A Sector that’s All in the Pink of Health
KIRAN KUMAR K V
Indian healthcare sector is on the go. With a series of IPOs and private equity over the past few years, innovative processes and entry of bigger players, Indian healthcare sector is currently the most adored investment destination by the investing community. Sector is the next big thing to look out for or so it seems. By healthcare sector, we mean hospitals, pharmaceuticals, medical insurance, medical equipment & supplies and diagnostics. Almost 3/4th of the revenue of the sector comes through hospitals. The sector can be segmented as public and private, of which the latter contributes almost 74% of the healthcare expenditure of households (for obvious reasons..!!) primarily from tier-I and tier-2 cities. Below Figure-1 presents a classified view of the sector.
Figure 1: Classified View of Indian Healthcare Sector
Let’s first answer why, off late, healthcare industry in India is demanding substantial attention of business and investment researchers. As such the global healthcare sector is going through a period of “GLOCALISATION”leading both increased consumption and supply of medical services. Global healthcare spending in itself is growing at a rate higher than 5%. Indian healthcare industry presents an even more dynamic case for discussion:
Firstly, healthcare sector in India is expected to grow at a CAGR of 23% between 2015 & 2020, which is way above the expectations from any other single sector (including the BFSI, which was till recently the darling of market participants). By 2020 the industry is expected to be of a US$ 280 billion size against a current size of US$ 100 billion (2015). Figure-2 presents the trend of sector size growth between 2008 and 2016 and also gives the estimate for 2020.
Figure 2: Healthcare Sector Growth Trend
Secondly, healthcare spending percapita is growing at 5% to nearly US$ 70 billion in 2015. Indian
healthcare industry is the sixth largest healthcare market globally (2014). By 2020 the industry is expected to be third largest. Policies favoring the sector like FDI allowance, listing support, tax benefits and liberal government policies are constantly helping the industry players to raise funds with never-seen-before ease, especially the private equity sphere.
Thirdly, there are signs of growth phase activities by the industry. In the last 6 months there were five initial public offers made and successfully oversubscribed. Total capital raised in the primary market is accounted to be Rs. 4317 Crore. A snapshot of the same in below Table-1:
Table 1: Recent IPOs of Healthcare Sector
Dr. Lal Pathlabs Ltd
Rs. 829 Crore
Alkem Laboratories Ltd
Rs. 1745 Crore
Narayana Hrudayalaya Ltd
Rs. 613 Crore
Healthcare Global Enterprises (HCG) Ltd
Rs. 650 Crore
Thyrocare Technologies Ltd
Rs. 480 Crore
Rs. 4317 Crore
Fourthly, the macro-economic outlook is all congenial for the sector. Income levels are rising, health consciousness is increasing among households, easy access to high-quality healthcare facilities, health insurance penetration is on the rise, rising urbanization. It may be interesting to note that, more than 50% of the spending on in-patient beds is on lifestyle diseases caused by high-cholesterol, high blood pressure, obesity, poor diet and alcohol. While this is not a welcome sign for the society at large, it does bring a higher demand for healthcare services and benefit the sector.
The sector uses number of beds as a metric to measure the market share. The major players thus would be Apollo Hospitals, Aravind Eye Hospitals, CARE Hospitals, Fortis Healthcare, Max Hospitals, Manipal Group and Narayana Health. Figure-3 below presents the market share of key players of the industry.
TRENDS & OPPORTUNITIES
Changing Needs Apart from the differing needs personalized healthcare, by replacement of traditional diseases by lifestyle related diseases, affordability of generic drugs is also increasing. It is surveyed that additional 3 million beds, 1.54 million doctors, 2.4 million nursing staff and an investment of US$ 200 billion are the additionally needed by 2025 for the industry to operate in full capacity.
Focus on Tier-2 & Tier-3 Cities Expansion by multiple players into tier-2 and tier-3 cities by private sector is another emerging trend. For instance, Vaatsalya Healthcare is one of the first chain of hospitals to focus on tier-2 and tier-3 cities and has been successfully implemented the model.
Network Mode of Operations Many hospitals are expanding in a chain of hospitals model, enabling them a greater cost advantage. Players like Manipal, Fortis and Apolloare entering into management contracts with local hospitals, adding up to their revenues.
Telemedicine Usage of ICT network to diagnose and consult is eliminating the geographical barriers, including for critical care and emergency situations. Telemedicine market alone is growing at a CAGR of 20% and many Public-Private Partnerships projects are operational in this space. Mobile Health Service, supported by increased internet speed (aka 4G) is supporting service oriented initiatives in the country.
Health Insurance A whopping US$ 2.9 billion of health insurance premium were collected in 2013 with a CAGR of 26%. This would enable the industry with increased top line. This is expected to do what credit cards have done to the retail industry.
Medical Tourism Medical tourism is expected to be of US$ 8 Billion sized by 2020. Currently more than 3 million medical tourists are visiting India annually.
Operational Efficiency Ably supported by technology and digitization, healthcare companies are able to manage their operations in a cost-efficient, patient-engaging, focused high service quality delivery. E-Commerce companies like Health Kart are emerging that deliver heath care products taking orders online.
FDI Support 100% FDI is allowed under the automatic route for Greenfield projects.
Availability of Talent Large pool of medical professionals is in supply. Cost advantage is on the rise.
M&A In the last 3 years there were nearly 7 major M&A transactions that consolidated the otherwise fragmented industry. Table-2 below presents a snapshot of these deals. It may be noted that most of these are in the pharma space and the motives of most of these mergers were expansion into Indian markets by globally renowned players. It may be noted that more than 70% of the M&As between 2013 & 2015 were in the pharmaceutical space.
Table 2: M&As in Indian Healthcare Industry
Type of Business
Pharma & Biotech
Rs. 2004 Crores
Pharma & Biotech
Meiji Seika Pharma
US$ 290 Million
Pharma & Biotech
$ 275 Million
US$ 880 Million
Rs. 671 Crore
US$ 4 Billion
INDUSRTY LEADERS TO LOOK OUT FOR
It is expected that below companies are going to lead the industry dynamics in the coming year, owing to their internal strengths as well as the capacity to catapult by grabbing every sort of opportunity the sector has to offer:
1. Max Healthcare – Established in the year 2000, currently has over 2000 beds, revenue of US$ 730 Million in 2016, focuses on providing quality healthcare. Growth model is primarily geographical expansion & playing on scale economies.
2. Global Hospitals – Current capacity of 2000 beds, is known for attracting huge funds and successfully introducing radical procedures.
3. Fortis – With more than 10000 beds, Fortis aims to build the super-specialty health centers and acquisitions for growth.
4. Apollo Hospitals – currently has over 9000 beds, revenue of US$ 430 Million in HY2016, focuses on joint ventures, expansion and telemedicine.
1. Delloitte. (n.d.). 2015 Healthcare Outlook India.
2. Indian Brand Equity Foundation. (2016). Healthcare.
3. Invest India. (2015). Healthcare. Retrieved from Invest India: http://www.investindia.gov.in/healthcare-sector/