Future Watch Report - India 2017, part II: Accessible and precision healthcare for all, new innovations

OTSIKKO
ALAOTSIKKO, KUUKAUSI VUOSIFUTURE WATCH REPORT- INDIA, 2017
+

2.
ACCESSIBLE & PRECISION
HEALTHCARE FOR ALL
Team Finland Future Watch Report, June 2017

3
I
TELEMEDICINE ON
THE RISE
AI FOR HEALTH| DIGITAL DATABASE| M-HEALTH
Unavailability of trained personnel due to a skewed doctor-
patient ratio has catalyzed the rise of telemedicine, specially in
rural India.
II
UNIVERSAL
AFFORDABILITY
GOVERNMENT INITIATIVES | HIGH PUBLIC
MEDICAL EXPENDITURE |
INSURANCE
Indians spend around 11% of the GDP on healthcare,
while the government spends only about 1.5 %. This
parity has led to unequal access to healthcare.
III 3D PRINTING IN
HEALTHCARE
STRATEGIZING TOOL IN SURGERIES|
CUSTOMIZED PROSTHETICS & ORGANS
3D printing has come in as a game changer and is
effecting the healthcare industry as largely as its
effecting the others. Many start-ups in India are
innovating around 3D printing in healthcare.
CHAPTER HEADING CHAPTER HEADING CHAPTER HEADING CHAPTER HEADING CHAPTER HEADING
ACCESSIBLE AND PRECISION HEALTHCARE FOR ALL
IV
PRECISION MEDICINE
AI FOR HEALTH| DIGITAL DATABASE|
APPROVAL TO STEM-CELL THERAPY
Miniscule availability of Indian genetic data
at world level leads to hit-&-trial solutions
for Indians. Meanwhile, the country is in
the initial stage of adoption for precision
healthcare.

4
V
WEARABLE DIAGNOSTICS | WELLBEING ECOSYSTEM
Personalized end-point diagnostic devices are preferred
over seeking direct medical-help for chronic illnesses and
for monitoring general wellbeing.
PERSONALIZED
DIAGNOSTICS

5
TELEMEDICINE ON THE RISE
India ranks very low on the doctor: patient ratio (1:1700), much lower than the
WHO norm of 1:1000. This skewed ratio and the unavailability of qualified
personnel- specially in rural India, has acted as a catalyst in the rise of
telemedicine in India. The increasing ease of access to the internet means that
telemedicine is no longer limited to m-health.
In the recent years, India has seen many emerging B2B (management system for
medical practitioners) and B2C (consumer facing search platform) solution
providers in the field of telemedicine .
I. TELEMEDICINE ON THE
RISE
II. UNIVERSAL AFFORDABILITY
III. 3D PRINTING IN
HEALTHCARE
IV. PRECISION HEALTHCARE
V. PERSONAL DIAGNOSTICS &
HEALTHCARE Doctor Patient ratio comparison
1:1700
1:950
1:350
1:1000 (W.H.O norm)
Other Reference 1, 2, 3, 4, 5, 6,

Growth of the m- Health market is predicted to
lead to a revenue opportunity USD0.6 billion for
India. MapMyIndia and VISIT Internet Services
Pvt. Ltd recently came together to help the
government launch Swastha Bharat m-health
app powered by their mapping technologies and
AI-enabled tele-medicine platform. The app
allows citizens to access emergency ambulance
services, find nearby hospitals, clinics, labs,
pharmacy outlets & consult doctors over chat,
phone and video. The app also solves health
queries by providing instant health answers
through a chat based health assistant.
6
I. TELEMEDICINE ON THE RISE| INDICATORS
Practo: leading the market in
telemedicine
Practo is one of the most promising startups
in Indian healthcare space, giving both B2B
solutions (management system for medical
practitioners) and B2C solutions (consumer
facing search platform). In just eight years,
the company—with revenues in the range of
Rs.100-Rs 120 crore—has grown four times
year-on-year. It is world’s largest
appointment-booking platform with over 40
million appointments annually. It is present
in four other countries too—Singapore, Brazil,
Indonesia and Philippines—and is exploring
entering newer markets in Latin America,
Southeast Asia and the Middle East.
Government’s e-health
initiatives
The Government of India is scheduled to
launch the National e-Health Authority
(NeHA), a regulatory body, tasked with
overseeing the digitization of health
information and creating a health
information system.
NeHa will give priority to the needs of
patients and clinicians; adopt human-
centered design & focus on abandoning
traditional institution-based electric
medical records in favor of an API-based
eco-system.
m-heath opportunities
in rural India

