Healthcare- Hospitals

Industry Size-Billions- but largely untapped

Industry Size-Billions- but largely untapped
The industry is expected to deliver a growth of 12% and reach 6.8 trillion by 2019-20 primarily
driven by:

Age demographics

Rising Income

Improvement of health awareness

Increase in life styled-related ailments

Rising penetration of health Insurance

Increase in Medical tourism

PRIMARY GROWTH DRIVERS-
STATISTICS
Trend in Life expectancy (at birth) & Infant mortality rate: India vs. others

LEB - Life expectancy at birth (years) ; IFR - Infant mortality rate (probability of dying by age 1 per
1000 live births)
POPULATION
Break-up of population by age (per cent)
RISING INCOME LEVELS
Rising Urban Population as a % of total population
Life style diseases on the rise
Lifestyle-related illnesses or non-communicable diseases (NCDs) have been increasing rapidly in
India over the last few years. Statistics show that these illnesses accounted for nearly 56% of all
deaths in India in 2008. CRISIL Research believes that these illnesses exhibit a tendency to increase
in tandem with rising income levels.
Low penetration of health care coverage
2011-12 and 2013-14, the total number of commercial health insurance policies in India increased at a CAGR of nearly 10%
while the premiums increased at nearly 16%.
~37.2 million households (nearly 110 million beneficiaries) have been brought under RSBY (as of April 2014)
19.5 million family units (nearly 75.8 million beneficiaries) have been brought under ESIS (as of March 2014
Health Insurance coverage expansion
Medical Tourism growth
Medical tourism break-up

INDIA HAS LOST A KEY MARKET OF THE MIDDLE EAST IN RECENT YEARS FROM 2014 ONWARDS AFTER DUBAI
HEALTH CARE CITY HAD STARTED OPERATIONS INDIA LOST A LOT OF ASIAN ELITE MEDICAL TOURISTS
Key areas of opportunity
Shortfalls in the Healthcare system
As per WHO data, India has 7 hospital beds per 10,000 population
thereby translating to an overall capacity of 0.9 million beds. This
figure, however, lags the global median of 27 beds per 10,000
population by almost 2.5 million beds.
In other words, India needs to nearly quadruple its bed capacity to
reach the global median.
With the population growing at almost 1% annually, India is expected
to have more than 1.34 billion people by 2020 (from 1.21 billion in
2011 and an estimated 1.26 billion in 2014),
Diversification in delivery formats- to increase reach and
efficiency
Single specialty healthcare units
Specialised care formats- lacking in India
Day care Centres

End-of-life care centres (HOSPICE)

Home healthcare
Other areas of opportunity
ERH :
Electronic heath records (EHR) are designed to manage detailed medical profile and history of
patients such as medication and allergies, immunization status, laboratory test results, radiology
images, Information stored in EHR can be in a combination of various formats including picture,
voice, images, graphs and videos.
Radiology information system (RIS)
RIS tool allows managing digital copies of medical imagery such as X-Ray, MRI, Ultra Sound etc. and
the associated data on a network. RIS is used by doctors to access medical imagery data from
multiple locations. RIS system is connected to medical equipment such as X-Ray machine, MRI
machine, Ultrasound machines which generate diagnosis results in the form of images and graphs
Other areas of opportunity
A clinical decision support system:
(CDSS) is software designed to assist doctors in taking decisions pertaining to the diagnosis
and treatment of patients. A CDSS is supported by a large database which has detailed
information on ailments with data aspects ranging from symptoms to the diagnosis. The
database is supported by a set of rules which help to generate accurate results for the
query made by the user.
Mobile based solutions:
Healthcare delivery is also seeing an influx of mobile-based applications (mobile apps)
which assist both doctors as well as patients. These apps typically provide features such as
self-diagnosis, drug references, hospital/doctor search and appointment assistance,
electronic prescriptions etc. While certain apps allow doctors to obtain information on
drugs, dosage, contradictions, disease and condition references and procedures, there are
others which allow patients to locate doctors and fix appointments and also to view video
consultations. There also are apps that help patients save their medical records and to
keep them updated regularly.
Other areas of opportunity
Telemedicine:
Telemedicine is a technology designed to increase the accessibility of healthcare
services from remote locations. Telemedicine makes extensive use of information
technology to create a connection between doctors at the main hospital and
patient at the remote centre or the telemedicine centre. The doctor analyses the
patient through telephonic conversation or video conferencing.
Robotic surgery:
(RAS) or robotic surgery is surgery conducted using a robotic arm. This arm is
controlled electronically using a control pad which may be located at local or
remote location and is also equipped with high definition cameras allow surgeons
to take a closer look of the areas being operated. Since robot assisted surgeries can
be performed from remote locations, it allows patients to avail treatment from the
desired specialist surgeons across the world without having to travel.
Revenue and Profitability

