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  • India’s healthcare growth is real - but the economics of large, bed-heavy hospitals are breaking down
  • Care delivery is decentralising toward asset-light networks, specialty platforms, and local access points
  • MedTech demand is fragmenting, shifting from capital intensity to utilisation-driven, modular models
  • Global incumbents misprice India by applying legacy playbooks to a structurally different care economy
  • If you can succeed in India today, you build the scalable, low-cost operating model that will shape how healthcare is delivered worldwide over the next 10 years

India and the End of the Fortress Hospital

Global MedTech is running out of easy growth. In the US and Europe - together ~73% of the global market - procedure volumes are maturing, capital replacement cycles are stretching, pricing pressure is intensifying, and incremental innovation is delivering smaller marginal gains. Post-pandemic growth has cooled sharply - falling from ~16% in 2021 to low single digits - while shareholder returns have lagged and scrutiny of R&D productivity has intensified. As a result, large diversified MedTechs are increasingly seen as operating in saturated markets with flattening growth profiles.

India has emerged as a prominent counter-narrative.

Now the world’s most populous country (>1.4B people), India is deep into an epidemiological transition toward non-communicable disorders - cardiovascular disease, cancer, diabetes, and chronic respiratory conditions - that directly drive demand for diagnostics, devices, implants, and monitoring technologies. At the same time, a rapidly expanding middle class with rising disposable incomes is increasing utilisation of private healthcare in a system where out-of-pocket spending remains high. On paper, India appears to offer what global MedTech needs most: scale, under penetration, and secular demand growth.

Supply-side signals point in the same direction. Estimates suggest private providers deliver ~70% of outpatient care and ~60% of inpatient care, with an outsized role in tertiary and quaternary services. In major urban centres, they are also the primary buyers - and fastest adopters - of advanced medical technologies. Taken together (and notwithstanding meaningful regional variation), this scale and purchasing power help explain why India features so prominently in boardroom growth narratives and long-range strategic plans across the sector.

But this enthusiasm rests on a flawed assumption: that MedTech growth in India will continue to track the expansion of large, urban, multi-specialty hospitals. That model is reaching its limits. India is no longer short of hospitals; it is short of productive hospitals - and the gap is widening.

A structural shift is underway in India’s hospital estate. Large 500+ bed “fortress hospitals,” once the backbone of private-sector expansion, are increasingly constrained by underutilisation, long breakeven periods, workforce shortages, and declining returns on capital. In contrast, asset light, technology-enabled hub-and-spoke networks - distributed, operationally integrated, and capital-efficient - are scaling faster, attracting investment, and capturing demand closer to where patients live. Growth is increasingly flowing toward models that minimise fixed assets, leverage partnerships, and use technology to expand reach and utilisation.

For US MedTech leaders, this is not a peripheral emerging-market nuance. It is a strategic inflection point. Whether India becomes a durable engine of value creation - or a large but structurally margin-dilutive market - will depend less on how big the opportunity is, and more on how the healthcare system scales from here.

 
In this Commentary

This Commentary examines how India’s healthcare system is structurally reshaping - and why legacy hospital-centric assumptions are becoming less relevant. It traces the shift toward decentralised, asset-light care models and the implications for MedTech demand, economics, and strategy. The core thesis is clear: India is forging new care architectures, and Western companies that adapt early will build advantages that extend beyond India's borders.
 
The Bed Count Fallacy

Over the past two decades, India has added substantial hospital capacity, driven primarily by private-sector expansion and the proliferation of large, multi-specialty tertiary hospitals. In Western board decks and investor presentations, this growth is often interpreted linearly: more beds imply more procedures, higher utilisation, and therefore rising MedTech demand. For executives accustomed to hospital systems in the US or Western Europe, this logic feels intuitive and transferable.

The reality in India, however, is more complex. Private providers account for ~60–65% of the country’s hospital beds, but this concentration of capacity masks variation in utilisation, profitability, and long-term sustainability across regions and service lines. Bed count has ceased to function as a reliable proxy for economic strength.
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Despite the addition of tens of thousands of beds, a significant share of this capacity remains under-utilised and, more critically, under-productive in economic terms. This is not a cyclical issue driven by temporary demand softness. It is structural. Many large private hospitals - particularly facilities with >500 beds - struggle to achieve sustained occupancy levels that support viable economics. Utilisation frequently settles in the 55-65% range, below the thresholds required to absorb fixed costs, amortise capital expenditure, and generate returns commensurate with risk.

This gap is not marginal. It reflects a misalignment between how India’s hospital infrastructure was built and how care is increasingly accessed and consumed. The assumed economies of scale no longer apply.

On paper, large tertiary hospitals appear advantaged by size and scope. In practice, their financial arithmetic is unforgiving. Capital expenditure per bed in large Indian private hospitals - factoring in land, construction, operating rooms, ICUs, advanced diagnostics, and specialty infrastructure - typically ranges from ~US$85,000 to US$145,000. A 500+ bed facility therefore locks in hundreds of millions of dollars in upfront capital, with breakeven timelines commonly extending eight to twelve years even under optimistic assumptions on utilisation and pricing.

At sub-optimal occupancy, many of these assets struggle to earn their cost of capital. Real-estate appreciation and patient volume growth, which once masked operational inefficiencies, are no longer reliable cushions. What appears as scale on paper increasingly translates into financial fragility in practice.

 
When Bed Count Stops Paying the Bills

Many of India’s large hospitals were designed for an earlier phase of the healthcare market. That phase assumed patients would travel across cities for specialist consultations and routine care, that high-skill clinicians could be recruited, centralised, and retained within flagship facilities, and that long capital horizons - supported by rising real-estate values - would compensate for operational inefficiencies.

Those assumptions no longer hold.
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Today, large tertiary hospitals operate within a different set of constraints. Fixed-cost structures remain high, while shortages of specialised clinicians and allied health staff have become persistent rather than episodic. At the same time, patient behaviour has shifted toward localisation. Care is increasingly accessed closer to home, with tertiary centres reserved for episodes of clinical complexity rather than routine engagement.
This shift is most visible in outpatient departments (OPDs), which function as the primary feeders for inpatient admissions. OPD activity is fragmenting geographically, dispersing across smaller hospitals, specialty clinics, diagnostic centres, and asset-light care models. Routine consultations, diagnostics, and follow-ups are no longer anchored to distant, monolithic hospitals.

As OPD footfalls decentralise, the inpatient pipeline weakens. Even hospitals with strong clinical reputations and advanced tertiary capabilities face structurally lower utilisation. The challenge is not competitive positioning or brand strength alone, but a care-delivery model increasingly misaligned with how demand is generated and sustained.

