. It

is focusing on inclusive growth, regulatory

reforms and a transparent policy

environment that would enhance the ease

of doing business in India.

Overall healthcare market in India

The healthcare sector in India is the third

largest contributor to the economy in

terms of revenue and potential for

employment generation. The Indian

healthcare sector encompasses hospitals,

pharmaceuticals, medical technology and

health insurance.

Among the primary sub-sectors,

hospitals and pharmaceuticals account

for the largest revenue generation,

contributing as much as 71% and 13% of

total revenues, respectively. Hospitals,

along with the pharma segment, are

expected to be worth US$81.2 billion by

2015.

Government of India has taken steps in this

direction for several sectors and industries.

Announcements in the new Budget are

likely to make the tax regime rational,

simple, non-adversarial and conducive to

investment. In addition, the promised

infrastructure development and

modifications to the Companies Act, 2013,

will boost growth. In all this, however, the

long-standing demands of the healthcare

sector remain unaddressed till date.

Healthcare

delivery

(Hospitals

and

Diagnostics) Estimated size:

US$ 32 billion

Includes

government and

private hospitals.

Diagnostics include

businesses and

laboratories

01 Pharma and

Biotech Estimated size:

US$ 16 billion

Includes the

manufacture,

extraction,

processing,

purification and

packaging of

chemical materials

to be used as

medication for

humans or animals

02 Medical

Insurance

Services Estimated size:

US$ 10 billion

Includes health

insurance and covers

an individual's

hospitalisation

expenses and medical

reimbursement

04 Medical

Technology Estimated size:

US$ 4.4 billion

Includes

establishments

primarily engaged in

manufacturing

medical equipment

and supplies such as

surgical, dental,

orthopedic,

ophthalmological &

lab equipment

03

CII-Grant Thornton 5

Page 6: Grant thornton   healthcare east

Economy, demography and industry

Indian

economy:

average annual

growth rate

over the past

half century

• During the ‟50s, ‟60s and ‟70s: 3.5%

• During the ‟80s: 5.7%

• During 1990-2005: 6.0%

• During 2005-10: Averaging at 8.9%

• During 2010-11 (8.9%), 2011-12 (6.7%) and 2012-13

(4.5%)

Cost advantage

of the

healthcare

sector in India

• Lower costs – infrastructure, operations and manufacturing

• Costs incurred for manpower are 15% lower than in the US

• Low cost of clinical research has made India a hub for

R&D for international players

• The rising numbers of middle class, ageing population and

growing healthcare awareness are also factors contributing

to growth in this sector

Unparalleled

demographics

• Over 1 billion population; 52% below the age of 25

• Median age of population will remain 30 years even till as

late as 2025

• Workforce (15-59 year age group) in India would grow to

approximately 325 million by 2050

• Today‟s youth in India is expected to drive tomorrow‟s

boom

6 CII-Grant Thornton

Page 7: Grant thornton   healthcare east

Healthcare market drivers

Decreasing physical activity, increasing consumption of unhealthy food, longer average life

span, rising income levels as well as increasing consumption of tobacco and alcohol have led

to a rise in the incidence of a heterogeneous group of diseases, including cardiovascular

disorders, chronic respiratory conditions, diabetes and cancer in the Indian population 1 • Only 230-240 million of the 1.2 billion Indian population has some form of health

insurance. This leaves the field wide open and a tremendous scope for growth

• Private insurance coverage will grow by nearly 15% annually till 2020

2 The Indian Medical Tourism Conference and Alliance (IMTCA) has predicted that the

Indian medical tourism industry will contribute over 25% of the total GDP

of the country over the next five years 3

Over the past two decades, a number of Indian private sector companies have set up

hospital facilities and clinics. Prominent among them are Apollo, Max, Fortis, Global,

Manipal, Care, Columbia Asia and Narayana Hrudayalaya. An estimated total of 150 facilities

cater to those seeking top-of-the-line medical treatment.

Please note that 70%-75% of total healthcare is provided by private players in India 4 With a rapid rise in the income levels of the middle class and the rich, there is an increased

awareness about healthcare, increased spend on healthcare and increased demand for

healthcare facilities 5

Heavy disease burden

Private health insurance

Medical tourism

Privatisation of healthcare

Income levels and awareness

CII-Grant Thornton 7

Page 8: Grant thornton   healthcare east

The healthcare value chain

Government

• District hospitals

• Community health

centers

Private

• Mid-sized secondary

care

• Nursing homes

The Indian healthcare delivery sector has seen both public and private participation and

comprises multi-specialty tertiary care hospitals, mid-sized secondary care hospitals and basic

care driven primary care clinics.

Tertiary care

Government

• Teaching institutions

• Medical colleges

• Super-specialty services

• Mostly in metros and Tier-I cities

• 15% = > 300 beds

• 80% = 200 to 300 beds

• 5% = Average 75 beds

• Mix of colleges, single- and multi-specialty facilities

Private

• Corporate hospitals

• Trust hospitals

Healthcare facilities for those requiring

constant medical attention, including short

period of hospitalisation

Secondary care

• General hospitals

• Absence of super-specialty services offerings

• Present in Tier-II, Tier-I and metro cities

• Patients shift to Tier-I cities for advanced treatment

• OT & ICU usually present

• Mostly 25-100 beds

• Some cases up to 100-200 beds

The basic healthcare

facilities for common and

minor ailments where

prevention is most effective

Primary Care

Government

• Primary healthcare

centers

• Primary role to treat ailments that do not require surgical intervention or advanced care

• Services vary across cities

• May have ICU and minor OT

• Up to 30-40 beds

• Located in smaller towns

• Also in Tier-I, Tier-II cities and metros

Private

• Clinics

8 CII-Grant Thornton

Page 9: Grant thornton   healthcare east

Healthcare service delivery models

Health City

Brief description Illustrative examples

Integrated healthcare facilities of more than 1,000 beds,

spread across a few acres of land and providing multiple

specialties

• AIMS, Kerala

• Apollo, Hyderabad

• Fortis, Gurgaon

• Medanta Medicity, Gurgaon

• Narayana Hrudayalaya, Bangalore, Jaipur, Kolkata

Hub-and-Spoke/ Multi-chain

Tertiary care hospital functions as hub, secondary care

hospitals and clinics as spokes. A hub is a high-end facility

located in a metro or Tier-I city, offering all the state-of-the-

art equipment needed for complex surgeries. Spokes are

traditionally located in Tier-II or Tier-III cities, where patient

affordability is typically low

• Apollo Hospitals

• Care Hospitals

• Global Hospitals

• Fortis Healthcare

• Manipal Hospitals

• Max Healthcare

Single-specialty Hospital

Upcoming healthcare facility models, where hospitals

focus on single-specialty care services

• Eye and Dental: Vasan Healthcare, Dr Agarwal's Eye

Hospital, Centre for Sight, Axiss Dental, EyeQ, Clove

Dental

• Mother and Child: Rainbow Hospital

• Oncology: HCG, International Oncology

• Orthopedics: Mewar Ortho, Hosmat

• Urology/ Nephrology: RG Stone, Sparsh, Nephro Plus,

Nephro Life Davita, Deep Chand, Apex

Primary Healthcare

Closest to the concept of a neighborhood clinic, and the

first point of contact for routine examination

• Express Clinics

• Nationwide

• Vidal Health

Emerging Delivery Models

New service providers are experimenting with different

delivery models focusing on low cost, day care and other

allied healthcare models

• Day surgery centers (Nova IVI)

• Home health providers (IHH in Chennai)

