|
but for whom, ask analysts, as investors and
the corporate medical sector gear up to pour
money into medical cities. Radhieka Pandeya
does some crystal-gazing. |
|
|
|
In August 1883, the quiet American city of
Rochester came tumbling down under a
tornado. As 24 people breathed their last,
40 others were left gasping for breath and
medical care. The disaster gave birth to an
idea, an idea that became a dream for Dr
William Worrall Mayo — to give Rochester its
first hospital. |
|
|
|
Six years later, the dream came to life and
in September 1889, under the watchful eye of
Dr Mayo, Saint Marys Hospital opened its
doors to the public. As decades passed, the
hospital spilled over into an institution
and a research and development centre,
giving America and the world one of its
largest, most prestigious medical cities —
the Mayo Clinic. |
|
|
|
A century after the inception of the clinic,
a young Indian doctor practicing in America
also began nurturing a dream. He wanted to
create in India the same standard of
healthcare, training and research that he
saw in America, to build in India the Mayo
Clinic of the East. |
|
|
|
In 2004, almost 20 years after his return
from America, popular (and now
controversial) heart surgeon Dr Naresh
Trehan and president of the Indian
Healthcare Federation announced his
ambitious project — the Rs 1,250 crore
MediCity coming up in Gurgaon. Enough ink
has already been spilt on Trehan’s
ignominious exit from the Escorts Heart
Institute and Research Centre (EHIRC), but
for a huge country like India with
healthcare the current buzz, it is hardly
surprising that medical and health cities
seem to be surfacing on the horizon.
|
|
|
|
Six months ago the Aditya Birla Memorial
Hospital started near Pune, last month Dr
Pratap C Reddy swung the doors open to the
Apollo Health City in Hyderabad, and at the
same time Shivinder M Singh began work on
two Fortis Medicities, one in Gurgaon and
another in Lucknow, with the promise of
eight more in the pipeline. |
|
|
|
The concept of a medical or health city
stands unprecedented in India. Not
surprisingly, it is often a misunderstood
term. A cluster of hospitals, a holistic
healthcare centre, a large hospital sprawled
across acres of land? Certainly.
|
|
|
|
But it doesn’t end here. In simpler terms,
the difference between a hospital and a
medical city is as vast as the difference
between a corner shop and a megastore… What
you won’t find at the shop, you will be
certain to get at the store. |
|
|
|
In what could be the beginning of a medical
renaissance, medical cities could change the
way medical education and research and
development is conducted in India, taking it
from public to private to corporate. For
Trehan, a medical city translates into an
institution that has the resources and
excellence to take clinical treatment out of
operation theatres and into classrooms and
laboratories. |
|
|
|
“It is an institution of the calibre to
train people from the level of a medical
school right to the end… the highest level
of medical education. But this needs to be
done through the highest level of faculty,
which is not only into practicing medicine
but equally involved in teaching and
research.” |
|
|
|
Institutions like the All India Institute of
Medical Sciences in Delhi, Christian Medical
College in Vellore and Maulana Azad Medical
College in Delhi have been pockets of
excellence in teaching and research in the
country. Until 2005, India had only 229
medical colleges of which 106 were
established through the private route with
Manipal Hospital in Bangalore towering above
the rest for its excellence in research,
especially stem cell research. |
|
|
|
But despite these institutions, with only
25,000 medical graduates each year, the
Indian ratio of doctors to population stands
small at 0.6 doctors per 1,000 people, the
world average being 1.8 per 1,000. This
translates into an immediate need of another
12-13 lakh doctors, a gap so vast it will
take decades to fill. A glimmer of hope now
flickers in plans that lie atop the tables
of medical India’s corporate world and
within bricks of foundation that have been
laid to mark medical city projects.
|
|
|
|
On top of EHIRC and Fortis Healthcare
managing director Shivinder M Singh’s office
table lie plans for not one but 10 medical
cities that will take shape over the next 10
years. Promising to generate over 10,000
medical graduates each year from each campus
and directly generating 30,000 jobs through
his medical city projects, Singh is running
hard to meet India’s requirement for
doctors. He too takes inspiration from the
Mayo Clinic and the Cleveland Clinic and
strives to create a campus that is complete
in itself. |
|
|
|
“Our medical cities will have an education
campus, research facility and multiple
disciplines. The intention is to have a
multi-super-speciality hospital with
expertise in 20 medical disciplines and 8-10
sub-specialties in each. We won’t have
laboratory research. We will take our
research out of the lab and put it to
practical application,” he explains. Singh’s
enormous project coming up in Gurgaon will
see an investment of over Rs 1,200 crore
with a 600-800-bed hospital at the education
campus alone besides the beds at the
multi-super-speciality hospital.