 
The Rise of Asset-Light Care Models

As patient demand decentralises and utilisation at large tertiary hospitals remains structurally constrained, care delivery is increasingly migrating toward asset-light models. These models are not peripheral experiments. They are emerging as the primary growth engines across multiple segments of India’s healthcare system.

Asset-light providers are designed around focused service lines rather than comprehensive infrastructure. They emphasise outpatient care, day procedures, diagnostics, and specialty-led pathways that require limited inpatient capacity or none. Capital intensity is lower, breakeven timelines are shorter, and returns are less dependent on sustaining high system-wide occupancy.

This structural advantage is reinforced by clinical labour dynamics. Specialised clinicians are increasingly unwilling to be fully anchored to a single, large institution. Asset-light platforms allow physicians to operate across multiple sites, concentrate on high-value procedures, and reduce administrative and non-clinical burdens. For hospitals built around large, centralised staffing models, this represents a competitive asymmetry.

From the patient perspective, these models align more closely with evolving expectations. Proximity, convenience, and speed increasingly outweigh the perceived value of scale. Routine consultations, diagnostics, and follow-ups are delivered locally, while complex interventions are escalated. The result is a care pathway that is unbundled by design rather than constrained by infrastructure.

Importantly, asset-light growth is not limited to greenfield entrants. Established hospital groups like Apollo, Fortis, Max and Narayana, are reconfiguring their networks through spoke facilities, specialty centres, partnerships, and management contracts. In doing so, they are acknowledging the limits of fortress-style hospitals as the organising unit of care delivery.

The implication is structural, not incremental. As demand shifts toward decentralised, lower-capital formats, economic power within the system follows. Growth accrues to models that convert patient volume into returns without requiring large, under-utilised balance sheets. In this environment, scale is no longer defined by bed count, but by the efficiency with which care is distributed, accessed, and monetised.

 
The Decentralisation Dividend

The decentralisation of care delivery and the rise of asset-light models are reshaping MedTech demand in India in ways that differ from historical assumptions. Demand is not disappearing, but it is fragmenting - shifting away from large, episodic capital purchases toward more distributed, utilisation-driven consumption.

In fortress-style hospitals, MedTech demand was anchored to large capital equipment, installed base expansion, and periodic upgrades justified by scale. By contrast, in asset-light environments, purchasing behaviour is more selective. Capital budgets are tighter, return thresholds are higher, and equipment must demonstrate rapid payback tied to throughput rather than institutional prestige.

This favours technologies that are modular, scalable, and deployable across multiple sites. Compact imaging, ambulatory surgical equipment, point-of-care diagnostics, and digitally enabled monitoring solutions align more closely with decentralised care pathways. Products designed for high-acuity, high-capex tertiary settings face a narrowing addressable market unless they can be adapted to lower-intensity formats.

Consumables and procedure-linked technologies gain relative importance in this shift. As providers prioritise asset efficiency over asset ownership, variable-cost models become more attractive than fixed-capital investments. Recurring revenue streams tied to procedure volume, rather than bed count, better match provider economics in a fragmented delivery landscape.
The sales motion is also changing. Decision-making authority is increasingly distributed across specialty heads, regional operators, and platform-level procurement teams rather than central hospital administrations. Sales cycles are shorter and more heterogeneous, requiring MedTech companies to manage a broader set of customer archetypes with differing economic constraints.

For MedTech portfolios built around assumptions of centralised scale, these shifts create friction. Growth strategies anchored to flagship hospital wins, national tenders, or top-tier academic centres are no longer sufficient. Sustainable growth increasingly depends on breadth of deployment, ease of integration, and the ability to support multi-site, specialty-driven operating models.
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The implication is not a contraction of opportunity, but a redefinition of it. MedTech demand is moving closer to the point of care, more tightly coupled to utilisation, and less forgiving of capital inefficiency. Portfolios that align with this reality will compound. Those that remain optimised for an earlier hospital paradigm will struggle to convert market presence into durable returns.
 
The India Discount Few Model Correctly

Incumbents entering or expanding in India often misprice the market by extrapolating familiar models onto a different care economy. The error is not one of optimism, but of misplaced assumptions about how value is created, captured, and sustained.

The first mispricing lies in equating market size with spending power. India’s patient volumes are vast but purchasing decisions are constrained by unit economics at the provider level. High procedure counts do not automatically translate into willingness or ability to absorb capital-intensive technologies. Incumbents that size the opportunity through population metrics or disease prevalence alone overestimate near-term monetisation.

A second mispricing arises from overvaluing institutional scale. Large hospital brands and national chains appear to offer efficient access to the market, but they represent only a portion of where care is delivered and decisions are made. As care decentralises, demand fragments across specialty centres, ambulatory facilities, diagnostics networks, and physician-led platforms. Incumbents that concentrate resources on flagship accounts miss the broader, more durable sources of growth.

Pricing architecture is frequently misaligned. Products designed for high-margin, reimbursement-led markets struggle in environments where payback periods are scrutinised at the procedure level. Indian providers price risk aggressively and expect equipment to earn its cost quickly and transparently. Solutions that require behavioural change, cross-subsidisation, or long utilisation ramps face structural resistance, regardless of clinical merit.

Operating complexity is also underpriced. India is often treated as a single market with minor regional variation. Differences in case mix, payer composition, clinician availability, and procurement processes are substantial across states and even cities. Incumbents that rely on uniform national strategies find that execution friction, rather than competition, becomes the limiting factor.

Finally, many incumbents misprice time. India rewards patience, but only when paired with structural adaptation. Early presence without localisation of portfolio, pricing, service, and commercial models rarely compounds into leadership. Conversely, companies that align offerings with provider economics, support decentralised deployment, and invest in long-term clinician and operator relationships often achieve scale that is difficult to dislodge.

The Indian care economy does not penalise incumbents for being global. It penalises them for being rigid. The opportunity is vast, but it accrues to those willing to reprice their assumptions - about scale, capital, demand, and speed - and redesign their approach accordingly.

 
A Playbook for Winning in India

Winning in India over the next decade will not be determined by early entry, brand recognition, or the size of legacy footprints. It will be determined by the ability to align strategy with the structural realities of how care is delivered, financed, and consumed.

The first requirement is a redefinition of scale. In India, scale is no longer synonymous with bed count, flagship hospitals, or centralised procurement. It is defined by breadth of deployment across decentralised care settings and by the efficiency with which products convert utilisation into returns. Companies that design for distributed volume rather than concentrated capacity will compound faster and more predictably.

Second, portfolios must be built around provider economics, not clinical ambition. Technologies that enable faster payback, support modular expansion, and flex across asset-light formats will outperform those optimised for capital-heavy environments. Recurring, procedure-linked revenue models are structurally advantaged in a system where fixed costs are under pressure.

