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Indian Medical Equipment Industry – Opportunities for US
                                           Companies

The Indian healthcare industry is estimated at $35 billion and is expected to reach over
$75 billion by 2012. The medical equipment market is growing at a rate of 15 percent
and the demand for equipment is expected to reach $5 billion by 2012 from the current
figure of $2.7 billion.
The medical infrastructure in India is far from adequate. Demand, for hospitals and
beds, far surpasses availability. The World Health Organization projected that India
needs to create at least 80,000 hospital beds per year for the next five years to meet the
expanding local demand. A significant portion of these hospital beds will be in various
specialties. Both the government and the private sector have embarked on a path to
bring about a rapid growth in the industry and to manage the demand for high quality
service. This has also brought a surge in demand for high-end medical devices and
equipment as the specialty hospital facilities depend on the import of high-end medical
equipment.




                               $ bn




Domestic Market
There is a growing demand for quality healthcare service. The Indian population of 1
billion people is growing at a rate of 2.5 percent per year. The growth in affluence of
200-300 million strong middle-income consumers has increased the demand for, along
with the discretionary income to purchase, private health care services. Many in the
growing "middle income" segment look for international quality medical services in
private super-specialty hospitals. This trend is likely to continue for the next several
years, thereby creating demand for a higher standard of healthcare. The changed



             501 Fifth Avenue, Suite 302   , New York, NY 10017 ● Tel: (646) 807-9290
   2010                                    www.ivgpartners.com                        Page 1 of 4
demographic profile and the rise of lifestyle-related diseases, has altered the health
seeking behavior of the consumer. There is a rise in lifestyle-related diseases such as
diabetes, cardiovascular diseases, and diseases of the central nervous system. The
number of individuals covered by health plans has increased, but there is a large Indian
population that still needs to be insured.


Growth Drivers
Both the government and private sector are up-grading existing hospitals and planning
to build new ones. Healthcare is provided through primary care facilities as well as
secondary and tertiary care hospitals. While the first two categories are fully managed by
the government, it is the tertiary care hospitals that are owned and managed either by
the government or the private sector.
Public Sector - The public sector is engaged in prevention and elimination of infectious
diseases and accessibility of basic healthcare facilities to the rural masses. The
government has launched the National RuralHealth Mission (NRHM) 2005-2020 with an
aim to provide quality medical care for rural Indians. In its first phase to be implemented
in the next seven years, NRHM will identify villages having weak medical care delivery
systems and improve the infrastructure. To meet the growing demand, one million beds
will be added by 2012 to bring the bed to thousand population ratio to 1.85. It requires
a total investment of $77.9 billion and large part will be from the private sector.
Private Sector - Corporations are sensing the huge untapped opportunity in the delivery
of quality healthcare to the Indian masses and are focusing on tertiary-level as wells as
preventive and diagnostic healthcare. There are global PE and venture funds that are
also vying to explore the opportunities. With this, the medical infrastructure market is
expected to grow at 14.5 percent. Demand for medical equipment is expected to reach
$ 3.27 million in the next two years and $5 billion by 2012, from the current figure of
$2.7 billion. Imports account for over 65 percent of the entire medical equipment
market , of which 85% is from the US.




  INR bn     Import of Medical devices                           Export of Medical devices
                                                        INR bn
 50              CAGR= +20%                     43      15           CAGR= +18%                 13.7
 40                         32.7     34.7                                      10.1     10.7
                    26.7                                10     7.1      7.6
 30       20.4
 20                                                      5
 10
  0                                                      0
      2004-05 2005-06 2006-07 2007-08 2008-09                2004-05 2005-06 2006-07 2007-08 2008-09




                  501 Fifth Avenue, Suite 302   , New York, NY 10017 ● Tel: (646) 807-9290
   2010                                         www.ivgpartners.com                        Page 2 of 4
In 2007, India treated 450,000 foreign patients. Medical tourism is one of the major
external drivers of growth of the Indian healthcare sector. With increased competition
for healthcare delivery, and promotion of medical tourism “Quality healthcare is the key
for survival”. The National Accreditation Board for Hospitals (NABH) has been set-up to
establish and operate accreditation programs for healthcare organizations. Some private
hospitals are also applying for accreditation from bodies such as the Joint Commission
International (JCI).



