SPECIAL ARTICLE
Investing in Health
Healthcare Industry in India
Indira Chakravarthi, Bijoya Roy, Indranil Mukhopadhyay, Susana Barria
The publication of “Investing in Health,” the World
Bank’s highly influential 1993 World Development
Report, has guided structural adjustment policies and
health sector reforms in many developing countries. This
study looks at how investment in health has since taken
place in India with the withdrawal of the state from
healthcare, transformation of healthcare into a
commodity, and promotion of the private healthcare
sector by the state. This has led to an unregulated
industry that is aggressively seeking expansion and
profits from the provision of healthcare, and attracting
investments by global finance capital.
Annexures to this paper are available on the EPW website.
The authors acknowledge the comments of an anonymous reviewer.
The usual disclaimers hold.
Indira Chakravarthi (indira.jnu@gmail.com) is a Delhi-based public health
researcher. Bijoya Roy (bijoya@cwds.ac.in) and Indranil Mukhopadhyay
(indranil.jnu@gmail.com) teach at the Centre for Women’s Development
Studies, New Delhi and O P Jindal Global University, Sonipat,
respectively. Susana Barria (susana.barria@world-psi.org) is a
researcher at Public Services International, Faridabad.
50
I
t is well known that since the mid-1980s, the Government of
India has actively encouraged the formal private healthcare
sector through direct and indirect concessions and policy
measures. The poor performance of the public healthcare sector,
arising from prolonged inadequate funding and deliberate
neglect, is conveniently used by the private sector as well as
policymakers to increase private sector participation. Private
sector healthcare in India is known to be a heterogeneous mix
of informal and formal providers, with the formal providers be-
longing to either not-for-profit or for-profit categories. Further,
formal providers range from individual practitioners to formally
registered small-to-medium private hospitals, and the corporate
commercial hospital sector. While there is a large unorganised
sector comprising own account/individual-run enterprises, how-
ever, the National Sample Survey (NSS) data points to a declining
trend in such individual-run enterprises in private health sector
and an increasing trend towards small-, medium- and large-sized
enterprises, with large-sized enterprises increasing at a much
faster rate as compared to medium- and- small ones, between
2001–02 and 2010–11 (Hooda 2015). The IMS census conducted
in 62 major cities of the country showed that there were around
13,413 private hospitals contributing to almost 95% of the total
hospital facilities in these cities (Mukhopadhyay et al 2015).
The National Health Policy (NHP) 2017, in its opening para-
graph, refers to the presence of a “robust” healthcare industry
and its double digit growth, and notes that it brings in revenues
and employment (GoI 2017a). Further, the NHP refers to “ongoing
efforts by the Government to streamline the own-account-enter-
prises (OAEs) within the corporate sector and to regulate them”
(GoI 2017b: 10). It calls for engaging with the private sector
through measures such as strategic purchasing of services from
different providers, including for-profit ones, and for encouraging
“the private sector to invest—which implies an adequate return
on investment that is, on commercial terms which may entail
contracting, strategic purchasing, etc” (GoI 2017a: 19).
The overall healthcare market in India was estimated to be
$100 billion (2015), and expected to grow to $280 billion by 2020,
an annual growth rate of 22.9%; healthcare delivery, which
includes hospitals, nursing homes and diagnostics centres, and
pharmaceuticals, constitutes 65% of the overall market (IBEF
2017). While business reports indicate that the healthcare industry
in India is rapidly growing, there is little information about the
growing commercial–corporate sector beyond these figures
and forecasts of growth and investments therein. While there
are anecdotal accounts or references in the context of medical
NOVEMBER 11, 2017 vol liI no 45 EPW Economic & Political Weekly

tourism and foreign direct investment (FDI) (Chanda 2010) or
from a business perspective (Burns 2014), there is little system-
atic documentation and study on companies and investors in the
healthcare industry, its characteristics, services provided, em-
ployment conditions, costs, and efficiency. It is important to
understand the implications of a growing network of for-profit
healthcare corporations for public health and health systems,
medical practice, cost, quality and ethics of care, access and
affordability (Chakravarthi 2013), especially in view of the in-
creasing calls for engagement with the private sector to move
towards universal health coverage.1
Given this gap, an exploratory study on the private hospitals
segment of the healthcare industry in India was undertaken
as a scoping exercise to obtain preliminary information on
companies, investments, location and ownership patterns, ser-
vices provided, etc. This study is intended to be illustrative
rather than comprehensive, the purpose being to draw attention
to this critical yet under-researched component of the health
system in India. The following four sections present sequen-
tially the method of information collection; the findings respe-
ctively on some general features and activities of few health-
care companies; profiles of the investors, namely, internation-
al institutions and private equity funds; and the implications.
The term “healthcare industry” is used as an umbrella term
encompassing hospitals and diagnostic centres, drugs and
pharmaceutical manufacturers, medical equipment and device
manufacturers, and the health insurance industry. The hospi-
tals sector is reported to be the major segment (GoI 2017a), and
hence, the term healthcare industry is often used while talking
about corporate and other big private hospitals in India. In this
paper too, it is used while referring to companies providing
clinical/medical care services. The activities and behaviour of
the pharmaceutical industry receive much attention and are
well-documented for long. While health insurance has grown
over the past decade (PHFI 2011), only 12% of rural and 13% of
urban population are reported to be under some kind of health
insurance (Prinja et al 2017). Others report coverage of 18% of
the population, with the majority covered under either govern-
ment or employer programmes and around 2.3% by commercial
private health insurance (Thomas 2017), and the presence of
about 40 private health insurance providers (Ahlin et al 2016).
Overall, health insurance in India in general, and the numerous
government schemes in particular, have also been receiving
attention, especially in the context of the government objective
and policy of universal health coverage. As mentioned earlier,
this study confines itself to the private and corporate hospitals
segment of what is referred to as the healthcare industry.
Methodology
Information collection was initiated with online search by using
specific search words relevant to the study, such as: healthcare
companies/healthcare industry in India, private hospitals, cor-
porate hospitals, diagnostic centres and private equity in health-
care. Search words included names of specific well-known cor-
porate hospitals. Based on the information that started becoming
available, a combination of snowballing and iterative process
Economic & Political Weekly EPW NOVEMBER 11, 2017 vol liI no 45
SPECIAL ARTICLE
Figure 1: Share of Wages, Outsourced Jobs, Marketing Expenses and Taxes
Wages as % of total expenses
Advertising and marketing
Outsourced jobs as % of
Taxes as a % of total income as % of total expenses
total expenses
Source: Annual reports of companies, PROWESS database CMIE, accessed on 5 December 2016.
was adopted, wherein the information available from the initial
search became the basis for more information. This was done
until information saturation was reached and some trends became
discernible. The information is largely from business newspapers;
publicly available information and reports from government
sources, websites of well-known companies in healthcare, private
equity firms, international institutions like the International
Finance Corporation (IFC), industry intelligence sources, Centre
for Monitoring Indian Economy (CMIE), Prowess database
(companies under Code No 86, Human Health Activities under
National Industrial Classification [NIC]) and secondary literature.
