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Healthcare industry - Overview

Market Overview

  • Healthcare in one of the largest service sectors in India.
  • In 2004, national healthcare spending was 5.2% of GDP, at about US$34.9 billion.
  • Healthcare spending in India is expected to rise by 12% per annum through 2005-09.
  • By 2009, healthcare spending is expected to increase to about 5.5% of GDP, or US$60.9 billion.
  • Other estimates suggest that by 2012, healthcare spending could contribute 8% of GDP and employ around 9 million people.

Key Market Segments

Driving the growth of India’s healthcare sector will be the expansion of the hospital, pharmacy, biotechnology and health insurance segments.

Hospitals

  • In 2006, the market for hospital services in India was estimated at over US$ 4 billion.
  • Private players account for almost 78 % of the healthcare delivery market. An estimated 95% of new hospital beds have come up in the private sector.
  • By 2027, 2 million more beds will be needed compared to current 1.1 million in response to the population growth.

Pharmacy

  • In 2005, India’s pharma market was about US$6 billion, ranking it as 14th in the world.
  • By 2015, the market will more than double to US$14 billion, ranking it 3rd in the world behind US (US$196 billion) and China (US$23 billion).

Bio-Technology

  • The biotech industry could surge to US$5 billion by 2010 and US$25 billion by 2015, from its 2006 level of US$1.5 billion.
  • Driving this segment will be biopharmaceuticals, bioservices and bioinformatics.

Demand Dynamics

India’s healthcare sector growth of US$40 billion and US$45 billion by 2012 and 2015 will result from the country’s health challenges7 and forecasted social progress achieved to lower those challenges:

Health Challenges

  • Mounting # of certain chronic diseases
  • Current infant mortality rate as high as 35 deaths per 1,000 births8, compared to less than 6 in developed countries9
  • Inadequate vaccinations for preventable diseases affecting children

Social Progress

  • Growing middle class fueled by rising incomes
  • Increased in health insurance coverage
  • Increased # of beds and services provided mostly by the private sector

FDI Opportunities

In 2006, the healthcare sector attracted 6.3% of the total private equity (PE) investment of US$5.93billion – an amount equal to the inputs placed into India’s automotive sector.

Hospitals

With the potential to return 30-40 percent margins11 and decreasing public sector investments, the hospital segment will be dominated by the private hospitals. The hospitals that will grow the fastest by 2015 are:

  • Top tier private hospitals offering more than 100 beds and increasingly higher quality of services
  • Private nursing homes in the primary healthcare segments , particularly in tier-II towns

Key Drivers for Hospital Infrastructure

  CAGR (%) 2005-2015 Key Drivers
Government Hospitals -2
  • Lowered investments by the government
  • Private Nursing homes 9-10
  • Large unmet needs for beds in the primary healthcare segment in tier II towns
  • Medium Tier Private Hospitals 5-6
  • Will lose value proposition as population and health services demand rises
  • Top Tier Private Hospitals 12-14
  • Demand for higher quality services by high and medium income households, rapid expansion by existing and new players
  • Source: McKinsey Quarterly, India Pharma 2015 – A Prescribed Growth

    Early international entrants, particularly Singapore-based & Malaysian-based companies are already taking advantage of the hospital segment potential. Currently, at least 20 international players are competing for a share of the Indian hospital market.

    Foreign investors

    Parkway Group Healthcare (Singapore based)
  • Seeking to acquire tertiary care hospital projects in A & B cities (especially in the South), including a possible 50% stake in Khubchandani Hospitals
  • Columbia Asia (Malaysia based)
  • Entered alliance with DLF Home Developers Ltd to construct five hospitals in Kolkata, Palam Vihar, Patiala, Mysore and Bangalore; and pursuing building permits in 15 other locations
  • Pacific Healthcare Holdings (Singapore based)
  • Invested US$ 1.5million for a 15% stake in Cure Heart Ltd, which owns 68% of a cardiac care group in Bangalore and Goa
  • Opening hospitals in Hyderabad, Chennai and Bangalore
  • Source: QRG press release, Express Healthcare Management, INRnews, International Business Times, BusinessWeek, Pacific Healthcare press release

    Health Insurance

    • Huge potential for the healthcare insurance segment exist in light of an astronomical business growth, low penetration rate to-date, tariff elimination, and a FDI cap hike:
    • A McKinsey-CII report estimates the number of potential insurable lives at 315 million. In 2006- 07, the fast-growing Indian health insurance business grew 40 per cent to US$ 812 million.

  • By 2010, the segment is expected to grow to US$5.75 billion.

