Orthopaedics as a segment of healthcare is gaining greater importance in India. This is mainly due to a confluence of factors— rising life expectancy, greater incomes, rising access to health insurance and healthcare facilities. Pune-based Sancheti Hospital is among the earliest dedicated facilities in the country to realise the growing demand of orthopaedic surgeries and other needs. The second-generation CEO, Dr Parag Sancheti, talks about the field and how the hospital has evolved, in a chat with Pankaj Joshi.
How did the Sancheti orthopaedic hospital evolve?
In 1965, the hospital was established by my father. We started off as a 10-bedded hospital, which then scaled up to 50 beds. Currently we are running a 175-bed hospital, and work is in progress of a new building, which will be completed in two years and will add more 75 beds. The total workforce with us is about 750. We have today 26 full-time orthopaedic surgeons as our staff.
Orthopaedics as a medical discipline was earlier practised by general surgeons. We were the first dedicated speciality hospital in Pune for orthopaedics. Today the field has evolved to the extent that we have specialised surgeons in orthopaedics. It is no longer a single field in itself. There are specialist surgeons for surgeries related to shoulder, knee, hip, the hand and upper limb, spine and so on.
How technological innovations helped this area of healthcare?
Technology has definitely helped us. It does raise the performance bar and improve output for the patients. Today, some knee and hip replacement surgeries are driven by robotics. Compare these with earlier times when a 2-D X-ray was the only technological assistance available to the surgeon.
How big is the space of orthopaedics in India?
I think this question needs to be looked at from both demand and capacity angles. Today at all-India levels, orthopaedics segment would be handling around 50 lakh cases annually. If the average cost is taken at Rs 5 lakh, you have an annual value figure of Rs 2.5 lakh crore.
Now if you look at the capacity across the country, hospitals dedicated to this practice would have 8,000 beds. For 50 lakh cases, you would broadly need a capacity of 20,000 beds so then the balance capacity is being provided by multi-speciality hospitals.
With this in mind, let us look at what is the real potential in terms of latent demand. India’s population stands close to 130 crore, and in this the segment of 50 years and above would be 50 crore. If we assume a 2 per cent incidence of some orthopaedic procedure need, it comes to one crore patients annually.
Given that India has traditionally been an undernourished nation, this 2 per cent figure is quite reasonable. To service this gap, greater penetration of health insurance will be a catalyst, as also greater availability of facilities in population centres beyond the top 50 cities.
How has the controversy over the Johnson group’s medical implants impacted the orthopaedic field in general and your operations in particular?
The Johnson controversy is regrettable, but you must understand that in the process of doing new things, one will not always get good results. When the technology was developed, the purpose was to make things better. There was a global leader in the medical field who was developing the technology. But things did not work out and they had to withdraw the product and recall their implants.
As far as recalls and compensations go, the whole matter is done and dusted. Not that all patients have suffered. For instance a couple of cases which was done in Sancheti hospital, were successful and the patients were happy with the results. The bigger thing to understand is that everything new will not necessarily be good. technology must be used but with caution and precision because after all we are dealing with human beings.
How much would insurance and access to formal finance impact your specific segment of healthcare?
There is no doubt that insurance penetration and effectiveness are a huge catalyst. About 50 years ago, when we started, the percentage of cases covered by insurance will be 2 per cent. But today, 40-45 percent of cases have some kind of fund access—insurance, corporate employee plan or government scheme.
However, you can see, the majority of patients even now pay from their own pocket. Insurance as a driver definitely will have a huge impact as time goes by. We believe that a decade from now insurance will completely drive healthcare, the way it does in the USA.
Given that you as of now are in single-location, including the upcoming facility, how do you see your growth panning out?
In terms of geographical expansion, we are a bit cagey about opening facilities at a second location. This is mainly because we do not want to dilute the brand in any way through lower efficiency of care. Speciality orthopaedics as a practice has quite different demands and standards compared to multi speciality corporate hospital chains. For our growth, we rely on the proven hub-and-spoke model.
We have a network of six satellite clinics all over Pune city. Patients can access diagnostic services, physiotherapy care and consultation from there. In short, non-operative patient treatment is done at the clinic itself. We have established 29 OPDs all over Maharashtra, where our doctors visit once a week on an average. We conduct camps in Maharashtra, Madhya Pradesh, Chattisgarh and Odisha.
Within our single speciality, we have not only created a niche but also extended a holistic treatment experience. For example, many elderly patients whom we treat have other parallel issues—cardiac, neuro, kidney—which also impact the procedure and recovery process.
They need support from different types of skill sets which is also made available by us. We are also building up our medical tourism practice. We receive a steady flow of patients from places like Muscat, Oman, Dubai, Yemen, Kenya, Nigeria and Tanzania. The patient flow from SAARC nations is less compared to patients from the Middle East and Africa.