In a country like India, where affordable, universal healthcare run by government agencies remains a work in progress, most people rely on private healthcare facilities. In fact, more than 70% of the country’s hospitals are privately owned and nearly 85% are in the unorganised sector.
As patients prefer visiting corporate chains or quality healthcare providers in metros during health crises, large payers are steadily increasing their market share. Consequently, small and midsized hospitals in non-metro locations are grappling with a decline in patient footfall. On the other hand, those who cannot afford expensive private care are left to bear the brunt of healthcare disparities. For context, a report by the National Insurance Academy suggested that about 30% of India’s population (around 40 Cr individuals) lack health insurance.
No doubt there are national and state-level health protection schemes for low-income families for secondary and tertiary care. But even a pan-India health assurance project like Ayushman Bharat with its HWCs (health and wellness centres) and flagship PM-JAY scheme (Pradhan Mantri Jan Arogya Yojana enables an annual spend of INR 5 Lakh per family) covered a little over 50% of its target beneficiaries as of December 2023.
However, a silver lining is there in the form of asset-light models. A new crop of healthtech startups such as Pristyn Care have come up to address structural and resource shortages. These innovative digital platforms connect patients with all available medical facilities in their own cities and nearby areas/regions to ensure maximum cost-effectiveness for patients and optimum occupancy rates at existing units.
It is a win-win for all. People do not have to travel far for treatment at corporate hospitals at six to eight times the usual cost. Also, smaller medical units can earn bigger revenues due to a significant rise in patient footfall. Besides, the latter can keep their capex under control and still improve care quality by sharing high-end portable devices used by many speciality hospitals. Additionally, there will be headroom to operationalise beds at existing facilities and introduce more paramedics and other trained healthcare professionals to the ecosystem.
“I have always been vocal about the underutilisation of small and midsized hospitals and nursing homes,” said Dr Vaibhav Kapoor, cofounder of the unicorn healthtech startup Pristyn Care.
“Covid-19 was a real eye-opener, underscoring what happens when we lack an agile healthcare infrastructure. The shortcomings became evident when every large hospital was full. However, in normal times, most small/midsized hospitals struggle daily due to low patient volume.”
Set up in 2018 by Dr Kapoor, Dr Garima Sawhney and Harsimarbir Singh, Pristyn Care had the foresight to recognise that improving capacity utilisation across could be a game-changer in terms of earnings and patient care.
The elective surgery marketplace (non-emergency medical procedures planned ahead) provides patient care through a network of 350 hospitals and 100+ clinics. It is present in more than 30 cities including Delhi NCR, Mumbai, Bengaluru, Kochi, Chandigarh and Ludhiana and ensures resource optimisation, resulting in affordable patient care.
In a one-on-one interaction with Inc42, Kapoor explained how the startup is expanding its presence beyond metros to empower small and midsized hospitals by increasing patient footfall and revenue. Here are the edited excerpts:
Inc42: What are the major challenges small hospitals, nursing homes and clinics in Tier II and III cities face nowadays?
Dr Vaibhav Kapoor: For context, it is worth noting that many doctors want to set up their medical practices after cornering professional success. So, it is common for groups of doctors to come together and run hospitals with 50-100 beds, which are much smaller than the large, branded hospital chains.
Now, these small, independent hospitals face numerous challenges. For instance, their capacity for high-end/advanced equipment is limited due to the costs involved, often ranging from lakhs to crores.
Another critical issue is adherence to protocols. Small and midsized hospitals often require a set curriculum to ensure that nurses are well-versed in duties for specific wards, operating theatres and patient admission procedures. In the absence of this procedure, there may be a lack of standardisation in implementing these protocols.
Finally, and this is particularly relevant for Tier II and III cities, these hospitals struggle to attract super-specialist doctors due to the limited availability of high-quality equipment. This, in turn, creates a lack of trust among patients and they hesitate to visit small hospitals.
Inc42: How can small healthcare facilities in Tier II and III cities best address low patient footfall and occupancy rates?
Dr Vaibhav Kapoor: We have many doctors working with us, and we can request that they visit small hospitals and nursing homes to provide surgical care. When patients see a doctor who regularly operates at a large corporate hospital and acts as a visiting consultant at a small facility, their confidence is boosted.
