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Health Care in Gujarat &
investment Opportunities!!!
Dr. Amarjit Singh
Principal Secretary FW, Commissioner Health
Government of Gujarat
Gujarat Snapshot
Population 50 million (5% of India)
Geographical Area 196,000 sq. km (6.19% of India)
Literacy Rate 69.14 % (National Literacy Rate: 61%)
GSDP (at current price) USD 52.8 billion
Revenue Surplus INR 1802.85 Crore (2006-07 – RE*)
Exports 14.3% of India
Urbanization rate 38% (vis-à-vis India’s 28%)
Per Capita Power Consumption 1,354 units (National Average: 665)
Cellular Connection 41 per 1000 persons (National Average: 26)
Cellular Subscriber 10.3 million
Motor Vehicles 118 per 1000 persons (National Average: 57)
Irrigated area as % of GCA* 32.15%
Villages Electrified 100%
Sex Ratio at birth (CRS – 06) 870 Females : 1000 Males
Inflation rate (WPI) 9.3 %
Manpower and Education 3
Manpower Statistics Medical Infrastructure in Gujarat (Map)
Number of Doctors - 39,734
Number of Nurses - 16,816
Medical Colleges
MBBS – 13 (6 Govt. & 7 Private)
Homeopathic – 13
Ayurvedic – 9
Dental – 12 ( 5 Govt. & 7 Private)
Physiotherapy – 17
Pharmacy - 50
Key Education Centres
• Institute of Kidney Disease and Research Centre
(IKDRC)
• Gujarat Cancer Research Institute ( GCRI) R & D Organisation
• U.N. Mehta Cardiology Research Institute
• B.J. Medical College Ahmedabad Medical Colleges
• Gujarat Ayurvedic University , Jamnagar MBBS & Dental
• Pramukh Swami Medical College , Karamsad Anand
• Nathiba Hargovindas Lalbhai Medical College,
Ahmedabad Hospitals
• Surat Municipal Institute of Medical Education &
Research
Source : Department of Health, Government of Gujarat
Facilitating Good Health
No. of Registered Doctors (2006): 39,734 No. of Registered Nurses (2006): 16,816
41000
39461 39734
40000 17000 16755 16816
39000
38013 16500 16299
38000
36831
37000 16000 15801
36000
35086 15478
35000 15500
34000
15000
33000
32000 14500
2002 2003 2004 2005 2006 2002 2003 2004 2005 2006
Health Pyramid of Gujarat Medical Colleges - 13
Mobile Health Care
Units - 85
Community Health Centres - 273
Primary Health centres - 1072
Primary Sub centres - 7274
Drivers of growth of Indian healthcare
Growing and aging Population
Growing urbanization
Rising Income
Increasing Burden of Chronic disease
Health Care Financing
Medical Value Travel
International healthcare expenditure perspective
India
China
Brazil
South Africa
Australia
United States
0 5 10 15 20
Public Health Expenditure(% of GDP) Private Health Expenditure (% of GDP)
Unmet Need
Healthcare Infrastructure need in India
2008 2018 2028
Additional Beds Required 1.1 million 3.1 million 2 million
Bed/1000 population ratio 0.7 to 1.7 4 5
Additional Floor space (800 sq. 880 million 2480 million 1600 million
ft./bed) sq ft. sq ft. sq ft.
Additional land area (Floor space 20,000 56,400 36,400
index 1:1) acres acres acres
Total Hospital beds
4 3.8
1.1 million additional 3.4
3.5 beds required
3 2.5
2.5
1.9
2 1.5
1.5
1
0.5
0
India India China Brazil Korea
No of beds '000 population2001-2012
At 1.9 bed per ‘000 population, India would be at 75% of
current Chinese ratio and at 50% of the level of Brazil & Korea
LEADING MAJOR CATEGORIES OF DEATHS : 2006
Diseases of the
circulatory system
Other causes (I00-I99) 22.6%
17.1%
Diseases of the
digestive system
(K00-K92) 3.9%
Certain Infectious
And Parasitic
Injury, poisoning and Diseases
certain other (A00-B99) 18.7%
consequences of
external causes
(S00-T98) 4.7% Symptoms, signs
and abnormal,
clinical and
Diseases of the Certain Conditions laboratory findings
respiratory system originating in the not elsewhere
(J00-J98) 5.7% perinatal period classified
(P00-P96) 10.2% (R00-R99) 17.2%
AGE GROUP WISE DISTRIBUTION OF SOME SELECTED CAUSES
OF DEATH : 2006
40
Diseases of
35 Circulatory System
Diseases of
30 Respiratory System
25
Percentage
20
Neoplasm
Certain Infectious &
15 Parasitic Diseases
10
Injury & Poisoning &
5 other consequences
of External Cause
0
<1 1-4 5 - 14 15 - 24 25 - 34 35 - 44 45 - 54 55 - 64 65+
Age groups
Why Gujarat????