Features of the Industry
It is seen that there is an increasing number of organised for-profit
private healthcare providers, and it is no longer the case that
there are a few corporates providing tertiary-level/super-specialty
care confined to the metros. Ninety-four healthcare companies
were found in the Prowess database in 2014. As of April 2017,
the National Accreditation Board for Hospitals and Healthcare
Providers (NABH) listed over 450 accredited hospitals in India.
While this includes a handful of government facilities, bulk of
them are private hospitals (NABH 2016). However, the actual
number of companies could be much more, as accreditation or
being in Prowess database is voluntary. The respective State
Registrar of Companies can be a starting point to get a realistic
statewise number of companies providing healthcare.
The analysis of financial data of 89 companies belonging to
hospital activities (NIC 86) in the Prowess database shows that
their revenues and sales have increased over the years, so have
profits (Table 1). From 2010 to 2014, total income and expendi-
ture grew at 19.3% per annum in nominal terms (whereas, the
gross domestic product (GDP) in that period grew at 13.5% at
nominal rate). However, the share of wages in total expenses
has remained nearly the same at around 17% and not increased
much (Figure 1). Among the other components of expenditure,
outsourced jobs and advertisement and marketing expenses
have increasing share of expenditure: outsourced jobs increased
from 2.6% to 4.1% in 2014. Advertisement and marketing ex-
penses grew from 2.5% to 2.7%. Advertisement expenditures
Table 1: Total Income and Expenses, 2010–14 (` million)
Year Total Income Sales Total Expenses Compensation to Employees
2010 81,885.9 78,256.3 79,617.3 14,053.5
2011 96,614.6 91,378 92,038.8 15,060.4
2012 111,594 105,229.9 107,164.8 19,785.1
2013 131,059 119,866.5 123,586.7 22,604.5
2014 169,839 161,127.3 166,541.8 29,632.4
Source: Annual reports of companies, Prowess database CMIE, accessed on 5 December 2016.
51
SPECIAL ARTICLE
Figure 2: Companies Classified in Terms of Ownership and Main Activities
• Entering through equity investments or subsidiaries or
Foreign or acquisitions, joint ventures;
multinational • In multi-specialty or single specialty or diagnostic services
companies
• Pan-india and overseas presence;
• In multi-specialty, super-specialty/tertiary, and multiple areas
Indian hospital and
diagnostics chains
of business such as pharmacy, education & training
• Some also in primary-secondary care (eg Apollo)
• Presence within a city or state and neighbouring states, providing:
• Multi-specialty, super-specialty services;
• Single specialty – eye care, dialysis, mother and child, etc
• Secondary or primary care (clinics)
Regional/smaller
companies • Diagnostics – pathology, imaging, genetics
• Home-based care
• Hospital management
grew at 23.2% during the period—indicating an increasing im-
portance of promoting healthcare. The assets of the companies
grew from `1,89,498 million to `3,22,870 million, a compound
average annual growth of 14%. An overwhelming 78.9% of the
investment in this period has been in the form of equity shares
(`2,06,912 million). Such equity investments are a reflection of
better financial prospects of the company, not necessarily green
field investments and expansion of healthcare services.
There is diversity in ownership and size. While there are few
big Indian companies, with thousands of beds and a pan-India
presence (Annexure 1), there are several smaller companies
with regional presence (Annexure 2). There are also companies
owned by non-resident Indians (NRIs), registered in Gulf coun-
tries (Figure 2). There is for-profit presence in every segment of
healthcare, primary, secondary, tertiary levels of care, in diag-
nostics, and single specialty services; some new segments have
also arisen, such as home-based care, hospital management,
online platforms (Annexures 3 and 4).
Ownership is no longer confined to medical professionals/
doctor entrepreneurs, nor is it local. Foreign institutions held 45%
stakes in the Apollo Health Enterprises Limited (AHEL 2016a,
2016b). Global and domestic private equity funds are acquiring
significant stakes in big and small regional companies, and are
becoming part of the governance and ownership of healthcare
companies, as demonstrated by the case of the Narayana Hru-
dayalaya (NH). In 2015, shareholders of the NH were: domestic
promoters 68.62%, foreign venture capital investors 11.22%
and corporate bodies 16.78%. Among the public shareholders
were: Ashoka Holdings 8.63%, Ambadevi 2.59%, JP Morgan
10.91% and CDC Group 5.88%. According to the company:
We may be viewed as a “foreign controlled” company beginning
22 August 2013, and investments made in our Subsidiaries thereafter
may be viewed as indirect foreign investment. JPM, Ashoka Holdings
and Ambadevi, who are persons resident outside India (Mauritius),
possessed extensive veto rights under the Shareholders’ Agreement
dated 28 January 2008, with respect to the management of our Company.
With the further investment that our Company received in December
2014 from CDC Group and CDC IOL, two other persons, resident out-
side India, acquired certain veto rights with respect to our Company ...
Our Company may likely be viewed as “foreign controlled,” beginning
22 August 2013, as a result of the veto rights exercisable by our foreign
investors. (Narayana Hrudayalaya 2015: 21)
Several foreign/multinational companies are operational in
India, either through greenfield ventures or acquisition of local
52
hospitals. Examples of the former are Columbia Asia with origins
in the United States (US) and the Japanese venture, Sakra World
Hospitals; meanwhile the NMC Healthcare, Dubai has acquired
several hospitals. DaVita India, subsidiary of DaVita Inc US,
acquired Bengaluru-based NephroLife (Annexure 5). Global
private equity companies have also acquired hospitals in
India—in 2016 Dubai-based Abraaj Group acquired a 72% stake
in Quality CARE India, Hyderabad, which owns CARE Hospitals
(Abraaj Group 2016) (Box; Annexure 5).
Box: Investment/Acquisition of Indian Companies by Foreign PE Firms*
IHH Healthcare Malaysia acquired Global Hospitals Hyderabad and Vikram
Hospitals Bengaluru.
* TPG Capital held 24.75% in Manipal Health Enterprises.
* TPG reported to be in talks to buy up to 26% and management rights of
Fortis Healthcare (Kurian 2017).
* Abraaj group acquired 80% stakes in Medall Healthcare, a diagnostics
company.
* Song Investment Advisors, Helion Venture Partners, Nexus Venture
Partners and International Finance Corporation (IFC) together held
majority stakes in Haryana based EYE Q.
*Germany’s Fresenius Medical Care AG acquired 85% stake in Sandor
Nephro Services Hyderabad.
* Domestic investor IVFA (renamed True North), with Canada Pension
Plan Investment Board and Abu Dhabi Investment Authority, acquired
controlling stakes in Kerala Institute of Medical Sciences (Balakrishnan 2017).
* Domestic firm Catamaran Ventures, Blue Cross Blue Shield Venture Partners
of the US, and Reliance Venture Asset Management invested in Wellspring
Healthcare Mumbai, which operates primary healthcare clinics (Healthspring).
