The Needle of Diagnostics

Powered by technology, dominated by corporates and driven by new-age consumers, the diagnostic laboratory market in India has taken a giant leap forward

By Dhirendra Pratap Singh

In the US, about 20 years back, there were at least 30 thousands laboratories, but today there are 4-5 major chains of organised laboratories, which constitute around 30 percent of the total market of pathological testing. Now the Indian market dynamics is also changing drastically the way US did. With more than 3000 labs and 85 percent of the total market share currently, the unorganised laboratories are growing at the rate of 10-15 percent, while the organised corporate chains having less than 15 percent share of the total market are growing at a much faster rate at 25-30 percent, annually.

Today, in India more than 25,000 clinical laboratories carry out around 11 lakh tests daily. These range from routine examinations of blood sugar and cholesterol levels to complicated hormonal assays and immunological investigations. The growing middle class population, coupled with rising demand for affordable health insurance for an ageing population, is expected to translate into an exponential growth driver for diagnostic laboratories.

The International Diabetes Federation estimates that the number of diabetic patients in India has more than doubled from 19 million in 1995 to over 41 million now. Cardiovascular diseases (CVD), cancer and stroke account for 53 percent of all deaths and 44 percent of disability-adjusted life years. Thus, the Indian population is graduating from cheaper to treat ‘infectious diseases’ to the more complex and expensive ‘lifestyle diseases’ which require greater diagnostic and therapy interventions. Lifestyle diseases are set to assume a greater share of the healthcare market.

The laboratory plays a central role in healthcare. By one estimate, 70 percent of all medical decisions are based on laboratory results. And now all the laboratories strive to use the latest in technology. However, technology is a mean to an end and not the end in itself. Optimising performance means that workflow and technology are integrated to yield an operation that best meets the clinical needs and financial goals of the organisation. High quality at low cost is another concern. Updates in technology must lower capital and operating costs and also improve turnaround time.

Market

The fast growing diagnostic sector opens several avenues for partnership between the Indian and International diagnostic companies. There is huge potential in the clinical research and trials market by combining the unique strengths of Indian and US companies, US companies are the leader in pharmaceuticals and biologics research and development.

Indian companies can leverage their extensive expertise in life sciences, the large number of CAP accredited labs in India and the huge patient base to collaborate with US companies in organising large scale and complex clinical trials at low costs. There is good potential to develop training and accreditation programmes for the Indian market. There is a need to design cheap, high quality equipment for Indian markets and device creative financing options and low cost, effective solutions for the Indian market.

Do You Know?

Life expectancy has shot up in India, from 23 at the turn of the 20th century to 65 years, while death rates have come down—from 25 per thousand to eight.The Indian healthcare market is on an unprecedented high at 16 per cent year on year. From Rs1, 02,600 crore in 2005, it now clocks Rs2, 00,000 crore and is projected to reach Rs3, 00,000 crore by 2012.The healthcare industry employs over four million people, making it one of the largest service industries in the economy, reports a study by ASSOCHAM and Yes Bank.


The Indian population is graduating from cheaper to treat infectious diseases to more complex and expensive lifestyle diseases, which require greater diagnostic and therapy interventions

 

Unorganised Sector in India
Major branded players in the Indian diagnostics market are Super Religare Laboratories, Dr Lal Pathlabs, Quest Diagnostics, Thyrocare and Metropolis.  Super Religare Laboratories is servicing nearly 1550 hospitals/path labs along with its subsidiary Piramal Diagnostic Services Private Limited, offering a comprehensive range of over 3,300 diagnostic tests, from the routine to the highly specialised tests.

Dr Lal Pathlabs has 65 laboratories at present in India and it is looking to add another 35 this year. The company has decided to invest `150 crore this year on acquisitions in India and abroad. The company is also looking to acquire in Middle East, Bangladesh, Sri Lanka and other South Asian nations.