Third, go-to-market models must match the fragmentation of demand. This requires moving beyond reliance on a narrow set of national accounts toward engaging specialty heads, regional operators, and platform-level decision-makers. Sales excellence in India is less about uniform coverage and more about segmentation discipline, local execution, and economic fluency at the point of decision.

Fourth, localisation is no longer optional. Products, pricing, service models, and training must be adapted to regional variation in case mix, staffing, and payer dynamics. Standardised global playbooks create friction in a market that rewards contextual precision. The most successful incumbents will be those that embed India-specific design and operating authority within their organisations.

Finally, time must be treated as a strategic asset. India rewards sustained commitment, but only when paired with continuous adaptation. Patience without learning stalls. Speed without alignment misfires. Durable leadership emerges from iterative presence, long-term clinician relationships, and an operating model designed to evolve alongside the care economy itself.

India’s healthcare market is neither a scaled-down version of developed systems nor a transient growth opportunity. It is a structurally distinct ecosystem that is shaping new models of care delivery. Companies that learn to win here will not only unlock India’s potential but also build capabilities that travel across the next generation of global healthcare markets.

 
Takeaways
 
  • India is not a derivative market. It is a structurally distinct care ecosystem reshaping how healthcare is delivered, financed, and scaled. Winning in India builds capabilities that matter globally.
  • US MedTech leaders face a strategic inflection point. One path extends familiar playbooks - incremental revenue from legacy hospital assets whose economics are weakening and whose system-level influence is declining. This path offers comfort and predictability, but limited durability.
  • The alternative path runs through India’s re-architected care system. Advantage is shifting toward network builders, platform operators, and population-scale orchestrators redefining care delivery. Partnering here is harder - but strategically decisive.
  • The shift is structural, not cyclical. Networks will continue to outperform buildings. Platforms will outperform standalone products. Intelligence, integration, and distributed scale will outperform volume-based selling.
  • Early alignment compounds. Companies that adapt now will not only win in India - but they will also develop operating models, economics, and capabilities that travel across the next generation of global healthcare markets.
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In this year-end episode of HealtPadTalks, we dissect the forces redrawing the MedTech landscape - and the blind spots leaders can no longer afford. Hardware is ceding ground to AI-driven, data-intensive platforms that span the full patient journey: always on, always learning, always scaling. The centre of gravity is shifting - and fast. While the US and Europe still command attention, momentum is accelerating in Saudi Arabia, India, and across Africa. New markets. New rules. New power dynamics. This is a wake-up call. The next generation of MedTech winners won’t compete on devices alone, but on intelligence, analytics, and business models built for a global MedTech arms race.

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  • From Science to Finance - and Back: MedTech’s journey from invention to consolidation, and the limits of a finance-first model
  • The Seismic Shift: AI, regenerative medicine, new materials, and emerging-market demand are redefining the field
  • Leadership at a Crossroads: Balance sheets are not enough - scientific fluency is now strategic
  • The “Bilingual” Strategist: The next-generation leader must be fluent in both frontier science and capital discipline
  • Key Shifts for a New Era: A practical framework to reset governance and culture for 21st-century innovation

The MedTech Empire Science Will Rebuild

In the 1970s and 80s, MedTech was propelled by a spirit of scientific audacity. Scientists, engineers, and clinicians collaborated to turn improbable ideas into transformative devices - from the first implantable defibrillators to the dawn of surgical robotics. Breakthroughs did not emerge from corporate strategy decks, but from hospital basements, university research labs, and, in some cases, improvised garage workshops. The sector’s DNA was shaped by curiosity, technical mastery, and an unflinching focus on solving clinical problems.

By the late 1990s, a different force assumed command: finance. Private equity firms and public markets brought professional management, access to capital, and a focus on operational efficiency. Leveraged roll-up strategies consolidated hundreds of smaller innovators into multinational powerhouses. Standardised compliance frameworks improved regulatory resilience. Streamlined supply chains reduced cost and increased speed. Harmonised systems allowed these new giants to operate at a scale that was previously unthinkable.

The results were tangible: global reach, higher margins, and more predictable performance. MedTech became one of the most profitable sectors in healthcare - admired by investors and emulated by adjacent industries.

 
In this Commentary

This Commentary charts the industry's journey from its science-driven origins through the finance-dominated era and argues that the next wave of leadership must be “bilingual” - fluent in both frontier science and capital discipline. It explores the movement back to science, the market dynamics and technological forces shaping healthcare, and five key shifts needed to ensure medical technology leads - rather than follows - the future of innovation.
 
The Limits of the Finance Era

The strengths that defined the financial era in MedTech are now revealing themselves as constraints. For decades, a model optimised for scaling proven devices, consolidating markets, and reliably delivering returns to investors brought order and professionalism to what had once been a fragmented industry. Yet, the same architecture that enabled discipline and predictability has, in many instances, dulled the sector’s adaptive edge. A system designed to favour efficiency, incremental improvement, and risk management struggles when confronted with scientific and technological discontinuities.

This is not just a question of pace but of orientation. The financial era prioritised business models that could be forecast, replicated, and leveraged across geographies. Today, however, medicine and healthcare are being reshaped by forces that resist such linear replication: the convergence of digital tools with biology, the rise of personalised and regenerative therapies, the blurring of boundaries between devices, diagnostics, and drugs, and the entry of new players from technology and data science. These shifts demand exploration, experimentation, and tolerance for uncertainty - the capacities a finance-driven paradigm has deprioritised.

The playbook that worked for three decades - built on consolidation, cost control, and incrementalism - now threatens to become a liability. Efficiency can calcify into rigidity; scale can suppress originality; risk aversion can translate into missed opportunities. Where science is once again becoming the primary engine of change, the industry’s reliance on financial engineering is proving insufficient, if not counterproductive. The MedTech sector now finds itself in a paradox: the strategies that once secured its dominance may impede its ability to navigate an era where breakthroughs are less about balance sheets and more about science, technology, and vision.
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The Shift Back to Science

The transformation now underway in MedTech is not incremental - it is seismic. The industry is being pulled back to its scientific roots, yet the scale, speed, and context of this shift are unprecedented. Changes that once took decades are now happening in years - or even months - as breakthroughs in biology, computation, and engineering fuel one another in a self-reinforcing cycle. Governance frameworks, regulatory pathways, and commercial models struggle to keep up with the pace of change.

The definition of “medical technology” is being redrawn. Once bounded by devices and diagnostics, the field is expanding into dynamic systems that fuse digital intelligence with biological function. Artificial intelligence and machine learning are no longer add-ons at the margins - they are embedded as decision-making engines in diagnostics, surgical robotics, and even semi-autonomous therapeutic interventions. Gene and cell therapies are not only redefining treatment modalities but are forcing the invention of new classes of delivery platforms and monitoring tools.

