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Mumbai in need of Renaissance

Mumbai was once known as the Mecca for all kinds of medical aid and its healthcare sector has seen many days of glory. However today the scenario is different. Raelene Kambli takes you through the highs and lows of its trade cycle and urges for a dramatic transformation.

Mumbai! The city that never sleeps has many interesting stories to tell, of poverty and riches, successes and failure, courage and conformity, all of which makes it a fascinating city in its own right.

Born out of seven pieces of marshy islands, reclaimed from the choppy waters of the Arabian Sea, the city was groomed by a progressing India. In the course of time, the city evolved radically in all spheres of life, with business in the spotlight. Slowly, all the major industries established their foothold here. With rapid industrial development taking place in the other parts of the country, many of these industries moved their bases out of Mumbai, leaving behind the film industry, real estate and the healthcare sector to thrive here.

The evolution...

Speaking of the healthcare sector, it is important to note that this sector shares a strong bond with the history of this enchanting city. Mumbai's healthcare sector characterises the evolution of modern medicine in India. Its journey began way back, during the British era, when Sir Robert Grant became the Governor of Bombay. During those days there were no proper medical aid available in this part of the country. Sir Grant was deeply touched by the vast number of people who died for want of proper medical care. Thus in 1845, Mumbai's first hospital and research institute- Grant Medical College (GMC) and Sir J.J. Hospital was established. The establishment of this hospital brought great respite to the inhabitants. Later, the Bai Motlibai Wadia Hospital, Cama Hospital and Albless Hospital were established to provide sufficient medical aid. As the city developed further the needs for hospitals increased. In 1926, one of India’s most premium medical institute- King Edward Memorial (KEM) Hospital was set up to cater to the immigrants who came to Mumbai in large numbers from other parts of the country. At this juncture, healthcare delivery was the sole responsibility of the government. The state government delivered healthcare mainly through three major multi-speciality hospitals: J J Hospital, KEM Hospital, Parel and Lokmanya Tilak Municipal General Hospital, Sion. The rest was managed by primary healthcare centres and family physicians.

And the revolution began....

The 1960s saw a new wave. The healthcare sector in Mumbai moved from individual doctor-driven practices to institutionalised care delivery. Several charitable trusts came forward to establish hospitals and medical educational institutes. This change also marked the entry of the private sector in the field of healthcare. Mumbai became a leading city in terms of healthcare facilities and medical education. During this era, the city recorded the maximum number of hospitals.

The time between 1970-2000, Mumbai's healthcare sector reached at the peak of success. One can call this era as the period of healthcare revolution within the city. Mumbai, became a preferred healthcare destination. The city attracted patients from Rajasthan, Gujarat, and other northern states of India. The sector was dominated by private trust hospitals, leaving behind the government-run hospitals which by this time had reached stagnation. Some of the leading trust hospitals who continue to be the vanguards of healthcare transformation in Mumbai are, Bombay Hospital. Jaslok Hospital, Tata Memorial and Research Institute, PD Hinduja Hospital, Breach Candy Hospital, Holy Family Hospital so on and so forth.

Winds of change

The new millennium ushered the winds of change for Mumbai's healthcare sector with the emergence of stand-alone medical centres and corporate hospitals. During this phase, the sector witnessed a rush of healthcare providers who flocked to Mumbai in order to set up super-speciality hospitals. Major corporate players who entered the market at this time were, Lilavati Hosptial, LH Hiranandani hospital, Asian Heart Institute, Wockhardt Hospital, Apollo Hospitals, Fortis Group of Hospitals, Saifee Hosptial, RG Stone, Kokilaben Dhirubhai Ambani Hospital and Medical Research, Nova Medical Centre, Cumballa Hill Hospital, etc. These players brought in the corporate revolution within the sector which made Mumbai stand out in the crowd. The city was positioned to be much ahead of other cities in the country in terms of pioneering clinical practices, incorporating technological advancements, and very importantly, considering healthcare delivery as a business proposition.

