Hepatology in India

Capitalising on its highly skilled and trained professionals, India has steadily risen in the ranks of premium healthcare service providers in the world. So much so that according to a report published by the Ministry of Commerce, the medical tourism industry is expected to reach $9 billion in 2020; so much so that the Ministry of Tourism reports a 166 per cent jump on the number of people entering India on medical visas – from 75, 688 in 2014 to 201,333 in 2016. One branch of medicine whose rise in India has paralleled this rise in medical tourism, almost as if the two are dependent on one another, is hepatology. A number of specialised hospitals in India with highly skilled and trained professionals are well equipped not only to deal with domestic patients, the country also sees a regular influx of medical tourists from countries such as Bangladesh, Afghanistan, Iraq, Maldives, Oman, Yemen, etc. Affordable treatment packages have also attracted patients from developed nations such as the US, UK, Germany, as well.

Greater health awareness coupled with ease of access to corresponding healthcare services have contributed to the growth of the Indian healthcare industry, with the sector expected to grow to US$ 280 billion by 2020. It is important to note that as much as globalisation and the increase in international tourism have contributed to the exponential growth of this sector, there have also been several notable domestic factors that have contributed to this growth.

● A number of specialised hospitals – from BLK Super Speciality Hospital in the north to Gleneagles Global Hospital in the south – offer complex procedures – from gastrointestinal bleeding from portal hypertension related to liver damage, to systemic diseases affecting liver and biliary tree; for example, haemochromatosis – at incredibly affordable rates. In fact, the “miracle pill” for Hepatitis C, that can completely cure the disease over a period of twelve weeks, is available for US $300. The same pill can cost up to US$ 1000 per pill, with the full course running up to US $84000.

● An increase in urbanisation has also contributed to an increase in problems associated with modern living. This, in turn, has led to a shift from communicable diseases to lifestyle diseases. Excluding hereditary hemochromatosis, liver cirrhosis and non-viral related cirrhosis, such as alcohol and NASH (Non-Alcoholic Steato-Hepatitis) are among the leading causes of death worldwide. In fact, in 2001, the estimated worldwide mortality from cirrhosis was 771,000 people, ranking 14th and 10th as the leading cause of death in the world and in developed countries, respectively. Deaths from cirrhosis have been estimated to increase and would make it as the 12th leading cause of death in 2020.

● Investments from the private sector into the healthcare industry in general but in the hepatology sector of that industry in particular has also grown over the years. Since it’s the capital, setting up the best hepatology centre in Delhi is priority for both the public and private sector. Not just in terms of hospitals and medical centers, India is also marking its mark in hepatology research as well. While earlier, publications by Indian investigators in peer-reviewed international journals, were a rarity, they have now become quite common.

Streamlined processes, advanced technologies, state-of-the-art infrastructures, specialised & interdisciplinary care, along with highly knowledgeable and skilled doctors, supported by a thoroughly trained and compassionate staff makes India one of the premium destinations for hepotalogic treatment in the world. However, challenges imposed by a developing economy also exert a significant influence upon the practice of hepatology in India. Many government hospitals do not have required technological tools needed to perform complex procedures. Clearly, an open collaboration between private and public stakeholders is the need of the hour.

With consistent efforts by the government to strengthen the sector and incredible growth opportunities across different segments, supported by increasing awareness and changing lifestyles, India is set to become a global hub for hepatology services in the coming years.

Eye Care Treatments and Procedures in India

As much as technology and modernisation have made our lives easier, equally have theygiven rise to lifestyle diseases.Particularly, as a result of the increased exposure of our eyes to various screens – laptops, phones, etc. – there has been an explosion of cases needing specialised care. Fortunately, a number of top ophthalmology hospitals in India are more than adequately equipped to handle this influx of patients. These hospitals employ advanced medical facilities and highly skilled staff to provide complete and thorough care to the patients – from accurately identifying the causes and containing the risk factors to preventing further complications. Not only is India equipped to handle its domestic patients, being globally recognised as the hub for the very best hospitals for ophthalmology treatment, the country sees a steady influx of tourists from United States, United Kingdom, Canada, Germany, France, etc., for a number of issues ranging from cataract surgery to squint surgery.

Greater health awareness coupled with ease of access to corresponding healthcare services have contributed to the growth of the Indian healthcare industry, with the sector expected to grow to US$ 280 billion by 2020. It is important to note that as much as globalisation and the increase in international tourism have contributed to the exponential growth of this sector, there have also been several notable domestic factors that have contributed to this growth.

• An increase in urbanisation have also contributed to an increase in problems associated with modern living. This, in turn, has led to a shift from communicable diseases to lifestyle diseases. The demand for specialised care for the diagnosis and treatments of eye disorders have also contributed to the growth of the sector.

• Ophthalmology hospitals and clinics in India offer complex procedures at an incredibly affordable rate. While a bilateral cataract surgery procedure can cost more than US $7,000 in the United Kingdom,the same procedure could be done under US$ 3,000-4,000 in India. It is important to note that the low cost of these services does not mean low quality of services. Healthcare is cheap in India as compared to other “western”/”developed” countries because of lower labour costs. A large population means a large batch of readily available pool of labour – doctors, nurses, janitors, etc – and this brings down the cost per head per hour, especially when compared to the West. Further, low labour costs bring down the taxation on the same since the two are directly correlated.

