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Dr Shubham Sogani

Dr Shubham Sogani
CEO, House of Diagnostics

Please comment on MRI machines market in India visa- vis the global market.

India is the second most populous country in the world with over 1.2 billion population. As expected, it also has a very high disease burden. This in turn represents the huge market and the large prospect for the healthcare industry.

The Indian MRI market has witnessed strong growth over the last few years and will continue to do so over the next five years. Southern India tops the list in terms of installations whereas in future bulk of the demand will come from West followed by North. Buying behaviour of MRI depends on the budget and the type of population catered by the institution. Therefore, the latest and advanced 3T MRI is not afforded.

An increase in healthcare infrastructure boosts the demand for MRI equipment installation, also increasing the demand from hospitals and imaging centres. Increased health insurance coverage and disposable income fuels the affordability among the patients, leading to increase in health insurances and per capita disposable income. Medical tourism is opening up new avenues for growth for this market. Greater budgetary allocation towards health sector will see better infrastructure in state run hospitals. The duty structure should be decreased for such equipment. Both doctors and patients are increasingly becoming more aware of the benefits of MRI test. Higher currency fluctuation squeezes the profit margin of the players. Currency fluctuation affects this market as this market sees heavy imports (for both first-hand and refurbished equipment). Highly capital intensive MRI equipment demand high service charges, which in turn is passed on to the patients resulting in lack of affordability amongst patients. Lack of regulation in the medical community on MRI referral fees further hampers the affordability of patients for this modality.

Looking into the rapid developments in technology such as faster scan times and higher imaging quality, higher and more sophisticated machinery makes it possible to even detect small lesions <5mm. The advancements in MRI Physics are decreasing the use of contrast administration for MRI. The latest advancement of PETMRI makes it a highly sensitive tool to detect any cancer anywhere in the body at very early stages, without giving any radiation from the machine unlike the PET-CT Scan. This makes this innovation of PET-MRI the safest way and most comprehensive way to study and deal with cancers. It has helped in decreasing the time for cancer imaging and diagnostics, further decreasing the time gap between diagnostics and treatment, helping patients fight cancer and time, as cancer is a fight against time. Right treatment at the right time may cure cancer. It gives the doctor the correct extent of cancer and helps him make the right decision. Lesions which are missed on a regular positron emission tomography (PET) scan are picked up using the MRI Scan, thus complementing the findings of a regular PET. It is safe as no radiation exposure from the MRI (unlike CT scan) completely removes the untoward side effects and harms from CT scan during a PET-CT. This technology is now being used for cancer screening and also can detect cancer anywhere in the body in just one examination which lasts for about 45 minutes only.

The Indian market is becoming increasingly more susceptible to refurbish MRI equipment because of cost advantage – about half the cost of new equipment. MRI equipment are penetrating more because of the various tie ups between government and private companies. As per latest trend MRI equipment is installed through PPP model. Teleradiology is emerging as a tool for reporting MRI images to counteract the lack of good radiologists especially in remote and rural India.

Please tell us about your current operations in India and your expansion plans.

We are mainly concentrated in the Delhi – NCR Region with the largest number of MRI scanners installed under one brand. We have the highest end PET-MRI (a high end 3T MRI with PET Scanner) at Indraprastha Apollo Hospital, a 3T super-magnet MRI installed at Hargovind Enclave in East Delhi, 1.5T super-magnets installed at Hargovind Enclave, Saket, Faridabad centers, Open cum standing and weight bearing MRI installed at Hargovind Enclave in Faridabad and Apollo New Delhi.

We have 8 MRI’s installed in Delhi/ NCR Region itself and six diagnostic centers being run and managed by us. With Delhi market maturing and the demand for MRI’s rising we expect to further expand our portfolio in Delhi -NCR and also are targeting other nearby markets with such fully equipped centers. Today we do diagnostic tests at rates which are lower than those being charged by government hospital also as we cater to large volumes.

On the price sensitivity of the Indian market, and how does your hospital counter this problem.

The Indian market is very price sensitive and patient’s affordability is a major challenge in diagnostics and treatment. We are now offering 50 percent discount on the prevailing market rates on all tests done at our centres in Hargovind Enclave, Saket and Faridabad. An MRI test prescribed by a doctor on a 3T MRI for instance, which costs Rs 18,000 at any private hospital, costs between Rs 7,000 to 9,000 at our centres. This has resulted in a large patient flow to our centres and we are now handling a good volume of patients.

On government regulation or any other challenges faced while operating the Indian market.

The main challenge faced by the healthcare industry is the huge costs of infrastructure. Government should look into subsidising the costs by removing VAT, service tax and excise applicable on all goods and services which are directly supportive to healthcare industry such as on equipment and consumables. This in turn will greatly decrease the burden of costs on patients making it more affordable to them. Lack of regulation in the medical community on medical referral fees further hampers the affordability of patients for diagnostics and treatment.

On emerging trends and new technologies.

The new technologies in the space of MRI are PET – MRI, which is a ground breaking innovation that has changed the way doctors are approaching and treating cancers. Also its use in cancer screening for people who wish to rule out any and all types of cancers by just one test makes this advancement truly a medical marvel. The 3Tesla MRI with high power of a 3Tesla magnet gives better quality images and resolution are far better, making even the minute lesions visible. Silent MRI decreases the noise inside a MRI machine. While open MRI is recommended on claustrophobic patients. Standing weight-bearing MRI has given a new dimension to spinal and joint problems, which get exaggerated in standing and weight bearing positions.

What are your Hospital’s offerings.

We are one of the healthcare institutions that offers discounts on all diagnostic tests, including 3T MRI, 1.5T MRI, open cum standing weight-bearing MRI, CT Scans, PETCT scans (at Rs.9,999), laboratory investigations besides all general tests such as X-Rays, ultrasounds, bone densitometry, mammography, OPG, PFT, EEG, EMG, ECG, etc. We offer a comprehensive whole body cancer screening check up using the PET-MRI at Indraprastha Apollo Hospital in New Delhi using the high end PET-MRI.

Affordability is the key for all. The manufacturers have to sell affordable products without compromising on quality, Government has to provide subsidy to the service providers to make investigations such as those of MRI affordable for patients.

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