Excellent achievements in National programs in RNTCP, Leprosy, IDSP, School health
Program
RNTCP
Indicator Norm (%) India (%) Gujarat (%)
NSP case detection Rate > 70 64 76
Cure Rate >85 84 88
Sputum conversion rate >90 >90 >92
NLEP 500 hours reconstructive surgery camp at Vadodara
Indicator India Gujarat
Prevalence Rate 0.84 0.80
NVBDCP
Indicator India Gujarat
% pf cases 43.3 21.03
NBCP
Indicator India Gujarat
Surgery rate per 100,000 442 1002
IOL (%) 90 98
All Suture-less surgery
Quality Assurance through Accreditation of hospitals
Quality Assurance Group (QAG)
Each district has a QAG with a
clear mandate for steering QA
programme interventions
Quality Improvement Programme (QIP)
National Accreditation Board for Hospitals and
Health Care Providers (NABH) • 8 Civil Hospitals
• 1 Teaching Hospital
National Accreditation Board for Testing and • 6 laboratories of All Govt.
Caliberation Laboratories (NABL) teaching hospitals
Investment Information and Credit Rating Agency of India (ICRA) Limited has graded six
hospitals under the grading agency’s pioneering services of Grading Healthcare
Institutions in India. One medical college hospital – District Hospital Ahmedabad ,
Vadodara, Surat, Mehsana, Gandhinagar, Sola, Godhara and Junagadh
Source: Department of Health, Government Of Gujarat
Hospital Management & Information System (HMIS)
• HMIS project was conceptualized by the department of Health & Family Welfare, Govt. of Gujarat
• Objective : To ensure the quality health using Information and Communication Technology (ICT) as the tool to provide
standard clinical & diagnostic tools, hospital management tools and integration of management information at the
state level to ensure online review & monitoring
• Aim: Management of vital patient records, analysis of the critical health related data so as to provide an updated
planning & policy tool towards provision of quality heath services
• Assists the doctors and medical staff to improve health services with readily reference patient data, work flow enabled
less-paper process and parameterized alarms and triggers during patient treatment cycle
Current status of HMIS project is as follows
No. of Users 9000 +
No. of Modules 26+2 (MIS/EIS)=28
Size of Database 500 - 600 MB at each hospital. 3 GB at central
server
No. of District Hospitals covered 24
No. of Teaching Hospitals covered 3
No. of LIVE Hospitals 22 (3 Teaching + 19 Non Teaching
No. of registrations (Average Daily) ( Data for 13 LIVE 750 per hospital. Overall Gujarat – 8000 +
hospitals)
Average No. of Transactions Approx 1,00,000 per hospital
No. of Users Trained 5000 +
Regular data entry for programs at blocks under DHIS, RIMS & CRS
Public Private Partnerships (PPP)
• Shamlaji Hospital located in tribal area of Sabarkantha district of Gujarat is managed by All India
Movement for Seva
• 5 CHCs (Malav, Shamlaji, Rajsitapur, Mota Phospholiya, Golagandi) and PHC (Chansad) being run by Community
based Organisations
• 108 grant in aid Hospitals
• Centre for Health, Education, Training and Nutrition Awareness (CHETNA) has been actively
supporting a total of 21 mother NGO’s working effectively to implement Reproductive and Child
• Program (RCH) Services under Chiranjivi Yojna
PPP for Delievery
• Sarva Swastha Abhiyan (SSA , an NGO dedicated to taking quality healthcare to inaccessible
areas) has opened 10 centres in the five predominantly tribal areas of Idar, Prantij, Bardoli,
Hansot and Mundra that will be connected through telemedicine to the super speciality hospitals
at Ahmedabad, Nadiad, Vadodara and Surat
