MUMBAI, Sept. 24 -- The healthcare sector in Mumbai is poised for a sea change with top hospitals entering into collaborations and acquisitions, apart from plans to expand to tier-2 cities. This is to overcome the grossly disproportionate people-bed ratio. Between 2023-26, city hospitals have seen a marginal improvement in the ratio. While in 2023, there were 3.5 beds for 1000 people, it only slightly increased to 3.7 beds in 2026, said N Santhanam, healthcare consultant and former CEO of Breach Candy Hospital. "In Mumbai-particularly the south and central parts - large contiguous land parcels are scarce and expensive, making the economics of developing a large greenfield (projects that start from scratch on a plot of land not meant for healthcare facility) hospital increasingly a challenge," said Dr Vivek Talaulikar, senior director & COO (Western Region), Max Healthcare. "This is the reason why the model of expansion has changed. We expect Mumbai to increasingly witness redevelopment of existing hospitals, optimisation of existing campuses and selective acquisitions. Greenfield hospitals may emerge in the developing parts of the Mumbai metropolitan Region's (MMR) micro-markets." The present trend of development therefore inevitably leans towards brownfield builds (where existing facilities are modified and expanded). "While building a hospital in Mumbai may cost around Rs.2 crore per bed, building a similar facility in a tier-2 city is around Rs.75 lakh per bed," said Dr Ramakant Deshpande, chairperson of Asian Cancer Institute (ACI), Cumballa Hill Hospital. "While the cost of construction and equipment are standard everywhere, the real estate cost marks the difference, making it difficult for hospitals to come up in Mumbai." The hospital tied up with HCG Cancer Hospital, Colaba, earlier this month to expand from a 52-bed capacity to 200-bed facility with ultra-modern equipment on its half-acre plot at Kemps Corner. "We are a small facility right now. Due to height restrictions, we can only go up to 14 storeys," he said. Santhanam said: "Every hospital cannot go beyond 60 metres in height, besides which they are also expected to retain a nine-meter perimeter on all sides to help fire engines and ambulances move easily around the building in case of emergencies. This means, you cannot build beyond 15-16 floors. With steep real estate cost in south Mumbai, breaking even will take that much more time." He added, "Building a 300-bed hospital in Mumbai could cost Rs.450 crores and a 500-bed hospital Rs.750 crores." As building in a tier-2 city is comparatively reasonable, some hospitals have chosen to look beyond the state. Bombay Hospital is one - it is planning to develop hospitals in Jaipur, Indore and Raipur. "The idea is to take world class healthcare, that was hereto accessible only in the metro cities, to the tier-2 cities," said Dr Gautam Bhansali, senior consultant physician, Bombay Hospital, adding that the management is also exploring opportunities in Palghar. Santhanam also pointed to the state government offering large tracts of land for expansion to hospital chains with global partners in Third Mumbai. "Space in the range of 100 acres is being offered to the healthcare sector. MMRDA is already in touch with many hospital chains to expand in this area. The Atal Setu and the new international airport have allowed easy access to this area from Mumbai as well," he said. In Mumbai, the HCG Cancer Hospital-ASI Cumballa Hill Hospital tie-up will bring multidisciplinary medical and surgical services, with cancer care as a key area of clinical focus, at the Cumballa Hill hospital. Nanavati Max Super Speciality Hospital is also on the verge of a major brownfield expansion at its existing Vile Parle campus by investing Rs.700 crores, apart from building a facility in Thane. "The hospital in Thane will have 500 beds, which will be commissioned by the end of 2028. The facility hopes to tap into the rapidly growing bustling urban city with a large population, rising middle class and the increasing demand for quality healthcare," said Dr Talaulikar. Santhanam added, "Apart from Apollo Group declaring its plans for a Worli hospital two years ago, there are no major developments in south Mumbai. Key players are looking to expand in the suburbs - the Manipal Group acquired a hospital at Andheri in May, while the Adani Group has planned one in Kandivli." As a part of its CSR initiative, the JSW Group is developing the St Elizabeth Hospital at Malabar Hill at an estimated project cost of Rs.100 crores. Plans are on to transform the three storeyed non-descript 47-bed hospital into a 10-storeyed 150-bed capacity, with upgraded facilities. The Reliance Foundation's growth trajectory includes the recent acquisition of SevenHills Hospital. "Plans are on to expand as a 1500-bed multi-speciality hospital," said Dr Tarang Gianchandani, director of Reliance Foundation Healthcare Initiatives....