• Portea Medical (Home Health)

• Top Tier >100 beds

• Mid-Tier 30-100

beds

• Nursing Homes <30

beds

Share of public and private sector in healthcare delivery services in India

Abuzz with activity, the sector sees newer models emerge every day, be it

integrated health cities, single specialty chains, multi-specialty tertiary care

34%

19%

26%

40%

14%

11%

26%

30%

2005

2015 Government Hosp

Top Tier

Mid Tier

Nursing Home

CII-Grant Thornton 9

Page 10: Grant thornton   healthcare east

The East India

story

Page 11: Grant thornton   healthcare east

Further development of super-specialties such

as cardio, neuro, transplants, orthopedics and

nephrology

Continue to be a deterrent in the smooth

functioning of hospitals, affecting patient care

services

Strong need for professionals (doctors,

technicians, nurses) conversant both in

medicine and technology. Healthcare workers

too have to be encouraged to work in primary

care centers and an incentive mechanism

developed for qualified professionals to work

in Tier-II and Tier-III cities

Need for super-specialty hospitals

Trade unions and lobbying

Lack of trained manpower

01

02

03

With real estate, technology, manpower

continuing to be key measures for a city‟s

potential for development, existing

infrastructure needs to be leveraged through

technology and mobile units in Tier-II and III

cities. Additional capacity should not be built

till existing bed capacity has been utilised

efficiently. Examples from overseas countries

in this regard would be instructive, where

hospital infrastructure is owned by Real Estate

Investment Trust (REIT) funds

Infrastructure and access to technology 04

Insurance coverage and penetration remain

abysmal in eastern India (other than RSBY

which offers limited support to persons below

the poverty line). With a majority of the

population living in rural areas, the paying

capacity of the people has to be supplemented

by large investments in the insurance sector

The eastern states fare poorly on several

health indicators despite a huge untapped

market. Investments in the sector now seem

to be gradually increasing, with capacity

additions being made, increased complexity of

the specialties being offered, patient flow

getting higher and the increasing participation

of the financing community

Inadequate insurance coverage

Encourage more private investments

05

06

The road less travelled: The Eastern

front

Beyond these roadblocks, unlimited potential!

CII-Grant Thornton 11

Page 12: Grant thornton   healthcare east

Bihar

Substantial gaps in sub-centers, with shortage

of drugs and equipment in primary healthcare

centers, limited manpower and woefully

inadequate training facilities

Jharkhand

Absence of super-specialty hospitals.

Predominance of trust-run charitable hospitals

and doctor-owned nursing homes

West Bengal

Kolkata alone is the preferred healthcare destination

in this part of the country. The city has established

hospitals such as Apollo Gleneagles, Wockhardt (now

Fortis), Narayana Hrudalaya, Medica Superspecialty

Hospital, AMRI, Ruby Hospital, Desun, Sankara

Nethralaya, Vasan, BM Birla Heart Research Centre,

the Calcutta Medical Research Institute, Mission of

Mercy Hospital, Bhagirathi Neotia Woman & Child

Care and Columbia Asia

Odisha

While the state has the highest number of

government hospitals in the country, it fares

poorly on health indicators

Bihar Population: 100,289,000

Doctors: 38,260

Population served per doctor: 2,621

IMR: Rural: 43 (M), 46 (F);

Urban: 33 (M), 36 (F)

MMR (2010-12): 219

Jharkhand Population: 32,334,000

Doctors: 4,373

Population served per doctor: 7,394

IMR: Rural: 38 (M), 41 (F);

Urban: 24 (M), 30 (F)

MMR (2010-12): 219

Odisha Population: 41,453,000

Doctors: 16,786

Population served per doctor: 2,469

IMR: Rural: 53 (M), 56 (F);

Urban: 38 (M), 40 (F)

MMR (2010-12): 235

West Bengal Population: 91,122,000

Doctors: 62,645

Population served per doctor: 1,455

IMR: Rural: 32 (M), 35 (F);

Urban: 25 (M), 27 (F)

MMR (2010-12): 117

1

2

4

3

1 2

3 4 3

The Eastern zone

IMR: Infant mortality rate; MMR: Maternal mortality rate

12 CII-Grant Thornton

Page 13: Grant thornton   healthcare east

How the East fares across state-level

rankings

West Bengal scores over its other siblings in eastern India, being in the first quadrant league of the

national state level rankings.

Note: The above rankings have been derived using parameters such as Below Poverty Line (BPL) indicators, literacy rates,

population density, per capita health expenditure, total government hospitals and beds, infant mortality rates, life expectancy,

Primary Health Care/ Community Health Care (PHCs/ CHCs), registered doctors and other available demographic and

healthcare indicators. Please note that Manipur, Meghalaya, Mizoram, Nagaland, Pondicherry, Sikkim, Tripura and Uttarakhand

as well as the Union territories of Andaman & Nicobar Islands, Arunachal Pradesh, Chandigarh, Dadra & Nagar Haveli, Daman

& Diu, Goa, Lakshadweep have been excluded from the above analysis as data for these were inadequate for consolidation.

Ranks 1-5

Ranks 6-10

Ranks 11-15

Ranks 16-20

Others

City Rank City Rank

Kerala 1 Rajasthan 11

Tamil Nadu 2 HP 12

Maharashtra 3 J&K 13

West Bengal 4 Odisha 14

Karnataka 5 Bihar 15

Delhi 6 Assam 16

AP 7 Haryana 17

UP 8 MP 18

Gujarat 9 Chhattisgarh 19

Punjab 10 Jharkhand 20

CII-Grant Thornton 13

Page 14: Grant thornton   healthcare east

Health insurance in India

Health insurance, which reimburses an

individual‟s hospitalisation and medical expenses,

continues to be a rapidly growing segment of the

Indian insurance industry. Less than 20% of

India‟s population has health insurance. Here too,

government schemes predominate.

The major public health insurance schemes in

India include the following:

Employee‟s State Insurance Scheme (ESIS),

and Central Government Health Scheme

(CGHS), available to all central government

employees; and the Rashtriya Swasthya Bima

Yojana (RSBY), launched by the Ministry of

Labour and Employment to provide health

insurance for BPL families. Beneficiaries under

RSBY are entitled to hospitalisation coverage of

up to Rs 30,000 for most diseases that require

hospitalisation.

Apart from these, there are community-based

healthcare schemes like Yeshasvini

Cooperative Farmers Healthcare System,

Aarogya Raksha Yojana, Rajiv Aarogyashri (in

Andhra Pradesh) and Karuna Trust (in

Karnataka). These help BPL people avail

super-specialty healthcare services.

To make RSBY more meaningful to both the

beneficiaries and the services providers, we

need to relook at the capping. Medicines and

diagnostics should be charged as per the

actual requirement and a percentage discount

on the rate should be established.

14 CII-Grant Thornton

Page 15: Grant thornton   healthcare east

Health insurance in India

20%

Merely 20% of India‟s

1.2 billion population is

covered by health

insurance

4%

Estimated at US$ 3.7 billion,

the Indian health insurance

sector accounts for 4% of the

overall healthcare market in

India

30%

Although growing rapidly at a

compound annual growth rate

(CAGR) of 30.05% in the last

seven years, penetration and

access remain limited

To expand the reach of health insurance, there

have been a number of initiatives in recent years to

involve various stakeholders. These include

coverage for Ayurveda, Yoga and Naturopathy,

Unani, Siddha and Homoeopathy (AYUSH)

treatments and special provisions for senior

citizens, apart from streamlining and bringing

under regulation the practices relating to file and

use of products, pre-insurance health checkups,

etc.