The primary Measure of Profitability in the hospital industry is Average Revenue Per Occupied Bed (ARPOB)
and Average Length of stay (ALOS)

During 2014-15 aggregate revenues of the key listed players grew nearly 16% y-o-y primarily lead by Apollo
Hospitals . The Industry expects revenue growth to pick-up marginally in 2015-16 driven by CAPACITY
ADDITION.

Apollo hospitals alone is expected to add approximately 1300 beds over the next 2-3 years
Revenue stability is expected to be achieved for newly opened
hospitals over a period of 2-3 years.
The Average margin achievable by the industry is expected to be
around 15%
HIGH GEARING HAS PLAGUED THE INDUSTRY- THIS IS PROBABLY THE FIRST INDUSTRY TO ENTER THE JUNK
BOND ARENA
HOSPITALS CHAINS KEY CHALLENGES
Aggressive, debt-funded expansion:
The debt-funded expansion strategy of these entities has dragged down their financial performance. Most of the
expansion is through greenfield projects (which typically take more time for completion and to break-even
compared with brownfield projects) and exposes them to liquidity pressures and to the risk of defaulting on their
debt servicing obligations should the projects fail to meet the scheduled commissioning timelines.

Issues concerning receivables management:

Many of these hospitals are empanelled for providing healthcare services under the government insurance
schemes and often face delays in receiving payments, thereby straining their cash flows.

Competition from national-level hospital chains:

Smaller hospitals also face tough competition from the national-level hospital chains setting up operations in their
geographies. These larger players attract patient inflows due to their established brand names and proven track
record in providing healthcare delivery.
Bed Density
Key Take aways
Healthcare delivery market to grow at 12% over next five years:

Based on India's healthcare indicators released by the World Health Organisation (WHO), CRISIL Research estimates the size of the
Indian healthcare delivery industry at Rs 3.8 trillion in 2014-15. With increasing healthcare coverage in India, the industry is
expected to grow at 12% CAGR to reach Rs 6.8 trillion in 2019-20. As private investments have been skewed towards in-patient
department (IPD) treatments, the share of IPD treatments in the overall healthcare delivery market is expected to increase
marginally to 83% in 2019-20 from 81% in 2014-15. Changing demographics, increasing income levels, greater health awareness
and expanding health insurance coverage will drive growth in demand for healthcare delivery services.

Capacity expansions by large, listed players to hurt operating margin in short term:

While key listed players' aggregate revenue has continued to grow at more than 15% y-o-y, higher overheads for new hospitals have
been pulling down players' operating margins since 2009-10. CRISIL Research believes that it takes nearly 18-24 months for a newly
opened hospital to stabilise operationally (this period can be higher for standalone hospitals vis--vis chains due to difference in
operational efficiencies). While aggregate revenues of these listed players rose by 16% in 2014-15, operating margins declined by
120 bps on a y-o-y basis. We foresee bed additions pushing up revenue growth marginally to 17% in 2015-16.
Standalone / small-scale hospitals in ill-health

Standalone / small-scale players are not currently in the pink of health.

A closer look at these entities reveals weak debt protection metrics because of liquidity pressure arising from high gearing. These
entities typically have high gearing in the range of two times and above, compared with sub-one gearing for established players
such as Apollo Hospitals (AHEL) and Fortis Hospitals Ltd (FHSL). We believe the aggressive, debt-funded expansion plans of these
entities, delays in receiving payments and tough competition from national-level players are the main deterrents for the industry.
Industry Characteristics
Medical - Spends
According to the World Health Organisation (WHO) report titled: 'World Health Statistics 2015', India's
healthcare industry constituted just 3.8 per cent of the country's gross domestic product (GDP) in
2012. The country's per capita healthcare expenditure stood at $196 (on a purchasing power parity
basis), a little over one-fourth of the global median of $651.
Healthcare expenditure as a percentage of GDP

