Project for Practo

1

Executive Summary This project report is the planning activity for the summer project at Practo Technologies Private Limited in Bangalore, India. The report provides a comprehensive knowledge about healthcare industry its’ scope and weaknesses in healthcare system in India. The report is focuses Health Information Systems Plan (HISP) and also the awareness of healthcare system in India. India being a country with a population over a billion and such a vast population requires large number of medical services but it’s not the case. Only a fraction of Medical service providers are there to serve such a large population and even the people of the country is also not aware about the healthcare facilities provided by private players in the market. People living in an area find hard to locate a doctor, ambulance and other services mainly outsiders, until and unless they are living in that specified area for a longer period of time. To help under such circumstances, Practo entered with a solution by building a Healthcare Information System and also started to create awareness among the people of the country especially in 5 metropolitan cities. So by seeing this there is multiple opportunities are available in healthcare industry for employment and future business. As Practo is already in Healthcare and its name they come with a web portal called Practo.Com to act as middlemen between healthcare facilities seekers and the healthcare facilities providers. This Information System not only provides the information about medical service providers but will also help in monitoring and improvement for the Health of populations. It will act as a single platform where all medical stakeholders can interact with each other. As internet is not available at everywhere for the patients to avail the information about health facilities, so for availing the information they have two more options via

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phone call and SMS. It gives outstanding functions such as selecting and searching the faculty and facility available at various healthcare stakeholders. This service will provide

patient a new kind of connectivity with healthcare service providers with an additional option for maintaining Electronic Health Records for them. The study is done with the help of primary data given by respondents during survey and secondary data was collected through the Internet and various magazines to know the scope of healthcare industry in India. Primary data is collected through personal interview using structured questionnaire provided by Practo Technologies Private Limited. From the findings we came to know that the scope of healthcare industry is immense and there are so many business opportunities are present for IT industry.

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TABLE OF CONTENTS S.L

CONTENTS

PAGE NO.

CHAPTER I

5-24

INTRODUCTION I

Healthcare Industry

6-9

II

Scope of Healthcare Industry

10

III

Opportunities in Healthcare Sector

10

IV

Present Healthcare System in India

11-12

V

Healthcare Industry in India and GDP

12

VI

Indian Pharmaceutical Industry:SWOT analysis

13-14

VII

SWOT analysis of Indian Healthcare Industry

15

VIII

Trends in Health Expenditure In India

15

IX

Share of Healthcare in Revenue Budget of Major States

16-17

X

Sources of finance in the Healthcare sector in India during 2001-02

17-18

XI

Innovation and Development in Indian Healthcare Industry

19-20

XII

Population Statistics

20

XIII

Suggestion of Changes

21-24

XIV

Steps can be taken to overcome these problems

25-26

3

4

XV

The Budget 2011-12 impact in Healthcare

26

CHAPTER II OBJECTIVE OF THE STUDY CHAPTER III i

Research Methodology

30

ii

Problem Identification and Problem Formulation

31

iii

Business opportunities for Healthcare Industries

31

iv

Challenges for Healthcare Industries

32

V

Scope of the study

32

vi

Review of Literature

32

vii

Public and private share of hospital

32

viii

Healthcare Insurance Industry

33-8

ix

Number of people covered by health insurance

x

Population projection

35

xi

Population by age

36

xii

Healthcare investment and shortage of medical practitioners

36-38

xiii

Supply and demand of medical personnel

38-40

xiv

Increasing demand pf private healthcare

40-41

xv

Personal Disposable Income

41

xvi

IT in healthcare Industry

42-43

xvii

E-Healthcare solution

44-45

xviii

Telemedicine

45-48

xix

Healthcare telemedicine software

49-64

CHAPTER IV

4

5

PROFILE OF THE COMPANY

50-53

1

About Practo Group

54

2

Key people

55-56

3

About Practo.Com

57-59

4

Key events and milestones

60

5

Practo products and services

61

6

Financial data of the company

63-64

7

Company name significance

64

8

SWOT analysis of Practo Technova

65-74

9

SWOT analysis of competitors CHAPTER V ANALYSIS AND INTERPRETATION OF THE DATA

1

Percentage of Doctors using Computers

76

2

Percentage of Doctors using Internet

77

3

Percentage of calls made from customer number and my number

78

4

Percentage of people asked for disease or not

81

5

Percentage o people saved healthline number or not

82

6

Percentage of people with different remarks

7

Popularity compare to Just dial

8

Percentage of people interested and non interested with respect to age CHAPTER VI FINDINGS AND RECOMMENDATIONS

A

Findings

5

6

B

Recommendations

C

Limitation of the study

D

Bibliography

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CHAPTER-1 INTRODUCTION

I.

Health care industry:

The health care industry, or medical industry, is the sector of the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative, palliative, or, at times, unnecessary care. The modern health care sector is divided into many sub-sectors, and depends on interdisciplinary teams of trained professionals and paraprofessionals to meet health needs of individuals and populations. The health care industry is one of the world's largest and fastest-growing industries. Consuming over 10 percent of gross domestic product (GDP) of most developed nations, health care can form an enormous part of a country's economy. In the greater India, the hospitals are run by government, charitable trusts and by private organizations. The government hospitals in rural areas are called the (PHC)s primary health centre. Major hospitals are located in district head quarters or major cities. Apart from the modern system of medicine, traditional and indigenous medicinal systems like Ayurvedic systems are in practice throughout the country. The Modern System of Medicine is regulated by the Medical Council of India, whereas the Alternative systems recognised by Government of India are regulated by the Department of AYUSH (an acronym for Ayurvedic, Yoga, Unani, Siddha & Homeopathy) under the Ministry of Health, Government of India. PHCs are nonexistent in most places, due to poor pay and scarcity of resources. Patients generally prefer private health clinics. These days some of the major corporate hospitals are attracting patients from neighboring countries such as Pakistan, countries in the Middle East and some European countries by providing quality treatment at low cost. In 2005, India spent 5% of GDP on health care, or US$36 per capita. Of that, approximately 19% was government expenditure. Healthcare in India features a universal health care system run by the constituent states and territories of India. The Constitution charges every state with "raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties". The National Health Policy was endorsed by the Parliament of India in 1983 and updated in 2002. Malnutrition 47% of India’s children below the age of three are malnourished, almost twice the statistics of sub-Saharan African region of 28%. World Bank estimates this figure to be 60 million children 7

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out of a global estimated total of 146 million. Although India’s economy grew 50% from 20012006, its child-malnutrition rate only dropped 1%, lagging behind countries of similar growth rate. Malnutrition impedes the social and cognitive development of a child, reducing his educational attainment and income as an adult. These irreversible damages result in lower productivity. High Infant Mortality Rate Approximately 1.72 million children die each year before turning one. The under five mortality rate and infant mortality rate indicators have been declining comparing years 1970 and 2002 (202 to 90 & 192 to 68 per thousand live births respectively). However, this rate of decline is slowing. Reduced funding for immunization leaves only 43.5% of the young fully immunized. Infrastructures like hospitals, roads, water and sanitation are lacking in rural areas. Shortages of healthcare providers, poor intra-partum and newborn care, diarrheal diseases and acute respiratory infections, also contribute to the high infant mortality rate. Diseases Diseases such as dengue fever, hepatitis, tuberculosis, malaria and pneumonia continue to plague India due to increased resistance to drugs. India is ranked 3rd among the countries with the most number of HIV-infected. Diarrheal diseases are the primary causes of early childhood mortality. These diseases can be attributed to poor sanitation and inadequate safe drinking water in India. Poor Sanitation As more than 122 million households have no toilets and 33% lack access to latrines, over 50% of the population (638 million) defecates in the open. This is relatively higher than Bangladesh and Brazil (7%) and China (4%). Although 211 million people gained access to improved sanitation from 1990-2008, only 31% uses them. 11% of the Indian rural families dispose of child stools safely whereas 80% of the population leave their stools in the open or throw them into the garbage. Open air defecation leads to the spreading of diseases and malnutrition through parasitic and bacterial infections. Inadequate Safe Drinking Water Access to protected sources of drinking water has improved from 68% of the population in 1990 to 88% in 2008. However, only 26% of the slum population has access to safe drinking water and 25% of the total population has drinking water on their premises. This problem is exacerbated by falling levels of groundwater, caused mainly by increasing extraction for irrigation. Insufficient maintenance of the environment around water sources, groundwater pollution, excessive arsenic and fluoride in drinking water pose a major threat to India’s health.

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Healthcare NGO The Smile Foundation is one of the top ten NGOs of India. It was formed in year 2002 with the objective of providing education and health to the underprivileged. According to the statistics provided by the foundation, urban population which occupies only 1/4 of India’s poor population has less than 4% of basic healthcare facilities provided by the government. Therefore access to healthcare remains a challenge to India’s health sector both in the urban and rural areas. In addition, The Smile Foundation believes that the two main reasons for the poor health conditions of the people in India are the lack of awareness and the high opportunity cost incurred by the people when they forgo a day of wages to seek medical consultations. To tackle these issues, the foundation brings forth a series of initiatives which include bringing healthcare services to the needy, promoting healthcare awareness and changing the mindset of the people towards seeking medical aid. One such initiative would be the introduction of the Mobile Health Van - Smile on Wheels. These health vans travel into inaccessible places to reach out to the inhabitants and provide them with primary healthcare. Till date, the foundation has 10 such mobile vans located in 126 areas that are spread across 9 states of India. With its wide reach to the population of India, the program has benefited over 250,000 people. Another initiative undertaken by the foundation is the Smile Health Camps. These camps reach out to the underprivileged with the provision of remedial, precautionary and referral services. The objective of the camps is to offer extensive healthcare services and promote greater healthcare awareness to those involved in the camps. One such camp is the “Health Awareness Camp with Barclays”. Basic healthcare services such as health and eye checkup and lessons on health and hygiene were provided in this health camp. In addition, a number of the camps involve cooperation with reputable institutions such as the Barclays Bank and the Canara Bank which offered sponsorships for the running of the camps. Healthcare Infrastructure The Indian healthcare industry is seen to be growing at a rapid pace and is expected to become a US$280 billion industry by 2020. Rising income levels and a growing elderly population are all factors that are driving this growth. In addition, changing demographics, disease profiles and the shift from chronic to lifestyle diseases in the country has led to increased spending on healthcare delivery. In order to meet manpower shortages and reach world standards India would require investments of up to $20 billion over the next 5 years.

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Healthcare industry trend Health care industry trends manifest an upward growth but several areas need to be attended to

for

enhancing

health

care

services

for

the

common

man.