The increasing corporatisation of hospital groups, promotion of medical tourism and increasing consumerism within the industry became the key drivers for growth. This in turn, propelled hospitals to resort to marketing and branding themselves as models of excellence that provide high standard of care to their patients. Five-star, uber-luxe hospitals were constantly in the news. From politicians to film stars and the nouveau riche, everyone checked in at these highly recommended hospitals for their world-class, state-of-the-art healthcare facilities.

In the last 10 years

So far so good! However, after experiencing a northward incline for almost three decades, the healthcare sector in Mumbai reached a plateau. Currently, the sector seems to be gripped by many challenges that could be nocent for its future augmentation. Expressing his views on the present scenario, Dr Rana Mehta, Executive Director, Healthcare, PWC says,“In the last 10 years the hospital sector in Mumbai has seen little activity. There are few entrants in the business. This is mainly due to exorbitant real estates prices in Mumbai which make it extremely difficult for private sector players to do viable business. Moreover, finding an appropriate piece of land in Mumbai to construct a hospital is another issue." “Entrepreneurs find it extremely difficult to make a project viable or sustainable due to the high real estate cost,” reiterates Joy Chakraborty, Director – Administration, PD Hinduja Hospital. Likewise, Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital and Medical Research, feels that the mounting land prices in Mumbai will act as a barrier in attracting new players in the market.

What’s more, high land cost is one of the key factors for rising healthcare costs in Mumbai. The debt that hospitals bear for acquiring land makes it extremely difficult for them to provide medical services at a lower cost. The other major road block is disproportionate distribution of healthcare services within the city.

Throwing some light on the issue related to distribution of healthcare, Dr Narain, discloses,“Hospitals and medical centres in Mumbai are clustered in the southern parts of the city making it very difficult for Mumbaikars living in the suburbs to seek these services.” Dr Mehta informs that studies conducted by the PWC indicate that the bed-to-patient ratio in the south is seven per 1000 beds, but in the north it is two per 1000 beds. This creates a divide of healthcare facilities within the city. Moreover, the cost of creating a bed is high in Mumbai when compared to the other parts of the country.

Chakraborty also agrees that distribution of healthcare facilities is not very homogeneous across the geographical territory of the city. He also highlights the other challenges in Mumbai’s healthcare sector and says, “Availability of trained human resource is another area to be looked into carefully. Even though corporatisation of healthcare is happening, many facilities are not able to come up further due to shortage of this resource. Probably the other issue that needs to be attended through regulatory mechanism is standardisation of infrastructure support and care delivery process.” Furthermore, the quest to be the best model of healthcare delivery in the city has coaxed hospitals to adopt high-end technology that at times may not be necessary.

High-end technology involves a lot of investments and if the returns on investment is not achieved at the right time, the hospital could run into a loss. Dr Narain urges hospitals in Mumbai to be very careful while selecting their medical equipment and technology. He goes on to say, “It’s time to think what kind of technology is actually needed for a particular hospital setting. Before making your choice, evaluate the technology and its usage in your hospital setting. It is important to position yourself in the right direction in order to run a viable business model.”

In addition to all the market impediments, the healthcare sector within the city also confronts the challenge of dealing with increasing disease burden of non-communicable diseases such as diabetes, CVDs, breast cancer as well as other ailments like malaria, dengue, tuberculosis and asthma.

With too many obstacles in its path, some experts feel that this could lead to the descent of Mumbai's healthcare sector. “Mumbai was probably the best centre for healthcare in India but others are now catching up, especially Delhi, Bengaluru and Chennai,” opines Shantanu Deb Mookerjea, Executive Director – Equity, LSI Financial Services. Dr Narain also believes that metropolitan cities like Delhi, Chennai, Hyderabad and Bangalore have stolen the medical tourism market from Mumbai. Besides these metro cities, tier II cities of Maharashtra like Kolhapur, Solapur, Ahmednagar, Nagpur, Jalgaon etc are also catching up with Mumbai.

