GT- CII Healthcare report

7/28/2019 GT- CII Healthcare report

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Grant Thornton India LLP. All rights reserved.

Agenda for Transforming Healthcare Delivery in the Northern Region

Bridging the Divide - for a Healthy India


3/48 Grant Thornton India LLP. All rights reserved. 3

Foreword

In a populous nation like ours, with an ever increasing need for healthcare infrastructure andservices, the private sector has remained the lynchpin of growth, accounting for more than half ofthe total healthcare spending in the country.

The healthcare delivery sector is characterised by wide regional disparities with rural India beinghighly underserved. Further, the Southern region has been a change catalyst and far ahead of itsNorthern counterpart in terms of access, technology, infrastructure and sometimes even, in the

quality of service.

Against a backdrop of changing demographics and socio economic mix in the Indian population, itis imperative to raise the bar on quality of healthcare service delivery and ensure equitable andaffordable access across social strata. Achieving this requires several factors to come together, notleast the optimal utilization of existing healthcare resources and the role the government needs toplay in the holistic development of a regional healthcare system.

In this paper, we attempt to bring out the current state of affairs in the healthcare delivery space inthe northern region of India, recent trends in the sector and challenges in executing an effective

healthcare agenda, with recommendations and actions for transforming healthcare in North India.

Mahadevan NarayanamoniPartner and Practice LeaderHealthcare and Life-sciencesAdvisoryGrant Thornton India LLP

Harpal SinghConference Chairman &Past ChairmanCII Northern Region



The Healthcare industryMarket size and segmentation



Glaring statistics

our country ranks 112th on the World Health Organisations (WHO) ranking of theworlds health systems.

doctor-to-patient ratio for rural India, as per the Health Ministry statistics, stands

at 1:30,000, well below the WHOs recommended 1:1,000.

Overall healthcare spending (public and private) accounts for a mere 4% of India'sGDP, far below the average of 9.5% across Organisation for Economic Co-operationand Development (OECD) countries. Private sector accounts for more than 70% ofthis spend, while the public sector spend has been only 1.4%.

in terms of the total health expenditure per capita (in US$), India spends the leaston public healthcare among the BRICS nations.

for FY14, the Union Budget has allocated larger funds for the health sector, Rs37,330 crore from the revised estimates of Rs 24,894 crore for FY13

merely 20% of Indias 1.2 billion population is covered by health insurance

of the 1.35 million hospital beds in the country, only 48% are functional

the private sector accounts for 65% of the total number of operational beds, andover 70% of the spending on healthcare in India.

lack of healthcare facilities in the rural areas as well as among those at thebottom of the pyramid is one of the big challenges in delivering scalablehealthcare options



While the healthcare delivery sector in Northhas been making progress with a number ofhospitals and healthcare centres gainingaccreditations from National AccreditationBoard for Hospitals & Healthcare Providers(NABH), the region still lags behind many partsof the country on several healthcare parameters.

The number of hospitals and inpatient bedsavailable relative to the total population of theregion is far lower than the national average.The states (Delhi, Haryana, Himachal Pradesh,Jammu & Kashmir, Punjab, Rajasthan,Uttarakhand and Uttar Pradesh) continue tobattle high rates of infant mortality andincidence of deaths due to dengue, cholera,diarrhea and other ailments.

The lack of requisite infrastructure in thesemi-rural and rural areas of northern India isone of the key barriers to the delivery of basichealthcare services in the region.

Market size and segmentation

The healthcare sector is the third largestcontributor to the Indian economy in terms ofrevenue and employment generation potential.The Indian healthcare sector encompasseshospitals, pharmaceuticals, medical equipmentand supplies, medical insurance anddiagnostics. Among the primary subsectors of

the healthcare sector, hospitals andpharmaceuticals account for the largestrevenue, contributing as much as 71% and13% of the total revenue, respectively. Thehospital services market, which forms one ofthe largest segments of the Indian healthcaresector, is expected to reach US$81.2 billion by2015.

Leveraging improved technology and

infrastructure of medical institutions,

northern India is witnessing a steady risein medical tourism. A number of cities

including Delhi / NCR, Chandigarh,

Amritsar, Mohali and the surrounding

areas have been attracting patients from

overseas.

Healthcare delivery in the North

71%

13%

9%

3%4%

Hospital Pharmaceuticals

Medical Devices Medical Diagnostics

Medical Insurance

Healthcaremarket in India

(% share)



What drives growth?

With the rising middle class population, theaverage real household disposable income islikely to double from 2005 to 2025 leading toan increased expenditure on healthcare. It isestimated that, by the end of 2025, the countrywill require an additional 1.8 million new beds

to fulfil the targeted 2 beds per thousandpeople. The demand for quality healthcareservices outstrips the supply from the publichealthcare system which becomes anopportunity to be a key growth driver for theprivate healthcare sector. The rise of healthconscious consumers who can afford qualityhealthcare is expected to also fuel the demandfor specialised healthcare services/delivery.This trend is already underway in Tier I cities,

including those in northern India, which hasbegun to witness the proliferation of specialtyhospitals and healthcare centres.

The growingdemand forquality care

Shift indemographicsand change inspendingpatterns

Increasingability to payfor services

Risingpenetration ofthe medicalinsurancemarket

Gaps inexisting andrequisitehealthcaredeliveryinfrastructure

1.

2 3 4 5

In a nutshell

the key challenges faced by thehealthcare delivery sector currentlyinclude the following:- access to affordable real estate- ability to leverage technology- ability to leverage existing

infrastructure (nursing homes/clinics/ excess capacity in hospitals)

- limited success under the PPProute

- the skill gap, shortage of doctorsand trained staff

deployment of technology, mobilelinkages to rural areas and efficient

utilisation of existing infrastructureholds the promise to bridge the gapbetween healthcare need and supply inseveral parts of the North



Recent policy initiatives

To increase access and utilisation of qualityhealth services by the rural population, theCentral Government launched the NationalRural Health Mission (NRHM) in April 2005.NRHM has helped upgrade healthinfrastructure, improve manpower availability

and skills of healthcare service providers andimprove accessibility of drugs and diagnosticsand service delivery in the rural areas. TheCentre is also planning to launch the NationalUrban Health Mission (NUHM), which willfocus on slums and urban poor. NUHM willcover all cities and towns with a population ofmore than 50,000. The scheme will coverover 779 Indian cities and towns, as well asseveral Tier I cities.

As a part of NRHM, Government of India'sMinistry of Health and Family Welfare(MoHFW) has instituted Accredited SocialHealth Activists (ASHAs). The initiativeentails the provision of a trained femalecommunity health activist in every village in

the country. The female community healthactivist is a representative of the village andworks as an interface between the communityand the public health system.