Different countries like Indonesia, Russia, Mexico, Brazil, India, Turkey and China comprise approximately 1/5th of the worldwide health care sales. Health care industry trends also suggest that the medical related conditions in the developing countries which are chronic in nature will be similar to the ones existing in the developed countries. In order to meet international standards, the existing health care industry is required to alter the mode of operation for generation of higher revenue and greater contribution to the Gross Domestic Product of the country. Facts about the health care industry trends:  The cost related to health care was seen to rise in the 90s. Americans not possessing any health care coverage or any kind of health insurance attained the 42 million mark.  It has been anticipated that the elderly sick people will impose considerable stress on the health care sector of US.  The total number of different health care programs and different health care insurance coverage are likely to increase in the coming years. There has been an escalation in the medical plans from 42.5 million in the year 2006. The health care industry trends also show that it is likely to attain 70.2 million in the year 2025.  The health care industry trends also indicate that the expenses for preventive measures is negligible as compared to the amount spent on treating chronic diseases which accounts for 70% of the fund used for health care.  Trends suggest that there are very less Americans (around 23%) who make an effort to prevent any lifestyle diseases by consuming the optimum level of vegetable and fruits.

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Development of Healthcare in India In mid 80’s most of the hospitals in India were owned by the government and treatment was free of cost. The implementation of the health policy in 1983 had encouraged private sector to participate in healthcare delivery. Therefore, with private sector participation, various private entities have blossomed in India of which 97% are in the unorganized sector and some are still not registered. Such establishment has called for the provisions for regulations, standards and accreditation. Through 1986–1996, growth in the private sector surpassed that in the public sector by a wide margin as the private sector is a preferred choice compared to public healthcare due to greater perception of ‘assurance’ in minds of the Indian consumer. The Indian healthcare industry is seen to be growing at a rapid pace and is expected to become a USD 280 billion industry by 2020. According to the Investment Commission of India, the healthcare sector has experienced phenomenal growth of 12% per annum in the last 4 years. Rising income levels and a growing elderly population are the driving factors of such growth. In addition, changing demographics, disease profiles and the shift from chronic to lifestyle diseases in the country has led to the increased spending on healthcare delivery. Despite having centers of excellence in healthcare delivery, these facilities are limited and are inadequate. In order to meet manpower shortages and be on par with the world standards, India would require up to USD 20 billion investments over the next 5 years. It has been estimated that 40% of the primary health centers in India are understaffed. According to WHO’s statistics, there are over 250 medical colleges in the modern system of medicine and over 400 in the Indian system of medicine and homeopathy (ISM&H) and India produces over 250,000 doctors annually in the modern system of medicine and a similar number of ISM&H practitioners, nurses and para professionals. The existence of policy regulations and the establishment of public private partnerships are solutions to the problem of manpower shortage to propel the growing healthcare industry. India is now looking at establishing academic medical centers (AMCs) for the delivery of higher quality care with leading examples such as The Manipal Group, Fortis Hospitals, Appollo Hospitals, & All ndia Institute of Medical Sciences (AIIMS) which have been set up. In the year of 2011 Practo group has entered in the national healthcare information 11

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exchange process to facilitate the right healthcare information services to the citizens of India as

Practo.Com is a comprehensive Voice and web based service powered by Practo Technologies Pvt Limited. Practo.com has the unique feature of Search, Compare, Evaluate, and Select. This service in India has started in the month of February 2011 in the 5 metropolitan cities (Delhi, Mumbai, Bangalore, Kolkata, and Chennai) of India. Practo is also trying to go down the line in Tire 2 Cities of India such as Pune, Lucknow, Kanpur, Coimbatore etc. to provide healthcare information exchange.

II.

Scope of Healthcare Industry

Health care industry focuses on treating patients suffering from any ailment. The treatment is done by trained professionals. Now let’s focus on Indian scenario.

Although Indian health care system has gradually improved over the years, it still lags behind our neighboring countries. The poor state of this industry may be attributed to lack of enough government push, as estimates reveal that per capita health care spending is far below international recommendations. It is to be noted that Developed nations spend about 10% of their GDP in health care, while Indian spending is at meager 5.25% of GDP.

The focus is definitely catching up on this industry and approximately 12% of the scope offered in India has been tapped. Currently valued at approximately $17 billion, it is expected to grow at 13% every year. The health care spending can reach $53 billion to $73 billion making it 6.2% of our GDP in next 5 years. Still leaves lot of scope to match up with standards set by the developed countries 12

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This industry in India provides employment to about 4 million people in various categories. So it can be any one's guess on number of positions that would be created in next 5 years. The vast difference in treatment costs in India vs Developed countries, and the improving standards and health care infrastructure as placed India as one of the favorite destinations for treatment. Several foreign companies are eying this opportunity and willing to invest in India's health care business.

This would definitely give rise to the medical tourism industry, which would help in providing a financial push more on Medical tourism some time later.

III.

Opportunities in Health Care Sector

Healthcare opportunities can be categorized broadly under four heads: 1. Medicine 2. Dentistry 3. Nursing 4. Pharmacy Each of these categories contains multiple job opportunities, including the support mechanism.

1. Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness.

Contemporary medicine applies health science, biomedical research, and medical technology to diagnose and treat injury and disease, typically through medication, surgery, or some other form of therapy. Though medical technology and clinical expertise are pivotal to contemporary medicine, successful face-to-face relief of actual suffering continues to require the application of ordinary human feeling and compassion.

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2. Dentistry is the branch of medicine that is involved in the study, diagnosis, prevention, and treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body. Dentistry is widely considered necessary for complete overall health. Those who practice dentistry are known as dentists. The dentist's supporting team aids in providing oral health services, which includes dental

assistants,

dental

hygienists,

dental

technicians,

and

dental

therapists.

3. Nursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from conception to death. Nurses work in a large variety of specialties where they work independently and as part of a team to assess, plan, implement and evaluate care. Nursing Science is a field of knowledge based on the contributions of nursing scientist through peer

reviewed

scholarly journals and evidenced-based practice.

4. Pharmacy is the health profession that links the health sciences with the chemical sciences and it is charged with ensuring the safe and effective use of pharmaceutical drugs.

The scope of pharmacy practice includes more traditional roles such as compounding and dispensing medications, and it also includes more modern services related to health care, including clinical services, reviewing medications for safety and efficacy, and providing drug information. Pharmacists, therefore, are the experts on drug therapy and are the primary health professionals who optimize medication use to provide patients with positive health outcomes.

5. Allied Health professionals are clinical health care professions distinct from medicine, dentistry, and nursing. Allied health professionals make up 60 percent of the total health workforce. They work in health care teams to make the healthcare system function by providing a range of diagnostic, technical, therapeutic and direct patient care and support

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services that are critical to the other health professionals they work with and the patients they serve.

IV.

Present Health care System in India

Inflation is sky rocketing, and there is nothing new in that. Over the past couple of years, India has seen a steady rise in Inflation, which is not being complimented by the rise in salary of majority of the population of India. The facilities offered by the Public Health Care system is just not enough for the majority, Private Health care needs to supplement it. The Government Hospitals are overburdened with long queues of patients and limited staff, and to add to the worries, most of the high end medical equipments primarily lie un-utilized due to lack of skilled technicians. So it is no rocket science to deduce that middle class in India are looking to Private health

care

offerings.

Private hospitals in India are comparatively very expensive for treatments. Patients are required to pay through their nose to get the required treatment. This should be an eye-opener for the Government to justify the tax payer, by focusing more on Public Heath care system. Although, lot’s of initiatives have been taken, but this has not materialized at the execution level.

V.

Health care industry in India and the GDP

Expenses incurred by the Indian Government on health care are the highest amongst developing countries. India's expense on health care sector comprises 5.25% of the GDP. Chances are that the health care market could experience a hike and attain a figure ranging between $53-$73 billion five years from now. This in turn will reflect an increase in the gross domestic product to 6.2% GDP. The health care industry in India earns revenues accounting for 5.2%

of

gross

domestic

product.

Employment opportunities are provided to as many as 4 million people in the health care segment or other related sectors catering to the health care industry in India in some way or the other. Owing to the vast differences in medical expenses in western countries and that of India, India has become one of the favorites for health care treatments. 15

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Due to the progressive nature of the health care sector in India, several foreign companies are intending to invest in the country.

VI.

Indian Pharmaceutical Industry: SWOT analysis

It is often said that the pharma sector has no cyclical factor attached to it. Irrespective of whether the economy is in a downturn or in an upturn, the general belief is that demand for drugs is likely to grow steadily over the long-term. True in some sense. But are there risks? This article gives a perspective of the Indian pharma industry by carrying out a SWOT analysis (Strength, Weakness, Opportunity, Threat). Before we start the analysis let’s look a little back in the industry’s last six years performance. The Industry is a largely fragmented and highly competitive with a large number of players having interest in it. The following chart shows the breakup of the growth (YoY) of Indian pharmaceutical industry in last six years. Strengths: 1. Indian with a population of over a billion is a largely untapped market. In fact the penetration of modern medicine is less than 30% in India. To put things in perspective, per capita expenditure on health care in India is US$ 93 while the same for countries like Brazil is US$ 453 and Malaysia US$189. 2. The growth of middle class in the country has resulted in fast changing lifestyles in urban and to some extent rural centers. This opens a huge market for lifestyle drugs, which has a very low contribution in the Indian markets.

3. Indian manufacturers are one of the lowest cost producers of drugs in the world. With a scalable labor force, Indian manufactures can produce drugs at 40% to 50% of the cost to the rest of the world. In some cases, this cost is as low as 90%.

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4. Indian pharmaceutical industry posse’s excellent chemistry and process reengineering skills. This adds to the competitive advantage of the Indian companies. The strength in chemistry skill helps Indian companies to develop processes, which are cost effective. Weakness: 1. The Indian pharma companies are marred by the price regulation. Over a period of time, this regulation has reduced the pricing ability of companies. The NPPA (National Pharma Pricing Authority), which is the authority to decide the various pricing parameters, sets prices of different drugs, which leads to lower profitability for the companies. The companies, which are lowest cost producers, are at advantage while those who cannot produce have either to stop production or bear losses. 2. Indian pharma sector has been marred by lack of product patent, which prevents global pharma companies to introduce new drugs in the country and discourages innovation and drug discovery. But this has provided an upper hand to the Indian pharma companies. 3. Indian pharma market is one of the least penetrated in the world. However, growth has been slow to come by. As a result, Indian majors are relying on exports for growth. To put things in to perspective, India accounts for almost 16% of the world population while the total size of industry is just 1% of the global pharma industry. 4. Due to very low barriers to entry, Indian pharma industry is highly fragmented with about 300 large manufacturing units and about 18,000 small units spread across the country. This makes Indian pharma market increasingly competitive. The industry witnesses price competition, which reduces the growth of the industry in value term. To put things in perspective, in the year 2003, the industry actually grew by 10.4% but due to price competition, the growth in value terms was 8.2% (prices actually declined by 2.2%)

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Opportunities 1. The migration into a product patent based regime is likely to transform industry fortunes in the long term. The new patent product regime will bring with it new innovative drugs. This will increase the profitability of MNC pharma companies and will force domestic pharma companies to focus more on R&D. This migration could result in consolidation as well. Very small players may not be able to cope up with the challenging environment and may succumb to giants. 2. Large number of drugs going off-patent in Europe and in the US between 2005 -2009 offers a big opportunity for the Indian companies to capture this market. Since generic drugs are commodities by nature, Indian producers have the competitive advantage, as they are the lowest cost producers of drugs in the world. 3. Opening up of health insurance sector and the expected growth in per capita income are key growth drivers from a long-term perspective. This leads to the expansion of healthcare industry of which pharma industry is an integral part. 4. Being the lowest cost producer combined with FDA approved plants, Indian companies can become a global outsourcing hub for pharmaceutical products. Threats: 1. There are certain concerns over the patent regime regarding its current structure. It might be possible that the new government may change certain provisions of the patent act formulated by the preceding government. 2. Threats from other low cost countries like China and Israel exist. However, on the quality front, India is better placed relative to China. So, differentiation in the contract manufacturing side may wane.

