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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

				
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