India's healthcare sector is growing rapidly and is expected to become one of the top 3 global markets by 2020. Both public and private sectors play a role, with the government providing policy initiatives and infrastructure while also encouraging private investments. Private hospitals now offer a wide range of specialty and super specialty services using advanced technologies. The growing middle class and changing lifestyles have increased demand for treatment of non-communicable diseases. Both domestic and medical tourism are contributing to the sector's growth.

1. SMARTER HEALTHCARE SERVICES
A COMPREHENSIVE MARKET REPORT ON INDIA'S HEALTHCARE
2018

2. The city
India - Demographics:
Population Density
Socio-Economic Indicators
Healthcare Scenario Of India
Medical Tourism In India
Major Private Chain Of The Hospital In India
Major Diagnostic Chain Center In India
Major Pathology Lab In India
Healthcare Development
02
03
04
05
07
11
13
15
16
21
Medical College In India 17
About us 01
Major Development 06
Major Government Hospital In India 12
Index
Need Gap Analysis 22
SWOT Analysis 25
Conclusion 30

3. Hospital Planning And Architecture
Hospital Management Consulting
Human Resource Management
Business Development And Promotions
Inventory & Biomedical Equipment Consulting
Hospital Information System
Healthcare operations and nance management
Hospaccx Healthcare Academy
The services we offer
1

4. India's healthcare sector is a fast-growing industry that has the potential to become one of the top 3
global markets in terms of incremental growth. Industry experts suggest that the annual growth of
investments is expected to reach a staggering US $280 billion by the year 2020. This sector is also one
of the largest in terms of revenue generation, and the employment opportunities for a young and
dynamic population are also huge. Health services are provided by the Government Institutions as
well as the thriving speciality and super speciality hospitals from the private sector.
Rapid urbanization and a prospering middle class has shifted the focus from traditional diseases to
lifestyle related health maintenance and care. The rural and tribal populations still rely on Government
agencies such as health care centres, district hospitals and general hospitals. These centres tackle
issues related to rst aid, primary healthcare, infant mortality, child malnutrition, etc., But, The towns
and cities grapple with lifestyle problems such as diabetes, obesity, alcoholism, high blood pressure
and cholesterol. The private players are also collaborating with the Government hospitals to extend
their reach to the rural, tribal, and remote areas.
Extensive healthcare facilities in India include hospital infrastructure, pharmaceuticals, diagnostics,
medical equipment and tools, insurance, and even telemedicine. The popular brands like Global
Hospitals and Max Healthcare operate full- edged private networks that deliver cutting edge medical
services. These accredited and well-funded institutions are famous for sophisticated treatments such
as radial procedures, intravascular treatments, advanced cardiac care, and multi-organ transplant
surgeries. Many Private Public Partnership (PPP) initiatives are on the anvil, and they are projected to
revolutionize the global healthcare industry.
2

5. India - Demographics:
3
India is not just a country, but a large sub-continent with an ancient history and a well-structured socio-
political organization. The parliamentary democracy distributes power between Union Government and
State Governments. Healthcare is a State issue and the Union Government only provides policy initiatives
while simultaneously facilitating the economic environment. The Nation-State is made up of very large
metropolitan cities such as Mumbai, Kolkata, Chennai, and the capital city New Delhi. The tier I and tier II
cities such as Hyderabad, Pune, Lucknow, Bengaluru, Indore, Cochin, Ahmadabad, etc., are not far behind in
terms of urbanization, health care demands, and an aging population.
In fact, the majority of secondary, tertiary, and quaternary health centres have their base in these bustling
cities. Economic freedom, changing lifestyle habits, and a young and enterprising citizenry is responsible for
the rapid growth in private healthcare services all across India. The Government ensures social harmony and
bridges rich-poor divide through health initiatives and policy plans such as rural health mission, national
insurance mission, etc. It also extends tax cuts to some of the well-known private hospitals, and as a result
institutes such as Vaatsalya Healthcare have managed to expand into tier II and tier III cities with their chain
of hospitals.

6. 4
India has more than 1.2 Billion people who have spread out into large cities, towns, villages, and tribal areas.
Moreover, the population of the elderly and senior citizens is set to grow from 98.9 million to 168 million by
the year 2026. The educated classes are globalized, and they are well aware of higher health standards and
developments in medicine. They expect preventive care along with high quality speciality and super
speciality services for lifestyle and terminal diseases. The availability of health insurance and the popular rise
in medical tourism has also spurred the growth, along with public interest, in private hospital facilities.
Rural India itself is a very large segment of the healthcare market, and it alone accounts for approximately
70% of India's population. Modernisation has reached these sections of the society through popular TV,
internet, and mobile communications. Urban infrastructure is picking up in the form of metros and bullet
trains, and the rural economies aim to catch up through higher health objectives and commercial
enterprise. The scope of private hospitals in rural areas is also very large as only 3% of specialist medical care
is available here. The opportunities for health insurance are also enormous as only 15% of the population
has medical coverage, and the positive projections include a 5% increase in very short time.

7. 5
Socio-Economic Indicators
Economic liberalization, technological in ux, and capitalist ventures have lifted considerable sections of
Indian society out of poverty. Urbanization has also brought in entertainment, leisure, and alternative
lifestyle choices for a large section of the population. This has led to enormous growth in post-industrial
diseases such as diabetes, heart problems, high BP, bad cholesterol, obesity, etc., the urbanized citizenry
faces up to these challenges through rising incomes, and the per capita expenditure in healthcare increased
to US $68.6 between the years 2008 and 2015 with a 5% CAGR (Compounded Annual Growth Rate).
Nowadays, the prospering sections of society have easier accessibility to generic drugs in the market, and
the private players also made notable contributions through effective cost leadership. They introduced
efficient supply-chain systems, and leveraged the economies of scale to drastically cut down costs. Narayana
Hridayalaya is one such popular destination that delivers high quality heart care solutions at affordable
costs. The Government also aspires to establish social harmony through policy initiatives such as National
Rural Health Mission (US$10 billion for facilities) and National Health Insurance Mission (coverage for the
entire population).