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3. The short-term threat for the pharma industry is the uncertainty regarding the implementation of VAT. Though this is likely to have a negative impact in the shortterm, the implications over the long-term are positive for the industry.

VII.

SWOT Analysis of Indian Healthcare Industry:

Strengths  Low cost of production.  . Large pool of installed capacities  Efficient technologies for large number of Generics.  Large pool of skilled technical manpower.  Increasing liberalization of government policies. Weakness  Fragmentation of installed capacities.  Low technology level of Capital Goods of this section.  Non-availability of major intermediaries for bulk drugs.  Lack of experience to exploit efficiently the new patent regime.  Very low key R&D.  Low share of India in World Pharmaceutical Production (1.2% of world production but having 16.1% of world's population).  Very low level of Biotechnology in India and also for New Drug Discovery Systems.  Lack of experience in International Trade.  Low level of strategic planning for future and also for technology forecasting. Opportunities  Aging of the world population.  Growing incomes. 19

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 Growing attention for health.  New diagnoses and new social diseases.  Spreading prophylactic approaches.  Saturation point of market is far away.  New therapy approaches.  New delivery systems.  Spreading attitude for soft medication (OTC drugs).  Spreading use of Generic Drugs.  Globalization  Easier international trading.  New markets are opening.

Threats  Containment of rising health-care cost.  High Cost of discovering new products and fewer discoveries.  Stricter registration procedures.  High entry cost in newer markets.  High cost of sales and marketing.  Competition, particularly from generic products.  More potential new drugs and more efficient therapies.  Switching over form process patent to product patent.

India has entered a high growth rate trajectory of 9 per cent. This high rate of growth,however, is not accompanied by a high level of social development. The social sectors particularly health and education have been accorded a very low priority in terms of the allocation of resources.

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For example, public expenditure on health services as a percentage of Gross Domestic Product (GDP) in India is less than 1 per cent likely to be one of the lowest across the globe.

VIII.

Trends in Health Expenditure in India (GDP is at Market Price, with Base Year 1993-94)

Year

Health Expenditure as % of the GDP

1950-51

0.22

NA

0.22

1955-56

0.49

NA

0.49

1960-61

0.63

NA

0.63

1965-66

0.61

NA

0.61

1970-71

0.74

NA

0.74

1975-76

0.73

0.08

0.81

1980-81

0.83

0.09

0.91

1985-86

0.96

0.09

1.05

1990-91

0.89

0.06

0.96

1995-96

0.82

0.06

0.88

2000-01

0.86

0.04

0.90

2001-02

0.79

0.04

0.83

2002-03

0.82

0.04

0.86

2003-04

0.86

0.06

0.91

Health sector suffered more during post-liberalization period. Economic Liberalization policy was introduced in India during the middle of 1991. The major thrust of economic liberalization is to give more leverage to market forces so far allocation of resources among various sectors of the economy is concerned. In the pre-liberalization period of independent India, the health expenditure as percentage of 6 the GDP increased as a whole from 0.22% in 1950-51 to 0.96% in 1990-91. However, it has seen a steady decline ever since in the Post-Liberalization period 21

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from 0.96 % in 1990-91 to 0.91% in 2003-2004. It is not only that India spends very low proportion of its GDP on public health services, another problem is the wide ranging regional variations in expenditure on public health services is also reported. A comparison of inter-state variations in expenditure on health suggests that Rajasthan spent 5.75 % of its budget on health, whereas it was only 3.63% in case of Gujarat in 2003-2004 (See Table 2). The State wise expenditure on health also reveals that the share of health sector in the overall budget has been declining over time. For example all the States spent 7.02% of their budget on health in 1985-86, which declined to 5.72% in 1991-92 and further to 4.97% in 2003-04.

IX.

Share of Health in Revenue Budget of Major States (in %)

S.No

States

1985-86

1991-92

1995-96

1999-2000

2003-2004

1

AP

6.41

5.77

5.70

6.09

5.21

2

Assam

6.75

6.61

6.08

5.25

4.39

3

Bihar

5.68

5.65

7.80

6.30

4.84

4

Gujrat

7.45

5.42

5.34

5.21

3.68

5

Haryana

6.24

4.19

2.99

4.08

3.63

6

Karnataka

6.55

5.94

5.85

5.70

4.85

7

Kerala

7.69

6.92

6.81

5.95

5.42

8

Maharastra 6.05

5.25

5.18

4.59

4.39

9

MP

6.63

5.66

5.07

5.18

4.89

10

Orissa

7.38

5.94

5.42

5.03

4.47

11

Punjab

7.19

4.32

4.56

5.34

4.27

12

Rajasthan

8.10

6.85

6.18

6.39

5.75

13

Tamil Nadu

7.47

4.82

6.40

5.51

5.26

14

UP

7.67

6.00

5.73

4.42

5.13

15

WB

8.90

7.31

7.16

6.30

5.23

16

All states

7.02

5.72

5.70

5.48

4.97

22

23

Low public sector spending on health services results in over-dependence on private sector for getting health services. In India the share of private sector on health care expenditure constitutes around 72 % and household sector being the major constituent of the private sector claims 68.8% of expenditure on health care (Table 3). In other words out-of-pocket expenditure comprises major share of expenditure on health care. All the three layers of governments (federal, state and local) spend only 23.8 per cent of the total expenditure on health services. NGO sector is almost non-existent in terms of spending on health services. Its share is only 0.3 per cent.

X.

Sources of Finance in the Health Sector in India during 2001-2002 Private

Govt

Public

Households Private Central States

Local

Firms

Firms Health

68.8%

3%

NGOs

External Funds

Sector Banks

7.2%

14.4%

2.2%

3%

0.2%

0.3%

2%

0.3%

2%

Spending Total

71.8%

23.8%

3.2%

It is not only that distribution of health services are skewed across strata, skewness in their distribution is also found while studying Rural-urban access to health services in India. For example, in rural India there are 0.2 hospital beds per thousand population as against 3.0 in urban areas.

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24

Sl. No

Characteristics

Rural (Per 1000

Urban( Per 1000

Population)

population)

1

Hospital Beds

0.2

3.0

2

Doctors

0.6

3.4

3

Public Expendetures

Rs.80,000

Rs.5,60,000

4

Out of pocket

Rs.7,50,000

1,150,000

5

Infant Mortality Rate

74/1000Live births

44/1000Live Births

6

Under Five Mortality

133/1000Live Births

87/1000 Live Births

rate 7

Birth Attended

33.5%

73.3%

8

Full Immunization

37%

61%

Similarly in rural areas there are only 0.6 doctors per 1000 population, which is as high as 3.4 in urban areas. Rural-urban disparities are equally pronounced on account of outcome of health services. For instance Infant Mortality Rate (IMR) in rural areas in 74 per one thousand live births which is about 44 per thousand live births in urban areas. Similarly Under-Five Mortality Rate (U5MR) is 137 per thousand live births in rural areas and 87 per thousand live births in urban areas (De, 2008). The Government of India has taken a new massive policy initiative known as National Rural Health Mission (NRHM) to reduce the divide between urban and rural areas in the field of health. The major objectives of NRHM are to improve the availability ofand access to quality health care by people, especially for those residing in rural areas, 9 the poor, women and children (NRHM, 2005). The pace of implementation of the Mission is very slow. Garg and Nath have opined that the progress of the Mission in Uttar Pradesh, one of the most populous states is very dismal. In NRHM, Accredited Social Health Activist (ASHA) is the key player, whose role is to work as an interface between the community and the public health system. In case of Uttar Pradesh, the performance on account of ASHAs is very discouraging. The State has selected only 9,548 ASHAs against the target of 65, 000. Unfortunately, the State has not made any arrangement 24

25

for their training. In most of the other States also the progress of NRHM is very tardy. In India as a whole out of the total 228,327 ASHAs proposed to be selected; only 145,546 ASHAs were selected (Garg and Nath, 2007). A government-funded review of NRHM also revealed its slow progress. The major problems in the implementation of the NRHM are: administrative constraints, governance issues, inadequacies in human resources as well as the poor investment in public health services in the recent past (Shrivastava, 2008). Commercialization and privatization of health services and introduction of users’ charges in pubic health institutions during post-globalization phase have excluded a sizeable number of population particularly belonging to socially disadvantaged groups and poor from the coverage of health services provided by organised sector. An earlier study by the authors has found that since the start of economic liberalization, privatization, and globalization in the 1990s, the Punjab government had introduced two drastic reforms in health policy. First policy decision was the significant opening of health-care services to the private corporate sector. Private sector hospitals were given land and facilities at concessional rates and were expected in return to provide free treatment to yellow card holders (people below the poverty line) – up to 10 per cent of outpatients and 5 per cent of inpatients. The second policy decision was that the Punjab Government set up the Punjab Health Systems Corporation (PHSC) in October 1995, under the World Bank-sponsored State Health Systems Development Project II, and transferred more than 150 health-care institutions run by the government to PHSC. To mobilize more resources, the hospitals no longer provided free services and instead charged all patients a user fee, barring few categories of patients including people below the poverty line. It was 10 revealed in the study that only a negligible proportion of people below poverty line availed themselves of exemptions from user charges at government hospitals. According to field survey ignorance among the poor about free treatment and the complex and cumbersome procedure were constraining the access of the poor to the health care services (Ghuman and Mehta, 2006). The unequal access to health services has succinctly been stated by the 11th Five Year Plan of India (2007-2012), “… there is also a divide between those who have access to essential services 25

26

such as health, education, drinking water, sanitation, etc, and those who do not. Groups which have hitherto been excluded from our society such as Scheduled Castes (SCs), Scheduled Tribes (STs) and some minorities and Other Backward Classes (OBCs), continue to lag behind the rest” (Planning Commission, 2006). Gender disparities in health services are also very acute and deserve special attention of the policy makers. Gender disparities are found on account of utilisation of health services both for in-patient and out-patient care. National Sample Survey Organization (NSSO) data reveal that in the rural areas the money spent per illness episode for outpatient care was Rs. 151 and Rs. 137 respectively for male and female. The respective amounts for urban areas were Rs. 187 and Rs. 164. Gender variation is expenditure spent for inpatient care is also reported (Saha and Ravindran, 2002). Glaring spatial disparities in health services and their outcomes are also found particularly in rural India (Kathuria and Sankar, 2005). In addition to inequity in health services, the quality of health services and governance of public health organizations are also matter of concern. First the infrastructural facilities are inadequate followed by their poor maintenance. Secondly most of public health institutions are understaffed accompanied by a high absence rate among the personnel. Thirdly, medicines are normally not available in the health institutions (Dreze, 2004).

