Delhi, officially the National Capital Territory of Delhi (NCT), has witnessed explosive growth in population and economy during the past decade. The NCT and its urban region has been given the special status of National Capital Region (NCR) under the Indian constitution’s 69th amendment act of 1991. There are nearly 22.2 million residents in the greater NCR urban area, which includes the neighbouring cities of Baghpat, Gurgaon, Sonepat, Faridabad, Ghaziabad, Noida and Greater Noida along with other smaller nearby towns.
Incidentally, the infrastructure and service segments have also grown in this region but not proportionate to the growing population, thus putting additional pressure on already stretched resources, with healthcare being one of them.
Healthcare overview
Healthcare services in NCR is provided by both government and private players. Govt of National Capital Territory of Delhi, local bodies i.e. MCD, NDMC and Delhi Cantonment Board, Ministry of Health and Family Welfare through its network of hospitals and other specialised institutions, Ministry of Railways, Ministry of Defence, Ministry of Labour and various Central Govt undertakings. Within the private sector, Delhi has good presence of non-profit organisations and charitable institutions in providing free health services or services at subsidised rates to the poor. Along with these non-profit organisations and NGOs, private sector super speciality hospitals are also functioning and getting patients referred from the hospitals based in different parts of the country and also from other countries.
Out of total number of 883 medical institutions in Delhi, 752 are in private sector and 131 institutions are in government/public sector. The total number of hospital beds in these institutions are 42698 which includes 24484 beds in government/ public sector institutions and 18214 beds in private sector institutions. With these hospital beds the bed population ratio is 2.55 beds per thousand population in 2011.
Healthcare spending
The state has constantly allocated more than seven per cent of the Plan outlay to the health sector and has utilised more than 80 per cent of the outlay. The commitment of the government to improve the healthcare services may be seen from the fact that as compared to plan expenditure of Rs 862 crore under health sector in 2007-08, the plan outlay for the year 2011-12 has been enhanced to Rs 1821.10 crore. This plan outlay for health sector accounts for 12.8 per cent of the total approved plan outlay for the year 2011-12.
Changing healthcare delivery
 “Carryout of selective healthcare segment as standalone chain is a new trend.”Shravan Talwar CEO, Moolchand Medcity, New Delhi |
In the past 10 years, Delhi-NCR, has seen remarkable growth in terms of healthcare infrastructure. “With fast economic growth and rapid urbanisation near Delhi-NCR areas, there has been a huge transition in hospitals infrastructure with key factors responsible such as shifting demographics, changes in morbidity pattern with growing degenerative and lifestyle diseases, affordable quality healthcare and increasing penetration of health insurance,” says Shravan Talwar, CEO, Moolchand Medcity, New Delhi.
In the last decade, hospitals not only grew in numbers but also in size; from stand alone hospitals to health cities everything grew around Delhi. “The last decade has seen an un-precedented healthcare activity in Delhi with the boundary of the healthcare capital extending to regions outside Delhi to Gurgaon and Noida. Corporate chains like Max, Fortis, Apollo setting up tertiary care hospitals, emergence of large standalone health cities, high-end hospitals like Medanta Medicity, Artemis and emergence of specialised centres in eye care, skin, IVF, birthing centres and day care surgery centres have metamorphosed Delhi-NCR into a healthcare hub,” adds Charu Sehgal, Senior Director, Consulting – Strategy & Operations, Deloitte Touche Tohmatsu India.
 “The last decade has seen an un-precedented healthcare activity in Delhi.”Charu Sehgal Sr. Director, Consulting – Strategy & Operations Deloitte Touche Tohmatsu India |
The change was not limited to increasing hospitals but also change in technology and treatment. “Hospitals are becoming more and more technology driven. The focus is on high-end technology solutions with improved health outcomes. For example, now with Fematosecond Laser, Cataract surgery has become significantly automated and blade free, ensuring greater safety and accuracy. Robotic surgery is also picking up in India,” explains Faisal Siddiqui, VP, Healthcare, Technopak Advisors.
| A comparative picture of some of the key demographic indices is as follows | |||||
| Sr. No. | Demographic indices | Delhi | India | ||
| 1. | Decennial Population as per | Growth | Rate | ||
| Census-2001 | Census-2001 | Census-2001 | 47.02% | 21.54% | |
| Census-2011 | Census-2011 | Census-2011 | 20.96% | 17.64% | |
| 2. | Crude Birth Rate SRS –2008 year | 18.4 | 22.8 | ||
| 3. | Crude Death Rate SRS –2008 year | 4.8 | 7.4 | ||
| 4. | Infant Mortality Rate SRS -2009 year | 33 | 50 | ||
| 5. | Sex Ratio | [Census 2011] | [Census 2011] | ||
| [Census 2001] | 821 | 933 | |||
| [Census 2011] | 866 | 940 | |||
| 6. | Child Sex Ratio | Child Sex Ratio | Child Sex Ratio | ||
| [Census 2001] | 868 | 927 | |||
| [Census 2011] | 866 | 914 | |||
| 7. | Neo-natal Mortality Rate -2008 | 20 | 35 | ||
| 8. | Institutional Delivery 2009 | 75.6 | 28.3 | ||
| 9. | Anti-natal Care – 2008 (in lakh) | 3.38 | 232.48 | ||
| 10. | Immunization Coverage – 2008 (%) | 83.2 (ICMR) | 43.5 | ||
New trends
 “The focus is on high-end technology solutions with improved health outcomes.”Faisal Siddiqui Vice President – Healthcare, Technopak Advisors |
This changing competitive landscape has kicked-off a slew of new trends, to keep the hospitals ahead of competition. “Spurred by the activity from the new players even the older hospitals like Moolchand and Gangaram are expanding and reinventing,” says Sehgal.