Meanwhile, material science innovations are shifting implants and prosthetics from inert supports to living interfaces - adaptive, regenerative, and in some cases self-healing. Synthetic biology is producing programmable therapeutics and biologically integrated sensors that blur the line between drug, device, and software. Each of these technologies alone would have redefined the industry; together, converging at speed, they are dismantling the legacy categories that structured healthcare technology for half a century.

The field of medical innovation is no longer strongly associated with just products - it is becoming an industry of platforms, ecosystems, and continuous scientific reinvention. The ground is moving faster than the structures built to govern it.

 
The Changing Market Landscape

The market context is entering a phase of disruption that is as much about geography and demography as it is about technology. Emerging economies such as India, Saudi Arabia, and a growing number of African nations are no longer peripheral markets - they are increasingly the laboratories of innovation. These regions are not just expanding demand; they are redefining product requirements, emphasising affordability, portability, and digital integration as foundational rather than optional.

Just as Japan, in the aftermath of World War II, leapfrogged legacy manufacturing constraints to build globally dominant automotive and electronics industries, today’s emerging economies are poised to bypass outdated healthcare delivery models. Their advantage lies in not being encumbered by entrenched infrastructures that slow transformation in mature markets. India’s push toward digital health records and telemedicine, Saudi Arabia’s strategic investments in biotech and AI, and Africa’s rapid adoption of mobile-first health platforms all reflect a trajectory that could set new global standards.
This leapfrogging dynamic positions these regions to define what the “next generation” of healthcare delivery looks like - blending value-based care with scalable, technology-enabled solutions. Value-based models are reshaping incentives, rewarding outcomes over throughput and pushing MedTech companies to design around patient journeys rather than isolated interventions. In emerging economies, however, the alignment between patient-centred care and systemic efficiency is stronger: what is affordable and portable for resource-limited settings also happens to be more sustainable and scalable globally.

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Adding further pressure and opportunity, the patient voice - amplified through digital networks and advocacy platforms - is now a determinant of adoption and reputation, not an afterthought. In this sense, healthcare is converging with broader consumer industries, where trust, transparency, and user experience dictate success. The next global leaders in healthcare may not emerge from traditional Western strongholds, but from those economies agile enough to leap ahead, leveraging digital-first infrastructures to reimagine care delivery at scale.
 
The Challenge for Legacy Leadership

This is an environment that rewards agility, interdisciplinarity, and vision. Yet it exposes the limits of a leadership model optimised for financial engineering. The next era of MedTech will not be won by the largest balance sheet, but by those who can harness science, technology, and patient insight with speed, fluency, and conviction.

For all the technological ferment at the sector’s edges, the centre of gravity in many boardrooms remains anchored in the finance era. The average age of C-suites is ~56 - leaders who are digital immigrants, shaped less by data and code than by balance sheets and capital markets. Their formative experience lies in M&A integration, operational cost discipline, and the choreography of quarterly expectations. These executives are skilled at optimising margins and executing acquisitions but often approach science and technology as assets to be financed rather than ecosystems to be inhabited. Yet healthcare itself is increasingly data-centric and digitally mediated, a trajectory that will only accelerate over the next decade - widening the gap between the capabilities at the industry’s core and the demands of its scientific frontier.

Financial orientation made sense in the years when growth was driven by consolidation and efficiency. But in a world where competitive advantage increasingly comes from anticipating scientific inflection points, it has become a structural vulnerability. The habits of financial leadership - rigorous capital allocation, risk minimisation, and preference for predictable returns - can inadvertently dilute the qualities that matter most: speed, curiosity, and tolerance for ambiguity.

The consequences are already visible. M&A sprees have left some companies saddled with high debt and complex remediation obligations, diverting capital and attention away from breakthrough innovation. Product portfolios skew toward incremental upgrades that can be forecast and monetised quickly, rather than R&D that might redefine a market. And while financial engineering can optimise a mature product line, it rarely creates the kind of disruptive leap that rewrites clinical practice.
  
Finance’s Lasting Value - But Changing Role

This is not about vilifying finance. The capital discipline and operational rigour it instilled remain essential to MedTech’s resilience. But the leadership archetype that powered the last three decades is not the one that will secure the future. A generation of executives fluent in the language of balance sheets yet unfamiliar with the lexicon of frontier science now face a world where mastery of both is essential. Without it, incumbents risk surrendering the future to smaller, science-led challengers - organisations able to perceive and pursue opportunities their financially minded rivals cannot.
 
The Bilingual Strategist: A New Leadership Archetype

If the finance era of MedTech was defined by leaders who mastered capital discipline, the next era will belong to those who can stand with one foot in the lab and the other in the marketplace. Leaders of the future will not be narrow specialists but bilingual strategists - fluent in the languages of science and capital, technology and regulation, patient need and shareholder value.

They will need to be scientifically fluent, able to sit in a room with geneticists, AI engineers, or materials scientists and engage meaningfully - not as distant sponsors, but as collaborators who understand the nuances and possibilities. They will be technologically engaged, tracking advances in machine learning, regenerative medicine, and bioelectronics not through second-hand briefings, but through direct dialogue with innovators and early adopters.

They will be ecosystem builders, recognising that the next big breakthroughs are unlikely to emerge from a single corporate R&D silo. Instead, they cultivate networks of start-ups, academic labs, and clinical innovators, investing “soft capital” - manufacturing expertise, regulatory guidance, access to distribution - alongside financial investment. They will be globally attuned, as comfortable discussing patient pathways in Riyadh or Mumbai as in Minneapolis or Munich, and alive to the cultural and economic nuances shaping adoption in emerging markets.

Crucially, they will understand soft power - the ability to earn trust and shape ecosystems through influence, relationships, and credibility. They move fluently among clinicians, regulators, and patient advocacy groups, recognising that success depends less on the performance of any single device and more on the trust surrounding the intelligent systems and data-driven platforms that support patients across their therapeutic journeys.

This archetype blends the curiosity of the scientist with the pragmatism of the operator, the vision of the innovator with the discipline of the investor. In an environment where the pace of change is accelerating and the boundaries of the industry are dissolving, these leaders will not just keep pace with science - they will help set its direction.

 
Transforming Leadership Culture: Five Deliberate Shifts

Transforming MedTech’s leadership culture is not about abandoning the discipline that has sustained the sector for decades. The financial rigour, operational efficiency, and consolidation strategies that built enduring enterprises remain essential. What is required now is a widening of the lens: ensuring capital works in service of scientific opportunity, patient value, and global healthcare dynamics - not the other way around.

The leaders who stewarded medical technology through its era of integration and scale are vital to its next chapter. But the sector’s centre of gravity is shifting. Innovation cycles are compressing, patient voices are growing louder, and science is intersecting with digital technology in ways that outpace financial logic. This is an evolution, not a coup - a deliberate broadening of the leadership portfolio through five strategic shifts:

1. Reframe Capital’s Role
Capital allocation will remain the industry’s backbone. But in the next era, finance must be reframed as a catalyst for science, not just its gatekeeper. That means board-level discussions weighing R&D roadmaps with the same analytical intensity as quarterly guidance and treating scientific optionality as a central part of investor communications. Leaders who can bridge financial and scientific worlds will anchor this shift.

