Tech-enabled remote care services
Tech-enabled remote care services
Business Model Description
Scalable mobile-based software solutions and workforce models that allow for remote/at-home medical consultation and symptom-management for chronic diseases. Telemedicine will provide low-cost diagnosis and remote patient care-management services leveraging the growing mobile phone penetration and internet connectivity in India.
Expected Impact
Improvement in chronic disease management, especially for populations in peri-urban and rural areas, through low cost, high quality, telemedicine/digi-healthcare services.
How is this information gathered?
Investment opportunities with potential to contribute to sustainable development are based on country-level SDG Investor Maps.
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Country & Regions
- India: Countrywide
Sector Classification
Health Care
Development need
India ranked 145 among 195 countries in a Lancet study measuring Healthcare quality and access. (2.1) India's progress on SDGs 3 (Good Health and Well-Being) was given a score of 61 on 100 on the SDG India Index as many States still lag behind on their health-related targets (2.2)
In 2017, India's Government Health Expenditure on healthcare was just 0.96% of GDP compared to the world average of 5.9% (2.5) While the expenditure increased to 1.28% of GDP in 2018, it still lags behind comparable countries (2.6) As a result, the private sector is the dominant healthcare provider in India (2.2)
Due to low government healthcare expenditure (2.5), and low insurance penetration (total insurance penetration in India was 3.69% in 2017 according to Insurance Regulatory And Development Authority Of India) (2.7), out-of-pocket expenditure accounts for 62.4% of healthcare expenditure in India compared to the world average of 18.2%. (2.8)
According to the NITI Aayog's State Health Index Report 2019 (Healthy States, Progressive India), the overall health index score of India's best-performing state is more than two and a half times as that of the bottom-most performer (2.2)
Policy priority
National Health Policy 2017 was introduced to lay out specific targets to increase life expectancy, reduce mortality rates and disease prevalence, ensure universal coverage of health services, increase healthcare financing, infrastructure and human resources and improve disease prevention and health information management efforts (2.11)
The Government of India (GOI) approved the continuation of National Health Mission with a budget of USD 4.88 billion under Union Budget 2020-21 (IBEF) The Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PMJAY), the largest government-funded healthcare programme targeting more than 500 million beneficiaries, was allocated USD 919.87 million (2.12)
Gender inequalities and marginalization issues
A lack of clear regulations has led to variation in quality and costs of private sector services. (2.2) As a result, out-of-pocket medical expenses were estimated to have pushed 55 million into poverty in 2011-2012 (2.9)
Investment opportunities introduction
Impact of COVID-19: COVID-19 has further highlighted the inadequacies of the healthcare system with respect to a lack of delivery capacity. As a result, healthcare has emerged as a priority area for the country is likely to remain a policy priority for the Government. Global disruptions in supply chains have also impacted the sector. As the country looks to "Make in India", there are likely to be a number of opportunities for local companies (2.13)
Key bottlenecks introduction
Low purchasing power among target communities and lack of insurance penetration.
Health Care Providers
Development need
A lack of both human and capital resources constrain healthcare delivery in India. In 2018, India had only 0.9 physicians for 1000 people (2.4).
Policy priority
Strong policy momentum driven by a number of strategic interventions in National Health Mission and the national disease control programmes (4.10)
Gender inequalities and marginalization issues
Nearly 75% of dispensaries, 60% of hospitals and 80% of doctors are located in urban areas, serving only 28 per cent of the Indian populace. (2.10)
Investment opportunities introduction
Telemedicine can bridge the rural-urban divide in terms of medical facilities and personnel, extending low-cost consultation and diagnosis facilities to the remotest of areas via internet and telecommunication. (5.4)
Key bottlenecks introduction
High cost of healthcare delivery due to unavailability of medical professionals, equipment import costs, infrastructure costs and cost of updating medical technologies.
Health Care Delivery
Pipeline Opportunity
Tech-enabled remote care services
Scalable mobile-based software solutions and workforce models that allow for remote/at-home medical consultation and symptom-management for chronic diseases. Telemedicine will provide low-cost diagnosis and remote patient care-management services leveraging the growing mobile phone penetration and internet connectivity in India.