8. 6
India's booming health care industry is the result of talented medical professionals, timely privatization,
State support, and optimized health services. The major development in this success story has
undoubtedly been the introduction of technology. Private hospitals extend speciality and super speciality
services in state of art facilitates with Hi-tech diagnostic tests. Big investors like Fortis and Manipal Group
brought in additional hospital revenues through management contracts. The Government has promoted
technological treatments for Cancer and TB, along with eHealth initiatives such as Mother-Child Tracking
Systems and Facilitation Centres (MCTS/MCFC).
Telemedicine has also become a fast-emerging sector with big names like Apollo, AIIMS, and Narayana
Hrudayalaya venturing into Public-Private Partnerships (PPP). The projected 20% CAGR growth and
valuation of US $32 million by 2020 seem totally plausible due to accrued bene ts. Hi-speed internet and
communication, low cost consultation and diagnostic facilities, and English speaking professionals augur
well for this market segment. The potential for growth is enormous as all these facilities can be extended to
the rural and remotest areas for diverse applications such as education, training, and management.
Major Development

9. Healthcare Scenario Of India
Stable Democracy:
Modern healthcare and medical services have become an essential requirement in a rising power like India.
The thriving democracy is housed in a large sub-continent, and the demographic diversity includes urban,
rural, and tribal population. In the last two decades, due to economic liberalization, the nation has
progressed in healthcare delivery due to the two most important factors listed below -
7
The Union Government in New Delhi collaborates with State Governments to ensure the health and
living standards of the people. Healthcare is a state subject, but the National-level leadership frames
policies and directives that enhance the quality of medical care for new-borns, pregnant mothers, and the
elderly. The Government initiatives for rural populace include technology-assisted facilitation and tracking
centres, mid-tier nursing homes, and promotion of alternative medical systems. The Government
healthcare institutions include AYUSH (Ayurveda, Unani, Siddha, and Homeopathy) and AIIMS.
Private Entrepreneurship:
India is an interesting mix of public initiatives and private entrepreneurship. The Government Ministries
spends about 2.5% of GDP on healthcare and they also invest in developing infrastructure such as
Government Hospitals, Primary Healthcare Centres, District Hospitals, and Medical Colleges. At the same
time, The Private sector is also encouraged to participate in healthcare and insurance through tax cuts,
privatization, and PPP or public-private partnerships.
Note: The Government has raised the tax exemption on preventive health check-ups from US$74.37 to
US$297.48 to ensure universal health coverage. In the recent Union Budget of 2017, the depreciation
rate on medical devices and equipment has also been doubled from 15% to 30% to promote private
investments in advanced technologies.

10. 8
International Management and Financial Consultancies forecast a positive and upward trend in Indian
sectors such as Healthcare, Education, and IT Services. Some of the most prominent and key indicators of
medical services in India include -
Key Healthcare Indicators
Health system was an independent and social sector with an estimated value of $60 billion by the
end of 2012. Through Government will and private players, it is slowly transforming into a modern and
networked healthcare industry. The new sector is growing at a high rate of 15% and the revenues are
estimated to reach anywhere between US$ 250 - 280 by the year 2020.
Growing prosperity, educated middle class, health awareness, and urban lifestyles have boosted
the demand for medical treatments related to obesity, diabetes, cancer, heart, liver, and neurological
disorders.
Fashion and glamour conscious citizenry also aspire for luxury care as well as advanced surgeries
related to hair transplant, rhinoplasty, breast reduction or enhancement, liposuction, and other cosmetic
procedures.
India is also a strong contender in medical R & D, pharmaceutical/formulation exports,
telemedicine, and other high quality healthcare services. The Government's objective is to convert the
Nation into a global healthcare hub, and it encourages medical tourism through private participation
and AYUSH.
To ensure social equity, Healthcare access and insurance coverage are extended across the demographic
and economic divide. The private sector is also incentivised and encouraged to take brand names and
hospital chains to tier II and tier III cities as well as rural and remote areas.

11. 9
By 2015, India has become the fth largest employer in healthcare sector through direct and indirect
employment. Health and allied services are delivered all across in India by various participants,
competitors, and partners. The signi cant points listed below indicate to the growth opportunities in
delivery of a range of medical services-
Types Of Healthcare Delivery In India
New Delhi, India's capital has the All India Institute of Medical Sciences (AIIMS), and large metro
cities such as Bangalore, Mumbai, Hyderabad, Chennai, etc. are the primary areas of focus for
investments.
Health is a state subject, and local governments in Karnataka, Punjab, AP, etc., have shown
interest in setting up public hospitals, speciality and super specialty hospitals, cancer treatment centres,
research institutes, etc.,
India is a suitable destination for promoting telemedicine due to the challenges in delivering
meaningful healthcare to rural and remote or tribal areas. Other technological initiatives include
Electronic Health and Medical Records, Hospital and MIS, mobile healthcare, digital health knowledge
resources, PRACTO, cashless transactions, etc.,
India is well known for IT industry, and the private health sector is leveraging tools and
techniques to cut down costs and improve the efficiency of healthcare delivery. Narayana Hrudayalaya,
Max Healthcare, Global Hospitals, etc., have become popular brand names for speciality and
multispecialty treatments.
Max Healthcare started as a hospital in 2000 and in a short period of 15 years it has transformed
into an affordable and efficient hospital network with revenues reaching up to US $2.17 billion. The
award winning hospital chain has other resources such as super speciality hospitals, quali ed and well
trained personnel, and millions of registered patients. It is also expanding into the global market by
partnering with South African companies and has plans for a US$ 47.79 million cancer hospital in New
Delhi.

