Hari S. Boolchandani, GLG Network Member and Co-Founder and Principal Consultant at Global Health Consultants
For a glimpse into the future of the healthcare in India, it may help to start with an overview of where we are now.
The sector is dominated by India’s biggest hospital groups: Apollo, Fortis, Narayana, Manipal, and Max Healthcare. Apollo Hospitals is largest in terms of revenue and owning, managing, or operating 33 hospitals with around 5,000 beds across India. Revenue, which comes from hospitals and stand-alone pharmacies, total about $1.6 billion. Next is Fortis Healthcare, which runs around 26 hospitals nationally and has revenue of about $620 million. Narayana, the largest in terms of beds, has revenue of about $440 million, and Manipal, with around 4,500 beds, boasts revenue of about $288 million. Max Healthcare is the smallest of the group, with around $260 million in revenue.
One of the system’s key areas of growth in recent years has been in telemedicine. Apollo was considered a pioneer about 20 years ago when it participated in a pilot project with the Indian Space Research Organization that connected its hospital in Chennai with a small village about 300 kilometers away. Other hospitals began experimenting too, but connectivity wasn’t optimal and cost was a big issue. Since then, of course, connectivity has greatly improved and costs have dropped. Now, almost all hospitals in India practice telemedicine in some form — and the variety of those forms has expanded.
Now, several telemedicine apps, including DocsApp, Practo and MFine, are used in India, as well as consultation services based on telephone, video, and email communication. These and especially WhatsApp consultations have become very popular among international patients. With WhatsApp, users can send almost any amount of data with absolute security and with great speed. Even with the limitations imposed by screen size, it’s been very popular.
Despite its terrible devastation, the COVID-19 pandemic has been a catalyst for the advancement of telemedicine in India. Before COVID-19, there were no guidelines, laws, or regulation regarding the usage or validity of telemedicine from any medical body, health department, or ministry. In fact, medical groups had opposed telemedicine, maintaining that if health professionals could not see or examine patients physically, they could not deliver proper advice.
But upon recognizing the nation’s physician shortage and the increased demand for doctors’ services, the government changed the rules to encourage more online and phone interaction. The Ministry of Health and Family Welfare even created a free national teleconsultation service known as eSanjeevaniOPD, designed to serve patients living in remote areas.
Although those areas are poor, mobile phones are plentiful, so the program has been a success. More than one million telemedicine consultations took place on eSanjeevaniOPD last year, and by May, that number had risen to more than three million. The nation’s large hospital chains also started telemedicine services. I’m told, however, that as soon as a physical outpatient center opens in an area, the local telemedicine numbers fall. Still, telemedicine has become a part of the healthcare delivery system throughout the nation — in urban as well as rural areas — and that is likely a permanent change.
More widespread internet and cell phone usage, which will support even greater telemedicine expansion in the future, are signs of the nation’s rising affluence, which bodes well for healthcare generally. But greater affluence is also increasing the incidence of lifestyle diseases, which will require more healthcare sector services. Concurrently, the increasing penetration of public and private health insurance has supported the rise of healthcare spending by improving accessibility to healthcare. Coverage has expanded from 2% of the Indian population to about 30% in 20 years, and 30% of 1.3 billion people is a huge number.
Just 10 to 15 years ago, most tertiary care hospitals and advanced healthcare were available only in the bigger cities or metro areas. Over the last 5 to 10 years, however, many of the bigger players have recognized an opportunity to move into tier-two cities.
Finally, there’s medical value travel. In the five years before the pandemic, the industry grew from around $3 billion to $9 billion. Of course, the pandemic disrupted that market significantly. But once pandemic concerns abate, the market forces that attracted patients to the Indian healthcare system are likely to attract them once more.
Despite the strains of COVID-19, the future of the healthcare industry in India looks bright.