Some key aspects relating to IRDA - Insurance

Regulatory and Development Authority (Health

Insurance) Regulations, 2013, are as under:

• All health insurance policies shall ordinarily

provide for an entry age of up to 65 years

• All individual health insurance shall allow

portability

• Insurers may provide coverage to AYUSH or

non-allopathic treatments, subject to some

conditions

• Claims shall be settled within 30 days of the

receipt of the last „necessary‟ document

• All health insurers and Third Party Alliances

(TPAs), as the case may be, shall establish a

separate channel to address the grievances of

senior citizens

• A sudden downward revision in CGHS rates in

2013 forced a lot of private players to limit the

number of patients under the schemes to

contain the losses on such procedures. For

instance, complicated cardiac surgery

procedures involving costly implants were

revised downward by up to 50%. Rates are

likely to be rectified in the last quarter of 2015

but patients will no doubt suffer in the interim

CII-Grant Thornton 15

Page 16: Grant thornton   healthcare east

State healthcare insurance schemes in East India

East India: Insurance coverage

Broad health insurance schemes offer a modicum of coverage in Odisha and West Bengal. Bihar and

Jharkhand are poorer cousins in this respect, with insurance coverage and expenditure on health in both

states significantly lower than in the rest of the country. People in these states, particularly in the rural

interior, have only the national schemes or community-based health insurance schemes to choose from. A

greater variety in health insurance products would only be too welcome. Access to the RSBY scheme, for

instance, has not dampened community-based health insurance (CBHI) uptake in these states.

Biju Krushak Kalyan Yojana

• Launched in 2013, the scheme is intended to benefit farmers and their families, and improve access to

quality medical care for treatment of diseases involving hospitalisation, through an identified network

of health care providers

Odisha State Treatment Fund (OSTF)

• Launched in 2011, OSTF provides financial assistance to poor patients suffering from life threatening

diseases. For eligibility, the person admitted in Government Hospitals, as in-patient, should be a BPL

Card holder or should have annual income upto Rs 40,000 in rural areas and Rs 60,000 in urban areas

Odisha

West Bengal Health Scheme

• Launched in 2008, the scheme provides cashless medical treatment facility to State Government employees

and their families

• In the new revised scheme, cashless medical treatment up to Rs 1 lakh will be provided to the beneficiaries

for undergoing treatment in private empanelled hospitals within the state including in the National Capital

Region (NCR)

West Bengal

16 CII-Grant Thornton

Page 17: Grant thornton   healthcare east

India has no single government authority to monitor compliance and assess the quality of services provided

by healthcare agencies through regular medical audits. An increasing number of hospitals, therefore, are

applying for, and receiving, accreditation and certification from national and international bodies to prove

their quality standards.

• Constituent of

Quality Council

of India

• The standard

consists of over

600 objective

elements and is

accredited by

ISQua

• Accreditation for

testing and

calibration, and

for medical

laboratories

• Associated with

APLAC, MRA

and ILAC

• Gold standard in

global healthcare

• The Joint

Commission

(TJC) is a US-

based parent

organisation

• Based in Geneva,

ISO is a

voluntary

organisation

whose members

are recognised

authorities on

standards

NABH NABL JCI ISO (National Accreditation

Board for Hospitals and

Healthcare Providers)

(National Accreditation

Board for Testing and

Calibration Laboratories)

(Joint Commission

International)

(International

Organisation for

Standardisation)

Major accreditation bodies in India

NABH Accredited Organisations

Type of Centre Number of pending

applicants

Number of accredited

organisations

Number of accredited

organisations in East

India

Hospitals 435 229 11

Small healthcare organisations 158 30 1

Allopathic clinics 5 13 0

Community health centers 4 1 0

Primary health centers 11 10 0

Accreditation status

CII-Grant Thornton 17

Page 18: Grant thornton   healthcare east

A very small percentage of accredited hospitals and healthcare organisations in India

are located in eastern India. Almost all of these organisations are based in metros and

Tier-I cities such as Kolkata, Ranchi and Bhubaneswar.

Many public hospitals and centers in Tier-II cities have been successful in obtaining

ISO certification. However, ISO standards are not as stringent as those of NABH,

NABL and JCI.

NABL Accredited Organisations

Type of Centre Number of pending

applicants

Number of accredited

organisations

Number of accredited

organisations in East

India

Medical laboratories - 503 53

Type of Centre Number of pending

applicants

Number of accredited

organisations

Number of accredited

organisations in East

India

JCI - 19 1

Joint Commission International

18 CII-Grant Thornton

Page 19: Grant thornton   healthcare east

News-wise

Page 20: Grant thornton   healthcare east

News-wise

The Odisha government, along with National

Thermal Power Corporation (NTPC), is

setting up a medical college and hospital in

Sundergarh district at an investment of Rs 350

crore. The medical college will have 100

MBBS seats, as per the norms prescribed by

the Medical Council of India (MCI). The

hospital will have a capacity of 400 beds.

Not a single government medical college has

come up in Jharkhand in the nearly 13 years

since the state was formed. The state has only

three medical colleges, producing doctors with

just bachelor degrees. These are the Mahatma

Gandhi Memorial College (MGM) in

Jamshedpur, the Rajendra Institute of Medical

Science in Ranchi and the Pataliputra Medical

College Hospital (PMCH) in Dhanbad. None

of them offer super-specialty courses.

Employee‟s State Insurance Corporation is

investing about Rs 1,100 crore in upgrading

hospitals and building a new medical college

in Odisha. In addition, they are setting up a

500-bed super-specialty hospital, as per MCI

guidelines and upgrading an existing 50-bed

hospital in Rourkela to a high-tech hospital

with 100 beds.

To improve access to healthcare services for

four million people and expand medical

infrastructure through public-private

partnership (PPP), the Jharkhand government

has appointed the International Finance

Corporation (IFC) as its consultant. IFC will

help the state government to develop Sadar

Hospital into a 500-bed facility for secondary

and tertiary care, train government staff and

identify private players who can provide

advanced radio-imaging and pathological

services.

UK-based Sun Consulting & Investments

plan to invest Rs 425 crore in a super-specialty

hospital in West Bengal. They also plan to

build a medical college. The company will

form a joint venture with the local Camellia

Group. It will purchase 10 acres of land from

the government for the medical college, while

the super-specialty hospital will come up in

Rajarhat across 2.5 acres.

Kolkata-based Emami Group is also set to

invest around Rs 1,000 crore for a 450-500

bed hospital in Rajarhat.

20 CII-Grant Thornton

Page 21: Grant thornton   healthcare east

The „Ananya‟ programme in Bihar uses mobile

phones to provide healthcare services. Run by

British Broadcasting Corporation (BBC) Media

Action in collaboration with the Bill and Melinda

Gates Foundation, Ananya offers a „Mobile

Academy‟ training course in eight of Bihar‟s

districts. The course seeks to enhance the health

workers‟ communication skills and teaches them

10 life-saving health behaviours. A multimedia

service - Mobile Kunji - provides information on

health issues.

A Durgapur-based group, The Mission Hospital

(TMH), aims to establish a super-specialty

hospital in the Tupudana Industrial Area, on

Ranchi‟s outskirts. Land lease formalities are

already underway.

The government plans to open eight more

medical colleges in Jharkhand, in addition to the

existing three. These medical colleges will come

up in Chaibasa, Dumka, Bokaro and Palamu.

