Healthcare is one of the most regulated industries in the world. Price caps, clinical compliance, ethical oversight, and scrutiny of foreign investment make it a challenging market to enter and scale. Yet, India has consistently produced healthcare champions who have turned regulation from a barrier into a springboard. Here are some interesting market entry strategies for the healthcare industry.
Three examples stand out — Meril, Narayana Health, and the Indian pharmaceutical industry. Together, they illustrate how Indian healthcare players can not only survive but thrive in a highly regulated ecosystem.
Meril: Turning Policy Shock into Global Expansion
When the Indian government capped stent prices in 2017, global giants scaled down their presence, and the market appeared destabilised. For Meril, however, it became a moment of opportunity.
The company doubled down on indigenous innovation, investing heavily in R&D. Their work on novel bioresorbable stents and transcatheter devices allowed them to secure exemptions from price control, protecting margins while maintaining affordability. More importantly, it created intellectual property that was ready for export.
This strategy paid off. Today, exports account for more than half of Meril’s revenues, a remarkable reversal in a sector that once imported the majority of its devices. Global investors noticed. Earlier this year, the Abu Dhabi Investment Authority (ADIA) invested around US$200 million in the company, valuing it at multi-billion-dollar levels.
The lesson here is clear: regulation does not always have to shrink opportunity. For companies willing to innovate, it can accelerate differentiation and global relevance.
Narayana Health: Building Global Bridges Through Offshore Structures
Another fascinating example comes from Narayana Health (NH). Known for its low-cost, high-volume cardiac surgeries, NH was already a pioneer in delivering affordable care in India. Its next challenge was internationalisation.
Rather than exporting patients alone, NH set up a hospital in the Cayman Islands — Health City Cayman Islands. The decision raised eyebrows: why Cayman? The rationale was pragmatic. Cayman provided regulatory flexibility, access to U.S. and Caribbean patients, and an investor-friendly structure for global expansion.
This model allowed NH to diversify revenues, earn in foreign currency, and establish credibility as a global care provider. The offshore structure gave them a platform to attract capital, manage partnerships, and scale internationally in a way that a purely domestic approach could not.
The lesson: in regulated healthcare, sometimes the key to market entry is choosing the right corporate structure and jurisdiction. That’s an interesting market entry strategy for the healthcare industry.
Indian Pharma: The Export-First Model
If Meril and NH are case studies of individual companies, the Indian pharmaceutical industry is a macro case study of how an entire sector can navigate regulation to dominate global markets.
India supplies nearly 20% of the world’s generic drugs. In 2024, pharmaceutical exports reached nearly US$28 billion, with the U.S. alone accounting for around US$8.7 billion. Strict U.S. FDA audits and EU quality standards have compelled Indian companies to maintain compliance at scale, while cost advantages have enabled them to compete aggressively on price.
The strategy here has been straightforward but effective:
- Enter global markets through generics and APIs
- Gradually move up the value chain into complex generics and speciality drugs
- Invest in compliance and scale simultaneously
For decades, the Indian pharmaceutical industry has demonstrated that regulation is not a hindrance when companies build compliance as a competitive advantage.
The Next Big Opportunities for market entry strategies in healthcare
While exports remain critical, the domestic Indian healthcare market itself is ripe for new market entry strategies. Several under-penetrated areas present strong opportunities:
- Insurance for the Uninsured – With penetration still low, especially outside of metropolitan areas, there is significant room for micro-insurance products that are bundled with telehealth and diagnostic services.
- Tier 3 and Rural Healthcare – The burden of chronic disease is shifting rapidly beyond metropolitan areas. Hub-and-spoke hospital models, franchised diagnostic centres, and digitally enabled primary care could redefine accessibility in smaller towns and rural regions.
- Medical-at-Home Devices and Services – As India’s population ages, there is a growing demand for at-home monitoring, physiotherapy, and chronic care services. Affordable medical devices and bundled home care services could reduce hospital load while creating scalable new markets.
- Medtech for Domestic and Export Growth – India’s medtech sector has the potential to replicate the pharma industry’s export playbook. With supportive government policies and production-linked incentives, companies that invest in clinical trials and regulatory approvals early can establish a strong global presence.
What Indian Startups Can Take Away From the Market Entry Staretgies in Healthcare
The journeys of Meril, Narayana Health, and Indian pharma are not just stories of established companies. They also offer a blueprint for startups navigating India’s regulated healthcare landscape. They need to think through interesting market entry strategies for healthcare and their ventures.
- Make compliance your moat
- Regulation is not a cost burden alone — if you embed quality systems and clinical validation early, it becomes a competitive differentiator.
- Choose the right structure early
- NH’s Cayman model shows how structure influences scale. Startups should assess if an Indian entity, a global holding company, or a hybrid is best for their capital and growth path.
- Build for India and beyond
- Pharma’s export-first strategy proves Indian innovation can scale globally. Startups should test whether their solution can also solve problems in Africa, Southeast Asia, or Latin America.
- Affordability with credibility
- India’s advantage lies in cost efficiency. However, without clinical credibility and certifications, affordability alone will not open global doors. Pair frugal design with strong validation.
- Capital follows clarity
- ADIA’s investment in Meril wasn’t about margins alone — it was about visible IP, export traction, and regulatory maturity. Startups that show these will attract serious institutional capital.
I would recommend all startup founders to conduct the Known-Unknown exercise. I had detailed this out in my earlier article, the link to which can be found here. This is the necessary starting point for them to start and build as they go along this journey.
A Playbook for Market Entry in Regulated Healthcare
Across these cases, a few patterns emerge:
- Policy as Catalyst: Meril demonstrates that regulation can drive innovation that yields lasting advantages.
- Structure as Strategy: Narayana Health demonstrates that corporate structuring and location choices can unlock international markets.
- Compliance as Differentiator: Pharma teaches us that world-class compliance, once seen as a cost, can become a competitive advantage.
For new entrants, the message is not to fear regulation but to design strategies that leverage it.
Conclusion
Market entry in healthcare is never straightforward. Regulation, ethics, and cost pressures can be daunting. But the Indian experience offers optimism. Companies that anticipate regulatory shifts, build compliance into their DNA, and innovate relentlessly can scale not only in India but across the globe.
The next decade belongs to those who see regulation not as a barrier but as the terrain on which competitive advantage is built.
Get In Touch
Do you want to re-examine your strategy for market entry for your healthcare organisation? Get in touch. Do drop me a note on drvikram@Healthcare-in-india.net