Source: WHO World Health Statistics report 2015

WHO World Health Statistics report 2015
Classification of Hospitals
Primary care/dispensaries/clinics
Primary care facilities are mainly outpatient units that offer basic, point-of-contact medical and preventive healthcare
services. These units do not have any intensive care units (ICUs) or operation theaters. These act as primary point of
contact in the healthcare system where patients come for routine health screenings and vaccinations. Primary care
centers also act as feeders for secondary care/ tertiary hospitals, where patients are referred to for treating chronic
ailments.
Secondary care
Secondary care facilities diagnose and treat ailments that cannot be treated in primary care facilities. These act as
second point of contact in the healthcare system. There are two types of secondary care hospitals - general and
specialty care. General secondary care hospitals

A general secondary care hospital is the first hospital a patient approaches for common ailments. It typically attracts
patients staying within a radius of 30 km. The essential medical specialties in general secondary care hospitals
include internal medicine, general surgery, obstetrics and gynecology, pediatrics, ENT, orthopedics and
ophthalmology. Such a hospital will have one central laboratory, a radiology laboratory and an emergency care
department. Generally, secondary care hospitals have 50-100 in-patient beds, a tenth of which are in the ICU. The
remaining beds are equally distributed between the general ward, semi-private rooms and single rooms
Specialty secondary care hospitals
These hospitals are typically located in district centres, treating patients living within a radius of 100-150 km.
These hospitals usually have an in-patient bed strength of 100-300, 15 per cent of which are reserved for
critical care units. The balance is typically skewed towards private beds rather than general ward beds. Apart
from the medical facilities offered by a general secondary care hospital, specialty secondary care hospitals
treat ailments related to gastroenterology, cardiology, neurology, dermatology, urology, dentistry and
oncology.

Single-specialty tertiary care hospitals

Tertiary care hospitals provide advanced diagnostic services and treatments. A single-specialty tertiary care
hospital mainly caters a particular ailment (such as cardiac ailments, cancers, etc). Prominent facilities in India
include the Escorts Heart Institute & Research Centre (New Delhi), Tata Memorial Cancer Hospital (Mumbai),
HCG Oncology (Bengaluru), Sankara Nethralaya (Chennai), National Institute of Mental Health & Neuro
Sciences (NIMHANS, Bengaluru), and Hospital for Orthopaedics, Sports Medicine, Arthritis and Trauma
(HOSMAT, Bengaluru).
Multi-specialty tertiary care hospitals:

Multi-specialty tertiary care hospitals offer all medical specialties under one roof and treat complex cases such as multi-
organ failure, high-risk and trauma cases. Most of these hospitals derive a majority of their revenues through referrals.
Typically, such hospitals are located in state capitals or metropolitan cities and attract patients staying within a 500 km
radius. The hospitals have a minimum of 300 in-patient beds, which can go up to 1,500 beds. About one-fourth of the total
beds are reserved for patients in need for critical care. Prominent examples of such hospitals include Lilavati Hospital and
Hiranandani Hospital in Mumbai, and NIMS in Hyderabad.
Quaternary care
Quaternary care facilities are similar to tertiary care facilities and focus on super-specialty surgical procedures (cardiac,
neurological and jointreplacements). These facilities also have in-house research departments, unlike tertiary care
hospitals.
Classification by complexity of the ailment
Classification based on ownership

Hospitals can also be classified based on ownership patterns:

Government-owned and managed: Brihanmumbai Municipal Corporation hospitals, KEM Hospital and the Cooper
Hospital (Mumbai), etc.

Privately-owned and managed: Asian Heart Institute, Apollo Hospitals, Fortis, etc

Trust-owned and managed: Lilavati, Hinduja, etc

Trust-owned but managed by a private party: Apollo Hospitals in Ahmedabad is owned by a trust but managed by
the Apollo Group, etc.