To-dos efficiently utilise current infrastructure, before allowing for more

link ASHAs to the nearest facilities, provide infrastructure and financial support

mobile healthcare units to form the link between the interiors and the nearest facility

rural public infrastructure must remain at the forefront of healthcare policies

preferential land allotment/ subsidies where there is infrastructure gap

cutting down the risk of deaths in maternal and perinatal conditions

increase public health spending streamline drug purchase stocking distribution arrangements

low-cost day care surgery models at government hospitals

continued focus on development of medical colleges and institutions



Healthcare deliveryKey players, operating models and recent trends



Healthcare delivery pattern

General Hospital

absence of super specialtyservices offerings

present in Tier 2, Tier 1 andMetros

patients shift to Tier 1 for advancetreatment

OT & ICU usually are present

mostly 25-100 beds

some cases up to 100 200 beds

Tertiary care

Government

TeachingInstitutions

Medical Colleges

Private

CorporateHospitals

Trust Hospitals

Specialised high-end Care, from trained manpower using high-end sophisticated technology

Secondary care

Government

District Hospital Community Health

Centre

Private

Mid-sizedSecondary care

Nursing Homes

Healthcare facilities that require constant medical attention, including short period ofhospitalisation

The basic healthcare facilities for common and minor ailments where prevention is most effective

Primary care

Government

Primary Healthcare centre

Private

Clinics

super-specialty services

mostly in Metros and Tier1

15% = > 300 beds 80% = 200 to 300 beds

5% = Avg 75 beds

mix of colleges, single andmulti-specialty facilities

primary role to treat ailments thatdo not require surgical interventionor advance care

services vary across cities

may have ICU and minor OT

up to 30 40 beds

located in smaller towns are also located in Tier I, Tier II

and Metros



Healthcare service delivery models

Health City

Brief description Illustrative examples

Integrated Healthcare Facilities of more than 1000beds spread across a few acres of land and providingmany specialties

AIMS (Kerala) Apollo (Hyderabad) Fortis (Gurgaon) Medanta Medicity (Gurgaon) Narayana Hrudayalaya (Bangalore, Jaipur, Kolkata)

Hub and Spoke / Multi chain

Tertiary care hospital functions as hub and secondarycare hospitals and clinics function as spoke. A hub is ahigh-end facility located in a metro/ tier-1 city,consisting of all the state-of-the-art equipment requiredto perform complex surgeries. A spoke is traditionallylocated in a tier-2/ tier-3 city, which have lowaffordability among patients

Apollo Hospitals Care Hospitals Columbia Asia Fortis Healthcare Manipal Hospitals Max Healthcare

Single Specialty Hospital

Hospitals focusing on single specialty care servicesare upcoming healthcare facility models.

Eye and Dental: Vasan Healthcare, Dr.Agarwal's EyeHospital, Centre for Sight, Axiss Dental, EyeQ

Fertility: Cocoon, Bourne hall, Nova IVI, Motherhood,Cloudnine, Fortis La Femme, Cradle, Adiva

Oncology: HCG, International Oncology

Orthopaedics: Mewar Ortho, Hosmat, Primus

Urology / Nephrology: RG Stone, Sparsh, NephroPlus, Nephro Life

Primary Healthcare

Closest to the concept of a neighborhood clinic, itforms the first point of contact for routine examination.

Express Clinics

Nationwide

Vital Healthcare

Emerging Delivery Models

New service providers are experimenting with differentdelivery models focusing on low cost, day care andother allied healthcare models

Day Surgery centres (Nova Medical Centres)

Home Health providers (IHH in Chennai)

Urgent Care

34%

19%

26%

40%

14%

11%

26%

30%

2005

2015 Government Hosp

Top Tier

Mid Tier

Nursing Home

Top Tier >100 beds Mid Tiers 30-100

beds Nursing Homes



Franchisee Model

Brief description Examples

Hospital group lends its brand, expertise, technologyto franchisee hospital or clinic.

Apollo Hospitals Max Healthcare

Public Private Partnership

Collaborative model, with funding often from the State/Centre and affordable/ accessible healthcare meantfor the masses

Apollo (tied up with public sector coal companies and in

negotiations with Indian Railways) Fortis (Rajiv Gandhi Hospital, Amethi) Seven Hills (partnered with Mumbai Municipal

Corporation)

Healthcare REIT

Global REITs such as Alexandria and Religare HealthTrust have entered in India. They are starting topromote asset-backed financing with an aim toaddress the infrastructure needs of hospitals

Germany: Vital Healthcare Property Trust, Ventas Inc,Universal Health Realty Income Trust

Singapore: Parkway UK: Primary Health Properties PLC, Target Healthcare

REIT Limited USA: LTC Properties Inc, NorthWest Healthcare

Properties Real Estate Investment Trust

Healthcare service delivery models

Top Tier >100 bedsMid Tiers 30-100beds

Nursing Homes 100 bedsMid Tiers 30-100

beds

Nursing Homes



Competition Dynamics sub 500 lead the pack!

1000 beds

Delhi

Kalawati Saran Children'sHospital (84)

Pushpawati SinghaniaResearch Institute (75)

R.G.Stone UrologicalResearch Centre (39)

Sanjeevani Medical

Research Centre (50) Shree Jeewan Hospital (40) Vinayak Hospital (39) VIMHANS (87) Sonia Hospital (65) Kukreja Hospital & Heart

Centre (70)

Holy Family Hospital(232)

Institute of Liver & BiliaryScience (180)

Jaipur Golden Hospital(256)

Kalawati Kasturba

Hospital (350) Maharaja AgrasenHospital (380)

Metro Hospital & HeartInstitute, Naraina (150)

National Heart Institute(104)

Primus Super SpecialityHospital (120)

Pushpanjali MedicalCentre (151)

Rajiv Gandhi CancerInstitute (241)

Park Hospital (170) Mata Chanan Devi

Hospital (207) Maharaja Aggarsain

Hospital (380) Kalra Hospital (P) Limited

(120) City Hospital (120) Delhi Heart & Lung

Institute (101) Dr.B.L.Kapur Memo

Hospital (300 Deepak Memorial

Hospital ( MedicalResearch Centre (100)

Max Balaji Hospital (134) Max Super Specialty,

Saket (490)

Guru Teg BahadurHospital (1000)

Paras Spring MeadowsHospital (806)

Ram Manohar LohiaHospital (984)

Rockland Hospital (664)

St. Stephens Hospital(595) Sucheta Kriplani

Hospital (877)

Lok Nayak JaiPrakash (LNJP)Hospital (1597)

Maulana AzadMedical College(2400)

Safdarjang Hospital

(1600)

Haryana

Artemis Hospital (300) Metro Hospital & Heart

Institute, Gurgaon (150) Paras Hospitals (250) Alchemist Hospital (120) Metro Hospital & Heart

Institute, Faridabad (250)

Fortis MemorialResearch Institute,Gurgaon (500-1000)

Medanta Medicity(1250)

J&K

Bone & Joint Hospital(244)

Shri Maharaja Hari SinghHospital (250)

GovernmentMedical College

Hospital (1700)

Please note that the above list of hospitals is not a comprehensive list of all hospitals in the respective regions and has been selectedbased on internet search and featured hospitals in reports and medical websites.