In pursuit of prosperity

The road ahead seems to have many stumbling blocks, but the city's healthcare players look at this situation in a different light. The healthcare providers are certain that if there is a challenge at hand then they will certainly find its solution as well. Dr Narain feels that the industry needs to find a mechanism which can bring down the cost of land. He prescribes, “In Mumbai, Brihanmumbai Municipal Corporation (BMC) offers long term leasing facilities to hospitals on certain conditions such as offering some percentage of benefits to poor patients. I think the private sector players can opt for land on lease adhering to the terms and conditions set by the Corporation. It has to be a win-win situation for both parties”. In order to deal with the high cost of land, Dr Sujit Chatterjee, CEO, Dr LH Hiranandani Hospital recommends that cost containment has to be done through new business models such as collaborative healthcare. Dr Narain also agrees that the industry should try and explore the public private partnership (PPP) model in Mumbai. Dr Sanjay Arora, MD, Suburban Diagnostics sees consolidation between healthcare providers as a good option, “There is large amount of consolidation happening in India. Maximum consolidation is taking place in diagnostics and pharma sector. It offers huge opportunity to players on both sides to be part of a large organised structure. Healthcare players in Mumbai can explore this area,” he states. “This can be done through a collaboration between real estate developers and hospital owners where the hospital will be developed by the real estate entity and the same will be run by the hospital as they have the proper domain knowledge. This model is working well in Delhi and Bengaluru,” chips in Mookerjea.

To tackle the manpower problem, Dr Chatterjee suggests that the nursing staff must get a unique identity, as in the West. He further says, “It's not only money that causes them to go elsewhere but the recognition that they are an integral part of the whole team. While the doctor is the captain of the team as a whole, the nurse should be the in-charge of the ward, the one who follows the ward processes and the one who has the authority and the responsibility to correct anyone who does not toe the ward rules. The nurse will then develop the leadership that is required of her and a number of tasks that a doctor does today will be done by the nurse. This will give doctors more time with patients.”

Dr Sunita Dube, President, Medscape India urges the industry to focus on single speciality set ups and to come up with new healthcare delivery models that can meet the demands of the citizens. Citing the examples of Dr Batra’s Clinics, Kaya Skin Clinics, Talwalkars Wellness Centres, Nova Medical Centres etc., she speaks of creating brands that can provide focussed care that is packaged well to suit the needs of its customers.

Dr Narain also vouches for new business models like Healthspring Community Healthcare Centres, hub and spoke models and other disease management models which are quite capable of creating a niche segment within the industry. He also points out that major tertiary care providers need to focus on complex medical cases, shifting the burden of primary and secondary care delivery to stand-alone healthcare set ups in order to synchronise care delivery among all healthcare providers within the city.

All these recommendations will help clear the clouds that have shadowed the industry; but a little backing from the government will fasten the progress.

“The government of Maharashtra needs to enforce a time frame for infrastructure projects in Mumbai. A well-known housing complex in Kandivali, a very huge infrastructure project, has a binding as per government rule to establish a hospital within the residential complex. The residential complex has been up and running since a very long time but there is no sign of a hospital within the complex. There are many such infrastructure projects that fail to deliver their responsibilities on time. The state needs to look into such matter,” informs an industry source who does not wish to be named.

New entrants

Although the current healthcare scenario within the city appears to be sluggish there are some new players who will soon enter the market. Global Hospital, Lower Parel is slated for a full launch in mid-November and Parkway Khubchandani Hospital, Juhu will be commencing their operations in few months time. Sahyadri Hospitals and Raptakos Brett, a leading nutraceuticals company also plan to set up their healthcare facilities in Mumbai. On the government front, there are plans to set up a tertiary care hospitals in the western suburbs of the city.

In hope of a new dawn

Moving forward, the healthcare players in Mumbai will have to break all jinxes that surrounds the sector. It is time for the city to rise up and take steps to herald the transformation which would again put Mumbai’s healthcare sector on the forefront. Market players will have to shift their focus from South Mumbai towards the northern and eastern suburbs. Experts feels that places like Andheri, Mira-Bhayander, Vasai, Malad, Borivali, Navi Mumbai and Vashi can become the next healthcare hot spots in Mumbai. In these areas, the lands prices are better priced as compared to South Mumbai and have much scope for growth.

But after all that is said and done, it is Mumbai Meri Jaan. Let's hope that the famous 'never say die' spirit of Mumbai prevails and helps its torch bearers to bring in the much needed renaissance in healthcare.

raelene.kambli@expressindia.com

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