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Small Island Big Business

Leveraging on Mauritius' long standing reputation as one of the world's finest hospitality destinations, leading hospital groups are setting up multi-speciality hospitals and specialised medical centres there, finds out Nancy Singh

If the executive diary of the top notch management leader mentions Mauritius in his long busy schedule, it is not because he is vacationing there. It is indeed because Mauritius is fast emerging as another check point for corporate healthcare.

While almost every big group has plans to enter this emerging market, the one that made news are Apollo Hospitals and Fortis Healthcare. These names are the ones who have re-defined corporate healthcare in India. And if both these giants have set their footsteps on the white sand beaches of this beautiful country, it is reason enough to convince us about the potential that this small island country may hold.

Talking about Fortis Clinique Darné, Shivinder Mohan Singh, Managing Director, Fortis Healthcare, says, "We are excited to be in Mauritius which has a strong cultural and historical connect with India. We are committed to bringing our healthcare expertise for betterment of healthcare standards not only in Fortis Clinique Darné but to the entire Mascaranes and beyond." Point taken. But obviously it cannot be just the historical and strong cultural connect with India. The reason is definitely more concrete.

The Mauritius Healthcare System

Before delving into the reason as to why companies are heading to the island, here is a basic framework under which its healthcare system operates.

Primary healthcare services: The current network consists of two Mediclinics (MC), 23 Area Health Centres (AHCs) and 103 Community Health Centres (CHCs). Hundred per cent of the population has reasonable access to the first point of contact with the health system (CHC and AHC) within a radius of three miles.

District & regional healthcare services: Secondary level has two district hospitals and five regional hospitals which provide primary inpatient and outpatient medical care to their respective catchment populations, emergency services and supervision of satellite AHCs and CHCs. Services provided include accident and emergency, general medicine, general and specialised surgery, gynaecology and obstetrics, orthopaedics, traumatology, paediatrics and intensive care services.

Hi-tech/ quaternary healthcare: Includes four specialised hospitals having a total-bed capacity of 980, including 803 beds at the level of the psychiatric hospital. In addition to this, it consists of a cardiac centre, a 53-bed institution, offering multi-disciplinary specialised services in cardiac surgery, invasive cardiology and neurosurgery.

Private Sector: Private healthcare has evolved in two-forms. Private practice of medical and dental care practitioners, and private clinics with inpatient beds, and facilities for examination, consultation and diagnostic procedures, mainly in radiology and clinical pathology, operating rooms and deliveries. Right now, there are around 13 clinics with in-patient service operating in the private sector, which besides the renal dialysis also provide cardiac surgery amongst other services. The total number of beds available in the private sector amounts to 562, representing 16 per cent for the Republic of Mauritius.

Healthcare services funding: General Government expenditure on health in Mauritius accounts for 9.8 per cent of the general government expenditure. However, per capita total expenditure on health is $222. The main sources of funding for health in the country are taxes, out-of-pocket payments, voluntary health insurance and external assistance. As health is a human rights issue in Mauritius, public care services are free and are tax funded.

Why Mauritius?

"We are committed to bringing our healthcare expertise not only in Fortis Clinique Darné but to the entire Mascaranes and beyond" - Shivinder Mohan Singh Managing Director Fortis Healthcare

"Mauritius serves as a strategic location which besides catering to the local population can also address the patient community in Africa" - Prathap C Reddy Group Chairman Apollo Hospitals

"We are looking for strategic partnerships to establish base in Mauritius" - Dr GSK Velu Managing Director Metropolis Healthcare Services

There are many socio-economical and political reasons as to why such a small country is evincing big interest for investors worldwide.

Medical Value Tourism: The number one reason to set up base in Mauritius is this. The natives of this country are not significant in terms of numbers, hardly one to two million, which the Government healthcare bodies can easily take care of. But it is indeed the huge amount of tourist population that has caught the eye of our Indian groups. Says Prateek Jain, Industry Analyst, Frost & Sullivan, "Predominantly, Mauritius receives a lot of patients from across the world. And Indian groups have the technical edge and expertise to provide quality healthcare, that too at a cheaper rate."

Hence, treatments like bilateral replacement, hip replacement, wellness therapy, liposuction, dental tourism are very popular there. Take, for instance, the 220-bed multi-speciality Apollo Bramwell Hospital that provides surgery and alternative therapies including acupuncture, aromatherapy and Ayurveda, as traditional Indian therapies are very popular for foreigners. Apollo Bramwell Hospital is a joint venture between British American Investment Company and Apollo Group. "Mauritius is targeting around 10,000 foreign patients to come here for treatment by the end of 2012," reveals the Minister of Health of Mauritius, Dr Rajesh Jeetah.

Metropolis Healthcare, which is also planning to expand in Mauritius, is still looking for better tie-ups and want to ride on this medical tourism boom. Dr GSK Velu, Managing Director, Metropolis Health Services, agrees, "The present Government facilities in Mauritius are not adequate enough to serve a large number of medical tourist patients. Also, this country is not so expensive. We are looking for strategic partnerships to establish our base in Mauritius and many other parts of South-East Asia too."

Strategic Location

Though the conventional reason to invest in Mauritius seems to be medical tourism, the non-conventional yet significant reason for popularity of Mauritius is the strategic location. Explains Satish Menon, Head of Healthcare, KPMG, "Mauritius is a small island country located in the middle of Indian ocean off the south-east coast of Africa. Hence, it receives a lot of patients from Africa. As for the medical tourists, due to its location, patients come from not only Africa, but Asia Pacific and Australia too." One reason for patients coming from far off countries like Australia and even the US too, is because many insurance companies have emerged in these countries where they offer packages only for these countries, at very attractive premiums.

