Chapter
Healthcare goals of India
Economic impact of the state of health
The public face of the healthcare system
Continuing burden of infectious diseases
Business and organizational challenges
Reproductive and child health and nutrition
Business and organizational challenges
Chronic diseases and injuries
Business and organizational challenges
Healthcare human resources
Business and organizational challenges
Business and organizational challenges
Access to care and health equity
Business and organizational challenges
3 India’s Healthcare Industry: An Overview of the Value Chain
Public administration and policy
Central versus state government responsibilities
Levels of governmental administration
Government roles in healthcare: Payer and provider
Evolution of health policy
Sources and destinations of funding
Governmental allocations: R&D investments and vertical disease programs
Other sources of financing: public–private partnerships and private equity
Structure of healthcare delivery
Levels of care: Primary, secondary, tertiary
Secondary and tertiary care
Geographic locale: rural versus urban
Ownership: Public versus private
Growth of the private sector and corporate hospitals
Manpower and human resource issues
Manpower levels and distribution
Causes of manpower shortages
Possible solutions to the manpower shortage
Pharmaceutical and life sciences sector
Brief history of the pharmaceutical sector
Recent achievements of the sector
Financing of drug expenditures
Efforts to rein in drug expenditures
Wholesale and retail pharmacy
Outsourcing and clinical research
Medical device and equipment sector
Growth drivers of the technology sectors
Governmental role in healthcare: Regulator
Governmental bureaucracy and regulatory ineffectiveness
Regulation and conflicts of interest
Regulation and pharmaceuticals
NRHM coordination with local government
Section II PROVIDERS: Delivery of Healthcare Services
4 The Medical Profession in India
Medical practitioner supply
Physician emigration: “The doctor is out”
Increasing career prospects in nonmedical sectors
Regulatory challenges to new school construction and physician recruitment
Central government obstacles
Medical college expansion in the 1990s
Geographic variation in medical college supply
Charges of commercialization and corruption
Commercialization of medical education
Alleged corruption in medical education
Becoming a physician in India
Practicing as a physician in India
Primary care versus speciality practice
Private practice characteristics
How different stakeholders deal with physicians
Pharmaceutical and device manufacturers
Important trends influencing the medical profession
Healthcare infrastructure build-up
The influence of mobile and other technologies
Globalization and offshoring
5 India’s Hospital Sector: The Journey from Public to Private Healthcare Delivery
Rising demand and imbalance with supply
Addressing the imbalance: Causes and solutions
Clinical right-siting of care
The public healthcare system
Gap between policy aims and achievements
Innovation in the public sector
The private healthcare system
Registration and accreditation
Low-cost innovative models in the private sector
Unique approach and media attention
A city of focused factories
Is Narayana scalable or replicable?
Major private hospital systems
Physician engagement model
Challenges with hospital operations
Vertical integration redux
Serving the bottom of the pyramid
Physician engagement model
Future strategic efforts and challenges
6 Medical Tourism: Opportunities and Challenges
Trade in healthcare services
Benefits and risks of trade
Medical tourism market size
Estimates of Mode 2 exports and imports
Estimates of US medical tourism patient and revenue volumes
Customer segments and value proposition
Profile of medical tourists
Supply and demand factors in medical tourism
The consumer experience in medical tourism: Integrated care
Sources of lower-cost care abroad
Comparable quality: Getting Harvard healthcare in Dubai
The emerging role of the payer
Availability of insurance coverage for healthcare abroad
Incentives and interests of payers to get involved
Cost savings: Win-win-win for individuals, employers, and payers
Medical tourism and current state of private payers
Barriers to payer involvement in medical tourism
Payer interests in overseas coverage in the interim
Consumerism and medical tourism: Synergistic trends
Concerns to be addressed or considered
Comparable quality of care
Malpractice and liability
Medical tourism opportunity in India
Medical tourism capabilities
Focused hospital initiatives
Focused government initiatives
Can disrupted innovation itself be disrupted?
Disruption by health cities in the Western hemisphere
Disruption by healthcare reform in the US
Appendix: Quality Standards and Performance of Indian Hospitals
Quality standards in the Indian public health system
The paradox of quality medical care in the Indian private sector
Quality standards and organizations
National Accreditation Board for Hospitals (NABH)
Patient-centered standards
Organization-centered standards
Joint Commission International (JCI)
Section I: Patient-centered standards
Section II: Health care organization management standards
The financial model as driver of medical quality
Consumer-centered experience
7 The Aravind Eye Care System
Aravind’s growth and performance drivers
Clinical spectrum and comprehensive eye care
Organizational capabilities
General applicability of the Aravind model
Can others replicate Aravind’s success?
Can Aravind replicate itself?