Business Case
Market Size and Environment
< USD 50 million
20% - 25%
Telemedicine market in India is expected to rise at a CAGR of 20% during FY16-20, reaching USD 32 million by 2020 (5.4) The home healthcare market is estimated to reach USD 6.21 billion by 2020 from USD 4.46 billion at the end of 2018. (5.4)
Telemedicine market is also dependent upon the availability of digital infrastructure, especially among last mile consumers living in rural/remote areas. India has over 900 million mobile phone users and 452 million internet users (99% of internet users use mobile phones to access data) that opens up opportunities for digital healthcare products. (5.11)
Indicative Return
10% - 15%
Healthcare sector investments provided a 3x return and had an average holding period of 5.3 years between 2012-2018, which roughly translates to an IRR of 20-25% (5.9) 80% of the investors surveyed reported a median IRR of 10-20% in healthcare investments in India (5.10)
Industry experts suggest that telemedicine can offer returns on the higher end of the spectrum as it optimised on two major costs of providing healthcare services: staff availability and consequently salaries and infrastructure costs (5.6)
Investment Timeframe
Short Term (0–5 years)
The technology is readily available and major hospitals (Apollo Hospitals, All India Institute of Medical Sciences (AIIMS), Narayana Hrudayalaya) have adopted telemedicine services in a short period of time (5.4)
Acquiring patients and change user behavior to use online healthcare services requires market-building.
COVID-19 has helped telemedicine providers in market-building and enrolling patients on the platform, doubling the growth in the number of online consultations (5.12) Heath technology or HealthTech remains a significant short- to medium-term bet (5.12)
Telemedicine optimises on two major costs of providing healthcare services: staff availability and consequently salaries and infrastructure costs and can therefore offer a shorter break-even period once the adoption increases (5.6)
Ticket Size
For the healthcare sector, data from Praxis Global Alliance, 2019 shows that early stage investments stood at USD 41 million, growth stage investments stood at USD 359 million and late stage investments stood at USD 1,486 million. (7.7)
Market Risks & Scale Obstacles
Business - Business Model Unproven
Impact Case
Sustainable Development Need
In 2018, India had only 0.9 physicians for 1000 people(5.1). A large section of the population travels more than 100 km to access basic healthcare. (5.2) According to estimates, urban centres are home to almost 80% of the doctors despite having less than 30% of the total population (5.3) Telemedicine can bridge the rural-urban divide in terms of medical facilities and personnel, extending low-cost consultation and diagnosis facilities to the remotest of areas via internet and telecommunication. (5.4)
India's disease burden is shifting as non-communicable diseases (NCDs), including cardiovascular conditions, chronic obstructive respiratory diseases, diabetes, mental health conditions and cancers now the leading cause of health loss, with 55% morbidity and premature mortality attributable to these conditions (5.5) NCDs require prevention and early detection. Further chronic disease require consistent monitoring and prolonged treatment, they increasing the burden on the healthcare system (5.6) Out of the total population, the share of ageing population in 2011 was 5.3% and is expected to increase to 6% of the total population by 2021. With an increasingly ageing population, there will be greater demand for better health care facilities and medical devices (5.7)
Out of the total population, the share of ageing population in 2011 was 5.3% and is expected to increase to 6% of the total population by 2021. With an increasingly ageing population, there will be greater demand for better health care facilities and medical devices (5.7)
Gender & Marginalisation
Nearly 75% of dispensaries, 60% of hospitals and 80% of doctors are located in urban areas, serving only 28 per cent of the Indian populace. (2.10)
Expected Development Outcome
The business models under this IOA can potentially provide critical preventive, primary and secondary health care services to patients in parts of the country that are either remote and/or not covered adequately by the healthcare system. Reduce costs of access to primary healthcare, including waiting time and transport costs
Gender & Marginalisation
Primary SDGs addressed
3.4.1 Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease
3.8.1 Coverage of essential health services
3.8.2 Proportion of population with large household expenditures on health as a share of total household expenditure or income
Secondary SDGs addressed
Directly impacted stakeholders
Gender inequality and/or marginalization
Planet
Indirectly impacted stakeholders
Public sector
Outcome Risks
Telemedicine is a relatively new domain with nascent regulations and standards.
As the models continue to operate, new challenges may emerge with respect to data collection and quality of service.
Mobile-based vernacular platforms using low-bandwidth solutions have the highest potential to impact the most underserved communities in remote areas.