2. Diversify Around the Decision Table
Historically, boards have been dominated by voices skilled in cost discipline, M&A, and market access. To thrive in the future, leadership tables must be rounded out with perspectives from clinical practice, patient advocacy, data science, and emerging health systems. Such additions do more than “broaden input” - they reshape the questions leadership asks and, therefore, the answers capital pursues.

3. Hybrid Innovation Models
Acquisition remains an indispensable tool. But when used alone, it cannot deliver the agility demanded by today’s innovation frontiers. Leaders must embrace hybrid models: structured partnerships with start-ups, academic labs, and hospital innovators. Financial resources should be paired with non-financial assets - regulatory expertise, global manufacturing networks, real-world data access - that create a multiplier effect. This is how incumbents maintain scale advantages while plugging into faster-moving discovery ecosystems.

4. Align Incentives with Long-Term Value
The industry’s strongest performers were built on predictable earnings growth. That remains essential, but it is no longer enough. Incentives at the top must now reward progress toward scientific breakthroughs, ecosystem scale, and patient impact. This realignment raises the bar: shifting ambition from extracting short-term multiples to creating durable value anchored in science and trust.

5. Global and Patient-Centric Intelligence
Emerging markets and patient engagement are no longer “adjacent skills” - they are determinants of competitive relevance. Tomorrow’s leaders will need fluency in how care is delivered, paid for, and demanded outside of legacy Western markets, as well as the agility to engage patients not as end-users but as partners in design, testing, and advocacy. Building these capabilities into leadership pipelines is a priority.

This is not a repudiation of MedTech’s leadership heritage. It is its extension. By layering scientific fluency, patient proximity, and global agility onto the industry’s proven financial and operational discipline, the field can define the next era of leadership - and sustain its position at the intersection of capital, science, and care.

 
Toward a Dual-Fluency Model of Governance

In practical terms, this means evolving governance into a dual-fluency model: financial acumen remains necessary, but it is matched by the capacity to interrogate a breakthrough technology, to understand the regulatory journey from concept to clinic, and to anticipate the market shifts it might trigger.

Such a shift does not threaten the incumbents who built today’s industry giants - it enhances their legacy. By embedding scientific and technological fluency at the highest levels, the sector can retain the scale, efficiency, and discipline finance delivered, while regaining the agility, curiosity, and daring that defined its birth. The reward is not only resilience in the face of disruption, but the opportunity to lead the next wave of medical innovation on the global stage.

 
Takeaways

The MedTech industry owes much to the era of financial leadership. Capital brought order to a fragmented sector, created global reach, and built the infrastructure that still underpins much of the industry’s strength. But every architecture is designed for the problems of its time - and the challenges now facing health innovation are no longer those of scale, compliance, or operational efficiency. They are challenges of scientific opportunity, technological acceleration, and shifting global health demands.

The next chapter will not be authored by leaders who simply manage existing assets. It will be shaped by those who can anticipate what lies ahead - who can read the signals from AI labs, genomic research centres, and emerging-market models of care, and convert them into products, services, and platforms that improve patient lives. This calls for leaders as fluent in the dynamics of innovation as they are in the mechanics of capital.

The shift does not demand that we discard the strengths of the finance era. On the contrary, the discipline, global networks, and operational mastery it produced will be essential assets in the science-led age now taking shape. But if MedTech does not rebalance its leadership to place science and technology on equal footing with financial imperatives, it risks being overtaken by more agile, more scientifically attuned challengers.
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  • India is a strategic growth and innovation hub for US MedTech
  • India’s healthcare giants are reshaping demand for advanced technologies
  • There is a competitive risk for US MedTechs delaying engaging with India’s fast-moving market
  • This Commentary presents a roadmap for CEOs and boards to build a lasting presence and partnerships in India

India: MedTech’s Next Frontier

In US MedTech boardrooms, global strategy still defaults to Western Europe, China, and high-income Asia. India - dynamic, innovative, and increasingly indispensable - remains underleveraged.

Geopolitical caution still lingers, but the signals are shifting in India’s favour. On May 15, India unexpectedly offered to eliminate tariffs on all US goods - just weeks after raising them - suggesting momentum toward a broader trade deal. This followed a series of assertive geopolitical moves, including Vice President JD Vance’s April 20 meeting with Prime Minister Modi, a landmark $100bn partnership with Saudi Arabia, and the finalisation of a UK trade agreement. Together, these developments reflect India's growing global clout and strategic alignment with US interests. At the same time, Apple’s decision to shift all US-bound iPhone production to India underscores a deeper transformation: India is emerging not only as a critical supply chain alternative but also as a next-generation hub for manufacturing and innovation - extending beyond tech into areas like MedTech.

India is no longer just an export play. It is a launchpad for next-gen R&D, rapid clinical trials, and agile multi-market manufacturing. It offers speed, scale, and strategic leverage - what legacy models cannot deliver in today’s fractured global order.

In 2007, 60 years after its independence from Britain, India became a $1trn economy. Today, its GDP is ~$3.5trn and on track to exceed $6trn by 2030. India has surpassed Japan to become the world’s 4th largest economy and is set to overtake Germany by 2028. This is not a future market - it is the current opportunity.

The tendency of many US MedTech boards to treat India as peripheral to their global strategy is less a reflection of market fundamentals and more a symptom of outdated thinking. Too many decision-makers remain tethered to legacy paradigms - views shaped in an era when India was seen primarily as a low-cost manufacturing hub or a long-term “emerging” market. But that era has passed. The ground has shifted.

India is no longer emerging. It has emerged - with scale, sophistication, and strategic weight. It is now the world's most populous country, home to one of the fastest-growing healthcare markets, a thriving innovation ecosystem, and a tech-savvy, increasingly health-conscious population. From digital health to surgical robotics, Indian clinicians and entrepreneurs are no longer just users or followers - they are contributors, co-creators, and global competitors.

Boards that continue to overlook India risk more than missed growth; they risk strategic irrelevance. Market access strategies, clinical trial networks, regulatory engagement, and talent pipelines - India plays a central role in each. Companies that sideline India not only leave value on the table but also fall behind competitors who are already embedding the country into their core operating model.

In today’s MedTech landscape, India is not a geographic add-on. It is a strategic multiplier. Forward-looking leaders are already recalibrating. The question is no longer if India matters - it is how quickly your organisation can adapt to the new global reality where India is not optional, but essential.