Indian entities are seen to be expanding their activities across
the country, including previously uncovered regions in eastern
and central India. Corporate hospital chains were acquiring
standalone hospitals; the focus and attention is on low-cost
models and Tier II cities to drive their growth plans, due to the
high competition and high land costs in Tier I cities (IRR 2015;
AHEL 2016a, 2016b), particularly targeting the expanding pur-
chasing power among the upper and middle classes. The bigger
companies have multiple operations that include: owned
hospitals, hospitals and/or some specialty centre operated and
pay revenue share to the owner of the hospital premises, hos-
pitals, standalone clinics and primary care facilities operated
on a lease or licence basis, hospital management services pro-
vided to third parties for a management fee, and pharmacies,
diagnostic centres. For companies with such multiple busi-
nesses in healthcare, hospitals contributed the largest share in
revenues. Some also conduct clinical trials for pharmaceutical
and medical equipment manufacturing companies and run
educational and training courses for doctors and paramedics
(from Red Herring prospectus and reports of companies; NH
2015: 47; HGEL 2016).
AHEL is the largest entity, providing a range of services from
tertiary care hospitals, diagnostic clinics, pharmacies, neighbour-
hood primary care clinics, Apollo Reach Hospitals in Tier II, III
cities, and telemedicine and education services. The group owned
and managed 69 facilities in India and abroad, with 9,554 beds
and 43,557 employees as on March 2016 (AHEL 2016a, 2016b).
Fortis Healthcare, which operates through Religare Health Trust
(RHT), a business trust owned by the Fortis group listed in the
Singapore stock exchange, had 18 owned and managed hospitals
across six cities (RHT 2015). NH, a Bengaluru based company,
NOVEMBER 11, 2017 vol liI no 45 EPW Economic & Political Weekly

operated a network of 57 facilities across 32 cities, towns and
villages, with 5,600 operational beds as of September 2015.
The chain employed around 11,478 employees and students
and additional 1,660 doctors on a consultancy basis (NH 2015).
Cardiac Research and Education (CARE Hospitals of Quality
CARE India), Hyderabad, founded in 1997 by a group of doc-
tors, had 17 hospitals across seven cities in five states, with
2,400 beds (Annexure 1).
The large hospital chains are acquiring smaller institutions.
For instance, AHEL increased its presence in the secondary care
segment by acquiring 11 Nova Surgical Centres of Nova Medical
Centres, entering cities like Mumbai, Jaipur and Kanpur; Manipal
Health Enterprises acquired SK Soni Hospital in Jaipur in early
2014; Max acquired 340-bedded Pushpanjali Crosslay Hospital,
Ghaziabad, and 51% equity stake in Delhi-based Saket City
Hospital from Singapore-based Smart Health City; Healthcare
Global Enterprises Ltd (HCGEL) acquired multispecialty hospi-
tals in Ahmedabad and Bhavnagar.
Some of these companies have gone public, such as AHEL,
NH, Aster DM Healthcare, Fortis, Thyrocare, Dr Lal PathLabs,
etc. Many have private equity investments to a small or large
extent (Box 1; Annexure 4). With increasing competition,
organised marketing as well as creation of brand value is
considered a necessity. Advertising and marketing expenses
form a significant portion of the expenses of bigger companies
(our analysis; Kanchan 2015).
Some of these companies also have overseas presence, in neigh-
bouring Asian, Gulf and African countries. For instance, AHEL has
facilities in Dhaka and Mauritius; Aster DM has hospitals, clinics,
pharmacies in Gulf countries. Fortis has five hospitals in Bangla-
desh with AFC of Bangladesh, and is also a shareholder in Lanka
Hospital, Sri Lanka; MHEL acquired a hospital in Malaysia. NH is
a shareholder in a hospital in Nairobi. It also owns a hospital
along with Ascension of US, in Cayman Islands Caribbean, run in
public–private partnership (PPP) mode. The Kerala Institute of
Medical Sciences has set up hospitals in several Gulf countries.
The Indian healthcare business is now seeing emergence of
small-format providers in single-specialty segments such as the
short-stay surgery care format started by Nova Medical Centres,
nephrology, and eye care, largely supported by private equity
(Singh and Mathews 2013). Centre for Sight, a Delhi-based eye
care chain, operated 51 facilities spread across nine states. Apart
from independent eye care centres, LASIK centres, pharmacies and
optical outlets, it also operated ophthalmology departments
within third party hospitals; and had acquired operations of lo-
cal eye doctors in various cities. Sandor Nephro services oper-
ates and manages a chain of in-hospital dialysis centres under
the brand name Sparsh Nephrocare, with 50 centres spread
across smaller cities and towns in 12 states. NephroPlus, another
Hyderabad-based entity has 75 operational centres—66 of them
as tie-ups with hospitals and nine stand-alone centres. The gov-
ernment tertiary institutions like King George Medical College,
Lucknow and the Jawaharlal Institute of Postgraduate Medical
Education and Research (JIPMER) Puducherry, and companies
like Apollo, Fortis, Max had tied up with these entities to operate
dialysis centres in their hospitals. Both these dialysis companies
Economic & Political Weekly EPW NOVEMBER 11, 2017 vol liI no 45
SPECIAL ARTICLE
had entered into PPP arrangements for setting up dialysis centres
in district hospitals, in Rajasthan (Sandor) and Andhra Pradesh
(NephroPlus). These single speciality settings are reported to
be low-cost models requiring a smaller area, and hence, lower
investment. At times these hospitals are based in rented premises
with equipment on lease. Through hub and spoke model the
smaller hospitals (spokes) refer patients to a large multi-specialty
hospital, and day care/ambulatory centres (IRR 2015).
Diagnostic chains Thyrocare (Mumbai based), Metropolis
Healthcare (Mumbai), Dr Lal Path Labs (Delhi), SRL Diagnostics
operate on a hub and spoke model, with a central processing
laboratory, some regional laboratories and a large number of
sample collection centres across states often on franchise basis
(Thyrocare 2016). These entities have operations in countries
of South Asia, West Asia and Africa. Some have PPPs with state
governments: like Medall Healthcare (with Tamil Nadu, Andhra
Pradesh, Karnataka); Suraksha Diagnostics (West Bengal).
Companies are also introducing a corporate model for primary
healthcare, by drawing individual practitioners and clinics into
a network. The following are some examples: Nation Wide Pri-
mary Healthcare Services, which is trying to revive the concept
of “family doctor,” Wellspring Healthcare Services running around
30 clinics with more than 100 doctors in cities like Mumbai,
Thane, Vashi, Pune, Bengaluru, and Delhi. Companies like HCL
(in information technology business) have also entered the
healthcare sector, by acquiring a family clinic in the primary
care segment in the National Capital Region (NCR) (Dey and
Dey 2014). HCL is tying up with hospitals such as Apollo, Fortis,
Max, Medanta to refer patients requiring hospitalisation.
