The document provides an overview of the Indian healthcare industry and infrastructure. It notes that the industry is growing rapidly at 17% CAGR and is projected to reach $280 billion by 2020. Key drivers of growth include rising incomes, health awareness, lifestyle diseases, and insurance penetration. However, healthcare spending and infrastructure in India remains low compared to global standards. The private sector dominates healthcare delivery, accounting for around 80% of total spending. The government is taking initiatives to boost diagnostic infrastructure through public-private partnerships.

1. Indian Healthcare Industry 2016
July 2016
A perspective on Healthcare Infrastructure

2. 1. Introduction to Indian Healthcare Industry ……………… ..1
2. Market view of Indian healthcare sector ……………...…….2
3. Growth Drivers of Indian healthcare sector…………………3
4. Healthcare Infrastructure in India ……………………...……..7
5. Key Players in the Private Healthcare Segment……………10
Contents

3. Section 1
Introduction to Indian
Healthcare Industry

4. The Healthcare sector, in India, has become one of India's largest sectors - both in terms
of revenue and employment. The industry comprises hospitals, medical devices,
Pharmaceuticals, clinical trials, outsourcing, telemedicine, medical tourism, health
insurance and medical equipment. The Indian healthcare industry is growing at a
tremendous pace due to its strengthening coverage, services and increasing expenditure
by public as well private players.
The Indian healthcare delivery system is categorized into two major components - public
and private. The Government i.e. public healthcare system comprises limited secondary
and tertiary care institutions in key cities and focuses on providing basic healthcare
facilities in the form of primary healthcare centres (PHCs) in rural areas. The private
sector provides majority of secondary, tertiary and quaternary care institutions with a
major concentration in metros, tier I and tier II cities.
The Indian healthcare industry is projected to continue its rapid expansion, with an
estimated market value of USD 280 billion by 2020, fuelled by increased population
growth in India's low income communities. Large investments by private sector players
are likely to contribute significantly to the development of India's hospital industry and the
sector is poised to grow to USD 280 billion by 2020.
Rising incomes, greater health awareness, lifestyle diseases, and increasing insurance
penetration will contribute to growth. Healthcare spending in India accounts for over 4.2
per cent of the country's GDP, of which the public spending is around 1 per cent of GDP.
The presence of public health care is not only weak but also under-utilized and
inefficient.
Healthcare delivery and pharmaceuticals account for nearly 75% of the total healthcare
market. India has only 0.7 beds per 1,000 people, far below the global average of
2.6.India needs to add 2 million beds to the existing 1.1 million by 2027, and requires
immediate investments of USD.
Introduction
1

5. The Indian healthcare industry is seen to be growing at a much rapid pace of 17% CAGR
and is expected to become a USD 280 billion by 2020 from USD 68.4 billion in 2011. A
break-up of the sector of 2012 is provided in Figure.
Indian Healthcare Industry (Revenues USD Bn) Healthcare Industry Breakup (%)
Market view of Indian healthcare sector
70%
20%
10%
Healthcare
Delivery
Pharma
Medical
technologies &
Other
45.0 51.7 59.5 68.4 72.8 81.3
160.0
2008 2009 2010 2011 2012 2014 2017F
Source: Frost & Sullivan, LSI Financial
Services, Deloitte, TechSci Research
India – Underpenetrated Healthcare Market
Demand for healthcare services in India is expected to rise owning to favourable
demographics and radical shift in the disease patterns of its populace. India’s healthcare
spending is lowest both (as % to GDP and Per capita spending) when compared to
developed countries suggest tremendous potential for growth.
As % of GDP
India’s healthcare spend is significantly low when compared to the global, developed and
other similar emerging economies. India’s healthcare expenditure as % of GDP was 3.8
% (in which government spends 1.2 %) as compared to global average of 8.6%
(government spends 5.0%).
Per capita healthcare spending
Also per capita healthcare spending of USD 196 is lowest compared to USD 8,845 in the
US, USD 3,235 in the UK and USD 578 in China.
As per Disease Load
India’s share in global disease burden is 20%, while its share of healthcare infrastructure
Source: Frost & Sullivan
2