Quest Diagnostics has operations in the US, India, UK, Brazil, Puerto Rico, Mexico and Ireland, it is a Fortune 500 company. In India, it has set up facility in Gurgaon, Haryana. It has recently launched a wide array of testing for diagnosing and monitoring blood cancer in India.

Thyrocare is one among the top laboratory brands in India. It is moving at 40 percent annually.  Another major player Metropolis has created an Indian Association of Pathology Labs in view to represent the industry to the government under the umbrella structure of CII (Confederation of Indian Industry). The company has been into the process of promoting three more tests viz. He4 (Ovarian Marker – Gynecological), Hair DX (Genetic hair loss – Dermatological), DNA paternity test, for the Indian citizens.

Opportunities and Challenges

Indian healthcare market is large but still fragmented and underserved. India is one of fastest growing and strongest global economies with about 8 percent growth rate. Our nation has 17 percent of the world’s population but poorest healthcare infrastructures among growing economies and healthcare accounts for only near 5 percent of GDP. Also, the diagnostic services in India are highly fragmented and unorganised. There is uneven penetration of services with greater concentration in South India and West India and scarcity in North-East.

Facts that count

In India, out of the 60,000 laboratories where testing is done, only 200 are accredited and only 1000 are worth being called as laboratories. By the year 2020, at least 60 percent of in-vitro business will become organised since, though slow, things are moving in right direction.

Unorganised laboratories are growing at the rate of 10 – 15 percent, while the organised corporate chains having less than 10% share of the total market are growing in a much faster rate at 25 – 30 percent, annually.
As on date only 10 percent is organised and though it has taken 40 years to move to 10 percent, this is likely to grow to 50 percent in just next 10 years.

The growing middle-class also recognises the value of pathology testing and is willing to pay for these tests. This is reflected in the over 20 percent CAGR in the last five years in India’s diagnostics industry.

The diagnostics industry is highly fragmented with the largest players account for less than 15 percent of the total diagnostics market.

 

The diagnostic services in India are highly fragmented and unorganised. There is uneven penetration of services with greater concentration in South and West India and scarcity in North-East

Experience has confirmed that full automation is a very gradual step towards efficiency in laboratory work and lab automation still continues to evolve. The drive or thrust for smaller, faster, and more-accessible devices is increasing. Emerging markets have different needs with respect to the test menus, technologies used and operating procedures. Thus, made-to-order solutions need to be developed for these markets.

Lab automation has also taken on a new level of importance in the ability to actually get instruments interfaced to various laboratory information systems (LIS). Information technology has taken a giant leap in the IVD industry, thereby reducing the dependence on a technically qualified individual to be present at all times during the analytical procedure without compromising on established levels of care.

In recent years, the workload on laboratory personnel has increased two to two-and-a-half times. An increase in the capacity and directions of laboratory investigations should be reflected in the quality of the work, or in the accuracy and reliability of the acquired data. But this is possible only when laboratories are equipped with modern technology, permitting a sharp rise in production and in the reliability of investigation results. Delivering the right data in a timely and cost effective manner while improving the sensitivity and specificity of the test is the need of the hour and the industry needs to gear up for single workstations that can carry multiple workloads.

Besides, in our country there is no regulation by the government to ensure the quality and authenticity of the pathological labs. Therefore, there is high risk of improper diagnosis by the doctors who bank upon the pathological tests’ results. In US there is CAP (College of American Pathologies), which is one of the expensive accreditations in the world and all the laboratories abide by the accreditation. But in India, we are still awaiting a set of regulations, and as such currently we are bound to set our own standard to match up to the quality. We have also created an Indian Association of Pathology Labs in view to represent the industry to the government under the umbrella structure of CII (Confederation of Indian Industry).

Technology has stepped in to play facilitator to improve healthcare delivery. Issues such as systematised capture, storage and sharing of patient information, allowing faster but error free operations are now achievable. The new buzz in the air raises new hopes. Fingers crossed.

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