The West Bengal government recently approved

several sops for government employees, including

cashless health insurance.

The Bihar government has directed the Indira

Gandhi Institute of Medical Sciences (IGIMS) and

the Indira Gandhi Institute of Cardiology (IGIC)

in Patna to mentor different district hospitals for

treating heart patients. In the first phase, intensive

care units (ICUs) for heart patients will be set up

across the 17 district hospitals.

Medica Superspecialty Hospital plans to add a

350-bed unit and cancer treatment centre to its

400-bed facility in Kolkata. The new facilities are

part of Medica‟s expansion plans in eastern India,

which include 12 new hospitals in several districts.

News-wise

CII-Grant Thornton 21

Page 22: Grant thornton   healthcare east

News-wise

The Bihar government has issued a directive for

all hospitals to be computerised and for all PHCs

to maintain registration and treatment records of

patients at out-patient departments (OPDs). This

is aimed at keeping a track of medicines

prescribed on a daily basis, as well as the number

of doctors and patients at OPDs and PHCs.

Canara Bank is providing financial aid to the

Orissa Trust of Technical Education (OTTET)

and Biocon Foundation for a unique PPP with the

Odisha government. The project aims to deliver

e-healthcare for the underprivileged and rural

communities of the State.

West Bengal is all set to establish three new

medical colleges in the state. Operated on the PPP

model, the colleges will come up in Krishnanagar

in Nadia, Cooch Behar town in Cooch Behar

district, and Tollygunge in Kolkata. The

Krishnanagar and Cooch Behar projects will be

executed by the State government in partnership

with the Camellia Group. The Tollygunge project

will be rolled out in partnership with the Techno

Group.

Tata Hospital has opened a new wing for cancer

care in Kolkata. An investment of Rs 340 crore

has gone into this facility with 160 beds. The

hospital has spent Rs 4 crore in subsidy for poor

patients. It plans to add another 250 additional

beds at an investment of Rs 200 crore. It will have

three more advanced radiotherapy machines, each

costing Rs 12 crore.

22 CII-Grant Thornton

Page 23: Grant thornton   healthcare east

Deal space and

funding

mechanism

Page 24: Grant thornton   healthcare east

During the period 2011-2014 YTD (Year till date), most of the PE activity was centered around the south,

with companies in eastern India attracting very little interest from PE investors. This was a trend across all

sectors, and healthcare and pharma were not immune to it.

Private Equity (PE) deals landscape

in the East

24 CII-Grant Thornton

North 2011 2012 2013 2014 YTD

Volume 107 92 110 127

US$ mn 2458 2293 2935 2196

Pharma/ Healthcare

Volume 5 8 16 5

US$ mn 42 125 512 36

East 2011 2012 2013 2014

Volume 14 6 15 7

US$ mn 354 30 118 137

Pharma/ Healthcare

Volume 1 1 5 2

US$ mn 3 5 45 10

Page 25: Grant thornton   healthcare east

PE deals landscape in the East

Deal activity in the Indian healthcare sector has historically been driven by PE investments. While interest

level from PE funds continues to be high, we are increasingly seeing strategic players, particularly

international, participating in transactions in India. This is a good development from the perspective that

such operators will hopefully be able to bring in best practices from other parts of the world.

Mahadevan Narayanamoni,

Partner, Grant Thornton India LLP

CII-Grant Thornton 25

West 2011 2012 2013 2014

Volume 127 123 151 125

US$ mn 2486 2298 3893 2502

Pharma/ Healthcare

Volume 4 8 16 7

US$ mn 7 107 219 194

South 2011 2012 2013 2014 YTD

Volume 125 180 176 133

US$ mn 3476 2756 3126 3228

Pharma/ Healthcare

Volume 8 21 35 20

US$ mn 209 669 648 337

Page 26: Grant thornton   healthcare east

The PE factor: Not all quiet on the

Eastern front

An assessment of hospital/ healthcare deals during 2009-2014 YTD presents the following trends:

- Of the 44 multi-specialty hospital fund raises in India, only four have been in eastern India

- Of the 33 primary healthcare deals, including diagnostics, home healthcare and rural healthcare, only

one was in eastern India

- Of the 40 single-specialty hospital deals, only four were in this region

In all, the east Indian states have contributed only 8% to the overall hospital/ healthcare deals since 2009.

Key healthcare investments in East India

Year Investor Investee Sub-sectors US$ mn

2010 Aureos Capital India BSR Super Specialty Hospitals Ltd Multi-specialty

hospital 10.0

2011 Sequoia Capital, Elevar Equity Glocal Healthcare Systems Pvt Ltd Multi-specialty

hospital 3.2

2012 Matrix Partners Enhance Aesthetic and Cosmetic

Studio Pvt Ltd

Dermatology &

Cosmetology 5.5

2013 Ennovent GmbH; Ankur Capital Advisors ERC EyeCare Pvt. Ltd. Eyecare N.A.

2013

Swedfund International AB; Deutsche

Investitions- und Entwicklungsgesellschaft

mbH; Quadria Capital

Medica Synergie Pvt Ltd. Multi-specialty

hospital 25.7

2013 Angel funding through the Intellecap Impact

Investment Network iKure Techsoft Pvt Ltd

Primary

healthcare N.A.

2013 Lighthouse Funds Suraksha Diagnostic Pvt Ltd Diagnostics

centre 9.0

2013 SIDBI Venture Capital Ltd Glocal Healthcare Systems Pvt Ltd Multi-specialty

hospital 4.0

2014 Samridhi Kanungo Institute of Diabetes

Specialities (KIDS)

Diabetes

specialities 2.9

2014 Arun LLC, Mumbai Angels iKure Techsoft Pvt Ltd Primary

healthcare 0.1

2014 Matrix Partners Hearing Plus ENT Clinic N.A.

26 CII-Grant Thornton

Page 27: Grant thornton   healthcare east

Fund fare

India is one of the largest emerging markets in the healthcare industry. The rapid rate of growth in the

healthcare industry and factors like demand-supply gap, need for better infrastructure, high capital

intensity, limited availability of manpower, etc have led companies to seek innovative funding techniques

over conventional fundraising methods. Tier II and Tier III cities resort mostly to conventional funding

techniques for healthcare facilities. The high interest rate on such bank loans makes it unfeasible to fund

and sustain such projects. This is true for most states in the east and is one of the major reasons for the

slower growth of healthcare in this region. Presently, debt financing is the predominant source of capital

for healthcare enterprises. While non-bank financial companies (NBFCs) have, for long, provided such

debt financing, now several private sector commercial banks have incorporated a separate healthcare

portfolio in their line of services.

• Government

budget for rural

and urban

health

• Focused

healthcare

schemes

• Incentives and

subsidies

• Debt and structured

finance

• Private equity

• REIT

• Corporate houses

• Capital markets

• Angel investors/

NRIs

Public Private

CII-Grant Thornton 27

Page 28: Grant thornton   healthcare east

Fund fare

There are various models available under the PPP mode. Several have already been implemented, while

some are in various stages of implementation. The expectation from the government is usually in

support for land and funding whereas private players contribute across the entire spectrum of real estate

development, medical operations and equipment supply. An underlying theme of the PPP route is that

concessional healthcare treatment would form an integral part of this ecosystem.