Owned by a private player and managed by another private player: East Coast Hospital, Puducherry is managed by
Fortis Healthcare, etc.
Variety of Business Models
Lease contracts:
In the hospitals sector, the ownership model has become a costly affair
because of the sharp increase in land prices, especially in metros and tier-I
cities, over the past few years. This has compelled private players to look for
other models such as lease contract. In a lease contract, the land owner
develops the hospital building as per specifications given by the private
player, and then the private player enters into a long-term lease agreement
with the land owner.
Expanding in tier-II and III cities through primary and secondary hospitals
Private players are now foraying into tier-II and III cities as income levels in
these cities are fast catching up with metros and tier-I cities. This will
increase the demand for quality healthcare services. Apollo Hospitals is
looking at expanding into tier-II cities such as Nellore through its 'REACH'
initiative as well as open a super speciality hospital in Vizag and Patna. Fortis
Healthcare is also expanding into Ludhiana.
Operation and maintenance contract:
Under an operation and maintenance (O&M) contract model, a large private player (or a hospital
chain) undertakes a contract for managing a standalone hospital and overseeing functions like
marketing, operations, finance and administration. In return, the private player receives a fixed
annual management fee and a share in revenues or profits from the standalone hospital's owners.
Apollo and Fortis have entered into such contracts to expand their base in India. For e.g., Fortis has
entered into an O&M contract with Cauvery Hospital in Mysore. Apollo has 14 hospitals under the
O&M model mostly across the northern states.
Medicities:
Medicities are an integrated township of super-specialty hospitals, diagnostic centers, medical
colleges, R&D, ancillary and subservient facilities. The concept of medicity is based on models
already operating in countries such as Scotland, the US, France, Algeria, etc. Prominent medicities in
India are Medanta, Narayana Hrudayalaya and Chettinad Health City, which are located in Gurgaon,
Bengaluru and Chennai, respectively. However, the success of a medicity would depend on its
location and the ability attract more in-patients. Due to large land requirements, health cities are
often situated in the outskirts of a city, and hence attracting patients could be a challeng
Franchise arrangements
In this model, the franchisees obtain the premises (owned or leased)
and bring in the capital (both fixed and working) while the franchisor
lends the brand name to the healthcare facility for a fee. The franchisor
has to ensure that the service quality is maintained across all
healthcare centres that use its brand name. The franchisor may also
help the franchisee in training and recruiting staff, procuring
equipment, designing the facility, etc. In India, a prominent example is
Apollo Hospitals which franchises its primary clinics
Revenue Cost Structure
Surgeries and diagnostics fetch bulk of revenues for hospitals
Surgeries and diagnostics account for the bulk of revenues for most hospitals. The share of these verticals in total
revenues differs across hospitals, depending on pricing strategies and the emphasis on different specialties. In
certain hospitals, facilities like diagnostic centres and pharmacies are outsourced.

Other monitorables that may boost revenues include:

Occupancy levels: Given the high fixed costs (equipment, beds and other infrastructure), occupancy levels need to
be commensurate for a hospital to break-even. Most large hospitals operate at over 65-70 per cent occupancy
levels.

The following factors can ensure high occupancy levels:

Good brand recognition
Reputed doctors
A strong referral network

Average length of stay: Large hospitals usually operate at high occupancy levels, but try to keep the average length
of stay (ALOS) short. This enables them to record higher utilisation levels and ensure that more patients are
treated at the same time.
A third of outpatients get turned into in-patients
As per industry interactions, the OPD contributes
almost one-third of in-patient volumes in most
hospitals. This phenomenon is especially evident
during the initial years of operations of a hospital.
The OPD also acts as a feeder for a hospital's
diagnostic/pathology centres within the hospital
premises
Cost structure
COST STRUCTURE
Capital costs
The capital cost to build a hospital ranges from Rs. 5-15 million per bed; while costs would hover
around the lower end of this range for secondarycare hospitals, high technology and equipment
costs keep total capital costs for super-specialty tertiary care hospitals at the higher end. Use of
imported equipment can further drive up equipment costs. The two key capital cost components
are land and building development costs and equipment costs.
Land and building costs: These costs usually form 30-40 per cent of total project costs, as land cost
varies with location. In some cases, land is offered at a concessional rate by the government.
However, after obtaining land at cheaper rates hospitals have to treat a particular percentage of
patients free of charge and a particular percentage of patients at a subsidised rate every year.
Equipment costs: Equipment costs comprise 25-30 per cent of total project costs, depending on the
sophistication of the equipment purchased. MRI, linear accelerators and CT scan machines are some
of the expensive equipment, costing Rs. 50-100 million. As these equipment rapidly become
obsolete, hospitals need to set aside resources periodically for technology upgradation. Moreover,
the maintenance cost for high-end equipment is typically around 5 per cent of capital costs. In the
case of tertiary care hospitals, most high-end diagnostic and surgical equipment is imported.
Equipment costs vary across hospitals, depending on the type of ailment the hospital specialises in.
COST STRUCTURE
Operating costs
Hospitals must manage operating costs effectively to be able to service their debt
obligations and remain profitable:
Raw material costs/ consumables: Typically, raw material costs (including drugs,
medical consumables, diagnostic consumables and other items such as linen, etc.)
account for 40-50 per cent of sales. These costs can be managed through effective
inventory management and effective sourcing of lower-cost raw material.
Wages and salaries: These form 15-20 per cent of revenues. While salaries are fixed
costs, consultants' fees can be linked to making it a variable expense. The bed-to-
staff ratio also varies from 1:3 to 1:5, with multi-specialty and super-specialty
hospitals having a higher ratio. The employee cost for a hospital is also dependent
on its doctor-engagement model.
Operational overheads: Overheads account for 5-7 per cent of sales, the highest
component being power and fuel (energy) consumption
Doctor engagement model
Hospitals generally operate on two models:
Model I - Under this model, hospitals have 100 per cent doctors on its pay
roles (Resident doctors).
Model II - Hospitals generally follow a mix of resident and visiting/consulting
doctors. Under Model 2 the consulting or visiting doctors share the revenue
earned by the hospital.
Large hospitals in the country typically follow Model II. The visiting
doctor/consultant typically shares a percentage of his consulting fee and the
IPD income (for surgeries done on the hospital premises) with the hospital.
Even the mid-sized hospitals in the India (100-400 beds) have visiting doctors
and consultants. There are alternative ways of referral too, where doctors
refer patients to specific doctors and demand compensation for the same.
REGULATORY FRAMEWORK
In India, hospitals are accredited by National Accreditation Board for Hospitals and Healthcare
Providers (NABH). The NABH is a constituent board of Quality Control of India and a member of
International Society for Quality in Health Care (ISQua). NABH accreditation is compulsory for
hospitals to get empanelled under the Central Government Health Scheme (CGHS). This scheme
provides healthcare facilities to all central government employees
Foreign direct investment (FDI)
Since 2000, the government has permitted foreign direct investment (FDI) up to 100 per cent under the
automatic route in hospitals in India. FDI under the automatic route does not require prior approval either
by the government of India or the Reserve Bank of India. Investors are only required to notify the
concerned Regional office of RBI within 30 days of receipt of inward remittances and file the required
documents with that office within 30 days of issue of shares to foreign investors. Between April 2000 and
March 2015 FDI equity inflows of nearly Rs 155 billion (USD 2.9 billion) were witnessed by the Hospitals
and Diagnostic Centres sector amounting for 1.2 per cent of the total inflows during the period.