Influx of Finance Capital
Healthcare has emerged as an attractive sector for investment
by venture capital and private equity funds2 (Malhotra 2014;
Babu 2013); the healthcare industry is reported to be flushed
with private equity funds (Dutta 2008). Private equity invest-
ment in the healthcare provider sector was reported to be $552
million in 2014 and $786.2 million in 2013 (Indulal 2015). As of
December 2013, 69 healthcare private equity and venture cap-
ital deals worth $1.11 billion were reported, compared with 65
deals worth $1.07 billion over the previous year (Chaudhary
and Joshi 2013). Healthcare is considered to be a recession
proof and a blue-eyed sector for investors, partly because of
the large profits that had been made by some private equity
firm exits. In 2013, Apax Partners exited from Apollo Hospitals
for $360 million, three times its initial investment in 2007;
Avenue Capital exited Medanta in 2013 for $155 million, more
than four times its initial investment in 2006. According to the
corporate advisory firm Grant Thornton, healthcare services
such as hospitals and diagnostics services witnessed a reason-
able deal activity:
Majority of the deals were driven by the imminent domestic consolida-
tion in these sectors and as such were small to mid-size deals ... Chain
of single-specialty centres such as eye care, dialysis care and primary
care continues to be the most actively invested segments, while multi-
specialty hospitals such as Aster DM Healthcare and Asian Institute of
Medical Sciences and Thyrocare (diagnostics chain) attracted the larger
investments, Grant Thornton officials said. (Badrinath 2014)
53
SPECIAL ARTICLE
Overall, domestic funds, family funds, large global funds and
sovereign wealth funds are seen to be active investors in the
healthcare companies in India (Annexure 5). High Net Worth
Individuals (HNWIs) are also reported to be interested in the
sector (Nair 2015).
A notable development is the intensified support by develop-
ment agencies and international finance institutions, such as IFC
of the World Bank group and the Commonwealth Development
Corporation (CDC) of the United Kingdom (UK), to the spread
of private companies in healthcare, through direct and indirect
financial support. This support is a manifestation of the larger
shift in international development policy to the use of loans and
equity investments to support the growth of a range of private
sector companies, in the name of creating employment opportuni-
ties and promoting economic growth and development. The Inter-
national Development Committee of the UK House of Commons
proposed a transition to “beyond aid” policies to remove the
underlying causes of poverty, which would “be good for UK in the
short run as well as in the long run” (Hunter and Murray 2015). In
December 2014, the UK secretary of state for international devel-
opment made reference to a transition towards “returnable capital
investments” in Indian health and education sectors. Subse-
quently, CDC, the investment arm of the Department for Inter-
national Development (DFiD), made an investment of $48 mn
(£32 mn) in NH to support its expansion. Apart from investing di-
rectly, IFC and CDC are also investing in several private investment
funds focusing on hospitals and healthcare in the Asian region.
Development financing institutions of other countries—Germany,
Sweden and United States Agency for International Development
—are also supporting private healthcare sector in several ways.
IFC is the largest multilateral investor in private health in
emerging markets. It has prepared a Guide to Investors in Private
Health Care in Emerging Markets, as part of its Health and Edu-
cation Advisory Services. At the IFC’s International Private
Health Conference in May 2011, an IFC functionary stated that,
“Healthcare has become a major global industry, growing faster
than GDP in most countries … as the world recovers from the
Table 2: IFC Investments/Loans to Healthcare Companies in India
Company
Duncan Gleneagles, Kolkata
Apollo Health Enterprises Ltd (AHEL) 2005, 2010, 2012, 2016
Max Healthcare, Delhi
Rockland Hospitals, Delhi
Super Religare Laboratories Ltd (SRLL)
Zulekha Hospitals UAE*/Alexis Hospital, Nagpur
Fortis Healthcare
Global Hospitals, Hyderabad
Nephropolus Health Services, Bengaluru
EYE-Q Vision Private, Haryana
Ivy Hospitals, Punjab
Portea Medical, Bengaluru
STS Chittagong Hospitals, Bangladesh (joint. venture with AHEL)
Healthcare Global Enterprises (HCG), Bengaluru
Regency Hospital, Kanpur
* Zulekha Healthcare Holdings is a UAE-based company owned by a non-resident Indian (NRI)
doctor. In 2012 the company started a greenfield hospital in Nagpur, Alexis Multi-specialty
Hospital.
@ German aid agency DEG has also provided finances for this project along with IFC.
Sources: Compiled from www.ifcext.ifc.org, www.ifcextapps.ifc.org. Disclosed Projects,
retrieved on 5 August 2016.
54
international financial crisis, the expansion of the private health
sector continues rapidly across emerging markets” (IFC 2011).
IFC’s investments are closely aligned to the World Bank group’s
strategy for private sector healthcare in India. It actively engages
with and promotes the private sector in the name of increasing
and improving access to affordable, quality health services,
particularly in low-income states and Tier II–III cities.
IFC has made equity investments and/or given loans to a
large number of healthcare companies in India (Table 2).
IFC has also made investments in healthcare companies in
Africa, in which Indian healthcare companies are partners such
as ISO Health hospital in Kenya, whose shareholders included
three Kenyan doctors, financial investors—IFC and the Abraaj
Africa Health Fund—and NH, the strategic operating partner,
which through its wholly owned subsidiary held 26% stake
(India Today 2016). ISO Health was to set up a greenfield 130-
bed multi-specialty hospital in Nairobi. CIEL Healthcare Ltd, a
Mauritius registered company, invests in tertiary hospitals
across sub-Saharan Africa, in association with Fortis Health-
care. Another important investment of IFC was in Abraaj
Growth Markets Health Fund (Annexure 5).
CDC UK is another agency for directly helping the private sector
in developing countries. DFiD is the sole shareholder of CDC and
directs its overarching strategy. It does not require a dividend from
CDC; instead, all profits are reinvested in funds throughout CDC’s
targets in emerging markets (Thompson 2011). The CDC group
has invested heavily in several private health facilities in India,
particularly those targeting middle- and high-income groups:
10%–15% stake in NH for expansion in Kolkata, Bhubaneshwar,
Lucknow and Bengaluru (Shah 2015); in Rainbow Hospitals (with
Abraaj Group), a paediatric and maternity healthcare business in
Andhra Pradesh for expansion in Chennai, Pune, Visakhapatnam
and Kurnool, and also expected to support the creation of as
many as 3,000 new jobs (CDC 2013; Gooptu 2013).
CDC has investments in several funds that have invested in
healthcare companies in India, such as the India Value Fund
Advisors (IVFA) (Badrinath 2012), which has invested in Aster DM
Healthcare, Manipal Hospitals, Trivitron Healthcare, Cloudnine
Year of IFC Investment Hospitals (Balakrishnan and Pilla 2015); in Aavishkar Venture
1999 Capital Funds in 2010, 2011, which made investments in Swas
Healthcare Pvt Ltd, a Gujarat-based chain; Vaatsalya Health-
2003, 2007, 2009
care Pvt Ltd, a hospital chain in Karnataka; and Delhi-based
2008
2012
GV Meditech Ltd, which operates a chain of secondary level
2012 hospitals in Uttar Pradesh, western Bihar, Jharkhand and of
2013 Nepal. In 2015, CDC invested around $75 mn in the Abraaj
2013 Growth Markets Health Fund (CDC 2016) (Annexure 5).
2014 Several global private equity firms are active in India; some
2015
have launched Asia-focused funds, focused on healthcare in the
2015
2015 region. Prominent Indian businesspersons have also invested
2015@ in healthcare companies through their family firms, such as
2016 Catamaran Ventures of former owner of IT company Infosys, that
2016 invested in Wellspring Healthcare Pvt Ltd, Entrust of former
Infosys CEO Nilekani that has invested in Drishti, an eye care
company, and Aarin Capital of another former Infosys CFO
Mohandas Pai that has invested in healthcare and life sciences
companies such as InVictus Oncology. Domestic firms such as
NOVEMBER 11, 2017 vol liI no 45 EPW Economic & Political Weekly

I-Ven Medicare of ICICI have invested in smaller regional com-
panies since 2007 (Annexure 5).