12. 10
The Government and Private hospitals deliver an extensive range of healthcare services in metros, State
capitals, and other cities and towns of India. The country is a mix of cosmopolitan lifestyles, dense
population, heavy traffic, and materialist consumerism. As a result, there is an increased demand for
traditional, modern, contagious, and emergency treatments or medical care. The patient in ow and
out ow can be gauged from the following list of notable features-
Patient In ow And Out ow
There has been a steady increase in speciality, super speciality, and multi-speciality hospitals not
only in metros, but also in several tier II and tier III cities. Allied services such as nursing homes, clinical
and imaging diagnostic centres, aesthetic and weight loss clinics, etc., also see a steady growth in the
patient lists, health records, and databases.
Modern and western in uences as well as improvements in education and health awareness has
created an increased demand for affordable and efficient healthcare services that are preventive and
diagnostic in nature.
Lifestyle diseases have become common place, and 50% of the inpatients in hospital beds spend
on treatments to kidneys, cancers, blood pressure, heart ailments, liver problems, bad cholesterol,
muscle-skeleton deformities, brain disorders, etc.,
Specialized in-patient care is also sought for obesity, diabetes, and other ailments resulting from
bad diet, alcoholism, sleeplessness, etc., Hospitalization cases for oncology, diabetes, and cardiac
treatments in the last decade have steadily increased between 15% to 20%.
Growth in the inpatient market for the next 3 years is projected at 13%, while outpatient market
is set to see a rise of more than 10%. In addition to the large patient pool, India is also a low cost
destination for clinical trials.
Luxury healthcare services are also on the rise as patients and visitors are provided access to luxury
facilities that also include 5 star room service, dedicated nursing staff, and helicopter transport.

13. 11
Healthcare sector has many allied industries which bene t from booming commercial activity, low
costs, and higher rates of efficient delivery in services. These opportunities include medical tourism,
health education and management, and leisure travel. The most salient features of this innovative and
enterprising eld include -
Medical Tourism In India
The potential for economic growth accompanied by creation of meaningful jobs is very high. An annual
growth rate of 30% was noted in 2015, and the projections for the year 2020 include additional revenues
between US$ 6-50 and 10 to 48 million jobs.
Medical tourism includes patients seeking affordable healthcare as well as international players who are
interested in cutting edge R & D.
State of art private hospitals and diagnostic facilities along with an educated and courteous medical staff
attract foreign tourists who expect better health, mental peace, and physical tness.
The medical tourism market has grown by 27% in the last 5 years, and the market share is estimated to
jump from US $3.9 billion of 2016 to US $8 billion by the year 2020.
More than 3 million tourists visited Indian by 2015, and the numbers are expected to swell as
Europeans and Middle Easterners are interested not only in allopathic treatments, but also in Yoga,
Ayurveda, Meditation, and other exotic and effective traditional methods.

14. Major Government Hospital In India
12
India is a disparate collection of metropolitan cities, State capitals, tier II/III cities, towns, villages, union
territories (UTs), and remote tribal areas. The governance is organized into Union Cabinet, State
Legislatures, District Headquarters, and Village Councils. The National and regional Governments have a
stake in medical services through primary healthcare centres, district or general hospitals, taluk or smaller
hospitals within the districts, and government medical colleges.
The Ministry of Health and Family Welfare is the primary stake holder in National health institutions,
services, equipment, and properties. The Union Ministry and various State governments jointly operate
regional cancer research centres and cancer care hospitals. The Government Medical Colleges are regional
referral hospitals, while AIIMS is the National level referral institute with specialised facilities, hi tech
infrastructure, telemedicine facilities, and regional branches.
The elected representatives have cut down the spending on Government hospitals from 34% to 19% in
the decade 2005-2015. This was done to promote large scale investments in private sector and establish
India as an International hub of reliable, low cost healthcare. However, All India Institute of Medical
Sciences or AIIMS is still a crucial player in the development of health sector due to the following
contributions-
(https://www.aiims.edu/en.html)
(http://pmssy-mohfw.nic.in/newaiimsstatus.aspx)
Apart from New Delhi, AIIMS has regional branches in Bhopal, Bhubaneshwar, Jodhpur, Raipur,
Patna, and Rishikesh. It also plans to set up two more medical institutions in the states of Gujarat and
Jharkhand.
The Government has also allocated US $ 82.6 million to set up medical institutions with "AIIMS
stature" in other States like Andhra Pradesh, West Bengal, Maharashtra, and Uttar Pradesh(India's most
populous State).
AIIMS has also implemented sophisticated telemedicine services to bridge the rural-urban
divide and ensure affordability and accessibility of efficient consultation and diagnostic healthcare
services for common man and the poor.
In January 2017, MobiKwik and AIIMS entered into a contract to promote cashless transactions
through mobile wallets.