                              INR




Opportunities


The large private healthcare services providers are actively seeking growth by enhancing
their reach across the country through the building new hospitals and acquiring and
upgrading existing hospitals. There are several groups that operate hospital chains,
such as Apollo Group, Fortis Healthcare, Manipal Group, Max Healthcare, and Wockhardt
Hospitals. In the medical equipment segment, competition is from the imports from
European companies and Japan.The most promising sub-sectors in the healthcare and
medical equipment sector are listed below:
                         Medical Infrastructure
                         Medical and Surgical Instruments
                         Medical Imaging
                         Electro medical equipment
                         Orthopedic and Prosthetic Appliances
                         Cancer diagnostic
                         Ophthalmic Instruments and Appliances


Few US Players have already entered this market in the diagnostic and surgical
equipment segment. Some of these are
    •     Baxter International Inc,


               501 Fifth Avenue, Suite 302   , New York, NY 10017 ● Tel: (646) 807-9290
   2010                                      www.ivgpartners.com                        Page 3 of 4
•      GE Healthcare
   •      Johnson & Johnson Services Inc and
   •      Boston Scientific Corporation.



The growing demand for quality healthcare and the absence of matching delivery
mechanisms pose a challenge and certainly a great opportunity. In infrastructure -
building, equipping, managing, and financing super specialty hospitals are areas for
growth. Some of the best sales prospects in the Indian medical equipment market
include    cancer   diagnostic,     cardiac     products,    medical    imaging,     plastic   surgery
equipment, as well as polymerase chain reaction technologies, laboratory products,
orthopedic and prosthetic appliances. India is full of opportunities as most Indian
healthcare institutes use foreign medical equipments.




               501 Fifth Avenue, Suite 302    , New York, NY 10017 ● Tel: (646) 807-9290
   2010                                       www.ivgpartners.com                        Page 4 of 4
FACT SHEET
ABOUT US
  IMaCS Virtus Global Partners, Inc. is a New York based advisory firm that offers services to
  North American companies and funds seeking India related growth and investment
  opportunities. The firm is a joint venture between Virtus Global Partners and ICRA
  Management Consulting Services Limited, which is a fully-owned subsidiary of ICRA Limited,
  one of India's leading credit rating agencies.

  Our mission is to enable our clients to transform their business by adding India as a key part
  of their global footprint. Our clients benefit from our local presence, strong relationships,
  knowledge of local business practice, experience, and financial expertise.

OUR PROFESSIONALS

  Our team possesses a deep understanding of the business environment, both in the US and
  India and is well connected with companies, financial institutions, governmental agencies, and
  private equity firms in both markets. We have an established track record of over 15 years
  and 1,000 engagements providing advisory services to a diversified client base across energy,
  manufacturing, infrastructure, and retail. We also work with multilateral and bilateral
  government agencies, banks and financial institutions, and regulators. We are headquartered
  in New York with eight offices in India.


OUR SERVICES



    Power Generation, Transmission & Distribution Equipments Engineering Renewable

       India Entry                                               Risk                        Reform &
                                Partner Search
        Roadmap                                               Management                    Regulations

    • India Strategy &         • Partner Identification     • Structuring Solutions      • Pricing/ Costing
      Investment Roadmap         & Due Diligence              to Address Payment           models
    • Market , Demand &        • Partnership                  Risk                       • Tariff Process
      Competition Analysis       Structuring                • Financial Assessment       • Regulatory
    • Local Regulatory         • Management of                of Project Sponsors &        Frameworks
      Compliance                 Negotiations                 JV Partners                • Privatization Advisory
    • Product Positioning      • Sourcing and               • Enterprise Risk            • Demand Side
    • Location Assessment        Licensing Agreement          Management                   Management
    • Sourcing Strategy        • Transaction Advisory       • Project Appraisal          • Creating Competitive
    • Operational Setup &      • Technology/ IPR            • Credit Risk                  Markets
      Support                    Protection                   Assessment                 • Performance
                               • Corporate                  • Solutions for IPPs and       Improvement
                                 Restructuring                Power Trading
                                                              Companies




               501 Fifth Avenue, Suite 302   , New York, NY 10017 ● Tel: (646) 807-9290
     2010                                    www.ivgpartners.com                        Page 5 of 4
REPRESENTATIVE EXPERIENCE
  Below is a partial list of our power related engagements in India for North American and
  European companies:

