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Healthcare boom

Damayanti Datta | April 1, 2010 | 20:32

There's a time for everything. For Dr Ramakanta Panda, it was time to build a 'modern hospital' in India. As a cardiacsurgeon from the prestigious Cleveland Clinic, US, he was known for his super-safe hands. But his ideas proved tooradical for the design team. Whoever heard of picture windows to ward off ICU psychosis? Or counselling areas forpatients' relatives? How would cafeteria, convenience s tore, library, public booth, Internet access , and hotel-like front deskcreate a "healing experience"? As modernity clashed with convention, Panda whisked the team off to the US to s how at firsthand what modern hospitals look like. Awed by his passion and armed with 5,000 photographs, they returned to translatehis dream into concrete: the Asian Heart Institute (AHI) in Mumbai. Seven years later, Panda, known today as "the prime

minister's surgeon", is busy planning yet another AHI. "A modern hospital focuses entirely on patient satisfaction," he says."India didn't have that culture then. But it's quite standard now," he smiles. Indeed it is.

BLEEDING-EDGE TECHNOLOGY, WONDER DRUGS AND STAR FACILITIES ARE THEHOSPITAL MANTRA NOW

A mas sive boom in private hospitals is changing the nation's health delivery landscape beyond recognition. New hospitalsare mushrooming, even in smaller towns, and leading healthcare entrepreneurs with deep pockets are expanding their

empires, often overseas . The scent of big money is in the air. It's capturing the dreams of young entrepreneurs. It's makingseas oned bus iness leaders look for an edge in marketing healthcare in a new avatar. It's giving doctors the choice andoption of moving from green to greener pastures.

At the root is the new-age patient who wants the best treatment money can buy. Bleeding-edge technology, wonder drugsand star facilities are now the hospital mantra. Healthcare systems are usual ly large, complex and slow to respond tochange. But the surge of new ideas , approaches and ins titutions is melting away the age-old barriers to change. India iswriting a new chapter of growth.

"Have a chat with hospital CEOs and you'll notice that they increasingly talk about the great Indian growth story and how thattranslates into robust growth for the healthcare industry in India," says Seema Chaturvedi, MD of Accelerator Group, astrategic advisory that has just brought out a hospital CEO survey. She is not surprised. The healthcare market is on anunprecedented high at 16 per cent year on year. From Rs 1,02,600 crore in 2005, it now clocks Rs 2,00,000 crore and is


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15 MEGA PROJECTS IN 2010

Total: Rs 3,415 cr

Rs 1,000 crore: SevenHills HealthCity, Mumbai. Multispecialty.

Rs 330 crore: Tata Medical Centre,

Kolkata. Single specialty offering

oncology services.

Rs 300 crore: Apollo Hospital,

Bhubaneswar. Multispecialty. Rs

250 crore: Fortis Hospital, Delhi.

Multi-superspecialty hospital in

Shalimar Bagh, Delhi.

Rs 250 crore: Rockland Hospital,

Gurgaon. Multispecialty.

Rs 200 crore: People International

projected to reach Rs 3,00,000 crore by 2012.

The industry employs over four million people, making it one of the largest service indus tries in the economy, reports a newstudy by ASSOCHAM and Yes Bank (Healthcare Services in India, 2009). Infrastructure spend is on a staggering growthclip, doubling in s ize and slated to reach Rs 63,900 crore in 2013 (KPMG, 2009). The private sector, up from Rs 85,500crore in 2006 to Rs 1, 48,050 crore now, accounts for 80 per cent of the market--highest in the world. It also controls 60 percent of the 15,393 hospitals in India, with cashrich corporates holding 10 per cent of the pie. In the metros, quali ty hospitalbeds are blooming, almos t at par with the global benchmark of 35 beds per 10,000 people, if you have the money to payyour bill.

Source: Healthcare Services in India: 2012, the path ahead. ASSOCHAM-YES Bank,

2009; McKinsey 2007

Big is Better

Despi te the meltdown, it's a world full of hectic buzz. Giant new projects are rolling off the line--be it pioneering cardiologis tand healthcare entrepreneur Dr Naresh Trehan's Rs 1,000-crore Medanta Medicity in Gurgaon, the 1,500-bed ("Asia'slargest hospital") Mumbai's SevenHills , Apollo's 200-acre wellness hub in Lavasa or the technology paradise that is KokilaDhirubhai Ambani Hospital in Mumbai. What's more? About 15 hospi tal projects are s lated to open this year and 90 percent of them are multi-specialty corporate hospi tals funded by private equity funds, parading top-of-the-line facilities andtotalling an eyecatching investment of Rs 3,415 crore.

