- What is the percentage split of dialysis centers in semi urban and rural India?
- What is the current infrastructure at dialysis centers in non-metro towns of India?
- What are the need-gaps and challenges as voiced by technicians, nephrologist and patients at dialysis center in non-metro towns of India?
- What is the revenue size for various machines and accessories in the dialysis market?
The stark contrast in socio-economic strata of patients is dominating the types of services offered by dialysis centers across metro and non-metro cities. While a corporate dialysis center may offer premium services such as personalized transportation, wi-fi enabled set-ups (among others), hospital linked (in-hospital) dialysis centers focus strictly on cost-effective dialysis sessions. There has also been an emergence of nephrologist-owned dialysis centers that promote themselves as a one-stop shop for nephrology and urology related diagnosis, therapy and transplantation. By virtue of their influence on purchase decision across multiple dialysis centers, nephrologists look to draw benefits impacting the total cost of ownership of machines for their private set-ups.
- What are various segments of dialysis centers in metro cities and non-metro towns?
- What are the respective strengths, weaknesses and expansion opportunities for each dialysis center segment?
- Who are the key purchase influencers in each segment?
- How are the various purchase parameters different for each customer segment?
- What are the value drivers while purchasing HD machines and accessories for each segment?
Affordability concerns in non-metro towns dominate the daily operational strategies of dialysis centers. “We re-use dialyzers for more than 25 sessions so that patients get some cost benefit. In fact many times patients ask us to reuse blood tubing sets and dialyzers for prolonged periods,” relayed a senior dialysis technician from North India. Cost cutting measures across certain dialysis center segments may also include installing low-cost water treatment systems, and manual washing of dialyzers instead of using re-processors. “In some facilities the water is taken from natural sources like rivers or wells, where the levels of magnesium and calcium are very high. Hard water previous to RO treatment needs to be pre-treated with softener. Many dialysis technicians and owners in small towns do not know about it. Others do not even have RO plants for cost cutting measures.” voiced a nephrologist from tier 3 town in west India.
- In the absence of strict guidelines and protocols what other cost cutting measures are being followed in non-metro towns of India?
- What are the dynamics around ancillary machines such as re-processors, RO plant etc. at the dialysis centers in non-metro towns?
- How equipped are dialysis centers in non-metro towns to cater to Hep-C and HIV positive patients?
Training of technicians and dialysis nurses continues to remain a key challenge for dialysis centers across India. Various machine related challenges have also been voiced by the technicians and nephrologists. “Breakdowns are quite frequent; we tend to resolve them remotely as the travel time for service engineer is high and we can't wait till then”, described a technician in tier 2 town in South India. With dialysis centers running on limited number of technicians, the need for technological modifications to the existing HD machines has been observed.
- What are the various training modules that may help dialysis technicians perform activities better?
- What are the after sales services related challenges faced by many technicians and nephrologists?
- What are the various challenges faced by nephrologists and patients in tier 2 and tier 3 towns?
- What are the various technological and design changes sought by end users of HD machines?
Unlike many other developing countries such as Mexico and Thailand, the number of patients on PD is significantly low. With late emergence of CAPD in India, most nephrologists have limited confidence in the modality. However, with the formation of Peritoneal Dialysis Society of India (PDSI), a gradual shift in awareness of the modality is expected. “The younger generation of nephrologists seems to have a liking for PD. Once an investment on PD centers is made, hospitals will be forced to take this modality more seriously” says a Senior Nephrologist from Southern India.
- What are the key barriers for nephrologists and patients while accepting PD as modality for RRT?
- In the absence of government aid, what are the key drivers for PD market in India?
- With increasing number of dialysis centers and hospitals setting up PD department, what are the growth prospects for PD in India?
This ethnography-backed VOC report attempts to answer the above questions leading to detailed understanding and segmentation of various customer types in India. The report is based on face-to-face interviews with key stakeholders (Dialysis technicians, Dialysis nurses, Nephrologists, Dialysis center owners, Service engineers and Dialysis patients) and ethnographic observations at customer sites (hospitals / stand-alone dialysis centers, etc.). The commercial and quantitative information and market size predictions are based on in-depth interviews with key product managers, sales and marketing managers as well as distributors of various international and regional brands of equipment and devices.
