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Concept of health

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  1. Will the next Google come from India with in next 20Years ? What must happens for innovation of such magnitude to emerge from India ? India need to take steps like creating a more enabling business environment, better usage of the Intellectual property rights regime, a robust ecosystem for funding, thrust on skills development, and collaboration between governments, academic institutions, corporations, financiers, and citizens. “ Innovations is the specific instrument of entrepreneurship, the act that endows resource with a new capacity to create wealth “ Peter Drucker

  2. Concept of health

  3. HEALTHCARE MODEL

  4. HEALTHCARE SNAPSHOT • Traditionally, a social sector with high Govt. role • Dominated by Small time players in the Private Sector • Growing @ 14-16 % per annum

  5. Improve physical reach of healthcare facilities, especially in rural interiors of the country. • Improve availability and resourcing of public facilities: e.g., by addressing concerns on availability of physicians and essential medicines, quality of care and prompt access at public healthcare facilities. • Make higher cost channels more affordable (or better financed): e.g. by price regulations, subsidization of treatment costs, increasing insurance penetration and including drug.

  6. Indian Healthcare Snapshot Healthcare sectors estimated revenue of around $ 30 billion constituting 5% of GDP & employment 4 million people. By 2025, Indian population will reach 1.4 billion with about 45% and the healthcare sector will have to be about $100 billion in size contributing nearly 8 to 10% of the then GDP. By then, the 10 large national healthcare networks would be able to absorb 30% of the market share. McKinsey-CII estimates the number of potential insurable lives at 315 million with a potential of US$ 7,700 million in health insurance premium by 2015. 90% of people were able to access diagnostic facilities and medicines within 5km of point of treatment

  7. Summary: Indian Healthcare Market • With only 10% of the Indian urban population covered by health insurance, the sector has growth potential of US$ 5.75 billion by 2010 • In fact, 84% of hospital beds are in urban areas, whereas 7 5 % of the population still resides in rural villages. • Medical tourism will be a US$ 2 billion industry by 2012, growing at 25-30% annually. In 2007, India treated 450,000 foreign patients and ranked 2nd in medical tourism globally.  • The total healthcare market with Pharma will be US$ 53 – 73 billion ( 6.2 – 8.5 per cent of the GDP) in the next 5 yrs • The Indian middle class estimated at 300 million has strong Purchase power. • According to Ernst & Young, the Indian medical equipment industry was US$ 2.6 billion in 2006 and is growing at 15 per cent and expected to reach US$ 4.5 billion by 2012.

  8. Market Reality • India has only 0.7 beds per 1000 people in contrast to the average of 3.3 beds per 1000 in other countries. • The demand completely eclipses capacity. India needs 80,000 beds each year for the next 8- 10 years at Rs 50,000 cr per year. • Double the number of doctors from 0.7 million to 1.5 million • Triple the number of nurses from 0.8 to 2.5 million. • Four times the number of paramedics from 2.5 to 10 million. • 60% of the 15,393 hospitals and 80% of all qualified doctors are in private sector

  9. Healthcare Today Cures Reach Ego Compassion Emotions & Feelings Family & Friends Patient Friendliness Labor intensive Cost Super Specialty Technological Advancements Hope Continuum of Care Complex Quality Health Tourism Anxiety Expense Commercialization Healing Managed Care Telemedicine

  10. Attendants Security Staff Housekeeping Lift Operators Canteen Room Boys Counselors Receptionist Technicians OT Staff OPD Secretaries Dietician Pt. Care Coordinators Admissions Admin Manager Nursing Pharmacist PRO Cashier Super Specialist Primary Physician Anesthetist Radiologist Physiotherapist Jr. Doctors Sr. Management • LOW • Socio-Economic Status • Education Levels • Intellectual Capability • MEDIUM • Socio-Economic Status • Education Levels • Intellectual Capability • HIGH • Socio-Economic Status • Education Levels • Intellectual Capability Healthcare Organization PATIENT / RELATIVES • LOW • Socio-Economic Status • Education Levels • Intellectual Capability • MEDIUM • Socio-Economic Status • Education Levels • Intellectual Capability • HIGH • Socio-Economic Status • Education Levels • Intellectual Capability HEALTH CARE TODAY(Spectrum of Skill Sets Involved in Service Delivery) Complex interaction