Apollo is planning 32 hospitals in two years, Wockhardt is spending Rs 400 crore in four superspecialties, Columbia Asiais setting up 15 new hos pitals in India, Shalby of Gujarat is opening OPDs across and beyond India, Narayana Health Cityis expanding to other states; DLF and Fortis are investing Rs 3,000 crore on 15 hospitals; Kolkata's Ruby General has aRs 10-crore expansion plan; Global Hospi tals of Hyderabad is charting a health city in Chennai; Max is expanding by Rs243 crore; Hindujas are foraying into boutique hospitals. The hospital growth saga is being written at a furious pace.

New Rules, New Deals

"I want you to give me a plan for a wellness city within three days," DrPrathap Reddy, chairman of the Apollo Hospitals Group, asked hissprightly grand-daughter, Upasna. When she showed him the PowerPoint,he gave her 100 days to visi t the seven best wellness destinations around

the world, wi th one condition: "You have to go to Kerala at the end of thejourney."

That created the blueprint of new growth for Apollo--be it developing high-end hospitals in Maldives, build ing the wellnes s city at Lavasa, or tying upwith ayurveda vaidyas in Kerala for research on the "science of life,prevention and longevity". Reddy is once again navigating unexploredterrains, where healing, learning and rejuvenation get coupled with world-class infrastructure and modern medicine.

"There's so much bus iness , nobody needs to fight for a piece of thehealthcare pie," Reddy's affable demeanour turns grave. "The market isbooming because the demand completely eclipses capacity. He holds out


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Hospital, Bhopal. Multispecialty.

Rs 200 crore: Asian Institute of

Medical Sciences, Faridabad.

Multispecialty.

Rs 200 crore: Global Hospital,

Mumbai. Superspecialty.

Rs 175 crore: Fortis Hospital,

Kolkata. Superspecialty.

Rs 120 crore: AMRI, Bhubaneswar.

Emami and Shrachi Group of

Industries. Multispecialty.Rs 100 crore: Narayana

Hrudayalaya Health City.

Multispecialty.

Rs 90 crore: ILS Hospital,Agartala.

Multispecialty.

Rs 90 crore: Vikram Hospital,

Bangalore. Multispecialty.

Rs 60 crore: Eternal Heart Hospital,

Jaipur. Superspecialty.

Rs 50 crore: Aadhar Hospital,

Kolhapur. Superspecialty.

Young Vision

Dharminder Nagar, PARAS HOSPITALS

Dharminder Nagarstarted work on ParasHospitals, Gurgaon, in2005. The Rs 70-croreneeded for his dreamventure was managedthrough a debt equityof 1:1. He s tudied

hospi tal and health systems at ImperialCollege, London. "It's this first handexperience as a practitioner in Londonhospi tals that inspired me to bringinternational quality healthcare to India," he

says. Within five years, the group hasgrown 30-40 per cent year on year andacquired a multispecialty hospi tal in SouthDelhi. NEW AGE TECHNOLOGY CHANGING

THE FACE OF THE OT

Doing Good Profitably

the promise of numbers: India needs 1,00,000 beds each year for the next20 years at Rs 50,000 crore per year; double the number of doctors from0.7 million to 1.5 million; triple the number of nurses from 0.8 million to 2.5mil lion; four times the number of paramedics from 2.5 to 10 million. "All ofus can play this game, provided we keep the momentum going."

The Fortis Group truly shows the might of private players with the hospitalbuying binge it has entered into--Escorts Heart Institute in 2005 for Rs 600crore, scores of hospitals in Bangalore, Kolkata, Hyderabad and Mumbai,10 Wockhardt hospi tals for Rs 909 crore last year and now 24 per cent of

Singapore's Parkway holdings last month. "That makes us the biggesthospital network in Asia," says Shivinder Singh, the man who heads theFortis hospital network. The group initially focused on expandingaggress ively pan-India through organic and inorganic growth. But itsaspiration is clearly global.

"The health boom is like the motorcycle revolution," says Dr Trehan. "Tenyears back, they used to make one million and couldn't sell those. Todaythey make nine mil lion and people are s till queuing up for more." ButTrehan's latest foray into healthcare hardly resembles a mass -producedmotorcycle. The Rs 1,000-crore Medanta Medicity has a blueprint that's asunique as it's new--not just in look or feel, but in orientation, purpose andspirit. It was a moment of introspection that had made Trehan plan a

Medicity.

"I built Escorts two decades back because at that time there were very few places in India that offered world-classtreatment and technology. But one can't possibly reinvent the wheel," he says. India may have moved up the healthcaredelivery ladder, but there's still a very real gap in the market. "Even now, we don't have a single place that's at the cutting-edge not jus t of technology and treatment but of education and research too," he points out. Medicity is a new model whereapplication and knowledge, cure and prevention, health and wellness , work and leisure, East and West can combine.

