Fortis Flt. Lt. Rajan Dhall Hospital
Sector B, Pocket 1
Aruna Asaf Ali Marg
Vasant Kunj
New Delhi- 110 070
Tel : 91-11-4277 6222
Fax : 4277 6221 Emergency No:
1800-11-7000 (Toll free)
011-26927000(Landline)
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“The equipment should be easy to set up, easy to use, and have an excellent battery life”
Dr. Amit Varma, Chief Operating Officer and Director — Critical Care Medicine, Fortis Healthcare
Dr. Amit Varma is the Chief Operating Officer and Director— CrUical Care Medicine, Forlis Hcalthcare. Dr. Varma pursued Critical Care Fellowship at the University of Pittsburgh Medical Center, while he obtained the experience in cardiac care at the Cleveland Clinic, On returning to India after almost a decade in the US, Dr. Varma joined the Man ipczl Heart Foundation in Ban galore and subsequently moved on to the Narayan Hrudayalaya as the Consultant in-Charge in critical care. In 2003, he moved to Fortis Healthcore, where he has been performing multiple administrative and clinical roles. Currently, he runs the integrated critical care services for Fortis Healthcare IC U network. Dr. Varma continues to be visiting faculty at the University of Pittsburgh and the Cleveland Clinic. He works as a healthcare consultant to the World Bank and the European Commission with special interest in quality. Currently, he is on the editorial board of the Society for Research and a member of the Society for Critical Care Medicine and the Asian Pediatrics Cardiac Surgery and Cardiology. He is also a consultant on CNN-IBN, and runs a weekly show with them.
What are your views on the medical ventilators market in India?
In India the incidences of acute and chronic diseases are currently on a high, which has resulted in an increase in the number of critical care patients in the hospitals. In the future, almost 30-40 percent of all hospital beds in the country will graduate toward ICU care beds. The ventilator is an integral component of an ICU. With time, we will also be able to bridge the gap between Indian and global medicine scenario. As a result the ventilators market will experience a rise.
The market has taken time to evolve. Traditionally, ICUs were treated as step children in most the hospitals. Hospitals avoided investing in ICUs because it was expensive to establish them, and even more expensive to run them. But, as I mentioned ear- her the scenario is changing, a lot of investments are being made in this area.
What are the various segments and main types of ventilators that are currently available in the market? What are the promising new technologies and products?
The segmentation may depend upon the place where the hospital is situated—a metro, a tier II city, or a district. In my opinion, the market should be broken down into three distinctive segments:
The district level that requires a base ventilator in order to provide the basic functions, which would at least keep the patient alive!
The tier II cities, which are now quickly catching up with the metros. These would require certain modalities which include assist control and other forms.
Patients who are extremely sick and require different modes with varied functions.
However, the market can also be segmented on the basis of the type of ventilator, for example, adult/pediatric ventilators, neonatal ventilators, non-invasive ventilators, potable ventilators, transport ventilators, etc. Generally, most places use non- invasive ventilators. Hence, most ventilators come equipped with NIV or non-invasive mode these days. Base adult ventilators may be classified as the most popular segment in this category, though BiPAP and NIV are also beginning to catch up. In terms of technology, there is no technology that is not available in India these days. However, some technologies like lung ventilation technique and assist ventilator devices are still not being explored completely.
Which companies are the main suppliers of equipment in this segment? Our group of hospitals, mainly purchases ventilators from Maquet, Draeger, and GE Datex Ohmeda because they are good suppliers and have an excellent installation base in India. Also, they offer very good post sale servicing.
Hamilton makes good ventilators but probably because of the pricing issue it has not been able to aggressively market them in India, though this seems to be changing.
What are the main desired features and specifications in ventilators? Is there any equipment that may be considered as Gold Standard in this segment?
The equipment should be easy to set up, easy to use, and have an excellent battery life especially in Indian context. At this point of time, I don’t think any equipment can be considered a Gold Standard, as constant evolution is going on in this market. What is Gold Standard today becomes obsolete within a year.
However, assist control and the open lung ventilation platform is one of those equipment which should be’ in demand over the next two years.
What would be your suggestion to a buyer of ventilators?
The buyer must take care of factors like price of the equipment, after sales service provided by the manufacturer, ease of handling and training, and education and training back-up provided by the company.
We are the second largest private healthcare company in the country. Today, we have 14 hospitals within our network. We are increasingly standardizing the kind of equipment that we buy. We are getting into long-term rate contracts. Using this every time, we buy a specific type of equipment. The reason for doing this, apart from the obvious pricing benefit we get, is that we can standardize the care, the trainee, and more importantly, we can transport ventilators from one place to the other.
What should be an ideal mix of ventilators in a standard ICU setting?
If I were to set up an ICU, my ideal mix for ventilators would be: 60 percent for what I term as base ventilators, another 20 percent for intermediate to high range ventilators (provide different modes of ventilation), and the balance 20 percent for upper most high-end ventilators (ventilate almost any disease condition).
“The buyer must lake care of factors like price of the equipment, after sales service provided by the manufacturer, ease of handling and training, and education and training bac4-up provided by the company.
What are the challenges and opportunities in the ventilation equipment segment in India? And what are the main limitations that equipment manufacturers need to overcome?
Looking at the seller’s perspective, there are a couple of challenges faced by them. Most ventilators are manufactured keeping in mind the western audience, which makes segmentation difficult. Some Indian companies are working toward bridging the gap in order to make basic technology available. The vendor must also check overselling of product by promising the moon and not being able to deliver it. I also suspect that the manufacturers are facing an acute shortage of technical trained manpower. Lastly, they need to keep pace with any technology breakthrough taking place across the globe.
Please comment on after- sales services being offered by equipment manufacturers and vendors in India.
Generally, manufactures tend to ignore the fact that after-sales service is an essential element providing customer satisfaction. One generally looks at two or three things. Firstly, the part replacement process must be quick. Secondly, there is a need for a continuous education process. After every quarter, an expert from the company should retrain the users about the system specifications. Thirdly and most importantly, the customers should be updated about the newer modes and technologies arriving in the company, on a regular basis.
What are the factors that drive the ventilators market in India? How do you perceive the future of this market segment?
Pricing has been a driving factor because high-end equipment are highly priced. Most buyers are very particular about the costs. People have also started appreciating the need for different modes. I personally look at 2-3 aspects, the major being price. One would not want to saddle himself with a Rolls Royce if he doesn’t know what to do with it. I also consider factors like the ease of equipment handling and training provided to the users. After-sales services is another crucial factor. Lastly, I look at the back-up provided by the company to education and training.
What are the regulatory issues pertaining to this market?
Currently, no restrictions are being placed by the government. A major problem faced by us is paucity of medical gas suppliers. Also, I have noticed that some smaller hospitals offer inferior quality oxygen and compressed air. As I know of certain infections that are taking place in ICUs because of lack of adequate repair and maintenance, it becomes mandatory for the government to lay down certain guidelines in order to keep a check on such situations.
Anything else you would like to tell us?
Education and training are of paramount importance. Because of rapid technological advances buyers are not able to take correct decisions while buying equipment. Also acquiring adequate training on all latest technologies becomes difficult.
My suggestion to the equipment manufacturers would be to create technology centers with industry back-up and support. This should be done on a global basis in order to train maximum number of people.
“Looking at the seller’s perspective, there are a couple of challenges faced by them. Most ventilators are manufactured keeping in mind the western audience, which makes segmentation difficult. Some Indian companies are working toward bridging the gap in order to make basic technology available.”