  11. Healthcare: Transformation through innovation • The mega trends driving healthcare are: • Complying with regulatory changes • Meaningful use of existing mandates • Improving clinical outcomes • Transformation and modernization of legacy systems • Increased focus on the customer • Increasing operational efficiency • Integrated care management • Bending the cost curve of healthcare

  12. Trends in Healthcare (1/2) Trend 1: New accountability concepts are reshaping healthcare delivery models, with risk shifting from payers to providers and from groups to individuals Trend 2: Changing channels: Payers will market directly to consumers, expanding the retail insurance market and readying themselves for participating in health benefit exchanges Trend 3: With an “app for that” available, all healthcare is not local. Experiments with “virtual care” models and telehealth will proliferate and accelerate throughout 2012 and beyond, disrupting traditional care models.

  13. Trends in Healthcare (2/2) Trend 4: Vertical integration, diversification and the emergence of healthcare conglomerates: With lines of demarcation among industry sectors blurring, healthcare players have new opportunities to work together to rethink business models to capitalize on each others’ areas of expertise and share the risks and rewards of new ways of delivering care Trend 5: Healthcare will begin unlocking the value in big data, artificial intelligence and next-generation health analytics and business intelligence. As the healthcare system removes structural barriers to data access and sharing — and puts the right incentives in place to encourage the same — tremendous value will be unleashed

  14. Medical Equipment Suppliers in India • Medical equipment market in India is currently the fourth largest in Asia and ranks among top 20 in the world, according to an annual report from India Semiconductor Association. • According to an industry estimate by FICCI, the Indian medical device and equipment sector which is currently valued at $4.4 billion is expected to grow at a CAGR of 15.5 per cent • The recent trends of higher adoption of health insurance are expected to further increase the overall demand of healthcare devices across the country. • There are major changes on the way which includes the Drugs and Cosmetic Amendment Bill (2013), the medical equipment industry is poised to grow at a growth rate which was never seen before.

  15. India is one among the top five medical tourist spots in the world. The medical tourism industry in India is expected to reach an estimated value of $6 billion (Rs 36,060 crore) by 2018 Estimated at USD 78.6 billion as of 2012, the sector has emerged as one of the largest sectors in India and is poised to grow at an annual rate of 15 per cent to reach about USD 158.2 billion by 2017 India is known mostly for its cost-effective medical treatments along with high standards in cardiology, orthopaedics, nephrology, oncology and neurosurgery. The country is also known for its alternative treatment options such as yoga and Ayurveda.

  16. Changing – Disease Profile Expected to Decrease • Lower Respiratory Tract Infection • Diarrhea diseases • Perinatal Conditions • Measles • Malaria • PEM • Anemia • Expected to Increase • I.H.D • COPD • CVA • Diabetes • Cancer • Road Traffic Accident • HIV • Psychiatric Conditions Transition from Infectious & Nutritional Diseases to Chronic & Lifestyle related diseases

  17. CHANGING TRENDS Transformation of Patients’ Status, Hospitals’ Attitude and Doctors’ Profession PatientsCustomersGuestsBlood Relatives HospitalsHospitality Homely Care Profession Generalist Specialist Super specialists Sub Specialist

  18. Ego Levels vs. Criticality of Organs Ego Levels of Health Professionals Anatomy handled CHANGING EGO LEVELS

  19. CHANGING TRENDS-BEHAVIORAL • Doctors • More Communicative, Humility • Doctor–Patient Relationship • Hospital-Doctor Relationships • Encouraging Second Opinion • Integrated approach- Respect all systems • Patient Safety / Medical Errors • Patients • Patient Education and Charter of Right • More Demanding • Nursing, Paramedical & Administrative Staff • Equipped with Tech Tools • Care Beyond Nursing