After energy, financial services, telecom and entertainment, the might of theReliance ADA Group has finally joined the healthcare fray with theKokilaben Dhirubhai Ambani Hospital, a brand new jewel on Mumbai'sskyline. It's, in fact, a pleasure to come to this den of luxury-- from high-endsalons that even work out hair solutions for chemotherapy patients, to fine-

dining res taurants, art not just on the walls but also on the floors, well-appointed rooms for patients, coffee kiosks everywhere. It's a hospi tal thathouses the best of technology--from intra-operative MRI suites to the high-end Trilogy radio-therapy equipment. "Our USP is our commitment toprovide maximum care to maximum people," says chairman Tina Ambani.

Max India boss Analjit Singhhad once famously said,"Hardware is out. The keydifferentiator is the soft side oflife." He, obviously, spokeabout today's healthcareconsumer--demanding and

discerning, intelligent andinterested in the s ervicesoffered to him. His hos pitalchain offers both-- servicewith a smile as well as thebest of technology, especially

in cancer care. So long, the chain did not foray outside NCR. "Delhi and the NCR is not a city but a country," says Singh. Butfinally it's planning to branch out across North India--with 1,050 new beds across Dehradun, Mohali and Bathinda. "Weintend to grow organically and through greenfield expansions," says Singh.

Dr Devi Prasad Shetty, who famously delivered cardiac care at Rs 10, isbusy perfecting a model that no one els e has dared to venture into. "We aretotally different from our competitors," he says. "As healthcare providers to


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Dr Ashwin Naik

"Doctors from rural

districts rarely go b ack

to their roots."

Dr Ashwin Naik, 37,and Dr VeerendraHiremath, 35, set upVaatsalya, a unique

model of affordable hospital network inunder-s erved tier II and III towns.Theydecided to address this demand-supplygap. Vaatsalya runs at eight locations inKarnataka, focusing on the mother andchild, offers about 520 beds and sees20,000 patients a month.

CARDIOLOGY IS SHAPING UP AS A

PRIME AREA OF HOSPITAL EXPANSION

Facts that count

Rs 200,000 crore is the s ize of theindustry, slated to clock Rs 300,000crore by 201280% of the market is in privatehands, the highest in the world4 mn people are employed, makingit one of the larges t service sectorsin the economy16% is the rate at which thehealthcare sector is growing year onyear1 lakh beds each year for the next20 years at Rs 50,000 cr per year iswhat India needs60% of the 15,393 hospitals and80% of all qualified doctors are inthe private sectorRs 5,400 cr is the value of thewellness market, growing at a fastclip of 35% a year5% of household income goes tohealthcare; 70% is sought from theprivate sector32 quality beds per 10,000 people

in the metros close to the lobal

the working class and the poor, we serve a market that no one else wantsto touch." And Shetty's aim is to add 20,000 hospital beds in the next fiveyears across states. To treat the ris ing tide of cancer patients, the grouphas created a Rs 250-crore cancer hospital in ass ociation with KiranMazumdar Shaw of Biocon. How does the socially-inclusive model work?"We do over 10 per cent of all heart surgeries in India. So, we benefit fromeconomies of scale," he says.

New Technology, New ProspectsTeleradiology is the electronic transmiss ion of diagnostic scans and X-

rays from one location to another to facilitate their reporting. The idea struckDr Arjun Kalyanpur while working at the Emergency Room at the YaleSchool of Medicine, US. "During night shi fts, we accessed scans from ahospi tal across town which were transmitted electronically to us," he says."I began to think that the same thing could be done from India, where itwould be daytime." But the idea of starting a company came later when hemet a radiologist friend in the US by chance.

When he told his wife, Sunita Maheshwari, also a Yale medic, herresponse was instant: "That is a space-age concept." But the couple anyway put down their savings and s tarted workingfrom home through the Internet for US clients. Now with the Indian health imaging market expected to double from theexisting Rs 1,575 crore in the next five years, competition is brewing up. Wipro, Reliance and Apollo have recently joinedthe fray. But Telerad holds 90 per cent of the market share in the country, growing at 50 per cent year on year.

Driven by the rising heal thcare demands and spending power of India'saffluent generation, medical technology looks set to enter a golden age. Anew FICCI-Ernst & Young study predicts 15-20 per cent growth for the Indianmedical equipment market, slated to grow from Rs 9,000 crore now to Rs22,500 crore by 2012. Not surprisingly, private hospitals are taking the lead inintroducing the latest technological wonders and creating miles tones intreatment. In 2006, Asia's first high field strength intra-operative MRI (iMRI),the mos t advanced technology to treat brain tumours with utmost precision,was launched at the Institute of Neuroscience of the Max chain in Delhi.

In the past, the difficulty indistinguishing between

diseased and healthy braintissue was addressed with afollow-up MRI scheduled aday or so after the surgery. Incases where residual tumourremained, a decision had tobe made about whetheranother operation was aviable option. That delaybetween surgery and follow-up MRI could now beeliminated with iMRI.Surgeons could operate on abrain tumour, sl ide the MRIinto the surgical sui te for ascan and immediatelyasses s whether moresurgery is needed. By 2010, ahost of private hospitals--fromMedanta to KokilabenDhirubhai Ambani Hospital tothe Asian Heart Institute--would have acquired thelatest in neurosurgeryinnovation.


