Medical Tourism ? Or Globalisation of Healthcare !

Indian President Off to U.S. AP Published: October 1, 1982

“President Zail Singh left here today for the United States where he will undergo a heart examination and possible surgery at the Texas Heart Institute in Houston”.

American Doctor gets a new hip at Mumbai hospital – Patients’s Experiences on a hospital website May, 2006

“I'm working full-time in a physically demanding job and my wife says she's never seen me happier. I run three miles every morning and say a little prayer for you, Pradeep and Dr Malhan and all of your wonderful staff while I run. You have truly given me my life back.

The only problem I have is occasional pain in the other hip. Hip resurfacing is now available at a nearby hospital but I'd prefer to have your team do it--even though it means paying out of pocket.

I hope this finds you all healthy and prosperous.”

Dr Jim Allen. Plymouth, MN, USA
(Seven months after returning to his home in USA after a Hip Surgery in India.)

These two news items are symbolic of the transformation that has taken place in just about the past two decades in the Indian healthcare sector ; particularly in the high end tertiary care segment. This has been made possible within such a short span of time due to the pioneering efforts of some of the top private hospital groups in India, like Apollo, Wockhardt Hospitals, etc. Today the top private hospitals in India not only have the best in class medical infrastructure and technology like 64 Slice CT Scans, Computer Navigated Surgery Suites, etc., they also have on board physicians and surgeons who are amongst the best in the world. There is a reverse brain drain happening now, with more and more top doctors of Indian origin returning back to India and delivering world class services at Indian hospitals.

INDIAN MEDICAL FRONTRUNNERS: MEETING INTERNATIONAL BENCHMARKS

The Joint Commission on Accreditation of Healthcare Organizations
(“JCAHO”), an organization that inspects hospitals, now has an international arm called JCI that audits and accredits foreign medical centers to see if they meet high American
standards. The hospitals belonging to the Wockhardt and Apollo group have received the JCI accreditation that confirms that these hospitals adhere to international standards of clinical care, safety of environment, medication safety, respect for rights and privacy, international infection control standards and access to dedicated, well trained staff.

Standards of care and level of medical expertise in top hospitals in India are generally just as high as and sometimes even higher than at home in the industrialized wealthy countries. The work culture in Asia is very persevering and countries are warm, both climate wise as well as hospitality wise. As the New York Times columnist Thomas Friedman noted in his authoritative book “ The World is Flat” , “France can forget about trying to save her 6 week worker vacation period standard holidays. In India they are trying to figure out how they can work 24 hours a day.”.

No wonder international patients are delighted with Indian hospitals. The Wockhardt Hospitals group has a page on its website that has over 30 video testimonials of American and British patients extolling them for the services experienced by them.

THE REVERSE INFLUX: REASONS

India has traditionally been always a destination for patients from the neighbouring countries like Nepal, Bangladesh, Afghanistan and Sri Lanka. In the eighties. patients from the Middle East began coming to hospitals in major Indian metros. A large number of patients come to private hospitals in India from countries in East Africa like Tanzania, Kenya, Uganda and in the West Africa like Nigeria , where the facilities for advanced medical care just do not exist .

But this recent phenomenon-- which has emerged over the last couple of years--of patients from the developed world, i.e, from USA, Canada and UK coming to India for high end surgical care is an interesting one and the primary subject of this article. In fact, this new wave of patients coming to India from the West for highly sophisticated surgeries like Hip Resurfacing , Cardiac and Spinal Surgeries may become another driver of strengthening India’s march towards becoming a global economic leader following its success in the field of Information Technology and Biotechnology.

United Kingdom and Canada have socialized medicine where the public exchequer bears the cost of the healthcare for the whole population but the system is under strain and the citizens have to wait and bear the pain for months. In some instances , the waiting period could be as much as a year to get a surgery done. Many of these patients are now taking their own decisions to fly to another country and get the procedure done and pay out of their own pockets.

THE COST DISADVANTAGE:

The situation in America is quite different, and, in fact, pretty serious. According to the Economic Research Initiative on the Uninsured, conducted by the University of Michigan, 20 percent of Americans between the ages of 19 and 64 — 36.5 million adults — have no health insurance. Nine percent of children under 19 are uninsured, bringing the total to 45.5 million uninsured Americans, or 17.8% of the non-elderly population.