Strategic analysis of Aravind
Operational efficiency and history
Government involvement in healthcare
8 The Real Deal at L V Prasad Eye Institute: Excellence and Equity in Healthcare
Introduction: an LVPEI experience
Healthcare and eye care in India
Mission of excellence, efficiency, and equity
Humble beginnings of a grand vision
Public health and community eye health
Financial review: Inflows and outflows
Expenditures/destinations of funds
Sustainability – making every rupee count
Strategic assessment: Opportunities and threats
Expansion and replication
Appendix: Discussion questions
9 Vaatsalya Healthcare: Promoting Access to Healthcare in Rural and Semi-Urban India
Primary evidence on lack of access to low-cost care
History, financing, and growth
New business development: how Vaatsalya selects location and service offerings
Attracting and retaining qualified clinical staff
Physician recruitment and compensation
Nursing and clinical assistant recruitment and compensation
Maintaining low-cost operations
Quality improvement and expansion plans
Current challenges to growth
Section III PAYERS: Financing of Healthcare Services
10 The Health Insurance Sector in India: History and Opportunities
Insurance company-level issues
Insurance market failures
The health insurance landscape in India
Early history of insurance
Current insurance coverage landscape
Employer-sponsored and wage-based insurance
Catastrophic insurance schemes for the poor
Community-based insurance
Challenges and future directions
11 Providing Care to the Bottom of the Pyramid
Bottom of the pyramid (BOP) defined
Demographic profile of the BOP population
Rural public health infrastructure
Ineffectiveness of rural public health
Urban public health infrastructure
Ineffectiveness of urban public health
Recent policy initiatives
Registered medical practitioners and quacks
Nongovernmental organizations (NGOs)
Other for-profit providers
Yeshasvini health insurance scheme
Narayana Hrudayalaya hospital group
Acumen Fund: Healthcare financing
12 Opportunities in Healthcare Private Equity in India
Key players and their strategies
Baring Private Equity Partners (BPEP)
Kotak Private Equity Group (KPEG)
Trends impacting healthcare opportunities in India
Contract research organizations (CROs)
Future prospects and barriers
Section IV PRODUCERS: Manufacturers of Healthcare Technology
13 The Indian Pharmaceutical Sector: The Journey from Process Innovation to Product Innovation
History of India’s pharmaceutical sector
Description of the Indian pharmaceutical market
The fragmented domestic market
Foray of Indian pharmaceutical companies into global markets
Development of the US generics market
Key drivers, trends, and areas of growth
A growing middle class and rising disposable income drive domestic consumption
Growing infrastructure and insurance drive domestic growth
Indian companies’ pursuit of inorganic growth
Japan’s emergence as an attractive market for generics
Indian companies’ collaboration with global MNCs
Indian pharmaceutical firms’ heavy investment in biosimilar development
Leading Indian pharmaceutical companies
Ranbaxy Laboratories (1961)
Recent events, opportunities, and concerns
Dr Reddy’s Laboratories (1984)
Key highlights of DRL’s current empire
Recent events, opportunities, and concerns
Sun Pharmaceuticals (1983)
Recent events, opportunities, and concerns
Key highlights of Lupin’s current empire
Recent events, opportunities, and concerns
Cipla Pharmaceuticals (1935)
Recent events, opportunities, and concerns
Global MNCs increase stake in Indian pharmaceutical sector through M&A
The India advantage: Costs and resources
Patent landscape in India
The Indian drug regulatory system
Economics and pricing of expensive drugs
Pharmaceutical innovation
14 India’s Biotechnology Sector
Domestic biotechnology company profiles
Regional biotechnology development
International partnerships as a funding source
15 The Medical Device Sector in India
Introduction: What are medical devices?
Summary of the global market
Overview of the Indian market
Market size and market segments
Market growth and drivers
Foreign versus domestic medical device manufacturers
Urban versus rural markets
Inefficiencies in medical device and equipment use
Distinguishing customers, payers, and consumers
Local innovators and “frugal innovation”
Financing of medical device innovation
Venture capital, socially conscious funds, and individual and institutional investors
Government sources of funding
Investments by large medical device companies/joint ventures
Regulation and reimbursement
16 Balancing Access and Innovation in Developing Countries
General determinants of competitiveness
Overview of the global medical device and technology sector
Dynamics of medical technology sector: lessons for developing markets
Segmentation of healthcare product choice, access, and financing
Benefits of medical technology innovation
Challenges and opportunities in accessing medical technology
Developments in reimbursement and health insurance in India
The role of infrastructure
Concluding observations on scalable and sustainable innovation in India
India's Healthcare Industry
：Innovation in Delivery, Financing, and Manufacturing
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