    The potential of the segments are attracting both foreign- life insurance companies and standalone health companies, some of which include:

    Company Main Business Market Entry Strategy Recent Investment Activity
    Star Health Allied & Insurance Co Health Insurance Joint Venture In April 2006, this joint venture formed between Indian insurance veterans and Middle East companies, Oman Insurance Company and ETA Ascon Group was India’s first specialist health-insurer.
    Apollo DKV Health Insurance Joint Venture In August 2007, this joint venture formed between India’s largest healthcare provider, Apollo Group and German health insurer, DKV became the country’s second stand-alone health insurer.
    BUPA Health Insurance TBD In June 2007, Britain’s largest private health insurer which is already operating in Hong Kong, Thailand, Australia, and Saudi Arabia announced expansions plans to India
    ICICI Prudential Life Life Insurance Organic growth In early 2008, expanded health insurance portfolio to cover 1,000 surgical procedures and hospitalization, most of which are beyond critical illnesses
    Max New York Life Insurance Life Insurance Organic growth In early 2008, began offering three distinct health insurance products, covering hospitalization, surgeries and critical illnesses
    Source: BioMedicine, Maps of India.com, TimesOnline, Watson Wyatt’s Healthcare Market Review

    Medical Tourism

    • Soaring healthcare costs and long waiting periods for medical procedures in industrialized nations and developing nations (particularly Africa, South and West Asia) are drawing more and more attention to India and other Southeast Asian countries that offer quality medical care at a much lower costs.
    • Cost of comparable treatment in India is on average 1/8th .to 1/5th of those in the West.
    • In 2007, medical tourism was estimated at US$350 million.
    • By 2012, it is predicted to a US$2 billion-a-year business opportunity.

    Key Areas Surgical Specialty
    Cardiology Cardiac Bypass surgery
    Cosmetics Cosmetic Surgery
    Orthopedic Surgery Hip Replacement
    Dentistry Dental Surgery
    Eye Care Vision Correction
    Preventive Health checks Organ Transplants
    Source: IBEF and Ernst & Young’s 2006 “Healthcare: Market Size and Growth” report

    Medical Devices

    • The medical devices market is expected to scale up to US$ 1.7 billion by 2010, against US$1.2 billion in 2005.
    • Changing disease profile and clinical needs, investments into infrastructure and quality of healthcare, liberalized regulations of the industry are all expected to drive the potential for medical devices.
    • The demand for hi-tech medical devices, which contributes to 80% of the overall medical devices market is growing between 12 -15% annually.
    • 90 % of the demand for hi-tech medical devised is being met by imports from countries like USA, Japan and Germany.
    • Medical device suppliers seeking to enter India’s market typically arrange joint ventures/ licensing agreements to manufacturer their products locally or employ local agents to distribute them.
    • One of the most successful tie-ups is between General Electric Medical Systems (US) and Wipro.

    In three years of entering the Indian market, GE has achieved second position in the Indian equipment market and using India as a low cost manufacturing base, plans to export its Indian made products to the rest of South Asia.

    Hi-Tech Medical Devices

    Cancer Diagnostic ECG & EEG Monitors Urgical Diathermy Units Laser & Fibre Optic Device
    Medical Imaging DC Debrillators Apnea / Respiratory Monitors X-ray Equipment
    Ultrasonic Scanning Patient Monitoring System Doppler Ultrasound Scanners Ophthalmology Equipment
    Plastic Surgery Equipment Radiology Equipments CT and MRI Systems Radiotherapy Equipments
    Polymerase Chain Reaction Technologies Therapy Equipments Digital Subtraction Angiography System Simulators and Treatment Planning Systems

    Pharmacy & Biotech

    • India is becoming an attractive destination for pharmaceutical R&D activities particularly for generic drugs, as they have the benefit of low-cost manufacturing, production skills and availability of quality manpower.
    • Production costs in India are almost 50% less than those of developed countries.
    • Indian drug-makers are expected to acquire a 33% share of the global generic drug market by 2009 against the2007’s 4 per cent market share.
    • Indian companies are exploring alliances, through strategic partnerships and M&As with MNCs to enlarge their market.

    Company Recent Investment Activity
    Biocon & Bristol Myers Squibb
  • Biocon has signed a long-term agreement with Bristol Myers Squibb to supply recombinant insulin; the firm has already filed a drug master file (DMF) with the USFDA to market bulk insulin in the US.
  • Biocon & Wockhardt
  • Wockhardt and Biocon have launched their indigenous recombinant insulin, marketed under the brands Wosulin and Insugen respectively in the domestic market.
  • Cipla Ltd, Torrent Pharmaceuticals & Merck KGaA’s
  • Indian pharmaceutical companies including Cipla Ltd and Torrent Pharmaceuticals are still among those considering the acquisition of the generic drug making unit of Germany's Merck KGaA's valued at about $7 billion
  • Source: ExpressPharmaOnline, Domain-B.com

    Market Outlook

    With Pharmaceuticals and hospital services accounting for 75% of the total healthcare market against a backdrop of rising population, increasing middle class, low production costs, social and economic progress, and need for better infrastructure and services, many FDI opportunities exists for: Hospitals, Medical Tourism, Pharmaceuticals, Biotechnologies, Medical Devices and Health Insurance

    • Driving the development of the market will be mostly the private sector, not the public sector. Currently, private sector contributes 75% to the total market and will likely continue to in the long term.
    • India’s public health management too premature compared to most countries’ standards, often characterized by resource crunch, political interference, inflexibility and other bureaucratic roadblocks.
    • With some 70% of the population residing in the rural areas, much of the development will be invested heavily in rural medical infrastructure, including the quality of medical education institutions.
    • The private sector players who will survive in this market are those who provide affordable and quality healthcare. Although the middle class is growing, the majority of the population still cannot afford health insurance to help cover medical expenses.
    • The current health insurance penetration rate is still relatively low at 3%.
    • Some 80% of the national healthcare expenditure is borne by the patients.
    • Consequently, price sensitivity is still quite high and the high-level healthcare facilities are not in the reach of many.

    Courtesy: Inbics

    Indiabiznews, October 01, 2009



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