Boom time for medicare
As medical tourism looks set to expand further, India must make use of the opportunity while ensuring that it does not create a health divide.
India's tertiary healthcare sector is on the road to global fame.
DESTINATION INDIA: From top: the First Lady of Guyana with patients from her country at Frontier Lifeline Hospital, Chennai; Iraqi children with Dr. K.M.Cherian and Noor Fatima at Narayana Hrudayalaya, Bangalore. PHOTOS: K. PICHUMANI, VINO JOHN AND V. SREENIVASA MURTHY
IT is an ironic outcome of neo-liberal economic reforms that in spite of fundamental policy failures in public health, India is increasingly seen as an attractive international healthcare destination.
National weaknesses start with one of the lowest rates of expenditure on public health, as a percentage of the Gross Domestic Product. Millions suffer from debilitating malnutrition, often from childhood. Basic requirements for good health such as sanitation, clean air and safe water remain unavailable to a vast population. Newer vaccines, expensive investigations and advanced drugs are beyond the reach of remote poverty-ridden communities.
Yet, India's tertiary healthcare sector is on the road to global fame. A growing number of spotlessly clean private hospitals are on the threshold of a boom in medical tourism, positioning themselves as the best destinations for procedures ranging from coronary bypasses to orthopaedic surgery at the most affordable costs. These hospitals offer high-quality care for international patients, whose numbers are reportedly rising 15 per cent annually; the prices that they charge are a fraction of what prevails in the developed world. India's corporate hospitals are fully equipped, up market and efficient. With their toll-free helplines, interactive websites, online quotes and time-bound treatment access, they appear to be a world apart from the overburdened, often badly managed and poorly funded public health system.
Just three major corporate hospital groups, Fortis Healthcare, Wockhardt and Apollo Hospitals run 26 hospitals in the subcontinent and that number is growing. They are forming partnerships with international insurance and tourism companies that will send both insured and uninsured patients for low cost treatment.
With some friendly policies from the Government, some analysts think, the private healthcare sector can transform the potential of medical tourism into a very profitable reality. One oft-cited report that endorses this optimistic outlook is "Healthcare in India: The Road Ahead", produced by the Confederation of Indian Industry and McKinsey and Company. It puts a number to the promise: tertiary hospitals, with a 25 per cent growth rate in revenues from foreign patients (comparable to institutions such as Bumrungrad in Thailand), could generate additional earnings of Rs. 5,000 crore to Rs. 10,000 crore by 2012. That potential is based, in part, on the low cost of care in international price terms, competent medical personnel and absence of long waiting times for procedures, says the report.
Stories of foreign nationals undergoing complicated surgery in the country are frequently featured in the media. Those who come now are not just from other developing countries (the first lady of Guyana brought a group of 15 patients for cardiac treatment to Frontier Lifeline hospital in Chennai), but also from the United Kingdom, Europe and North America. Tanzania and Iraq have a Memorandum of Understanding with the Madras Medical Mission.
Many opt to undergo surgery in India for reasons that range from long waiting times in the U.K., high costs or lack of insurance cover in the U.S., to plain lack of expertise in many Asian, African and West Asian countries.
The CII-McKinsey report says that the allopathic system can offer treatment in specialities such as cardiac, liver, renal and orthopaedic procedures, while Indian systems of medicine could attract patients from even the developed world to treat "lifestyle diseases" such as stress and rheumatism. Many visitors who come for such de-stressing and health-building treatment may also choose to visit tourist spots. Such tourism potential holds the key to Kerala's plans. The Ayurveda State has declared 2006 the year of medical tourism and is actively supporting its well-known traditional medicine and tourism sectors, as they reach out to more potential visitors.
Elsewhere, development plans, both State-led and in the private sector are being pursued actively: Karnataka, which gets about 8,000 patients a year and forecasts an annual growth rate of 25 per cent, will promote a massive health park near a new international airport in Bangalore; non-resident Indians have formed a medical tourism company in Vadodara and international property developers are venturing into the healthcare sector to participate in the construction boom. In Maharashtra, the State Government is part of the Medical Tourism Council that has members from Association of Hospitals and FICCI.
In New Delhi, Naresh Trehan, executive director of the Escorts Heart Institute and Research Centre has proposed a Medicity on the outskirts of the capital to develop a 1,500-bed healthcare centre of international standards with 20 super specialities. It will incorporate traditional medicine too and have such facilities as hotels, serviced apartments, clinical and biotechnology laboratories.
Ventures such as these draw encouragement from the National Health Policy 2002, which endorses provision of health services "on a payment basis to service seekers from overseas". The corporate healthcare sector views such support as critical, considering that it is competing with Thailand, Singapore, Malaysia and South Korea for a bigger share of Asia's medical tourism market. "Medical tourism can be a much bigger business, if we have infrastructure and networking among hospitals, hotels and tourism agencies. The Central and State governments must extend tax and other concessions, on the lines available to IT and BPO sectors," says K. Ravindranath, managing director, Global Hospitals, Hyderabad. He readily favours cross subsidy for domestic patients from revenues flowing out of medical tourism.