“Concept of hospotel (hospital + hospitality) is gaining momentum with newer facilities being constructed keeping in mind not just high-end medical facilities but also patient comfort, convenience and safety,” she adds.
New formats of healthcare delivery is also seen emerging in the past few years. “Carryout of selective healthcare segment as standalone chain is a new trend,” informs Talwar. “The new formats include day-care surgery centres, stand-alone dialysis units, ophthalmology units, birthing units, dental units and primary healthcare clinics,” adds Siddiqui.
 “Solution lies in the creation of a health network based on an asset light model.”Rajiv Tewari Director – Health & Wellness, Rockland Hospital |
“The current patient mix does not match with the huge investments made in land, building, equipment, manpower and operational costs. Solution lies in the creation of a health network based on an asset light model connecting the primary, secondary and tertiary health care providers to generate volumes with the right patient mix at all stages of treatment,” opines Rajiv Tewari, Director, Health & Wellness, Rockland Hospital.
| Future plans of Delhi Government |
| The ratio between government and private sector hospital beds was 57:43. With the same ratio of govt and private sector hospital beds, 8152 new beds are required to be added in govt hospitals and 6150 beds by private sector hospitals during 12th Five Year Plan. To achieve the projected target of 14302 new beds during 12th Five Year Plan both by government and private sector hospitals, Delhi Development Authority will have to allocate adequate and suitable sites both for these hospitals, failing which it will be difficult to add the proposed number of new beds by 2017. At the same time higher FAR also need to be allowed to hospital buildings to promote new institutions.
With the expansion of health care institutions, the need for doctors and trained para medical manpower has increased manifold. The adequate number of para medical training institutions specially for radiology, operation theatre technicians courses need to be set up during 12th Five Year Plan. Three new medical colleges will be started. DGHS Cadre recruitment will be made to fill up all the vacant posts of doctors. With the growing population of senior citizens, all public and private hospitals may set up Geriatric Clinics. Delhi Government Hospital Services will be improved with the target for 50 per cent hospitals to get the accreditation from NABH. NAT Testing in blood banks, registration of all clinical establishments, strengthening of diagnostic facilities with PPP approach will improve the quality of health care services. |
Focus on quality
Quality service at reasonable cost is the need of the hour yet it seems not many hospitals focus on quality. “Several large hospitals have come up in Delhi but the problem of delivery of quality services at reasonable costs has not been resolved,” laments Tewari.
Today, with the rise in competition among hospitals quality service has become a key differentiator between a good hospital and a better hospital. “More and more hospitals are measuring performance and analysing their clinical, operational and financial dashboards. They are now more open to ideas and take initiative to benchmark their performance against the best in industry; nationally as well as globally,” states Siddiqui. “Focus on quality certification and accreditation is an emerging trend,” agrees Sehgal.
Changing investor outlook
Healthcare is one of India’s largest sectors, in terms of revenue and employment, and the sector is expanding rapidly. Today, investors look at great opportunities in the healthcare sector. With rising health insurance, soaring medical tourism and added advantage of IT technologies like telemedicine potential in this segment is enormous. “Healthcare industry in India has a huge demand-supply gap. Ageing population, rising disposable income, increased health insurance penetration along with growing urbanisation and increasing life style related diseases have been the key growth drivers. Establishing India as a hub for medical value travel has given a bigger platform to this industry. All this is very encouraging for entrepreneurs and non-healthcare business houses to venture into this space. The advantage is that such houses do not hesitate in implementing innovative care model and hence they assist in identifying new formats to serve the population,” opines Siddiqui.
“Healthcare is seen as being relatively immune to recessionary conditions. The constantly increasing demand for healthcare services due to rising disposable income, increase in life style diseases, improving insurance penetration have all led to a keen interest in this sector, The increasing interest of private equity players has also helped the emergence of innovative partnerships in this sector. Non-traditional businesses not just in Delhi but countrywide are entering or evaluating an entry into the healthcare sector. Some of these new players are looking for alternate models (day care surgery centres, asset light models, partnering with experienced healthcare players etc.) to establish themselves in the sector. Overall, it is a positive step for the development of the sector,” adds Sehgal.
All this may seem very encouraging but new entrants to healthcare should be aware of the risks. “Healthcare is viewed as an attractive segment and new players are entering into it. However, they are likely to face significant challenges on multiple issues like historic low return on capital on healthcare despite of high-capital investment and complexity of business,” alerts Talwar.
“Not everyone finds the going that easy as running healthcare operations is a highly complex activity. Healthcare also needs patience as financial returns take time to accrue. New players have to be mindful of both financial and operational challenges when they evaluate the sector,” advices Sehgal.
Looking forward
The future of healthcare delivery in Delhi-NCR looks bright with many efforts from both public and private players. Where as the public sector is engaged in capacity building the private sector is looking at innovative methods to increase patient footfall and profits. The combined effort is bound to take Delhi-NCR to new heights in healthcare delivery.
“In the coming years, we will see a great out-of-the-box thinking by the strategists in the field of healthcare which will change the whole scenario of healthcare delivery,” feels Talwar. “Consolidation of hospitals will accelerate; additional areas of specialty player (eg IVF) will emerge; institutionalisation of quality accreditations (eg NABH) will happen, as without theses accreditations, providers will get lower prices and we will see the opening of specialised second opinion centres,” he adds.
“The increased supply in big towns and the ensuing competition will also lead to the need for the healthcare players using innovative marketing and customer relationship management techniques. Once the customers have choice, the providers will need to differentiate their offerings. There will be increasing partnerships between the various players- insurance companies, pharma companies. medical device players, ICT players,” opines Sehgal.
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