7
I. TELEMEDICINE ON THE RISE| IMPLICATIONS & OPPORTUNITIES
1. OPPORTUNITIES IN DATA DRIVEN HEALTHCARE
Telemedicine will lead to increased generation of data in healthcare leading to more precise and personalized
treatment to be provided by doctors and hospitals. Data driven healthcare can lead to better prognosis of
diseases based on the digitized medical records and data driven health insurance. Doctor- patient interaction
through digital media can lead to newer business opportunities for pharmaceutical companies and other
health related businesses (digital marketing, education-based marketing etc.). Finnish companies specializing
in telemedicine and data driven services (such as Carecode and Telia) could enter this space.
2. DIGITAL PRESENCE OF DOCTORS, PHARMACIES AND HOSPITALS LEADING
TO NEW DIGITAL SERVICE MODELS
Doctors increasingly becoming part of a digital hub and spoke model which means they have the opportunity
to widen their range of services to other parts of the country leading to EMERGANCE OF STAR DOCTORS who
provide their services to different parts of the country from their smartphones/other digital devices. E-
COMMERCE IN MEDICINE could play a major role in further reducing the inequality gaps in healthcare.
Emergency services can be integrated into the telemedicine services. Telemedicine would also reduce the fear
among patients for being stigmatized for particular conditions/diseases such as mental health disorders, STDs
etc.
3. HEALTHCARE EDUCATION WILL HAVE TO BE REVAMPED
Telemedicine and Data driven healthcare will become a part of healthcare education, and doctors and other
medical stuff will require training in effectively implementing technology in their professional practices.
4. ON-DEMAND MEDICAL SERVICES

8
UNIVERSAL AFFORDABILITY
India’s government expenditure on public health per capita is a meagre USD 60,
compared to USD 9451 in the USD 3984 and as of 2015.
Healthcare forms 1.25% of the total GDP of the country although, the High-Level
Expert Group (HLEG) report on Universal Health Care in India recommended
increasing public expenditures on health from 1.2% of GDP to at least 2.5% by
the end of the 12th plan, and to at least 3% of GDP by 2022.
According to India’s draft National Health Policy 2015, the country’s OoP
expenditure for health (at 60% of total health expenditure) is one of the highest in
the world.
Public Spending on health per capita
$60
$300
$1000
$10735
RISE
II. UNIVERSAL
AFFORDABILITY
III. 3D PRINTING IN
HEALTHCARE
HEALTHCARE
Other Reference 1, 2, 3, 4, 5

9
II. UNIVERSAL AFFORDABILITY| INDICATORS
De-stigmatizing mental
health & making it affordable
Affordable menstrual
health management
CSR drives skills
development
Nearly 6% of Indian population (around
60 million) suffer from mental illnesses,
which is more than the entire population
of South Africa, and yet India only spends
about 0.06% of its health budget on
mental health. A Mental Healthcare Bill
was passed by the Indian government in
March 2017 that ensures that each
person has a right to access mental health
care and treatment from mental health
services run or funded by the appropriate
government.
The Bill also assures free treatment for
such persons if they are homeless or
belong to Below Poverty Line, even if
they do not possess a BPL card.
India. The bill also now ensures a life of
dignity, right to choose means of
treatment, right to choose the nominee &
the right to confidentiality.
A pilot model for vending machines that
dispense affordable sanitary pads has
been installed recently in all secondary
schools in Kerala by a brand called
Vendigo.
88% of Indian women cannot afford
sanitary pads and use alternate means to
manage menstruation, which include old
cotton rags, sand and other unhygienic
material. Of late, NGOs and now the
government are trying to provide rural
women and urban low-income women
with cheaper options for their menstrual
management.
Indian Government launched the ‘Pradhan
Mantri Suraksha Beema Yojana’, a flagship
social security scheme in 2015 to provide
highly affordable accident insurance to the
lower income population. It has already
crossed 100 million enrollments over the
last two years.
Under PMSBY, the risk coverage available
is USD3000 for accidental death and
permanent total disability, and USD 1500
for permanent partial disability. More than
400 people die on Indian roads every day,
and the rate has been growing in the past
few years.

