Health Services India

Dr. Sumit Seth Embajada de la India [email protected] http://www.embajadaindia.org/

EXPORT OF HEALTH SERVICES

The Indian Experience

Dr. Sumit Seth

Second Secretary

Embassy Of India


Over-View

• Health Care Market• Health Care Trends-Past, Present & Future• Trends Favoring Health Service Exports• Medical Infrastructure-Demand-Supply Gap• Health Services Export-Opportunity• Quality Control & Accreditation-New Trends• Public Private Partnership• Future of India’s Health Care • India-Colombia Partnership


India Spends US $ 22.7 Billion On Healthcare*

The Indian Healthcare Market


Hotels, restaurants

Sector Direct employment Revenues/GDPMillion, 2000-2001 Per cent, 2000-2001

Healthcare

Education

Retail banking

Power

Railways

Telecom

Healthcare is the largest service

industry in terms of

revenues and the second largest after education in

terms of employment

4.0

5.3

1.0

1.2

1.6

0.8

1.7

0.4

5.2

4.8

3.5

3.0

1.8

1.4

0.9

1.7IT

Hotels, restaurants

Sector Direct employment Revenues/GDPMillion, 2000-2001 Per cent, 2000-2001

Healthcare

Education

Retail banking

Power

Railways

Telecom

Healthcare is the largest service

industry in terms of

revenues and the second largest after education in

terms of employment

4.0

5.3

1.0

1.2

1.6

0.8

1.7

0.4

5.2

4.8

3.5

3.0

1.8

1.4

0.9

1.7IT

Sectorwise Distribution

By 2012, the Healthcare sector could account for 7- 8% of GDP and provide direct and indirect employment to 9 million


*

Healthcare Market (2005 vs 2025)

Healthcare is the third largest growth segment in India


Healthcare

Power

Telecom

Roads

23-32

25-35

41-53

99-131

Investment needs of the healthcare sector are

comparable to other

infrastructure sectors

Healthcare

Power

Telecom

Roads

23-32

25-35

41-53

99-131

Investment needs of the healthcare sector are

comparable to other

infrastructure sectors

Investment in India (Estimates)

Healthcare in India will grow at 10.8% annually to reach USD 190 billion


Share of the wallet

McKinsey : Healthcare share of the wallet in India will be very close to China.



Healthcare trends in India


Broad trends favoring Health Services Exports

• The first is the globalization of business which is characterized by introduction of market forces, freer trade, and widespread deregulation. This means international trade and investment play a much greater role .

• The second trend is the revolution in information technology which has shrunk geographical boundaries and made the world ‘a global village’. The IT revolution has ensured emergence of demanding & aware consumers and globalization has enabled these discerning consumers to access world standards.

• Both these factors have come together to usher new era for Indian healthcare.


Growth Drivers

• India is now the second fastest growing major economy in the world.

• Third largest economy in the world • Indian healthcare has emerged as one of

the largest service sectors in India.• Healthcare spending in India is expected

to rise by 15% per annum.• Healthcare spending could contribute

6.1% of GDP in 2012 and employ around 9 million people.


Factors favouring Export of Health Services

Shift from socialized to private providers

Booming economy and High literacy rates

Shift to lifestyle-related diseasesEasier financing

Increasing life expectancy Recognition by government priority

section


Shift from socialized to private providers…

• The majority of healthcare services in India are provided by the private sector

• Private sector in India is one of the largest in the world:

• 80 percent of all qualified doctors, • 75 percent of dispensaries • 60 percent of hospitals in India belong to the

private sector. • Government expenditure on healthcare has been on

the decline in relative terms and is currently at 0.9% of the GDP.

• The average for developing countries as a whole is around 3% of GDP and for high income countries, 5% of GDP.


Booming economy and High literacy rates.

Capacity to Spend• The capacity of the people to pay has increased, • When families move from middle income to rich,the highest growth in

spending is recorded in healthcare.• The top 33 per cent income earners in India accounted for 75 per cent of

total private expenditure on healthcare.• The proportion of households in the low –income group has declined significantly and the “Great Indian Middle-class” has come of age.Literacy• Per-capita expenditures on healthcare rise with higher education levels. • Households that have higher education levels tend to spend more per illn


The Demographics

Middle Income Class in India to grow to 400 to 500 Million by 2015


Shift to lifestyle-related diseases

• The shift in disease profiles from infectious to lifestyle-related diseases is expected to raise expenditures per treatment.

