People expect significantly more from country's healthcare system. In order to correctly define an effective, cost efficient, and appropriate healthcare system for all Indians, we must first address the fundamental issues, disconnects, and problems. Therefore deal with the disease not the symptoms - we need to first identify and agree on what the fundamental problems are.
We believe we can find simpler, stronger, efficient system for all to get care they need in crisis and the care they want by choice. They must exist in manner that systematically provide certain controls, checks and balances. We must reset our own false expectations for better reflect the reality of the care that can be provided in order to minimize extraneous cost. Price certainly, transparency, portability and effectiveness need to be codified as requirements of any solution. Oversight and responsibility at ividual level also very important factor to be integrated into the healthcare system. The solution must provide an effective safety net for all the helpless while filtering out the clueless - who inadverteltly and significantly increases costs and utilization of scarce resources - and the fraudsters who purposely game the system in order to inappropriately receive disproportionate and unnecessary gain while also consuming available resources from those who desparately need them. Finally, the solution shall at its safety net, basic care level, provide the same access, scope and treatment options for all regardless of income or means with no additional hidden costs, taxes, fees or shifting of costs, from one system to the other.
We need to create a basic marketplace, focused on a equal access, treatment, and affordable cost to all Indians. The system should provide for individual care they want, beyond basic care needs. These systems should be tighly integrated through a central point of access and administration that provides for full coordination of care and benefits across all available sources - as well as other benefits.
What are the Challenges?
India is the second most populous country in the world
The death rate has declined but birth rates continue to be high in most of the states.
Health care structure in the country is over-burdened by increasing population
Family planning programs need to be (re)activated
India faces the twin epidemic of continuing/emerging infectious diseases as well as chronic degenerative diseases.
The former is related to poor implementation of the public health programs, and the latter to demographic transition with increase in life expectancy.
Economic deprivation in a large segment of population results in poor access to health care.
Poor educational status leads to non-utilization of scanty health services and increase in avoidable risk factors.
Both are closely related to life expectancy and IMR.
Advances in medicine are responsible for no more than half of the observed improvement in health indices.
Longevity, literacy and GDP per capita are the main indicators of human development
Longevity is a measure of state of health, and is linked to income and education
Weakness in health sector has an adverse effect on longevity
India ranks low (115th) amongst world nations judged by HDI
India faces high burden of disease because of lack of environmental sanitation and safe drinking water, under-nutrition, poor living conditions, and limited access to preventive and curative health services
Lack of education, gender inequality and explosive growth of population contribute to increasing burden of disease
Full impact of the HIV epidemic and tobacco related diseases is yet to be felt
Expenditure on health by the Government continues to be low. It is not viewed as an investment but rather as a dead loss!
States under financial constraints cut expenditure on health
Growth in national income by itself is not enough, if the benefits do not manifest themselves in the form of more food, better access to health and education: Amartyo K Sen
India has 48 doctors per 100,000 persons which is fewer than in developed nations
Wide urban-rural gap in the availability of medical services: Inequity
Poor facilities even in large Government institutions compared to corporate hospitals (Lack of funds, poor management, political and bureaucratic interference, lack of leadership in medical community)
Health Care in India: Curative Health Services
Increasing cost of curative medical services
High tech curative services not free even in government hospitals
Limited health benefits to employees
Health insurance expensive
Curative health services not accessible to rural populations
Components of healthy life style
Abstinence from tobacco use
Regular physical exercise
Balanced nutritious diet rich in vegetables and fruits, and low in fats and refined sugar
Avoidance of pre and extramarital sex
Yoga and meditation
Avoidance of alcohol and substance abuse
All people benefit from regular physical activity
Moderate physical activity for 30-45 minutes on all days of the week is required
Additional benefits can be gained from more strenuous activity for longer periods
Physical activity reduces the risk of premature death, CAD, hypertension, diabetes and colon cancer. It also improves mental health.
A large number of adults including youths are not regularly physically active
Certain interventions to promote physical activity in schools, work site and health care settings have been found to be beneficial
Interventions with a large potential impact on health outcomes
Immunization (EPI plus)
DOTs for tuberculosis
Maternal health and safe motherhood interventions
School health interventions
Integrated management of childhood illnesses
Treatment of STD
Rational use of diagnostic tests
Inappropriate and irrational use of high tech and expensive diagnostic tests is widely prevalent in developing countries (CT, serology for TB)
Market forces, misinformation, desire to do something
Governmental regulation not feasible; improved diagnostic reasoning required
There has been an explosion of high tech diagnostic, therapeutic and preventive interventions in the field of medicine and surgery
This has resulted in physicians spending less time in history taking and physical examination.
Rational Drug Use
Can prevent emergence of anti-microbial drug resistance, and reduce drug toxicity, adverse drug reactions, and the cost of treatment
Requires coordinated approach: Patient and physician education, antibiotic policy, hospital infection control team, regional and national antibiotic resistance surveillance
Health Care in Developing Countries
Existing infrastructure for health care needs to be strengthened. Health should be perceived as an investment and receive greater budgetary allocation
Education, safe water and sanitation need priority
Vaccination coverage to be improved
Better implementation of national health programs
Judicious use of the scant resources by promoting most cost-effective strategies for disease prevention
Inclusion of all level of stakeholders in planning and policy making using tremendous human resource available in the country
The Rapidly Evolving Landscape of Indian Healthcare: A Comprehensive Case Study
India's healthcare sector has experienced a significant transformation in recent years, emerging as one of the country's largest industries in terms of revenue and employment. This case study delves into the various aspects of this transformation, including the market size, policy issues, market entry, current trends, and the best prospects for international companies. With a focus on medical devices, healthcare infrastructure, biotech, medical tourism, and telemedicine, we explore the challenges and opportunities presented in the dynamic Indian healthcare landscape.
