By Vanita Khetan
Introduction to Healthcare in India
Healthcare in India is typical to that of any developing country, characterized by combination of public-private, advanced-rudimentary and accessible-unavailable oxymorons.
High rural-urban ratio, innumerable geo-socio-cultural variables, high economic dependence on the monsoon, deficient infrastructure and of course core development issues like poverty, illiteracy and nutrition, characterize the Indian fabric. However, rapid urbanization, positive consumer outlook, increase in foreign exchange reserves do not bring significant panacea for Indian business.
Within healthcare, the national indicators mask the immense disparities. The combined investment in health by the Centre and State governments is just 1.3 percent of GDP. Reimbursement is negligible, though privatization of the insurance sector has helped.
Figure below numerates the Supply Side and Demand side issues being faced in the Indian Healthcare Scenario
SUPPLY SIDE ISSUES
DEMAND SIDE ISSUES
1. Prevalence and prioritization of basic health problems in reproductive health, immunization and communicable diseases leaves little room for else;
2. Vast diversities in demography, geography, weather, culture and economy making conflicting health-related demands, making monitoring, planning, implementation of concerted programs a daunting task;
3. Non-uniform supply of manpower / services / facilities / equipment / drugs;
4. Lack of financial muscle for R&D investment in both public & private sectors
5. Non-availability of cost-effective high-technology quality health solutions
1. Sub-optimal functioning of the system
2. Both accessibility and usage of services being the worst in critical areas.
3. Increasing plurality in disease burden (communicable and non-communicable diseases) as a result of ongoing demographic, lifestyle, and environmental transitions.
4. Ever-widening gap between availability and affordability due to complete lack of social security and inadequate coverage by insurance.
5. Lack of consumer and health awareness
6. Rife use of alternative medicine techniques, especially in rural / illiterate settings
Source: Frost & Sullivan
India’s 16,000 hospitals house over 900,000 beds, but 60% of these are in the public sector. This, at best, is inadequate and not maintained. The private healthcare sector is booming, even in the smaller towns, due to, or maybe leading to, increase in quackery and alternative medicine. Health surveillance, tracking & record-keeping loses out to basic priorities in healthcare.
Most among the populace have minimal accessibility or affordability for even basic healthcare. Low purchasing power, combined with low health protection, makes the Indian customer extremely price-sensitive. The doctors’ choice of products depends on the economic status of the patient. This patient has extremely low awareness about advancements in therapy or quality. Hence, usage of advanced techniques & products is very limited.
The Indian Wound Care market
This Rs. 521 crore market is a typical competitive market – products are available across a wide range of quality and price points.
The traditional wound care segment is the Goliath in Indian Wound care, what with products like cotton & gauze still ruling the roost. Swabs & dressings, and tapes make up the rest of it.
The Medical bandages & plaster segments has mostly orthopedic products like crepe & elastic adhesive bandages, and immobility products.
In a stark contrast to developed markets, the smallest segment in the Indian Wound care market is advanced wound care, consisting of high-technology products like hydrocolloid, hydrogel, alginate, foam, film & tulle dressings among other scar / burn management products.
There are a handful of organized companies in this market, namely 3M, Beiersdorf, Casil Health Products, Johnson & Johnson, Elder-Hartmann and Smith & Nephew.
All the other international brands (Coloplast, Convatec, Hollister, Lohmann & Rauscher and Molnlycke) are present indirectly, through large wholesalers. More players are entering the market through this route in the next few years.
But they are trounced hands down by the unorganized sector in both numbers as well as value. In fact, some of the unorganized players have a very significant presence in most of the traditional wound care & medical bandages segments.
The primary methods of sales are to hospitals through the wholesaler-stockist channel, or through institutional business. Promotion is primarily done only by the large players to doctors and purchase officers.
Moist wound care is not a well-known concept in India. The few doctors who are aware about it know it either by virtue of traveling abroad or by updating themselves with the latest. Advanced wound care products have a perception of high cost-low benefit products, and hence the use of traditional products like cotton and gauze is rampant. Counterfeit and local substitutes are easily available and there is continuous downward pressure on pricing. This further drives down the usage of advanced wound care products towards traditional wound care. However, the market scenario is changing, with increasing realization of the value of advanced wound care. For instance, already most of the hand-made plaster bandages have now been replaced with ready-to-use POP bandages. In fact, in many settings, even those are getting substituted with artificial casts.
The advanced wound care market in India definitely has many mountains to climb before it can overtake the huge traditional wound care market, as in developed countries. Vendors will need to educate the medical fraternity to make inroads. But only a reimbursement system can bring about the penetration levels seen in developed economies, and that, is unexpected in the foreseeable future.