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benchmark of 35 per 10,00012% insurance penetration in top 20cities.The business is growing at50% every yearRs 4,500 cr is what PE firmsinvested in Indian healthcare during2006-10.5-10 times higher salary rates arebeing offered by corporate hos pitalsto doctors63% hospital CEOs think gettingtrained manpower will be achallenge in future29% CEOs believe lack ofconsis tent policy on accreditationhinders growth

Technology is spreading tosmaller towns as well.Faridabad in Uttar Pradesh,for instance, has always beena sleepy little townshipdespite its proximity to theCapital. "It never had goodhealthcare infrastructure,"says Dr N.K. Pandey, formerhead of surgery at Escortsand a Dr B.C. Roy awardeewho has just started theAsian Institute of MedicalSciences (AIMS).

"There is a huge demand-supply gap," he says. "Thereis a lack of good infrastructureand quality healthcare services here." AIMS is gearing up as the first superspecialty focusing on cancer care in the area.From the cutting-edge Varian Trilogy machine-- one of the very few hospitals in North India with such a device--Pandey hasalso brought in s tate-of-the-art systems--PET-CT, MRI, gamma camera, brachytherapy to mam mography. His dream is toturn the 350-bed multispecialty tertiary care hospital into a flagship hos pital in the field of oncology, minimal invasivesurgery, urology and nephrology.

New Facilities, New Service

What's that buzz overhead? Dr Nis hith Chandra scanned the skies. Escorts Heart Institute, Delhi, is no longer the onlyhospital flying critically-ill patients to and fro. Every hospi tal worth its sal t is d ishing out air ambulance services these days.For a moment, he thought about the patient with abnormally fast heartbeat he had flown in from Ludhiana that afternoon. Itwas nearly touch-and-go, but they had managed to wheel him in to the OT safe and sound. For Chandra, head of airrescues at Escorts, it's all in a day's work. And it's that promise of being saved in the nick of time that's m aking more andmore patients s eek air ambulancing despite the cost (Rs 75,000 to Rs 100,000 per hour) and lack of insurance cover.When Dr Nitin Yende of Mumbai floated Vibha Lifesavers in 1996, calls came once in s ix months.

"Today, we handle over 40 calls from across India and the world every month," he says. Older hospitals are tying up withprivate charter (Air Ambulance India lis ts up 24 hospi tals in NCR, Tops Air Rescue 60 in Mumbai) or aviation companies(Deccan and now Religare Voyages). New hospi tals are s tealing the thunder by building roof-top helipads. Check out the19-storied Kokilaben Dhirubhai Ambani Hospital in Mumbai. Not just the metros, they are all across-- from the Aditya BirlaMemorial Hospital in Pune to the Yashoda Hospital in Secunderabad, Akshaya Apollo in Ahmedabad, PushpanjaliCross lay in Ghaziabad to Sri Hari Health Foundation in Bhiwani, Haryana.

The moment you walk into a hospital, an unmis takable "hospital smell" engulfs you. But at the Fortis La Femme in Delhi,the flavour of orange blossom s hangs in the air. Expect waiting-room gridlocks. At Bangalore's The Nest, the waiting arealooks more like a bank, with wait-for-your-turn counters. Think twiddling your thumbs is your lot as a hospital visi tor? At theOyster & Pearl Hospital in Pune you can spend hours at the cyber caf or the mass age parlour. Worried aboutcommuting to and from the hospi tal? At The Cradle, Bangalore, a luxury car will be at your beck and call.

No matter how friendly the ads and cheery the ambience, hospitals are not hotels, you thought. But the new generationbirthing centres mushrooming across the country are turning that conventional wisdom upside down. But lavishpersonalis ed care is not jus t the forte of high-end birthing centres. Now m ultispecialties are entering that zone too.

New Technologies

Robotic Surgery

A mechanical unit witharms and tiny hand-like instruments thatthe surgeon controlswith joss-sticks from aconsole. The sm allincisions and extreme


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precision m ake it a patient-friendlyprocedure. Was introduced for cardiacsurgery by Escorts in 2001. Today usedwidely across the country: Jaslok andHiranandani hospitals in Mumbai,Narayana Hrudayalaya and WockhardtHospitals in Bangalore, Care hospital inHyderabad etc. Swarup Hospi tal inKolhapur has an indigenous method ofrobotic laparoscopy; "intelligent robotics" forcancer--CyberKnife--was brought last yearby the Apollo, Chennai. A Da Vinci robotcosts about Rs 10 crore, a cyberknifesystem 65-70 crore.

