India-EU FTA, And Collaboration Can Reduce Healthcare Costs For All

Hospital expenses are dominated by real estate (property), infrastructure (logistics, utilities, telecom, and IT), salaries (for specialized and support staff offering 24/7 services), advanced technology devices (diagnostics, surgical, and critical care), medical-surgical supplies (consumables and specialized instruments), pharmaceuticals, and facility maintenance. The Indo-EU FTA and their collaboration can make a huge difference to both parties in reducing these expenses and increasing the affordability of healthcare and its spread to less populated areas.

Indian hospitals import over 75% of high-value medical technology, cutting-edge devices, specialized drugs, and consumables from the US, EU, Japan, and China to meet global standards of care, especially in laboratory, imaging, surgery, and critical care. Europe, despite being a global leader in medical technology (imaging, endoscopy, OT infrastructure, dialysis, and lab diagnostics), still depends on the U.S. for advanced MRI/CT innovations (GE Healthcare), molecular/genetic platforms (Illumina, Thermo Fisher, Beckman Coulter), robotics (Intuitive Surgical), OT integration systems (Stryker, Hill-Rom), cardiac devices like stents, pacemakers, defibrillators (Medtronic, Boston Scientific, Stryker), and implants and prosthetics. Japan for flexible endoscopy (Olympus, Fujifilm, Pentax), haematology analysers (Sysmex), and dialysis consumables (Nipro); and China for low-cost disposables (syringes, gloves, masks, gowns). These are the very items India imports from the US, Japan, Europe, and China. Imported systems significantly raise treatment costs, especially in oncology, cardiology, dialysis, surgery, and critical care.

Indian firms like Trivitron Healthcare, Poly Medicure, and Meril Life Sciences are growing but still limited in cutting-edge imaging (ultrasound, MRI, CT, PET scanners), flexible endoscopy, lab systems (analysers, immunoassay systems, diagnostic reagents and kits), robotics, critical care devices (Ventilators, infusion pumps, anesthesia and dialysis machines), radiation therapy equipment (linear accelerators and proton therapy systems), orthopaedic and dental implants, and specialized prosthetics.

The US is the leader in robotics, implants, and advanced molecular/genetic testing, and Japan is strong in endoscopy, dialysis consumables, and imaging systems. European companies like Siemens, Philips, Esaote, Karl Storz, Richard Wolf, Medtronic (Europe), Dräger, Maquet, Getinge, Trumpf Medical, Fresenius, B. Braun, Zimmer Biomet (Europe), Roche Diagnostics, BioMérieux and Qiagen, with their technology and finances can harness Indian frugal engineering, cost-optimized design, labour and market to prototype, test, and manufacture these at global scale in India with European quality standards that are recognised globally, and make both European and Indian hospital care affordable and less dependent on imports and supply chain vulnerabilities. Maintenance and upgrade costs will also be reduced. The FTA will reduce Indian equipment import costs and expand Indian exports of medical textiles, surgical instruments, and disposables. Indian researchers, engineers, and entrepreneurs will have more incentive to develop cutting-edge technologies, mass-manufacture them, and make India a global MedTech hub. During the pandemic, the manufacture of medical diagnostic and critical care equipment, consumables, vaccines, and medicines was massively scaled up. Indian Phased Manufacturing Programme (PMP) aims to boost domestic production of medical X-ray machines and their sub-assemblies, and other advanced medical equipment.

Till now, liquid helium has been the only medium cold enough to eliminate metals' electrical resistance, enabling them to generate powerful and stable magnetic fields. Recently, a Bengaluru startup, Voxelgrids Innovations, successfully developed and installed India's first indigenous MRI scanner, using a liquid nitrogen (-196°C/ 77 Kelvin) instead of a liquid helium (-269°C/ 4.2 Kelvin) cooled superconductor magnet, a global first. This technology makes the MRI machine 40% cheaper, with lower operating costs, 10% smaller, 30% lighter, and more reliable, even in hot conditions.

It is suitable for mobile use, helping increase access to MRI diagnostics in rural or smaller hospitals.

India, the “pharmacy to the world”, is dependent on imports for specialized vaccines (HPV, Pneumococcal), growth hormone and insulin analogues, peptide-based therapies for metabolic disorders (semaglutide for weight loss and diabetes, octreotide for growth hormone disorders), infectious diseases (polymyxins and polypeptide antibiotics), targeted autoimmune (certain JAK, TNF and IL inhibitors) and cancer (monoclonal antibodies like trastuzumab, rituximab) therapies, immunotherapy (nivolumab, pembrolizumab, Bevacizumab), advanced cardiovascular drugs (Rivaroxaban, Dabigatran), Alzheimer's, Parkinson’s (entacapone), and rare diseases (biologics, gene therapies and CAR-T, and fermentation-based antibiotics, vitamins and steroids). India produces over 500 active pharmaceutical ingredients (API) but still depends on imports for cheaper fermentation-based APIs from China, accounting for nearly 65-70% of India's API imports, and specially APIs (statin intermediates for heart, platinum-based intermediates, and complex peptides for cancer) from the US. Many large-scale fermentation plants in India were dismantled in the 1990s due to dumping by China.

India’s Production Linked Incentive (PLI) scheme targets 53 critical APIs to revive domestic production. Europe can help by sharing biotech expertise, licensing patents, and enabling joint ventures, especially in oncology, biologics, and fermentation-based APIs. European green chemistry & bioprocessing expertise can help India reduce the environmental costs of fermentation APIs. Collaborative trials can accelerate biosimilar development. India can provide the cost advantage and global scale required to compete with China and the US. India can help Europe with IT, AI, and cybersecurity for healthcare. Global Engineering Centres like GE Bangalore, Philips Pune, Siemens Bengaluru can become co-owned EU-India R&D labs. A symbiotic relationship between India and Europe can significantly reduce healthcare costs for at least one-third of the world’s population.

The Indian budget can designate the healthcare sector as “core infrastructure,” correct “inverted duty structures,” reduce duties on critical medical equipment and consumables, and financially help biotech and pharma R&D, self-reliance in manufacturing (PMP, PLI), health insurance (AB-PMJAY), and the spread of preventive and curative healthcare to remote populations through training of more healthcare workers, digital infrastructure (ABDM), AI-led innovation, cybersecurity, telemedicine, logistics, mobile clinics and hospitals, and primary and secondary health centres.

Dr P.S.Venkatesh Rao is a Consultant Surgeon, Former Faculty CMC (Vellore), AIIMS (New Delhi), and a polymath in Bengaluru, drpsvrao.com