• Wockhardt Hospitals Group (WHG), along with the Government of Gujarat will conduct and
manage the 275-bed Palanpur Civil General Hospital
• Hyderabad-based Emergency Medical Research Institute (EMRI) with the Gujarat government will
take care of road and fire accident victims on a 24-hour basis through the year by just dialing 108
• Indian Institute of Public Health with Public Health Foundation of India
Source: Department of Health : Government of Gujarat
Private Players in Gujarat (PPP)
Medisurge
IKDRC
Civil Hospital
Hospital
SAL Hospital
Atharva
Multispecialty
Ayurveda Hospital
EMRI
Players in Gujarat
Hospital Merits Key Features
Tertiary Care Hospital State of Art Facilities For
Treats about 6 to 6.5 lakh Outdoor patients, Cancer treatment and research at
GCRI
CIVIL Admits 70,000 patients annually I
Kidney and urology related ailments
Performs about 26,000, surgeries and 6500 deliveries per year
HOSPITAL at the IKDRC
Cardiac diseases at the UN Mehta
Cardiac Institute
Multispecialty (Ahmedabad) Has been rated Ahmedabad’s Best
Hospital – 2007 by IMRB and “ The
Networth of over INR 1 billion Week Magazine”
300 beds First Private Bone Marrow Unit set
up in Gujarat
State of the art infrastructure to provide high quality services Pathology Department ranked 3rd in
across a range of specialties India & 10th in the World Over
150 Successful Cadaver & Living
Around 60-70 medico tourists visit the hospital for treatment Related Renal Transplants
Largest corporate hospital in Gujarat Meal on metal Knee Replacement
surgeries
Has a number of specialized clinics and centers of excellence Renal Transplant for both live donor
400-bed and cadaver
Stem Cell Transplant
Handles around 10,000 patients every year Largest and most sophisticated
Success rate of 98% Dialysis Unit with an in-house
Reverse Osmosis plant
sis
Players in Gujarat
Hospital Merits Features
A charitable Trust Multi Purpose Laser Centre
230 beds Orthopedic Hospital
Quality System Is Certified as fulfilling the ISO Handicapped Centre
9001-2000 standards Research Unit
Provides medical relief by way of medical
research, medical treatment and medical
education
Largest private care Women’s hospital in Western In vitro Fertilisation
India Endoscopy (Laproscopy)
50 Bedded Hospital Karl Storz in Germany is the key
Tertiary Care Super Specialty Hospital supplier of the medical equipments
Mayflower Children’s Hospital
Neonatal Intensive Care Unit (NICU)
N.M. Virani Wockhardt Hospital - World-class Dedicated Cardiothoracic and
super specialty hospital (Rajkot) Orthopedic/ replacement Operation
200 beds Theatres
Rich medical expertise from Wockhardt’s True flat panel Cardiac Catheterization
association with Harvard Medical International Lab
(HMI), the international arm of Harvard Medical Dedicated super specialty hospital to
School, USA offer comprehensive end-to-end care in
cardiology, cardiac surgery, Neurology,
Neurosurgery, Orthopedics, Joint
replacement & Minimal access Surgery
Superspecialty Cardiac Centre Non Invasive Cardiology
ISO 9001:2000 Certified Heart Institute Balloon Valvuloplasties
More than 4500 Cardiac Angioplasties Pacemaker Implantations
Coronary/ Radial Angioplasties
MOUs signed
Name of the Company Project Details Location Cost (INR Crore)
Medical College cum
Hospital
Apollo Tyres, Artemis Ayurvedic College Baroda 500
Health Science (AHS) Paramedical College
Nursing College
Wockhardt Hospitals District Hospital Tertiary Care Hospital 2 Crore
Palanpur
Anoop kothari, VC 150 bedded
Kapoor and Other Surat multispecialty and 90-100
superspecialty hospital
Public Health Ahmedabad Indian Institute of Public 140
Foundation of India Health