1000 beds

Chandigarh Government Medical

Hospital and College(60)

Mukat Hospital & HeartInstitute (100)

Ivy Hospital (180)

Government SpecialtyHospital (500)

Post GraduateInstitute of MedicalEducation andResearch (1402)

Punjab

Cosmos (60) Bahri Hospital,

Gurdaspur (20) Garg Mission Hospital

(30) Jattinder GH Hospital

(50) Modern Hospital (32) Seth Hospital (30) Sibia Healthcare

Private Limited (26) Tagore Hospital &

Heart Care Centre(24)

Vidya MemorialKanwal Hospital (35)

Silver Oaks Hospital (149) Fortis Hospital (279) Ivy Hospitals (180) Apollo Hospital (350) BBC Heart Care Pruthi

Hospital (300) Fortis Escort Hospital (133) Indus Super Specialty

Hospital (115) Ivy Hospital-Multi Specialty &

Cancer Research Institute(180)

Kidney Hospital (125) Nagpal Super Speciality

Hospital (100) Nova Heart Institute and

Research Centre (200) Max Super Speciality

Hospital, Mohali (200)

Christian Medical College& Hospital (850)

Shri Guru RamdasHospital (992)

DMC Ludhiana (1326) Guru Nanak Dev

Hospital (1158)

Rajastha

n

Dr. Virendra Laser,Phaco Surgery Centre(30)

Dwarka OrthopaedicHospital (30)

Jaipur Hospital (93) Khandaka Hospital

(30) Shubh Hospital,

Vidhyut Nagar (40)

Maitri Hospital,Talwandi (50)

Fortis Escorts (210) Soni Medicare (225) Sahai Hospital (100) Fortis Life Line Hospital

(100) Fortis Escorts Hospital,

Malviya Nagar (350) Mahaveer Cancer Hospital

(250) Rukmini Devi Jaipuriya

Government Hospital (100) Rungta Hospital, Malviya

Nagar (100) Saket Hospital, Mansarovar,

Jaipur (110) Santokba Durlabhji Memorial

Hospital (375) Soni Hospital (225) Mathura Das Mathur Hospital

(493) Sudha Hospital, Talwandi

(350) Ramsnehi Chikitsalaya AvmAnusandhan Kendra (300)

Mahatma GandhiMedical Hospitals (750)

Mahatma GandhiHospital (820),Jaipur

Mahatma GandhiHospital (624),Jhodpur

Umaid Hospital (700)

NarayanaHrudayalaya Hospital(1000)

Sawai MansinghGovernment Hospital(1563)

HP

Indus Hospital (90) Delek Hospital (45)

Mahatma Gandhi MedicalServices Complex Khaneri(360)





1000 beds

UttarPradesh

Sri Ram Hospital (50) Bhola Hospital (40) Heartline Cardiac Care

Hospital (50) Happy Family Hospital

(62) Jain Hospital (30) R K Devi Memorial

Hospital (45) Fortis Hospital (75)

Asopa Hospital, Sikandra(100)

District Hospital (118) Lady Lyall Hospital, Noorie

Gate (331) Pushpanjali Hospital and

Research Center, DelhiGate (350)

Jeevan Jyothi MultiSpeciality Hospital (400)

Kamla Nehru MemorialHospital (306)

Nazreth Hospital (300) Priti Hospital (108) Pushpanjali Crosslay

Hospital, Vaishali (400) Gangasheel Hospital (100) Shanti Gopal Hospital

(102) Yashoda Super Speciality

Hospital (106) District Hospital (172)

Divisional Railway Hospital(185)

Kulwanti Hospital andResearch Center (100)

Nirmal Hospital (150) Chandani Hospital (152) Mariampur Hospital (194) Regency Hospital Limited

(225) Ajanta Hospital (100) Awadh Hospital (102) Chhatrapati Shahuji

Maharaj Medical University(226)

Mayo Hospital (300) Neera Hospital (160) Kailash Hospital & Heart

Institute (325) Vinayak Hospital (150) Kailash Hospital & Heart

Institute (325) Vinayak Hospital (150)

Institute of Mental Healthand Hospital, Billochpura(838)

Sarojini Naidu MedicalCollege (976)

Moti Lal Nehru Hospital(1000)

District Deen Dayal

Upadhayay Hospital(500)

Jawaharlal NehruMedical College, A.M.U(1000)

Jeevan Jyoti Hospital(500)

MLB Medical Collegeand Hospital (700)

Command Hospital (544)

Ram Raghu Hospital(1047)

LLR Hospital (1615)





Industry speak

We need to re-write the blueprint forHealth India

All three segments (public healthsystems, NGOs and private sector)should be aligned to make a full chainfrom ground up

We have a mass enabler already inthe form of ASHA - upgrade theirskills, provide access to technology,clearly define the functionalities, usemobile units for connectivity to B&Ccities and a national network will bein place

Dr Naresh TrehanMedanta Medicity, envisioned as ahealth city, has changed the face ofsurgery in India across multiple

specialties.

Dr Amit SachdevaAxiss Dental is currently a NorthIndia focused chain of dentalcentres providing orthodontic andimplantology solutions. Thechain has recently securedprivate equity funding from IndiaEquity Partners.

Dr Manish ChhaparwalMewar Ortho provides high quality,fast turnaround care for patients in TierII cities, where there is a dearth oforthopaedic and allied care facilities.Mewar has recently completed its firstinstitutional round of equity fundingfrom Matrix Partners.

We aim to keep our capital andoperating costs low and operate ourcentres in an environment of patientcentricityquality surgeries, quickdischarge, technology advancementand safe infrastructure



Healthcare infrastructurePublic health, disease profiles, mortality

rates



North

inadequate infrastructure and facilities as compared to South metro cities still preferred as medical tourism destination more hospitals opening up. At least 80 hospitals in Uttar Pradesh have recently applied for

NABH accreditation

East

least developed among all zones inadequate and low-end infrastructure and facilities hospital projects in Tier II towns getting funded by borrowings from banks which carry

significant amount of interest. This makes projects unviable and attracts less investments resistance from skilled staff to settle in this region high number of private nursing homes but very few multi-specialty hospitals

South

Chennai is also known as the Mecca of healthcare delivery top seven out of the ten PE healthcare deals were in South India in 2012 higher concentration of super specialties and average bed size greater than other zones better infrastructure hospitals such as Vaatsalya Healthcare, Apollo and Global are entering rural markets and

establishing secondary care hospitals in view of lower investments and higher profitability

West

good multispecialty hospitals are concentrated in Maharashtra and Gujarat wide rural-urban gap in health infrastructure facilities both in terms of quality and quantity district-wise variances (Mumbai and Pune have better population to facility ratios)

Zonal characteristics of Healthcare in India



Population: 12,548,926

Doctors: 11,200

Population served per doctor:

1120

IMR: Rural43 (M), 47 (F);

Urban28 (M), 37 (F)

MMR (2007-09): N/A


Doctors: 800

Population served per

doctor: 8571

IMR: N/A

MMR (2007-09): N/A


Doctors: 38,400


doctor: 721

IMR: Rural36 (M), 39

(F); Urban27 (M), 29 (F)

MMR (2007-09): 172


Doctors: 4100Population served per doctor

6184

IMR: Rural51 (M), 52 (F);

Urban35 (M), 42 (F)

MMR (2007-09): 153


Doctors: 28500Population served per

doctor 2408


(F); Urban29 (M), 34 (F)

MMR (2007-09): 318


Doctors: 46800Population served per

doctor: 358


(F); Urban29 (M), 29 (F)

MMR (2007-09): N/A


Doctors: 3300

Population served per doctor

3066IMR: N/A

MMR (2007-09): N/A


Doctors: 57900


doctor 3477IMR: Rural61 (M), 67 (F);

Urban44 (M), 45 (F)

MMR (2007-09): 359

1 2 3

4 5 6

7 8

Source: Ministry of Health & Family Welfare and National Health Profile, 2011, Medical Council of India (MCI), Press InformationBureau, Figures of Medical Practioners are related to doctors registered with State Medical Councils.