10
II. UNIVERSAL AFFORDABILITY | IMPLICATIONS & OPPORTUNITIES
1. OPPORTUNITIES IN AFFORDABLE HEALTHCARE
India faces a giant crisis in affordable healthcare, with areas such as mental health and infant care
severely affected. India’s Infant Mortality Rate of 42 deaths per 1,000 live births is worse off than poorer
neighbors Bangladesh (31) and Nepal (29), and the African nation of Rwanda (31). India’s healthcare
future is heavily hinged upon affordability, and organizations who can provide better affordability have
major opportunities in the healthcare sector.
2. OPPORTUNITIES IN LOW COST/ALTERNATIVE MEDICINES
There are a number of startups in India such as 1mg which provide cheaper alternatives and substitutes
for medicines. Indian government is also implementing a generic medicine policy through legislation
which will mandate doctors to prescribe generic medicines which are cheaper than their equivalent
branded drugs. Indian government has also been pushing the alternative medicine through the ministry
of AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) in development, research
and education of alternative medicine. Recently the union cabinet of India approved a Joint Declaration
of Intent (JDI) between Germany and India regarding cooperation in the sector of alternative medicine.

11
3D PRINTING IN HEALTHCARE
India is one of the fastest growing markets for the 3D printing industry. India’s 3D
printing prototyping and materials market is expected to reach USD 62 million by
the year 2022.
Hospitals in India are finding various applications for this technology. Be it
prosthetics or surgeries to treat complex heart diseases, the three dimensional
structures always come in handy. 3D printed models are also used for treating
complex fractures and face reconstruction surgeries among others.
3D printing is cost-effective too, in certain cases. A myoelectric hand with all
finger movements costs around USD 10,843 while the 3D printed hand costs only
around USD 300.
RISE
III. 3D PRINTING IN
HEALTHCARE
HEALTHCARE
Other Reference 1, 2, 3,

12
III. 3D PRINTING IN HEALTHCARE | INDICATORS
Startups innovating in
healthcare with 3D printing
Organ & prosthetics
developed using 3D printing
3D printing at the strategizing
stage for critical surgeries
Hospitals like Fortis in Mumbai have been
using 3D printing to make models which
help in strategizing pre-surgery
procedures.
3D printing is being used in a number of
hospitals throughout India to replace old
practices like echocardiograph- for a
higher precision rate and for cutting
down the cost of surgery. In a firsts,
Medicity hospital in Gurugram replaced a
woman’s vertebrae with a 3D printed
one, thus saving her life.
India has a fast growing market for 3D
printing in medicine. Many young
startups- like Osteo3D and Novabeans-
are entering the field to provide
innovative 3D printing solutions- in the
field of health- education, surgery
strategy, organ replication & prosthetics.