These statistics don’t include the underinsured, such as people who pay a lower premium for policies with larger deductibles and co-pays. So the likely number of people uninsured or under insured and those left to fend for themselves is estimated to be over 65 million. Health insurance policies -- with high deductibles, co-pays, and many exclusions -- offer little protection during a serious illness.

The cost of surgery at a private hospital in the United States is very expensive due to various reasons like the general high cost and scarcity of skilled medical manpower, cost of litigation that forces the hospitals and physicians to buy expensive indemnity cover and its impact on the whole practice of medicine. As a result, the medical practice has become mired in documentation and procedures, and physicians are compelled to resort to defensive medicine and over consumption to avoid litigation, inflating the costs further.

Illness and medical bills caused half of the 1,458,000 personal bankruptcies in 2001, according to a study published by the Journal of Health Affairs. The research was carried out jointly by researchers at Harvard Law School and Harvard Medical School, Dr. David Himmelstein, the lead author of the study and an Associate Professor of Medicine at Harvard comments: "Unless you're Bill Gates you're just one serious illness away from bankruptcy. Most of the medically bankrupt were average Americans who happened to get sick."

The result is that thousands of American citizens are now increasingly traveling to countries like, India, Thailand, Costa Rica and Mexico for surgical care. Often these are desperate patients for whom the choice is either to mortgage their property and pay for the much needed surgery or take a leap of faith and travel to another country for surgery. The United States Senate Special Committee on Ageing held hearings on the issue of medical tourism in June 2006 and called for a task force of experts to explore the impact and safety of lower cost healthcare abroad.

Health insurance has been a major plank on which the elections are being fought in the USA, currently. Electoral promises of revamping the health insurance sector and restoring it to a semblance of normalcy have been flying thick and fast, but it remains to be seen how many of these commitments made in a pre electoral, myopic context will actually translate into policy changes—rather, how much of it would be possible.

That medical tourism is a reality and will continue to be so is not even arguable. But it’s necessary for all stakeholders to look at the developments from a pragmatic perspective so that expectations are realistic. This is all the more necessary because medical tourism is already mired in many myths, many of which can be detrimental to the healthy growth of the sector. Discussed below are five such myths that have been projecting a distorted picture of medical tourism and the expectations associated with it:

SEARCHING FOR SOLUTIONS:

Many of the big corporate groups, particularly the automobile companies in Michigan, have a mounting healthcare cost burden that seems to be threatening their survival. In an effort to reduce the financial burden of employee healthcare, several Fortune 500 corporations are evaluating the feasibility of outsourcing expensive medical procedures to offshore healthcare destinations.

The insurance industry is looking at becoming an active participant in medical tourism. Top insurance groups like Blue Cross Blue Shield, Aetna and CIGNA etc. are exploring the opportunity to sell insurance policies that will enable or encourage patients to have expensive surgical procedures in India.

The outsourcing of healthcare services to hospitals outside the USA is therefore inevitable and considering that the present size of US healthcare is 2 trillion dollars which is expected to triple in next 10 years, even a fraction of the surgical work outsourced would mean a tremendous opportunity for high quality providers in Asia.
In view of the above, there is a tremendous opportunity for India to position itself as a destination for high quality and good value healthcare destination. Other countries in Asia like Thailand, Singapore and Malaysia are getting organized and would certainly provide tough competition. These countries, though cost wise slightly more expensive than India, have an advantage of being popular tourism destinations with good external infrastructure.

Medical Tourism is expected to be a $40 billion industry by 2010 [1] . Globalisation will mean more choices and flatter terrain for patients across the world and they will go to wherever they find better service, better quality of clinical outcomes and better monetary value. While the Indian government would have to take a number of initiatives to improve our infrastructure, air connectivity and liberalize the visa regime, the providers i.e. the top hospitals need to work together to build a strong positioning for Indian healthcare. There are a myriad variety of issues to be addressed by us together like finding ways to ensure continuity of care to the foreign patient after his return home, preparing for legal liabilities, ensuring uniformity of pricing and presentation of medical treatment packages, and, above all, ensuring that all our actions keep the Indian Healthcare brand flying high.


[1] Open-Heart Surgery--90% off - Forbes.com http://members.forbes.com/forbes/2007/0813/021.html