15. 13
Major Private Chain Of The Hospital In India
A succession of Indian Governments in New Delhi created the right atmosphere for foreign investments in
Private Healthcare Sector. The nancial and strategic investors grasped this opportunity since the early
2000s, and the hospital and allied industries have grown at an impressive pace. As of 2015, the healthcare
market size jumped up to a US $110 billion, and the sector has registered 88 new funding deals to the
amount of US $397.41 million as of September, 2016. The strong presence of private sector in India has
accrued many tangible bene ts for the middle classes and the upwardly mobile sections of the society.
The notable successes that raised the stature of India as a National and International healthcare destination
include-
More than 80% of the country's hospital industry is being captured by private investors.
The private sector has more than 74% of the share in India's hospitals.
Private hospitals have more than 40% beds for patients, and their healthcare accounts are a whopping
74% of the total expenditure in this sector.
Well-trained, English-speaking medical staff delivers high quality services at state of the art private
hospitals and diagnostic centres.
Some of the more popular diagnostic and hospitalization facilities have created a brand value,
along with chain centres in large Metro cities, State capitals, and smaller cities.
The success stories include MAX Healthcare, Global Hospitals, Fortis, Apollo, Manipal Group, and CARE
Hospitals.
1.
2.
3.
4.
5.
6.

16. 14
Apollo Hospitals Enterprises Ltd.
Apollo group started its healthcare operations in the year 1983 by focussing on South Indian cities of
Chennai and Hyderabad. As of today, they have a chain of hospitals in all the major and minor Southern
cities. The company has a more than 9000 beds and they expanded into other cities like Delhi, Noida, Goa,
Pune, Indore, and even Dhaka in Bangladesh.
It is an undisputed leader in super-speciality healthcare with its own diagnostic centres, pharmacies,
and children hospitals.
Hi-tech facilities include GPS-enabled ambulance services, robotic surgeries, telemedicine systems for
rural India, and stem cell research ventures.
Apollo is setting up outlets for traditional healthcare remedies along with wellness centres across India
to expand its market share.
The company is striving for incentive packages and 10 year tax holidays on hospital packages to
promote investments and medical tourism.
It has a multi-pronged strategy to attract and invest foreign funds, and also enter into private-
public-partnerships (PPP) with regional governments in India.
1.
2.
3.
4.
5.

17. 15
Major Diagnostic Chain Centre In India
In addition to hospitals, pharmaceuticals, equipment, telemedicine, and insurance, India has seen a major
spurt in diagnostic facilities. Modern citizens are well aware of bene ts derived from preventive health
and tness services. This rising demand for diagnosis and medical analysis has attracted FDI in ows up to
US $1.61 billion during 2000-2017. Patients expect preventive care, and state of art diagnostic centres is
being set up to ensure technically accurate body uid analyses. Both the inpatient and outpatient markets
are set to grow between 10% to 13% in the few years. The diagnostic market leaders such as Metropolis
and SRL are gearing up for the competitive edge in this segment.
SRL offers 3500 tests on the human body which is the highest possible number in India (maximum of
4000).
The company also innovates, introduces specialized technologies, and conducts cutting edge research
projects.
Their high quality diagnostic, prognostic, and monitoring services are extended to other hospitals, labs,
and patients as well.
It collaborates with MNCs and Indian Pharmaceutical companies for Phase III/IV clinical trials while
adhering to international regulations.
The company also organizes free camps, promotes franchisees, and facilitates hi-tech management of
hospital laboratories.
Young and dynamic employees manage more than 5606 collection points spread across India.
Diagnostic market is estimated to grow by 20.4% in the next 5 years, and SRL investment plans
include infrastructure development and visible collection centres.
1.
2.
3.
4.
5.
6.
7.
(http://www.srlworld.com/)
SRL Diagnostics
SRL is India's largest and leading diagnostic chain with an efficient network of 370 labs and 40 franchisee
labs. The company aspires to reach as many customers as possible and create a trust based relationship
backed up by affordable and efficient diagnostic services. The networked facilities include reference labs,
radiology and imaging centres, excellence centres, accredited labs, and wellness centres.

18. 16
Major Pathology Lab In India
In India, Health awareness has improved and the demand for hospitalization and preventive care through
diagnostic tests has also increased at a noticeable rate. As of now, The diagnostic services are split into
imaging and pathology with the later claiming a lion's share of 70% in the testing market. Demand for IVF
equipment has also increased, and the FDI in ows into diagnostic centres are expected to reach a high of
US $1.45 billion.
The potential for hi-tech diagnostics is very promising in the country, and health companies have raised
more than US$ 80 million by the end of 2016. The high cost differential of diagnostic services also attracts
foreign hospital chains. They outsource pathology and laboratory tests to the renowned diagnostic and
pathology giants such as SRL and Metropolis, or other major hospital brands with in-house diagnostics.
Metropolis leverages logistics and IT to reach 200 lab locations and 1000 collection centres all
across India.
The company started as a referral lab in 1981, and by 2015 it has earned the award of best
diagnostic chain from CMO Asia group.
Over the years, Metropolis focussed on hormonal disorders, allergy detection, HIV testing and
management.
Technological innovations include automation in Radio-immunoassays and clinical
microbiology, Flow Cytometry, molecular diagnostics, and immunochemistry.
Other highlights include Cancer cytogenetic studies, hair loss tests, DNA paternity tests, and
cervical cancer detection through liquid based cytology.
1.
2.
3.
4.
5.
(http://www.metropolisindia.com/)
Metropolis
Metropolis is the largest and best pathology lab in India, and its track record and reputation are
impeccable. The company has more than 34 years of experience in delivering accurate pathology
reports, and it is also tapping into emerging markets like medical tourism and hi-tech medical
equipment.

19. 17
Medical College In India
Healthcare opportunities are very high in India, and the potential of allied markets is also very attractive
for investors. High quality medical services are not possible without proper infrastructure, dedicated
professionals, friendly Government policies, and rising demand. The demand is growing due to acute
awareness of preventive care, aging population, and change in lifestyle habits. The WHO recommends a
doctor patient ratio of 1:1000, but India is still behind this mark at 1: 1674 as of 2015.
India has a federal structure with Union and State Governments that co-operate to deliver medical
education through 189 Government colleges.
There are a total of 404 medical colleges that churn out MBBS graduates every year, and the private
sector managements are in charge of 215 colleges.
More than 25,346 PG students pass out of these highly competitive academic institutions on an yearly
basis.
The Government is promoting public-private partnerships or PPPs, and leading healthcare experts like
FORTIS are venturing into the medical education business.
Fortis group is contributing to the development of infrastructure by setting up a 500 student medical
college along with 2 super speciality hospitals.
1.
2.
3.
4.
5.