Chapter 2: ESRD IN INDIA - EPIDEMIOLOGY
End Stage Renal Disease Prevalence: Global vs. India
Dialysis in India
State of Peritoneal Dialysis (PD) in India: Comparison with Other Developing Countries
State of Kidney Transplant in India: Comparison with Other Developing Countries
Chapter 3: DIALYSIS LANDSCAPE IN INDIA
Dialysis Market Landscape
Key Drivers for the Indian Dialysis Market
Key Market Challenges for the Indian Dialysis Market
Dialysis Market Sizing
Forecasts for the Indian Dialysis Machines and Accessories Market
Classification of Indian City Tiers Based on Population
Chapter 4: UNDERSTANDING DIALYSIS CENTERS IN INDIA
Dialysis Centers: Split across India
Customer Segmentation of Dialysis Centers in India
Comparison of Dialysis Centers in Metro and Non-Metro Cities
Understanding Dialysis Center Segments
Corporate Chain Dialysis Centers
In-hospital Dialysis Centers
Nephrologist-owned in-hospital Dialysis Centers
NGO Supported / Charitable Dialysis Centers
Stand-alone Satellite Dialysis Centers
Chapter 5: UNDERSTANDING DIALYSIS CENTERS IN NON-METRO CITIES
Dialysis Centers in Non-Metro Cities: Workflow
Space Utilization and Facility
Understanding Dialysis Staff
Patient Flow Pathway
Profile of Patients
Financial Scenario of Dialysis Centers in Non-Metro Cities
Chapter 6: STAKEHOLDER CHALLENGES IN NON-METRO DIALYSIS CENTERS
Overview of Challenges
Key Challenges Faced by Dialysis Technicians
Key Challenges Faced by Nephrologists
Key Challenges Faced by Patients
Chapter 7: UNDERSTANDING VOICE OF CUSTOMER – NEED-GAPS AND USER CHALLENGES WITH MACHINES AND DEVICES IN DIALYSIS CENTERS
Components of Hemodialysis Machines
Reverse Osmosis (RO) Plants
Key User Challenges with HD Machine and RO Plant
Key Need-Gaps for End Users
Key Issues with Servicing and After-Sales Support
Current Price Points
Key Motivators to Purchase
Chapter 8: UNDERSTANDING VOICE OF CUSTOMER – PERITONEAL DIALYSIS
Current State of PD in India
Workflow of PD Procedure
Business Model for APD Machines
Perspective of Patients and Physicians on Choice of Dialysis Modality
Challenges for Penetration of PD in India
Opportunities for Penetration of PD in India
Cost Comparison between Dialysis Modalities
Chapter 9: NEED GAPS AND RECOMMENDATIONS
Current Need-Gaps in the Current Dialysis Market
Chapter 10: VALUE DRIVERS FOR EACH CUSTOMER SEGMENT AND NEED-BASED SEGMENTATION OF DIALYSIS CENTERS
Value Drivers for Customer Segments
Needs Based Segmentation of Dialysis Centers
Chapter 11: WAY FORWARD AND COMPETITIVE LANDSCAPE
Way Forward for Dialysis Market in India
Company and Product Profile
Chapter 12: APPENDIX
List of Tables and Figures
Figure 1: Comparison of ESRD Incidence Rates among Various Developing Countries, 2011
Figure 2: Comparison of HD vs. PD in Various Developing Countries, 2011
Figure 3: Comparison of Transplant Rates in Various Developing Countries, 2011
Figure 4: Key Drivers for the Indian Dialysis Market
Figure 5: Key Challenges of Indian Dialysis Market
Figure 6: Revenue Comparison: Indian Dialysis Market versus Global in USD, 2013
Figure 7: Revenue Analysis of Indian Dialysis Machine and Consumables Market, 2013
Figure 8: Indian Dialysis Machines and Consumables Market through 2018 (USD Million)
Figure 9: Indian Hemodialysis Machines and Consumables Market through 2018 (USD Million)
Figure 10: Indian Peritoneal Dialysis Market through 2018 (USD Million)
Figure 11: Split of Dialysis Centers between Metro Cities and Non-Metro Towns
Figure 12: Comparison of Population Split vs. Dialysis centers in Metro and Non-metro Cities, 2013
Figure 13: Key Dialysis Center Segments across India
Figure 14: Key Segments of Dialysis Centers in Non-Metro Cities
Figure 15: Comparison of Dialysis Fee (in USD) by Various Segments in Metro and Non- Metro Cities
Figure 16: Typical Floor Layout of a Dialysis Center in Non-Metros, India
Figure 17: Routine Workflow during Hemodialysis