United Phosphorus Ltd 1.Civil Hospital Investment by GoG
& Rotary Club of Vapi Valsad
2. Medical College URMET Trust
Under Graduate and
Bombay Hospitals Ahmedabad Post Graduate Medical 150
institute with MS
Hospital
Fortis Healthcare Ahmedabad Setting up a healthcare 750
hub
Clinical Islet Transplant Clinical Islet &
Group Inc Ahmedabad Transplantation for 450
diabetes
•EMRI (Ambulance 108)
•PHFI foundation
•Swasthya Bima Yojana
•Chiranjeevi Yojana (with private gynecologists)
Expansion Projects
Hospital Investment Plans
• Surat – 150 beds hospital – INR 700 Cr
Sterling Addlife India Ltd • Rajkot- 125 beds hospital – by 2008
• Mundra SEZ – 100 beds - by 2008
• Ahmedabad Multi Specialty- 100 Cr
• Surat- Oncology – 20 Cr
Medisurge Hospital
• Rajkot- Oncology- 20 Cr
• Bhavnagar- Oncology- 20 Cr
• Medicity – Hansol Ahmedabad
Rajasthan Hospital • Transplantation Hospital- Ahmedabad
• Naturopathy Hospital –b Ahmedabad
• Palanpur – 1 Cr
Pulse Women’s Hospital Pvt. Ltd
• Surat – 25 Cr
Source: Industry Analysis
Foreign Collaborations
Krishna Heart Interfaith Medical
Institute New York Centre
Sterling Actis Equity
Addlife India Ltd. Private Equity Investor Firm
Pulse Women’s Jubail Specialist
Ghana
Hospital Pvt. Ltd Hospital
Mayflower Women’s Karl Storz,
Germany
Hospital Pvt. Ltd
Comprehensive Blood and
Apollo Hospital Bakersfield CA
Cancer center (CBCC),
Mix of population and health care spending by income segment
100%=1 bn Rs. 69,000 cr Rs. 27,000 cr Rs. 42,000 cr
7
Rich*
23
21 30
43
Middle Class**
41
Poor
42
72 43
36
28
14
Population Private spending on inpatient spending outpatient spending
delivery
*Annual per capita income >Rs. 5 Lakh
**Annual per capita income of Rs. 2 to 5 lakh
Source: Morbidity and treatment of Ailments , NSSO1998, Mckinsey Analysis analysis
Current Health Insurance Scenario: India
Health Insurance Penetration in India
Uninsured
82.65%
Indian Railways
0.59% Pvt. sector
ESIS Community
Enterprise (Self
Pvt.Health 3.19% Insurance
Funded)
Insurance 4.19%
4.61%
1.42% CGHS
3.35%
Low penetration of Insurance and Low Govt. expenditure in India . . .
Has resulted in high Out-of-Pocket spend
Source: Business World (India) – Oct 2007
Health Insurance Market
Key markets : Health spend Trend
India
Vietnam
Singapore
China
Mexico
Indonesia
Philippines
Sri Lanka
Russia
Brazil
Thailand
Chile
Japan
USA
UK
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Govt Funded Pvt. Insurance Out of Pocket
% of Total Health Spend
Source: National Health Accounts, WHO
Special Economic Zones: The Hidden Opportunity
4125
13500
Sector specific Multi product
For a sector specific zone a hospital with minimum bed strength
of 25 is stipulated.
100 beds for a multi product special economic zone.
Source: Technopak Healthcare Outlook
Also Gujarat excels in
• Cardiology
• Cardiothoracic surgery
• Joint replacement
• Orthopedic surgery
• Gastroenterology
• Ophthalmology
• Transplants
India-Rising Incomes
140
132
120
114
House holds in Million
100 98
80
Maximum rise in income 2000
66 to 10000 US$ per annum
60
40
20
9
4
0.6 1.4
0
0.05 0.14
income in US$ per annum
<2000 2001-11000 >11000-50000 >50000-200000 200000+
Favorable destination
Best
Favourable
Hospital
Tourist
facilities
Destination
Medical
Tourism
Technology
Infra structure
Medical Tourists visiting India, 2000-2006
250000 230000
200000
150000 140000
100000
50000 40000
10000
0
2000 2001 2002 2003 2004 2005 2006
Source: Technopak Healthcare Outlook
Medical Tourism
• A recent study by the New York-based consulting
firm, McKinsey, found that medical tourism could
bring over $2 billion a year to India by 2012.