J&K

Rajasthan UP

HimachalPradesh

Punjab

Haryana

Uttarakhand

Delhi

1

23

4

5

6

7

8

The total number of doctorsregistered (allopathic) in thecountry till 31st July, 2011 is8,56,065. The currentdoctor-population ratio inIndia has been worked out to

be approximately 1:2000.Within the northern region,states such as UP,Uttarakhand, Haryana arealso lagging behind the WHOrecommended norm of onedoctor per 1000 people

A Northern Tale - Healthcare Indicators



Table 1: Number of Government hospitals and beds in rural and urban areas - North India

North Indianstates

Rural Hospitals(Government)

Urban Hospitals(Government)

Provisional/Projected

Population ason reference

period in(000)

AveragePopulationServed Per

Govt.Hospital

AveragePopulationServed Per

Govt.Hospital Bed

Number Beds Number Beds

Haryana 61 1212 93 6667 24597 159721 3122

HimachalPradesh

97 2905 53 5574 6856 45707 809

Jammu &Kashmir

61 1820 31 2125 11099 120641 2813

Punjab 78 2360 135 8063 27704 130066 2658

Rajasthan 380 13754 446 12236 68621 83076 2640

Uttar Pradesh 515 15450 346 40934 197271 229118 3499

Uttarakhand 666 3746 29 4219 9511 13685 1194

Chandigarh 1 50 3 570 1328 342000 2206

Delhi - - 126 43109 16955 134563 393

Source: National Health Profile, 2011

Although healthcare choices, healthcare spend, patient profile, disease prevalence varyacross states, it is evident that there exist significant inequities in healthcare access withinthe states of the northern region.

Densely populated areas such as Uttar Pradesh and Rajasthan are ranked poorly as theaverage population served per government hospital bed is significantly higher as

compared to other northern cities such as Delhi and Punjab which have better accesshealthcare quality and infrastructure.

States such as Karnataka, Kerala and West Bengal perform far better in publicinfrastructure as compared to their Northern counterparts such as Uttar Pradesh andBihar.

The Jammu and Kashmir Government is planning an investment outlay to the tune ofRs 140 million to establish two hospitals in Kulgam and Anantnag districts.

UP Health Systems Strengthening Project has been launched by the State Governmentwith World Bank funding worth Rs 800 crore.

Public Healthcare Infrastructure



Some recent activities in the healthcare

sector in the northern region

News bytes



Fortis Healthcare (India)plans to launch four

hospitals including one inHimachal Pradesh to beoperational by 2013, as

part of its plans tostrengthen its nationwide

presence.

Immediate expansion plansfor Mewar Ortho include

setting up a 100bedcentre of excellence in

Udaipur while alsoincreasing its footprint inCentral India with centres

in Sirohi, Mandsaur,Chittorgarh and several

more.

ASG Eye Hospitals, aRajasthan based group of

super specialty eyehospitals has recently

raised Rs 50 crore fromSequoia Capital. The fund

will support the expansionplan of the hospital

Metropolis Healthcare hasmade investments of Rsone crore each in Tier II

and Tier III cities such asLucknow, Bareilly, and

Jalandhar and has recentlyacquired two brownfieldventures in Chandigarh

and Jodhpur.

Apollo Hospitals Grouplaunched its first ApolloCosmetic Clinic in North

India.

As a part of its expansionplans over the next coupleof years, Rockland Group

will open a multi-specialty505 beds hospital in

Manesar, Haryana as wellas a 500 beds hospital in

Greater Noida (UttarPradesh)

Rajasthan based group ofsuper specialty eyehospitals, ASG Eye

Hospitals has raised Rs 50crore from Sequoia Capitalto support expansion incentral and north Indianstates including MadhyaPradesh, Uttar Pradesh,

Jharkhand, Chhattisgarhand Bihar

Besides undertaking theconstruction of a new 300-bed hospital at its Medcity

campus, MoolchandHealthcare has also

earmarked Rs 100 crorefor acquisitions in the

pathology and diagnostic

segment

News bytes

Some recent activities in the healthcare sector in the northern region



Investment HorizonDeal trends, optionspublic and private route



Private Funding Options

Establishing and growing a hospital business requires intensive planning and large capital outlay,which makes it imperative for players to pursue new avenues to meet their capital needs.

2CapitalMarkets

Dependsentirely onmarketconditions,not easy formid-capcompanies

Mezz/ Debt

High fixedcost,restrictionson dealstructuresdue to FDIregulations,limitednumber ofproviders

PrivateEquity

GrowthCapitalMost activein today'smarket

OverseasListing

Depends onmarketconditions

REIT

Limitednumber ofoperators,restrictionson dealstructuresdue to FDIregulations

1 3 4 5Angel

Investors

For veryearly stagedeals, thereis usually noother option

6



Deal Street

The healthcare delivery market is very interesting and active from a transaction point of view. Inmulti-specialty hospitals, we are seeing consolidation, which is driving increasing corporatisation ofthat market. This is enabled by a few players with access to significant amounts of capital and withambitions/ plans to expand rapidly without going through the typical 3 year + maturity period forgreenfield projects.Fortis has been an active player, having made several acquisitions in India and Overseas (andinterestingly, some divestments as well already).

Chains of single specialty hospitals and diagnostics businesses are to continue attracting significantinterest from PE funds as well as strategic players, given their attractive unit economics and capitalefficiency metrics. Eye care, dental care, maternity, paediatrics, orthopaedic surgery, pathology,low-end imaging, etc. are areas we expect to see significant transaction activity in 2013, andbeyond.

Investor InvesteeAmount

(US$ million)

SONG InvestmentAdvisors

Eye Q -

Temasek Holdings Max India ~ 26.3

Helion VenturePartners, NexusVenture Partners

Eye Q -

Sequoia CapitalMoolchandHealthcare

20

India EquityPartners

Axiss Dental -

Matrix PartnersIndia

MewarOrthopedic

5.4

Source: Grant Thornton Deal TrackerThe data includes deals till March 2013

Table 4: PE deals in the hospitalssector in north India (2010-2013)

SectorAmount

(US$ million)

Hospital and diagnosticcentres

1,542.35

Drugs and Pharmaceuticals 9,783Medical and surgicalappliances

584.14

Table 3: FDI inflows in healthcaresector (April 2000 to December 2012)

Source: Department Of Industrial Policy & Promotion(DIPP), Government of India



Policy Initiatives

National Health Mission (NHM)

Creation of a new integrated NHMwith an allocation of Rs 21,239crores National Program for Healthcare of Elderly

Allocation of Rs 150 Crores to NationalProgramme for the Health Care of Elderly(implemented in 100 selected districts of 21States)

Rashtriya Swasthiya Bima Yojana

Health insurance covers under extendedto include rickshaw pullers, taxi drivers,sanitation workers, rag pickers and mineworkers

Infrastructure Development

Intends to enhance its investment

outlay in the infrastructure developmentto over Rs 46.74 trillion during the nextfive years

Medical Education

To improve medical education, training andresearch Rs 4,727 Crores has beenallocated. Additional funding of Rs 1,650

Crores provided to AIIMS-like institutionscommissioned in September 2012 fordevelopmental activities