Flat Panel Digital Cath Lab

Cath labs haveadvanced imagingsystems that allowdoctors to see theworkings of the heartand of tiny blood

vess els around it. It'sall live and doctors

really rely on the images to make accuratedecisions . The latest flat-panel digitaldetectors don't just capture distortion-freeimages but also bring the advantage oflower radiation dose to the patient,clinicians and technologis ts. A staple in allmodern hospitals today.

Pneumatic Chutes

They connect

and servehospitaldepartments,transporting

pharmaceuticals, lab samples andsensitive medical items at high speed.Done manually once, it ensures integrity ofdiagnostic processes , patient safety andservice efficiency. Almost every specialtyhospi tal in India has introduced the chute.

Paperless, Filmless

Scribblednotes, bills,

prescriptions, large diagnostic charts,reports and even patient queues will soonbe a thing of the past. Hospital workflows--


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New Ethics

Dr Ramakanta Panda

Asian Heart Institute

The 'Prime Minister'ssurgeon' wanted toreplicate the modelfrom the prestigiousCleveland Clinic, US,

where he used to work. Today, Asian HeartInstitute in Mumbai is one of the very fewhospitals in

India to win ISO, NABLand JCI and otheraccreditations. "Thehealthcare business

was chaotic and

from patient consultation, prescription,investigations, registration, doctor andnursing notes, billing, inventorymanagement to discharge--areincreasingly just a click away. Modernhospitals are now starting out with hospitalinformation systems in place. ArtemisHealth Institute of Gurgaon, for instance,had an IT budget of Rs 6.5 crore when itstarted in 2007.

IMRI & BrainSUITE

The technologicalbreakthrough inmagnetic resonanceimaging (MRI). iMRI(intraoperativeimaging) utilises MRIduring surgery to helpneurosurgeons

determine the success of a procedure bychecking real-time images in complicatedbrain tumour and other brain surgerycases. A separate but fully-integratedoperative area is named BrainSUITE. MaxHealthcare, Delhi, brought in Asia's firstBrainSuite to India. Today, a number ofprivate hospitals--Asian Heart Institute andKokilaben Dhirubhai Ambani Hospitals inMumbai, Medanta-Medicity in Gurgaon,Parvathy Hospital in Chennai--haveintroduced this fabulously expensivefacility.

Hospi tals are now finding ways to reach more patients and expand their business . Retail clinics l ike Manipal Cure andCare (MCC) in Bangalore are unique in that they complement the hospital bus iness by providing feel-good, look-good care.A brainwave of the Manipal Hospi tal group, MCC offers a mix of world-class products and services in preventive, wellnessand beauty--from heal th packages to skin care products, premium exercise machines, anti-snoring nas al devices tocosmeceuticals.

"I am an active proponent of this integrated approach, especially thewellness to prevention route," says Dr Ranjan Pai, managing director,Manipal Education and Medical Group, Bangalore. That makes perfectbusiness sens e in an age when Generation-X does not want to get intohospitals for services that can be rendered in a "non-sick" environment."They prefer being served in boutique ambience, where service s tandards

and the assurance of the genuineness of clinical care would be asigni ficant pull," he adds.

New Models, New Terrain"Improving the lives of billions of people at the bottom of the economicpyramid is a noble endeavour. It can also be a lucrative one," so s aysmanagement guru C.K. Prahalad. New business models in Indianhealthcare back up that theory. Ask Dr Ashwin Naik, 37, and Dr VeerendraHiremath, 35, who grew up in Hubli, Karanataka, went around the worldand returned to set up Vaatsalya, a unique m odel of affordable hos pitalnetwork in under-served tier II and III towns. "Doctors from rural districtsrarely go back to their roots," says Naik. They decided to address thisdemand-supply gap.


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without format earlier,"he says. "Today evenhygiene value hasgone upexponentially."

Dr Ashok SethEscorts Heart Institute

and Research CentreWith his wideexperience ins ideIndia and around the

world, in public and private systems, DrSeth, the man who heads Escorts hospi tal,understands the compulsions andrestless ness of a market on a roll. "Whatthe nation lacked so far was infrastructure,"he says. "Indians s pent money to go tounsani tary places or overseas . With thehealthcare boom, as infrastructure comes

into place, the private players need to keepone eye on the costs and another onquality," he points out.

When Vaatsalya started, they tapped into their NRI friends and family tochip in. "They gave eas ily because everyone wants to connect to theirroots." Venture funds began contributing gradually, both with money andexpertise. Vaatsalya runs in eight locations in the s tate, focusing on themother and child, offers about 520 beds and sees 20,000 patients amonth. Apart from full-time doctors, Vaatsalya also gets consultants frommetros who want to go back to their roots or from local partners. Whatnext? "Building up the chain in Maharashtra and Andhra Pradesh," they say.