External Commercial Borrowing (ECBs)

Currently, entities in the services sector, which include hotels, hospitals and software sectors, are allowed
to avail ECB up to 100 million USD per financial year for import of capital goods, under the approval route.
Further the government also permits entities in the hotels, hospitals and software sectors to avail ECB up
to 100 million USD per financial year, under the automatic route, for foreign currency and/or rupee capital
expenditure for permissible end use.
Players Profile
Apollo Hospitals
Apollo Hospitals Enterprises Ltd (AHEL) was jointly promoted by Dr Prathap Reddy and Mr Obul
Reddy in 1979. The company commenced operations in 1983 with 'Apollo Chennai', the first
corporate hospital to be set up in India.
Apollo is one of the largest private healthcare service providers in India with 9,215 beds across 55
hospitals. Apollo Hospitals has JCI (Joint Commission International) accreditations for 8 hospitals
and 10 hospitals have NABH (National Accreditation Board for Hospitals) accreditation. While
hospitals is the core business of the company, it is also present in allied businesses such as
pharmacies, clinics, hospital consultancy, health insurance, education, research and telemedicine.
Apollo Group business structure
Fortis Hospital
In December 2012, the company announced the selling its 63.51% stake (held through Fortis Healthcare Australia) in
Dental Corp. Holdings Ltd (DC), Australia, to Bupa Healthcare, for a consideration of A$270 million (~Rs 1550 crore). The
deal is expected to be completed in March 2013 subject to shareholder and regulatory approvals. Fortis had invested
around Rs 1,000 crore for the stake in Dental Corporation in 2011.
Fortis Healthcare sponsored Religare Health Trust (RHT), which houses the hospital services business of Fortis, has raised
US$419 million by listing its units on the Singapore Exchange in October 2012. Following the listing, Fortis, through its
wholly owned overseas subsidiary, will continue to hold a 28% stake in Religare Healthcare Trust.
In a move to consolidate its overseas operations, the company acquired the Singapore based Fortis Healthcare
International Pte for Rs 32 billion (USD 665 million) in January 2012 . This would enable the company to earmark its entry
into newer verticals like primary care and day care specialty and increase its presence in Asia-Pacific regions.
In May 2011, Fortis acquired 74.59% stake in Super Religare Laboratories Limited (SRL) for Rs 8 billion in order to venture
into the diagnostic business. This helped it foray into standalone and in-hospital diagnostic centers. SRL is a diagnostics
services company in India with eight reference laboratories, seven centers of excellence, 181 network laboratories, 15
wellness centers and 888 collection centers.
Fortis Healthcare added its eighth medical facility in the NCR region as it entered into a tie up with south Delhi based
Aashlok Hospital. The 30bed hospital has been substantially upgraded with addition of new operation theatres,
infrastructure and medical specialties.
In 2013-14, a total of 28 esoteric and innovative new tests with demonstrated, clinical value were developed and released
successfully. Among these, 12 tests were released for the first time in India thereby providing a competitive edge to the
Company.
In April and May 2015, Fortis divested stake in FSH and RadLink Singapore
Narayana
Narayana Hrudayalaya Hospitals (NHH) is a Bengaluru based chain founded by cardiac
surgeon Dr. Devi Shetty. Four Naryana Hrudyalaya Hospitals are NABH (National
Accreditation Board for Hospitals) accredited. Currently, NHH operates 8,210 beds across
31 multispeciality and superspeciality hospitals in India.
The NH group offers services in all areas of medicine with special thrust in the areas of
Cardiology & Cardiac Surgery, Cancer Care, Neurology and Neurosurgery, Orthopaedics,
Nephrology & Urology, Gastroenterology, General Surgery, Solid Organ Transplant & Critical
Care and is focused on awareness, disease prevention, screening and early intervention.