  20. Medical Education and Workforce – India’s Advantage

  21. Latest Trends in Healthcare Sector Telemedicine: used to connect remote rural populations to medical advice from specialists. Telemedicine Technology: allows easy access for physicians to their colleagues in multiple locations across health facilities, thus offering the possibility of creating a network of health service providers. Technology: to improve efficiency, Technology is offering comprehensive clinical and financial solutions that enable better decisions and outcomes for both businesses and patients, improve revenue cycle, drive quality outcomes and accelerate image management and workflow. Patient Remote Monitoring: Care from the admission to post discharge  Multispecialty Outpatient Clinics: large number of providers are setting up chains Medical City: relatively new concept offering immense growth opportunities Medical Tourism: great boon for the healthcare industry

  22. Challenges faced by India in Healthcare Sector Diabetes Capital of the World: According to the International Diabetes Federation (IDF), India is expected to be the diabetes capital of the world, with the number of diabetes cases expected to increase from nearly 60 million in 2011 to 100 million by 2030. Rising Costs&Increased Customer Expectation: Reason being the health facilities are increasingly run by corporates and funded through private equity, which demands better management practices  Dual disease Burden: Changes in the lifestyle of the people is the result of dual disease burden Private Partnerships: The Public Sector is keen to continue to encourage private investment in the healthcare sector and is now developing Public – Private Partnerships i.e. PPP models to improve availability of healthcare services and provide healthcare financing. India has witnessed an increase in the number of patients from Africa, CIS countries, Gulf and SAARC nations, Pakistan, Bangladesh and Myanmar, who mainly come for organ transplant, orthopedic, cardiac and oncology problems.

  23. Quality And Quantity Of Human Resource To Enhance • The Govt Policy must encourage PG Courses so that Hospitals meeting certain minimum criteria can offer these courses with relaxation in terms of restrictions.( Fellowship / DNB) • Qualitative Educational Institutions to be commenced. • Continued medical education (CMEs) for medical, nursing and para-medical professionals • Mandatory credentialing of Medical Professionals while recruiting. • The current compulsory rural stint for medical professionals. • Huge Health cities/ Medi-cities will induce employment and even provide human resources through education facilities. • To have 2 nd line – Health Assistants to assist Nursing in non clinical work and Physician assistant programmes • To give importance to Healthcare management programmes and make them popular career option. • Staff for accreditation programmes- NABH / NABL/ J CI / ISO etc

  24. CHALLENGES & OPPORTUNITIES- HEALTHCARE IN INDIA • CHALLENGES • Affordability of Quality Healthcare. Currently ~3% of population are covered by Insurance/Third Party Funding • Accessibility to Quality Healthcare, especially in rural areas • Brain Drain: Availability of trained Doctors / Nurses / Paramedics • Intense Competition: Entry of private players, and MNCs • Govt. Spending(<1% of GDP): Low healthcare spending by the government and increased load towards the payment of Salaries (80%) • Ailing Government Infrastructure: healthcare with high maintenance costs OPPORTUNITIES • Recognition as an Industry: Transition from “healthcare” as a Social Responsibility to “healthcare” as a business. • Tap Domestic Potential: Increased Health Insurance Cover, improving Domestic affordability • Integrated Urban-Rural Presence: Tele-Medicine and integrated networks of care to help tap the large rural population • Medical Process Out-Sourcing: Clinical Research, Tele-Radiology, Medical Transcription etc. • Medical Tourism: International community recognizing India as a quality care provider

  25. Selection of States used economic and healthcare parameters, while ensuring regional representation across India

  26. Economic Snapshot: GSDP of Andhra Pradesh Latest update: April, 2014 At current prices, Andhra Pradesh’s gross state domestic product (GSDP) was estimated at US$ 137.3 billion over 2012-13. Break up of outstanding investments in Andhra Pradesh Over 2012-13, outstanding investments in Andhra Pradesh totaled US$ 225.5 billion

  27. Andhra Pradesh

  28. Andhra Pradesh – Economic Scenario

  29. RISING CITY Vijayawada is a natural choice for the Andhra Pradesh government An effort to develop Vijayawada with nearby Guntur, Tenali, Mangalagiri towns through a VGTM Development Authority VGTM area consists a population of 1.72 million people while that of Krishna and Guntur districts is at 9.4 million A proposal for operational airport at Gannavaram near Vijayawada Krishna river can provide the drinking water needs of the future capital city

