2017年-世界发展银行全球_Landscape_of_Inclusive_Business_Models_of_Healthcare_in_India___Business_Model_Innovations_92页_2mb

Summary of "Landscape of Inclusive Business Models of Healthcare in India"

Core Content

This report, commissioned by the International Finance Corporation (IFC) and the Wadhwani Initiative for Sustainable Healthcare (WISH), provides an in-depth analysis of inclusive business models (IBMs) in the Indian healthcare sector. It aims to understand the challenges and success strategies of these models and offers insights on how the ecosystem can support their growth and scalability.

The study highlights the increasing focus on addressing healthcare needs at the base of the pyramid (BoP), defined as individuals earning less than $3,000 per year in purchasing power parity. The Indian healthcare market at the BoP is estimated to be around $95.5 billion, indicating a significant opportunity for inclusive models.

Key Findings

1. Focus of Healthcare IBMs

• Most Common Focus: Hospital and outreach models (65%) and medical technologies (35%) are the primary areas of focus.
• Diseases Addressed: The majority of IBMs target multiple diseases, including TB, malaria, cardiovascular, and neurological diseases (48%).
• Reproductive and Child Health (RCH): Second most popular focus (16%), with access to funding and public systems.

2. Age of IBMs

• Majority are Young: 70% of IBMs are less than 10 years old.
• Technology IBMs: 55% are less than 3 years old.
• Traditional Models: Older IBMs are mostly in the hospital and outreach category, which is less risky and more established.

3. Geographical Distribution

• Concentration in Southern States: 33% of IBMs are located in southern states, especially Chennai and Bangalore (17%).
• Other Key Cities: Delhi (12%) and Mumbai (10%) also have a high proportion of IBMs.
• Infrastructure Influence: Availability of transport connectivity and supportive ecosystems are key factors in the geographic concentration of IBMs.

4. Target Population Segments

• For-Profit IBMs: Focus on individuals earning $5–$8 per day due to the need to balance affordability and profitability.
• Non-Profit and Government: Address lower-income segments and are more involved in public health programs.

5. Funding Sources

• Equal Distribution: Around 41% of IBMs are for-profit, 42% are not-for-profit, and 16% are public-private partnerships (PPPs).
• Impact Investors: Major source of funding (46%).
• Diverse Funding: Almost all IBMs use multiple funding sources, including donor support, government grants, and private equity.

Business Models and Challenges

IBMs are classified into B2C and B2B models:

B2C Models

• Primary Care Delivery and Outreach

  • Focus: Promotive-preventive care, health education, basic curative care.
  • Examples: Swasth India, Ziqitza, Arogya Parivar.
  • Challenges:
    • Limited viable business models.
    • Large patient volumes and catchment size are critical.
    • Need for combined medical and managerial skills.
    • Difficulty in attracting skilled personnel.
  • Strategies:
    • Offer diversified services to improve value proposition.
    • Use local communities as health educators.
    • Build capacity and para-skilling to increase efficiency.
    • Implement hub and spoke models to expand reach.
    • Use asset-light and no-frills strategies to reduce costs.

• Secondary and Tertiary Care Hospitals

  • Focus: In-patient care, diagnostic tests, and multi-specialty treatments.
  • Examples: Glocal Healthcare, Vaatsalya, GNRC.
  • Challenges:
    • Shortage of trained medical personnel.
    • Low patient paying capacity and inadequate insurance.
    • Weak referral systems.
    • High cost of medical equipment and maintenance.
    • Delays in payments by institutional customers.
    • Limited investor interest in primary care.
  • Strategies:
    • Diversify offerings to include services like analytics and program management.
    • Reduce manufacturing costs through indigenous production.

B2B Models

• Standalone Devices and Consumables

  • Focus: Frugal innovations, low-cost diagnostics, and therapeutic devices.
  • Examples: Embrace Innovations, AYZH, Axio Bio Solutions.
  • Challenges:
    • Long product development cycles.
    • High investment needs at early stages.
    • Lack of marketing and distribution strategies.
    • Dependence on healthcare providers for adoption.
    • Limited technical skills among distribution partners.
  • Strategies:
    • Leverage existing distribution channels.
    • Conduct pilot studies and proof-of-concept trials.
    • Form strategic partnerships with healthcare delivery players.
    • Expand product scope to include analytics and program management.
    • Reduce manufacturing costs through local production.

• Networked Devices and Technologies

  • Focus: Technology-enabled medical devices and integrated information systems.
  • Examples: Swasthya Slate, Dimagi, Dhilcare.
  • Challenges:
    • Lack of awareness among buyers and patients.
    • Resistance to change in healthcare delivery behavior.
    • Consumers associate low price with low quality.
    • Unreliable telecom and electricity infrastructure.
    • Limited market information and research support.
  • Strategies:
    • Develop robust marketing and distribution strategies.
    • Provide training and technical support.
    • Advocate for regulatory clarity and standardization.

Ecosystem Enablers and Suggestions

To enable success and overcome challenges, the report outlines the roles and actions of various ecosystem enablers:

Impact Investors

• Support IBMs through innovative financing.
• Invest in early-stage innovations.
• Form investor networks.
• Provide advisory services and mentorship.
• Offer trading platforms and results measurement.

Foundations, Donors, and Development Agencies

• Provide technical support and funding.
• Support research and proof of concepts.
• Make funding decisions context-responsive.
• Help define quality standards and raise health awareness.
• Advocate for critical reforms to create a more supportive environment.

Government

• Purchasing and scaling innovative solutions.
• Relaxing procurement rules for IBMs.
• Incentivizing private sector to serve BoP.
• Reducing bureaucratic delays and simplifying procedures.
• Accrediting and endorsing new solutions.
• Setting up venture funds and allocating existing resources to IBMs.
• Strengthening demand-side financing.
• Generating health awareness.
• Increasing HR availability.
• Systematic need-gap assessment for better planning in medical education.
• Facilitating para-skilling reforms.
• Improving infrastructure.

Networks, Incubators, and Accelerators

• Facilitate ecosystem growth.
• Provide mentorship and strategic advisory services.
• Offer technical assistance and incubation support.

Conclusion

The report emphasizes the need for a collaborative ecosystem to support the scale and sustainability of IBMs in the Indian healthcare sector. While IBMs have shown great potential in addressing healthcare access for the BoP, they face systemic barriers at multiple levels. The role of impact investors, governments, foundations, and incubators is critical in enabling these models to thrive. The report also includes a database of 85 IBMs, which is periodically updated by WISH, providing a valuable resource for further research and development in the sector.