20. 18
Paediatric and neo-natal diseases require child-friendly environment, and Rainbow is a leading hospital
in this category. Its perinatal division also carries out gynaecological and antenatal procedures that
include endoscopy, fetal medicine, obstetrics, and genetics. The Rainbow Group has talented
professionals, hi-tech equipment, and its 800+ beds are spread across 10 branches in large cities like
Hyderabad, Vijayawada, Bengaluru, Delhi, etc., their award-winning corporate services are characterised
by 24X7 high quality cares, state of art labour rooms, and NABH accreditation.
Rainbow Children's Hospital
Major Single Specialty Hospital In India
(https://www.rainbowhospitals.in/delhi/)
A thriving economy produces an educated and inspirational society, and India has its share of
billionaires, multi-millionaires, and the nouveau rich. The country's healthcare services are booming,
and private players have captured between 70%-80% of the market. FDI in ows are mainly directed at
newer hospital beds, medical tourism, insurance, and super-speciality hospitals. Robust and reliable
healthcare is not possible without specialty and emergency services, and there has been a discernible
increase in single speciality hospitals in recent years. These specialty hospitals are springing up mainly
in tier II and tier III cities, and they are also introducing telemedicine to deliver high quality services to
rural and remote parts of the country.
Single specialty hospitals and clinics are growing at double digit rate in recent years, and the major
players such as Fortis and Apollo have already entered this market space. Venture capitalists (VCs) are
also enthusiastic about betting on this model, and promote healthcare services that are dedicated to
pregnancy, neonates, heart, cancers, kidneys, and eyes. The Odisha Government has entered into a
public-private partnership (PPP) with CARE hospital to establish a 100 bed cardiac hospital that is
worth US$ 11.45 million. The management and daily operations will be under the supervision of CARE
hospital which is a proven expert in eld of super specialty heart care.

21. 19
Market Size - Hospital, Diagnostics And Lab
Business friendly Union and State Governments have facilitated the establishment of a strong private
sector in healthcare services in India. Investments have been given a boost, and FDI in ows into drugs
and pharmaceutical sectors have peaked up to US$ 14 billion by the end of September, 2016.
The foreign direct investments (FDA) in hospitals and diagnostic centres reached a peak
gure of US$4.1 billion between Apr, 2000 - Sep, 2016.
The allied markets in medical equipment and devices have also received investments up to
US$ 1.45 billion during these years.
Tax bene ts and 100% FDI in Green eld and brown eld projects are set to attract more
private investments, mergers and acquisitions, and medical tourism.
Private sector has contributed to 80% of total hospital market with 40% share in hospital
beds and 74% health expenditure goes into the pockets of private players.
Top Medical Consultants In Major Super Speciality - Ortho, Neurology, Cardio, Gastro,
Urology, Ophthalmology
1.
2.
3.
4.
5.
The last two decades have been transformational for India, particularly in the healthcare sector. The IT
revolution and economic liberalization have improved the living standards, and modern people
started aspiring for better health and tness services. The Governments made friendly policies and the
private sector increased its investments. As of 2015, The country has multi-specialty and super-
speciality hospitals, hi-tech medical devices and equipment, and a wide range of diagnostic and
pathology services.
Companies like Apollo, Global Hospitals, Fortis, and Max Healthcare have become popular brands with
enviably large patient databases. These healthcare giants deliver a wide range of medical services
through corporate style management and well trained professionals. They operate a network of
hospitals, promote foreign investment, liaison with government agencies, and participate in public-
private projects that also include super speciality care. Case in point, Apollo Healthcare is starting a
290-bed super speciality hospital in Bhubaneshwar, the capital city of the Eastern state known as
Odisha.
In 2012, The Company commissioned a 450 bed multi-super-speciality and multi-organ transplant
facility in India's commercial capital, Mumbai. In contrast, Fortis Group leads the way in diversi cation
through mergers and establishment of hospital networks, satellites, and international quality medical
colleges. Recently, The company completed the acquisition of Wockhardt Hospitals which increased its
portfolio by 10 hospitals. Fortis is also coming up with two multi-speciality hospitals and a medical
college for 500 students.

22. 20
Major Healthcare Milestones In The History
Of India
( http://www.expressbpd.com/healthcare/cover-story-healthcare/milestones-in-indian-healthcare/191620/)
India is an ancient land with rich history, heritage, culture, and a breathtakingly diverse population. Modern
India, however, was created in 1947, and in this 70 odd years the country has gradually progressed from
socialist governance to economic liberalism. Privatization has picked steam in the last two decades, and the
healthcare sector has been a major bene ciary due to indigenous talent and investor friendly Union
Governments.
The healthcare market in the country thrives in the form of hospitals, pharmaceutical companies,
diagnostic centres, medical equipment suppliers, insurance, and telemedicine. All these market segments
have gone through a remarkable transformation, and the future potential is also described as "very high".
This can be gauged from the noticeable growth in mergers and acquisitions (M&A), in ow of foreign direct
investments (FDIs), medical tourism, and diversi cation through single speciality hospitals.
The country has seen a large number of developments in healthcare, and there are also some major
milestones that need a good mention.
India is home to very ancient systems of healing that include Yoga and Meditation. The
Government has also initiated a project known as AYUSH to promote Ayurveda, Unani, Siddha, and
Homoepathy medical practises.
British, German, and American in uences have created a solid base for Western Medicine or
allopathic treatments that include hospitalization, surgeries, and chemical formulations.
In the last two decades, Affluence and living standards improved due to economic policies
and entrepreneurship. The health indicators such as life expectancy, infant and maternal mortality
rate, etc., have improved.
Campaigns and penetration of services into rural and remote areas brought down or
eradicated the incidences of Polio, HIV, TB, Leprosy, etc.,
Vaccination drives and modern treatments have contained or removed the fears of Filariasis,
Mumps, Measles, Rubella, AIDS, Malaria, STDs, etc.,
Visionaries and entrepreneurs have introduced modern technologies and India has a vibrant
market related to Pharmaceuticals, Stem Cell Research, Genetic Testing, Laser Treatments, Advanced
Diagnostics and Pathology, multi-specialty and super-speciality hospitals.