 
In this Commentary

This Commentary argues that India is no longer optional for US MedTech - it is a strategic necessity. With its vast scale, rising healthcare demand, and growing innovation ecosystem, India offers opportunities for growth, R&D, and supply chain resilience. Succeeding there requires more than transactional engagement; it demands long-term partnerships, backed by CEO and board-level commitment. For MedTech leaders, understanding India’s fast-evolving landscape is essential - not just to access a major market, but to help shape the future of global health innovation and expand equitable access to care.
 
Strategic Opportunity Hiding in Plain Sight

India is rapidly emerging as one of the world’s most pivotal healthcare markets - not just due to scale, but because of how care is being reimagined. With a population >1.4bn and a middle class expected to exceed 500m by 2030, demand for quality healthcare and advanced technologies is entering a phase of sustained, structural growth. Private spending is surging, and MedTech is leading the charge: currently a $12bn market, it is projected to surpass $50bn by 2030, within a broader $372bn healthcare sector.

At the centre of this transformation is a private sector that is not just expanding - it is innovating. Healthcare leaders like Apollo Hospitals Narayana Health, and Fortis Healthcare are redefining global benchmarks through scale, tech integration, and clinical excellence.

Apollo Hospitals, founded in 1983 by Dr. Prathap C. Reddy, has built an ecosystem of >70 hospitals, ~5,000 pharmacies, and a digital health platform spanning diagnostics, telehealth, and AI-enabled care. With >125,000 heart surgeries annually - among the highest globally - Apollo is pushing digital frontiers, bringing advanced care to Tier-II and Tier-III cities. Led by Dr. Reddy’s four daughters and CEO Dr. Manhu Sasidhar, Apollo is setting the pace for tech-powered, inclusive healthcare.

Narayana Health, founded by Dr. Devi Shetty, offers a radically efficient model: high-quality, high-volume care delivered at a fraction of global costs. With >40 hospitals and a flagship Health City in Bengaluru, Narayana performs >18,000 cardiac surgeries annually with outcomes that rival top global institutions. Its digital and international footprint - from the Cayman Islands to a nationwide telemedicine network - reflects a model built for scale and impact.
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Narayana’s innovation extends beyond clinical delivery. It helped launch Yeshasvini, one of the world’s largest self-funded rural insurance schemes, and played a key role in Arogya Karnataka, aimed at universal health coverage. Most recently, it launched Narayana Aarogyam, a next-gen wellness centre in Bengaluru offering AI-driven diagnostics, 90-minute checkups, and personalised care - underscoring its pivot toward preventive health for India’s rising middle class.

Fortis Healthcare, meanwhile, is becoming a specialty care leader in neurology and spine, with strong digital capabilities and ~23,000 employees driving expertise in tertiary and quaternary care.

Together, these providers are not just catching up - they are leapfrogging global peers. By marrying scale with process innovation and advanced tech, they are redrawing the global healthcare map - and creating significant demand for robotics, AI diagnostics, digital therapeutics, and precision tools.

This private sector dynamism is reinforced by Ayushman Bharat, the world’s largest public health insurance programme, covering >500m people. India now offers a unique dual-market dynamic: premium private care scaling up, and public coverage expanding out - unlocking demand across the spectrum.

Regulatory reform is keeping pace. The Medical Device Rules (MDR 2017) introduced a risk-based framework aligned with global norms. As quality, data, and safety take centre stage, India is becoming a familiar, investable environment for companies with mature compliance systems.

Early movers like Siemens Healthineers and Philips are doubling down on R&D, manufacturing, and commercial operations in India. Yet many US MedTech players remain underexposed - held back by outdated views of price sensitivity or regulatory ambiguity. This is a costly misread. India is not a low-margin detour - it is a parallel frontier.

While the US MedTech market has matured - slower growth, squeezed margins, tougher competition - India is greenfield. Demand is accelerating, digital health is scaling, and infrastructure is still being built.

The instinct to compare India’s trajectory to the US is not just flawed - it is misleading. India is not retracing old paths; it is blazing new ones. For US MedTech firms, the choice is clear: lead or lag. In this market, passivity is not safe - it is risk, misjudged as strategy.

 
India: The Rising Powerhouse of Global MedTech

For much of the traditional MedTech establishment, India has long been cast in a familiar role: populous, price-sensitive, and peripheral - a market more tolerated than targeted, complex to navigate and rarely central to strategic thinking. For executives steeped in the logic of high-margin devices and legacy health systems across the US and other affluent markets, the notion that India could help define the future of MedTech has often felt not just unlikely, but incompatible with industry orthodoxy. That orthodoxy is now a risk.

India’s relevance in the emerging healthcare paradigm is no longer tethered to scale alone. It lies in its growing strategic leverage - not just as a market, but as a force multiplier for innovation. As global healthcare pivots toward digital-first, data-intelligent, and cost-sensitive models, India is increasingly where new rules are being written. To overlook this shift is to misread the momentum - and to underestimate where the next gravitational pull is forming.

1. India as a Deep-Tech Forge
India is no longer an emerging player in healthcare innovation - it is already powering the R&D engines of some of the world’s most advanced MedTech systems. At the convergence of elite engineering, robust digital infrastructure, and thriving innovation hubs, Indian cities like Bengaluru are building the future: AI-driven diagnostics, robotic surgeries, and cloud-native digital therapeutics are not exceptions - they are standard practice.

This is not imitation. It is leadership. What sets India apart is its ability to fuse technical depth with real-world healthcare needs, delivering solutions that are not only cutting-edge, but also frugal, scalable, and globally deployable. In a software-defined MedTech world, India is the crucible where cost, complexity, and innovation compress into export-ready breakthroughs.

2. India as a Data Powerhouse
Global regulators are demanding more diverse, real-world clinical evidence - and India delivers. Its unmatched population diversity and disease burden offer a live lab for inclusive datasets, AI training, and large-scale tech validation.

With digital health adoption accelerating and clinical research capabilities maturing fast, India is becoming a prime site for faster, cheaper, and globally relevant evidence generation. MedTech players rooted here not only cut development time and cost but boost regulatory credibility across both established and emerging markets.

3. India as a Strategic Manufacturing Hub
In today’s fractured supply chain landscape, resilience is the new gold. For US MedTechs, India offers more than low-cost assembly - it is a launchpad into high-growth markets across Asia, the Middle East, and Africa. Backed by Production-Linked Incentive (PLI) schemes and rising standards, India is scaling up from basic production to high-credibility, export-grade manufacturing.