Alternative is the new normal now. Take Rajiv Vasudevan, founder andCEO of the new-generation AyurVAID Hospitals. That's because, he isapplying contemporary business models to the ancient science of healing-- ayurveda. AyurVAID operates exactly like a modern hospital--from a hub-and-spoke approach to insurance coverage, focus on chronic conditions,end-to-end medical management protocol. "We integrate ayurveda withmodern m edicine," says Vasudevan, who is hopeful that the businessmodel will attract many more credible players to the industry. The 150-bedhospitals grew from three to seven centres across south and wes t Indialast year.

New Money, New People

Time was when health

insurance was notconsidered a safety net.The only insuranceeveryone knew and optedfor was l ife insurance. That is increasingly a thing of the past. The healthinsurance business is growing at 50 per cent and is projected to grow toRs 25,875 crore by 2010, according to a s tudy by the PHD Chamber ofCommerce and Industry. Health insurance premium is also increasing byover 20 per cent every year and many stand-alone health insurancecompanies are coming into the field, apart from the general insurancecompanies focusing on health insurance. "This shows the important roleplayed by insurance companies which has driven home the point thathealth insurance is becoming a very ess ential part in anybody's life," saysV. Jagannathan, chairman and MD of Star Health Insurance, healthinsurance specialist.

Emerging trends s how that today every middle income family feels that health insurance is a mus t for them, especiallyupper m iddle incom e groups. "Perhaps not to the extent of understanding every nitty-gritty of a policy, but they definitelyinsis t on adequacy of the cover in most cases," he adds.

"In the top 20 urban cities, the penetration of health insurance is 12 per cent," says Antony Jacob, CEO, Apollo MunichHealth Insurance. Yet another trend is that executive health check-ups have become more common, especially amongpeople above age 40, he explains . Health insurance is als o being driven by group insurance covers, as most medium tolarge companies have group health insurance schemes.

Not just insurance, private equity (PE) funds are upbeat on healthcare and have invested in several health corporates. But

how crucial a role are the PE firms playing in the healthcare boom in India? "PE firms invested Rs 4,500 crore in Indianhealthcare between 2006 and 2010," says Krishnakumar, executive director, private equity syndicator, Avendus Capital.Sandeep Singha, MD of Sequoia Capital India, which has invested Rs 450 crore into healthcare, agrees: "PE is crucial.Healthcare requires capital and unless you have PE funding, the evolution of the sector will be slower."

Also, healthcare is a high-growth area that does not get impacted by an economic downturn. "It's a huge m arket," points outSingha, "that will be growing for the next 50 years and the market opportunity is staggering." Rs 900 crore of PE has beeninvested into Indian healthcare companies in 2010.

It's the surge of private equity in healthcare that's bringing in young entrepreneurs, often from unexpected backgrounds.Take Dr Dharminder Nagar. He started work on Paras Hospitals, Gurgaon in 2005. The Rs 70-crore venture required forthis dream project was managed through a debt equity ratio of 1:1. "My father, Ved Ram Choudhary, was a philanthropistand the founder chairman of Paras Group of Industries," he says. From a humble beginning as the owner of a dairy, Paras,


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he became the largest mi lk producer and exporter, with interests in real es tate across north India.

Nagar worked as a doctor in the UK for a while and later joined the Imperial College, London, to study hospital and healthsystems. "It's this first hand experience as a practitioner in London hos pitals that inspired me to bring international qualityhealthcare to India," he adds. Paras Hospitals s tarted in Gurgaon in 2005. Within five years, the group has grown 30-40 percent year on year and acquired a multispecialty hospital in South Delhi.

With easy access to visa facilities, medical tourism is turning out to be the other potential source of income for thehealthcare industry. "It's a growing segm ent in India, with over 2 to 2.5 lakh annual travellers to India increasing at a rate of30-35 per cent," says Charu Sehgal, head of life sciences and healthcare at Deloitte Touche Tohmatsu India. Most large

healthcare providers are increasingly focusing on attracting medical tourists. "Apart from generating higher revenues forthe hospital--to an Indian patient--a medical tourist also spends 2-3 times more than a normal tourist in the country." "It isdefinitely a segment that the big players have in m ind as they make their expansion plans ," says Sehgal.

New Ethics, New QualityAfter all the fuss he made about building his hos pital, Dr Ramakanta Panda is left with a sm ile on his face today. In aresounding testimony to his commitment to quality health delivery, AHI is winning praises and kudos. "Healthcarebusiness was a bit of a Munnabhai earlier," he jokes. "There was no format or organised approach. Today, even hygienevalue has gone up exponentially." Experts agree.

To Dr Sachin Wagh, with his experience in hospital management, the main reason behind new-look hospitals is thatplanning and designing are now widely available to promoters. "A sim ple brief we recently received was that the hospitalshould not look like a hospital." The spectrum of catering, food and dietetics have gone up, along with the processing of

linen as an integral component of infection control. "Almost all newer hospitals opt to outsource s upport services--dietary,laundry, housekeeping and security," he adds. Apart from medical technology, hospitals are investing in electronic systemsfor hospital records.