|
|
|
|
In the south, Dr Pratap Reddy’s Apollo
Hospitals Enterprise Limited took Rs 1,000
crore out of its pocket to launch the Health
City — a project that marries allopathic
medicine with alternative medicine in an
attempt to usher in the concept of holistic
healthcare under one roof. Unlike Trehan and
Singh’s medical city projects that will
impart undergraduate and postgraduate
medical education, Reddy’s educational
institution will restrict itself to
postgraduate education for doctors under
Medical Council of India guidelines.
|
|
|
|
Dr Hari Prasad, chief executive officer,
Apollo Hospitals, says, “We have over 300
students in different courses and our
endeavour is to bring together the heavily
fragmented healthcare space. At the Health
City research and development will happen in
a clinical setting allowing both clinical
doctors and researchers to interact and take
from each other.” Having begun operations
last month, Reddy is already looking at
investing a further Rs 150 crore over the
next 18 months to increase the bed count and
the doctor count at the Health City.
|
|
|
|
Interestingly, the turn of the wheel of
thought has given birth to a unique concept
of research in each mind. Where research at
premier institutions like Harvard Medicine,
Johns Hopkins and Mayo Clinic continues to
redefine medical boundaries, the idea of
directly copying therapies, cures and
procedures from the West does not go down
well with Indians any longer. |
|
|
|
“We don’t have to copy everything that comes
out of the West because their gene pool is
different from ours,” stresses Trehan, “We
must develop our own therapies, our own R&D,
our own devices, so that medicine can be
custom made for Indians at lower costs.”
|
|
|
|
His own concept is unheard of. At his
MediCity, Trehan intends to combine modern
medicine, Ayurveda, homeopathy and Chinese
medicine to create what he calls “New Era
Medicine” — a more effective, less traumatic
cheaper form of treatment. With the planned
research, healthcare could bring a whole new
paradigm for patients too. |
|
|
|
The choices will only grow, and going by the
intended research and development, hope
could become a much-used word among doctors
and for patients. “Bench-to-bed” research,
as Prasad calls it, is the concept at Apollo
Health City where stem cell research will be
a major focus. The bench-to-bed format will
aim to bridge the gap between research labs
and patient beds, resulting in steady
delivery of healthcare. |
|
|
|
However, the big question that hangs above
these medical city projects is that of the
private healthcare cost advantage to
consumers. Institutions like the Mayo Clinic
have been modelled to be not-for-profit
healthcare providers because the patients
are being treated at a teaching hospital as
also because of funds available from
numerous foundations and grants.
|
|
|
|
Analjeet Singh, chairman and managing
director of Max Healthcare and ex-president
of CII, explains that when a patient seeks
medical treatment at a teaching hospital, he
pays little for it. But in a corporate
set-up like India’s, where foundations don’t
have enough money to invest in such
projects, the costs have to be borne by the
investor alone. |
|
|
|
Yet, L N Rawat, CEO, Aditya Birla Memorial
Hospital, claims his medical city is one of
the cheapest in private healthcare and
having filled 100 beds on a single day this
month at the in-patient department, there is
no dearth of consumers. |
|
|
|
Fortis’ Singh confirms that the cost of
healthcare at the medical colle ge campus of
his medical city will be lower but goes on
to add that “the campus won’t make any
profit, but at the same time it isn’t a
charity initiative” . Trehan agrees but
furthers that healthcare should not make
huge profits. It should make modest profits.
|
|
|
|
Despite assuring a definite decline in the
cost of healthcare at his MediCity as
compared to that at corporate hospitals,
Trehan is certain that his model will make
profits because “if you offer treatment at a
reasonable price, you will do large volumes
and make money as a result”. |
|
|
|
But industry watchers are still doubtful
that healthcare costs will decrease. Utkarsh
Palnitkar, partner, transaction advisory
services, Ernst & Young, says, “The medical
cities might even translate into higher
costs of healthcare for the consumer.” Dr
Rana Mehta, vice president for healthcare at
management consulting firm Technopak,
agrees. |
|
|
|
“Since the investment will be by corporates
alone, costs might not come down at all.”