• India has the potential to attract 1 million tourists
per annum, which could contribute up to US$ 5
billion to the economy.
(CII : August 16, 2004)
• Subcontractors provide services to the
overburdened medical care systems in western
countries.
Medical Tourism
Gujarat’s medical expertise and the strength of its facilities are better than those of some of the South – East Asian Nations and
Gujarat hospitals are trying to do a lot more hard selling abroad. They are seeking to achieve this by measures such as
Creating centre of excellence in respective fields, Developing a Network, Customised packages available and
Quality stamp through accreditation from global certification agencies such as JCI
Experienced &
qualified
Holistic medicinal specialists No waiting list
services
Language is another
Cost Benefits plus point – English
widely spoken
Medical Tourism : Key Drivers
In Gujarat
Advantage Gujarat
State-of-art multispecialty Highest number of
hospitals airports in India
Excellent rail-road
Corporate hospitals connectivity
6 million Gujarati’s
receive about 60-70 international Gujarat contributes
spread across the world –
patients during October to to 25-31 % of Medical
constituting 32% of Indians
January each year Tourism
abroad
Source: Industry Analysis, Gujarat Infrastructure Development Board (GIDB),
Cost Benefits in Gujarat
Procedure United States (USD) India (USD) Approx
Approx
Liver Transplant USD 3,00,000 USD 69,350
Heart Surgery USD 30,000 USD 8,700
Orthopedic Surgery USD 20,000 USD 6,300
Metal Free Bridge USD 5,500 USD 600
Dental Implants USD 3,500 USD 900
Porcelain Metal Bridge USD 3,000 USD 600
Porcelain Metal Crown USD 1,000 USD 100
Tooth Impactions USD 2,000 USD 125
Root Canal Treatment USD 1,000 USD 110
Tooth Whitening USD 800 USD 125
Tooth Colored Composite USD 500 USD 30
Fillings / Tooth Cleaning USD 300 USD 90
Investment in Gujarat
Win –Win!!!
Cause for attraction
• United States
– At a quarter or sometimes even a 10th of the cost at
home
• Canada
– Frustrated by long waiting times
• Great Britain
– Can't wait for National Health Service
– Can't afford to private practice
• For others
– A chance to combine a tropical vacation with elective
or plastic surgery.
State tax revenue and Medicaid spending growth, 1997-2006
12.4
10.3
8.2 8.3
6.6 7.1 7.4
5.3 5.2 5.1 5.36.3
5.1 3.7
3.2
3 2 2.8
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
State Tax revenue (%)
Medicaid spending growth (%) -3.5
-7.3
Source: Analysis by the Rockfeller Institute of Government for State Tax Revenue
Health Insurance coverage of the Nonelderly population 2001 & 2005
100
90
80
70 64.7 60.8
60
50
40
30 13.6 13.9
20 5.2 5.4
10 16.5 17.9
0
2001 2005
Un-insured Private, nongroup Medicaid/other public Employer/sponsored
Source: Health Insurance coverage in America: Kalper Commission on Medicaid & uninsured
Investment Opportunities
Integrated Medicity
Healthcare Outsourcing (BPO)
Establishing Global Accreditations Facilities
High – Tech MRI/CT Scan Facilities
DESTINATION Establishing Chain of Primary public /Community Centres
GUJARAT
Holistic Wellbeing- Yoga, Physiotherapy, Acupressure
Computer Navigated Surface Replacement Surgery of the Hip
and Knee-Joint
Low Cost Paid Surrogacy through In- Vitro Fertilisation
Hospital Management on Rehabilitate, Operate and Transfer
(ROT) basis
HEALTHY GUJARAT!!!
Connecting Further….
Health & Family Welfare Department,
http://www.gujhealth.gov.in
Govt. of Gujarat
Dr. Amarjit Singh - Commissioner of
Health, Medical Services, Medical cohealth@gujarat.gov.in
Education and Research Mob: 9825037421