• Lifestyle-related diseases are typically more expensive to treat than infectious ones. • India’s disease profile is expected to follow the same pattern as in developed economies.

• Diseases - cardiovascular, asthma and cancer have become the most important segments

• Inpatient spending is expected to rise from 39% to nearly 50% \• The share of infectious diseases is expected to decline from 19 per cent in

2004 to 16 percent in


Easier financing in a capital intensiveIndustry.

The Indian healthcare industry has gone through the entire cycle of financing 1. Government funded socialized system 2. Privately funded ‘Mom & Pop’ shops (small

nursing homes)3. Non Resident Indian & Foreign Investment

funded enterprises 4. Financial markets.


Increasing life expectancy

“ Increase in healthcare spending increases life Expectancy which cyclically further drives increase in Health Care spending “


Recognition by government as a priority section.

• The government of India has also identified Healthcare as the priority section for focused attention.

• Measures taken by the government to stimulate market development in the healthcare sector

• § Reduction in Import duty on medical equipment

§ Depreciation Limit on medical equipment increased

§ Customs duty reduced

§ The Government has announced Income tax exemption of the Income Tax for the first five years, to hospitals set up in rural areas

§ US$ 56 million will be earmarked for HIV/AIDS control programme through the use of primary health centers, prevention of drug abuse etc.



Healthcare : Demand & Supply

90 % patients need primary and secondary care


Countries

India

Low income (e.g., sub-Saharan Africa)

Middle income (e.g., China, Brazil)

High income (e.g., US, Western Europe)

BedsPer ’000 population

1.5

1.5

4.3

7.4

World average 3.3

1.2

PhysiciansPer ’000 population

1.8

1.8

1.0

1.5

0.9

1.6

1.9

7.5

NursesPer ’000 population

3.3

Distribution is skewed towards Urban/ Metro Areas

Countries

India





1.5

1.5

4.3

7.4

World average 3.3

1.2


1.8

1.8

1.0

1.5

0.9

1.6

1.9

7.5


3.3


India





1.5

1.5

4.3

7.4

World average 3.3

1.2


1.8

1.8

1.0

1.5

0.9

1.6

1.9

7.5


3.3


Total expenditure in India as percentage of GDP : 5.0 (2007)

Global Healthcare Infrastructure


Gap Analysis


Areas of Opportunity

• Health services outsourcing• Telemedicine• Medical value travel• Clinical Trials• Miscellaneous

• Health Insurance• Medical Equipments etc.




Why India?- Hub for Health BPO

• Low cost and reliable high bandwidth communications for both voice and data.

• The internet technology revolution that enables shared processing of transactions and information across locations and time zones.

• Very large labor cost arbitrage

• The availability of highly skilled English speaking workforce in India.

• The lack of governmental interference

• Strong tax incentives


Need for Outsoucing in US, EU

. • Spiraling healthcare costs, • Unbearable squeeze on margins • Process inefficiencies• Acute talent shortage • Aging population • Cost savings to the tune of 20-30 per cent.


The types of services offered

• Data capture– Reporting of diagnostic tests and Radiology reporting

• Documentation– Data coding, Medical Transcription, Billing and Data migration

• Commercial– Invoicing, Disbursal, Expense Reporting, Procurement, Cash management, General ledger and Receivables management

• Administration– Claims processing, Adjudication,Mailroom services and Records management

• Human resources– Employee assistance, Training and payroll

• Customer care– Dispatch and Activation services, Technical support companies are further involved in various functions such as Converting existing data to HIPPA format, Scanning written documents, converting them into an electronic format, and sending them back.

• BPOs are further involved in claims forms processing for health insurance companies.


Health Care BPO: The Indian Companies


Outsourcing of pathology and laboratory tests

High cost differential in India.

Example

Thyroid profile blood test costs anywhere from US$ 30-50 in the US, while the same can be analyzed by Indian companies for less than US$ 5 per patient.

The outsourcing opportunity from UK alone is about US$ 800 million .

Case study

Metropolis Labs has inked a partnership with a US-based consortium to bid for outsourced pathology work from the National Health Services (NHS) of the UK. Metropolis would be investing approximately US$ 1 million technology up-gradation in its Mumbai lab for handling outsourcing jobs.