Upcoming hospitals
Aravind
Aravind Eye Care System, founded by Dr G. Venkataswamy in 1976 in Madurai, is the largest eye
care facility in the country, in terms of number of surgeries and the number of patients treated. The
company has 3,567 beds across Tamil Nadu.
Aravind Eye Care System encompasses ten owned hospitals, a manufacturing center for ophthalmic
products - Aurolab, an international research foundation, a resource and training centre, eye banks
and an eye laboratory
AIIMS
The All India Institute of Medical Sciences (AIIMS) was established in 1956
through an Act of Parliament. AIIMS, is a health care centre with facilities for
teaching, research and patient-care. AIIMS conducts teaching programs in
medical and para-medical courses both at undergraduate and postgraduate
levels and awards its own degrees.
Teaching and research are conducted in 42 disciplines. AIIMS also runs a
College of Nursing and trains students for B.Sc. (Honours) degrees.
AIIMS has 25 clinical departments including six super-specialty centers (Dr.
Rajendra Prasad Centre for Opthalmic Sciences, Cardiothoracic Centre,
Neurosciences Centre, Dr B.R. Ambedkar Institute Rotary Cancer Hospital,
National Drug Dependence Treatment Centre and Centre for Dental
Education and Research). AIIMS also manages a 60- bed hospital in the
Comprehensive Rural Health Centre at Ballabgarh, Haryana
Thematic Studies
Cardiac Healthcare
Based on the study conducted by National Commission on Macroeconomics and Health (NCMH),
CRISIL Research estimates that 49 million people of India were afflicted by CAD in 2011-12. While the
overall prevalence of the disease was 4 per cent, the prevalence was significantly higher in urban
areas at 7 per cent vis-a-vis 3 per cent in rural areas. This is because most of the risk factors
associated with CAD result from an urban lifestyle
Source :(1)- Global Adult Tobacco Survey 2009-10; (2)- ICMR India Diabetes Study 2011; (3)- WHO Study
2012; (4)- WHO Infobase 2010
CRISIL Research expects the overall prevalence of CAD to increase to 5 per cent in 2016-17 from 4 per cent in 2011-
12. This will translate to over 65 million cases of CAD in 2016-17. The prevalence will increase as a result of the
increase in number of people exposed to risk factors like tobacco consumption, diabetes, obesity,
high cholesterol levels, stress and hypertension .
Cancer - Oncology
Causes of Cancer
Although cancer is caused by multiple factors like genetic,
environmental, medical or lifestyle, around 90-95 per cent of all
cancers can be attributed to environmental and lifestyle factors like
consumption of tobacco (both smoking and smokeless), alcohol
consumption, dietary factors like high fat diets, grilled and smoked
foods etc, obesity, lack of physical activity, etc. Apart from these,
exposure to pollutants, radiation, and cancer linked chemicals
(carcinogens), infections like Human Papilloma Virus (HPV) etc. can also
cause cancer.
Only 5-10 per cent of cancers are caused by genetic and hereditary
factors.
Examples of cancers caused by environmental and lifestyle factors

Examples of cancers caused by hereditary factors

Common cancers in India - Males (2010)
Common cancers in India - Females (2010)