There are no published data on the market size of Cardiac Surgery and Cardiology. About 32 million Indians have Cardiac issues. The industry data that we have is that there are about 1 million cardiology procedures in the country annually. This number is divided equally between Angiography and Angioplasty. About 150 to 200 thousand Cardiac Surgeries performed every year. Out these about 25 to 35 thousand are valve surgeries and the rest is mostly Coronary Artery Bypass Grafting (CABG), in terms of revenue. Care of the cardiac patients in India is typically being offered by the private sector. Government hospitals all across the country lack the infrastructure capabilities to cater to these patients, except a very few centers that are small islands in the vast market. The rural population is almost completely devoid of these facilities and these patients are being transported to urban facilities most of the times. In fact, even the transport is by private vehicles as there is a scarcity of well-equipped Ambulances even by the privately-run Hospitals / Nursing Homes.

In terms of policies since there is no universal health insurance that is provided by the government, privately funded payor model is in prevalence. The government hospitals in most places in the country lack even the basic facilities of Cath Lab and an experienced Cardiologist to care for these patients. The facilities for even a basic Cath lab and Cardiac operation theatre require a high initial investment and high ongoing costs in terms of maintenance and manpower.

Besides these costs there are various ancillary services that are required which include a good Emergency and Ambulance facility, critical care facility and a whole gamut of cardiac investigations such as 2D ECHO, TMT, etc. Recently, there has been some regulations in terms of capping the price of stents that are used in angioplasties. This will definitely reduce the cost these procedures making it more affordable to the masses. What we feel is that this measure is not sufficient as availability of these facilities is a major concern. To cover the whole of the country, the biggest challenge is that a cardiac patient can’t travel far and should have access to a well-equipped cardiac centre within half an hour’s reach. Due to high equipment costs and a dearth of trained doctors, nurses and technicians, there is a limitation on the number of such facilities that can be stared in a given region. Besides the curative treatment, there is vast scope of prevention of the cardiovascular events that can save millions of lives and lead to enormous savings to the community and the government.

This segment is completely underutilized in our country. Even well reputed cardiac centers don’t emphasize on prevention and miss out on the opportunities to prevent cardiac and many other related diseases such as obesity, stroke, etc. This poses a serious problem to solve for any government. The efforts need to be sustained and goal directed. A concrete plan of action has to be formulated by the central government and put into execution. Adequate budget allocation and manpower planning will be the key factors. On Behalf of Aakash Healthcare, I suggest some measures which need urgent attention at multiple levels.

Recommendations are:

1. Public Private Partnership: A model a need to be devised that is a win – win for both the parties. The private sector can gain from the vast virgin markets in the rural and urban poor. The public sector can gain from the expertise and manpower that is housed by the private sector.
2. Universal Health Insurance: This is the need of the hour. According to a recent WHO report, due to out-of-pocket spending of their income in medicines and healthcare services, about 3.2% of India's population will fall below the poverty line (BPL). This is an alarming situation and cardiac diseases is going to be the major culprit.
3. Universal Health Coverage: A basic facility of a general physician, Laboratory services and medicines should be made available to citizen of the country. This will help in early diagnosis of cardiac problems and timely intervention.
4. Preventive Healthcare: This segment which has a strong presence in the western world is deficient in our country. About half of all the deaths in a study in the USA, were found to be preventable and cardiovascular diseases were the on the top of the list.