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Catalysts of Change A rainbow like collection of vibrant innovations and sky-high investments are enabling the healthcare sector in India to grow at a scorching pace By Dhirendra Pratap Singh, dhirendra@elets.in
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january / 2012 www.ehealthonline.org
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s George Bernard Shaw once said, “Progress is impossible without change, and those who cannot change their minds cannot change anything.” The last year, defined by innovations and new technology trends in healthcare, one word that dominated the global vocabulary was ‘change’. Healthcare has emerged as one of the most progressive and the largest service sector in India. The sector’s share in India’s GDP is expected to reach 8 percent by 2012. In 2009, it was 5.5 percent. At present the sector is estimated to be around US$ 40 billion and will grow to US$ 78.6 billion by 2012. The Indian healthcare sector is expected to become a US$ 280 billion industry by 2020 with spending on health estimated to grow 14 percent annually. The year 2011 can be considered a year of technology advancements. This was the year when innovative business models using IT ensured reach out of healthcare facilities to the masses. The year 2011 has been like no other for healthcare IT, not just in terms of the revolutionary and ground-breaking technology advancements, but also in terms of innovative business models. As Anthelio Business Technologies, Vishwanath Sivaswamy explains, “In 2011, Telemedicine - remote diagnosis, monitoring and treatment of patients via videoconferencing or the Internet - was seen as a fast-emerging trend in India. Telemedicine was supported by exponential growth in the country’s information and communications technology (ICT) sector, and plummeting telecom costs. Several major private hospitals have adopted telemedicine services, including those that have developed Public-Private-Partnerships (PPPs), such as the AIIMS. There are approximately 120 telemedicine centres across the country, and the government has pledged support for hundreds more.” He adds, “A booming healthcare insurance scenario is paving the way for hospitals to be able to afford use of technologies such as HIS and EMR. With the introduction of 3G, the possibilities of remote treatment and diagnosis of patients through mobile phones have been strengthened. In 2011, the number of cell phone users in India stood at approximately 600 million, with a projected increase of 20 million each month. In 2012, some telecom operators and value-added service developers are considering usage of mobile phones for diagnostic and treatment support, remote disease monitoring, health awareness and communication.” With the introduction of 3G ready devices like iPads, Samsung Galaxy Tab, Dell Streak etc., which have much bigger screen to facilitate content and application placement the mHealth space is poised to get even more expansive. The global healthcare IT market is forecast to exceed $24 billion by 2015 with a CAGR of 11 percent. The market is expected to be driven by governments’ financial incentives and regulations requiring automation in healthcare practices. The market growth is also expected to be driven by increasing need for hospitals to attain cost efficiencies and growing evidence of use of IT in healthcare practices.
“In 2011, Telemedicine - The remote diagnosis, monitoring and treatment of patients via videoconferencing or the Internet - was seen as a fast-emerging trend in India. Telemedicine was supported by exponential growth in the country’s information and communications technology (ICT) sector, and plummeting telecom costs.” Vishwanath Sivaswamy MD, Anthelio Business Technologies
The concept of Remote Diagnostics is picking up in India. More and more experts are interpreting digital images of MRI, CT scans, X-rays, etc and sending their interpretations to doctors practising not only in various parts of the country but also abroad. This innovative solution is simply a new paradigm of seeking medical expertise. Similarly, Telemedicine is fast becoming an integral part of healthcare services in several countries including Canada, Italy, Germany, Japan, Greece, Norway and now India. In India, Karnataka has become the role model for implementing telemedicine in all its districts. The market penetration of Picture Archiving and Communication Systems (PACS) in India is gaining momentum owing to the growing popularity of digitisation at the level of hospitals and healthcare delivery centres.
Medical Technologies Medical Technology over the past ten years has transformed the healthcare sector with several cutting edge technologies in the areas of molecular diagnostics, molecular imaging, minimally invasive therapies, implantable medical devices etc. The world today needs technology related innovation from the emerging world to ensure that the new technologies are affordable to a larger section of the population. The size of the Indian medical technology industry may touch US$ 14 billion by 2020, up from US$ 2.7 billion in 2008. The increased market share is on account of strong economic january / 2012 www.ehealthonline.org
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With increase in awareness, growing income level, rapid increase in health infrastructure, gradual increase in state level reimbursement, and the enhancements of institutional and private medical insurances, India is now one of the fastest growing healthcare markets in the world.” Kaustav Banerjee Country Manager, India- St. Jude Medical Devices growth, higher public spending and private investments in healthcare, increased penetration of health insurance and emergence of new models of healthcare delivery. Kaustav Banerjee, Country Manager, India- St. Jude Medical Devices, says, “The medical technology space is diverse, and there are various therapies currently being offered for an array of diseases and ailments. This diversity makes it difficult to point towards one or two specific medical technologies.”
He adds, “We offer technologies that help achieve cost reduction benefits, including our fractional flow reserve (FFR) PressureWire™ technology. FFR is a physiological index that helps physicians to identify the severity of blood flow blockages in the heart. This information helps guide decisions as to whether stenting or optimal medical therapy would be the best course of treatment for each individual patient. The FAME study demonstrated that use of FFR prior to coronary stenting resulted in superior outcomes for patients – including a 28 percent reduction in major adverse cardiac events – as well as a reduction in cost.” Dr Bhaskar Krishna Arumugam, Chief Executive Officer, Granules India Ltd., says “Over the next several years, companies will focus on generics for biotech products. This sector will become the next big growth driver for Indian healthcare companies. India’s biotech sector is relatively small, but it will continue to grow over the next few years as more companies focus on this space.”