23. 21
Healthcare Development
India has a Union Government that de nes health policy, while the regional State Governments implement
the medical services. Health is a State subject, although All India Institute of Medical Sciences (AIIMS)
hospital is under the purview of Union Health Ministry. Healthcare has developed in India through a
combination of Government initiatives and private enterprise. A large number of Government hospitals,
medical colleges, primary health centres, and district hospitals deliver a wide range of services including
vaccinations, child birth, rst aid, and hospitalization.
Private players started making their mark after the 1980s, and they have become a force to reckon with by
the year 2015. The private hospitals take a lion's share of the healthcare market at 80% and more than 74%
medical expenditure by Indians is on treatments and preventive care at these health institutions. The
Governments try to bridge the rich-poor gap through public private partnerships, telemedicine for rural
areas, and eHealth initiatives to reduce infant and mother mortality rates in remote and tribal areas.
A large part of India lives in urban areas comprising of metropolitan cities, State capitals, tier II and tier III
cities, district headquarters, and towns. The Government encouraged the growth of privatization through
tax deductions, and the healthcare market valuation jumped to US $1 billion by 2016. By 2020, This market
is predicted to increase by 1.5 times due to economic activity, affluence, medical tourism, and mergers and
acquisitions(M&As).
Per capita expenditure on treatments and preventive care has grown as can been seen from the increase in
number of inpatients and outpatients. Aging population, dense urbanization, awareness, and sanitation
issues have been in the forefront, and the healthcare expenses are estimated to reach US$ 68.6 with a
predicted CAGR of 5%. A shift has been noticed from traditional to lifestyle diseases, and hospital chains
expanded into tier II and tier III cities.
The major hospital chains like Apollo, Fortis, Max, Global, etc., have diversi ed from mere hospitalization to
specialization, super-specialization, and allied markets including diagnostic centres, pathology labs,
pharmaceutical shops, telemedicine, investments, Government partnerships, medical tourism, and IT-
enabled outsourcing services.

24. 22
Need Gap Analysis
A competitive healthcare market thrives on demand, and India has become a major focus area for
international investors. The modern citizenry aspires for health and tness, and this includes both
treatments and preventive care. As a result, There has been a large increase of in and out patients in the last
5 to 7 years. The diagnostic market is also expected to grow at a CAGR of 20.4% from 2012 to 2022.
The in-patient ows jumped from 53% to 81% by the end of 2015. In the same period, The outpatient
market reduced by 28% from a high of 47% to a low of 19%. The projections for in-patient in ows indicate a
2% increase by 2020, while the diagnostic market is predicted to increase by 20% to reach a peak gure of
US $ 32 billion during this period.
The Government has noticed this huge demand in healthcare market, and the objectives have been laid
out in the 12th Five Year Plan of 2012-2017. The challenges related to gaps in available infrastructure,
universal access, research and development, and regulation are being met through various solutions.
Universal Health Coverage has been proposed and the budgetary allocations have been increased by US $
55 billion. The increased Government allocations are being distributed among Ministry of Health and
Family Welfare, traditional AYUSH hospitals, research departments, and AIDS control centres.
The health and nance policies are also being tweaked to accommodate and attract a larger number
of private players -
The IT Act bene ts are extended to nancial institutions that invest for long term in 100 bed or more
hospitals.
For rural hospitals with 100 or more beds, Investors are entitled to 100% deduction on pro ts for 5
years.
Tax incentives also cover education, training, 50 bed non-metro hospitals, remote radiology,
telemedicine, arti cial hearts, and domestic technology manufacturing.
1.
2.
3.

25. 23
Growth Drivers
The high spirits and investor trust in healthcare market in India is justi ed due to various reasons. The
sector already has clearly demarcated segments or participants such as hospitals, pharmaceuticals,
equipment suppliers, diagnostics, telemedicine, etc., The projected CAGR of 22.87% between 2015-20 is
all set to take the healthcare industry value to an impressive US $280 billion by the year 2020. The
population density and lack of penetration into rural and remote areas is the major driving force for
growth in this sector.
Top 4 Drivers Of Healthcare Sector's Growth-
Demand: Affluence and affordable treatments create a huge demand in domestic as well as
foreign market (in the form of medical tourism). The hospitalization need has jumped to 80% from
50% in recent years due to aging population and lifestyle diseases such as obesity, diabetes, high BP,
bad cholesterol, kidney dialysis, cancers, etc., People are well aware of the value of good health, and
they are determined to receive hi-tech diagnostic and preventive care.
1.
Government Policy: The Finance Ministry encourages privatization through FDI, custom duty
reductions, tax cuts, and green eld/brown eld projects. National Rural Health Mission, NRHM, has
allotted US $10 billion for healthcare facilities, while National Health Insurance Mission, NHIM, aspires
to cover the entire population of the country.
2.
Innovation: India has already made a mark in IT, and the tech-savvy generation aspires for better
education, research and development opportunities. Global projects are entering into joint projects to
outsource their work, while R&D centres and modern technology are also spreading far and wide.
3.
Investment: Foreign investors have more faith and increased FDI in ows are directed towards hospitals,
R&D centres, pathology labs, and medical colleges. The big players are into mergers and acquisitions
(M&As) and more such ventures are on the anvil.
4.