Overview of the Indian Healthcare Industry:
The Indian healthcare industry, encompassing hospitals, medical infrastructure, medical devices, clinical trials, telemedicine, health insurance, and medical equipment, reached a value of $150 billion in 2018 and is projected to grow to $280 billion by 2022. Private players dominate the market, fueled by investments from corporate hospital chains and private equity investors. Changing demographics, disease profiles, and a shift towards lifestyle diseases have led to increased spending on healthcare delivery.
Healthcare Policy Issues:
While India's healthcare market presents immense potential, it also faces significant challenges. Non-tariff barriers, such as treating medical devices as pharmaceuticals and price controls, constrain market attractiveness for exporters. Weak intellectual property protection and enforcement hinder the pharmaceutical industry. However, recent regulatory changes regarding clinical trials for innovative pharmaceutical products offer opportunities for clinical research organizations.
Healthcare services in India are delivered by both the public and private sectors, with the latter growing faster than government investment. Foreign direct investment (FDI) in healthcare services faces no restrictions. Medical equipment import regulations allow for the import of most products under the "Open General" category, and customs duty rates have been reduced for certain lifesaving equipment. Price, quality, and after-sales service support are crucial factors influencing purchase decisions.
Current Market Trends:
Factors driving growth in the Indian healthcare industry include a population of over one billion people, an aging population, lifestyle diseases, rising incomes, increased health insurance penetration, and government support. Private players are expanding into Tier II and Tier III cities, capitalizing on the demand for quality healthcare facilities. The medical device market is estimated to reach $14 billion by 2025, and health insurance coverage is expected to increase affordability for healthcare services.
Best Prospects and Market Size:
The most promising sub-sectors within the healthcare and medical equipment industry in India include medical infrastructure, medical and surgical instruments, medical imaging, electro medical equipment, orthopedic and prosthetic appliances, cancer diagnostics, ophthalmic instruments and appliances, orthodontic equipment, dental implants, and point-of-care testing (POCT) diagnostic devices.
Main Competitors and Current Demand:
The Indian healthcare market features large private healthcare providers, both domestic and international. Competition arises from European and Japanese medical equipment imports, as well as low-priced Chinese products. Opportunities exist in building super specialty hospitals, supplying medical equipment and consumables, introducing industry standards for health insurance and hospital administration, and catering to the growing demand for diagnostic kits and portable diagnostic equipment.
Regulatory Landscape and Reimbursement:
The Central Drugs Standard Control Organization (CDSCO) and the Drug Controller General of India (DCGI) play key roles in regulating medical devices and pharmaceuticals in India. Medical care in India is predominantly provided at cost, with health insurance gaining momentum but still limited in coverage.
Barriers and Opportunities:
Regulatory changes, such as the classification of medical devices and price controls on certain products, pose challenges. However, opportunities exist in the development of healthcare infrastructure, supply of high-technology medical equipment, diagnostics, telemedicine services, and refurbished medical laboratory instruments.
In conclusion, the Indian healthcare sector is undergoing a rapid transformation, driven by various factors such as rapid economic growth, rising middle-class incomes, lifestyle diseases, and increased demand for specialized and quality healthcare services. This transformation has made healthcare one of India's largest sectors in terms of revenue and employment.
The industry, valued at $150 billion in 2018, is expected to reach $280 billion by 2022. The market is dominated by private players, who are investing heavily in healthcare facilities, medical diagnostic laboratories, and the health insurance sector. The government has also been actively supporting the sector through policy reforms and public-private partnerships.
Despite the tremendous growth potential, the Indian healthcare sector faces several challenges. Non-tariff barriers, price controls, weak intellectual property protection, and regulatory complexities affect the market attractiveness for pharmaceuticals and medical devices. However, recent regulatory changes have shown promise, encouraging clinical research organizations and attracting foreign investment.
Market entry opportunities exist for foreign firms, with no restrictions on foreign direct investment in healthcare services and favorable import regulations for medical equipment. Price, quality, and after-sales service support are critical factors influencing purchase decisions. The private sector, accounting for 80-85% of required healthcare investment, is expanding in Tier II and Tier III cities to meet the growing demand for quality healthcare.
Key areas of opportunities in the Indian healthcare sector include medical infrastructure, medical and surgical instruments, medical imaging, electro-medical equipment, orthopedic and prosthetic appliances, cancer diagnostics, ophthalmic instruments, orthodontic equipment, dental implants, and point-of-care testing (POCT) diagnostic devices.
Additionally, the biotech industry is rapidly growing, clinical trials and contract research are on the rise, medical tourism is flourishing, and e-healthcare/telemedicine services are gaining traction. The demand for refurbished medical laboratory instruments is also high, particularly in less sophisticated hospitals and district facilities.
However, challenges related to service accessibility, patient care quality, and healthcare infrastructure persist, particularly in rural areas. The government's support and investments are crucial for the sector's overall development and growth. Efforts to improve healthcare delivery, expand hospital facilities, and increase health insurance coverage are ongoing.
The Indian healthcare sector offers immense opportunities for both domestic and international players. With the right strategies, innovative business models, and a focus on quality and affordability, companies can tap into the growing market and contribute to India's journey towards a robust and inclusive healthcare system.