Evidence based medicine tools As the healthcare industry matures in terms of infrastructure and innovative technologies, the next goal of care delivery demands clinical excellence through evidence based medicine tools and benchmarks. Evidence based medicine is already being promoted globally and has been proved to be beneficial for all the stakeholders- clinical teams, hospital management as well as the patients. Evidence based medicinal tools, like clinical protocols and clinical pathways, provide explicit and well defined standards of care for the clinical teams and support multi-disciplinary care planning. From a management perspective these tools reduce healthcare costs, reduce patient documentation, optimise management of resources and help continuous clinical audit. They improve clinical care by delivering superior outcomes, improved clinical effectiveness and patient satisfaction. These tools can also be integrated with the existing EMR for providing decision support to the clinical teams.
A study by Ernst & Young says that India will require another 1.75 million beds by the end of 2025. The public sector is likely to contribute only around 15-20 per cent of the required US$ 86 billion investment. Healthcare sector in India, at present is estimated to be around US$ 40 billion and will grow to US$ 78.6 billion by 2012 The size of the Indian medical technology industry may touch US$ 14 billion by 2020 on account of strong economic growth, higher public spending and private investments in healthcare The global healthcare IT market is forecast to exceed $24 billion by 2015 with a CAGR of 11 percent The government has proposed to step up the plan allocations in 2011-12 by 20 percent amounting to Rs 26,760 crore With a world average of 3.96 hospital beds per 1000 population India has only 0.7 hospital beds per 1000 population. The country will require another 1.75 million beds by the end of 2025
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january / 2012 www.ehealthonline.org
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Clinical protocols and pathways based on evidence available from the Indian sub-continent are now available and need to be adopted in healthcare settings to achieve the next level of quality. The right amalgamation of modern infrastructure, innovative technologies and clinical skills guided by evidence based tools will go a long way in bridging the gap in the Indian healthcare industry.
Government Policy The Government has proposed to step up the plan allocations in 2011-12 by 20 percent, amounting to ` 26,760 crore. This was announced by the Union Finance Minister Pranab Mukherjee while presenting Sixth Union Budget 2011-12. The boost provided to healthcare is welcome and shall continue to support the industry’s need to reach a larger population, including the people in the remotest districts. The reassurance shall provide the push for further growth. In India, the increased budget can further be fruitful as it will ensure good progress at the technological aspect. The Rashtriya Swasthya Bima Yojana (RSBY) has been extended to cover unorganised sector workers in hazardous mining and associated industries, like slate and slate pencil, dolomite, mica and asbestos. The Yojana has emerged as an effective instrument for providing a basic health cover to poor and marginal workers. Presently it is being extended to MGNREGA beneficiaries, beedi workers and others. Government of Maharashtra is using ICT as a tool to enhance their ability and bring more professionalism in healthcare services. Tripura has initiated Tripura Vision Centre Project, a Tele-ophthalmology project aimed at offering primary and preventive eye care services to rural citizens. The project has adopted the latest ICT related advances in medical sciences and bio-medical engineering. However, there are lot of challenges ahead. India faces the huge need gap in terms of availability of number of hospital beds per 1000 population. With a world average of 3.96 hospital beds per 1000 population, India stands just a little over 0.7 hospital beds per 1000 population. Moreover, India faces a shortage of doctors, nurses and paramedics that are needed to propel the growing healthcare industry.
Wish-list to the government Says Vishwanath Sivaswamy, “I believe that India can leverage its prowess in computer technology, along with its highly skilled medical fraternity, to enable and augment technology in healthcare. With spending in the industry likely to touch ` 200,000 crores by next year, policy initiatives by government will go a long way in ensuring effective penetration of healthcare technology.” To support and nurture the growth of healthcare technology, the Government should provide incentives to hospitals to seek NABH (National Accreditation Board for Hospitals) accreditation and IT enablement by allowing 100 percent tax exemption for expenditures related to accreditation and IT enablement. Such initiatives will not only pave the way for a sustainable fu-
“Over the next several years, companies will focus on generics for biotech products. This sector will become the next big growth driver for Indian healthcare companies. India’s biotech sector is relatively small, but it will continue to grow over the next few years as more companies focus on this space.” Dr Bhaskar Krishna Arumugam Chief Executive Officer, Granules India Ltd ture for healthcare, but will also give rise to a nation where advancement in technology can truly be leveraged for prosperity and change. Indian pharmaceutical companies will benefit if the government takes steps to modernise the infrastructure, including roads and ports. Modern infrastructure would reduce transportation time and costs, which and enable the healthcare leaders to create more value for customers.
Future A booming healthcare insurance scenario is enabling hospitals to afford technologies such as HIS and EMR. With the introduction of 3G, the possibilities of remote treatment and diagnosis of patients through mobile phones has been strengthened. In 2011, the number of cell phone users in India stands at approximately 600 million, with a projected increase of 20 million each month. In 2012, some telecom operators and service developers are considering to use mobile phones for diagnostic and treatment support, remote disease monitoring, health awareness and communication. In the healthcare sector, Electronic medical record (EMR) services have a high growth potential and is expected to become the most popular in 2012. According to Reuters, EMR growth is pegged at an estimated compound annual growth rate (CAGR) of 13.5 percent from 2009 to 2016. The spate of new private hospitals that accounts for more than 80 percent of the country’s total healthcare spend is likely to boost this further, with investment in EMR being seen as a necessity. january / 2012 www.ehealthonline.org
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