Public Needs Private Profits
The neglect of the public health infrastructure in India is a
deliberate strategy to promote the large private health interests
that have grown over the years, and in keeping with the larger
neo-liberal thinking against healthcare as a social good and provi-
sion of welfare services by the state. In addition, public funds are
being diverted to the private sector through state insurance pro-
grammes and PPPs, which reduces funds available for the public
healthcare sector (Sundararaman et al 2016). Undoubtedly, the
healthcare system in India, specifically the private sector, has
moved into a distinct new phase where the provision of medical
care has become a highly sought-after sector by capitalist institu-
tions, with a growing network of companies supplying medical
care for profit. The medical/healthcare sector is getting rapidly
transformed from an “unorganised” to organised sector, a process
being facilitated also by powerful institutions such as IFC. Not
only is there expansion of corporate hospitals and diagnostic
chains to smaller cities and towns, for-profit enterprises are enter-
ing into setting up of smaller facilities for specialised, single-spe-
cialty care—such as maternity eye care, cardiac care, care-dialy-
sis-diagnostics, etc—primary care clinics, providing home-based
care, and getting into partnerships with governments.
This healthcare industry adopts a moralistic stance and talks
of working towards universal, affordable and high quality
healthcare to the millions of Indians who do not have access to
good medical care. This, the industry says, is possible through
innovative business and market mechanisms, and is making
plans for expansion, penetrating new markets, targeting new
segments, training and attracting medical professionals, etc.
The discourse is dominated by business notions of healthcare
as an attractive destination for growth and investment, increas-
ing interest of private equity investors, acquisition-expansion-
diversification-strategic planning-adopting aggressive techni-
ques, creating brand value, innovative healthcare start-ups,
vertical horizontal integration, etc.
Experiences from other countries shed some light on the impos-
sibility of achieving universal care through such measures. There
is not much evidence that a mixed system is better, more equi-
table or efficient. On the contrary, there is plenty of evidence of the
adverse and pernicious effects of corporate investment, of private
capital, as well as of having a system of public funding, private
provisioning and of purchasing healthcare. Analysing the phe-
nomenon of entry of financial and industrial capital in medicine
and healthcare in the US in the 1970s, McKinlay (1978) pointed
out that the industrial and financial capital institutions in medi-
cal care impose the same logic (profitability through expansion)
on this field that they have been doing in other sectors of the
economy since around the turn of the 20th century. There is an
urgent need to comprehend the behaviour and power of corpo-
rations that have the resources to raise finance, hire marketing
expertise to create, package and sell new demands, to influence
medical practice and the nature and pricing of services offered,
and the kind of technologies used.
Economic & Political Weekly EPW NOVEMBER 11, 2017 vol liI no 45
SPECIAL ARTICLE
Several concerns arise about private finance capital in health-
care. When capital market provides funds to the healthcare com-
panies, it expects a return just as in any other area of enterprise.
In his discussion on the role of capital markets in the healthcare
system in the US, Silvers (2001: 1022–23) says: “The capital
market is dominated by an economic perspective, which leaves
little room for broader measures of welfare. Those who lend
money want it back.” Furthermore, accessing equity capital car-
ries implications for expected financial returns, as well shared
control or ownership. In the context of US, it has been found that
the capital market has had a major role in restructuring the health-
care sector (Silvers 2001). Reliance on private investment sources
in the US has fundamentally shaped the focus of the industry in
a manner dramatically different from the systems found in other
countries where governments supply capital. As the level of out-
side financing has grown, other differences blur and traditional
concern for the public or even attending physicians may come
second after profitability (Silvers 2001: 1027–28). The resulting
market discipline extends to both for-profit firms and non-profit
organisations in several ways. The important question that
emerged was whether the requirements of private capital can
be made compatible with larger needs of society to provide
service to marginal populations (Silvers 2001: 1028).
A review of a large number of studies of the US healthcare
system concludes:
The US has four decades of experience with the combination of public
funding and private healthcare management and delivery, closely analo-
gous to reforms recently enacted or proposed in many other nations. Exten-
sive research shows that for-profit health institutions provide inferior
care at inflated prices. The US experience also demonstrates that market
mechanisms nurture unscrupulous medical businesses and undermine
medical institutions unable or unwilling to tailor care to profitability. The
commercialization of care in the US has driven up costs by diverting money
to profits and by fuelling a vast increase in management and financial
bureaucracy, which now consumes 31 percent of total health spending …
The poor performance of the US healthcare is directly attributable to reli-
ance on market mechanisms and for-profit firms, and should warn other
nations from this path. (Himmelstein and Woolhandler 2008: 407)
Experience all over the world shows that corporations, big or
small, wield great social, political and cultural influence, nationally
and globally; and influence local communities, and behaviour
and values of ordinary individuals. For instance, we see that the
healthcare industry is active in promoting health insurance for low
income groups, in creating demand and consumer awareness of
market opportunities for buying healthcare, in portraying health
as an individual responsibility, and so on. Although corporate
businesses are privately-owned enterprises, still their activities are
as pervasive as that of governments, and have consequences that
affect the larger public. The primary focus of the corporate sector
is on individualised curative care; there is no attention to public
health concerns of disease prevention, surveillance, monitoring
and reporting of epidemics and illness data, research, all of which
form important inputs for comprehensive public health planning
at population level. This phenomenon of private business in provi-
sion of a social-public good such as public health, therefore, has
deep ramifications for the kind of public health systems we want,
for goals such as universal healthcare and even universal health
coverage, and for regulation of the private healthcare sector.
55
SPECIAL ARTICLE

In this context, when the NHP 2017 is openly encouraging
further growth of this healthcare industry and for aligning pri-
vate sector with public health goals, there is need to under-
stand the nature and behaviour of the private sector and the
healthcare industry. Is it possible to align the activities of this
private industry to meet public health objectives of compre-
hensive, universal, rational, and equitable healthcare? What
will be the consequences of “strategic purchasing” on cost of
care? Our study indicates that the private sector is moving
towards an organised industry status and oligopolisation. This
would give an increasing bargaining power to the for-profit
sector to negotiate prices with government purchasing agen-
cies. The experiences of the US or even some European coun-
tries that depend on private provisioning show that the cost of
healthcare has gone up significantly in the last few decades,
which the best of regulatory systems have not been able to
contain, raising questions about the efficiency and sustain-
ability of these models. On the other hand, experiences of
Thailand, Malaysia show that, in the long run, a well-function-
ing public health system is the only way to contain costs, regu-
late practices in the private sector and deliver united health-
care at sustainable costs.