Tax Initiatives

Subsection (11C) in Section 80-IB, theGovernment is granting Tax Holiday tohospitals starting their operations in ruralbelts between 01 April 2008 to 31 March

2013

Union Budget 2013-2014



Fostering Partnerships

As per estimates, debt financing/bank loans from nationalised bankscontribute over 50% of long-termfinancing for hospitals

With the Planning Commission intending toaugment the public health spending up tothree times during the 12th Five Year Plan,there exists huge opportunities for fosteringpartnerships between the public and privatesectors as well as the various private sector

players in the healthcare space to deliverquality healthcare to the Indian population

During 2012, healthcare and lifesciences sector became the secondmost preferred investment destinationamong the venture capital investors

The healthcare and life sciences sectorattracted 18 investments worth US$98million during the year

The development of industrialcorridors across Delhi, UP, Haryana

and Rajasthan is expected to boostinvestment to the pharmaceuticalsand healthcare sector of the region

A large number of biotech andpharmaceutical players are partneringwith domestic players in Haryana,

Delhi, Rajasthan, Uttarakhand tostrengthen their market standing

Demand-supply mismatch is likely tocreate enormous investment potentialacross specialities such as cardiology,neurology and joint replacements,

especially in tier I and tier II cities in theNorth

Public/ Private Boost



Changing trendsImproving healthcare delivery



The technology impediment

Lack of data of outcome is key cons Technology progression is set to change the face ofhealthcare delivery in the country, by controlling costs, standardising quality of service delivery,and improving the experience of care for patients and families. IT enables the development ofnew models of care delivery and payment reform by bringing in better billing transparency andbuilding capacity in line with the demand. Spending on Information Technology (IT) products andservices by the healthcare providers in India will increase by 7% between 2012 and 2013, from

US$53 billion to US$57 billion. (Source: Gartner).

Technology inhealthcare

Brief description Advantages/ Uses

Digital HealthKnowledgeResources

Archived medical and scientific information, these aremainly set up in hospitals, healthcare centres,medical colleges, healthcare sector firms, researchinstitutes, etc.

relatively lower storage space requirement low cost of maintenance over the traditional medical

libraries

E-learning platforms This non-traditional collection of tutorials andinformation in the form of text, images, audio or video

is currently being deployed to provide frequenttraining programmes to doctors, basic training andvarious intricacies of in-patient care to nurses,training to medical personnel in the use of newdiagnostic and surgical equipment, etc.

training patients who use self-diagnostic kits training the users of device implants

training the various stakeholders in the use of new ITapplications in healthcare such as EMR, HER, etc. educating the general public about the various

essentials of healthcare advocating a shift from curative to preventive

healthcare

The ElectronicMedical Record(EMR)

Signifying the digital format of a patient medicalrecord, the EMR is, essentially, a tool to capturebasic patient data such as patient medical history,history of various drug allergies, prescriptions,previous consultation records, etc.

enables hospitals to ameliorate the inconveniencies ofusing existing paper records

ensures efficient data storage, data backup, datarecovery, data portability and data maintenance, atcompetitive costs

aids in better retrieval of information by doctorsresulting in informed and swift decision making

Mobile healthcare(m-health)

Use of mobile phones to improve the real-timecollaboration between healthcare service providersand patients

relatively lower storage space requirement low cost of maintenance over the traditional medical

libraries

The ElectronicHealth Record(EHR)

EHR serves to overcome the limitation of EMR; thatpatient medical records cannot be sent electronicallyto any other sources such as laboratories, practicesor specialists outside the home provider practice.

facilitates bidirectional electronic sharing of patientdata between external laboratories, external providerand the home provider practice

Hospital InformationSystem (HIS)

HIS is an electronic platform, encompassing variousmodules associated with the innumerabledepartments and functions in a hospital, which isused to seamlessly manage the whole process ofhealthcare delivery right from the entry of the patientto his discharge.

rooting out inefficacies in the system reducing costs offering a higher quality of patient care improving patient medical data integrity avoiding duplication of data minimising transcription errors ensuring real time data access for doctors and other

healthcare service providers

PRACTO An online practice management software thatfacilitates storage of healthcare records such aspatient demographics, billing data, insurance detailsetc.

used to capture billing data including patientdemographics, information of insurance payers, etc.

help in scheduling of appointment and reportgeneration

Table 5: Technology in healthcare



Tele-docs and Tele-medicine

A novel idea implemented byHaryana Jiva International, ahealthcare venture on the outskirtsof Delhi. It deploys a GPRS enabledJava application to enhance thereach of medical care to rural partsof the region. The project, known asthe Teledoc project, has won

widespread acclaim globally,including the World Summit Awardfor eHealth.

Grameen Foundation has rolledout an m-health service for AIDSpatients in India. The applicationis used to send healthy livingtips, messages and remindersregarding consultations andmedications to AIDS patients.

In a recent report for the 12th Five Year Plan, the steering committee on health hasrecommended connecting all the district hospitals to tertiary care centres by telemedicineusing applications such as Skype which facilitate audio-visual interactions. The committeealso advocates adoption of mobile health solutions to enhance real-time collaborationbetween patients and providers and between providers, improvement in the rate oftransmission of data and information between the various stakeholders and promotion forthe adoption of preventive healthcare across the various Indian states.



Non Conventional Delivery Models

In addition to Narayana Hrudayalaya, which plans to establish low cost hospitals in Mysore,Siliguri and Bhubaneshwar in the near future, the Apollo Hospitals group has also adopted thismodel to set up 250 low cost Apollo Reach Hospitals hospitals in Tier II and III cities.

Model Brief description

Low cost, no-frillshospitals

Enable cutting back the extraneous costs associated with healthcare and diagnostics for the middle andlower-middle classes

Specialist hospitalsfocus on a single target patient group or disciplinecomparatively lesser capital expenditure and operating costs than multi-specialty hospitalsspecialised training ensures higher success rates and efficiency

Day care surgery

these centres focus mainly on minimally invasive surgical proceduresafter recovering from a surgery, a patient is fit to be discharged within 24 hourslow cost of surgery owing to lower capital cost and reduced time required to break-evenhigher incentives for doctors and healthcare professionalsuse of modern anaesthesia and painkillers enables the patient to recover consciousness quickly aftersurgery and recuperate at home

Ambulatory Surgeryovernight stay in the hospital is not required by the patienta patient recovers from surgery and is deemed fit to be discharged within a couple of hours of surgery

Primary care networksintegrates primary care, diagnostic, pharmacy and wellness services to coordinate management of accessto appropriate primary healthcareassists in broadening the market reach

Senior Living Centres/

Hospitals

given that the senior living sector in the country comprises of nearly 100 million people, most of whom areindependent and financially stable, it is a largely untapped sectoras per Association Senior Living India (ASLI), by 2025, the senior living sector will grow to nearly 173millionin such centres, elderly people are offered various facilities including full time/ visiting professionalpersonnel, as well as medical and entertainment facilities

Wellness Centres

increased discretionary spending, rising income levels and changing lifestyles are driving the focus towards

wellness and preventive healthcarethese centres encompass Ayurveda treatment centres, dietary counselling facilities, medi-spas, alternativemedicine centres, etc.