Private hospitals in Hyderabad, some of which get 10 per cent of their patients from abroad, are planning to open separate wards or wings for foreigners. The Apollo Hospitals already has a ward and wants to upgrade it to an international multi-speciality block while the Asian Institute of Gastroenterology plans to create a separate wing for foreigners.
The key to a significant increase in patient arrivals, however, lies in becoming globally accredited. Corporate hospitals have begun factoring this requirement into their medical tourism plans.
Joint Commission International, a benchmarking body lists Indraprastha Apollo, New Delhi, and Wockhardt, Mumbai, as accredited hospitals. Accreditation apparently brings immediate benefits. "There has been a steady increase in the number of patients over the last six to eight months, particularly from the U.K. and U.S. The numbers have been increasing after accreditation, particularly from the U.S.," says Vishal Bali, chief executive officer of Wockhardt.
It is also important to have systems that meet the criteria of insurance companies. Says cardiac surgeon V.V. Bashi of MIOT Hospital, Chennai: "Our medical standards are world class, but if we have to get more patients from the U.S. and other developed countries, we must match their hospital documentation standards. This is really important because the insurance companies must cover all the risks in the event of an adverse treatment outcome."
Wockhardt's hospital in Bangalore, which has a Harvard Medical International tie-up, gets half of its foreign patients (about 900), from the U.K. The media reported the story of one such patient with coronary heart disease, 73-year old George Marshall last year. This violin repairer from Bradford was operated upon at the hospital for a quarter of what he would have paid for private care in the UK, including the airfare.
When he arrived in India, he was initially shocked by the traffic chaos and urban squalor, but it appeared to be a better decision than having to suffer a long delay for bypass surgery in a state-supported National Health Service hospital or fork out GBP £19,000 for immediate private care in his home country.
Another 35 per cent of Wockhardt's patients come to Bangalore from the U.S. and the rest from the European Union and South East Asia. Another heart care institution in Bangalore, Narayana Hrudayalaya, has a record of 15,000 surgeries performed on patients from 25 foreign countries, half of them children.
The biggest disincentive to medical tourism, the hospitals say, is the insensitive handling of visa issuance to those who come for treatment. While people-to-people relations are strengthened when a patient from Pakistan, Iraq or Afghanistan gets operated upon in India, the requirement that visitors must report to designated officials periodically is viewed as avoidable harassment. "The patients get dejected, though they are grateful to the doctor, hospital and host country for saving their lives," says Dr. Bashi.
Strong emotional bonds can indeed be built by treating patients from other nations, says urologist Sunil Shroff of Sri Ramachandra Medical College and Research Institute, who has led a campaign for ethical transplants and altruistic organ donation in India through the MOHAN Foundation. "Medical tourism needs a national task force that will bring hospitals and the government together. We must ensure that a health divide is not created within the country and yet use this huge opportunity," he says.
The corporate hospitals have not failed to recognise the opportunity. Many of them are upgrading to offer the latest medical diagnostic facilities to medical tourists, which may also be packaged with vacations in a tie-up with airline companies. Says Anil Maini, president, corporate development, Indraprastha Apollo, "We have 64 slice CT scans, PET CT and 3 TELSA MRI machines which most hospitals abroad cannot boast of."
But as corporate hospitals open their doors to a greater number of medical tourists, some analysts believe that the impact of this phenomenon on national healthcare needs careful study. Some observers fear an exodus of highly skilled doctors from the atrophied public health system to high paying private hospitals. "Many States are not even ready to fill vacancies in government medical service, compounding the problem," says a surgeon in Chennai's Government General Hospital, the apex public health institution in Tamil Nadu.
(With inputs from Aarti Dhar in New Delhi, Prachi Pinglay in Mumbai, Sahana Charan in Bangalore and Y. Mallikarjun in Hyderabad)
On the road to global fame
THE size of the Indian medical tourism sector is thought to be about 1,00,000 to 1,50,000 patients a year. The Indian Healthcare Federation, a consortium of non-governmental hospitals, diagnostic centres, medical equipment manufacturers and pharmaceutical industries says about 1,00,000 foreign patients are coming to the country, up from 10,000 five years ago.
The CII-McKinsey report estimates that the annualised growth of the medical tourism market was about 30 per cent in 2000, up from 15 per cent in the five previous years. The growth has been limited, the study says, since foreign patients represent only a fraction of total patients handled by individual hospitals.
Figures for patient arrivals from abroad are available from individual states and hospitals: The Karnataka Tourism Department says it has been receiving about 8,000 patients annually, mostly for cardiac and orthopaedic procedures. Manipal gets 3,000 foreign patients a year, some of them for dental care; Wockhardt Hospital and Heart Foundation in Bangalore gets 900 patients a year.
CII-McKinsey forecasts upmarket private care in India to be worth anywhere from Rs.15,000 crore to Rs.30,000 crore by 2012 and medical tourism can potentially raise that by Rs.5,000 crore to Rs.10,000 crore. Medical tourism represents 25 per cent of revenues of private up market care in this estimate and three to five per cent of the total delivery market.
With increased activity to build hospitals in the corporate sector, foreign patient arrivals are expected to rise significantly.
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