We also understand the challenges these hospitals face when investing in high-end equipment. Pristyn Care addresses this by purchasing the equipment. For instance, kidney stone removal can be done using traditional open surgery or a Laser procedure [Holmium laser]. However, the machine costs around INR 25 to 30 Lakhs. Similarly, Laser treatment for proctology is expensive, amounting to INR 1 to 1.5 Lakhs.
Fortunately, these machines are portable and can be shared between hospitals on demand. By operating in multiple hospitals in a region, we can optimise the use of these advanced instruments. Access to them further builds patient trust in small hospitals.
Inc42: India’s Tier II and III cities also face a shortage of trained healthcare professionals. How does Pristyn Care deal with it through its training programmes? Has that initiative improved care quality?
Dr Vaibhav Kapoor: Pristyn Care’s quality control (QC) team is based in Gurugram and travels to our 350 partner hospitals and 100+ clinics across India to train healthcare professionals, including nurses and paramedics. These programmes focus on standardising protocols to ensure optimal patient care.
For example, the QC team updates staff on areas like OT equipment sterilisation and patient safety measures, such as fall prevention and allergy management protocols. We have trained more than 9K staff members across our partner facilities. Our training programmes include on-site sessions and virtual sessions for constant reference by hospital staff.
Essentially, we help hospitals in Tier II and III regions gain patient trust by standardising processes and providing staff training.
Inc42: How does your technology infrastructure ensure scalability and patient privacy as you expand your reach?
Dr Vaibhav Kapoor: Well, patient safety is paramount. During my decade-long career as a surgeon, I have seen numerous medical errors stemming from patients and pharmacists misinterpreting doctors’ handwriting, leading to wrong medications.
We have proactively addressed this by introducing electronic medical records (EMRs) with the help of an AI-ML platform. EMR helps surgeons access patient data, review medical history and monitor how their patients are doing on all critical parameters. Within our distributed network across 30+ cities, this centralised system has significantly reduced patient-related errors. Typed prescriptions also mitigate misinterpretation risks.
We have also partnered with many insurance companies to offer medical insurance through our platform. Additionally, we have developed three apps to enable a seamless flow of information. These include a hospital app, a patient app and an insurance app. They ensure patient privacy and eliminate the need for information sharing via WhatsApp or over the phone. This streamlined process further enables speedy patient admission.
Inc42: With major healthcare chains foraying into Tier II and III cities, will small hospitals face unique challenges? How can they navigate those?
Dr Vaibhav Kapoor: Large healthcare chains may not pose a big threat to small players because the former typically focusses on tertiary and quaternary care [advanced levels of specialised care]. The capex associated with advanced equipment for such procedures is very high, and hospitals can only profit from complex surgeries like liver/kidney transplants and cardiac or brain surgery.
In contrast, small hospitals can excel in secondary care surgeries, which are typically two- to three-day procedures and require specific expertise. This focus on specialisation is precisely our strategy. For instance, patients may prefer a small maternity clinic to a large hospital where gynaecology is just one speciality.
Therefore, we envision our partner hospitals to become centres of excellence for secondary care surgeries, carving a valuable niche in the healthcare landscape.
Inc42: Can you elaborate on how Pristyn Care’s support system goes beyond patient footfall and delve deeper into how it empowers doctors to tackle day-to-day operational challenges.
Dr Vaibhav Kapoor: I became a doctor because I felt committed to this profession. But the healthcare landscape has changed since then. Surgical expertise is just one aspect. Doctors now face many challenges, including setting up clinics, managing operations, building a digital presence and dealing with medico-legal risks.
Doctors gain confidence when they work with Pristyn Care, knowing that we handle patient footfall and ground operations. This comprehensive support system is valuable and has attracted nearly 600 doctors to our network – all through word of mouth, with minimal marketing expenditure on our part.
Inc42: Secondary-level critical care may involve longer hospital stays than elective surgeries. Do you think an asset-light model like Pristyn Care is fully equipped to cover those complex medical procedures?
Dr Vaibhav Kapoor: Absolutely! We started with elective surgeries, but now we are doing knee replacements and vascular surgeries – both classified as tertiary care. Our asset-light model can be applied across diverse medical needs if we can effectively deal with low patient footfall.
Pristyn Care plays a critical role in generating revenue for its partner hospitals. For instance, we generate 60-70% of the income for around 30% of the hospitals. Overall, we help drive around 50% of the revenue for most midsized hospitals in our network. It enables them to make the most of their existing resources without hiring additional staff.
