Healthcare in India India’s population growth over time

HISTORICAL CONTEXT

1

I N C R E A S I N G P O P U L AT I O N W I T H D E C R E A S I N G P O V E R T Y R AT E S

India’s population has grown by 0.45 billion (BN ) people in the last 25 years. Along with significant population growth, the percentage of people living

below the poverty line has decreased by half. The percentage of the urban population continues to increase despite the majority rural population.

Below Poverty Line

Total Rural Urban

Healthcare spend (2014) A C C E S S I B I L I T Y: RURAL-URBAN INEQUITY

» ~74% of India’s doctors cater to ~30% urban population » Shortage of specialists in CHCs (rural India) is high at 81% » Private sector accounts for 63% of MM hospital beds the ~1.56 AFFORDABILITY

» Low per capita healthcare expenditure & low insurance penetration (24%); approximately ~60% out of pocket expenditures » High expenditure on medicines, doctors fee

Total

Below Poverty Line

Rural Urban

»

of deaths in 2015

TA K I N G I N N O VAT I O N S T O S C A L E

» Lack of patient capital owing to modest ROI » Market fragmentation with indepen dent, local providers » mentors); regulatory barriers

Below Poverty Line

Total Rural Urban

Burden of disease

1

R AN K

LIFE EXPECTANCY AT BIRTH*

USA

a communicable disease burden, with an increasing NCD burden

Rural Urban

1

D UA L D I S E A S E B U R D E N

»

Total

As % of GDP

Public Spend (as % of GDP)

Per Capita (in USD)

UK

INDIA

CHINA

63 68

17.1

9.1

4.7

5.5

8.3

7.6

1.4

3.1

$3,935

$75

$420

21.3

16.5

5

10.4

Out of Pocket (%) (2004)

Out of Pocket (%) (2014)

76

79

81

2015

Per 1,000 people

100

13.4

10

67.9

53.6

11.1

9.7

62.4

32

India

China

US

UK

48

0 India

11

7

4

China

US

UK

MATERNAL MORTALITY

Per 1,000 live births

Per 100,000 live births

0

374

400

66

India

174

50

38 9

6

4

China

US

UK

0 India

200 27

14

9

China

US

UK

0

MARKET GROWTH

F R U G A L I N N O VAT I O N

Growth of Indian healthcare delivery market at a CAGR of 17%, driven by increasing demand, government policy support, and value-chain partnerships.

Innovation in products and delivery models (e.g., Narayana Health, Glocal

D I G I TA L I N N O VAT I O N

E X PA N S I O N T O T I E R I I & TIER III CITIES

Increasing penetration of mobile technology and data services in rural areas drives delivery through telemedicine and health information systems.

CAPACITY (2011)

Organized providers, driven by rising middle-class incomes, shift from chronic to lifestyle diseases, and consumer awareness of health and demand for quality beyond Tier I cities.

# of Nurses 9.8

1.5 1.5 Glob. Avg. India China

India health insurance coverage

3.3 1.6 Glob. Avg.

US

India China

US

CHCs

78%

68%

India China

6 Tracxn 7 IRDA Annual Report, 2014 - 15 8 Rural Health Statistics - National Health Mission 9 IFC Report - 2015 10 NSSO – 68th Round, 2011-12

5,396

153,655

Target: 29,337

7,322

179,240

A B B R E V I AT I O N S CAGR – Compound Annual Growth Rate CHCs – Community Health Centers DALY – Disability-Adjusted Life Years NCD – Noncommunicable Diseases PHCs – Primary Health Centers

RMNCH – Reproductive, maternal, newborn and child health ROI – Return on Investment RSBY – Rashtriya Swasthya Bima Yojana

PRIVATE INVESTMENTS IN HEALTHCARE LIFE SCIENCES (HCLS), N 5, 6 $.5

2013

$1.0

Neonatal Disorders**

61.7

Other Non-Communicable

34.3

5

Chronic Respiratory

31.1

6

Diabetes, Urogenital, Blood, and Endocrine Diseases

30.3

7

Mental and Substance Abuse

26.5

8

Musculoskeletal Disorders

25.1

9

HIV/AIDS & Tuberculosis**

23.3

10

Unintentional Injuries

23.2

(includes diseases such as renal failure, congenital disorders, etc.)

$1.31

-24% 14% 7% 23% 21% 25% -26% -12%

210–220

18% Gov’t Schemes including RSBY

5 1990

1% Family/Floater Schemes

SEGMENTATION OF PRIVATE INVESTMENTS IN HC

$1.6BN

30 Disc. & Patient Mgmt Pharmacy Home Healthcare Telemedicine Monitoring Others

60

90

13% Pharmaceuticals

50

(Primary to Tertiary)

2015

4% Diagnostics 4% Med-Tech 3% Insurance

2010

2020

5% Others

18% CAGR

H E A LT H T E C H S TA R T- U P S GAINING TRACTION*

120 $102

$51

$8

150

10

$131

$25 $21

71% Healthcare Delivery

22 2000

13% CAGR

FUNDING TO CONSUMER HEALTHCARE START-UPS ( )6

18.2% Hospitals 9.6% Diagnostics 5.3% Devices 1.1% Biotech 1.1% Wellness 15.1% Others

200

90–100 100 66

27% private companies

1% Inidividual Schemes

Startup ecosystem

48.6% Pharma

INSURED BY

(exc. Gov’t)

80%

$1.5

$1.6 2015

3 4

3

4% Group Schemes

(India only)

Sub-Centers

Functional: 25,308

~1.2BN PEOPLE

2 World Bank Database Institute for Health Metrics & Evaluation Fitch, Crisil, CII Healthcare Report WHO Database KPMG Report

65.6

22% -34%

73% public companies

REFERENCES 1 2 3 4 5

Diarrhea, Lower Respiratory, and other infectious diseases**

7

76% UNINSURED 24% INSURED

10 8 6 4 2

INFRASTRUCTURE SHORTFALL (2015 - AS OF 03/2015) PHCs

65.8

# of Hospital Beds

1.7

0.7

US

Cardiovascular Diseases

Capacity data per 1,000 people

# of Physicians

2.5

DA LY

** Communicable, maternal perinatal, & nutritional. All others are non-communicable.

* Life expectancy data – 2000 and 2014

1,8

D I S E AS E AR E AS

2

50

INFANT MORTALITY 100

1

100

91

50

$9,403

As % of Gov’t Spend

2000

Total years

2

Cumulative funding in Health Tech (2009–16): ~$560MM Funding in 2015–16: MM ) ~56% of total ($311 (100+ health-tech startups in 2016)

Largest sub-sector: Consumer Health (60%) Key services: home healthcare, online discovery, and online pharma delivery * Health Tech includes consumer health, health enterprises, and medical devices; excludes hospitals, clinics & labs, pharma.