Take, for ins tance, the Shalby Hospital, a 240-bed multispecialty private hospi tal in Ahmedabad. It transi tioned from asmall 15-bed s ingle specialty unit established in 1993 to a technologically-advanced 200-bed multispecialty hospital in2007. The hospi tal has invested heavily in IT infrastructure with Cis co and Nortel networking infrastructure. It has a fullyintegrated hospital management and information system, designed to manage every aspect of information flow and controlacross the hospital--right from vendor records to patient data--electronically. "Our goal is a paperless office," says DrVikram Shah, managing director and an orthopaedic surgeon. Shalby is also one of the first hospitals in the country topioneer incorporation of infection control measures like HEPA Filters, Laminar Air Flow, Body Exhaust System, Plasm aSterilizer and Maquet Operating Tables.

An unintended consequence of the flourishing healthcare market has been a nation-wide "poaching" of human resources."There's a lot of poaching going on," endorses Dr Ashok Seth, head of Escorts Heart Institute & Research Center, Delhi.Not only are people moving out of government hospitals, corporates are taking from each other too. "But these are marketforces that you have no control over. You cannot make legislation to stop this. It's a free country, after all !" The prim e driveris the compensation packages that corporate hospitals offer, often five to 10-times more than the market rate. "Some have20 different scales and salary systems-- with fixed and variable pay," he says. But not everyone would be eligible for the topslots.

Even a reputed doctor would have to conform to various marketdriven parameters to jus tify such a jum p. A doctor's field, hisreputation capital and his finance-generating capacity will have to tally with the 'needs' of the healthcare corporate."Someone in cardiac, for instance, will be able to dictate terms more than a skin specialist," he adds. "They consider thereturns that we will get by investing on a certain person." The bottoml ine in salary negotiation, however, is that the patient isking. "A patient doesn't care how m uch you know. But a patient knows how m uch you care," laughs Seth.

"The private sector has not been able to take technology to the common man, although it has created phenomenalstandards in the country," adds Hemant Khavle, hospi tal planner and a senior consultant with KJWW Engineering. "It istechnology that forms the backbone of the paradigm s hift in healthcare, but cost goes up as technology and treatmentoptions increase," he puts it bluntly.

The constant evolution of life-support systems, diagnostics, expensive third and fourth generation medicines and greaternumber of devicesrelated surgeries--all come at a cost. "There are many hospitals which over equip thems elves withtechnology," he says. "Where a 64-slice CT scanner is enough, people ins ist on buying 256-slice."

The Growth Drivers

Fortis

Hos itals

Medanta

Medicit

Dayanand

Medical


10/13

Locations: 62hospitalsacross India.Total Beds:

10,000USP: Deeppockets, topdoctors,specialised

services.Apollo

Locations: 50hospitalsacross India.Total Beds:

9,000USP: TheApollo HeartInstitute is oneof the largestcardiovascular

groups in theworld.

Manipal

Hospitals

Locations:

Manipal andBangalore.Total Beds:

3,571USP:Pioneeringpresence in

medicaleducation.

Narayana

Hrudayalaya

Location:BangaloreTotal Beds:

Over 3,000USP:Subsidisedcardiacsurgeries.

Christian

Medical

College

Location:VelloreTotal Beds:

2,512USP:

Leveraging onhighly skilledglobalnetwork, high

Location:

GurgaonTotal Beds:1,600USP: Medantahas 45operatingtheatres andover 350

critical carebeds.

Arvind

Hospitals

Locations:

Madurai,Tirunelveli,Coimbatore,PuducherryTotal Beds:Over 1,500USP:

Traditionalhospi tality andlow costeyecaretreatment.Known forserviceorientedinitiatives.

Kasturba

Hospital

Location:

ManipalTotal Beds:

1,475USP: Serviceto the needyand poorpeople withcare andcompassion.

Yashoda

Hospitals

Location:

HyderabadTotal Beds:

1,200USP:

Foremostcentre forcancertreatment inthe state usingAsia 's firstRapid Arcmachineequipped with

College &

Hospital

Location:LudhianaTotal Beds:1,000-beddedtertiary careteachinghospital in

North India.USP: The onlyinstitution inNorth Indiawhich has anentire floor ofICUs with 100bedsincorporatingall the criticalcare areas.

Sri

RamachandraMedical Centre

Location:

ChennaiTotal Beds:900USP:

Internationaltechnology forIndian patients.Specialists inortho. One ofthe key player

in medicaltourism.

Global

Hospitals

Location:

Hyderabad,Bangalore andChennai.Total Beds:

900USP: Organtransplantation.