notes
1 See Lancet series on the private sector, 26 June
2016, Vol 388, pp 596, 606, 613, and 622; http://
dx.doi.org/10.1016/S0140-6736(16)30774-7.
2 Ashoka and Ambadevi are together referred to
as AIG Funds; these two companies and JPM
are listed as foreign venture capital investors
by SEBI, http://www.sebi.gov.in/investor/for-
venture.html, viewed on 2 August 2016.
3 For more on private equity as “a new form of
investment, ownership and power that has
helped to rewrite the rules of the financial sec-
tor at the time of its greatest dominance over
the world economy,” see Corner House (2008: 1).
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56 NOVEMBER 11, 2017 vol liI no 45 EPW Economic & Political Weekly

Annexure 1: Large Domestic Companies with Pan-Indian Presence
Company Name
Apollo Health Enterprises LTD (AHEL)
incorporated in 1979 in Chennai
Aster DM, Kochi, Kerala
Healthcare Global Enterprises lTD (HCGEL),
Bengaluru (Focused on cancer care and
fertility centres)
Fortis Healthcare
Manipal Health Enterprises—healthcare
arm of Manipal Education and Medical
Group (MEMG)
Max Healthcare, a part of Max India, is a
joint venture between Max India and Life
Healthcare Group of South Africa
Narayana Hrudayalaya, Bengaluru
Kerala Institute of Medical Sciences
CARE Hospitals, Hyderabad
Annexure 2: Companies Operating at Regional Level
Company Name
Global Hospitals, Hyderabad
Krishna Institute of Medical Sciences,
Hyderabad
Vikram Hospitals, Bengaluru
Sahyadri Hospitals, Pune
Sterling Addlife Gujarat Paras
Pharmaceuticals
Medica Synergy, Kolkata
AMRI (Advanced Medical Research
Institute), Kolkata
IVY Health and Life Sciences, Punjab
Regency Hospital, Kanpur
Global Health City, Medanta Delhi NCR
PARAS Healthcare Gurugram, Haryana
(by PARAS Group)
Economic & Political Weekly EPW NOVEMBER 11, 2017
SPECIAL ARTICLE
Pan-India Presence
Delhi; Tamil Nadu (Several), Chennai, Karur, Karaikudi, Madurai, Ranipet Tiruvannamalai, Trichy; Mysore and Bengaluru
in Karnataka; Hyderabad, Kakinada, Karimnagar, Nellore, Visakhapatnam and Aragonda Village Chittoor; Bilaspur,
Durg, and Bacheli (Chhattisgarh); Bhubaneshwar; Nashik, Lavasa, Mumbai ; Indore; Goa; Gandhi Nagar; Kolkata;
Assam; Dhaka and Mauritius.
In southern India—Kolhapur; Kochi, Kottakal, Kozhikode; Bengaluru; Hyderabad, Vijayawada, Guntur.
Expanding in Africa through HCG Africa, with CDC investments.
Cancer centres at Bengaluru, Shimoga and Ahmedabad, Nasik, Hubli, Ranchi, Cuttack, Vijayawada, Chennai,
Ongole, Tiruchirapalli, and Delhi; Centres under development: Nagpur, Mumbai, Baroda and Kolkata, Kanpur and
Vishakapatnam, Gulbarga, Jaipur, Mumbai, Bhavnagar.
Diagnostics centres; Chennai, Mangalore and Vijayawada;
Fertility centres and outreach clinics in Bengaluru;
Multi-specialty hospitals acquired in Ahmedabad and Bhavnagar.
One each in Jaipur, Kolkata, Hyderabad; two each in Mumbai, Chennai. Three each in Punjab and in Bengaluru;
five in NCR. Acquired SRL Diagnostics.
Operates/manages 16 hospitals, including eight teaching hospitals and seven rural maternity and child welfare
homes; 5,500 beds under management.
Multi-specialty hospitals: Maharashtra, Karnataka, Andhra Pradesh, Tamil Nadu and Goa.
Clinics: Bengaluru and other parts of Karnataka.
Medical teaching hospitals: Karnataka and Sikkim.
Fertility clinics: Karnataka, Andhra Pradesh, Tamil Nadu and Madhya Pradesh.
For home-based post-operative care partnership with Bengaluru-based Portea medical care.
Facilities in north India, 10 in Delhi-NCR and the others in Mohali, Bathinda and Dehradun.
NH Health City Bengaluru, Mysore, Bellary, Shimoga (Karnataka); Kolkata (5), Durgapur Berhampore (West Bengal);
Jamshedpur, Guwahati, Raipur, Jaipur; Palanpur, Ahmedabad, Mahuva (Gujarat); Lucknow; Mumbai; Jammu.
Thiruvananthapuram, Kollam, Kottayam, Kochi and Perinthalmanna (in Kerala), Hyderabad and in Gulf countries.
Hyderabad (5) Secunderabad, Vishakapatnam (3), Raipur, Bhubaneshwar (2), Nagpur, Pune.
Regional Presence
Tertiary/quaternary care hospitals—Hyderabad, Chennai, Bengaluru and Mumbai.
Super-specialty hospitals—Hyderabad, Nellore, Kondapur, Rajahmundry and Srikakulam.
Seven hospitals across Karnataka—Bengaluru, Mysore, Mandya and Tumkur.
10 hospitals in Maharashtra.
“Sterling Hospitals” in Gujarat; also into diagnostics and home healthcare services.
Owns and operates hospitals and retail pharmacy outlets in Kolkata, Jamshedpur and Siliguri; management
of Tata Steel hospitals in Jamshedpur and Odisha.
Four hospitals—Kolkata (3), Bhubaneshwar (1).
Five multi-specialty hospitals—Mohali, Nawanshahr, Khanna, Hoshiarpur, Amritsar. Greenfield hospitals in
Panchkula (Haryana), Bhatinda and Jalandhar.
Two tertiary care hospitals, clinic; joint venture with Fresenius Medical Care, Germany for dialysis centres;
Oncology Hospital in Kanpur in joint venture with HCGEL.
Medicity in Gurugram (NCR); Lucknow—Medanta Awadh.
Six multi-specialty hospitals in Gurgaon, Darbhanga and Patna; mother and childcare centres under the
Paras Bliss brand, in NCR, Panchkula.
vol liI no 45 1
SPECIAL ARTICLE
Annexure 3: Companies in Primary/Secondary Healthcare Segment
Nationwide Primary Healthcare Services,
Bengaluru
Wellspring Healthcare, Mumbai
HCL Healthcare, Delhi, subsidiary of HCL
Corporation, HCL Avitas acquired two clinics of
Bharat Family Clinic in NCR region
Vaatsalya Healthcare Solutions, Bengaluru
BE WELL Hospitals, Chennai
Glocal Hospitals, Kolkata (by retired
bureaucrats and doctors)
Team of NRI specialists and GPs from UK and US relocating to India. Over 20 clinics across Bengaluru and
Gurgaon; acquired Ovum Hospitals of Bengaluru-based Neonatal Care and Research Institute.
