Healthcare sector is seeing better growth in smaller towns now than before. In smaller towns hospitals are typically between 20-100 beds, catering to semi-urban or rural population where patients are looking for affordable treatment and care. To keep the cost of setting up hospitals low and returns reasonable, doctors very often look for used (pre-owned / second-hand or even refurbished) equipment. Used medical equipment market in India is said to be nearly 1/4th– 1/3rd of the total medical equipment market.
Used/ refurbished products can be purchased at about 35-65% less than the original equipment and hence provide tremendous value to hospitals that are set-up and operate with budgetary constraints.
What are the most commonly purchased used / refurbished medical equipment in India? Which segment of healthcare market prefers to buy refurbished/used equipment and why? Who are the key sellers in each of these segments? Read on to know more about used medical equipment market and its dynamics in India.
Reasons for opting used medical equipment
Hospitals generally prefer to purchase used or refurbished medical equipment for the following reasons:
- The remaining life of the equipment is atleast another 5 years. E.g X-Rays can be used for as long as 13-15 years. Therefore a 8-10 years old X-Ray machine still has a life of 5-7 years remaining.
- High-Value item – E.g Many snamll hospitals cannot afford to buy a new CT or MRI Scanner.
- Usage is likely to be low – E.g some hospitals buy used C-arm since their case-mix may have very less use for it.
What are the most commonly purchased used/ refurbished medical equipment?
The most popular in used medical equipment segment is certainly ‘Imaging’, followed by ‘critical care’. Endoscopes are the third most sought after category. Many other specific items like Heart & Lung machine, Surgical head lights, autoclave, OT Tables, imaging tables, electrosurgical units, high-end operating microscopes, laparoscopes etc. are also sought after.
Some time back, even ICU beds from Hillrom and Huntleigh etc. were in much in demand and imported since they are very durable. Choice of vendor depends mainly on their ability to offer Support, quality of their refurbishing facility and spare part supply.
8. Bone Mineral Densitometer
9. Anaesthesia workstation
Diagnostic & Imaging equipment
CT, MRI & Cathlab
CT and MRI are certainly the most popular of the refurbished medical equipment. Most mid-sized hospitals and diagnostic centres are looking for affordable options when it comes to high-end imaging equipment. At the same time it is critical to ensure high uptime of the equipment, as every day of down-time can be very expensive for the healthcare provider both in financial terms as well as loss of reputation.
The technical skills needed to maintain CT, Cathlab and MRI are not easily available and keeping spare parts in stock to meet SLAs can be prohibitively expensive. Most sellers who succumb to competitive pressure and sell at untenably low prices are then unable to maintain the requirements for timely support later on.
Some sellers, with an aim to make quick bucks don’t bother to invest in required capabilities for sustained performance. These ‘fly by night’ operators, start-off for quick profits, causing suffering and loss to customers as well as patients. Just a hand-ful of these type of sellers, end up damaging reputations of genuine vendors in the refurbished medical equipment business.
Owing to these issues there are only a few trusted players who really invested in people skills, their training, state-of-the art refurbishing facilities and stock of spares, and have succeeded in this market with a name for themselves. The OEMs themselves, GE, Philips, Siemens, Toshiba, Hitachi etc. are big players in the refurbished medical equipment market globally, for CT, MRI and Cathlab. Other players in India like Sanrad, Medirays, Cura have been other long-term players.
CT and Cathlab being radiation equipment, come under strict AERB regulations. Today in India, as per AERB regulations no radiation equipment greater than 10 years of life can be imported. Hence supply of refurbished CT and Cathlab has definitely shrunk.
The basic configuration of a small hospitals being set-up today includes, basic OPD, IPD with 20+ beds, 1 or 2 OTs, few ICU beds or step-down ICU and a basic diagnostic facility. An ultrasound machine has come to be part of the basic diagnostic facility along with a basic laboratory and X-Ray machine. Most diagnostic centre set-ups too include a little more extensive laboratory and X-Ray, ultrasound facility.
Owing to nature of these facilities catering to General medicine, Obgyn and General Surgery cases – the most in demand ultrasound machine is a general purpose colour Doppler with (3/4 probes) – Convex, Linear and TVS probes or if stretched include a cardiac probe.
X-Ray / C-Arm
As mentioned before there cannot be a hospital or diagnostic centre with-out an X-Ray facility today! Nowadays the healthcare community is going green and shunning films and development rooms. So the popular ask today is ‘Digital X-Ray’, essentially a combination of conventional X-Ray with CR system (Not to be mistaken for the expensive Digital Radiography systems – that only large hospitals with very high volume of patients can afford in India)
X-Ray machines are extremely durable equipment, commonly with a life of 15 or so. They are also being indigenously produced by several Indian players. Service capability is far more common compared to CT/ MRI or Ultrasound machines, especially if it is not High Frequency (HF). Supply has been high for a long time and hence even used spare parts are more easily available. Supply of X-Ray tubes, which are arguably the most expensive spare part in X-Ray machine is far easier with most of the production coming from China. Hence, used X-Ray machine market is highly fragmented with several local players.
Hospitals looking to expand into Orthopedics/ trauma or Urology are looking for basic refurbished C-arm machines. Most Indian manufacturers of X-Ray machines are also offering C-arm machines. The same holds good for used X-Ray machine sellers. Both being radiation equipment come under the purview of AERB regulations. The supplies are mostly from within the country.
Mammogram and Bone Mineral Densitometer
Both Mammo and BMD machines are again radiation equipment, commonly used for screening purposes. Hence buyers of these machines tend to be diagnostic centres or hospitals with high focus on preventive health programs.
Also as the breast cancer screening and Osteoporosis screening are generally part of women’s health check package, especially in the higher age group (>35 years), optimum utilization of these equipment generally becomes a challenge. Most buyers therefore prefer lower-end systems that would just about do the job. There are very few suppliers in this segment and most equipment is imported.
Critical Care equipment
Critical care equipment such as Anaesthesia workstation, Ventilators, Defibrillators and even high-end patient monitors have perhaps been some of the most imported and refurbished, used equipment category by volume. There are several importers who acquire equipment in bulk through auctions in other countries and distribute through several local equipment vendors.
Market for these refurbished equipment have been established traditionally due to the fact that most mid-sized hospitals could not afford to buy new equipment. However now, there are many affordable options from China and several good quality Indian manufacturers such as Skanray, BPL etc. who have a full range of critical care equipment offerings.
Upcoming hospitals look for used Endoscopes to start with and upgrade to new when the volumes pick-up. The most popular brands are Olympus (Flexible), Karlstorz, Stryker (Rigid) etc.
Over 90% of private medical establishments in India fall in the Small and Medium (SME) segment. Used medical equipment are affordable and fit into their budgets. PrimedeQ addresses the medical equipment related needs of hospitals on one hand and on the other gives access to up and coming vendors supporting the Make in India initiative.
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PrimedeQ offers a full range of medical equipment typically required by small hospitals along
with related services & spares. There is no platform like them today in the country.
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This article is authored by none other than the pioneer and founder of PrimedeQ India, Mrs. Shanthi Mathur. Thanks mam for penning down this wonderful and informative read!