Apollo’s Prasad admits that at the Health
City, cost of healthcare remains parallel to
the cost at any other Apollo hospital.
|
|
|
|
Medical cities are marked by mammoth
investment and long gestation periods. The
gestation period can squeeze a lot of money
out of the investor without offering much in
return. “Here,” explains Palnitkar, “the
investor needs to look at a de-risking
model. This could either be done through
leasing or forming strategic alliances.”
|
|
|
|
Fortis thus signed an agreement with real
estate developer Ansal API to set up a
52-acre medical city in Lucknow at an
investment between Rs 500-800 crore. The
project, owing to its proximity to the
airport, hopes to attract medical tourism as
well. |
|
|
|
Kunal Banerjee, vice president for marketing
with Ansal API, explains, “The medical city
will be complemented by a hotel and a
country club, so there is enough
infrastructure to promote medical tourism.”
|
|
|
|
GE Healthcare, a medical technology and
equipment developer, also collaborated with
Trehan’s Medicity for developing diagnostic
and R&D facility. But Max’s Singh warns,
“The question is who the stakeholders are
and what their expectations are. As a
profit-making proposition, it isn’t a good
model but if the motive is creating a talent
and research pool, then it is excellent.”
|
|
|
|
At the same time, industry insiders and
analysts admit that there will be no
shortage of consumers. “Growing
urbanisation, consumerism and accountability
brought in by brand equity will make sure
that private medical facilities continue to
do good business because consumers now want
facilities that are better than the best,”
says Mehta. |
|
|
|
The trend can be related with the growth in
the health insurance market. At about 30 per
cent CAGR in terms of collection of premium
for health insurance, the growth is faster
than anticipated. |
|
|
|
Medical cities may be the next ideal step
towards building India’s healthcare and
medical expertise, but the numbers are still
insufficient. Even under the current,
growing corporate set-up, a Technopak report
points out that almost 90 per cent of the
private healthcare is being serviced by an
unorganised sector. |
|
|
The need is to take India’s current ratio of
1.5 beds per 1,000 people to the world
average of four beds per 1,000. Though this
could be done through a trickle-down effect,
Mehta believes that it would also require a
bottoms-up approach, which would entail
starting smaller medicity formats in
tier-three cities. Trehan also admits that
the way forward is by coming up with a new
paradigm and newer cures, and “we will have
a small role to play in it”.
|
|
|
|
UP AND COMING MEDICAL CITY PROJECTS
|
|
|
Naresh Trehan’s MediCity
The Rs 1,200 crore project in Gurgaon spread
over 93 acres will consist of a 1,600-bed
hospital with a complete biotechnology
backup and R&D facility. It will have major
undergraduate and postgraduate institutions
for cardiology, oncology, bone and joint,
neurosciences, regenerative medicine and
trauma care. |
|
|
Fortis Medicity
At an investment of over Rs 1,200 crore, the
project in Gurgaon will have two campuses.
The hospital campus will have a high-end,
multi-super-speciality hospital and research
centre. The college campus will boast of a
medical college for undergraduate and
postgraduate education, a dental college,
nursing college and facility for primary and
applied research in medicine along with a
600-800-bed hospital. |
|
|
|
Spread over 52 acres, the project in Lucknow
will see an investment between Rs 500 and Rs
800 crore. It will have an 800-bed hospital,
a medical college offering undergraduate,
postgraduate and post doctoral courses, a
dental college, nursing college, college of
physical medicine and rehabilitation,
college of rehabilitative medicine and a
college of allied medical science.
|
|
|
Apollo Health City
At an investment of Rs 1,000 crore, this
33-acre project in Hyderabad will not impart
undergraduate education. However, it has a
postgraduate college for doctors, a nursing
school and college, college of
physiotherapy, institute of hospital
administration, institute of medical
informatics, institute for emergency
medicine and an institute for paramedics.
The hospital has 500 beds and almost 200
more will be added over the next six months
|
|
|
MIOT medical city
Founder of the MIOT hospitals, Prof Dr P V A
Mohandas plans to set up a multi-speciality
medical city. |
|
|
Dhirubhai Ambani Health City
Reliance Anil Dhirubhai Ambani Group has
expressed interest in building a 60-acre
health city in Kolkata. |
|
|
CMC Ajit Singh lottey medicity
A sister concern of the famous CMC, Vellore,
the Christian Medical College and Hospital
at Ludhiana has initiated a Rs 50 crore
medicity project in Ludhiana. The project
will have a general and speciality hospital
and an education institute. However, lack of
funds and other hurdles have currently
stalled it. |