6. India Healthcare Spending (% of
GDP)
India - Per Capita Healthcare Spending
(USD)
17.0
11.6 10.9 10.3 9.3
5.4
3.8
8.6
Source: WHO – World Health Statistics 2015
8845
4610 4213 3632 3235
894 630 578 273 196
Source: WHO – World Health Statistics 2015
Demand for healthcare services in India is expected to rise owning to favorable
demographics and radical shift in the disease patterns of its populace. The key factors
attribute to growth in healthcare sector are:
 Increasing health awareness and disposable incomes
Rising per capita income in India has improved affordability of healthcare and
significantly expanded the addressable market for private healthcare providers. This has
led to an increase in the standards of consumer awareness and patients are now
demanding and willing to pay for better infrastructure, improved diagnostic facilities,
latest technology and best-in-class medical care. Even though healthcare is considered
as a non-discretionary expense, considering that an estimated 59 per cent of households
is much lower with only 6% of global hospital beds and 8% of share of doctors and
nursing staff.
in India had an annual income of less
than 2 lakh in 2013-14, affordability of
quality healthcare facilities remains a
major constraint.
Growth in household, and
consequently, disposable incomes, is,
therefore, critical to the overall growth
Rising Disposable Incomes
1.8 3.2
20.4
107.2
92.1
5.6 10.9
81.8
102.8
61.7
GLOBALS
(UPPER
CLASS)
STRIVERS
(MIDDLE
CLASS)
SEEKERS
(MIDDLE
CLASS)
ASPIRERS DEPRIVED
Source: CRISIL Research
3
Growth drivers of Indian healthcare sector

7.  Increasing penetration of health insurance
The insurance penetration level in India is very low when compared with the global
average. Low Health insurance penetration is one of the major impediments to the
growth of the healthcare delivery industry in India as affordability of quality healthcare
facilities by the lower income groups continues to remain an issue. As per the Insurance
Regulatory and Development Authority (IRDA data, less than 15 per cent of the Indian
population is covered through health insurance).
in demand for healthcare delivery services in India. The immense opportunity in the
industry can be gauged from the fact that the share of households in the 2-5 lakh per
annum income bracket is expected to go up to 38 per cent in 2017-18 from 28 per cent in
2013-14.
Rising Penetration of Health Insurance (%)
1.03
1.30
2.42
2.79 2.85 2.90
2008-09 2009-10 2010-11 2011-12 2012-13 2013-14
Source: IRDA LSI Financial Services, TechSci
Research, World Bank
Increasing healthcare cost and burden of
new diseases along with low government
funding is raising demand for health
insurance coverage. Many companies
offer health insurance coverage to
employees, driving market penetration of
insurance players.
By 2015, spending through health
insurance will reach 8.4 per cent of total
health insurance is poised to grow exponentially in the coming years. The share of
population having medical insurance is likely to rise to 20 per cent by 2015.
 Rising incidence of lifestyle-related diseases
Demand for lifestyle diseases-related healthcare services in India is expected to grow
over the next 5 years. Life-related illnesses or non-communicable diseases (NCDs) have
been increasing rapidly in India over the last few years. Statistics show that these
illnesses accounted for nearly 56 per cent of all deaths in India in 2008. CRISIL
4

8. Research believes that these illnesses exhibit a tendency to increase in tandem with
rising income levels. With the share of households earning above 5 lakh per annum is
Rising Lifestyle Related Diseases
201
115.0
29.0
509
274
79
1030
519
163
CARDIAC ONCOLOGY DIABETES
Source: CRISIL Research
expected to go up to 20 per cent in 2017-18
from 13 per cent in 2013-14, the share of NCDs
as a major cause of deaths in India will rise.
Consequently, demand for healthcare services
associated with lifestyle diseases such as
cardiac ailments, oncology, diabetes, etc. is also
forecast to increase.
 Increasing ageing of Indian population
India is the second most populated country in the world and is expected to surpass
China to become the world’s most populated nation by 2025. While it is considered as a
country with a large proportion of population below the age of 30, India is also expected
to have a significant population of middle-aged and older adults, leading to a
corresponding increase in demand for healthcare delivery systems and services. Nearly
8 per cent of the Indian population was above the age of 60 years in 2011. This
proportion is expected to climb to 12.5 per cent by 2026, but there is no documented
knowledge base on the healthcare needs of the elderly (aged 60 years or more).
As per the ‘Report on the status of elderly
in select states of India, 2011’ published by
the United Nations Population Fund
(UNFPA) in November 2012, chronic
ailments like arthritis, hypertension,
diabetes, asthma and heart diseases were
common place among the elderly. Nearly
Indian Demographic Shift
66 per cent of the elderly reported at least one of these. Hence with more and more
people being added to this age group, the demand for healthcare infrastructure in
India will only increase in the future.
5