26. 24
Medical Tourism And Bridging The Gap
India has youthful, dynamic, and skilled medical professionals, and medical tourism prospects are very
high in both traditional and allopathy segments. More than 3.2 million tourists from developed and
developing nations prefer low cost, high efficiency treatments and healthcare in India. This market too
is expected to reach US $8 billion by 2020, and the growth opportunities for investors, foreign hospitals,
insurance companies, equipment manufacturers, training and management professionals are de nitely
on the rise.
The private players are striving for further tax holidays and incentive packages to encourage
investments in the healthcare sector. Till 2015, The Private entrepreneurs tried supply chain
efficiency, cost reduction through economies of scope, brand creation, mergers and acquisitions,
and multi-speciality differentiation. However, The future trends include -
Focus on single speciality hospitals for advanced cancer(oncology) and eye care.
Leveraging IT and technologies through remote radio-pathology, telemedicine, etc.,
Investments in tier II/ III cities to improve quality of single or multi speciality care.
Taking hospitalization and diagnostic services to rural/ remote areas of the country.
1.
2.
3.
4.

27. 25
SWOT Analysis
( https://www.equitymaster.com/detail.asp?date=6/21/2004&story=5&title=Indian-Pharma-Industry-SWOT-
analysis)
To understand the healthcare market in India, The investors need a clear perspective and SWOT analysis
comes in handy. Knowing the Strength, Weakness, Opportunities, and Threats of a particular industry is
essential in the uctuating economic scenario.
1. Strengths
India is a stable democracy, and the Finance Ministry and Union Health & Family Ministry are
investor friendly departments.
Educated middle class, distinctly segmented market, technological in ux, Affluence, And Cost
Differential indicate a strong future.
Private Hospital Industry has 80% of the market share, and more tax holidays and investment
friendly policies are on the anvil.
Existing Brand Names, Hospital Networks, Diagnostic chains, and smaller private hospitals in
metros, cities, and towns.
Potential for telemedicine, cashless payments, e-transactions, outsourcing, and joint ventures
with foreign brands and markets.
2. Weaknesses
Fear of bureaucratic obstacles, red tape, corruption, and economic disparities or rich-poor
divide.
Non-penetration of healthcare services into rural and remote areas due to insurgency
movements, illiteracy, malnutrition, and lack of political will power.
Highly uneven market with established private players who have already captured a large
segment of the State capitals and metropolitan cities.
3. Opportunities
Rising middle class with greater awareness of health, tness, wellness, and preventive care.
Lack of penetration of high quality healthcare in Tier II/III cities, villages, and towns.
Encouragement of public private partnerships in hospitals, education, management,
telemedicine, outsourcing, and record digitization.
Recent mergers and acquisitions, followed by investor meets focussing on single-speciality
hospitals across the country.
Opening up of the insurance sector to private players along with tax holidays for investments in
rural and remote areas.

28. 26
4. Threats
Low cost competitors from China, South East Asia, and other SAARC countries.
Fear and doubts of policy changes as and when Union Government completes its allotted term
of 5 years.
A parallel healthcare system including alternative treatments such as AYUSH, Wellness Centres,
Meditation, and Yoga are competitors of allopathy.
Thrust Area In India - Speciality Wise Demand
The emerging trends in Indian healthcare system suggests a shift from multi-specialty hospitals to
single specialty units in tier II and tier III cities. The market observers suggest that the system is going to
become more robust and efficient by delivering both specialty and emergency care services in smaller
hospitals and nursing homes across the country. The job market also spreads out with newer
opportunities springing up for nurses, paramedics, technicians, and emergency medicine specialists.
The revenue streams of such single speciality hospitals is also found to be much better than
multispecialty facilities that have already established a very strong presence in the same developed
regions or States of India.
In recent years, Private investments and active participation has augmented the Union and State
Governments' initiatives in a big way. The evolving healthcare models are indicating a move towards
delivering high quality services in specialty centres as well as at wellness centres. Some of the recent
and noticeable speciality wise patterns and illustrations are -
Odisha Government entering into a partnership with CARE hospital to start a 100 bed super
speciality unit that is dedicated for cardiac care. The CARE team manages the US $11.45 million hospital
through the public private partnership model.
The rural poor is also able to access basic and speciality care through innovative and highly
effective telemedicine procedures.