XI.

Innovation and Development in Indian Healthcare Industry

According to the United States Central Intelligence Agency (CIA) India’s current population is estimated to be 1,173,108,018 people. This makes India the second largest population in the World behind China’s estimated 1,330,141,295 people, and ahead of the United States, which comes in third place at only 310,232,863 people. The CIA estimates the rate of population growth to be approximately 1.376% as of 2010 compared to only 0.49% annual population growth in China (“CIA July 2010.”) This means that by 2030 India will have surpassed China as the world’s most populous country, and will reach a population of 1.4 billion people by 2050 (“PricewaterhouseCoopers LLP 2007.”)

26

27

This rapid population increase in India is due to several factors, including but not limited to, a decrease in the infant mortality rate, increased vaccination at birth, and increased life expectancy. As a result the growing elderly population in India will place a large burden on India’s Healthcare infrastructure, with estimates that by 2025 nearly 189 million Indians will be over age 60 (“PricewaterhouseCoopers LLP 2007.”)

XII.

Population Statistics

Top Five Countries by Population. Rank

Country Name

Total Population

1.

China

1,330,141,295

2.

India

1,173,108,018

3.

United States

310,232,863

4.

Indonesia

242,968,342

5.

Brazil

201,103,330

Statistics Population Growth Rate: Birth Rate (births/1000 pop):

1.376% 21.34 births

Avg. Life Expectancy:

66.46 years

Median Age:

25.9 years

Pop. Infected with AIDS/HIV:

2.4 million (2007)

Percentage AIDS/HIV in pop:

0.3% (2007)

(Source: “CIA World Fact book 2010”)

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28

XIII.

Suggestion for changes

A health care industry trend suggests changes in the following spheres: The company’s manufacturing medicines provide health care plans More stress is to be laid on prevention than treatments Sufficient supply of the essential health care products should be made available to the consumers to meet the demand of the health care industry. Health care industry trends manifest an upward growth but several areas need to be attended for

enhancing

health

care

services

for

the

common

man.

With the invention of latest technological developments, the world health care industry is catching up with the other leading industries of the world. World health care industry is one of the largest industries catering to the medical needs of innumerable people around the globe. Statistics show that in the year 2004, employment provided by the health care industry accounted for 13.5 million job opportunities. Out of the 13.5 million jobs, some of the people opted for self employment while others remained salaried workers related to the health care. It has been predicted that between 2004 through 2014, increase in the health care jobs would be by approximately 19% or as many as 3.6 million job opening would be produced The statistics provided above reflect the health care scenario in the India,Generally, the world health care industry comprises of the following segments: 

Hospitals



Nursing Homes



Physicians



Dentists



Health care services at home.



Medical practitioners



Outpatient departments



Ambulant health care facilities 28

29 

Diagnostic laboratories and medical services Health care industry includes any medical institution which includes either a single medical assistant to the medical practitioner or medical practitioners attached to different hospitals and other medical establishments. The rate of growth of the health care industry in India is moving ahead neck to neck with the pharmaceutical industry and the software industry of the country. Much has been said and done in the health care sector for bringing about improvement. Till date, approximately 12% of the scope offered by the health care industry in India has been tapped. The health care industry in India is reckoned to be the engine of the economy in the years to come. Health care industry in India is worth $17 billion and is anticipated to grow by 13% every year. The health care sector encompasses health care instruments, health care in the retail market, hospitals enrolled to the hospital networks etc.

XIV.

Steps can be taken to overcome with these problems By Government:

Budget 2013 is round the corner, and if section 80D is revised (currently deductions are allowed to Rs. 15,000) to maybe Rs. 50,000 (this was a wish list last year also), that would give a sigh of relief to the middle class. The details of this section are available on Income Tax's website. The Government can also look at privatizing the hospital management part (for Government Hospitals), may be on a contractual basis, which would ensure the finances are well utilized. This should be just a beginning, as in the long run the health system itself needs to improve. It is true that many initiatives have been taken by the Government but most of them have been focused on Rural India, and the transparency of the execution is not available to a great extent. This should be a focus area. If the public remains healthy, the lack of medical infrastructure can be overlooked to some extent.

29

30

By Common Man: The best option one can have is to buy a health insurance plan. There are plenty of offerings by various companies which one can look into. This will provide them much needed support in case of any emergency. Many health insurance advisers are already giving guidance to people on what to look for when buying insurance.

What else can be done In Healthcare Sector: Private health care companies should focus on reducing costs of treatments for various ailments. This can be achieved by channelizing a part of their profits into Research for advancements. They should also impart trainings to the patients on how they can stay healthy. The Private companies should just not focus on "to extract more money from the patients". They should also offer support for those who are elderly so that they will not be prone to getting sick caused by negligence and poor health care. It should be clearly imparted to patients and public to get treated when the symptoms appear and before it gets worst to a full

blown

disease.

Another aspect of our health system that needs overhauling is the large bureaucracy that needs trimming. This will enable local public hospitals to make crucial decisions, which it has failed to do so, leaving many people to doubt the reform proposals of the government to improve health care. The key is to provide immediate and efficient health care delivery to every Indian.

XV.

The Budget 2011-12 impact on Healthcare

Union Budget for 2011-12 had its highlights for the health care sector. While much have been talked about the inclusion of this sector under the service tax net, there have been other highlights as well, which should not be ignored.

30

31

From the budget speech, I would like to highlight a few points, which address health care infrastructure improvements. If we cannot add more hospitals, we can definitely have healthy citizens, who can save their costs by avoiding the frequent visits to the hospitals. While we ensure food for all, we must also promote balanced nutrition. Bajra, jowar, ragi and other millets are highly nutritious and are known to possess several medicinal properties. The availability and consumption of these Nutri-cereals is, however, low and has been steadily declining over recent years. A provision of Rs 300 crore is being made to promote higher production of these cereals, upgrade their processing technologies and create awareness regarding their health benefits. This initiative would provide market linked production support to ten lakh millet farmers in the arid and semi-arid regions of the country. The programme would be taken up in 1000 compact blocks covering about 25,000 villages. This will help improve nutritional security and increase feed and fodder supply for livestock. This step is definitely a boost towards the health care infrastructure. With the increase in production of these nutritious cereals, these will be easily available at affordable prices. A positive move indeed! The consumption of foods rich in animal protein and other nutrients has risen of late, with demand growing faster than production. The National Mission for Protein Supplements is being launched in 2011-12 with an allocation of Rs 300 crore. It will take up activities to promote animal based protein production through livestock development, dairy farming, piggery, goat rearing

and

fisheries

in

selected

blocks.

Adequate availability of fodder is essential for sustained production of milk. It is necessary to accelerate the production of fodder through intensive promotion of technologies to ensure its availability throughout the year. I propose to provide Rs 300 crore for Accelerated Fodder Development Programme which will benefit farmers in 25,000 villages. Over the years, with increase in awareness about animal products, masses have increased the consumption of milk and milk products, meat, eggs etc. With the focus on the same, these two

31

32

initiatives and fund allocation should encourage more investment, leading to lowering of costs of animal products and should get better distribution network. A positive move! For health, I propose to step up the plan allocations in 2011-12 by 20 per cent to Rs 26,760 crore. The Rashtriya Swasthya Bima Yojana has emerged as an effective instrument for providing a basic health cover to poor and marginal workers. It is now being extended to MGNREGA beneficiaries, beedi workers and others. In 2011-12, I propose to further extend this scheme to cover unorganized sector workers in hazardous mining and associated industries like slate and slate pencil, dolomite, mica and asbestos etc. This part is totally focused on population below the poverty line and those who are extremely poor. Increasing the fund allocation and extending the benefits to more unorganized sectors is a great vision. Hazardous industries is often ignored by private insurers, and with government taking care of the workers, the organizations can encourage more workers to join by luring them with these government benefits. On a health care perspective this is a positive move! Environmental pollution has emerged as a serious public health concern across the country. I propose to allocate Rs 200 crore from the National Clean Energy Fund as Centre's contribution in

2011-12

for

launching

environmental

remediation

programmes.

A number of projects under the National Ganga River Basin Authority have been approved in 2011-12. This momentum will be further stepped up. There are many rivers and lakes of cultural and historical significance that need to be cleaned. In the course of the year 2011-12, I propose to provide a special allocation of Rs 200 crore for the clean-up of some important lakes and rivers other than the Ganga. Addressing environmental pollution related issues has always been an issue surfacing around the developing economies. The "big bosses" of developed nations, who unfortunately fail to control pollution limits of their own countries, show their weight and push the developing economies to control pollution. With this step of our finance minister, at least we can show the world that we also care for the health of our citizen's and also the world. A welcome step, which would help Indians to live in better conditions and get clean water and hopefully avoid need for hospitals. 32

33

Now the most hyped negative for the health care sector, which directly impacts the majority of the urban population. I imposed service tax in 2011-12 on health check up or treatment. This levy has resulted in differential treatment between persons who make payments themselves and others where payments are made by an insurance company or a business entity. Thus, I propose to replace it with a tax on all services provided by hospitals with 25 or more beds that have the facility of central air-conditioning. Though the tax is on high- end treatment, I propose to sweeten the pill by an abatement of 50 per cent so that the actual burden is kept at 5 per cent of the value of service. I also propose to extend the levy to diagnostic tests of all kinds with the same rate of abatement. However, all Government hospitals shall be outside this levy. With the intent of making things transparent, the finance minister might have tried to address the issues of insurance companies, but this step would lead to more expensive treatments for individuals who prefer not to have health insurance (the majority) as well as for those instances where the insurer does not provide cover on specific ailments. In majority of the cases, doctors advise to first get n number of tests done before prescribing the medication... well all gets more expensive from April. Most of the hospitals are air conditioned, and have more than 25 beds. The infrastructure, facilities and management at Government hospitals is very poor in spite of having good doctors. The welcome step would have been adding more Government hospitals, alas that did not happen! Though few initiatives have been taken for this sector, but they are not enough. Especially, inclusion of all services of hospitals under the service tax net (though giving a 50% discount on service tax). Nothing has been done to improve the conditions of the government hospitals. The current rough ratio of 70 beds per 100,000 people is far too less than the world average of 396 beds per 100,000. Well, we are just dragging the ratio down! Baby steps could have been taken to reduce this gap. Most of the state governments are already cash starved, and would have expected investments from the center to do something in this direction. We can only look forward for the private sector to do anything in this direction, but that is all taxed for the

33

34

patients! Investing in this sector rewards long term players given the fact that the break-even period lies close to 5 years. Nothing was done in the budget for medical education. There are plenty of ideas to encourage students and investors to join hands for Medical Education.... if that was properly incentivized by the finance minister. Taxation of services could have been avoided, and instead the services could have been made less expensive, making the masses to go for preventive check-ups and treatments. Unfortunately, now people would avoid visiting health care facilities to save their pockets with the ever increasing inflation. Specific target was on air conditioned facilities... most of the hospitals/nursing homes are air conditioned not because of luxury, but because of necessities. Various equipments would fail if they are not kept in controlled temperatures. They need air-conditioning for precise and expected results! This is not for luxury! The rooms need air-conditioning to avoid 

Insects flying all over (imagine opening the windows of your hospital room),



The summer heat (which would nowhere help in treating a patient),



The noise pollution (what would be the impact on heart patients, with cars honking outside the hospitals?),



The air pollution (can this help in treatment in any way?)