PPP funding and other collaborative models

A schematic representation of a collaborative model

Concessional

land bank Real estate

developer Medical

operator

O&M (Other

than medical

operations)

Ancillary

(equipment/

pharmacy/

radiology)

Fixed lease

rental/ share

of profits

Private

land or

lease

rentals for

long term

lease

Maintenance

charges

Per

use payments

Share of

profits

28 CII-Grant Thornton

Page 29: Grant thornton   healthcare east

Fund fare

Whether land and building or equipment, funding for healthcare delivery primarily centers around hospital

infrastructure. Innovative new models like REIT may go a long way in reducing financial challenges and

capital outlay for basic healthcare infrastructure. Most healthcare operators concur that access to medical

instruments and technology is not a problem, financing them is. Import duties being prohibitively high,

importing high-end equipment is a challenge for smaller hospitals.

Land and

building

• Most medium-sized hospitals operate out

of leased properties. It‟s the larger

greenfield hospitals that come up on owned

land

• A fortunate few get access to government

allotted land to build their own facility.

However, an accessible and feasible

location automatically hikes up the capital

requirement of hospitals, particularly in key

cities. A lot of the current land ownership is

with charitable trusts, which often makes

structuring and financing options difficult

• Hospitals set up on owned properties can

take long-term bank loans against land as

the guarantee

• Shop-in-shop model is another key trend,

with single-specialty outfits in radiology,

cardiac and the traditional eye and dental

care tying up with larger hospitals and

sharing rent or revenue

- Refurbished equipment too, is becoming a

feasible option for players who cannot

afford first-hand imported equipment.

1 Equipment

• Equipment is another major capital outlay

for hospitals, especially for tertiary or

quaternary care establishments. Different

specialties require different levels of

equipment-related expenditure. Though we

have more cost-effective indigenous

medical devices and equipment now, large

hospitals still prefer to import high-end

devices at a significant cost. Equipment

financing typically happens via:

- Bank loans

- Lease or sale and leaseback

arrangements

- In some cases, the equipment maker

installs the equipment and collects a

guaranteed consumable fee upon use of

equipment and later transfers it to the

hospital at negligible cost (largely for

high end laboratories, diagnostic and

radiology) equipment.

• Refurbished equipment too, is becoming a

feasible option for players who cannot

afford first-hand imported equipment

2

With rising real estate prices (especially in the cities), asset light models are becoming the most viable

for emerging healthcare organisations. For tertiary and higher secondary care, the government must

provide land and other civic amenities at discounted rates and actively facilitate entry of healthcare

entrepreneurs.

CII-Grant Thornton 29

Page 30: Grant thornton   healthcare east

Debt financing

Fund fare

External commercial borrowings

(ECBs)

ECB financing has so far been mired in

countless regulations and approvals, which

is why only a handful of healthcare players

consider it as a funding option. This might

change soon, with RBI looking at relaxing

certain regulations to promote ECBs as an

accessible fundraising route for healthcare

delivery and large pharma projects.

• Although large and small players alike

prefer debt financing, most medium and

relatively smaller players in the healthcare

sector currently rely solely on fundraising

from banks and financial institutions

• The role of banks is imperative in

facilitating healthcare growth. However, the

focus is largely on Tier-I cities, and with

secondary and tertiary care segment only

emerging in Tier II and Tier III cities, the

high interest on bank loans is discouraging.

The risk assessment of healthcare ventures

is another concern for those seeking to

expand their presence in these regions. On

the positive side, healthcare expenditure in

these regions is rising and a flourishing

corporate presence will only encourage

lending institutions to extend credit

30 CII-Grant Thornton

Page 31: Grant thornton   healthcare east

PE and other avenues of financing

Fund fare

Individual investors

In recent years, rural and semi-urban

markets have witnessed a spurt in the

growth of nursing homes catering to

primary healthcare, diagnostic centers and

medical centers/ clinics emulating the hub

and spoke model. Largely the

entrepreneurial effort of doctors and

specialists, they are funded by individuals

owning family businesses. While these

investments are key to bringing the

hospitals to a certain scale and size, they

need to be complemented by other funding

routes to propel healthcare delivery to the

next level.

Private equity

It is estimated that around 20% of new PE or

Venture Capital (VC) funds will be directed at

healthcare services. With no dearth in delivery

models to choose from, these investments

have come in single centre large multispecialty

hospitals aiming to add new centres, as well as

in corporate hospital chains, hub-and-spoke

model hospital chains, shop-in-shop model

hospital networks, primary healthcare clinic

chains, single-specialty centres/ chains (eye,

dental, orthopaedic, cardiac, nephrology), etc.

Foreign investors and capital markets

Currently, regulated by the Consolidated

foreign direct investment (FDI) Policy, foreign

investment up to 100% is permitted through

the automatic route in the healthcare services

sector. However, the lack of transparency, the

comparatively lower quality of service and

assets, the absence of large facilities for

healthcare and the low numbers of listed

hospitals act as inhibiting factors for foreign

investors.

CII-Grant Thornton 31

Page 32: Grant thornton   healthcare east

Conclusions and

recommendations

Page 33: Grant thornton   healthcare east

Conclusions and recommendations

Compared to South and West India, East India continues to somewhat grapple with inadequate

healthcare infrastructure, poor population-to-bed ratio and low percentage of public healthcare

spending. The region requires a concerted effort to improve access to quality healthcare and deeper

penetration in remote areas. Rewarding doctors and hospital operators with higher incentives for

working in remote areas may be one tool. There is also a need for a single-window mechanism that

supplements the capabilities of the collaborating forces like the government, the private sector and not-

for-profit organisations, and forms an effective PPP model that ensures quality and curative healthcare

services to all. Leveraging IT and technology further can bring the masses closer to affordable

healthcare.

Build adequate training facilities and

overcome resistance of trained staff to work

in Tier II and Tier III cities

The skills demand-and-supply gap needs to be

plugged urgently through better education and

training avenues. This can be achieved by:

• Offering doctors higher incentives to work in

remote areas

• Renewing focus on the setting-up of medical

colleges and training institutes

• Designing specific courses for healthcare

delivery and services

Develop patient-centric innovative

healthcare models

• The healthcare model needs to be nurtured in

the collaborative environment of public,

private sector and non-governmental

organisations (NGOs). The real challenges lie

in primary and secondary care. These are the

areas each of the collaborators must focus on

Apply technology and non-conventional

delivery models to healthcare

• Technology can serve as an enabler to

measure outcomes and patient satisfaction,

while also facilitating systems to send

reminders for basic health statistics

• Enable technology to do the first-level

patient care rather than involving semi-skilled

workforce

• Integrate home-based healthcare with

technology and satellite/ internet reach to the

healthcare specialist

Leverage the strengths of the private sector

(centers of excellence, efficiency and quality)

