“ Investment Opportunities in Healthcare” Gaurav Malhotra

1. “Investment Opportunities in Healthcare” Gaurav Malhotra

2. Flow of Presentation

3. Indian Healthcare landscape

4. Market Size, Growth and Infrastructure Needs Growing at about 15% CAGR, healthcare market is expected to reach about $120 Billionby 2015 and should continue to double every 5 years for the next 10 Years CAGR 15% Source: National Health Account Latest Publication 2004-05, World health organization Statistics 2010,

5. Indian Healthcare – Transition Phase Conventional hospital Long stays at hospitals Unorganized sector Curative Out of pocket payments Travel to urban areas for treatment Lack of system and accountability Driven by supply No quality check on service State of the art corporate hospitals Short stay and outpatient surgical centers Organized sector Preventive Insurer or employer paid Availability of facilities in tier II & III cities Working towards standardization Driven by demand Quality services & accreditation

6. Zonal Healthcare Characteristics North and East are witnessing change: Increased investment in North and East India. In West, Maharashtra and Gujarat have relatively good healthcare infrastructure. Madhya Pradesh has scarce healthcare infrastructure similar to North and East East falls way behind all the zones in healthcare. But the utilization of private nursing homes is one of the highest, as it has very few larger private hospitals. South scores better in almost all the healthcare indicators than North and East India. This can be attributed to higher concentration and larger average size of hospitals Beds/ ‘000 Population Avg. Size of Providers Doctors/ Beds Occupancy

7. Private Sector Takes The Lead Public-Private Share of Hospitalization ~ 60% of the population today prefer to undergo hospitalization at private hospitals Non- Hospitalization Treatment ~80% use the private sector for outpatient curative services as a first line of treatment in both urban and rural areas Expected Trend 2014 Rural Urban 1986-87 Rural Urban 1995-96 RuralUrban 2004 Source: NSSO 60thRound Round Morbidity and Healthcare Survey

9. Key Issues in Investing in Healthcare 1 High cost impacting viability Non availability in dense population pockets Adherence to Statutory Guidelines Real Estate Medical, Nursing and Allied Professional Managers Inadequate skill sets 2 Workforce Quality Accreditation Clinical Outcomes Inadequate focus NABH/ JCI/NABL Protocols 3 Data for Comparables 4 No Central Repository Non Disclosure of Sentinel Events Regulatory Compliances 5 Lack of Enforcement Antiquated legislation

10. Growth drivers

11. Growth Drivers Others: Regulatory Impact, Increased Awareness, Quality up gradation, corporatization, etc.

12. Indian Consumer Spend The share of average household spend on Healthcare in India, is expected to increase from 7% to 10% in the next decade. 2020 $2500b 2015 $1400b 2010 $800b Source: National Accounts Statistics

14. Investment Opportunities in Healthcare

15. Investment Opportunities in Healthcare

16. Key Investment Criteria

17. Attractive Investment Opportunity in Healthcare

18. Comparative Analysis of Various Growth Options

19. Summary

20. Overall we believe that the investment opportunity in healthcare services is sound and attractive due to the following reasons: 1 2 3 4