The import of medical equipments did not get any tax exemptions. How can we encourage the much hyped medical tourism industry, if our basic cost is high? We need to have facilities much cheaper than our neighbors, forget the west. The finance minister definitely missed revenues from this industry.

34

35

CHAPTER I OBJECTIVE OF THE STUDY The main objectives of the Study are;

Primary Objectives: To study the market potential of Healthcare sector in Bangalore.

To understand competitive market for the Practo.Com.

To understand people mentality about Practo.Com .

Secondary Objectives:

To understand the present situation of the health sector in India.

To understand the future business opportunities around Healthcare industry.

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36

CHAPTER II i.

Research Methodology

The project was carried out for understanding advertising and sales promotion straties of Healthcare Business in India Its Future Growth and opportunities for the industry. Healthcare sector comprises of many segments, which include hospitals, medical infrastructure, medical devices, clinical trials, outsourcing, telemedicine, and health insurance. The global economic slowdown has affected many segments of the economy. However, as comparison, the healthcare sector has outperformed the broader market. Health care system runs by the constituent states and territories of India. The Constitution charges every state with "rising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties". The National Health Policy was endorsed by the Parliament of India in 1983 and updated in 2002. However, the government sector is understaffed and underfinanced; poor services at state-run hospitals force many people to visit private medical practitioners. India’s pharmaceutical market is highly dynamic and presents significant upsides for both local firms and foreign multinationals. However, as with all emerging markets, there are under-appreciated risks to investments. BMI forecasts that combined sales of prescription drugs and over-the-counter (OTC) medicines will increase from US$15.7bn in 2009 to US$54.2bn in 2019 – a compound annual growth rate of 13.2%.In our Q410 Business Environment Ratings, India has maintained its status as the eight most attractive pharmaceutical market in Asia Pacific, ahead of Malaysia but behind Hong Kong. According to the World Health Organization (WHO), private per capita expenditures on health increased by more than 15% in the last 5 years in emerging markets such as Malaysia, Vietnam, Indonesia and India. Moreover, based on medical claims analysis, premium costs in Asia will double in the next five years.

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37

The main competitors of Practo.Com (A product of Practo Technologies Pvt Limited) are Just Dial, HealthCare Magic and yellow pages companies and they are well established in the existing market. Just Dial Private Limited, a company incorporated under the Companies Act 1956 with its registered office at Building M, 501-B, Palm Court Complex, Besides Goregaon Sports Complex, New Link Road, Malad (W), Mumbai 400 064, that governs your use of the search services offered by JustDial through its website www.justdial.com ("Website"), telephone search, SMS, WAP or any other medium using which JustDial may provide the search services (collectively "Media"). When you access or use any of the Media you agree to be bound by these Terms and Conditions. Yellow Pages refer to a telephone directory of businesses, categorized according to the product or service provided. As the name suggests, such directories were originally printed on yellow paper, as opposed to white pages for non-commercial listings. The traditional term Yellow Pages is now also applied to online directories of businesses.

ii.

Problem Identification and Problem Formulation:

The hospital services market represents one of the mοѕt lucrative segments of the Indian healthcare industry. Various factors such аѕ increasing prevalence of diseases, improving affordability and rising penetration of health insurance continue tο fuel growth in the Indian hospital industry. With continuous increase in demand, the industry іѕ expected tο witness growth of around 8% in 2009 over the previous year. Government hospitals, some of which are among the best hospitals in India, provide treatment at taxpayer expense. Most essential drugs are offered free of charge in these hospitals. Government hospitals provide treatment either free or at minimal charges. For example, an outpatient card at AIIMS (one of the best hospitals in India) costs a onetime fee of rupees 10 (around 20 cents US) and thereafter outpatient medical advice is free. In-hospital treatment costs depend on financial condition of the patient and facilities utilized by him but 37

38

are usually much less than the private sector. For instance, a patient is waived treatment costs if he is below poverty line. Another patient may seek for an air-conditioned room if he is willing to pay extra for it. The charges for basic in-hospital treatment and investigations are much less compared to the private sector. The cost for these subsidies comes from annual allocations from the central and state governments. By 2014, revenues estimated to reach USD 52-69 billion, 6.2 to 8.5 per cent of GDP; employment will Double. The pattern of healthcare spending will also change The share of outpatient spend will decrease from 61 percent to 53 per cent Lifestyle diseases will drive the growth of outpatient spend Lifestyle diseases will drive the growth of outpatient spend Cancer and heart diseases will drive most of the growth of inpatient spend 80,000 additional hospital beds required every year for the next 3 to 4 years to meet growing demands

iii.

Business Opportunities for healthcare industry: India needs an investment of USD 203 billion to meet the ‘Health for All’ target by 2010 Significant requirement in increase in number of beds per 1000 population – from 3 beds per 1000 population to 5 beds per 1000 population by 2010 (in both private and public) This translates to an addition of 2.2 million beds requiring investment of USD 77.9 billion, majority of which will come from the private participation Increasing preference for private medical care amongst the urban population 38

39

High growth domestic market arising from increasing health awareness Rapid growth in private sector companies owning and managing hospitals Cost of advanced surgeries in India is about 10 per cent of that in USA Service Providers: Curative and preventive in primary, secondary and tertiary care

iv.

Challenges for Healthcare Industry

Various Challenges faced by healthcare industry are: Low consumer awareness about differences in quality of care across different provider types By 2010, 4,53,785 doctors and 1,290,174 more nurses will be required by the Indian Healthcare Industry, which is both a big challenge and an opportunity Having well organized healthcare system the services provided by healthcare industry is not up to the mark. The people of the country are facing the problem for getting right information at right time. The Product of Practo (Practo.Com) is made with the motive to provide free customer assistance 24x7.

v.

Scope of the study :

Though the study is limited to the Practo.Com (A product of Practo technologies Ltd.) within the area of Bangalore , it is very useful for those coming healthcare industries to take straties of advertisement and sales promotion for their product . It is also useful to the stakeholders for the awareness of oresent situation of Indian health services and the need of healthcare industries.

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vi.

Review of Literature

The study of “Advertising and sales promotion straties of Practo.Com was carried out for understanding advertising and sales promotion straties of Healthcare Business in India and its future growth and opportunities. Healthcare sector comprises of many segments, which include hospitals, medical infrastructure, medical devices, clinical trials, outsourcing, telemedicine, and health insurance. The global economic slowdown has affected many segments of the economy, however the healthcare Industry was one of them was not affected by the economic slowdown. The healthcare industry is growing rapidly and the industry has lot of scope in the future. The scope of healthcare industry is not only limited with the healthcare but also it also providing opportunities to several sectors such as IT (Information Technology), Insurance, Tourism, etc. In modern world healthcare is providing several opportunities to IT Industry in term of electronic medical records (EMR), Appointment Scheduler. The concept of EMR is getting popularity among the healthcare stake holders. The industry is providing opportunity to Insurance sector in terms of health insurance. Healthcare industry is providing scope to the Tourism Field in the form of Medical Tourism. The main aim of the market research of Practo.com was to understand the scope of healthcare information exchange because it is totally innovative concept in India. The secondary objective of this research was to develop a database for Practo.comabout healthcare service providers such as their timing of availability, their experience, their expertise, their charges, etc.

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41

vii.

Public and Private share of Hospitals

(Source: Ministry of Health and Family Welfare)

41

42

viii.

ix.

Healthcare Insurance Industry:

Number of People Covered By Health Insurance:

Demographic and population growth will support the performance of health insurance in India. India is home to one-sixth of the world’s population occupying less than 3% of the world’s area. The population in India stood at 1.17 billion in 2009 and according to the projection by the US 42

43

Bureau, India’s population is estimated to reach 1.33 billion in 10 years time. There is ample potential in health insurance as population increases in the near future. The Institute of Economic Growth has expected the age group ranging from15-64 to grow by 11%, which will also support health insurance growth in tandem. As income rises and the number of available financing options in terms of health insurance policies increase, consumers become more engaged in making informed decisions about their health and are well aware of the costs associated with those decisions. In order to remain competitive, healthcare providers are now improving their operational efficiency and enhancing patients experience overall. The increase number of population would also translate into higher demand of healthcare services and facilities to meet the needs of its citizens. The government would need to be far sighted to map out a comprehensive healthcare plan to cater for the growing population in the near future. Moreover, the rising fraction of the aging population would also increase the demand for healthcare. As projected, the number of citizen between 15-64 years old will increase by 10.9% in 2010 compared to year 2005.

x.

Population Projection

Source :CEIC 43

44

xi.

Population by Age:

Year

Under 15 year old Person

15-64 Old Person

64+Year old person

Total

(million person)

(million person)

(Million Person)

(Million Person) 2000

361

604

45

1,010

2005

368

673

51

1,080

2010

370

747

58

1,175

2015

373

825

66

1,264

Projected Source: CEIC

xii.

Healthcare Investments and Shortage of Medical Practitioners’:

The rewarding healthcare sector has been attracting huge investments from domestic players as well as financial investors and private equity (PE) firms. PE funds are estimated to invest at least USD 1 billion in the healthcare sector over the next five years. Health care facilities and personnel increased substantially between the early 1950s and early 1980s. The number of population has always outpaced the number of licensed medical practitioners with 3 medical practitioner per 10,000 individuals compared to 1.4 doctors per 1000 people in China. In 1991 there were approximately ten hospital beds per 10,000 individuals. Realizing the huge need gap in terms of availability of number of hospital beds per 1000 population and the need of medical practitioners, the government has embarked on improving the sector.

