Late last year, reports emerged that one of India’s earliest healthtech startups, Practo, was considering selling its business to a new entrant, Pristyn Care. The putative deal, largely a stock swap, pegged 13-year-old Practo’s worth at about $650 million, far lower than three-year-old Pristyn’s valuation of $1.4 billion.

The news surprised some because Practo had just entered the $12-billion market of secondary-care, or elective, surgeries after spending years building a platform for doctor discovery, appointments, online consultations, tests and medicine delivery.

But some other industry watchers saw natural synergies between the two companies — Pristyn was already an aggressive mover in the surgery space — and pointed to the fact that they had a common backer, Sequoia. 

Pristyn pushed hard for a deal, but no term sheet was signed, said a person familiar with the matter. Practo denies there were any acquisition talks.

So, this leaves the two as direct rivals in one of healthcare’s fastest-growing segments. According to one estimate, about 20 million surgeries take place in India every year and the majority fall under secondary care (non-urgent). Will Practo’s experience in creating an ecosystem give it an edge, or will Pristyn’s hyperfocus propel it ahead?