Tele-Medicine


• “Telemedicine today has given the capacity to the ordinary doctors to do

extraordinary things”


Telemedicine: The Promise

• Taking modern healthcare to remote areas • Majority of diseases not requiring surgery

conducive to telemedicine• Training of medical personnel across the country

• Last five years price and complexity of this technology has decreased making T.M economically viable


Benefits of Tele-Medicine


Tele-Radiology

• The global demand for radiology services is growing rapidly while the supply of radiologists is not growing in tandem. Such professionals are in short supply the world-over.

By outsourcing Teleradiology to India, overseas hospitals are assured of :

• Competent & trained professionals, • Time zone advantages• Skill set availability• Patients can be diagnosed and effectively treated round-the clock services. • Need to recruit night shift personnel is minimized.

50 per cent of the 6,000-odd hospitals in the US still do not have the technology for tele-radiology, and this represents a huge potential market to be tapped.


50 per cent of the 6,000-odd hospitals in the US still with the technology for Tele-radiology

One in every seven radiology positions in the UK is vacant. On the other hand, in India, there is a relative abundance.

Currently---- US$ 3.7 billion 2012----US$ 7.4 Billion

Employment for 200,000 people

The estimated opportunity for India




India presents First World Treatment at Third World Costs.

The India Advantage

Trained manpowerand knowledge base

Rich biodiversity Extensive clinical trialsopportunities

Excellent network of research laboratories

Well-developed base industries


Over 60,000 cardiac surgeries done per year with out comes at par with international standards

Multi organ transplants like Renal, Liver, Heart, Bone Marrow Transplants, are successfully performed at one tenth the cost.

Patients from over 55 countries treated at Indian Hospitals.

INDIAN HEALTHCARE CAPABILITYFACT#1: Proven Indian healthcare system


PROCEDURE COST (US$)

THAILANDTHAILAND INDIA

Heart Surgery

Bone Marrow Transplant

Liver Transplant

Knee Replacement

Cosmetic Surgery

7,500

-------

-------

8,000

3,500

6,000

26,000

69,000

6,000

2,000

USUS

40,000

2,50,000

3,00,000

20,000

20,000

UK

23,000

1,50,000

2,00,000

12,000

10,000

Indian Healthcare : The Changing Scenario

Cost Advantage


Ayurveda recognized as an official healthcare system in Hungary.

Doctors in the west are increasingly prescribing Indian Systems of Medicine

More than 70% of the American population prefer a natural approach to health

Americans are said to spend around $25bn on non-traditional medical therapies and products *

Ayurveda

Yoga

Siddha

India’s Gift to the World

INDIA HAS THE OPPOURTUNITY TO PROVIDE THE BEST OF THE WEST & EASTERN HEALTCARE SYSTEMS

Indian Systems Of Medicine “Staging a Comeback”


Medical tourism: High Reward for government

Medical value travel pushes up quality of Healthcare in India

Tourism & Employment will get an extra boost

Win-win situation: as healthcare companies also benefit



Oppurtunities…

• The Clinical trails market with an estimated

expenditure of $ 1.27 Bn in 2012

• Profit margins of 20-25% , unfolds one of the most gripping chapters of Indian healthcare.


Strengths & Weakness


KEY ACHIEVEMENTS

India has the 2nd highest number of qualified doctors in the world. Of every six medical doctors in the US,

one is Indian

700,000 science and engineering graduates &

1500 PhDs qualify annually. Over 15,000 scientists

Investigational New Drug stage costs about $100 to

150 million in US, but costs only around $10 to

15 million in India

Indian companies are offering custom synthesis services at

30-50% cost savings compared to global costs

While clinical trials cost approximately $300 to 350 million in US, they cost only about $25

million in India

India’s huge population and the prevalence of a

wide spectrum of disease conditions offer a wide

patient-resource for clinical trials


Clinical Trial: A Model


Health Insurance

Private Health Insurance to cover 20% to 25% by 2020


Quality Control and Accreditation

• Patients are the biggest beneficiaries. Accreditation results in high

quality of care and patient safety. The patients get services by credential medical staff. Rights of patients are respected and protected. Patient satisfaction is regularly evaluated.

• Accreditation to a Hospital stimulates continuous improvement. It enables hospital in demonstrating commitment to quality care. It raises community confidence in the services provided by the hospital. It also provides opportunity to healthcare unit to benchmark with the best.