But the real differentiator? India’s geopolitical sweet spot. It is a neutral, democratic, technically skilled partner with global trade credibility. As the China+1 strategy gains steam, India stands out not just as an alternative - but as the answer.
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Yet this opportunity demands a shift in mindset. Legacy MedTech firms must move beyond offshore outsourcing and embrace strategic embeddedness. That means local leadership, on-the-ground investment, and the cultural agility to scale in a complex, non-Western market. The choice is stark: build where growth is emerging - or watch more adaptive competitors take the lead.
The Competitive Clock Is Ticking

The global MedTech race is accelerating - and legacy US players are falling behind in India. For decades, strategic focus has orbited around the familiar: affluent, regulation-heavy markets that reward incrementalism and shield leaders from systemic complexity. India, by contrast, has remained a blind spot - viewed largely as a cost centre or corporate social responsibility (CSR) afterthought, not a strategic imperative. But the ground is shifting. Growth in traditional markets is stalling, and relevance is being redefined - not in Boston or Basel, but in Bengaluru and beyond. European and Chinese firms are moving decisively, embedding themselves deeper into the Indian healthcare landscape through strategic partnerships, localised manufacturing, and tailored go-to-market strategies. The question is no longer whether to engage, but whether today’s leaders can unlearn fast enough to stay in the game.

European players like Smith & Nephew are strengthening their footprint by investing in local production and regulatory integration. In 2022, the UK-based MedTech inaugurated its first Asian manufacturing facility in Pune, Maharashtra, focused on orthopaedic implants for both domestic and global markets. This, not only slashes production and logistics costs but also streamlines regulatory navigation. More strategically, it aligns the company with India’s PLI schemes while positioning it closer to fast-growing regional markets in Asia and the Middle East.

Chinese companies, meanwhile, are capturing market share with disruptive pricing and products tailored to local needs. Mindray, a leading Chinese medical device manufacturer, has rapidly expanded across India by offering essential diagnostic and monitoring equipment at lower price points - without compromising on core functionality. By simplifying features for cost-sensitive and resource-constrained settings, and backing it with robust after-sales support, Mindray has become a preferred supplier across Tier II and Tier III hospitals. This mass-market playbook is gaining traction and redefining expectations for affordability and access in emerging healthcare systems.

At the same time, Indian MedTech start-ups - bolstered by increasingly sophisticated private capital - are scaling with speed. Dozee, a Bengaluru-based company, exemplifies this new wave of innovation. Its AI-powered, contactless vital signs monitoring system is helping hospitals modernise care delivery without the burden of ICU-level investments. With backing from Prime Venture Partners and investor Gokul Rajaram, Dozee has rolled out its Hospital Ward Automation Programme (HWAP) across hundreds of hospitals, especially in underserved regions. It is an example of how domestic innovation, when combined with smart capital and regulatory support, can deliver scalable, high-impact healthcare solutions.
These emerging players are not just surviving - they are rewriting the rules in a landscape increasingly defined by pro-innovation policy tailwinds, accelerating technical sophistication, and an urgent, unmet demand for context-specific healthcare solutions. Every year of hesitation by global MedTech incumbents does not just forfeit market share - it erodes their strategic leverage to influence standards, pricing architectures, regulatory frameworks, and models of care in what is fast becoming a bellwether market for the Global South.
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Those who move early will not just compete - they will codify the norms, forge enduring alliances with India’s top-tier hospitals, academic powerhouses, start-ups, and policymakers, and embed themselves in the next wave of global health innovation. For US firms, continued inertia is not just a missed opportunity - it is a slow slide into irrelevance in one of the most dynamic, politically influential, and strategically decisive healthcare arenas of the coming decades.
 
India Should Be on CEO and Board Agendas

For far too long, India has been relegated to the margins of strategic planning by US MedTech leadership - an afterthought in global roadmaps dominated by familiar, high-margin markets. That posture is not just outdated; it is strategically negligent. India’s scale, demographic churn, and accelerating economic trajectory demand focused, top-tier attention - not token visits, quarterly check-ins, or outsourced responsibility to regional teams operating without real authority. That playbook will not cut it anymore.

What is required is a pivot: direct CEO and board engagement, deep local investment, and long-term alliances with India’s most innovative health systems, research centres, and regulatory thinkers. This is not just about “entering” a market - it is about embedding within a proving ground for the future of global healthcare. In India, innovation is not a buzzword - it is a necessity. MedTech solutions built for this environment - where cost, scale, and clinical relevance must coexist - will become the blueprint for global competitiveness. The firms that recognise this will define the next era of MedTech. Those that do not, risk watching from the sidelines as the centre of gravity shifts - not gradually, but decisively.
  
Winning in India: Commit, Don’t Just Transact

For global MedTech leaders, the question is no longer if India matters - it is how deeply you are prepared to commit. Success is not about market access; it is about strategic reorientation. India does not respond to transactional overtures or perfunctory interest. This is a market that runs on trust, endurance, and presence - where meaningful partnerships are forged through time, not tactics. Deals of consequence are not won by intermediaries or fly-in executives armed with pitch decks. They are earned - patiently and persistently - by CEOs, boards, and leadership teams who show up, engage, and signal serious intent. The architects of Indian healthcare are not holding their breath for fly-in managers. They demand leadership with skin in the game, staying power at the table, and a vested commitment to long-term value creation. Anything less is just background noise.

Winning in India’s healthcare market demands high-level commitment and decisive action. First, align leadership by forming a board-backed India Task Force and refreshing market intelligence - mapping hospital networks, digital disrupters, and regulatory shifts. Establish an India Advisory Board of local and global experts to guide strategy and relationship-building.

Next, forge deep partnerships: co-develop solutions with leading hospital chains, collaborate with AI and diagnostics innovators, and tap into government-backed incentives through local manufacturing alliances.

In the medium term, localise R&D - set up innovation hubs focused on affordability and AI, leverage India’s robust clinical trial ecosystem, and design India-first products with global potential.

Long-term success hinges on full integration: embed India into global strategy and P&L, cultivate local leadership, and pursue targeted acquisitions to deepen market roots.

India will not reward half-measures. MedTech leaders who invest, engage, and help shape its healthcare future will secure a stake in one of the world’s most dynamic growth arenas.

 
Takeaways

India is no longer a “nice-to-have” - it is a strategic non-negotiable for any MedTech company serious about global relevance. With unmatched scale, breakneck innovation, and rising digital adoption, India is not just a growth market - it is where the future of healthcare is being built. From AI-driven diagnostics to efficient care models, India is pioneering solutions that will ripple far beyond its borders. At the same time, it offers a hedge against geopolitical shocks, supply chain fragility, and overexposure to legacy markets. For CEOs and boards, the message is clear: India must move from the sidelines to the centre of strategic focus. This is not a market to dip into - it is one to embed in. Early movers will shape the rules. Latecomers will scramble to stay relevant. The next chapter of global MedTech is being written in India. The only question is: will you be part of it - or play catch-up?
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Aging populations, soaring costs, failing access - Western healthcare is stuck in a loop. But in India, Narayana Health is breaking it. With high-volume surgeries, telemedicine, and radical efficiency, it’s redefining what affordable, quality care looks like. In this episode of HealthPadTalks, we explore a model that serves millions - and ask why the West isn’t watching.