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45

In India, the current ratio of beds per thousand persons is a mere 1.03 (well below the WHO norms) compared to an average ratio of 4.3 for developing countries like China, Korea, and Thailand, and in the best circumstances, it is projected to reach 1.85 per thousand persons by 2012. It is estimated that over a million beds have to be added to attain this 1.85 ratio, which translates into a total investment of USD 78 billion in health infrastructure. India will require an estimated investment of USD 74 billion for additional 1.75 million beds by 2025, compared to its present capacity of about 1.22 million beds to meet the projected demand and maintain the ratio of bed-to-population at 1.9:1,000. In line with the concern of insufficient manpower, India is now looking at establishing academic medical centers (AMCs) for the delivery of higher quality care with leading examples of The Manipal Group & All India Institute of Medical Sciences (AIIMS) which had been established to laud the government effort. The density of doctors per 10,000 populations in India is 6 while the world average is 13. There could be a shortfall of over 450,000 doctors in the year 2012. While the shortfall of physician is great, the shortfall for nurses is even more remarkable. Density of nurses per 10,000 population is 13 in India while world average is 28 and it has been projected that at least 350,000 nurses are required for primary and secondary care by the year of 2015. Benefits and lucrative monetary returns offered in developed countries have led to emigration of such healthcare professionals. This phenomenon is one of the main reasons for domestic shortage. According to official statistics, 60,000 Indian physicians have been estimated to be working in developed countries such as USA, UK and Australia.

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46

xiii.

Supply and Demand for Medical Personnel

Category

Physicians Dental Surgeons Nurses

Statics as of 2009-10

Required Person

(Person)

(Person)

660,801

1,200,000

73,000

300,000

1,371,121

2,100,000

(Source: Ministry of Health)

xiv.

Increasing Demand of Private Healthcare

The significant and growing role of the private sector in healthcare delivery and total healthcare expenditures are the current trends of the healthcare industry. In 2007-08, public health expenditure in India accounted for less than 1% of the country’s GDP compared to 3% of GDP for developing countries and 5% for high income countries. Private healthcare sector in India had accounted for over 75% of the total healthcare expenditure in India and is one of the largest in the world. In the Indian’s land, it has been estimated that 60% of hospitals, 75% of dispensaries, and 80% of all qualified doctors are in the private sector. However, private healthcare delivery is highly fragmented with over 90% of private healthcare being serviced by the unorganized sector of all the private hospitals, 2 to 3% of hospitals are 200-bed plus, 6-7% are 100-200 bed size hospitals, and the majority of 80% of private sector hospitals are very small, less than 30 beds. According to the Studies by the Central Bureau of Health Intelligence, majority of Indians trust and visit private healthcare despite a higher average cost of USD 4.3 compared to USD 2.7 in government owned healthcare centers. Only a small portion of 23.5% of urban residents and 30.6% of rural residents choose government facilities. The low percentage of public healthcare 46

47

demand is a reflection of the common lack of confidence and bureaucracy in the public healthcare system. The setback of public healthcare has stimulated growth for private healthcare. According to the Studies, it was estimated that out of the 1 million beds to be added into the industry by 2012, the private sector will contribute to the addition of 896,000 beds while the remainder will be provided by the government arms, which had implied that government spending on healthcare infrastructure (excluding land) is projected to rise only marginally, by 0.12% of GDP. Government investments is expected to meet only 12% of the huge investment required in the healthcare sector, with the remaining balance of the investment requirements to be provided by private entities to conclude the significant role of private sector for future growth of India’s healthcare sector. As India advances and improves its socio economy, the overall income of its population rises. The rise of personal disposable income at large among the Indians has also served as an influencing factor to stimulate healthcare spending as it become more affordable. Personal disposable income of 2008/09 had increased drastically by about 71% from the figure in 200405. Moreover, with the increasing number of financing options such as health insurance policies available, consumers become more engaged and are well aware of the costs associated in healthcare. The increasing demand for high quality and efficient healthcare system has urged the players in the market, being the public or private sector to improve operational and management efficiency to provide patients with overall better and enhanced services and experience to remain competitive in the market.

47

48

xv.

Personal Disposable Income:

xvi.

Information Technology in Healthcare Industry

The healthcare industry today after twenty five years, since computers started influencing our society, is standing at the threshold of a world of possibilities thrown up by technologies such as Virtual Reality, Cyber surgery, Micro - robotic Surgery and 3D image modeling. It is said that the Internet should be used for the benefit of mankind. Internet pundits have always felt that development and delivery of Medicine will be one area where this medium is likely to have immense benefit to mankind. For e-healthcare and telemedicine to emerge as a viable alternative modality for delivering medical care and expertise there are a few preconditions that are to be met. Some of these are,  Adaptation of Information technology by hospitals especially in terms of networking and Hospital Management systems.  Increasing awareness on IT among medical professionals. 48

49

 Better Internet access; possibility the mad vent of broadband in India that can transfer video files faster.  4Standardization of various protocols (like DICOM in teleradiology) and acceptance of these protocols by the relevant equipment manufacturers.  Decline in the cost of telemedicine hardware to make it more financially viable.  Govt. encourages a Public – Private enterprise.  Large Corporate leading in overseas healthcare contracts - TCS, Cognizant, etc. At present, the major constraint is in terms of the financial viability of e-healthcare initiatives. However there have been several isolated initiatives from various organizations and hospitals for implementation of projects. For example The Indian Space and Research Organization has today 32 telemedicine location in India and is investing heavily to help Indian healthcare to graduate in this technology and then use it for its own purpose in the future to monitor Indian astronauts who undertake journeys in space. Most of the developments in this field are likely to focus around the needs of ISRO. The answer to make projects financially viable also probably lies in pooling together resources by various facilities within a geographic locality and sharing the benefits and revenues thus created. To elaborate on this point, several hospitals within a city like e.g. Salem can share a common Tele-pathology service or Teleradiology service. The benefits of such a pooled service are obvious.

Investigations can

be viewed by a group of expert consultants. Such a model will reduce the initial project costs and with the patient traffic from several affiliated hospitals can achieve economy of scale and thus reduce costs of trained manpower and material costs and also provide a very efficient and optimal service to the community.

49

50

xvii.

E-Healthcare Solution:

India is well placed and potentially the ideal location for experimenting with e healthcare solutions for the following reasons: India has best computer Technocrats India has a very skilled medical fraternity private healthcare emerging as a key-player in the country Indian Healthcare spending likely to increase to 200,000 crores by 2012 from present 86,0000 crores. Potentially India a very suitable location and resources pumped in this sector now are likely to be of great benefit Practo is engaged in providing the latest in internationally recognized medical care to patients with a variety of ailments and medical conditions. Practo ensures patient access to expert care for any specialty. This unique network architecture provides expert care to our patients and a level of confidence in receiving the latest medicare to offer.

xviii.

Telemedicine:

Telemedicine in principle is well suited for countries like India, Africa and South America where there is a large rural based population separated by large distances and needing access to regular medical care of quality. The telephony revolution of nineties of India has linked most of our smaller towns and villages with rest of the world. The railway also has a vast network of fibre-optics cables already laid out on many of its routes. The Space scientist of our country have placed strategic satellites of communication making a broadband network not too difficult to achieve with expenditure of minimum resources, These gateways of communications should be all used to help with the project of telemedicine and hence reduce applications costs. Even subsidies could be incorporated to facilitate telemedicine projects in our country.

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51

Practo has built a tele-medicine network, which connects each of its facilities, so expert care is never out of reach. In addition, Fortis Practo is working with both private and public partners in the Indian Healthcare industry to provide Super Speciality and quality healthcare services. Practo provides services covering ICU Management, ER Management, OPD Management, Radiology Reporting, Pathology Reporting as well as Training and Education Opportunities. Utilising our strong HIS backbone, and PACS technology, we are able to seamlessly transmit patient information in a secure and confidential environment. The use of tele-medicine has provided a much-needed boost to the Indian Healthcare sector. It has also allowed our network to expand its presence by extending quality healthcare treatment to the remote areas of Northern India as well as overseas

xix.

Healthcare Tele-medicine Software Browser based Built on HL7 and DICOM standards Open Source Technology Linux Offers Real time and delayed Access Streaming without transfer, real-time ECHO, US Statistical Reporting Interface with Legacy Machines Flexible clinical reporting formats

Some other healthcare software’s: Electronic Medical Record (EMR) Appointment Scheduler Account Management.etc 51

52

CHAPTER IV

Profile of the Company About Practo Group: During his college days Shashank, co-founder Practo, had his father undergoing an orthopedic surgery on short notice. Since he couldn’t find a place to search for doctors he struggled to get a second opinion. Soon he jotted down a few contacts through family friends. But when he just about got one abroad, he had a tough time getting the medical reports sent across since they were on paper. A few snap shots on his camera mobile and few scans later he just about send it across. Go online and you can book flights and movie tickets but not a doctor’s appointment. You opt for organized office-documents but still keep your prescriptions filed in thick-dusty files.You keep reminders on all important conferences but miss out on a follow up with your doctor. The solution to all this seemed ridiculously simple to Shashank and his partner, Abhinav. But the most compelling fact was that no one in India had tried this before. Thus in May 2008 they went on to found Practo Technologies Pvt Ltd. An attempt to use emerging technologies to rev-up clinics across India and thus enhance patient experience.

52

53

1. Key People:

Shashank ND (Chairman & MD)

Mr. Abhinav Lal

Raksha Siddharth

(CTO)

(HR)

Amal Kiran (CST)

53

Siddharth Agarwal (Marketing)

54

Practo is currently operating in eight cities including all major metros, as well as smaller cities like Pune and Nagpur. In each location, it has appointed a couple of resources to reach out to more people. “With a high local penetration, we hope to triple our sales team this year. Plus, we are looking to go global. We have opened a branch in Singapore last week and within the next 6-12 months, we will enter mature markets like the US,” details Shashank. “Our primary focus is the Indian subcontinent, though, and by the end of this month, we will be operating in more than 20 states,” he adds. This also means the company is looking to scale up its team and wants to more than double its headcount by next year. “We were just about 10-15 people when we started. We are 100 now and we will add around 250 more people by next year,” says Shashank. Thanks to its aggressive growth drive, the startup claims to be clocking 3x revenues every year and targets to double its revenues by the end of the current fiscal. Practo expects to break even by 2014. Yet, unlike other startups, Practo is not targeting the Indian market alone. “We are investing more money to capture new markets, especially the US market, and gain a good market share,” says Shashank. The company has already raised $4 million (Rs 25 crore) from Sequoia Capital this year in a Series A funding and the fund is adequate to take the company to the next level, he feels. But why does the company target more mature markets like the US? According to Shashank, the US offers highly developed medical technologies but there is ample scope to explore the healthcare management space and one also gets good pricing. “Our market is a bit tricky as people expect awesome products at cheap prices and keeping them happy is a tedious task,” he says. Shashank also feels that the go-to-market strategy is more physical here in India. “In developed markets, it is more online than offline and there’s more scope to scale up,

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   



Instant Confirmed Appointments Powered by Practo ABS Practo Software for Doctors Practo Groups for Doctors

Appointment Scheduler Book, cancel and reschedule appointments with ease!!