        India Entry Strategy for a global power developer, including location assessment, investment
        roadmap, and partner search
        Risk Assessment of a copper cathode manufacturing project for a financial investor that included
        market, technical, business, and financial risks
        India Market Study and Commercial Viability Assessment for setting up a 150 MW power plant in
        India for a global power generation company
        Preparation of India Entry Strategy for a leading global EPC contractor, including power sector
        policy and regulatory framework, market size, and investment/ implementation roadmap
        Assessment and Due Diligence of joint venture partner for a global power project investor
        Assistance in developing a cost-to-serve model for a leading power distribution company,
        including collection of field data, consumer based load curve, and voltage-level losses
        Entry Strategy into the gas transportation business, including analysis of bulk supply to industrial
        consumers, availability, and price elasticity of gas
        Contracting strategy for a proposed coal based power plant, including demand-supply situation,
        simulation of merit order situation, assessment of financial health of utilities and market analysis
        Power sector financing and strategy study for the Asian Development Bank (ADB)



REPRESENTATIVE GLOBAL CLIENTS IN POWER




OFFICES
   New York (HQ)                 New Delhi                        Mumbai                    Bangalore
   501 Fifth Avenue, Suite 302   Buildingo. 8, 2nd Floor, Twr A   Electric Mansion, FL 4,   Vayudooth Chambers,
   New York, NY 10017            DLF Cyber City, Phase-II         Appasaheb Marathe         Fl 2, Trinity Circle
   USA                           Gurgaon 122002                   Marg, Prabhadevi          15-16 MG Road,
                                                                  Mumbai 400 025            Bangalore 560 001
   Kolkata                       Chennai                          Pune                      Hyderabad
   FMC Fortuna, A-10, FL 3,      Karumuttu Centre, 5th Floor      5A, 5th Floor, Range      301, Concourse Fl 3
   234/3A AJC Bose Road          634 Anna Salai, Nandanam         Hills Road, Shivaji       No 7-1-58, Ameerpet
   Kolkata 700 020               Chennai 600 035                  Nagar, Pune 411 020       Hyderabad 500 016


  Please visit our website www.ivgpartners.com. For further information, please contact:
      -   Anil Kumar in New York at akumar@ivgpartners.com or +001-646-807-9290
      -   Ravi Chauksey in Mumbai at rchauksey@ivgpartners.com or +91-9819234478

                  501 Fifth Avenue, Suite 302      , New York, NY 10017 ● Tel: (646) 807-9290
     2010                                          www.ivgpartners.com                        Page 6 of 4

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US India medical devices opportunities

