Interview with Dr Johannes Wamser and Mike Batra, Germany, about the dental market in India

The Indian market with a population of more than 1 billion people and an emerging middle class offers enormous potential for all kinds of industries. Dentistry is one of them. Editor Claudia Salwiczek spoke with Dr Johannes Wamser and Mike Batra from German consulting company Dr Wamser + Batra GmbH about the current market conditions in India and why foreign manufacturers of medical and dental equipment should start to invest now.

Claudia Salwiczek: Dr Wamser, you offer consulting services to companies that are interested in setting up in India. Why are you focusing on dentistry?
Dr Wamser: We are not exactly focused on dentistry and offer our services to many industries. The common denominator is simply India. In our company, you will find a number of professionals that have much experience in doing business there, such as managers from German companies who worked and lived in India for a couple of years. The reason that we are dealing with dentistry now is trivial. India has much going for it!

Could you please explain this to us?
Dr Wamser: Sure. Currently, a small but powerful social class is developing in India that is influenced by international media and is able to fly to London or Dubai occasionally to do shopping. This developing part of the population is placing high demands on the Indian health care system, which unfortunately is still underdeveloped in most parts of the country. India is still a classical example of a developing nation with low standards in clinics and the education of medical personnel. This is changing now only in a small segment that offers high-quality products and services, but not throughout the country.

So there is no mass market for medical or dental equipment in India?
Dr Wamser: I have to agree because the number of doctors and clinics that want to purchase advanced technology and are able to use it is manageable. However, the number is sufficient to make the market attractive for foreign manufacturers. There is a large gap between what is currently available there and what people are willing to pay for good health care. In my opinion, foreign manufacturers would be able to sell their technologies in India at a price range comparable to Europe or the US.

Could you please briefly explain the health care system in India?
Mr Batra: Similar to other markets, the health care system in India is divided into the public and private sectors. In the past, we accompanied a number of German medical companies that were focusing on private clinics, which have multiplied in the big cities like Delhi, Mumbai and Bangalore. As these clinics are brand new, the risk of infection with Methicillin-resistant Staphylococcus aureus is minimal or non-existent, which is something these clinics regularly exploit for their advertising.

I suppose the conditions in public hospitals paint a different picture?
Mr Batra: Indeed. Public hospitals are generally uninteresting for most foreign manufacturers of medical equipment because the price and quality levels are different from what they offer in their markets. For example, it is common for 300 people to share a room that only has the capacity of 100 beds. Syringes are re-used twice or even three times, which makes these hospitals perfect breeding grounds for diseases like hepatitis C. Patients also have to bring or buy wound dressing material from the clinics, and bedside care is often provided by a family member instead of a nurse.

Is medical treatment free?
Dr Wamser: In most cases, the treatment is free and patients only have to pay for materials and medicine. The public health care system is state subsidised and financed, but as you can imagine, these financial means are not sufficient for the 1.2 billion people living on the subcontinent.

What about dentistry?
Mr Batra: There are certain basic procedures like normal check-ups that are free. Dentures, however, must be paid out of pocket and this is where street dentists usually come into play. We focus mainly on the private sector, which has experienced quite an upswing in the last four to five years. In this sector, the technological standard, the dentist–patient ratio and the quality of bedside care is comparable to Western countries. At the moment, a number of private clinics with capacities of 1,000 to 1,500 beds are being built that are aimed primarily at dental tourists.

And these clinics mainly treat foreign patients...
Dr Wamser: They do at a very high level of quality but also at a reasonable price. Many private clinics have dental departments that were established especially for overseas patients, which help them with travel arrangements, such as booking flights, transport from the airport and getting visas. I have to say that this has become very successful.

It is also not a secret that many Indian dentists who have practised in England or the US are now using the opportunities that these clinics offer and return to practise in India for a while.

What’s the price range of these clinics?
Dr Wamser: Dental services are 60 to 70 per cent cheaper than in Europe or North America but the cost of materials is more or less the same. These clinics are independent and can offer less expensive services because they do not have to pay opportunity costs, for example.

India is often compared to China when it comes to economic development. What potential does the Indian dental market really have?
Dr Wamser: On the one hand, we have a mass of people that offer dental services on the streets but who have never had any dental education. On the other hand, we have a small segment of well-educated and foreign-trained dentists who work in many of the private dental clinics. The group of street dentists or those with small practices are not able to buy expensive equipment; therefore, it falls upon the private sector and hospital chains to invest in new equipment. Meeting this growing demand is a significant opportunity for foreign manufacturers of dental equipment.

What should be done?
Dr Wamser: India needs a big leap forward to reach the same level of technological development that Western countries have achieved in two decades. This includes all sectors, such as high-quality equipment, sterilisation methods and hygiene standards. India is in need of—and certainly wants—foreign expertise and this can only be achieved through the purchase of new products. However, merely selling advanced equipment will be not enough: doctors in India have to be trained in new methods and technologies.

In most Asian countries, manufacturers often struggle with the various registration procedures for their products. What is the case in India?
Dr Wamser: I have to admit that India is a country with a very high level of bureaucracy. The system introduced by the British in the 19th century was taken over and even extended by the Indians. Therefore, product registration is a requirement in India and will become a problem when industry players try to achieve it under time pressure. Companies that plan and provide all the necessary documentation will face no problems.

Mr Batra: We found out that it took many German companies actually longer, sometimes years, to register a product in China than in India, even though they had been on the market there for quite some time. There is certainly the risk that guidelines and regulations change and extend the registration process, but usually it goes smoothly. As far as dental products are concerned, we have learned that the registration of implants takes more time than the registration of dental units.

How competitive is the dental market in India?
Dr Wamser: To answer that question we have to look into other industries. There certainly is competition and the market in India is not necessarily uncharted territory. If you compare it with China once again, private business has been allowed in India for decades and small- and medium-sized enterprises have been producing and selling dental equipment for years. Their products, however, usually do not meet the requirements for quality and technology that we have here in Europe or the US.

Sounds promising...
Dr Wamser: Well, not really. Foreign manufacturers still try to enter the Indian market by dumping technology that was state-of-the-art 20 years ago. Doing so is a big mistake and will definitely backfire because the low-price sector clearly is and will be dominated by Indian companies.

So what are your recommendations?
Dr Wamser: There are not many standards in India as far as technology is concerned and this gives companies the chance to influence the future of dentistry in India. Manufacturers that enter the market early will be able shape the market conditions there.

Being the first is the key?
Dr Wamser: If we talk about dentistry in India, we do not only look at the present state and today’s market potential but at development that will last for the next two or three decades. Manufacturers can choose to enter the market now as pioneers or later when the market will be fully developed.

Also keep the persistence effect in mind. Dental graduates who practised on one particular device are likely to use that device or its successors for the rest of their professional lives. Being the first in the market can mean successful business for decades to come. Entering the market later means more competition or breaking into an already established market or system.

Thank you very much for the interview.