Patients from remote areas may have lower access to digital tools, lower healthcare awareness and may not adopt tech-based health platforms.
Impact Risks
While the model is proven in urban areas, external factors (limited connectivity and digital literacy of target populations) might limit the efficacy of service in more rural/remote areas.
Impact Classification
What
Healthcare provision through scalable online channels could include rural and remote populations into the healthcare system and reduce the impact of an unevenly distributed healthcare workforce.
Who
Populations in smaller cities and / or rural or remote areas of the country are underserved due to lack of healthcare coverage and/ or dearth of healthcare professionals.
Risk
While the model is proven in urban areas, external factors (limited connectivity and digital literacy of target populations) might limit the efficacy of service in more rural / remote areas.
Impact Thesis
Improvement in chronic disease management, especially for populations in peri-urban and rural areas, through low cost, high quality, telemedicine/digi-healthcare services.
Enabling Environment
Policy Environment
In light of the pandemic, the GOI introduced a number of initiatives to leverage the potential of digital healthcare: (5.12) (5.13) - introducing the Aarogya Setu (an open-source application for COVID-19 contact tracing, syndromic mapping and self-assessment) - revising the telemedicine practice guidelines to encourage the industry - promoting both the National eHealth Authority and e-Sanjeevani - an online OPD (Doctor-to-Patient), integrated telemedicine solution.
In March 2020, the Ministry of Health & Family Welfare launched National Teleconsultation Centre (CoNTeC) - a COVID-19 National Teleconsultation Centre (5.4) (5.14)
Through the State Telemedicine Network (STN), the states and union territories have been provided support under the National Health Mission (NHM) under Program Implementation Plan (PIP) to create a reliable, ubiquitous and high-speed network backbone for telemedicine (5.4)
Financial Environment
Financial incentives: The GoI is offering 250% deduction for approved expenditure incurred on operating technology enabling healthcare services such as telemedicine, remote radiology for making healthcare in remote areas accessible, affordable and of adequate quality standards (5.4)
Regulatory Environment
Ministry of Health and Family Welfare, NITI Aayog and the Medical Council of India formulate the Telemedicine Practice Guidelines, which govern telemedicine platforms in the country (5.15)
In March 2020, the government’s revised telemedicine guidelines were notified under the Indian Medical Council (Professional Conduct, Etiquette, and Ethics) Regulations, 2002. (5.16) The guidelines made relaxations to the Telemedicine Practice Guidelines and made it legal to provide teleconsultation by medical practitioners, with certain restrictions (5.17)
Marketplace Participants
Private Sector
Investors: Accel Partners; International Finance Corporation; QUALCOMM Ventures, Ventureast Fund Advisors, Sabre Partners, Sequoia Capital, Sofina, Matrix Partners India; Altimeter Capital Management, Tencent Holdings Investment Arm, CapitalG Management Company, RTP Global, Thrive Capital; Recruit Holdings Co. Investment Arm, IQGEN Holdings, Dream Incubator, Inventus Capital Partners; Chiratae Ventures India, Blume Venture Advisors, Sistema Asia Fund; Samsung NEXT; NB Ventures; Atlas Asset Management, Kotak Private Equity Group; DG Ventures, Tokio Marine Holdings, Mistletoe Inc., Trifecta Capital, DG Daiwa Ventures, Bessemer Venture Partners, Rebright Partners, Milliways Ventures, BACE Capital Partners; Omidyar Network, BabyTree Group, LGT Lightstone Aspada, SBI Investment Co., SBI Ven Capital Pte. Ltd., Prime Venture Partners, Beenext Pte. Ltd., Stellaris Venture Partners, Quadria Capital, Mahindra Partners; Eight Roads Ventures India invested in few of the largest deals in technology-enabled services vertical (5.18)
Private Sector