Total Security Access and transfer your data securely on Amazon's Virtual Private cloud!!



Digital Health Records Keeping track of your patient reports and prescriptions was never this easy!!



Great Customer Support Reach our experts on phone, live chat and email anytime!!



Follow up reminders Send out automated SMS and Email reminders for follow up and routine check ups.



Access Anywhere, Anytime On the go or on a vacation? Your practice is now just a click away with our Android app!!

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 Never miss patient calls At a conference or on the go, attend to your patient’s needs on time.

 24x7 Appointment Scheduler Your patients can now book and confirm appointments over phone- anytime, anywhere!

 No more busy tones Your patients will always be heard. Call waiting is now history!!

 Instant Call Recordings Keep track of your clinic activities even on the go, with quick access to call recordings!!

 One Number for all your practices Your patients can now reach you quick and easy at any of your clinics on one number!

 Smart Emergency Caller ID Be there by your patients, when they need you the most!!

 

About Practo.Com:

Practo.Com - the one and only place for reliable relevant and complete health information. HealthLine 24x7 is a one-stop destination for in-depth and exhaustive patient centric information on healthcare. At Practo.Com, the consumer can search a comprehensive database of all the healthcare service providers listed from across the five metros. These healthcare service providers have been categorized on basis of various parameters of consumer’s choice to make things easier. This categorization will help you to compare and evaluate the healthcare service provider not only on the criteria of location and specialization but also on other benchmarks like- experience level, education details, fee, timing, emergency handling, home visit, awards won, etc. Our aim is to help you select the most suitable healthcare service provider. Practo.Com does not end

56

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with the search; we even have the facility to schedule appointment of the healthcare practitioner for you. Practo.Com provides robust information on all medicines categorized by pharmacology action time, common dosage, what to do in a missed dose, over dose, precaution during pregnancy, for kids and for old age, side effects, used to treat diseases, price comparisons by various manufactures, availability in locations, brands available, substitutes or alternatives, etc. At Practo.Com the consumer gets access to all this information and more. Apart from being a credible source of health information, Practo.Com is also a platform where you can connect to people suffering from similar diseases/conditions; take opinion and guidance from expert medical professionals, etc. on the various discussion forums.

Life at Practo We are a bunch of passionate, young (average age 25), creative, quirky, curious people working out of our offices at Chennai,Bangalore,Mumbai, Delhi, Kolkata, Hyderabad and Pune. We stick by our ethics and don’t shy away from being bold. Our culture comes from our people. It is to get things done. We don't crib or cry over why things don't happen – we make them happen. We are the doers. We work nights at a stretch. We can’t procrastinate. We don’t compromise. We create new. We ideate. We have no respect for status quo. We are powered by our people, who are carefully selected from diverse backgrounds, each with a distinctive quirk quotient. What’s more? - Our work leaves us clueless to the difference between work and fun. 57

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Sequoia Capital 

In a recent announcement, Sequoia Capital has invested Rs 25 crore in Practo , a web service startup. Founded by graduates from National Institute of Technology, Abhinav Lal and Shashank ND , The Bangalore-based startup offers web service for scheduling appointments with doctors. Practo Ray, the primary product from Practo provides automated appointment scheduling, storage of healthcare records, including x-rays, files, prescriptions and billing. Practo will use the funding to expand its 80-member team to around 350 and launch products in the US and Europe in next two years. “You can discover a good food joint or order pizza online, but cannot schedule the appointment with a doctor,” said Shashank ND . “Our technology significantly improves patient experience and allows better functioning of clinics,” he added. Key Stats: Practo’s platform currently manages 10,000 appointments per day Associated with 8,000 doctors at 5,000 dental, wellness and other healthcare centers across India. It serves three million patients. The service is free for patients, but doctors have to pay Rs 700 per month. Practo aims to reach one lakh doctors and 50 million patients in the next three years. The fast adoption by thousands of doctors is what has led Sequoia to invest in Practo . “Doctors and patients can now access their appointments and health records online or through their mobile device,” said Shailendra Singh , managing director, Sequoia Capital.

Press Mentions Healthcare is one sector which has always lacked the full-fledged support of IT. They somehow were thought of as two entities which wouldn’t go hand in hand which was obviously not true. Few initiatives were taken initially but now we’re seeing the integration of IT with the healthcare sector. Practo, a product of Naabo medical solutions, is one such initiative which was launched in May 2009. It was earlier known as turbodoc.in. The service has grown exponentially and they claim to be serving 500 practices, 5000 doctors and 500,000 patients. Practo is an online practice management software which helps doctors and clinics to manage their practice from anywhere and anytime to provide better services to their patients. Practo automatically reminds patients about their appointments. Practo allows the doctors to store and manage their patient records and photos related to treatments. It also helps in accounting and billing. The only perceivable problem would be the inability of some of the old school doctors and patients to convert as they would be too well adept into the prevalent system and wouldn’t want to change. The

59

60 reputation of these doctors over the years would give them a cushion and wouldn’t necessitate them to adapt to changing technologies. Targeting these doctors or clinics would be a challenging task but Practo would have a large enough market even if it doesn’t focus on the members of the old-school healthcare system. Practo provides four different plans for doctors and clinics one of which is the free version which has very limited features. Every plan has a free 14-day trial period which indicates the trust Practo has on its product. After this trial period, the plan can be activated on a monthly chargeable basis. Practo also provides a 100% data protection warranty. Integration of IT with every sector is a must in the current age. With all these features at pretty reasonable rates, solutions like Practo could be the way forward for any healthcare practice looking to develop and expand.

 Customer relationship 

Campaigns Management – Telemarketing and Emails



Loyalty Program Management



Frequent Flyer Program (FFP) Management



Customer Surveys



Customer Analytics



Emergencies

Back office 

Supplier Content Loading 60

61



Promotions



Accounting – Billing, Accounts Receivable



Expense Reporting and Spend Analytics

Infrastructure At Practo Technologies, they fully understand the CIOs are hard pressed not just to deliver cost savings on their IT infrastructure but Optimization, Transformation and efficiencies .Practo’s remote infrastructure management services streamline the day-today event driven work to be increasingly proactive in nature. Practo’s remote infrastructure services offer a range of benefits through state-of the-art business transformation solutions. 

IT Helpdesk/Service Desk o

o

o

Level-I Support 

Information Capture



Request Qualification



General Enquiries



Functional Usage Support



License Compliance / Warranty Support



Escalation support



Trouble Ticket Management

Level-II Support 

Software Installation



Troubleshooting



LAN/WAN Connectivity



Support



Utility Support

Antivirus 

Remote Access Support 61

62

o



Navigation Issues



Upgrades and Patch Support



Knowledge Base Creation,



Maintenance and Update

Multi Channel Support: Phone, Email, Web Chat and Web Support



Stymied by the lack of digital access to critical records, the then-final year engineering undergraduate student at National Institute of Technology at Surathkal founded Practo Technologies with fellow student Abhinav Lal.



"At the time, there were no facilities available to a doctor to keep digital records of medical reports, which in turn, could also be accessed by patients. It was common to see doctors' appointments get missed, wrong prescriptions filled and reports going missing. Our plan was to change the existing scenario as it was, through technology," Shashank says.



The four-year old, Bangalore-based venture offers clinic management software solutions to medical practitioners, helping them to automate appointments with patients, store healthcare records, including x-rays, files, prescriptions and billing.



The start-up's flagship product, Practo Ray, is a software-as-a-service (SaaS) tool hosted online, which helps doctors schedule appointments, track a patient's medical records and send out follow-up reminders to them.



According to Shashank, the software tool is used by close to 10,000 doctors across the country, as they look to streamline their practice by going digital.



Practo's platform currently manages 10,000 appointments per day across 5,000 dental, wellness and other healthcare centres across India. It serves an estimated three million patients, for whom the service is free.



"Doctors pay a monthly fee to utilise the services provided by Practo Ray, but it goes a long way in solving their problems, and ensuring that their patient records are free from any damage or loss," he says. It is a model that has gone on to capture the attention of risk capital in India.



"All things start small. Practo started as a tool for doctors, but has now evolved into something far bigger and with wider reach," says Shailendra Singh, managing director of Sequoia Capital.



Sequoia, with its investment focus on healthcare and consumer-facing businesses, found Practo fitting in well in its portfolio.



In July earlier this year, the global venture capital firm invested Rs 25 crore in the start-up "It has become a multi-dimensional communication platform for doctors and patients," Singh pointed out.



The fact that Practo has managed to straddle three sectors - Healthcare, Consumer and Information Technology - that have traditionally received a majority of private capital in India, makes it a unique proposition for investors.

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Financial Data of the company: SHAREHOLDING

Industry :

Group :

ISIN No :

IT & IT Related Services

Practo Technova Group

as on : Face Value :

Code : NSE Code : Market

INE991C01018

Share Holding Pattern

BSE

Lot :

Book

526927

Closure : Market

N.A.

Cap : Face

1

Value :

21/12/2010

Rs. 270.88 Cr.

Rs. 10.00

30/09/2010

30/06/2010

31/03/2010

10.00

10.00

10.00

PROMOTER'S HOLDING

No.

Of %

No.

Of %

No.

Of %

Shares

Holding

Shares

Holding

Shares

Holding

Indian Promoters

28032462

63.90

24760973

61.29

24760973

61.29

Sub Total

28032462

63.90

24760973

61.29

24760973

61.29

63

64

NON PROMOTER'S HOLDING

Institutional Investors FII's

2568000

5.85

3210000

7.95

3210000

7.95

Sub Total

2568000

5.85

3210000

7.95

3210000

7.95

18.65

7744825

19.17

2855502

7.07

454066

1.04

500058

1.24

501108

1.24

Directors/Employees

528369

1.20

660462

1.63

660462

1.63

Other

208468

0.48

179231

0.44

180535

0.45

Sub Total

9372687

21.37

9084576

22.49

4197607

10.39

General Public

3893428

8.88

3341764

8.27

8228733

20.37

GRAND TOTAL

43866577.00 100.00 40397313.00 100.00 40397313.00 100.00

Other Investors Private

Corporate 8181784

Bodies NRI's/OCB's/Foreign Others

BANKERS

Industry :

Group :

IT & IT Related Services

Practo Technova Group

BSE Code : NSE Code :

526927

N.A.