Health cities

refers to a single campus having wellness centres, multiple single speciality hospitals, educational andtraining institutes, centres of excellence (COEs), etc.facilities such as blood banks, imaging centres, clinical laboratories, as well as functions such as financeand management are often shared between the different speciality hospitalsmostly, health cities are located on the outskirts of cities

Table 6: Non-conventional healthcare delivery models



OutlookStrategic recommendations



Transforming Healthcare - Agenda

for action

Challenges (s) Recommendations Success stories

lack of requisiteinfrastructure

Adopt PPP model to permitprivate sector to expand thecoverage of healthcaredelivery and provide diversityof services, and the publicsector to ensure equitableaccess to quality healthcare

Undertake pilot programs firstto assess effectiveness andacceptance of this model.

Do not build additionalcapacity until the existing bedcapacity is not efficientlyutilised.

GVK Emergency Management and Research Institute (EMRI) a not-for-profit professional healthcare services organisation

B. Braun has signed a MoU with the Government of Andhra Pradesh to buildand operate 11 dialysis centres in the state

Government of Karnataka partnered with the Indian Space ResearchOrganisation (ISRO) and Narayana Hrudayalaya to launch the KarnatakaTelemedicine Programme in the states underserved areas

A three-way partnership among the Government of Uttarakhand,

Technology Information, Forecasting and Assessment Council (TIFAC) andBirla Institute of Scientific Research (BISR), the Uttarakhand Mobile Hospitaland Research Center (UMHRC) to offer healthcare services diagnosticfacilities to poor and rural people residing in the hilly terrains of the state

UP State Government considering adoption of PPP to launch districthospitals, CHCs and super specialty clinics/hospitals

Ayush Graham Bhawali Project, operating on Build -Operate-Transfer (BOT)mode, established in Nainitial

A joint venture of the Apollo Hospitals group and the Government ofKarnataka, the Rajiv Gandhi Super-Specialty Hospital in Raichur, Karnataka

Gujarat Government has signed a MoU with GE Healthcare for upgradingthe existing medical technology in the state and for setting up diagnosticimaging centres in five medical colleges and hospitals in the regions ofRajkot, Ahmedabad, Baroda, Bhavnagar and Jamangar

skill gap,especially inrural areas

improve the outlay forestablishing Governmentmedical institutes

improve the training methods train the district head in ASHA

Tamil Nadu State Government has undertaken a pilot project to train andcertify the practitioners of indigenous medicines such as Ayurveda, Unaniand Siddha medicine to serve as independent care providers in a rural

setting

inefficiencies inpublic healthcaresystem in semi-urban and ruralareas

launching secondary carehospitals in less developed TierII tier III belts of the country

link the deeper regions throughmobile vans.

Fortis healthcare, which already has presence in Tier II cities, is coming upwith 5 hospitals in Tier III cities. The chain also plans to open 25 morehospitals in Tier II and Tier III cities within the next 2-3 years

besides 10 centres in Delhi/ NCR, Eye Q also operates a customised modelin rural areas

Apollo Hospitals group has set up 250 low cost Apollo Reach Hospitals

hospitals in Tier II and III cities

the UP State Government has sectioned 150 medical mobile units underNRHM to improve the accessibility to medical services in the remote places

Narayana Hrudayalaya plans to establish low cost hospitals in Mysore,Siliguri and Bhubaneshwar

It is imperative for the sector to not only raise the quality of service delivery, but also ensure equitableaccess of basic healthcare to the dramatically increasing population and gear up its capabilities to tacklethe changing disease incidence profiles. Inspiration and learning from southern states such as Keralaand Tamil Nadu which have successfully brought about effective changes to their healthcare regime, byundertaking strong action on social determinants and making comprehensive efforts to enhance theefficiency of public health system respectively, can go a long way in assisting the northern regions of thecountry in devising a robust healthcare structure. Going forward, the ability of the healthcare sector to

institute an effective healthcare policy will be critical to define the manner in which the nationshealthcare resources, funds and services are equitably allocated, utilised, developed, distributed andaccessed.



Challenges (s) Recommendations Success stories

lack ofinfrastructure,technology andpractical toolsfor effectivemonitoring ofpatient outcomes

oiutcomes could be clinical(assessing therapeutic resultssuch as blood pressure andinvolving extensive use oftechnology), human (effect ofmedication on human life) oreconomic (in terms of the costof care). Increasing quality of

healthcare delivery in the longterm can be achieved onlythrough a robust mechanism totrack outcomes and takecorrective actions whereveroutcomes are not in line withdesired levels

International Players

Novartis is investing innovative technologies which involve the use ofsensor-based and digital packaging technologies which serve as tele-monitoring applications

GE patient monitors help manage Clinical Information Logistics by capturingand presenting accurate information to help improve decision-making,patient outcomes and provider performance

Domestic India has put in place 22 monitoring centres to combat adverse drug

reactions (ADR) -- unintended side effects, some of which could prove fatal.These centers have been put under the country's new pharmaco vigilanceprogramme.

Mobiles for Disease Surveillance

standard Mobile enterprise services used by healthcare workers, suchas remote access to e-mail and health information systems;

Mobile Applications to meet a specific need of medical workers, such asmobile prescriptions and remote diagnoses;

applications that play a direct role in the provision of care, such asmobile data collection and wireless transmission of health data; and

consumer-targeted applications to encourage health and help preventillness

poor reach ofhealthcareservices tounderserved/unservedareas

inadequateaccessibilityto specialtycare for ruraland semi-urban patients

scope fortimelydiagnosis and

treatment

set up a national task force topromote the adoption ofTelemedicine, as well as todefine the standards ofimplementing telemedicinesolutions to healthcaredelivery

Sir Ganga Ram Hospital operates a telemedicine unit across threecentres in the underserved areas of North India - Gohana in Haryana,Dasmal in Himachal Pradesh and Kaithun in Rajasthan

Online Telemedicine Research Institute (OTRI) tapped this technology forproviding telemedicine links for tele-consultation in Bhuj, Gujarat after theearthquake in January 2001

OTRI also transferred cardiology and radiology-related data of over 200ailing pilgrims during the Kumbh Mela festival in Uttar Pradesh. As a partof this initiative, OTRI also transferred microscopic images for monitoringthe levels of cholera-causing bacteria in the river

Government of Karnataka partnered with the Indian Space ResearchOrganisation (ISRO) and Narayana Hrudayalaya to launch the KarnatakaTelemedicine Programme in the states underserved areas such as

Chamrajanagar

availability ofoverallhealthcarefacilities at asingle location

strategies toboost medicaltourism

set up health cities which canact as the hub for smallerspokes/ nursing homes/clinics.

Apollo Health City, established in Hyderabad, offers varied medicalservices and facilities including preventive care, wellness services,integrated multi specialiy healthcare service, education and research andlife sciences under a single roof

Chettinad Health City in Chennai, spread over an area of 100 acres,provides comprehensive healthcare services to patients

Narayana Health City, estimated to be operational by 2013, will beestablished as 5,000-bed health cities across the North Indian cities suchas Delhi, Jaipur, etc

affordability ofhealthcareservices inrural areas

set up health insuranceprograms in rural areas

with a coverage value of Rs 30,000 to each below poverty line categoryhousehold in the country, Rashtriya Swasthya Bima Yojana (RSBY) hastoday become one of the worlds largest medical insurance programmes.