to make cost of delivery economical

• Build more health cities that promote medical

tourism with infrastructure support from the

government

• Corporate players, being the fountainheads of

innovation, need to venture into formats that

involve lower in-patient hospital stay, higher

bed turnover and lower operational costs

CII-Grant Thornton 33

Page 34: Grant thornton   healthcare east

Efficiently utilise existing infrastructure

• Leverage existing infrastructure through

technology and mobile units to Tier II and

Tier III regions

• Limit focus on additional capacity (in larger

cities) until existing bed capacity has been

efficiently utilised

• Encourage overseas models of REIT fund

involvement in developing further

infrastructure

Focused efforts to promote medical tourism

• Government bodies, private and public

healthcare operators and industry bodies

should collectively endeavour to create the

right logistics framework and brand image of

healthcare services in the East to attract

floating medical travellers from neighboring

countries such as Bhutan, Bangladesh and

Burma

• Ensure that India‟s northeastern states, which

already view the East as a healthcare hub,

continue to avail quality healthcare in the

larger eastern states

Adopt PPP model to permit private sector to

expand the coverage of healthcare delivery

and provide diversity of services

• Establish simple PPP models (Ambulatory

services and dialysis test centers) where the

model of engagement is clearly defined both in

terms of deliverable and monetary mechanism

• Make the PPP model viable without

subsidisation or cross-subsidisation

• Create well defined roles in terms of who has

the risk bearing capabilities and who manages

information in the value chain

Set-up state health insurance programmes in

rural areas

• Make public spending on healthcare

independent of other general economic

growth/ downturn

• Learn from the experience of other

Southeast-Asian countries on how to ensure

good health outcomes at lower per capita

income

• Set-up health insurance programmes in rural

areas to ensure widespread reach

• Broaden the scope of public insurance

schemes like Arogyashree and RSBY

• Allocate funds towards controlling non-

communicable diseases (NCDs) and diabetes

Conclusions and recommendations

34 CII-Grant Thornton

Page 35: Grant thornton   healthcare east

Improve patient outcomes with connected

and integrated healthcare

• Primary care and hospital-based

infrastructure needs to be integrated to

provide seamless, uniform and proactive care,

keeping in mind the level of clinician support

(doctor availability and referral channels) that

are available in and around such regions

Create an intermix of competencies and

proactive collaborative action from all

bodies – government, private and not-for-

profit

• The private sector must work towards

creating a regional focus rather than focusing

only on top-tier cities

• The government must ease norms for setting

up medical and institutional infrastructure by

relaxing minimum requirements, mandatory

affiliations with existing government district

hospitals and other private players

Conclusions and recommendations

CII-Grant Thornton 35

Page 36: Grant thornton   healthcare east

Appendices

Appendices

Page 37: Grant thornton   healthcare east

Appendix: NABH accredited

organisations

NABH Accredited Hospitals in the East

B.M. Birla Heart Research Centre, Kolkata, West

Bengal

Desun Hospital & Heart Institute, Kolkata, West

Bengal

Rabindranath Tagore International Institute of Cardiac

Sciences, Kolkata, West Bengal

Medica Superspecialty Hospital, Kolkata, West Bengal

Fortis Hospitals Ltd. , Kolkata, West Bengal

The Mission Hospital, Durgapur, West Bengal

Abdur Razzaque Ansari Memorial Weaver's Hospital,

Ranchi, Jharkhand

Aditya Care Hospital, Bhubneshwar, Orissa

LV Prasad Eye Institute, Bhubneshwar, Orissa

IMS and SUM Hospital, Bhubneshwar, Orissa

Apollo Hospitals, Bhubneshwar, Orissa

NABH Empanelled Hospitals in the East

Hi-Tech Medical College and Hospital, Pandara,

Rasulgarh, Bhubaneshwar

Kalinga Institutes of Medical Science, Patia,

Bhubaneshwar

Kalinga Hospital Limited, Chandrasekhar Pur,

Bhubaneshwar

Raj Hospital and Research Center, Ranchi

Anupama Hospital Pvt. Ltd., Ashok Raj Path, Patna

Magadh Hospital, Rajendra Nagar Road, Patna

Apollo Gleneagles Hospitals Ltd., Kolkata

Armenian Church Trauma Center, Kolkata

B.M. Birla Heart Research Center, Kolkata

Calcutta Medical Res. Institute, Kolkata

Cancer Center Welfare Home, Kolkata

Dafodil Nursing Home, Kolkata

Kothari Medical Center, Kolkata

Mission of Mercy Hospital, Kolkata

Peerless Hospital & B.K. Roy Research Center,

Kolkata

Rabindranath Tagore International Inst. of Cardiac

Sciences, Kolkata

Ruby General Hospital, Kolkata

Wockhardt Hospital & Kidney Institute, Kolkata

NABH Accredited Small Healthcare Organizations

in the East

Kashyap Memorial Eye Hospital, Ranchi, Jharkhand

CII-Grant Thornton 37

Page 38: Grant thornton   healthcare east

Appendix: Health infrastructure

State

Rural Hospitals

(Government)

Urban Hospitals

(Government)

Total Hospitals

(Government) Provisional

/Projected

Population

(000)

Average

Population

Served per

Govt.

Hospital

Average

Population

Served per

Govt.

Hospital

Bed Number Beds Number Beds Number Beds

Bihar 1,325 5,250 111 6,302 1,436 11,552 100,289 69,839 8,681

Jharkhand 545 4,879 4 535 549 5,414 32,334 58,896 5,972

Odisha 1,659 7,099 91 9,584 1,750 16,683 41,453 23,688 2,485

West

Bengal 1,272 19,679 294 58,509 1,566 78,188 91,122 58,188 1,165

Number of government hospitals and beds in rural and urban areas (01.01.2014*)

*Except Jharkhand - Data as on 01.01.2012

Source: National Health Profile, Central Bureau of Health Intelligence

38 CII-Grant Thornton

Page 39: Grant thornton   healthcare east

Appendix: Human resources in

healthcare

Allopathic doctors registered with Central/ State Councils, 2013 (Provisional)

State Number of allopathic doctors

Bihar 38,260

Jharkhand 4,373

Odisha 16,786

West Bengal 62,645

Dental surgeons registered with Central/ State Councils, 2012

State Number of dental surgeons

Bihar 2,807

Odisha 289

West Bengal 3,120

Source: National Health Profile, Central Bureau of Health Intelligence

CII-Grant Thornton 39

Page 40: Grant thornton   healthcare east

Appendix: Healthcare indicators

Projected levels of expectation of life at birth

State 2011-15 2016-20 2021-25

Male Female Male Female Male Female

Bihar 68.6 68.7 69.6 70.2 70.6 71.4

Odisha 64.3 67.3 66.3 69.6 67.8 71.6

West Bengal 69.2 72.1 70.2 73.3 71 74.3

IMR by sex and residence

State Total Rural Urban

Total Males Females Total Males Females Total Males Females

Bihar 43 42 45 44 43 46 34 33 36

Jharkhand 38 36 39 39 38 41 27 24 30

Odisha 53 52 54 55 53 56 39 38 40

West Bengal 32 31 33 33 32 35 26 25 27

MMR

State 2004-06 2007-09 2010-12

Bihar 312 261 219

Odisha 303 258 235

West Bengal 141 145 117

Source: National Health Profile, Central Bureau of Health Intelligence

40 CII-Grant Thornton

Page 41: Grant thornton   healthcare east

Appendix: Disease profiles

Cases and deaths due to Malaria

State 2012 2013(P)

Cases Deaths Cases Deaths

Bihar 2,605 - 2,249 -

Jharkhand 131,476 10 97,215 6

Odisha 262,842 79 216,568 66

West Bengal 55,793 30 28,040 17

Cases and deaths due to Acute Diarrhoeal Diseases, 2013 (Provisional)

State Male Female Total

Cases Deaths Cases Deaths Cases Deaths

Bihar 321,269 15 229,012 9 550,281 24

Jharkhand 47,241 2 31,051 2 78,292 4

Odisha 333,550 122 259,657 79 593,207 201

West Bengal 940,980 184 889,330 118 1,830,310 302

Cases and deaths due to Enteric Fever, 2013 (Provisional)

State Male Female Total

Cases Deaths Cases Deaths Cases Deaths

Bihar 153,597 2 108,194 - 261,791 2

Jharkhand 14,020 4 10,786 3 24,806 7

Odisha 31,885 20 21,858 15 53,743 35

West Bengal 57,482 19 51,213 20 108,695 39

Cases and deaths due to Acute Respiratory Infection, 2013 (Provisional)