Figure 18: Income -Expense Analysis of Dialysis Center for Two Inaugural Years
Figure 19: Overview of Key Challenges Faced by Various Stakeholders in Non-Metro Dialysis Centers
Figure 20: Key Components of an HD Machine
Figure 21: Representation of Indian Dialysis Machine and Consumables Market and Split of Indian PD Market Segment Wise, 2013
Figure 22: Challenges for Penetration of PD in the Indian Dialysis market
Figure 23: Opportunities for Penetration of PD in the Indian Dialysis market
Figure 24: Cost Comparison of Various Dialysis Modalities
Figure 25: Need-Gaps and Way ahead in Indian Dialysis Market
Figure 26: Perceptual Mapping of Dialysis Centers: Cost to Quality
Figure 27: Need-based Segmentation of Various Dialysis Centers
Table 1: Incidence of ESRD in Various Countries, 2011
Table 2: Demographics of Dialysis in India, 2013
Table 3: Revenue Forecast of Indian Dialysis Machines and Consumables Market through 2018 ($ Million)
Table 4: Revenue Forecast of Indian Hemodialysis Machines and Consumables Market through 2018 ($ Million)
Table 5: Revenue Forecast of Indian Peritoneal Dialysis Market through 2018 ($ Million)
Table 6: Percentage Contribution of Various Product Categories through 2018 (%)
Table 7: Key Differences in Dialysis Centers in Metro Cities vis-a-vis Non-Metro Towns
Table 8: SWOT Analysis of Corporate Chain Dialysis Centers
Table 9: SWOT Analysis of In-Hospital Dialysis Centers
Table 10: SWOT Analysis of Nephrologist-Owned In-Hospital Dialysis Centers
Table 11: SWOT Analysis of NGO Supported / Charitable Dialysis Centers
Table 12: SWOT Analysis of Stand-alone Satellite Dialysis Centers
Table 13: Classification of Dialysis Centers in India on Various Parameters
Table 14: Positioning and Future Potential of Dialysis Centers
Table 15: Educational Qualification and Responsibilities of Nurses and Dialysis Technicians
Table 16: Educational Qualification and Responsibilities of Nephrologists
Table 17: Advantages and Disadvantages of Various Vascular Accesses used in India
Table 18: Projection of Expenditure in the first Year of setting up of dialysis center in Tier 3
Table 19: Projection of Revenue in the first Year of setting up Dialysis Center in Tier 3
Table 20: Projection of Expenditure in the Second Year of setting up of Dialysis Center in Tier 3
Table 21: Projection of Revenue in the Second Year of setting up of Dialysis Center in Tier 3
Table 22: Ranking of Major Challenges Faced by Dialysis Technicians in Non-Metro Cities
Table 23: Ranking of Key Challenges Faced by Nephrologists
Table 24: Ranking Of Key Challenges Faced By Dialysis Patients in Non-Metro Cities of India
Table 25: Types of Dialyzer Membranes
Table 26: Key Challenges Faced by End Users with HD Machines and RO Plants
Table 27: Need-Gaps of End Users in Non-Metro Dialysis Centers
Table 28: Key Metrics of Service Support as Perceived by End-Users
Table 29: Current Price Ranges for Various Machines involved in HD
Table 30: Ranking of Training Needs Identified by Dialysis Technicians
Table 31: Motivators to Purchase HD Machine and Consumables
Table 32: Purchase Decision Matrix across Various Dialysis Center Segments
Table 33: Key Purchase Parameters for Various Stakeholders and their Relative Importance
Table 34: Advantages of Various RRTs as perceived by Patients and Physicians
Table 35: Disadvantages Various RRTs as Perceived by Patients and Physicians
Table 36: Cost Comparison of Various RRT Modalities per Month
Table 37: Classification of Patients by Socio-Economic Class
Table 38: Ranking of Key Parameters Influencing Choice of Dialysis Centers by Patients
Table 39: Value Drivers for Corporate Chain Dialysis Centers
Table 40: Value Drivers for In-Hospital Dialysis Centers
Table 41: Value Drivers for Nephrologist - owned In-hospital Dialysis Centers
Table 42: Value Drivers for Stand-alone Satellite Dialysis Centers and NGO Supported or Charitable Dialysis Centers