Coverage
Implementing Services
Disclaimer: The views expressed in this paper/presentation are the views of the author and do not
necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors,
or the governments they represent. ADB does not guarantee the accuracy of the data included in this
paper and accepts no responsibility for any consequence of their use. Terminology used may not
necessarily be consistent with ADB official terms.
1.25
billion
+
US
Indonesia
+
Brazil
+
Russia
Japan
Mexico
Germany
17.6%
Every 6th person on
earth lives in India
181
~
= million
~
Brazil
Nearly equals
the population
of Brazil
Decadal growth
from 2001 to 2011
World Economic Forum, WHO, Bain & Co analysis, MoHFW, CII McKinsey study
Slide No.Source:
37
325
Population
per sq km
385
~75%
~2 Million
~$ 6.2 Trillion
178
~$ 3Trillion
Cumulative healthcare
spending requirement by
2025
1.3%
Percentage of GDP as
public spending on
healthcare
<1%
Percentage of delivery
providers accredited
World Economic Forum, WHO, Bain & Co analysis, MoHFW, CII McKinsey study
Slide No.Source:
37
~3 Million
Urban diabetes patients
who receive adequate
treatment, out of ~38Mn
Russia
India
China
South
Africa
Global
75
69
66
75
60
71
22
17
17
19
17
20
8.4
5.3
29.2
7.7
14.8
20
93
74
253
41
612
178
514
790
682
576
711
539
80
103
116
50
104
73
96
75
95
97
83
99
100
67
100
94
74
18.9
14.9
7.8
13.9
76
17.1
16.6
51.1
28.6
% of GDP
9.5
6.5
3.8
5.4
8.9
8.6
47.5
51.1
30.5
56
48.4
57.6
7.9
8.9
4.3
0.1
14
14.1
57.8
92
87.2
78
13.8
52.6
14.9
11.8
20.4
13.3
20.9
19.5
6.1
14.8
7.9
7.2
11.1
7.8
Indicators
Life expectancy at birth(Years)
Health Expenditure
Socio
economic
Slide No. 37
150
2010
65
52
2009
Medical Insurance
36
2006
4% 3%
28
Diagnostics
20%
Pharmaceuticals
9%
13%
Hospitals
71%
Slide No. 4
Source: IBEF
5.50%
5.00%
4.20%
4.00%
4.50%
4.40%
4.10%
3.60%
3.90%
4.00%
2011
2012
3.00%
2.00%
1.00%
0.00%
2006
2007
2008
2009
2010
2022 (P)
Vision
Increased Regulation
Limited Incentives
Medico-legal liabilities
Regulatory
Major cause of
indebtedness
Affordability
and
Accessibility
Healthcare
ecosystem
Competition
Fragmented
New formats
Innovative
Commoditization
High inflation
Manpower
Capital Expenditure
Rising Expectations
Social responsibility
Sustainability
Our Journey
2013-16
2012
2013
2011
Acquired stake in
SRL (Diagnostics
laboratory network)
Acquired Fortis
International Pte. &
85% stake in
RadLink-Asia
Commissioned 2
new hospitals &
divested Dental
Corp. / Hoan My /
Quality Healthcare
Commissioned
FMRI, LDH &
Bengaluru;
Divested
International Assets
Acquired 51% in
FHTL
YTD FY2017
Announced
demerger of
Diagnostics Business
(including SRL ) into
Fortis Malar in
August 2016
2010
Acquired &
divested stake in
Parkway Holdings
& commissioned 2
new hospitals
2009
Acquired 10
hospitals from
Wockhardt group
Slide No. 17
2008
Acquired Malar
hospitals, Chennai
2005
Acquired Escorts
chain of hospitals
2004
Commissioned
the second
Hospital in NCR
2001
Started first
hospital at
Punjab, Mohali
Slide No. 37
16
12
CAGR 14%
0.3
0
FY 05
FY 10
FY 15E
7%
3
2
1
FY 20P
4
1
6%
FY 20P
FY 15E
4.5%
FY 10
CAGR 17%
8
4
The health
insurance market
in India is
expected to grow
at 17%, driven by
increasing
demand from
individuals and
corporates,
coupled with
supportive
government
initiatives
Employer Provided: In the employer-provided insurance model, the employee is reimbursed for his health
expenses upon producing a claim. Many of these insurance schemes include dependents. The employer usually
pays the insurance company directly.