State Male Female Total

Cases Deaths Cases Deaths Cases Deaths

Bihar 1,017,177 14 741,478 6 1,758,655 20

Jharkhand 142,647 49 93,817 31 236,464 80

Odisha 820,066 145 632,396 86 1,452,462 231

West Bengal 1,323,201 506 1,191,405 247 2,514,606 753

Source: National Health Profile, Central Bureau of Health Intelligence

CII-Grant Thornton 41

Page 42: Grant thornton   healthcare east

References

• Central Bureau of Health Intelligence,

Ministry of Health and Family Welfare

• Internal Grant Thornton Publications

• National Health Profile 2013:

http://cbhidghs.nic.in/index2.asp?slid=128

4&sublinkid=1166

• http://planningcommission.nic.in/data/dat

atable/0814/table_2.pdf

• Accreditation: http://www.nabh.co/

• http://www.nabl-india.org/

• http://www.jointcommissioninternational.o

rg/about-jci/jci-accredited-organizations/

• Insurance

• http://bkky.gov.in/

• http://nrhmorissa.gov.in/OSTF/

• http://www.wbhealth.gov.in/health_schem

e.asp?pass_file_id=-1

• http://www.pwc.in/en_IN/in/assets/pdfs

/publications/2013/enabling-access-to-

long-term-healthcare-funding-in-india.pdf

• pwc/IN/in/assets/pdfs/publications-

2012/healthcare_financing_report_print.pd

f

• http://www.pharmatutor.org/pharma-

news/doctors-population-in-india

• http://www.hindustantimes.com/india-

news/ranchi/jharkhand-doctors-shun-rural-

postings-citing-maoist-threat/article1-

1249617.aspx

• http://healthcare.financialexpress.com/mar

ket-section/1663-ranchi-on-the-radar

• http://indianexpress.com/article/india/poli

tics/government-plans-10-new-aiims-more-

cancer-centres/

• http://www.unicef.org/india/state_profiles

_4362.htm

• http://www.unicef.org/india/state_profiles

_4304.htm

• http://www.unicef.org/india/state_profiles

_4346.htm

• http://www.ibef.org/download/Jharkhand-

March-2014.pdf

• http://www.ibef.org/industry/healthcare-

india.aspx

• http://infochangeindia.org/agenda/access-

denied/public-health-infrastructure-what-

we-need-and-what-we-have.html

• http://articles.economictimes.indiatimes.co

m/2014-07-10/news/51300758_1_aiims-

healthcare-finance-minister-arun-jaitley

• http://economictimes.indiatimes.com/articl

eshow/41526496.cms?utm_source=content

ofinterest&utm_medium=text&utm_campa

ign=cppst

• http://blogs.timesofindia.indiatimes.com/t

oi-edit-page/how-and-why-india-must-

introduce-universal-healthcare-coverage/

• http://www.thehindu.com/opinion/op-

ed/taking-healthcare-to-indias-remote-

tribes/article6370400.ece

• http://www.thehindubusinessline.com/opi

nion/india-can-be-more-than-a-pharma-

hub/article6370230.ece

• http://articles.economictimes.indiatimes.co

m/2013-10-

27/news/43432740_1_healthcare-

infrastructure-12th-plan-period-capital-

investment

• http://articles.economictimes.indiatimes.co

m/2014-07-17/news/51656708_1_infant-

mortality-rate-health-officials-health-sector

• http://cbhidghs.nic.in/writereaddata/mainl

inkFile/Health%20Status%20Indicators-

2012.pdf

• http://www.newindianexpress.com/magazi

ne/India-has-just-one-doctor-for-every-

1700-

people/2013/09/22/article1792010.ece

• McKinsey

42 CII-Grant Thornton

Page 43: Grant thornton   healthcare east

References

• http://gadgets.ndtv.com/mobiles/news/an

anya-programme-providing-health-care-

services-in-bihar-via-mobile-phone-450605

• http://www.avenuemail.in/ranchi/eight-

medical-colleges-opened-jharkhand-

cm/31619/

• http://timesofindia.indiatimes.com/city/ra

nchi/No-room-for-critical-patients-in-

Jharkhand/articleshow/26060133.cms

• http://www.biznewsodisha.com/hospitals/

ntpc-to-set-up-medical-college-hospital-in-

odisha/

• http://articles.economictimes.indiatimes.co

m/2013-11-19/news/44242326_1_esic-

state-insurance-corporation-odisha

• http://www.thestatesman.net/news/32749-

uk-firm-to-invest-rs-425-cr-in-west-

bengal.html

• http://www.business-

standard.com/article/companies/emami-

to-invest-rs-1-000-crore-in-cement-hospital-

biz-in-bengal-113080701146_1.html

• http://www.ibef.org/industry/healthcare-

india.aspx

• http://news.oneindia.in/2013/05/14/jhark

hand-approves-act-to-protect-doctors-

hospitals-1216292.html

• http://southasia.oneworld.net/news/indian

-state-hires-ifc-as-healthcare-

consultant?searchterm=#.VAlBHfmSwsd

• http://articles.economictimes.indiatimes.co

m/2012-08-27/news/33424914_1_ifc-

medical-colleges-private-sector

• http://www.downtoearth.org.in/content/bi

har-district-launches-scheme-provide-

emergency-healthcare-through-community-

donations

• http://gadgets.ndtv.com/mobiles/news/an

anya-programme-providing-health-care-

services-in-bihar-via-mobile-phone-450605

• http://www.avenuemail.in/ranchi/eight-

medical-colleges-opened-jharkhand-

cm/31619/

• http://healthcare.financialexpress.com/mar

ket-section/1663-ranchi-on-the-radar

• http://indianexpress.com/article/cities/kol

kata/mamata-approves-cashless-insurance-

easy-house-loans-for-state-govt-staff/

• http://www.dailymail.co.uk/indiahome/ind

ianews/article-2180676/Bihars-womb-

thieves-Private-hospitals-accused-carrying-

unnecessary-operations-claim-insurance-

money.html

• http://www.telegraphindia.com/1130818/j

sp/bihar/story_17241417.jsp#.VAlaVfmSw

sc

• http://timesofindia.indiatimes.com/city/pa

tna/Bihars-government-hospitals-in-

districts-to-treat-heart-

patients/articleshow/23843905.cms

• http://archive.indianexpress.com/news/bi

har-to-make-phcs-hospitals-

webenabled/1166585/

• http://www.telegraphindia.com/1130606/j

sp/calcutta/story_16755327.jsp#.VAlKfm

O971U

CII-Grant Thornton 43

Page 44: Grant thornton   healthcare east

About Grant Thornton

Grant Thornton International Ltd

Grant Thornton is one of the world‟s leading organisations of independent assurance, tax and advisory

firms. These firms help dynamic organisations unlock their potential for growth by providing

meaningful, forward looking advice. Proactive teams, led by approachable partners in these firms, use

insights, experience and instinct to understand complex issues for privately owned, publicly listed and

public sector clients and help them to find solutions. More than 38,500 Grant Thornton people, across

over 130 countries, are focused on making a difference to clients, colleagues and the communities in

which we live and work.

Grant Thornton India LLP

Grant Thornton India LLP is a leading professional services firm providing assurance, tax and advisory

services to dynamic Indian businesses. “The firm‟s mission is to be the adviser of choice to dynamic

Indian businesses with global ambitions.”