• The Staff in an accredited hospital are satisfied lot as it provides for continuous learning, good working environment, leadership and above all ownership of clinical processes. It improves overall professional development of Clinicians and Paramedical staff and provides leadership for quality improvement within medicine and nursing.

• Accreditation provides an objective system of empanelment by insurance and other Third Parties . Accreditation provides access to reliable and certified information on facilities, infrastructure and level of care.


Certification or Assessment of quality

• Advantages

– Makes the organization quality driven

– Provides measurable parameters

– Removes ambiguity in operations & increases efficiency

– Builds patient confidence & credibility


ISO v/s NABH

Limitation of ISO Certification

1. ISO is more documentation oriented and hence a certification does not guarantee level of implementation.

2. ISO is a certification where the examinee pays the examiner to get certified.

3. ISO does not involve the customer


Latest Trend : Health Quality Control

• NABH (National accreditation board of hospitals)

• National Accreditation Board for Hospitals & Healthcare Providers (NABH) is a constituent board of Quality Council of India, set up to establish and operate accreditation programme for healthcare organizations. The board while being supported by all stakeholders including industry, consumers, government, have full functional autonomy in its operation.


Latest Trend : Health Quality Control

• NABH (National accreditation board of hospitals)

• It is an institutional member of ISQua

• It is alsomember of ISQua Accreditation Council.

• NABH standards for hospitals has been accredited by ISQua.

• Accreditation system close to JCI

• More and more Hospitals are seeking NABH accreditation



Public Private Partnership will enhance healthcare services




Service Contract Model

• In Maharashtra, the contracting out of

ancillary services is very common particularly in Mumbai. The Bombay Municipal Corporation has been contracting out services such as catering, laundry and hospital maintenance


Management control Model

• In India, under the World Bank assisted Andhra Pradesh Urban Slum Health Care Project, the State established the Urban Health Centers and contracted them out to NGOs and/or service providers. Each UHC is assigned a definite slum area, clearly demarcated in terms of boundaries and average population of 15,000-20,000. In addition to drugs and supplies, a grant in aid of Rs. 2.80 lakhs per annum is provided to the NGO to cover operational cost


Chiranjeevi Yojna

• “Chiranjeevi Yojna” has been implemented by the state of Gujarat with the intent of encouraging private medical practitioners to provide maternity health services in remote areas .The scheme aims at improving the institutional delivery rate in Gujarat thereby providing financial protection to poor families.


Case Studies-PPP

Tamil Nadu: » Management of Primary Health Centres by Corporate

houses

» Outsourcing of high technology services in major teaching hospitals

Gujarat: » Management of a PHC by SEWA (non-profitorganization)

Karnataka: » Outsourcing of cleaning, maintenance and waste management of 82 hospitals

UttarPradesh:» Outsourcing of diagnostic services of teaching hospitals


US $ IN BILLION at 2000-2001 prices

2001

Private spending

Government spending

2012Scenario 1: Baseline increase in private spend

2012Scenario 2: Baseline with insurance in middle class

2012Scenario 3: Baseline with insurance and high government spending

19

4351.0

60.0

3.76

15.24

8.0

8.0

17.0

35.043.0

43.0

Key Assumption* 1% GDPGovernment Spending 1% GDP 2% GDP

2001

Private spending

Government spending

2012Scenario 1: Baseline increase in private spend

2012Scenario 2: Baseline with insurance in middle class

2012Scenario 3: Baseline with insurance and high government spending

19

4351.0

60.0

3.76

15.24

8.0

8.0

17.0

35.043.0

43.0

Key Assumption* 1% GDPGovernment Spending 1% GDP 2% GDP

Huge Growth Potential

Majority of the spending in Private Sector


“Physicians, Nurses, Medical Technicians and Other Scientific Occupations will Become Growth Industries to Rival the IT Sectorwithin

the Next Decade”

- India Vision 2020 Report

HEALTHCARE….THE SUNRISE INDUSTRY


INDIA-COLOMBIA PARTNERSHIP

• Scholarship Programmes• Participation in Health Fairs• Memorandum of Understanding • Statergic Alliance between Indian & Colombian Health care Industries• Health experts from India can learn from Colombia’s experience


Thank You

Sources: MINISTRY OF HEALTH& FAMILY

WELFARE FICCI EARNST & YOUNG REPORT, PWC

REPORT Dr. Hemant Bakhru,Dr. Kapil Jain,Dr. Ruchi

Bhatt

Date post:	21-Apr-2017
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