29. 27
Up Coming Hospitals In India
The Government is encouraging private partnership and investments in healthcare in a very big way.
With this objective in mind, The Income Tax section 80-IB bene ts have been extended to 100 or more
bed hospitals in rural areas. These hospitals are also entitled to 100% deduction on pro ts for the rst 5
years of their service. The 2010-2020 decade looks bright as many new hospital beds are being added to
ensure growth of specialization, medical tourism, and increase job opportunities for the young
graduates.
Max Healthcare with over 9 million customers and 22,500 employees has plans of investing US
$ 47.79 million to build a cancer hospital in Delhi.
Fortis is adding approximately 400 new beds every year to increase its capacity.
Two multispecialty hospitals, along with 500 seat medical college, are also being planned by
Fortis for the second half of this decade.
Apollo is unveiling a 290 bed super speciality hospital in Bhubaneswar, capital city of Odisha
State in Eastern India.
More than US $ 200 billion are expected to be spent on medical infrastructure up to 2024, with
the addition of 3 million beds by 2024.
1.
2.
3.
4.
5.
Challenges In Entering India Healthcare Market
Indian Healthcare market is very exciting, but there are many challenges and obstacles that have to be
crossed over the next 7 to 10 years. India is bound to face higher unemployment rates by the end of this
decade. But this shortage is relatively smaller when compared to the challenges that are currently
troubling many of the Western countries.
Skilled workforce requirements are rising, but the supply is not matching up to the demands in
terms of both quantity and quality.
Allied sectors of Medical and Healthcare such as IT and Education are facing shortfalls that can
slow down the economy and create socio-economic adversities.
By the year 2020, a net workforce shortfall of 32 to 39 million is estimated, and this obstacle
affects strategic investments.
The Health and BPO sector in India may face challenges such as US sanctions on outsourcing
that can threaten the country's potential growth.
India lacks in emergency care in terms of centralised administration, penetration into rural
segments, and trained paramedic personnel.
Tender based projects require Union Government co-operation, and the lead time is longer for
such initiatives.

30. 28
Educational budgets in India are extremely low for some investors who do not nd them pro table
enough for starting a joint venture.
R&D challenges for Government are mainly found in the ability to translate from bench to bedside
abilities.
Medical equipment manufacture is also limited only to some Southern States and cities such as
Bengaluru, Hyderabad, and Pune.
Government Indicatives
India's health system has been a Government supported sector with many loose ends and social welfare
as the objective. The opening up of the investment scene has converted the healthcare market into one
of the largest sectors for revenue and employment. To counter the shortages in infrastructure, regular
and specialist personnel, and technology, The Government has planned many indicatives to emphasize
its full- edged support -
The healthcare expenditure has been doubled to 2.5% of GDP with special focus on
development of high quality public healthcare infrastructure.
Punjab State Government is interested in setting up public hospitals, cancer centres and
research facilities through private investments.
In the latest 12th Five Year Plan the biotechnology spending has been increased from the
previous plan's US $ 1.1 billion to US $ 3.7 billion.
Government is also focussing on attracting private players into the R&D eld to ensure
competency, higher quality, and effectiveness in the near future.
Special funding programs are also being initiated with the well-de ned objective of
developing higher quality diagnostic care and medical devices.
Strategic and nancial investments are being attracted through tax cuts, custom duty
exemptions, and public-private partnerships.

31. 29
Recent Financial M& A In India
Private players have already captured more than 80% of the Indian healthcare market with prime focus
on large metros and State capitals. Customers have also responded in a positive manner due to lifestyle
diseases, preventive care demands, and higher quality of treatment and diagnostic services. Lucrative
Merger and Acquisition opportunities are readily available in India and the higher FDI in ows and
private sector investments clearly indicate a change in the strategy by major brands and investment
rms.
Strides Shasun has entered into a business acquisition agreement with Perrigo API India for
US $ 14.94 million.
Continental Hospitals Limited has handed over a 51% stake to IHH Healthcare Berhad.
Famy Care Ltd., that specialised in biotech, pharma, and healthcare, has been merged 100%
with Mylan Lab. Ltd.
Cipla, the pharmaceutical giant, has merged with InvaGen Pharm. Inc. and Exelan Pharm.
Inc.
Meiji Seika Pharma has entered into an M & A with the Indian based pharma company
Medreich Ltd.
India based Torrent pharma has merged with Elder Pharmaceuticals to promote healthcare and
biotech services.

32. India is a diverse country with huge population, rich heritage, and a history of traditional medical
systems that go back to ancient times. Modern India, however, is poised to grow into a global healthcare
giant with focus areas being allopathy, medical tourism, wellness centres, investments, biotechnology,
pharmaceuticals, mergers and acquisitions. The Government has started many initiatives to bridge the
supply-demand gaps in healthcare services across the country. Metros and other large cities already
have a strong brand presence along with reliable diagnostic and speciality services.
However, more needs to be done due to shortage of beds, infrastructure, hi-tech equipment shortage,
and lack of penetration into rural and regional market segments. The urban and English-speaking India
drives the economy and there is already a system in place that includes hospital chains, pharma
companies, diagnostic networks, telemedicine, and private investments. But the demand is rising
steeply due to aging population, dense cities, sanitary challenges, and modern diseases. Urban activity
has shifted focus from traditional to lifestyle diseases including diabetes, obesity, bad cholesterol, kidney
failure, liver problems, high BP, and many more.
Government is facing up to the challenges through investment friendly policies, increased expenditure
in health sector and e-Health initiatives to reduce mother-child mortality rates. Private players are also
seeking greater market presence and aim to reach out to tier II/III cities with the objective of making
higher pro ts through better quality services. Technology and education are being leveraged to employ
trained personnel and deliver modern and reliable services far and wide.
Telemedicine, hi-tech diagnostics, cutting edge pathology labs, single and multi-speciality hospitals are
making their mark across the country. Incremental growth and 4 million additional jobs are projected up
to the year 2020 with a CAGR of 22.87% and total valuation of US $280 million. Although India has
thousands of Government and Private hospitals including branded chains such as Apollo, Global, Fortis,
Max Healthcare, etc., The demand is still very strong. Investments are owing in and public-private
partnerships are being regularly implemented to start more super-speciality units, medical colleges and
single speciality hospitals in tier II/III cities.
India has many challenges that include bureaucratic obstacles, and lack of skilled workforce and
infrastructure. The education and equipment businesses in health sector are not yet pro table for many
European investors. But Government indicators are good, and recent high pro le mergers and
acquisitions suggest a growth in demand and spurt in technology intensive health care activity across
the country. Strategic investments are on the rise, and the projections for single speciality units,
telemedicine, and emergency care are positive.
30