  • 1. Indian Medical Equipment Industry – Opportunities for US Companies The Indian healthcare industry is estimated at $35 billion and is expected to reach over $75 billion by 2012. The medical equipment market is growing at a rate of 15 percent and the demand for equipment is expected to reach $5 billion by 2012 from the current figure of $2.7 billion. The medical infrastructure in India is far from adequate. Demand, for hospitals and beds, far surpasses availability. The World Health Organization projected that India needs to create at least 80,000 hospital beds per year for the next five years to meet the expanding local demand. A significant portion of these hospital beds will be in various specialties. Both the government and the private sector have embarked on a path to bring about a rapid growth in the industry and to manage the demand for high quality service. This has also brought a surge in demand for high-end medical devices and equipment as the specialty hospital facilities depend on the import of high-end medical equipment. $ bn Domestic Market There is a growing demand for quality healthcare service. The Indian population of 1 billion people is growing at a rate of 2.5 percent per year. The growth in affluence of 200-300 million strong middle-income consumers has increased the demand for, along with the discretionary income to purchase, private health care services. Many in the growing "middle income" segment look for international quality medical services in private super-specialty hospitals. This trend is likely to continue for the next several years, thereby creating demand for a higher standard of healthcare. The changed 501 Fifth Avenue, Suite 302 , New York, NY 10017 ● Tel: (646) 807-9290 2010 www.ivgpartners.com Page 1 of 4
  • 2. demographic profile and the rise of lifestyle-related diseases, has altered the health seeking behavior of the consumer. There is a rise in lifestyle-related diseases such as diabetes, cardiovascular diseases, and diseases of the central nervous system. The number of individuals covered by health plans has increased, but there is a large Indian population that still needs to be insured. Growth Drivers Both the government and private sector are up-grading existing hospitals and planning to build new ones. Healthcare is provided through primary care facilities as well as secondary and tertiary care hospitals. While the first two categories are fully managed by the government, it is the tertiary care hospitals that are owned and managed either by the government or the private sector. Public Sector - The public sector is engaged in prevention and elimination of infectious diseases and accessibility of basic healthcare facilities to the rural masses. The government has launched the National RuralHealth Mission (NRHM) 2005-2020 with an aim to provide quality medical care for rural Indians. In its first phase to be implemented in the next seven years, NRHM will identify villages having weak medical care delivery systems and improve the infrastructure. To meet the growing demand, one million beds will be added by 2012 to bring the bed to thousand population ratio to 1.85. It requires a total investment of $77.9 billion and large part will be from the private sector. Private Sector - Corporations are sensing the huge untapped opportunity in the delivery of quality healthcare to the Indian masses and are focusing on tertiary-level as wells as preventive and diagnostic healthcare. There are global PE and venture funds that are also vying to explore the opportunities. With this, the medical infrastructure market is expected to grow at 14.5 percent. Demand for medical equipment is expected to reach $ 3.27 million in the next two years and $5 billion by 2012, from the current figure of $2.7 billion. Imports account for over 65 percent of the entire medical equipment market , of which 85% is from the US. INR bn Import of Medical devices Export of Medical devices INR bn 50 CAGR= +20% 43 15 CAGR= +18% 13.7 40 32.7 34.7 10.1 10.7 26.7 10 7.1 7.6 30 20.4 20 5 10 0 0 2004-05 2005-06 2006-07 2007-08 2008-09 2004-05 2005-06 2006-07 2007-08 2008-09 501 Fifth Avenue, Suite 302 , New York, NY 10017 ● Tel: (646) 807-9290 2010 www.ivgpartners.com Page 2 of 4
  • 3. In 2007, India treated 450,000 foreign patients. Medical tourism is one of the major external drivers of growth of the Indian healthcare sector. With increased competition for healthcare delivery, and promotion of medical tourism “Quality healthcare is the key for survival”. The National Accreditation Board for Hospitals (NABH) has been set-up to establish and operate accreditation programs for healthcare organizations. Some private hospitals are also applying for accreditation from bodies such as the Joint Commission International (JCI). INR Opportunities The large private healthcare services providers are actively seeking growth by enhancing their reach across the country through the building new hospitals and acquiring and upgrading existing hospitals. There are several groups that operate hospital chains, such as Apollo Group, Fortis Healthcare, Manipal Group, Max Healthcare, and Wockhardt Hospitals. In the medical equipment segment, competition is from the imports from European companies and Japan.The most promising sub-sectors in the healthcare and medical equipment sector are listed below: Medical Infrastructure Medical and Surgical Instruments Medical Imaging Electro medical equipment Orthopedic and Prosthetic Appliances Cancer diagnostic Ophthalmic Instruments and Appliances Few US Players have already entered this market in the diagnostic and surgical equipment segment. Some of these are • Baxter International Inc, 501 Fifth Avenue, Suite 302 , New York, NY 10017 ● Tel: (646) 807-9290 2010 www.ivgpartners.com Page 3 of 4