Also, in healthcare, the more cosmetic aspects of it are very popular, like weight loss, wellness, medspas etc. Says Prathap C Reddy, Group Chairman, Apollo Hospitals, "We believe that Mauritius serves as a strategic location which besides catering to the local population can also address the patient community in the African continent."

Apart from the very obvious treatments, in-fertility treatment graph scales high. Menon tells us why so. "There are many men and women who seek infertility treatment, as genetically Africans are weaker in reproduction. IVF is really picking up fast in Mauritius. "Africa is also devoid of good treatment options and even the ones that are provided prove to be too costly for the native Africans. Hence, they prefer getting world-class healthcare treatment at low costs. And the hospitals are also doing well there. For instance, Apollo Hospitals posted an EBIDTA margin of 22 per cent in Mauritius, which is way beyond imaginable healthcare standards.

Other Opportunities Include:

Plastic, reconstructive and cosmetic surgery clinics providing a comprehensive range of surgical and non-surgical services such as abdominoplasty, blepharoplasty, mammoplasty, mastopexy, rhinoplasty, otoplasty, lipoplasty, mesotherapy and botox injection, amongst others. Medical laboratories and diagnostic centres with focus on pathology, microbiology, fertility, in vitro fertilisation, diagnostic radiology and imaging. Dental clinics and laboratories providing a full range of services: dental diagnostics and check up; cosmetic and paediatric dentistry, oral and maxillofacial surgery, prosthetic dentistry, amongst others. Convalescence centres and pain clinics. Health resorts and wellness centres: hydrotherapy, thalassotherapy, ayurvedic treatment centres. Luxury residential care homes for non-citizen retirees. Source: Board of Investment, Mauritius

Healthy Investment Climate

"Indian groups have technical edge & expertise to provide quality healthcare" - Prateek Jain Industry Analyst Frost & Sullivan

"Mauritius offers both a low tax jurisdiction and competitively priced business costs" - Satish Menon (satish) Head of Healthcare KPMG

The policies of the Mauritian Government are highly in favour of new investments, not only for healthcare but all other sectors. After a sustained growth path over the last three decades based on sugar, textiles and tourism, Mauritius is now shifting gears to move towards a higher stage of economic development so as to consolidate its position as a premier international hub.

In view of the importance of foreign investment as a source of sustenance to economic growth, the Government of Mauritius has taken a series of policy measures to encourage its flows into manufacturing, offshore banking and financial services, information technology, communication and tourism. As far as foreign investors are concerned, Mauritius offers itself as an attractive destination because of several positive features such as political stability, availability of skilled labour and investment-friendly rules and institutions. Menon elaborates, "Any investor would go and put in money in a country only after checking the political stability of that place. As it is the socio-political scene that decides the framework of the policies. For an institutional investor is not thinking short-term, but needs to envision a future for as long as 15-20 years. Mauritius offers both a low tax jurisdiction and competitively priced business costs. The Mauritius tax regime is one of the lowest in the world." Mauritius is a free-enterprise economy just like Singapore or Dubai.

Elaborates Nitin Pandea, Head of Healthcare and Life Sciences Cluster, Board of Investment, Mauritius, "Mauritius is in the midst of a great change, a total innovation of the business and investment climate that makes the island state really advantageous as a premier investment destination. Opening bold moves have been made to further ease investment and entrepreneurship. A new business can now be up and operational in just three days. Investors and professionals benefit from a hassle-free environment where income and corporate tax are harmonised at a low 15 per cent."

Foreign Direct Investment (FDI) has played an important role in the development of Mauritius and will again be decisive when the country embarks on high value-added, capital intensive and knowledge-based activities. Adds Pandea, "The Government plays the role of a facilitator and has endeavored at all times to create the most conducive investment environment by enacting appropriate legislations, building state-of-the-art infrastructure, investing in human capital and introducing packages of investment incentives for the manufacturing, financial services and ICT sectors so as to enhance the image of Mauritius."

Human Resources

Mauritius is one of the countries in the African Region with a good doctor to patient ratio (898 inhabitants per doctor) and with a national plan to foresee how the industry would develop in the future. The Government also has sufficient medical colleges to generate adequate amount of medical workforce. One big added advantage is also that the workforce population is conversant in many languages. "Be it the nursing staff or the paramedics, they are not only good in English but they are fluent in French and Spanish too," says Menon from KPMG.

A Global Island in the Making

All in all, Mauritius has all the pre-requisites for a strong and fast-growing life sciences and healthcare industry entrepreneurial spirit, cutting-edge technologies, academic excellence, a highly skilled and bilingual workforce, and a strong intellectual property protection regime. Says Pandea, "Mauritius offers the perfect combination of expertise with a uniquely pleasant living environment, ideal for the development of world-class healthcare and wellness services. Leveraging on the island's long standing reputation as one of the world's finest hospitality destinations, leading hospital groups are setting set up multi-speciality hospitals and specialised medical centres over the island. Health and wellness tourism in Mauritius is poised for formidable growth."

He concludes, "Mauritius offer is unbeatable. Where else on this world could you enjoy a memorable vacation, undergo high-tech medical treatment or elective cosmetic surgery at an affordable cost and indulge in a rejuvenating stay in one of the island's exquisite wellness centres altogether?" It is all poised to steer growth and become a major player in the fields of biomedical research, clinical trials, medical devices and pharmaceutical/ phyto-pharmaceutical products.

nancy.singh@expressindia.com