By Apex Hospitals, 13th June, 2025
For years, most of India’s healthcare system has been centred around metro cities, where it’s easier to find top specialists, big hospitals, and advanced treatments. But this focus has left a large part of the country behind. The truth is, over 65% of India’s population lives in Tier 2 and Tier 3 cities, where access to good, affordable healthcare is still a daily challenge.
As India evolves, our healthcare system must grow with it. We can’t focus only on big cities anymore. People in smaller towns and rural areas deserve the same standard of care. Because the real need lies in the heart of Bharat.
Dr. Shailesh Jhawar, Director at Apex Hospitals, is one of the leaders showing how this can be done. Building hospitals in smaller cities isn’t just about medical expertise—it takes smart planning, strong operations, and a deep connection to the local community. In conversation with Vishal Seth, Managing Director at Protiviti India, Dr. Jhawar shares what it takes to create a sustainable hospital chain in underserved regions.
India’s smaller cities are home to millions of people who often lack access to timely and advanced medical care. As Dr. Jhawar notes, “Healthcare shouldn’t just be for people in metro cities. It should reach every part of India.” These regions are seeing a rising demand for quality services but face challenges in infrastructure, staffing, and operations.
Whether it’s Jaipur, Jabalpur, or Jhansi, timely care should not depend on your location. Yet millions in rural and smaller cities face delayed diagnoses, limited specialists, and under-resourced facilities.
“Good healthcare shouldn’t be a privilege. It should be a right available to everyone, everywhere.”
To bridge this gap, Dr. Jhawar introduced scalable innovations like Critical Care, Tele-ICU services, and modular hospital expansion models. These approaches are both cost-effective and scalable—bringing advanced care closer to communities without heavy infrastructure costs.
Delivering super-specialty care outside metros isn't easy. One challenge is the volume-value mismatch.
“In smaller cities, you must have a certain population base to sustain specialties. Footfall matters; a hospital without enough patients cannot survive, no matter how advanced.”
Apex targets regions with a population of 25–30 lakhs—enough to support long-term, sustainable operations.
In Tier 2 and Tier 3 cities, 40–50% of patients are covered under Ayushman Bharat or state health schemes. These provide volume but come with fixed pricing and slower reimbursements.
So, how do you stay cash-flow positive?
“Cash flow is the most important part of this business. Managing working capital well is key. You need professionals who understand finance, not just medical operations.”
At Apex, financial and operational teams work closely. Strong internal systems, data-driven cost control, and clear accountability help manage cash flow and scale effectively.
Instead of building large hospitals all at once, Apex follows a modular growth model—starting with 100–200-bed units and expanding as demand grows.
This strategy includes:
“Each hospital is at a different stage. Some are mature, others are building their medical identity. But our DNA stays the same—community-first, sustainable, and innovation-led.”
The next decade of Indian healthcare will be shaped not by metros, but by progress in Tier 2 and Tier 3 towns. Leaders like Dr. Jhawar are showing that with empathy, innovation, and strong systems, it’s possible to create healthcare chains that serve millions—profitably and meaningfully.
For policymakers, investors, and healthcare entrepreneurs, this is more than an opportunity. It’s a responsibility to build inclusive, resilient systems that reach every Indian, regardless of geography.
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