Telemedicine, despite being an old subject, is presently receiving a huge push from government to address the healthcare inadequacy in India. The speciality health infrastructure is a need of the hour and presents an opportunity for telecom vendors, healthcare providers and policy makers to provide healthcare to masses. This document identifies the opportunity in telemedicine and indicates the efforts so far.

1. Telemedicine: An opportunity in Healthcare Amit Bhargava Feb 2010

2. Executive Summary India with its vast population, of which 70% are poor and often live in difficult to reach and inhospitable terrain, along with inadequate healthcare network faces a daunting challenge of providing quality healthcare to its citizens. Here, the average per capita spend on healthcare is one of the lowest in the world and various healthcare indicators are also lower than the global average. In order to provide quality and affordable healthcare to all, Telemedicine – the use of telecommunications to improve patients health status by exchanging medical information from one site to another, has provided an impetus to the government’s vision of quality health for all by helping in delivering quality healthcare and in controlling the spiralling medical costs. With Telemedicine, more than 300,000 people have already benefited. Telemedicine in India has a market of more than $500mn and has been implemented in places far and wide under the Public-Private Partnership (PPP) model. As the reach of Telemedicine increases, the market for medical diagnostic, healthcare providers, drug manufactures, telecom equipment manufacturers, software vendors is bound to increase. Telemedicine, however is not a panacea for Indian healthcare problems. It is instead a great facilitator in bridging the healthcare divide, representing an early opportunity in the sector which has 5.2% share in the Indian GDP. The future for Telemedicine at the moment looks promising with governmental backing and private initiative. An early move by private enterprise in PPP is highly recommended in the sector.

3. Telemedicine in India Stakeholders in a Telemedicine Network The Market Opportunity Current Challenges, Future drivers and Risks Conclusion

4. Indian Healthcare is city centric The Indian healthcare services are highly skewed in favour of urban population, which is 28% of Indian population Population deprived of primary health care – 700+ million Specialist healthcare providers in urban areas – 70% Allopathic doctors available per 1000 of population – 0.6 Doctors available per 1000 of urban population – 2.97 Doctors available per 1000 of rural population – 0.50 Relative cost of setting a 100 bed primary care hospital to a tertiary care super-speciality hospital – 1/10 Spend on healthcare as % of GDP – 5.2 Governmental spend on healthcare as % of GDP – 0.9

5. Telemedicine in India 11th Five-Year plan allocates priority for providing accessible health care to rural population using existing fibre optic and satellite infrastructure With the help of IT, satellite and fibre optic network, Telemedicine provides specialized healthcare to remote corners of country Telemedicine as a practice has been adopted by both – private and public sector healthcare providers Public healthcare network using Telemedicine consists of 42 super-specialty hospitals with 8 mobile vans and 200 rural and remote hospitals 300,000 people have benefitted from the Telemedicine network Telemedicine at present is mainly used for non-invasive and non-surgical diagnosis and treatment Telemedicine is making healthcare financially viable to non-insured and poor people

7. Lack of disease management framework

8. Lack of healthcare facilities in far-off regions

9. Reduced technology cost and availability of qualified technical personnel

10. Shortage of qualified medical professionals

11. Increased governmental focus on healthcare for all

12. Urban-Rural divide causing disparity in medical facilities

13. Dedicated satellite for health communications from ISRO

14. Growth of Information and Communications Technology (ICT) as a sector

15. National Telemedicine Grid to connect practitioners and institutions

18. Department of Information Technology, GoI

19. State Government, which manages hospitals in district and remote places

20. Satellite bandwidth provider – ISRO

21. Medical Education provider – AIIMS, SGPGI, Medical Colleges across India

22. Healthcare providers - Apollo Hospitals, AIIMS, Asian Heart Foundation, NarayanaHrudalya, Amrita Institute of Medical Sciences, District hospitals

23. Telemedicine software provider – C-DAC, Televital, Apollo Telemedicine Networking Foundation

24. Medical equipment providers – Wipro GE Healthcare, Siemens, Philips

25. Telecommunications equipment providers – VTEL, Cisco, Ericson

27. Varying local cost factors

28. Ability of public bodies to subsidize the input cost

29. As a policy ISRO provides free satellite bandwidth for TelemedicineSpecialist console (Telemedicine setup adapted from “Telemedicine in India: Initiatives and Perspective” B.S.Bedi, Senior Director, Department of IT)

30. Telemedicine in India Stakeholders in a Telemedicine Network The Market Opportunity Current Challenges, Future drivers and Risks Conclusion

32. With CAGR of 19% from 2005, global market opportunity for Telemedicine by 2015 stands at - $18bn

33. The Indian Telemedicine market potential in 2007 - $500mn

34. Revenue from Indian Telemedicine market in 2007 - $50mn

35. Telemedicine provides multiplier effect on ancillary industries creating new opportunities for

36. Medical consumables

37. Medical equipments

38. Drugs

40. Various state governments under National Rural Health Mission (NRHM) have begun implementing Telemedicine network

41. States such as Andhra Pradesh, Karnataka, Chattisgarh, Rajasthan and Kerala have all district covered under Telemedicine network

42. States such as Haryana, Madhya Pradesh, J&K, Punjab including North East states have taken to Telemedicine in big way.

43. Under NRHM, government has allocated a budget of Rs. 10 million per annum for each state to increase Telemedicine nodes at district level.

44. Telemedicine network under the eHealth initiatives has been put to use to provide Continual Medical Education (CME) for doctors and nurses

47. With increased disposable income, lifestyle changes are leading to more chronic ailments putting further pressure on healthcare infrastructure

48. Telemedicine provisioning is a competitive advantage for healthcare providers

49. Availability of affordable technology to aid penetration far and wide

50. Shortage of trained healthcare professionals forcing better management of healthcare resources

51. Increasing ageing population that is unable to reach for consultation

52. Factors constraining adoption of Telemedicine

53. Policy issues about the CME of doctors at Medical Colleges

54. Lack of trained manpower to support Telemedicine

55. Interoperability of various software and hardware systems

57. Technology is making tremendous impact on healthcare Healthcare in India is in the midst of a major market transition and technology is definitely making a tremendous impact on the way healthcare is delivered. Telemedicine, despite being in practice from a very long time in forms such as health consultation over telephone, has recently seen lot of action and development. Government has long realised that given the constraints, it is difficult to reach everyone to provide quality healthcare. The PPP model in Telemedicine is helping in delivering quality healthcare to wider set of citizens who earlier could not be reached. The development in various fields including telecommunications, Information Technology have further aided in providing healthcare to the poor and the needy, which in turn is creating new market opportunities for the market players. The urban population has always had the benefit of specialist healthcare, Telemedicine is fulfilling the promise for rural population as well.