Part 1: PE calling "I" of "BRIC" in Healthcare

Brazil, Russia, India and China "BRIC" has maintained active attention of Private Equity (PE) players in multiple verticals for quite some time. However, current economic turmoil, business slow down, and pessimism of economic revival in near future has resulted in tightening of investments from investor's communities.

 

Interestingly one industry that surely is attracting safe and high returns on investment in the "BRIC" region is "Healthcare".

 

Healthcare in BRIC region has experienced a robust growth in last couple of years and is predicted to maintain buoyancy of "sustained high growth" in coming years.

 

The reasons for this robust growth and predicted consistency of high growth is due to:

  1. Robust economic growth
  2. Expansion of "the middle class" and increasing disposable income
  3. An aging population and greater health awareness.
  4. Government active impetus to this industry
  5. Aggressive penetration of insurance.
  6. Lower base and hence higher growth and returns potential.

 

China and India from BRIC have shown remarkable growth in last decade.

Going by the above reasons coupled with vast population (37% of world population!!) both countries have become the most sought after destinations for investments in healthcare industry. While China has been ahead of India, the investment community is getting bullish on India from long term investment perspective. Revenues from the Indian healthcare sector account for 5.2 per cent of the GDP, making it the third largest growth segment in India. (Pricewaterhousecoopers study)

 Jeremy J. Siegel (Prof. of Finance at Wharton-UPENN) and Mukund Krishnaswami (managing director of Krilacon Group) re-affirm on the long term investment edge in India. Ajit Thakur (Broadline capital;NYC) has set his eyes in Indian healthcare sector. According to him, India offers good long-term investment possibilities.

Out of 40 richest people in India, 9 of them come from healthcare industry!

"Healthcare industry in India is capable of generating 10% net on sales and with a good capital to turnover ratio of at least 4 could get a return on capital in excess of 25%" says suryanarayan (A leading healthcare venture consultant, founder of medybiz and lifeken)

 

India's rapid growth has induced ‘health transition' in terms of shifting demographics, socio-economic transformations and changes in disease patterns. The new found prosperity of many Indian households are spurring demand for high-quality medical care, transforming the healthcare industry into a profitable industry.

Healthcare sector's growth in India will be driven by growing middle class, which can afford quality healthcare. Over 150 million Indians have annual incomes of more than US$ 1,000, and many who work in the business services sector earn as much as US$ 20,000 a year. It's estimated that most of India would be "middle income group" by 2020. USD50 billion is projected as the investment required annually for next 20 years to meet this growing demand.(CII) . India needs to add 2 million beds to the existing 1.1 million by 2027, and requires immediate investments of US$ 82 billion as per the Technopak Advisors report.

Health insurance is one of the key drivers in increasing the quality healthcare access for the masses. Currently only 10 per cent of the Indian population has health insurance. The Indian health insurance business is growing at 50 per cent. The sector is projected to grow to USD 5.75 billion by 2010, according to a study by the New Delhi-based PHD Chamber of Commerce and Industry. According to a report by McKinsey on the Indian pharmaceutical and healthcare sector, one-fifth of India's population is likely to have medical insurance by 2015, leading to an estimated increase in consumer spending on healthcare from USD 2,054 per household in 2005 to US$ 3,514 per household by 2015.

As per Technopak advisors, a US$ 35 billion healthcare industry in India, is expected to reach over US$ 75 billion by 2012 and US$ 150 billion by 2017.

2006 attracted  $379 million in healthcare industry. Thats 6.3 per cent of the total PE investment of $5.93 billion( Report from Technopak). Experts predict that   access to PE would help the $35 billion domestic healthcare sector grow at 15 per cent year-on-year.

While most of the investment community is investing in quite a wide spectrum of healthcare ecosystem, there are some verticals that will see major investment convergence. These are:

  • Hospitals
  • Diagnostics
  • Pharmaceuticals
  • Medical Insurance (TPA)
  • Retail

 

I foresee major investments to converge to Hospitals (primary-secondary-tertiary), diagnostics and medical devices sectors. This is where the major opportunity exists.

 

In another article we will explore Indian hospitals and diagnostic industry. We will analyze potential major investment possibilities.

 

I would like to invite your views on why hospitals and diagnostics would attract major investments in India? 