13
III. 3D PRINTING IN HEALTHCARE| IMPLICATIONS & OPPORTUNITIES
1. OPPORTUNITIES IN 3D PRINTED IMPLANTS & ORGANS
Better affordability of implants if they can be 3D printed, will be a boost to the implants industry. (Companies
such as Planmeca could invest in bringing 3d printed implants to India). 3D bio printing is being applied to
regenerative medicine to address the need for tissues and organs suitable for transplantation. It could have a
major impact on India where almost 500,000 people die every year due to non-availability of organs. Affordable
3D printing will also lead to boost for the 3D printing raw material industry, such as Thermoplastic filaments, and
also lead to an increased demand for skilled 3D printing technicians and operators. Build to order methods will
overhaul the current supply chain systems since 3D Printing code can be sent electronically.
2. USE OF 3D PRINTED ANATOMY IN RESEARCH, EDUCATION & PRE-SURGERY
PROCEDURES
3D printing could become part of the college curriculum for doctors, completely eliminating the use of cadavers
and specimen. 3D Printing also helps in improved understanding of complex body organs – for medical
researchers. Research could fundamentally change with the advancements of 3D printing.

14
PRECISION HEALTHCARE
Precision healthcare has been a rising trend in Indian over the past few year,
fueled by multiple startups working in areas such as Gene Mapping and Stem
Cell Therapy.
On an international level, India forms only 0.2% of the gene-data available, a
gap that means that most of drugs made internationally are a hit-and-trial for
the 400 population subgroups present in India. This, with the increasing
number of genetic diseases and increase in the rate of cancer, calls for a faster
action in precision medicine.
Many Indian startups as well as international organizations are working
towards mending the hole in the Indian genetic data availability and in
precision medicine in India.
RISE
III. 3D PRINTING IN
HEALTHCARE
HEALTHCARE
Other Reference 1, 2, 3

15
IV. PRECISION HEALTHCARE | INDICATORS
Approval to stem cell
therapy
Genomic mapping for
preventive diagnosis
Started in 2013, Hyderabad based
startup MapMyGenome helps medical
fraternity and patients in all stages of
diagnostic tests, through professional
genetic counseling.
‘Genomepatri’ is one of their products
that provide a detailed report of risks for
a broad spectrum of diseases on the
basis of the patient’s DNA. All a person
needs to do is submit a saliva swab
sample and the startup comes up with a
detailed Genomepatri in three weeks.
Mapmygenome has rolled out other
products like Baby Map Carrier (which
determines the chances of future
children being affected by certain
hereditary conditions) & TB diagnostics
kit. The company has raised around
USD 2 million till date and is now at a
growth stage with focus is on customer
acquisition
Recently, Mumbai based company
Regenerative Medical Services Pvt. got
an approval from the Drug Controller
General of India (DCGI) for its stem
cell-based therapy to treat cartilage
defects named Chondron. This is the
first stem cell-therapy product to be
approved in India.
Chondron, its cartilage repair
procedure, uses the body’s own
cartilage cells that are cultured,
multiplied and implanted into the
patient’s damaged joint leading to
new cartilage regeneration and
avoiding the need for early joint
replacement.
Bot aided implant to cure
Parkinson’s disease
A hospital in Kochi in the state of Kerala
performed Asia’s first bot-aided implant
for Parkinson’s. Zubair, the patient was
35 years old when he was diagnosed with
Parkinson’s disease. Over the years, his
fits got more violent. The ROSA robotic
technology was used in this case to cure
his disease, often called the GPS system
for the skull, ensures high precision
during the implantation of the neuro-
stimulator. This was used for the first time
in Asia in the case of Zubair.

16
IV. PRECISION HEALTHCARE| IMPLICATIONS & OPPORTUNITIES
1. OPPORTUNITIES IN DEMOCRATIZING GENETIC DATA
since Indian genetic data forms only 0.2% of the globally available data, there is a huge opportunity for
creating an India-centric genetic database. This may lead to opportunities research and for making more
precise medications for the 400 population groups that live in India.
2. STEM CELL THERAPHY
India recently took its first steps in the field of Stem Cell Therapy with Chondron (as elaborated on
previous page). The market for stem-cell therapy though in nascent state, holds the opportunity for new
players.
3. PRECISION MEDICINE IN EDUCATION
The rising awareness around genomics and stem-cell therapies would also requires a them to be a larger
part of the medical school curriculum- which is not the case right now. This would require course-work,
expert professionals & academics etc. This opens up an opportunities of collaboration between
institutions in India and Finland.
Other Reference 1, 2, 3, 4, 5, 6, 7