9.  Government initiative to boost diagnostic infrastructure through PPP model
The Govt. of India has proposed national strategy for providing essential diagnostics
facilities free for all under National Health Mission. The Scheme is aimed at providing
free diagnostic tests, including several blood tests, x-rays and advanced CT scans, for
those visiting public health facilities. It also aims to rope in Private Service providers
wherever required.
Government is taking initiatives in boosting up the healthcare sector by entering into
Public-Private-Partnership (PPP) and attracting inflows of foreign direct investment in
diagnostic sector. Healthcare is one of the most significant social sectors in India and
government expenditure on this sector is expected to rise further. Entering into
partnership with government at various levels can help private diagnostic players to enter
difficult rural market and in fact expand at larger scale.
 Growth in Medical Tourism
India was one of the first countries to recognize the potential of medical tourism and
currently it is leading destination for global medical tourists. Advantages for medical
tourists include reduced costs, the availability of latest medical technologies and growing
compliance to global standards. Moreover foreigners are less like to face a language
barrier in India.
Indian Medical Tourist Arrivals (Mn)
0.9
3.2
2011 2014E
Source: ASSOCHAM
A key competitive advantage India has in
medical tourism, in comparison to other
countries, lies in the cost effectiveness it
has to offer to its patients. A person
coming to India for his/her medical
treatment can have savings anywhere in
the range of 30 to 70 per cent. As medical treatment cost in western world balloon,
westerners are finding the prospects of international medical care increasingly appealing
and India is the popular destination of choice among them.
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10. Healthcare Infrastructure in India
Healthcare is one of the key parameters in which a country’s development and stature
are measured. It is an important indicator to understand the healthcare delivery
provisions and mechanisms in a country. It also signifies the investments and priority
accorded to creating the infrastructure in public and private sectors. Health Infrastructure
indicators are subdivided into two categories viz. educational infrastructure and service
infrastructure.
 Educational Infrastructure: Educational infrastructure provides details of medical
colleges, students admitted to M.B.B.S. course, post graduate degree/diploma in
medical and dental colleges, admissions to BDS and MDS courses, AYUSH
institutes, nursing courses and para-medical courses. Medical education
infrastructures in the country have shown rapid growth during the last 20 years.
 The country has 381 medical colleges, 301 Colleges for BDS courses and 140
colleges conduct MDS courses with total admission of 43,576 (in 381 Medical
Colleges), 25,320 in BDS respectively during 2013-14.
 There are 2670 institution for General Nurse Midwives with admission capacity
of 109224 and 686 colleges for Pharmacy (diploma) with an intake capacity of
40898 as on 31st March, 2013
 Service Infrastructure: Service infrastructure in health include details of allopathic
hospitals, hospital beds, Indian System of Medicine and Homeopathy hospitals, sub
centers, primary health centres (PHCs), community health centres (CHC), blood
banks, mental hospitals and cancer hospitals.
 There are 19,817 hospitals having 6, 28,708 beds in the country, of these
15,398 hospitals are in rural area with 1, 96,182 beds and 4,419 hospitals are
in urban area with 4, 32,526 beds.
Source: Shodhgandha Report, National Health Profile 2013, Government of India
7

11.  There are 1,51,684 Sub Centers, 24,448 Primary Health Centers and 5,187
Community Health Centers in India as on March 2013.
 There were 2760 licensed blood banks in the country as on February 2015.
 CGHS has health facilities in 25 cities having 260 allopathic dispensaries and
90 Ayush dispensaries in the country with 9,82,461 registered cards/ families
 Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH): A
separate Department of Indian Systems of Medicine and Homoeopathy (ISM&H) was
set up in 1995 to ensure the optimal development and propagation of AYUSH systems
of health care. The Department of ISM&H was renamed as the Department of AYUSH
(an acronym for – Ayurveda, Yoga and Naturopathy, Unani, Siddha, Homoeopathy) in
November 2003.
 The Department of AYUSH under the Ministry of Health and Family Welfare, promotes
and propagates Indian systems of Medicine and Homoeopathy, and is committed to
infuse the wisdom of traditional medicine with the methodologies of modern science,
scientifically validating the systems and presenting them in the scientific idiom, relating
their efficacy to modern life styles. The Department has, over the years, developed a
broad institutional framework to carry out its activities.
 Medical care facilities under AYUSH by management status i.e. dispensaries
and hospitals are 26,107 & 3,167 respectively as on 1.4.2013.
Country
Rural Hospital
(Govt.)
Urban Hospital
(Govt.)
Total Hospitals
(Govt.)
Provisiona
l/Projected
population
(in 000)
Average
Populati
on
served
per
Govt.
Hospital
Average
Populatio
n served
per Govt.
Hospital
Bed
No. Beds No. Beds No. Beds
India 15398 196182 4419 432526 19817 628708 1223581 61744 1946
Source: Shodhgandha Report, National Health Profile 2013, Government of India
8

