Tackling India's skewed healthcare distribution

Amid changes in the healthcare industry, a push by private and public sector hospitals is offering a respite to the nation's growing population

Census India, 2017

The government's efforts to provide better healthcare to people in rural areas could result in improving formal healthcare infrastructure – particularly in rural areas.

With health-primed policies and initiatives like Pradhan Mantri Jan Aarogya Yojana (PMJAY) and Ayushman Bharat already being implemented, healthcare is seeing an unprecedented push from the government. The efforts to improve healthcare is not just limited to policies as the country looks to build decentralized units to cater to the rural population.

Health in India (NSSO)

In addition to that, a draft policy to facilitate opening of hospitals in tier II and tier III cities across the country is already on the cards. "With the launch of the PMJAY and 500 million beneficiaries, there will be a requirement of 0.64 million additional beds required over the next 10 years," states the policy made after inputs from the Niti Aayog. "We now need three times more growth but it should be primarily focused on Tier II and III cities. Private players (both for profit and not for profit) have a key role to play in bridging the supply demand gap in health infrastructure while advancing the standards of care," the draft policy stated.

That considered, funds, land, and the human capital requires India to utilize the resources of private players in the healthcare industry.

To that effect, private healthcare units have also started making inroads through either smaller clinics localised in towns or larger multi-specialty hospitals helping patients from several regions – established in the hinterlands of India. For instance, a rather successful healthcare initiative, Nayati Healthcare, headed by Niira Radia, has already started making its presence felt in Uttar Pradesh's Mathura city.

Started as a healthcare initiative in Badrinath, Nayati Healthcare has set up its first hospital in Mathura and has now expanded its services to Agra, Delhi, and will soon be present in Varanasi, Amritsar, and Gurugram, offering advanced healthcare, otherwise only available in metropolitan cities. The services, especially the out-patient clinical department and critical surgery wing, receive the largest number of patients – availing affordable services at Nayati.

Like Nayati Healthcare, several other multi-specialty hospital chains are inclined towards setting healthcare centres in Tier-ll and Tier lll 3 cities. For instance, Narayana Hrudalaya has expanded to Lucknow and Bhubaneshwar after its success in Bangalore.

Likewise, Fortis and Apollo too are working on targeting different segments in tier II markets – which could be a ripple effect caused by Niira Radia's success with Mathura's Medicity as well as the government's push towards building a strong healthcare system in rural areas and small towns.

Another cause, apart from the necessity of large healthcare units is the incumbent competition and market saturation in Tier-I cities. While Apollo Hospitals is tapping Tier-II markets in Nashik, Indore, Vishakhapatnam, Guwahati and Tiruchi. Similarly, Shalby is expanding operations in Jaipur, Mohali and Surat, while Max Healthcare is tapping into the Tier-II markets of Mohali, Dehradun and Bhatinda. Manipal Health Enterprises is eyeing organic and inorganic acquisitions in Jaipur, Salem and Vishakhapatnam.

"In Tier-II cities, competition intensity and real-estate costs are lower, and hence, the preference," said Vanyasree Paila, Senior Analyst, India Ratings and Research.

The development is concurrent with launches and announcements by hospital chains, as the groups are earmarking funds for tier-2 & 3 cities. The move is supposed to provide a much needed relief to the rural and small town population, while reducing the burden from hospitals in major cities. That said, the impact of opening new hospitals and launching new schemes would not probably be reflected immediately. However, as Fortis, Max and Nayati healthcare along with the government make inroads into the smaller regions, it won't be surprising to hear happy stories of a healthy population.