  30. Some major projects proposed VISAKHAPATNAM: International airport, Metro rail, IIM, Indian Institute of Foreign Trade, Mega IT hub, new railway zone, electronics manufacturing hub, innovation and incubation hub and Gangavarm L&G Terminal SRIKAKULAM: New industrial city, Bhavanapadu and Kalingapatnam ports, new airport, School of Planning and Architecture, tourism circuits, open university VIZIANAGARAM: Greenfield airport, industrial city, tribal university, electronics hardware part, port, music and fine arts academy EAST GODAVARI DISTRICT: Petroleum University, port, electronics hardware part, Telugu University, L&G terminal, ship building unit WEST GODAVARI DISTRICT: National Institute of Technology, coal exploration, horticulture research centre KRISHNA DISTRICT: Up gradation of the existing airport into an international airport facility, oil refinery and cracker unit, Machilipatnam port, VGTM (Vijayawada-Gunture-Tenali-Mangalagiri) Metrorail, agri processing and textile parks GUNTUR DISTRICT: VGTM Metrorail, agriculture university, AIIMS, National Institute of Disaster Management, airport PRAKASAM: Donakonda industrial city, University of Mines and Minerals Sciences, airport, national manufacturing investment region NELLORE: Automobile hub, airport, institute of hotel management, marine institute CHITTOOR: Tirupati international airport, Kuppam airport, IIT, IT hub and Metrorail KADAPA: Steel Plant, mineral based industries KADAPA: Horticulture hub, Central University, satellite centre of AIIMs, electronics and hardware cluster KURNOOL: new airport, textile and cement clusters, Indian Institute of Information Technology, Nuclear Fuel Complex

  31. Industrial Planning in AP Wipro's enhanced presence in Visakhapatnam would boost the IT sector in the port city Premji may expand Wipro's operations to other locations in (new) Andhra Pradesh like Tirupati, Vijayawada and Kakinada HP has teamed up with Mediciti and CSIR to open the fourth cloud-based e-health center in the AP region The state government has also come up with a proposal of setting up of a PCPIR (petroleum, chemicals, petrochemical investment region) industrial corridor between East Godavari district & Vizag The new 8-lane Outer Ring Road, more then 42 Special Economic Zones, a number of IT and ITeS industries, Universities, Research Institutes, massive irrigation projects and 10 new seaports form part of rapid infrastructure development of the State. Andhra Pradesh has the most transparent and proactive and investor friendly government. It Is 2nd among the top 10 Investment destination states in India with the Industrial investments in the state crossing Rs.123.5 billion during the last three and half years.

  32. Expansion of Healthcare Apollo Hospitals Enterprise Ltd has inked a pact with Hetero Med Solutions Ltd to acquire its pharmacy stores business for about Rs.146 crore & comprises 320 pharmacy stores Helion today announced a Series A investment of INR 27 crores in Denty’s, a multi-speciality dental care chain. The healthcare sector in India roughly employs around 3.8 million people. This sector is witnessing a compounded annual growth rate (CAGR) of 13.4%. A pojection that arises from this CAGR is that the healthcare sector will need to employ an additional 13.3 million people by 2022. Dr Sanjeev Bagai, vice chairman, director and dean, Manipal Hospitals, says, “The private sector contributes to approximately 75% of the Indian healthcare industry and the new hospitals translate to a great opportunity for employment across all verticals.”

  33. Expansion of Healthcare The GSK Consumer team has shortlisted one location each in Nellore and Chittoor for the plant, which will produce Horlicks and Boost branded products with an investment of up to Rs 1,000 crore

  34. Price controls now cover up to 30 per cent of the medicines sold in India“For the healthcare sector, the government's pledge towards 'Health for All' through two initiatives announced, namely Free Drug Service and Free Diagnosis Service.Expanding healthcare insurance will also be critical if the nation is to provide the 1.8 million hospital beds needed by 2025 and create new doctors and nurses in their millions to meet demand from a growing population. A McKinsey report - India Pharma 2020 - predicted that 650 million Indians will be enjoying heath insurance cover by 2020.India is also well placed for telemedicine and e-health with the sector predicted to jump from $7.5m to $18.7m by 2017