17
PERSONALIZED DIAGNOSTICS
The traditional form of diagnostics are giving way to personalized diagnostics
which include diagnostic wearables and personal diagnostic devices.
Personalized diagnosis eases the process and saves the cost of seeing a
doctor especially in the case of long-term conditions like blood-pressure,
diabetes etc. Fitness wearables are also becoming a large part of this
ecosystem.
India is also looking at a growing opportunity in the field of in-home
healthcare as the number of elderly population increases and doctor to
patient ratio becomes poorer (1:1700).
RISE
III. 3D PRINTING IN
HEALTHCARE
HEALTHCARE

18
V. PERSONALIZED DIAGNOSTICS | INDICATORS
Diagnostic
Devices
UE Life Sciences – Self
diagnosis for breast cancer
India is often termed the diabetic capital
of the world, with more number of
patients than anywhere in the world (>50
Million) and is expected to rise almost by
58% to a staggering 87 million by 2030.
The home diagnosis market for diabetes is
already strong with giants like Johnson
and Johnson having a range of products in
the offering.
Cooey, a Bengaluru startup is making a
smart glucometer. A drop of blood placed
on the strip triggers a chemical reaction
that sends an electrical signal to the
glucometer, and generates a reading
showing the sugar levels. It connects to
your phone using the 3.5mm headphone
jack and when you do this, it connects
to Cooey's mHealth application.
In 2013, approximately 70,000 Indian
women died due to breast cancer; a 43%
jump from 2008. Today, one in every two
diagnosed women are dying of breast
cancer. The mortality rate is alarmingly high
due to two major reasons – delay in early
diagnosis and lack of preventive breast
health checks.
Conceived by UE Life Sciences, a company
started by an Indian Computer Engineer
from Drexel University; iBreastExam is a
hand-held, painless and radiation-free device
that detects abnormalities instantly, helping
women detect cancer at an early stage. iBE
pairs with smartphones through Bluetooth
and scanning results appear on the screen.
The emphasis is on affordability with each
screening costing just USD 1.5.
In less than a year, iBreastExam has screened
30,540 women in India, of which 30 early
detections were confirmed. For the next
year, UE LifeSciences has already received
financial commitments to screen 400,000
women.
Personalized healthcare
at home
The global market for home healthcare
(services, devices, products) is expected to
reach USD 355 billion by 2020, growing at a
CAGR of 8% from 2014. Meanwhile, in India
it is worth about USD 2.3 billion and growing
at 20% annually. With technology-led
transformation, the home healthcare market
in India is in a comfortable space to address
gaps in the country’s healthcare system, and
allow people, especially seniors, to access
healthcare at their comfort.
Portea, a home care startup focused on the
elderly, leads the in-home care segment with
operations in 16 Indian cities. In its largest
market in Bengaluru, the company conducts
over 500,000 monthly visits, including elder
care and registered a month-on-month
growth of 15% in the number of home visits
since 2013.

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V. PERSONALIZED DIAGNOSTICS| IMPLICATIONS & OPPORTUNITIES
1. SELF ASSISTED DIAGNOSTICS & MONITORING
Self-assisted diagnostic, which takes away from the cost and effort of having to go to a medical
practitioner- specially in the case of chronic diseases or for the elderly who need regular monitoring,
has the potential to become a large market opportunity in India. Lack of easy access to qualified
medical practitioners also adds to the reason.
2. OPPORTUNITIES FOR CREATING WELLBEING ECOSYSTEM
With the growing market of wearables that monitor health and fitness, there arises the need for a
larger idea of wellbeing- ecosystems that provide end-to-end solution, including:
I) Preventive healthcare
2) End point diagnostics
3) Emergency medical services

+
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Nilakh, Pune 411027, INDIA
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