Primary healthcare clinics (Healthspring Community Medical Centres) around 30 centres; reported to have
about 100 doctors. Mumbai, Thane, Vashi, Pune, Bengaluru, and Delhi.
Only outpatient services, planned to enter into clinical partnerships with regional hospitals to refer patients, also
has agreement with Quest Diagnostics. Reported to have eight clinics across Delhi-NCR.
Low-cost primary and secondary care hospital chains in Tier II and III towns; also re-furbishing and managing
nursing homes of doctors in small towns. Around 12 hospitals in Karnataka and Andhra, planning to expand into
Tamil Nadu and Maharashtra.
Establishing secondary care medical facilities (40-60-bed hospitals) targeted at Tier II and Tier III cities, and
metro suburbs (in underserved towns and localities). Reported to have hospitals in Chennai, Pondicherry,
Pudukottai, Sivakasi, Erode and Tuticorin.
To set up 30-bedded primary and secondary hospitals in rural India; In Sonamukhi, Bankura, Dubrajpur,
Birbhum, Murshidabad, Bolpur, and Behrampur, districts of West Bengal.

Annexure 4: Companies in the Diagnostics, Single Specialty, and Other Segments of Healthcare
Thyrocare, Mumbai
Metropolis Healthcare, Mumbai
Dr Lal PathLabs, Delhi
SRL Laboratories
iGenetics Testing 2013, Mumbai
Medall Healthcare, Chennai
Suraksha Diagnostics,
Panorama Group, Kolkata
Centre for Sight, Delhi
EYE Q, Rewari, Haryana
Dr Agarwal’s Eye Hospital, Chennai
Nova Medical Centres, Bengaluru
Sandor Nephroservices 2011, Hyderabad About 50 centres in smaller cities and towns in 12 states; dialysis centres within established hospitals. Operates and
manages in-hospital dialysis centres—Sparsh Nephrocare.
NephroPlus, Hyderabad
Portea Medical, 2012, Bengaluru
Radiant Life Care, Delhi
Practo Technologies, Bengaluru
Central Processing Laboratory in Navi Mumbai, Regional Processing Laboratories (RPLs) in Delhi, Bhopal, Kolkata,
Hyderabad, Coimbatore; network of 1,041 authorised service providers, for sample collection from 466 cities, under
franchise agreements. Molecular imaging centres through subsidiary, Nueclear Healthcare (NHL) in Mumbai, Delhi,
Hyderabad, proposed in Gurugram, Raipur, Kolkata and Coimbatore. Also in Bahrain, Nepal and Bangladesh.
Around 100+ labs and 800+ collection centres. Across almost all states except in the North-East; global labs in South
Asia, West Asia and Africa.
National Reference Laboratory in NCR. Nationwide network of 172 clinical laboratories, patient service centres; and
over 7,000 pick-up points, largely in North India; also in the business of hospital and clinical laboratory management
branches in Bangladesh, Nepal, Malaysia, Kuwait, Riyadh, Muscat and Qatar.
230 laboratories included self-operated, franchisee laboratories, laboratories located in own healthcare facilities,
laboratories located in other third-party hospitals, two international laboratories. SRL also had 1,000+ sample collection
centres, which included 37 collection centres at international locations. Across India and in Sri Lanka, Nepal, Maldives,
Malaysia, several Gulf and African countries.
Central processing laboratory in Mumbai with operations in cities, including Delhi, Hyderabad, Ahmedabad, Baroda,
Nagpur and Pune; looking to make acquisitions; molecular diagnostics services in oncology, gynaecology (infertility).
Pathology and Imaging Services 60 centres across southern states—Chennai, Bengaluru, Trichy, Tirunelveli, Pudukottai,
Rajapalayam and Virudhunagar. PPP with Tamil Nadu, Andhra, Karnataka governments.
25 centres across West Bengal, Bihar and Delhi NCR. Also polyclinics. Operates a centre in NRS Medical College and
Hospital in Kolkata on PPP basis.
Chain of eye centres, eye bank, etc; 51 facilities across Punjab, Delhi, Uttar Pradesh, Madhya Pradesh as acquired,
Rajasthan, Gujarat, Maharashtra, Telangana, Andhra Pradesh; acquired operations of local eye doctors in Meerut,
Vadodara, and Jaipur.
Forty-plus hospitals in Haryana, Uttar Pradesh, Uttarakhand and Gujarat, in smaller towns, such as Rewari, Gurgaon,
Rohtak, Sonipat, Yamunanagar, Hissar, Bhiwani, Meerut, Lucknow, Saharanpur, Muzaffarnagar, Kanpur, Jhansi, Surat,
Vadodara, Bharuch. Also in Nasik, Jalgaon, Pune and Aurangabad.
60 hospitals; also in Africa, Cambodia, Mauritius.
Two companies—Nova Specialty Surgery, which introduced short-stay surgery in the secondary care segment; and
Nova IVI Fertility (joint venture with IVI Spain). 11 Nova surgical centres Mumbai, Jaipur, Gwalior, Pune, and Kanpur.
Fertility centres in Ahmedabad, Chennai, Delhi, Hyderabad, Jalandhar, Kolkata, Mumbai, Pune, Surat and Bengaluru.
Nova Specialty Surgery acquired Excel Hospital, Kanpur.
Dialysis centres in partnership with hospitals such as Apollo and stand-alone.
Home-based services—provides doctors, nurses, physiotherapists for home visits—across 20 cities; Medwell
Ventures, India Home Health Care are some other home-based healthcare companies.
Operation and management (O&M) of old/existing hospitals which are under-performing due to lack of management
expertise—B L Kapur Hospital Delhi, Nanavati Hospital Mumbai; operations in Nepal.
Digital platform providing information on doctors, hospitals, pricing and services. Doctor search and appointment
booking for patients; Revenue sources: software sales to hospitals and clinics; hardware sale of tablets to doctors to
manage appointments, digitise patient records; sponsored listing service for hospitals and clinics.

2 NOVEMBER 11, 2017 vol liI no 45 EPW Economic & Political Weekly

Annexure 5: Foreign/Multinational Companies In Healthcare Sector, India
Company Name Company Profile
Columbia Asia Seattle-based individual and institutional investors
investing in healthcare business in Asia; managed by
Columbia Pacific Management, through wholly owned
subsidiary Columbia Asia, registered in Malaysia.1
IHH Healthcare In 10 countries under the brands of Mount Elizabeth,
Parkway Health, Parkway Pantai, Gleneagles brands.
Last two in India.
Sakra World Hospitals By Takshasila Hospitals Operating, a joint venture
between the medical arm of Secom, Toyota of Japan and
Kirloskar Group of India; now fully Japanese owned.
NMC Healthcare Dubai By Indian origin pharmacist; network of hospitals
in the UAE.
VPS Healthcare Abu Dhabi By NRI radiologist.
Zulekha Healthcare Holdings UAE By NRI doctor, has hospitals and clinics in UAE.