• Investments from the private sector into the healthcare industry in general but in the Ophthalmology, Optometry, and Orthopticssector of that industry in particular has also grown over the years. Many big players such as Apollo, Fortis, etc. are setting up specialised centres for eye care across the country. Since it’s the capital, setting up the best eye care hospital in Delhi is priority for both the public and private sector.

In a country where nearly 15 million of the 1.27 billion people are blind, mostly due to cataract, one of the most easily treatable causes of blindness and low vision, setting up proper centers for the care and treatment of these ailments, along with creating an adequate number of physicians with expertise to tackle the challenges presented by a growing economy, has been a high priority for the government. With the help of the World Bank, Indialaunched the Cataract Blindness Control Project (CBCP) in 1994 to improve the quality of cataract surgery and expand the coverage of tribal and isolated areas for blindness prevention, education and treatment.Meanwhile, recognising the incredible potential of growth and business, the private stakeholders have more than doubled their investments in setting up the infrastructure to make the most of the market.

With consistent efforts by the government to strengthen the domestic infrastructure and incredible growth opportunities across different segments supported by increasing awareness and changing lifestyles, India is set to become a global hub for eye care in the coming years.

The Government’s Role in Driving the Indian Healthcare Industry Forward

To drive the growth of the healthcare industry even forward, the government has launched a number of policies and programs. With the National Health Policy, for example, it aims to, domestically, achieve the highest possible level of health and wellbeing for citizens of all ages, and internationally, develop India as a global healthcare hub. It approved the continuation of National Health Mission with a budget of US$ 4.40 billion under the Union Budget 2019-20 and has opened collaboration with the private sector to improve the ease of access to and quality of healthcare services within the country.

Launched fairly recent (on 23 September 2018, to be precise), the Pradhan Mantri Jan Arogya Yojana (PMJAY), has already made considerable impact. Around 9,00,000 patients have received benefits of worth US$ 167.71 million and many more are expected to soon. Advertised as the world’s largest health insurance scheme fully financed by the government, it aims to provide comprehensive primary, secondary, and tertiary healthcare services to over 10.74 crore poor and vulnerable families.

The National Nutrition Mission, aimed at reducing the level of stunting and under-nutrition, has received a budget of US$ 13.16 billion for a three-year period. The policy aims to gradually work towards the attainment of malnutrition free India by 2022 by covering 315 identified districts in the first year, 235 districts in the second year, and the remaining districts in the third.

Mission Indradhanush was launched in December 2014 with the target of ensuring full immunization coverage for at least 90% of the country by December 2018. 201 districts across 28 states in the country have been identified under the “high focus” category. These have the highest number of partially immunized and immunized children.

Further, schemes and policies such as the RashtriyaSwasthyaBima Yojana, that aims to promote and provide health insurance across the country, and the Pradhan Mantri Swasthya Suraksha Yojana, that aims at increasing the quality of tertiary healthcare capacity in medical education, research, and clinical care, and many more, are supported by an increase in allocation to the Ministry of Health and Family Welfare in the Union Budget 2019-2020. The ministry, and the policies coordinated by it, have seen an increase by 16.28 per cent year-on-year to US$ 8.51 billion.

The healthcare delivery system in India is driven by two players – public and private – which is necessary to support such a large population. To attract, invite, and drive collaboration from the private sector, the government has launched various incentives. For example, it has increased the tax holiday under section 80-IB for private healthcare providers in non-metros for minimum of 50 bedded hospitals. Further, all healthcare education and training services are exempted from service tax; income tax has been exempted for 15 years for domestically manufactured medical technology products; and more.

India has strong bilateral relations in the healthcare sector with over 50 countries, as of August 2019. This international cooperation is aimed to encourage joint training and manpower development, exchange of experts, exchange of information and knowledge, etc. Additionally, to ease the influx of international medical tourists to the country, India has deconvoluted the visa process for over 130 countries. Highly skilled professionals, ease of travel, cheap and affordable services have given India an edge in the medical tourism sector of the healthcare industry and it is the fastest growing premium medical tourism destination in Asia, attracting patients from all over the world but in particular from its neighbours such as Pakistan, Bangladesh, Nepal, Afghanistan, Malaysia, Thailand, and Singapore. Since India is expected to grow by 22-25 per cent in this sector, new markets are sure to emerge, especially with the government now working in close collaboration with the private sector to drive this growth forward. For example, special tax holidays and incentives are offered to hospitals and wellness centers that deal with medical tourists.

With an increase in revenue and an expected growth to US$ 280 billion by 2020, stakeholders are looking to explore the latest trends in the healthcare industry in order to make positive impact to their businesses. The hospital industry itself, a rather small portion of the overall healthcare industry, is expected to reach US$ 132.84 billion by FY22. The government’s open collaboration with the private sector to provide cheap, affordable, safe, and effective healthcare services to its citizens and beyond has also helped drive the growth forward leading to ample investment opportunities in the sector.