Government/Social: Employee Social Insurance Scheme (ESIS) and Central Government Health Scheme (CGHS)
are types of mandatory or social insurance schemes. The ESIS scheme automatically covers labour class
employees, while the CGHS covers Central Government employees
Voluntary: Many voluntary schemes are administered by public or private companies, such as Life Insurance
Corporation, Oriental Insurance Company Limited, United Insurance Company Limited, Star and Health Allied
Health Limited, among others
Community-based: These are insurance schemes specifically applicable to certain segment of the population;
usually implemented in areas where there is a special need to address concerns like low premiums, reduction in
default payments or improve social healthcare. These insurances are sponsored by governments or NGOs
Currently, the competitive landscape is largely made up of pure play and diversified health
insurance companies
Government
Source: Secondary Research, PwC Healthcare Database, PwC Analysis
Note: *P&C refers to Property and Casualty Insurance
Group
Individual
UHC : INDIA
UHC IN ACTION
Slide No. 37
Key Challenges
Funding
Availability
Access
Affordability
Paucity of infrastructure
Shortage of Talent
Delivery mechanism
Integrated healthcare planning: from prevention to primary care to secondary care to tertiary care
Future Outlook
Recommendation
Govt should increase public expenditures on health from the
current level of 1.2% of GDP to at least 2.5% by the end of the
12th plan, and to at least 3% of GDP by 2022.
Ensure availability of free essential medicines by increasing
public spending on drug procurement.
Use general taxation as the principal source of health care
financing
Do not levy sector specific taxes for financing.
Current Status
Unchanged; public expenditure on health still at 1.2% of GDP
Only 9 countries (out of 191) devoted a smaller share of
government spending to health than India.
Has been set into motion
Looks unlikely as tax to GDP ratio still below 15%; overall tax
revenues insufficient
Might need to levy specific taxes the way it has been done for
Swacch Bharat
Will require RSBY and other government insurance schemes to
comprehensively increase scale which has not been seen yet
Future Outlook
Recommendation
Current Status
Reorient health care provision to focus significantly on primary No significant change in allocation
care.
Some progress; in principal call taken to upgrade 58 district
Strengthen District Hospitals
hospitals
Increase the bed capacity to at least 2 functional beds per
Low progress; India still at 1.3 beds (out of which only 60%
1,000
functional)
District Hospitals should be large enough to cater to 95% of
Bed capacity growth at existing district hospitals not yet seen
populations need
All health facilities should be licensed by Indian Public Health Likely to miss target
Standards (IPHS) by 2017
Ensure 1.0 doctor per 1,000 population by 2027
Currently at 0.7
Ensure 3.0 nurses per 1,000 population by 2025
Currently at 1.5
Invest in additional educational institutions to produce and
Nursing capacity needs major capacity addition: 149 districts in
train additional healthcare manpower
14 states do not have any nursing school or nursing college
Set up 187 new medical colleges by 2022
Likely to miss target
Establish a dedicated training system for Community Health
Workers
Establish State Health Science Universities.
Establish National Council for Human Resources in Health
(NCHRH)
Not started
Not started
No progress
Creation of the High-Level Expert Group (HLEG) on Universal Health Coverage (UHC), constituted by the Planning Commission of India in October 2010,
with the mandate of developing a framework for providing easily accessible and affordable health care to all Indians.
HLEG recognized that it is possible for India, even within the financial resources available to it, to devise an effective architecture of health financing and
financial protection that can offer UHC to every citizen. Some of the recommendations are as follows:
The government (Central government and states combined) should increase public expenditures on health from the current level of 1.2% to at least
3% of GDP by 2022
Developing a National Health Package that offers, as part of the entitlement of every citizen, essential health services at different levels of the health
care delivery system with ensuring adherence to quality assurance as per Indian Public Health Standards (IPHS).
In order to improve community participation, transforming existing Village Health Committees or Health and Sanitation Committees into
participatory Health Councils
Enforcement of price controls and price regulation on essential and commonly prescribed drugs as well as revising and expanding the essential drug
list.
The HLEG Group envisages that over time, every citizen will be issues an IT-enabled National Health Entitlement Card (NHET) that will ensure cashless
transactions, allow for the mobility in the country, and contain personal health information
The Indian insurance industry is expected to grow to US$ 280 billion by FY2020, owing to the solid economic growth and higher personal disposable
incomes in the country
Thank You