64

Book Closure : Market Cap :

16/09/2006

Rs. 333.28 Cr.

65

ISIN No :

INE991C01018

Market Lot :

Face

1

Value :

Name of Banker ABN Amro Bank N.V. Central Bank of India HDFC Bank Ltd. ICICI Bank Ltd.

Other Details Listings

Incorporation

BSE

23/03/1994

Practo Group 1. 2. 3. 4. 5.

Shanshank ND- CEO & founder Abhinav lal- CTO HR Team- Raksha Siddharth Finance Team, Admin & Operations Team- Kalyan V Region wise Sales Team

 North & East India- Manoj Kumar  West India- Aditya Bhat  South India- Vikas kumar 6.Marketing team- Siddharth Agarwal 7.CST team: Amal Kiran (Head)

65

Rs. 10.00

66

This are the different key people in practo handling different departments being head of each department and everyone reports to the CEO

Business Partners

Sequoia Capital Sequoia Capital in India has invested in more than fifty companies during the past decade catering to the founders, families and management who have selected

us

as

their

business

partners.

With

offices

in Bangalore, Mumbai and New Delhi, Sequoia Capital has a mixture of local experience and global ties that let us work with great entrepreneurs to help build market leading companies. We have learned that the only way to develop a fabulous company is one step at a time. This only happens if the company makes wonderful products or delivers a service that thrills large numbers of customers. If that occurs then founders, management, and employees of these companies prosper. It is only then that the investor deserves to be rewarded. It has to happen in that order. There are no shortcuts. Technology Partners 

HP



IBM



Lenovo



Vmware



Acer

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Enterprise Messaging and ERP & CRM 

Microsoft Gold Certified Partner



Microsoft Dynamic



Microsoft Dynamics CRM



Microsoft Exchange Server



Oracle Partner

Information Security, Storage and Availability 

Trend micro



Internet Security Systems



Citrix



McAfee



Symantec



Check Point



Fortinet



Ironpont



Cyberoam



Websense



Sonicwall



Packeteer



RSA Security



Radware



Barracuda

Infrastructure Management 

IBM Business Partner



Tivoli software

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Networking 

Cisco



Nortel

Comapy name significance Name - Practo is a Latin word that translates as 'to bind together'. This name has been chosen to reflect the integrated nature of the financial services the company offers. Symbol - The Practo name is paired with the symbol of a four-leaf clover. Traditionally, it is considered good fortune to find a four-leaf clover as there is only one four-leaf clover for every 10,000 three-leaf clovers found. Each leaf of the clover has a special meaning. It is a symbol of Hope. Trust. Care. Good Fortune. Vision "To build a globally scalable business of excellence in the IT domain" . “Be the leading healthcare exchanger in India”. Mission “To institutionalize and put into place, processes that shall enable the organization to achieve leadership position in the IT domain and to develop, build and nurture high quality client relationships backed by diligence, ethics and values” Values The following values are core to Practo Group. The values are rooted in current reality, but also represent the path we wish to follow tomorrow. 68

69



Integrity and fairness to employees and customers



Equal opportunities for all- no discrimination on any ground.



Move ahead together



Deliver value through deep domain expertise



Commitment to building long term relationships

SWOT Analysis of Practo Strengths: 

Strong brand name in the Financial services market



Well known in developed countries and being established in developing countries as well.



Leader of innovations



Success various products in the market



Highly skilled resource pool - 700+ - with diverse skill sets



Loyal satisfied customers



Affordable prices of various IT solutions and other enterprise solution in the market



Certifications in various platforms



strong partnerships with some of the world’s most renowned technology companies

Weaknesses 

New in the IT market



Supply chain management is weak



Availability in very few countries



Brand awareness of is low which is also a reason for its low sales.

Opportunities 

Broaden its range to capture more market share. 69

70



Capture more market share by introducing solutions in new markets with Improvements and innovations so it will help to establish them in those markets.



Increase its brand awareness through excessive marketing and better market communication.



Establish itself in Global market as they are currently present in only 10 countries all over.



Take risk willingly in product innovations to capture more market share and increase the sales.

Threats 

Dominant competitors of Practo



Promotional activities of competitors are stronger



Brand name of competitors are well known ,for e.g: SAP, MICROSOFT,etc

SWOT Analysis of Competitor’s

Strengths: 

Support sales activities by understanding your customers’ businesses better



Qualify prospective partners and suppliers



Keep fully up to date on your competitors’ business structure, strategy and prospects



Obtain the most up to date company information available



Global relationships with all major Techno companies worldwide



Availability all over.



Strong management team.

Weaknesses: 

Products are very costly



Very few competitors providing health care solutions. 70

71

Opportunities: 

Provide products in different areas



Products should be cost effective

Threats: 

Availability of other Enterprise solution vendors



Availability of products at very effective cost by other vendors.

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CHAPTER V Analysis & Interpretation of data

1) Percentage of Doctors using Computers

Most of the Doctors in Bangalore instead of doing their job manually use Computers to perform their day to day work.

72

73

2) Percentages of Doctors using internet

66.6% of Doctors in Bangalore use Internet in their Clinic’s for connecting with their patients and for other medical purpose.

73

74

3) Percentage of calls made from customer number and my number

Percentage of calls made from customer number and my number 13.34% 32%

From his/her number From my phone

55.66% Didn't call

Most of the people are able to connect with the concerned Doctors with the help of Practo number.

74

75

4) Percentage of people asked for disease or not

100% 90% 80% 70% 60% Percentage of people asked for disease or not

50% 40% 30%

20% 10% 0% AskedOnly for disease for resistration

Most of the Customers were interested only for registeration in Practo,rather than disease inquiry.

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76

5) Percentage of people saved healthline number or not

As a part of promotion percentage of people saved healthline number or not

45.34%

Saved number Didn't save

54.66%

Healthline number is the best way to connect Patient to the concerned Doctor.

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6) Percentage of people with different remarks

60.00% 50.00% 40.00% 30.00%

Percentage of people

50.66% 20.00% 10.00%

33.66% 18.66%

0.00%

Good service Satisfied Helpful

Most of the people are satisfied with the service provided by Practo Technologies Private Limited.

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7) Popularity compare to just dial

Popularity compare to just dial 5.34%

Just Dial 94.66%

When it comes to popularity Just Dial stands one step ahead to Practo.

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Practo.com

79

8) Percentage of people interested and not interested with respect to age

Chart Title 80.00% 60.00% 40.00%

69.33%

20.00%

24%

0.00% 18-30yr

31-45yr

6.67% 46yr and above

Percentage of people interested and not interested with respect to age

Now a days people like instant service,and youth is the mouthpiece of the growing population.

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9) Percentage of doctors using Practo’s software.

A large number of people are using software from Practo for their daily work purpose.

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10) Specialty wise distribution

In Bangalore almost all kind of Doctors with various specialities are linked with Practo.

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CHAPTER VI

Findings and Recommendations

A. Findings : Youth generation is more interested about the product as well as this kinds of healthline. So there is vast opportunities in Indian market as ….% of population is youth . Just Dial have been made a brand image in the market and the popularity of Health line 24*7 is very negligible compare with that as it is very new in the market. Apart from that there are sulekha.com, yellow pages etc. I found that when I explained our services then 50% of the people are just satisfied , 33% are impressed and approximate 20% people told that it is a helpful service. As a part of market research, after influencing , approximately 55% people saved the Practo healthline number but 45% didn’t saved the number. During demo call to Healthline 24*7 only 10% people asked for their disease but rest of 90% made the demo call only for resistration. During market research it was clear that approximately 32% of the people made demo calls from their own number , 55% don’t want to make any calls as they think they might get problem in future. And 13% people even didn’t make any call.

B. Conclusions and Recommendation: As young generation is interested and there is vast market , so an attractive and effective promotional strategy should be adopted.  Like Just Dial , Practo.Com also has to focus to make a brand image in the market .  As people are not interested to tell about their diseases then free medical camp is recommended to organize for all level of people on society.  By campaign people awareness about the usefulness of the health-line is recommended.

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C. Limitations of the study: 

Sample size is limited to a particular area.



Accuracy of the information collected .

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D. Bibliography: Websites and sources:

 http://indiabudget.nic.in  http://www.religaretechnova.com/introduction.html  http://www.religare.in/About_us.asp  http://www.scribd.com/search?cat=redesign&q=mumbai+health+sector&x=0&y=  http://www.slideshare.net  www.ibef.org/industry/healthcare.aspx  www.frost.com  www.investmentcommission.in/healthcare  www.economywatch.com  www.whoindia.org  www.healthcare-india-statistics.blogspot.com  www.pwc.com/.../healthcare/.../emerging-market-report-hc-in-india  www.globalpost.com  en.wikipedia.org/wiki/Healthcare_in_India  India Budget 2009, Ernst & Young 2009  Four years of NHRM, Ministry of Health and Family Welfare, May 2009  Global atlas of the health workforce [online database].  Geneva, World Health Organization, 2008  India Chronicle: 2008, Ernst & Young Analysis  he Business World, Ernst & Young Survey; June 2009  Ten industry trends 2009, Technopak healthcare outlook, 2009, p. 1  Fostering quality healthcare for all, Ernst & Young, 2008  Ministry of External Affairs.

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Annexure Health care center type: Clinic

Nursing Home

Hospital

Diagnostic Center

Center Name:

Mobile (Doctor):

Center Owner:

Email ID:

Contact numbers:

Web site:

Address: Area:

Pin code:

Timings: Specialities available Ayurveda

Dentistry

Dermatology

OBG & Gynecology

Ophthalmology

Orthopedis

ENT

General Physician

Homoeopathy

Pediatrics

Wellness

Physiotherapy

Veterinary

Spa and salon

Diagnostic facility

Others:

Facilities Receptionist

YES

NO

Computer generated Treatment Plan YES

Computer

YES

NO

Prescription

YES

NO

Internet

YES

NO

Bills

YES

NO

Printer

YES

NO

Records

YES

NO

Software

YES

NO

Software name: …………………………………..

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NO

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Mode of Marketing used o Advertisements o Online Listing o Clinic website/SEO o No Marketing. o Others ………………………….. Cost of Consultation o Upto Rs 100 o Rs 100 - Rs 300 o Rs 301 – Rs 500 o Above Rs 500 Marketing Expense per year

o o o o

Rs 0 – Rs 10,000 Rs 10,001 – Rs 50000 Rs 50,001 – Rs 100,000 More than Rs 100,000

Years in practice o 0 – 2 Years o 3 – 6 Years o 7 – 15 Years o More than 15 years Name of the consultant

Specialization

Contact no

No. of Doctors:

No of staff:

Established since: Size of the Team: Notes: Disclaimer: You are hereby authorizing us to use this information for internal purposes only. Name of the respondent: Signature (with Seal) Place: Date: Surveyor code:

Clinic

Code: Geo Location: Quadrant: 86