  • 4. GE Healthcare • Johnson & Johnson Services Inc and • Boston Scientific Corporation. The growing demand for quality healthcare and the absence of matching delivery mechanisms pose a challenge and certainly a great opportunity. In infrastructure - building, equipping, managing, and financing super specialty hospitals are areas for growth. Some of the best sales prospects in the Indian medical equipment market include cancer diagnostic, cardiac products, medical imaging, plastic surgery equipment, as well as polymerase chain reaction technologies, laboratory products, orthopedic and prosthetic appliances. India is full of opportunities as most Indian healthcare institutes use foreign medical equipments. 501 Fifth Avenue, Suite 302 , New York, NY 10017 ● Tel: (646) 807-9290 2010 www.ivgpartners.com Page 4 of 4
  • 5. FACT SHEET ABOUT US IMaCS Virtus Global Partners, Inc. is a New York based advisory firm that offers services to North American companies and funds seeking India related growth and investment opportunities. The firm is a joint venture between Virtus Global Partners and ICRA Management Consulting Services Limited, which is a fully-owned subsidiary of ICRA Limited, one of India's leading credit rating agencies. Our mission is to enable our clients to transform their business by adding India as a key part of their global footprint. Our clients benefit from our local presence, strong relationships, knowledge of local business practice, experience, and financial expertise. OUR PROFESSIONALS Our team possesses a deep understanding of the business environment, both in the US and India and is well connected with companies, financial institutions, governmental agencies, and private equity firms in both markets. We have an established track record of over 15 years and 1,000 engagements providing advisory services to a diversified client base across energy, manufacturing, infrastructure, and retail. We also work with multilateral and bilateral government agencies, banks and financial institutions, and regulators. We are headquartered in New York with eight offices in India. OUR SERVICES Power Generation, Transmission & Distribution Equipments Engineering Renewable India Entry Risk Reform & Partner Search Roadmap Management Regulations • India Strategy & • Partner Identification • Structuring Solutions • Pricing/ Costing Investment Roadmap & Due Diligence to Address Payment models • Market , Demand & • Partnership Risk • Tariff Process Competition Analysis Structuring • Financial Assessment • Regulatory • Local Regulatory • Management of of Project Sponsors & Frameworks Compliance Negotiations JV Partners • Privatization Advisory • Product Positioning • Sourcing and • Enterprise Risk • Demand Side • Location Assessment Licensing Agreement Management Management • Sourcing Strategy • Transaction Advisory • Project Appraisal • Creating Competitive • Operational Setup & • Technology/ IPR • Credit Risk Markets Support Protection Assessment • Performance • Corporate • Solutions for IPPs and Improvement Restructuring Power Trading Companies 501 Fifth Avenue, Suite 302 , New York, NY 10017 ● Tel: (646) 807-9290 2010 www.ivgpartners.com Page 5 of 4
  • 6. REPRESENTATIVE EXPERIENCE Below is a partial list of our power related engagements in India for North American and European companies: India Entry Strategy for a global power developer, including location assessment, investment roadmap, and partner search Risk Assessment of a copper cathode manufacturing project for a financial investor that included market, technical, business, and financial risks India Market Study and Commercial Viability Assessment for setting up a 150 MW power plant in India for a global power generation company Preparation of India Entry Strategy for a leading global EPC contractor, including power sector policy and regulatory framework, market size, and investment/ implementation roadmap Assessment and Due Diligence of joint venture partner for a global power project investor Assistance in developing a cost-to-serve model for a leading power distribution company, including collection of field data, consumer based load curve, and voltage-level losses Entry Strategy into the gas transportation business, including analysis of bulk supply to industrial consumers, availability, and price elasticity of gas Contracting strategy for a proposed coal based power plant, including demand-supply situation, simulation of merit order situation, assessment of financial health of utilities and market analysis Power sector financing and strategy study for the Asian Development Bank (ADB) REPRESENTATIVE GLOBAL CLIENTS IN POWER OFFICES New York (HQ) New Delhi Mumbai Bangalore 501 Fifth Avenue, Suite 302 Buildingo. 8, 2nd Floor, Twr A Electric Mansion, FL 4, Vayudooth Chambers, New York, NY 10017 DLF Cyber City, Phase-II Appasaheb Marathe Fl 2, Trinity Circle USA Gurgaon 122002 Marg, Prabhadevi 15-16 MG Road, Mumbai 400 025 Bangalore 560 001 Kolkata Chennai Pune Hyderabad FMC Fortuna, A-10, FL 3, Karumuttu Centre, 5th Floor 5A, 5th Floor, Range 301, Concourse Fl 3 234/3A AJC Bose Road 634 Anna Salai, Nandanam Hills Road, Shivaji No 7-1-58, Ameerpet Kolkata 700 020 Chennai 600 035 Nagar, Pune 411 020 Hyderabad 500 016 Please visit our website www.ivgpartners.com. For further information, please contact: - Anil Kumar in New York at akumar@ivgpartners.com or +001-646-807-9290 - Ravi Chauksey in Mumbai at rchauksey@ivgpartners.com or +91-9819234478 501 Fifth Avenue, Suite 302 , New York, NY 10017 ● Tel: (646) 807-9290 2010 www.ivgpartners.com Page 6 of 4