With a partner led approach and sound technical expertise the firm has extensive experience across

many industries and businesses of various sizes. We provide focused practice groups in a range of

industries, sectors and market segments. We have extensive experience in the Healthcare and Life-

sciences industry providing end to end compliance and advisory solutions to several prominent players.

Moreover, with our robust compliance solutions and ability to navigate complexities we help dynamic

organisations unlock their potential for growth through global expansion, global capital or global

acquisitions. With over 2,000 people, the Firm is recognised as one of the largest accountancy and

advisory firms in India with offices in New Delhi, Ahmedabad, Bengaluru, Chandigarh, Chennai,

Gurgaon, Hyderabad, Kolkata, Kochi, Mumbai, Noida and Pune, and affiliate arrangements in most of

the major towns and cities across the country.

We provide meaningful, actionable advice, every step of the way.

44 CII-Grant Thornton

Page 45: Grant thornton   healthcare east

About Grant Thornton

Our services: Unlocking the potential for growth in dynamic healthcare organisations

Grant Thornton‟s assurance, tax and advisory professionals have extensive experience serving a broad

spectrum of growth-oriented organisations. The Firm seamlessly combines the international reach, depth

and expertise with personal attention and a relationship approach, which has made us the leading firm in

each of our chosen markets. With shorter decision making chains, more senior personnel involvement

and distinctive client services, we are able to take a wider view and operate in a coordinated way that‟s as

fast and agile as our clients.

We have a dedicated healthcare & life-sciences practice in India with extensive experience, having

worked across over 100 clients in the sector. Building successful organisations requires management to

work on many fronts simultaneously. Organic growth, capacity building, mergers and acquisitions, joint

ventures, managing business risk and putting in place the right capital structure are all equally important

in dynamic organisations looking to realise their full potential. To help healthcare organisations unlock

their potential for growth, we provide robust advice in the areas below:

Healthcare &

Life sciences

Advisory

Tax and

Regulatory Business Risk

& Process

Improvement

Due Diligence

& Valuation

Strategic

Services

JV &

International

Expansion

Assurance

& Compliance

M&A and

Capital Raising

To know more about our solutions for healthcare businesses, please contact:

Mahadevan Narayanamoni

Partner

Grant Thornton India LLP

[email protected]

+91 40 66308200

Ashish Chhawchharia

Exectuive Director

Grant Thornton India LLP

[email protected]

+91 33 4050 8000

Vrinda Mathur

Director

Grant Thornton India LLP

[email protected]

+91 124 462 8000

CII-Grant Thornton 45

Page 46: Grant thornton   healthcare east

The Confederation of Indian Industry (CII) works to create and sustain an environment conducive to

the development of India, partnering industry, Government, and civil society, through advisory and

consultative processes.

CII is a non-government, not-for-profit, industry-led and industry-managed organisation, playing a

proactive role in India's development process. Founded in 1895, India's premier business association has

over 7200 members, from the private as well as public sectors, including SMEs and MNCs, and an

indirect membership of over 100,000 enterprises from around 242 national and regional sectoral industry

bodies.

CII charts change by working closely with Government on policy issues, interfacing with thought

leaders, and enhancing efficiency, competitiveness and business opportunities for industry through a

range of specialised services and strategic global linkages. It also provides a platform for consensus-

building and networking on key issues.

Extending its agenda beyond business, CII assists industry to identify and execute corporate citizenship

programmes. Partnerships with civil society organisations carry forward corporate initiatives for

integrated and inclusive development across diverse domains including affirmative action, healthcare,

education, livelihood, diversity management, skill development, empowerment of women, and water, to

name a few.

The CII theme of „Accelerating Growth, Creating Employment‟ for 2014-15 aims to strengthen a growth

process that meets the aspirations of today‟s India. During the year, CII will specially focus on economic

growth, education, skill development, manufacturing, investments, ease of doing business, export

competitiveness, legal and regulatory architecture, labour law reforms and entrepreneurship as growth

enablers.

With 64 offices, including 9 Centres of Excellence, in India, and 7 overseas offices in Australia, China,

Egypt, France, Singapore, UK, and USA, as well as institutional partnerships with 312 counterpart

organisations in 106 countries, CII serves as a reference point for Indian industry and the international

business community.

Confederation of Indian Industry

The Mantosh Sondhi Centre

23, Institutional Area, Lodi Road,

New Delhi – 110 003 (India)

T: +91 11 4577 1000 / 2462 9994-7

F: +91 11 2462 6149

E: [email protected]

W: www.cii.in

Reach us via our Membership Helpline: +91 11 435 46244/ +91 99104 46244

CII Helpline Toll free No: 1800 103 1244

-----------Follow us on ---------

About CII

46 CII-Grant Thornton

Page 47: Grant thornton   healthcare east

Editorial team: Vrinda Mathur, Sanjana Shankar, Misbah Hussain

Design and production: Ankita Arora, Rakshit Dubey

Contact us

To know more about Grant Thornton India LLP, please visit www.grantthornton.in or contact any

of our offices as mentioned below:

NEW DELHI

National Office

Outer Circle

L 41 Connaught Circus

New Delhi 110 001

T +91 11 4278 7070

BENGALURU

“Wings”, 1st floor

16/1 Cambridge Road

Ulsoor

Bengaluru 560 008

T +91 80 4243 0700

CHANDIGARH

SCO 17

2nd floor

Sector 17 E

Chandigarh 160 017

T +91 172 4338 000

CHENNAI

Arihant Nitco Park,

6th floor

No.90, Dr. RK Salai

Mylapore

Chennai 600 004

T +91 44 4294 0000

GURGAON

21st floor, DLF Square

Jacaranda Marg

DLF Phase II

Gurgaon 122 002

T +91 124 462 8000

HYDERABAD

7th floor, Block III

White House

Kundan Bagh,

Begumpet

Hyderabad 500 016

T +91 40 6630 8200

KOLKATA

10C Hungerford Street

5th floor

Kolkata 700 017

T +91 33 4050 8000

MUMBAI

16th floor, Tower II

Indiabulls Finance Centre

SB Marg, Elphinstone (W)

Mumbai 400 013

T +91 22 6626 2600

NOIDA

Plot No. 19A, 7th Floor

Sector – 16A,

Noida – 201301

T +91 120 7109001

PUNE

401 Century Arcade

Narangi Baug Road

Off Boat Club Road

Pune 411 001

T +91 20 4105 7000

Disclaimer:

The information contained in this document has been compiled or arrived at from other sources

believed to be reliable, but no representation or warranty is made to its accuracy, completeness or

correctness. The information contained in this document is published for the knowledge of the

recipient but is not to be relied upon as authoritative or taken in substitution for the exercise of

judgment by any recipient. This document is not intended to be a substitute for professional, technical

or legal advice or opinion and the contents in this document are subject to change without notice.

Whilst due care has been taken in the preparation of this document and information contained herein,

neither Grant Thornton nor CII nor other legal entities in the group to which they belong, accept any

liability whatsoever, for any direct or consequential loss howsoever arising from any use of this

document or its contents or otherwise arising in connection herewith.

Page 48: Grant thornton   healthcare east

© 2014 Grant Thornton India LLP. All rights reserved.

Grant Thornton India LLP is registered with limited liability with identity number AAA-7677 and its

registered office at L-41 Connaught Circus, New Delhi, 110001

References to Grant Thornton are to Grant Thornton International Ltd (Grant Thornton International) or

its member firms. Grant Thornton International and the member firms are not a worldwide partnership.

Services are delivered independently by the member firms.


Recommended