Da Vita India Subsidiary of DaVita Inc, US, leading dialysis provider;
investor Warren Buffett’s Berkshire Hathaway held
16.5% of Da Vita in 2013.3
Quest Diagnostics India Subsidiary of Quest Diagnostics Inc US. Also provides
services for clinical trials.
Healthcare UK A joint initiative of the UK Department of Health (DH), UK
Trade and Investment (UKTI) and NHS England in order to
win overseas contracts and to do more business overseas.4
Healthcare UK is supporting Indo UK Healthcare, a
consortium of UK and India-based businesses (of bank
and private equity funds) to develop a chain of 11 Indo–
UK Institutes of Health (IUIH) across India.
1 http://www.columbiaasia.com/about-us.
2 Reportedly, over 90% of the healthcare business is in secondary care. Secondary care hospitals are cheaper and faster to build and operate; not being in critical tertiary care means less
investment on high-end medical equipment and specialist doctors (Goyal 2010).
3 http://www.warrenbuffett.com/berkshire-picks-up-even-more-dva-stock/ retrieved 23 August 2016. Ownership of Berkshire Hathway was gradually being transferred by Warren
Buffett to Bill and Melinda Gates Foundation.
4 https://www.gov.uk/government/news/india-and-the-uk-establish-a-strategic-partnership-in-healthcare, http://www.iuih.co.uk/home/about-us/224-2/.
Economic & Political Weekly EPW NOVEMBER 11, 2017 vol liI no 45
SPECIAL ARTICLE
Geographical Spread
Focus is secondary care;2 “McDonald’s of the healthcare business”
(Goyal 2010). Greenfield hospitals in non-prime areas in Tier-II and
Tier III cities, such as in Kolkata, Ahmedabad, Bengaluru, Mysore,
Gurgaon, Ghaziabad, Patiala and Pune.
Apollo Gleneagles Hospital, Kolkata, a joint venture between
Parkway and Apollo, Continental Hospitals, Global Hospitals
in Hyderabad–Mumbai–Chennai–Bengaluru, Gleneagles
Khubchandani Mumbai, Apollo Gleneagles PET-CT Centre
Hyderabad.
Multi-specialty hospital in Bengaluru.
Acquired Sunshine Hospitals (in Hyderabad–Secundrabad
and Bhubaneshwar; four in Thiruvananthapuram, in Raipur,
Chhattisgarh. MoU with Andhra Pradesh, Karnataka governments to
set up hospitals.
Acquired Rockland Hospitals Delhi, Lakeshore Hospital, Kochi.
Greenfield hospital in Nagpur, Alexis Hospital.
Acquired Bengaluru-based NephroLife–15 centres across Bengaluru,
Tumkur, Hosur, Chennai, Hyderabad, Pondicherry, Delhi, Pune. In
2014 moved into primary care, by acquiring Pune-based primary
care chain Express Clinics, with 26 clinics in Pune, Delhi, Mumbai and
Bengaluru.
Main laboratory in Gurugram NCR; collection facilities across 25
cities (metros and Tier I); pathology lab in Lucknow in 2015.
In 2015 King’s College Hospital, England (through its commercial
arm KCH Management) along with Indo–UK Healthcare initiated a
King’s College Hospital in New Chandigarh, with £100 mn of private
investment.
3
SPECIAL ARTICLE
Annexure 6: Global and Domestic PE Firms in Healthcare Companies: India
Global Company invested in Domestic Company invested in

TPG Capital Inc US1
Abraaj Group Dubai—Abraaj Growth
Markets Health Fund is a PE fund dedicated
to investments in the healthcare sector in
various countries in Africa and South Asia.2
Has investments from IFC, CDC, OPIC of US.
Temasek Singapore—sovereign wealth
fund fully owned by the Singapore
government.3
Quadria Singapore.4
IHH Healthcare Bhd Malaysia/Singapore—
sovereign wealth fund of Malaysia—
Khazanah—is the largest shareholder in
IHH Berhad.5
Sequoia Capital—US reported to manage
nearly $4 bn across many funds, including
those from endowments of Stanford and
Harvard Universities.6
SONG Investment—by Soros Economic
Development Fund, Omidyar Network,
and Google.7
1 www.tpg.com, http://press.tpg.com/phoenix.zhtml?c=254315&p=irol-newsArticle_pf&ID=2146604.
2 http://www.abraaj.com/portfolio/category/asia-portfolio/healthcare#sthash.tvGMy89M.dpuf.
3 www.temasekholdings.com.sg.
4 http://www.quadriacapital.com/about-us/#our-investors.
5 http://www.ihhhealthcare.com/index.php.
6 https://www.sequoiacap.com/india/companies/.
7 https://www.omidyar.com/investees/song-investment-company.
Rhea Healthcare, Bengaluru; Cancer I-Ven of ICICI Bank
Treatment Services, Hyderabad; Surya (exited from several)
Mother and Child Care, Mumbai; Manipal
Health Enterprises, Sutures India (Guptu
2016, Batra 2015).
Rainbow Hospitals, Andhra Pradesh; Sabre Partners
(with CDC UK), Apollo Bhilai Scan and
Research Group, Quality CARE Hospitals,
Hyderabad.
Healthcare Global Enterprises (HCG), Asian Healthcare
Bengaluru; Global Health (Medanta Fund
Medicity Gurugram, Haryana);
Nationwide Primary Healthcare Services,
Bengaluru.
Medica Synergie, Kolkata; Asian Institute Manipal Education
of Gastroenterology, HCG and Krishna and Medical Group
Institute of Medical Sciences (exited). (MEMG) and CDC UK
Economic Times (2015b).
Global Hospitals and Continental TATA Capital
Hospital, Hyderabad; Vikram Hospitals, Healthcare Fund
Bengaluru; Apollo Health Enterprises
(minority stake). As of March 2017 had 10
operating hospitals in India.
Cloudnine Hospitals, Bengaluru;
Moolchand Healthcare, Delhi; Glocal
Healthcare, Kolkata; ASG Eye, Rajasthan,
Suburban Diagnostics, Mumbai; Vasan
Healthcare, Tamil Nadu; MedGenome
Diagnostics.
EYE Q, Delhi; Be Well Hospitals, Chennai.
Sahyadri Hospitals Pune, Vikram Hospitals
Karnataka, Medica Synergie Kolkata, RG Stone Delhi,
Krishna Institute of Medical Sciences Hyderabad,
Metropolis (pathology labs) Mumbai.
SRL Diagnostics Delhi, Oyster and Pearl Hospitals,
Pune, Healthcare Global Enterprises (HCG), SRL
Diagnostics, Invictus Oncology, Delhi.
Delhi-based private healthcare equity fund founded
in 2010 by owners of Dabur India, and invests in the
healthcare and life sciences sector in India. It has
invested in Wellspring Healthcare, a Mumbai-based
primary healthcare chain.
In early 2017 they have together set up a healthcare
fund of `500 crore to invest in “out-of-hospital” care
companies, like diagnostics and home-care services
in India, Africa and South Asia.
In Sandor Nephro Services, a dialysis provider, and
Lokmanya Hospitals, a tertiary care chain around
Pune providing orthopaedic surgeries.

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