The scheme has also been chosen by the United Nations DevelopmentProgramme (UNDP) and International Labour Organisation (ILO) as oneof the top 18 social security schemes in the world

Community Health Insurance Scheme, launched in Karnataka, inpartnership between Karuna Trust with the National Health InsuranceCompany and Government of Karnataka


for action




for action

Role theGovernment

can play

PrivateSectorFocus

Strengthening the PPP model

Establish StructuredFramework

Ensure multi stakeholderparticipation

Run a pilot to testefficacy

Financially viableproposition for all

stakeholders

Improving paymentmechanism and cycles

Priority redressal ofmedico legal issues

Viable exit options forstakeholders

Continued financial andoperating support

work towards creating a regional focus rather than focusing only on toptier cities.

link existing infrastructure through technology and mobile units to Tier IIand Tier III regions

integrate healthcare delivery with technology that will redefine healthcareand reduce costs

refrain from mere additions in bed capacity and focus on efficientutilization of current infrastructure

focus on emerging healthcare delivery models that provide affordableand quality healthcare in Tier II and Tier III Cities.

build more health cities that provide ease of access, promote medicaltourism with real estate support from the government.

encourage usage of re-furbished equipment in district and tier II hospitalswhich significantly reduce the cost burden of the private sector withoutcompromising on quality.

granting Healthcare an Industry Status expand the scale and scope of Rashtriya Swasthya Bima Yojana encourage health programs that focus on preventive health care ease visa norms to boost medical tourism empower the ASHA representative and grant resources, technology and

establish linkages to hospital infrastructure in larger cities/ towns

pilot programs to test the PPP model to establish effectiveness before aroll out preferential allotment of land to private sector players to overcome the

rising real estate costs preferential allotment of land to private sector players to overcome the

rising real estate costs ease of norms for setting up medical and institutional infrastructure by

relaxing minimum requirements, mandatory affiliations with existinggovernment district hospitals and other private players.



A regional health strategy

A regional approach for developing sustainable health systems is the only means to address theballooning healthcare need of the Northern Region. Combined with innovative delivery modelsand technological interface to bring regions together, Healthcare continues to remain one of themost promising sectors for the Indian Economy for the coming decade and thereafter.

A regional focus can be maintained either through the current state wise institutionalframework or by channelizing the existing ecosystem of district/ civil hospitals, smallerhospitals/ nursing care to larger hospitals in Tier I and Tier II cities. Spreading outdelivery models on the basis of the population profile of regions and doctor availabilitywill ensure equitable allocation of healthcare resources across all regions

Reach

Integration

Keeping the drivers in mind

Developing a clinical pathway

Skill enhancement

Integration of primary care and hospital based infrastructure to provide seamless,uniform and pro-active care, keeping in mind the level of clinician support (doctoravailability and referral channels) that are available in and around such regions.

Ageing population profile, disease prevalence and general medical technology are keydrivers fueling the demand for healthcare in the Northern Region.

Depending on the need and complexity of surgical intervention, every doctor/representative at the bottom of the clinical ecocystem shall decide on what activities canbe done at the primary centre level, what needs to be referred to relatively largerhospitals/ nursing homes and finally acute needs which may need to be referred to

specialty hospitals with skilled professionals. A clear, well defined policy framework ofthis clinical pathway is critical for the creation of a holistic and interlinked regionalhealthcare system.

Overcome resistance of skilled medical professionals in moving to Tier II, Tier III citiesby creating a timetable of periodic mobility of professionals across deeper regions.Develop adequate infrastructure and provide institutional support by regular andcontinuous training of medical doctors and other skilled manpower to service the sector

Infrastructure support

Reducing the real estate burden and providing support for setting up infrastructureacross the entire spectrum of this regional ecosystem.



AppendicesHealthcare Indicators, Deal summary



Maternal Mortality Rate

North Indian states 2004-06 2007-09

Haryana 186 153

Punjab 192 172

Rajasthan 388 318

Uttar Pradesh 440 359

Note: Per1,00,000 Live BirthsSource: National Health Profile, 2011

Projected Levels of Expectation of Life at Birth

North Indian states 2011-15 2016-20

Male Female Male Female

Haryana 68.9 71.3 69.9 72.5

Punjab 69.7 72.8 70.7 73.8

Rajasthan 67.6 70.7 68.6 71.9

Uttar Pradesh 66 66.9 67.5 69.2


Infant Mortality Rates

North Indian states Rural Urban

Male Female Male Female

Haryana 51 52 35 42

Himachal Pradesh - - - -

Jammu & Kashmir 43 47 28 37

Punjab 36 39 27 29

Rajasthan 58 64 29 34

Uttar Pradesh 61 67 44 45

Uttarakhand - - - -

Chandigarh - - - -

Delhi 32 42 29 29

Note: Per 1000 live birthsSource: National Health Profile, 2011

Appendix 1: Health IndicatorsNorth India



Number of registered allopathic doctors and dental surgeons in North India

Source: Ministry of Health & Family WelfareFigures of Medical Practioners are related to doctors registered with State Medical Councils.Figures of Dental Surgeons are related to doctors registered with Central/State Councils.

North Indian statesAllopathic doctors Dental surgeons

2010 2011 2010 2011

Haryana 4100 - 1740 1740

Himachal Pradesh 800 - 772 772

Jammu & Kashmir 11200 - 1090 1090

Punjab 38400 - 6996 6996

Rajasthan 28500 - 364 364

Uttar Pradesh 57900 - 8152 9441

Uttarakhand 3300 - 451 451

Chandigarh - - 675 675

MCI Delhi 37000 - - -

Appendix 2: Healthcare Indicators



Malaria cases during 2011 NorthIndia


Appendix 3: Disease profilesNorth India

North Indian states 2011 (Provisional)

Haryana 33345

Himachal Pradesh 247

J&K 1031

Punjab 2693

Rajasthan 46457

Uttarakhand 1162

Uttar Pradesh 56438

Chandigarh 582

Delhi 413

Acute Diarrhoeal Diseases casesduring 2011 North India

North Indian states 2011

Haryana 224223


Jammu division 342670

Kashmir division 202041

Punjab 190022

Rajasthan 227571

Uttarakhand 79643

Uttar Pradesh 554770

Chandigarh 42615

Delhi 102983


Enteric Fever (Typhoid) casesduring 2011 North India


Acute Respiratory Infection casesduring 2011 North India


Haryana 1275035




Punjab 656544

Rajasthan 1089640

Uttarakhand 130283


Chandigarh 49649

Delhi 198541



Haryana 25469




Punjab 36263

Rajasthan 7902

Uttarakhand 13760


Chandigarh 3190

Delhi 42976



Appendix 4: Deal summary (Diagnostic chainsand hospitals)North India

Year Acquirer TargetValue (US$

million)