12. Private Healthcare infrastructure
The Indian healthcare delivery system is categorized into two major components - public
and private. The government's share in the healthcare delivery market is 20% while 80%
is with the private sector. The Government i.e. public healthcare system comprises
limited secondary and tertiary care institutions in key cities and focuses on providing
basic healthcare facilities in the form of primary healthcare centers (PHCs) in rural areas.
A major portion of secondary, tertiary and quaternary healthcare institutions comes from
private sector with a concentration in metros, tier II and tier I cities.
While India did have a private hospital sector at the time of Independence, it is only
recently that it has grown and diversified over the years. As per report from Sehgal and
Sood, the private hospital market in India is estimated at USD 54 billion at end-of 2014
from USD 22 bn in 2009. Increase in number of hospitals in Tier-II and Tier-III cities has
fueled the growth of private sector.
Meanwhile, private sector is quite dominant in the healthcare sector. Around 80 percent
of total spending on healthcare in India comes from the private sector. Inadequate public
investment in health infrastructure has given an opportunity to private hospitals to
capture a larger share of the market. In addition the demand for hospital services has
been increasing due to the rise in lifestyle related diseases.
Market size of private hospitals (USD Bn) India - Share of private hospitals (2014)
80%
20%
Private Sector
Public Sector
22.0
54.0
2009 2014E
Source: Sehgal and Hooda, ISID
Source: IBEF
9

13. Key Players in the Private Healthcare Segment:
Private players have made significant investments in setting up state-of-the-art private hospitals in cities
like Mumbai, New Delhi, Chennai, and Hyderabad. The following are the major domestic private
healthcare providers in India:
 Apollo Hospitals: Apollo Hospitals has emerged as the single largest private hospital group in South
Asia. It operates hospitals, dispensaries, clinics, and laboratories. It manages a network of
approximately 41 specialty hospitals and clinics with a bed capacity of over 9,000 across the country
and abroad.
 The Escorts Group: This has a presence in specialized cardiac treatment and multi-specialty care
hospitals providing a whole gamut of specialized medical services. Escorts operate ten hospitals
across India. The group is also reputed for tertiary care services such as neurology, neurosurgery,
plastic surgery, and urology. Escorts Heart Institute and Research Centre (EHIRC) has a 325 bed
tertiary care institute, with 9 operation theatres, 5 Cath labs, 2 heart command centers and world class
facilities.
 Fortis Healthcare: This is a company founded by the promoters of the Indian pharmaceutical major,
Ranbaxy Laboratories, and started operations in 2001. It has approximately 12 hospitals with 1,900
beds. It has operations across North Indian the cities of Delhi, Noida, Mohali, Amritsar, Faridabad,
Raipur, and Srinagar.
 Max Healthcare: This is a fully owned subsidiary- of the highly diversified Max Group, with a chain of
clinics and hospitals with a bed capacity of 1200. On =average, Max Healthcare treats 30,000 patients
every month, with 200 new patients visiting the facilities every day. It has collaborated with Singapore
General Hospital in the areas of medical practices, nursing, paramedical research and training.
 Wockhardt: This is among India's leading pharmaceutical and healthcare companies. Since inception
in 1989, the Wockhardt Hospital & Heart Institute has become a renowned tertiary level heart center
providing cardiac care to patients of all age groups. It is the first recognized hospital in South Asia on
the worldwide panel of Blue Cross blue Shield, the largest provider of health insurance in USA. It has
approximately 10 hospitals with 1,500 beds. It has entered into Public-Private Partnership with the
Government of Gujarat to manage the 275-bed Palanpur Civil General Hospital in Gujarat
 Manipal Health Systems: Its chain consists of approximately 9 primary centres at7 rural locations, 8
secondary hospitals at urban and semi-urban locations and 3tertiary hospitals at urban and semi-urban
locations. It has a joint venture with Pantaloons Retail for comprehensive retail healthcare foray.
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14. Feedback & suggestions are welcome
Contact Details
Mr. Irish Pereira
Pharma Market Analyst
Email: irishpereira@gmail.com
Mob: +91-8087068343