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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 email@example.com Education and Research Mob: 9825037421
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