2010 Fortis Healthcare Ltd Parkway Holdings Ltd 685.30

2010 Fortis Healthcare Ltd OP Jindal Hospital -

2010 Fortis Healthcare Ltd Vivekanand Hospital and Research Centre -

2010 Fortis Global Healthcare Holdings Pte Ltd Dental Corporation Holdings Limited 95.74

2010 Fortis Global Healthcare Holdings Pte Ltd Dental Corporation Holdings Limited 95.74

2011 Shalby Hospitals Vrundavan Hospital -2011 Fortis Healthcare Ltd Super Religare Laboratories 174.57

2011 Fortis Healthcare Fortis Healthcare International 665.00

2011 Life Healthcare Group Holdings Max Healthcare Institute Ltd 112.28

2011 Fortis Global Healthcare Lanka Hospitals Corporation Plc 36.30

2011 Max India Ltd Max Healthcare Institute Ltd 30.43

2011Surya Healthcare, majority owned by SuryaPharmaceuticals

Medimart Pharmacy 2.39

2011 Halcyon Finance and Capital Advisors Pvt. Ltd BLK Super Speciality Hospital 44.4

2012 BUPA Care Services Ltd Dental Corporation Holdings Ltd- Subsidary of Fortis Healthcare 286.00

2012 Radiant Life Care Pvt Ltd Guru Harkishan Hospital-management rights 77.00

2012 Fortis Healthcare RadLink-Asia Pte Ltd 50.00

2012 Radiant Life Care Pvt Ltd Guru Harkishan Hospital-management rights 77.00

2012 Fortis Healthcare RadLink-Asia Pte Ltd 50.00

2012 Centre for Sight New Vision Laser Centre 10.00

2012 Shalby Ltd Yogeshwar Healthcare Ltd -Krishna Heart Institute 13.64

2013 Moolchand Healthcare Pankaj Apollo Hospital -

M&A deals (2010-13)

Source: Grant Thornton Dealtracker -the data includes deals till March 2013

Year Investee InvestorValue (US$

million)

2010 Asian Healthcare Fund Diwan Chand Medical Services Pvt Ltd 20.00

2010 SONG Investment Advisors Eye Q -

2010 Matrix Partners India Investment Holdings,LLC Centre for Sight 10.64

2010 Temasek Holdings Max India 25.532010 Aureos Capital India BSR Super Specialty Hospitals Ltd 10.00

2011 Intel Capital Sudhir Srivastava Advanced Robotic Surgery Centre -

2011 Helion Venture Partners, Nexus Venture Partners Eye-Q -

2011 Avigo Capital Partners Super Religare Laboratories Ltd 21.74

2011 Sabre Capital Super Religare Laboratories Ltd 10.87

2011 Franklin Templeton Symbiotec Pharmalab 9.78

2012 NYLIM Jacob Ballas Super Religare Laboratories 50.00

2012 International Finance Corporation Super Religare Laboratories 24.00

2012 Sequoia Capital Moolchand Healthcare 20.00

2012 India Equity Partners Axiss Dental -

2012 Matrix Partners India Mewar Orthopaedic Hospital 5.45

2012 Rajasthan Venture Capital International Oncology Services Pvt Ltd 4.002012 India Innovation Fund, Indian Angel Network Consure Medical -

2013 Sequoia Capital ASG Eye Hospitals 9.09

2013 WestBridge Capital Partners Dr Lal PathLabs 36.00

2013 TA Associates Dr Lal PathLabs 9.00

2013 Artiman Ventures Core Diagnostics 4.91

PE deals (2010-13)



IMR: Infant Mortality Rate MMR: Maternal Mortality Rate GDP: Gross Domestic Product OECD: Organisation for Economic Co-

operation and Development BRICS: Brazil, Russia, India, China and

South Africa FDI: Foreign Direct Investment PE: Private Equity FVCI: Foreign Venture Capital Funds FIIs: Foreign Institutional Investors ADR: American Depositary Receipt GDR: Global Depository Receipt M&A: Mergers and Acquisitions NRI: Non-resident Indian Pvt: Private Ltd: Limited

MoU: Memorandum of Understanding IT: Information Technology HIS: Hospital Information System EHR: Electronic Health Record EMR: Electronic Medical Record RGI: Registrar General Of India SRS: Sample Registration System RSBY: Rashtriya Swasthya Bima Yojana ASHAs:Accredited Social Health Activists OT: Operation Theatre

ICU: Intensive Care Unit US: United States of America UK: United Kingdom UT: Union Territory MIOT: Madras Institute of Orthopaedics

and Traumatology GPRS: General Packet Radio Service AYUSH: Department of Ayurveda, Yoga &

Naturopathy, Unani, Siddha andHomoeopathy, Government of India

AHM:Ahmedabad CHD: Chandigarh DEL: Delhi GUR: Gurgaon GZB: Ghaziabad LUD: Ludhiana RAJ: Rajasthan UP: Uttar Pradesh J&K: Jammu and Kashmir WHO:World Health Organisation PPP: Public-Private Partnership ANC:Ante-Natal Care CAGR: Compounded Annual Growth Rate NRHM: National Rural Health Mission NABH: National Accreditation Board for

Hospitals & Healthcare Providers MoHFW: Ministry of Health and Family

Welfare NUHM: Ministry of Health and Family

Welfare OTRI: Online Telemedicine Research

Institute TIFAC: Forecasting and Assessment

Council BISR: Birla Institute of Scientific Research UMHRC: Uttarakhand Mobile Hospital

and Research Centre

BOT: BuildOperateTransfer AIIMS:All India Institute of Medical

Sciences AIDS:Acquired Immunodeficiency

Syndrome ISRO: Indian Space Research Organisation ILO: International Labour Organisation UNDP: United Nations Development

Programme

Appendix 5:Abbreviations



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KOLKATA10C Hungerford Street5th floor

Kolkata 700 017T +91 33 4050 8000

CHANDIGARHSCO 172nd floor

Sector 17 EChandigarh 160 017T +91 172 4338 000

GURGAON21st floor, DLF SquareJacaranda MargDLF Phase IIGurgaon 122 002T +91 124 462 8000

HYDERABAD7th floor, Block IIIWhite HouseKundan Bagh, Begumpet

Hyderabad 500 016T +91 40 6630 8200

MUMBAI16th floor, Tower IIIndiabulls Finance Centre

SB Marg, Elphinstone (W)Mumbai 400 013T +91 22 6626 2600

PUNE401 Century ArcadeNarangi Baug RoadOff Boat Club RoadPune 411 001T +91 20 4105 7000

BENGALURUWings, 1st floor16/1 Cambridge RoadUlsoor

Bengaluru 560 008T +91 80 4243 0700

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The information contained in this document has been compiled or arrived at from other sources believed to be reliable,but no representation or warranty is made to its accuracy, completeness or correctness. The information contained in thisdocument is published for the knowledge of the recipient but is not to be relied upon as authoritative or taken insubstitution for the exercise of judgment by any recipient. This document is not intended to be a substitute forprofessional, technical or legal advice or opinion and the contents in this document are subject to change without notice.

Whil d h b k i h i f hi d i f i i d h i G Th d

Editorial team:Vrinda Mathur, Misbah Hussain, Sanjana ShankarDesign and production: Rakshit Dubey, Sushant Hivale

Abhishek Puri

Deputy Director

Confederation of Indian IndustryNorthern Region Headquarters

Sector 31A

Chandigarh 160 030T: +91 172 502 2522

F: +91 172 260 6259, 261 4974

E: [email protected]

Pankaj Jain

Executive

Confederation of Indian IndustryNorthern Region Headquarters

Sector 31A

Chandigarh 160 030

T: +91 172 502 2522F: +91 172 260 6259, 261 4974


Jasdeep Kaur

Executive

Confederation of Indian Industry INorthern Region Headquarters

Sector 31A

Chandigarh 160 030

T: +91 172 502 2522F: +91 172 260 6259, 261 4974

mailto:[email protected]:[email protected]

GT- CII Healthcare report

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