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How do you develop a patient centred healthcare system that serves vast numbers of transient poor people? India has an answer: Rashtriya Swasthya Bima Yojna (RSBY), which has won plaudits from the World Bank and the United Nations as one of the world's best health insurance schemes.

RSBY combines state-of-the-art technology and incentive structures. It is paperless, does not use cash and provides affordable health insurance to millions of people. The overwhelming majority of who, are illiterate, transient people living below the poverty line.

RSBY employs cost effective, scalable technologies to help satisfy the health needs of a significant proportion of India’s poor. Enrolment of families into the scheme, biometric smart card generation, pre-authorization of admissions, as well as claim submission and approval, all occur electronically. Beneficiaries can use their smartcards in any empanelled hospital across India and therefore travel is no barrier to receiving healthcare. Patient data are transferred electronically between empanelled hospitals and insurance companies and claims are settled automatically. The scheme lowers costs, increases efficiency and reduces fraud.

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How do you develop a patient centred healthcare system that serves vast numbers of transient poor people? India has an answer: Rashtriya Swasthya Bima Yojna (RSBY), which has won plaudits from the World Bank and the United Nations as one of the world's best health insurance schemes. RSBY combines state-of-the-art technology and incentive structures. It is paperless, does not use cash and provides affordable health insurance to millions of people. The overwhelming majority of who, are illiterate, transient people living below the poverty line. According to Dr Anshuman Kumar, Chief Oncosurgeon, Dharamshila Cancer Hospital and Research Centre in New Delhi,

“Since its launch, four years ago, Rashtriya Swasthya Bima Yojna covers some 40 million people many of whom have benefitted from in-patient hospital procedures. The scheme has been so successful that the Government is planning to extend it to India’s old age and disabled pension schemes”.

In developing countries, poverty and ill health are synonymous. Billions of poor people lack access to healthcare while being exposed to multiple health risks. This, not only increases the health consequences for those individuals and their families, but has both a direct and indirect effect on economies. Widespread poverty as well as ill health decreases productivity; lowers competiveness, increases fiscal pressure, creates further poverty and promotes greater inequity.

India is a rising global economic superpower with a GDP roughly equivalent to 3% of the world economy, but has a third of the world’s poor. In 2011 the World Bank reported that 33% of India’s population fell below the international poverty line of US$1.25 per day and 69% live on less than US$2 per day. Although India is on track to meet its poverty reduction goal set by the United Nations in 2000; by 2015, 53 million people are expected to be still living in extreme poverty and 24% of India’s population of 1.2 billion is expected to be still living on less than US$1.25 per day.

India is not unique in being a rich country with poor people. This is a phenomenon shared by several developing countries. For example, Mozambique, rich in gas, oil and minerals, is a fast growing rich country with poor people. Ninety nine per cent of Mozambicans are small scale farmers and a large proportion of these are poor. Mega projects, such as the planned US$6 billion investment by Vale, a Brazilian company, to create the world’s largest coal mine in Mozambique, do not generate large numbers of jobs, do not foster entrepreneurship and because of the tax incentives they receive, only make modest contributions to exchequers. African rich countries with poor people might do well to look to India’s RSBY health insurance scheme.

Like many fast growing developing economies, India needs to fuel economic growth by reducing the percentage of poor and reaping the benefit from her working age population. India’s declining fertility and mortality rates have resulted in a population bulge of about 0.45 billion people between the ages of 15 and 25 years. This gives India the world’s largest share of working age population: a demographic dividend. But, how does India finance and provide healthcare for this vast group, a third of which are illiterate, transient and live below the poverty line? The answer is RSBY.

RSBY employs cost effective, scalable technologies to help satisfy the health needs of a significant proportion of India’s poor. Enrolment of families into the scheme, biometric smart card generation, pre-authorization of admissions, as well as claim submission and approval, all occur electronically. Beneficiaries can use their smartcards in any empanelled hospital across India and therefore travel is no barrier to receiving healthcare. Patient data are transferred electronically between empanelled hospitals and insurance companies and claims are settled automatically. The scheme lowers costs, increases efficiency and reduces fraud.

RSBY is run on shared financial contributions by both central and state governments. Seventy five per cent of the premium is borne by the central government and the rest by state governments and all parties involved benefit. The Indian Government benefits by providing cost effective healthcare to millions of poor people. This helps to reduce poverty and increase productivity. Insurers benefit because they are paid for each household they recruit. Empanelled hospitals benefit as they are incentivised to provide treatment to a large number of participants. Non government agencies benefit because they are paid to find and recruit households. Poor people benefit because the scheme transforms them into customers and provides them access to healthcare, which they never had before. 

 

Beneficiaries receive hospitalization coverage up to US$560 per year for some 700 in-patient procedures. Central and state governments pay the premium to insurers who are selected by state governments on the basis of competitive bidding. Insurers monitor participating hospitals, which reduces unnecessary procedures and fraud. Beneficiaries need only pay about US$0.75 as an annual registration fee. The scheme has no age limit, it covers pre-existing ailments, provides surgical and health expenses for five family members and covers pre and post hospitalization charges and transport expenses of US$2 per visit.

RSBY’s has its challenges. There are human rights issues associated with biometric identification and the digitalisation and use of confidential personnel data. There have been delays in the issuance of smart cards. Some people have complained that they do not know how and where to utilise the scheme. Some hospital personnel have not been appropriately trained to use card-reading technology and there have been delays in the reimbursement of treatment expenses to hospitals and some hospitals stopped accepting patients under the scheme. On 12th October 2012, the Times of India reported:

Privatehospitals are reportedly milking Rashtriya Swasthya Bima Yojnaby carrying out fictitious or unnecessary surgical procedures on poor patients covered under the scheme. . . . . . When payers do not have a tight supervisory mechanism or do not care since the government is footing the bill, ultimately, hospitals get away with murder. The right thing to do is to align incentives, not put more constables on the hospital watch.”

India is not known for its good governance, especially among public officials, but challenges encountered by RSBY should not detract from the importance of this innovative and ambitious scheme.

 

Healthcare systems throughout the world are challenged by rising costs, poor quality of care and inaccessibility to healthcare. Healthcare systems will become unsustainable if they continue to focus on diseases rather than patients. Patient-centred care has become one of the principal goals of health advocacy. RSBY, based on digital technologies, makes patients the primary focus of the system and individuals are helped to self manage their conditions. It is not surprising that last summer a delegation of policy makers from Germany, Europe’s industrial powerhouse, spent time in India learning more about RSBY with the intent of changing Germany’s social security systems. Policy makers from rich countries with poor people might think of doing something similar.

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