PART TWO >> 

Edited: January 24, 2009 09:51AM

Replies to this Topic

One key aspect to attracting major investments to hospitals and diagnostics in India will be an increase in the number of patients from the U.S. and other countries who are outsourced for treatment due to cost reductions for payors, such as Blue Cross/Blue Shield.

As a marketing and business development professional with over 16 years experience in the U.S. health care industry, I have seen first-hand the correlation between rising patient care costs in this country benchmarked with both a decline in quality of care and available health care practitioners (doctors, nurses, etc.).

Even on the administrative and support services areas (my area of expertise), I have seen a number of highly competent and qualified individuals either be down-sized from the industry or decide to leave for different industry sectors as they feel the U.S. has not sufficiently invested in our health care infrastructure.  And yet, our health care and insurance premiums have continued to rise exponentially.

Until the higher costs in this county are reconciled with better service delivery standards, which would take some time to accomplish, I believe there is a great business opportunity for India and other countries to develop a health care service model that would attract patients from the U.S.

http://www.aarp.org/health/insurance/articles/outsourcing_medical.html

http://www.businessweek.com/magazine/content/08_12/b4076036777780.htm

http://www.time.com/time/magazine/article/0,9171,1196429,00.html

Very well said Sherry. Thanks for the links.

In my next article, this is one section that will be area of exploration.

It is important that a business should be able sustain itself in the home country first. This article shows that the demand in the country (India) itself is high enough to sustain a great growth.

To add to this, there is an immense opportunity of what you mentioned in your write-up. It is commonly called as "Medical tourism" . (I hate this terminology!  Smile  ) . This makes the investment opportunity in healthcare delivery infrastructure much more attractive. No country in "emerging economies" bracket can afford to ignore it.  

Indian government has also been proactive in encouraging prospects in this sector with a number of initiatives in medical tourism for instance Medical Visa ('M'-Visa) has been introduced which can be given for a specific purpose to foreign tourists coming into India. Consequently, easy access to visa facilities coupled with the best emerging medical infrastructure in large and tertiary towns will lead to an increase in foreign exchange earning through medical tourism. Annual earnings from medical tourism are estimated to rise from the current US$815.32m to US$1.87 billion by 2012.

Sherry, do you know of any health insurance that covers the treatment in foreign country?  This will help patients in the United states.

Mark

Mark,

Blue Cross/Blue Shield does.  The are based in most of each state in the United States.  Also, one of the articles I shared mentioned United Health Group, which a third party that makes arrangements for foreign treatments of US citizens.  Hope that helps!

Sherry

Mark,

There are approximatel 3 companies providing limiting after care coverage currently.  I sold Health Insurance a number of years ago and am acutely aware of reading between the lines.  The best policy that is out there now which just launched provides 150K of after care for complications for up to 6 months after the procedure has been delivered.

Edited: January 11, 2009 06:27AM

Sherry,

I concur with your viewpoints.  I have worked on almost all sides of Healthcare for the last 17 years.  The world is becoming flat and technology will level the playing field as more International Hospitals receive their International JACHO Certifications.  Next week I am launching a site that has tracked Medical Tourism and will be assisting International Providers in getting to their target audience www.medicaltourismnewswire.com

Even if we go to to a Universal Model in the states to provide open access to healthcare to everyone there is still a tremendous Primary Care Doc shortage as well as a nurse shortage.  Outside of escalating costs that is the real problem that we are faced with.

Arthur,

Yes, the nursing and primary care physician shortage is also a factor in our domestic health care service delivery.  Also, shortages of rehabilitation therapists and pharmacists (especially those providing consulting services to reduce med error rates and provide recommendations for reducing medication costs) will have an increasing impact.  Factor in physicians who are opting out of Medicare, then you only have a situation that will continue to escalate until appropriately addressed.  Unfortunately, that will take a huge initiative and investment at a time when funds are limited.

Sherry

 

Edited: January 11, 2009 08:20AM

India is providing cheap medical care to rich at the cost of its poor population residing in villages

Dr R P Pareek, MD

Pilani

Though this may sound as a remote thought, but very much doable. If there can be some kind of regulatory body, that allows consultants to enrol and practise over telemedicine then it can address the immediate need of primary consultancy for the many. I often come accross unofficial sites offering consultancy online but I guess they are not authorised to do so.......

Any comments?

Edited: January 13, 2009 04:58PM

Hey Arthur, www.medicaltourismnewswire.com is pretty informative. This will be a handy site for thoe who have a stake in this business.

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