Corporations: Major hospitals (Apollo, AIIMS, Narayana Hrudayalaya) have adopted telemedicine services (5.4) Portea, CallHealth, Medwell Ventures and Healthcare at Home offer home healthcare services (5.12) A number of companies offer online consultations: Practo, Novocura Tech Health Services (mfine), DocPrime, DocsApp, Click2Clinic, iCliniq. Wellness start-up Cure.fit has introduced telemedicine services (5.6). Mobile labs and rapid testing: In April 2020, first COVID-19 sample collection mobile lab of the country, namely ‘Mobile BSL-3 VRDL Lab’, was launched (5.4) Expedient Healthcare Marketing Pvt. Ltd. operates an online healthcare platform in India for diagnostics and testing. Collaborations: In May 2019, NASSCOM and GE Healthcare entered into a partnership to develop digital healthcare solutions (5.4). Swasth is a not-for-profit, voluntary consortium of 100+ members representing stakeholders in the healthcare sectors that have come together to work in coordination with the government and the medical council to expand quality healthcare access to the masses (5.17)
Non-Profit
Indian Medical Association also governs the telemedicine providers. Teleconsultation Centre (CoNTeC) is a Telemedicine Hub established by the All India Institute of Medical Sciences. State Telemedicine Network (STN) was set up to provide the technological backbone for telemedicine (5.4)
Target Locations
India: Countrywide
References
- (2.1) https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30994-2/fulltext#seccestitle190
- (2.2) https://niti.gov.in/sites/default/files/2019-12/SDG-India-Index-2.0_27-Dec.pdf
- (2.3) https://in.one.un.org/page/sustainable-development-goals/sdg-3-2/
- (2.4) https://data.worldbank.org/indicator/SH.MED.PHYS.ZS
- (2.5) https://data.worldbank.org/indicator/SH.XPD.GHED.GE.ZS?view=chart
- (2.6) https://www.financialexpress.com/economy/india-spending-more-on-healthcare-now-but-yet-not-as-much-as-others-heres-how-much-us-china-spend/1922253/
- (2.7) https://data.worldbank.org/indicator/SH.XPD.OOPC.CH.ZS
- (2.8) https://www.irdai.gov.in/ADMINCMS/cms/whatsNew_Layout.aspx?page=PageNo3729&flag=1
- (2.9) https://bmjopen.bmj.com/content/8/5/e018020#DC1
- (2.10) https://www.indiaoppi.com/wp-content/uploads/2019/12/Report-on-healthcare-access-initiatives-For-web.pdf
- (2.11) https://www.nhp.gov.in/nhpfiles/national_health_policy_2017.pdf
- (2.12) Stakeholder Consultations
- (2.13) https://www.ibef.org/industry/healthcare-india.aspx
- (5.1) https://niti.gov.in/writereaddata/files/Strategy_for_New_India.pdf
- (5.2) http://www.businessworld.in/article/Providing-Affordable-Rural-Healthcare-Ecosystem-In-India-Is-Need-Of-The-Hour/25-05-2019-170968/
- (5.3) https://www.indiaoppi.com/wp-content/uploads/2019/12/Report-on-healthcare-access-initiatives-For-web.pdf
- (5.4) https://www.ibef.org/industry/healthcare-india.aspx
- (5.5) https://data.worldbank.org/indicator/SH.MED.PHYS.ZS
- (5.6) Stakeholder consultations
- (5.7) https://www.makeinindia.com/article/-/v/sector-survey-medical-devices
- (5.8) https://www.brookings.edu/blog/up-front/2020/03/24/is-indias-health-infrastructure-equipped-to-handle-an-epidemic/
- (5.9) https://www.bain.com/insights/india-private-equity-report-2019/
- (5.10) https://www.praxisga.com/press-releases/praxis-global-alliance/praxis-global-alliance-recent-report-healthcare-investor-sentiment-spotlight-2019-uncovers-investor-outlook-and-value-creation-opportunities-in-india
- (5.11) https://www.iamai.in/KnowledgeCentre[Digital in India 2019- Round 2 Report]
- (5.12) https://www.moneycontrol.com/news/trends/health-trends/digital-healthcare-gets-a-boost-during-covid-19-5373591.html
- (5.13) https://www.investindia.gov.in/team-india-blogs/e-sanjeevani-largest-online-opd-india
- (5.14) https://covid.aiims.edu/covid-19-national-teleconsultation-centre-91-9115444155/
- (5.15) https://mciindia.org/MCIRest/open/getDocument?path=/Documents/Public/Portal/LatestNews/Final_FAQ-TELEMEDICINE%20%206-4-2020..pdf
- (5.16) https://www.medianama.com/2020/03/223-summary-india-telemedicine-guidelines/
- (5.17) https://www.mohfw.gov.in/pdf/Telemedicine.pdf
- (5.18) S&P Capital IQ data