CARE

Hospitals

Location:

HyderabadTotal Beds:950USP:

Cardiologysuperspecialty.

Little Flower


11/13

,focused onthemarginalised.

Max Hospital

Location:

DelhiTotal Beds:

1,900

USP: Over 225ICU beds,world-classphysicians,3,000 supportstaff and mostadvancedtechnologies.

SevenHills

Health City

Location:Mumbai

Total Beds:1,850USP:Expertise incardiology,emergencycare, etc.

KLES Hospital

Location:Belgaum,KarnatakaTotal Beds:

1,820USP: Accidentandemergencydepartmentcompareswith the best.

sophisticated3D planningsimulators.

Amrita

Institute of

Medical

Sciences and

Research

CentreLocation:

KochiTotal Beds:1,200USP:

Superspecialtywith anattachedmedicalcollege.

Lisie Hospital

Location:CochinTotal Beds:1,080USP: Hospitalrecognised bythe MCI for

junior andsenior Housesurgency.

Research

Centre

Location:

Angamaly,KeralaTotal Beds:

800USP:Registered not

for profit healthinstitution.

Kokilaben

Dhirubhai

Ambani

Hospital

Location:

MumbaiTotal Beds:

750USP: Top of theline technology.

Sterling

Hospitals

Locations:Rajkot, Baroda,Ahmedabadand MundraSEZ.Total Beds:725USP: Centre ofexcellence forcardiac care.

Healthcare as an industry is coming into its own. If wishes were horses, there would be third-party payers subsidisinghealthcare, laws compelling profit-making organis ations to insure all employees, indigenous manufacturers developingcutting-edge technology, bodies standardis ing procedures and quality, corporates running sens ible business models,doctors compuls orily treating patients free of cost one day a month, universal insurance at Re 1 a day. There's more: the

rich will patronise the private sector, the poor wil l flock to the public s ector, while subsid ised hospitals under public-privatepartnerships will provide qual ity healthcare to the rest at reasonable rates. That's the dream scenario but the new buzz inthe air is contagious and the ambitious projects on the ground and in the pipeline point to an inescapable truism: health iswealth.

New Facilities

Air Ambulance


12/13

It is the most 'in' thing in the hospital circuittoday with almost every super specialtyhospi tal, over 24 in the NCR region alone,offering the service. With top-draweremergency doctors on-board, it's a m uch-needed s ervice for patients who can't reachhospi tals eas ily or on time. Many hospitalslike the Apollo, Hyderabad, and AkshayaApollo, Ahmedabad, have their ownhelipads. The cost can run into lakhs

depending on the distance.

Hospital Retail ClinicsHospitals are now finding ways to reachmore patients and expand their business.Retail clinics like Manipal Cure and Care(MCC) in Bangalore are unique in that theycomplement the hospital business byproviding feel-good, look-good care. Theseclinics, a mix of world-class products andservices in preventive, wellnes s and beauty,will offer everything--from health packages toskin care products, premium exercise

machines to cosmeceuticals.

Boutique Hospitals

More money,more attention. Lavishpersonalised care was so long the fort ofhigh-end birthing centres. Now Multi-specialties are entering that zone. Check outtwo upcoming hospitals of Mumbai--SevenHills in Marol Andheri and PD Hindujaat Khar--that are gearing up to offer thisservice--green sprawl, designer suites,spas , fine dining--to patients who expectcountry club facilites while in a hos pital.

Presidential Suites


13/13

Print Close

What's common between Fortis , VasantKunj, in Delhi, Kokila Dhirubhai Hos pital inMumbai, Artemis in Gurgaon, Sagar Apollo inBangalore or Ruby Hall Cl inic in Pune? Well,they all have something that was so longass ociated with business travellers and five-star hotels: Presidential suites. Completewith patient and fami ly rooms , separatebathrooms, microwave and refrigerator(sometimes a kitchen), computer stations,WiFi--there's enough room to accommodatepersonal s taff as well . All clinicalappendages are neatly tucked behindslid ing artwork to complete the illus ion. At Rs

25,000-30,000 a day, it might just beposs ible to forget the reason for gettingadmitted to a hospital.

Bar-coded OPD card

Be it Paras Hos pitalin Gurgaon or thebrand new DesunHospital & HeartInstitute in Kolkata--bar-coded smart

cards to track patient details are fas t

catching the fancy of hospital planners .These are iss ued the first time a patientvisi ts a hospital. The unique computergenerated registration number would notonly hold good every time the patient visits, itwould also give the hospital instant accessto his/her profile.

with inputs from Stephen David, Uday Mahurkar, Senthil Kumar, Nishika Patel, Harsha Bhat, Vanita Chitkara, Sharmi

Ghosh Dastidar, Arvind Chhabra, Elora Sen, Amarnath Menon, Anand Natarajan, Nandini Vaish and Ayesha Singh

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