Patient outsourcing: No stopping this
one By Siddharth Srivastava
NEW DELHI - The label is "patient outsourcing",
and fears that the US Congress may pass inimical federal
laws or electoral politics cannot impinge on its growth.
After all, it's not a matter of jobs at stake, but a
matter of life and death. And while multinationals look
to India as an outsourcing hub, citizens of more
advanced countries are increasingly making India their
medical destination of choice. The reasons include both
of the familiar buzzwords: quality - high, whether in
terms of people, expertise or state-of-the-art
equipment; and cost, which could work out to be a tenth
of what similar procedures cost abroad.
"Foreigners are arriving in hordes for quality
medical care at low cost," says Naresh Trehan, who
practiced in the United States for more than a decade
and is now a top cardiologist in India and chief
executive officer at Escorts Hospital, which specializes
in cardiac care. "Two areas in heart care - angiography
and angioplasty - are keenly sought. In the last year
more than 100 foreigners from the US and UK were treated
at the Escorts Heart Hospital in Delhi," he adds.
Medical experts have been referring to India as
a major health-care destination for quite some time. And
long queues of patients from neighboring countries such
as Bangladesh, Pakistan and Malaysia along with regions
such as the Middle East and Africa are a regular affair.
Recently, India has seen a sudden burst of
patients from Western countries as well. Estimates
suggest that up from a previous 3-5 percent, foreigners
account for 10 percent of patients in India today.
Patients from the United States and the United Kingdom
who are not covered by medical insurance at home in
particular are making a beeline for India.
Not
to be outdone, major travel firms have devised packages
with hospitals to make the stay of patients and that of
their kin more comfortable. The state government of
Maharashtra - which encompasses Mumbai, the capital, and
boasts of several state-of-the-art hospitals - is in the
process of launching special medical-tourism packages
that will include a visa, airport pick-up,
transportation, hotel and hospital and recuperation
requirement. Cox and Kings India, a major travel
company, currently chalks out itineraries for patient
recovery, including bookings to quiet and scenic
locations in Goa and Kerala. Special arrangements also
can be made to mix in visits to places of interest for
friends and kin.
India's health-care
advantages Delegations of Indian doctors
regularly are being invited to London to brief British
Prime Minister Tony Blair's medical advisers about
India's health-care advantages. The British government
is desperate to break the logjam of more than a million
National Healthcare Service (NHS) patients stuck on
waiting lists. One solution: fly them over to quality
hospitals in India's mega-cities Mumbai or Delhi.
At the Apollo Group of hospitals - one of the
top groupings in India, with 30 hospitals across the
country - more than 60,000 foreign patients from 34
countries have been treated in the past decade. Half
have arrived in the last few years. Meanwhile, more than
70,000 visitors arrive annually to India from the
Persian Gulf countries.
"India has truly emerged
as a health-care destination of choice," says Pratap
Reddy, chairman of Apollo Hospital, which is negotiating
with NHS to treat exceptional cases. And indeed, a
multitude of factors have combined to make India,
labeled as a Third World developing country, an
attractive medical-tourism destination.
The
foremost factor is the proven record of Indian doctors
abroad, and the adequate supply of medical-related
brains here. There are more than 40,000 highly sought
Indian doctors in the US, which has strengthened Western
confidence in the Indian medical system.
Another
equally important facet is cost. Private-sector
specialty hospitals in India offer treatment and
facilities that meet international standards at 10-20
percent of the cost of treatment abroad.
Lasik
(laser-assisted in-situ keratomileusis) eye surgery in
India, for instance, costs a fraction of what it does
abroad. Cosmetic surgery, dentistry, kidney transplants,
bypass surgery and cancer treatments are the other areas
of interest. A bone-marrow transplant that costs
US$200,000 (Rs9 million) in the United States costs only
$20,000 (Rs904,700) in India; orthopedic surgery $20,000
in the US, $5,000 in India; liver transplant $200,000 in
the US, $60,000 in India; breast enlargement $2,000 in
the US, $1,500 in India.
The average cost of
cardiac surgery at the best hospital in India is $6,000
and boasts a success rate of 98.5 percent. Open-heart
surgery in the UK can cost more than $20,000, while it's
double that in the US. A single tooth filling costs $10
here against $300 in the US. Further, there is no
waiting period for major medical procedures. Routine
procedures such as cataract and heart surgeries require
a wait of almost a year in the UK, and many patients who
are critically in need don't survive the waiting period.
In addition, treatments using alternative medicine such
as Ayurveda and Reikh are already popular in India.
These costs are based on hospitals and doctors
in India that can compare with any medical facility
across the world. In fact, most doctors who practice in
India already have been exposed to international stints
in the US or Europe.
Plugging the technology
gap In keeping with demand from their
international clients and that of big business,
corporate hospitals have adopted the latest medical
technology to plug the gap vis-a-vis the rest of the
world. According to Gurmit Singh Chugh, marketing
manager of cardiology at Boston Scientific International
BV, a subsidiary of the $3 billion Boston Scientific
Corp, "Medical technology used to be a differentiator
between us and the developed countries. But this gap
doesn't exist anymore today because corporate hospitals
in India offer the same technology as their counterparts
in the rest of the world."
The Indian government
too has recognized the enormous potential of the global
health-care industry. A series of tax concessions and
incentives for private investment in private hospitals
has been announced, and import duties on life-saving
equipment has been reduced from 25 percent to 5 percent
to encourage hospitals to import the latest equipment.
The government estimates that the Indian
health-care industry is valued at $17 billion, 4 percent
of India's gross domestic product (GDP), and is growing
at more than 10 percent each year. It is expected to
reach $60 billion by 2012. A recent study conducted
jointly by the Confederation of Indian Industry lobby
and McKinsey said that by 2012, India can earn more than
$2 billion a year from health-care tourism alone. "Like
information technology, this sector will create millions
of jobs and will earn huge foreign exchange," says
Reddy.
However, experts also warn that a
majority of the Indian population does not even have
access to basic medical facilities, and that is a cause
for concern. There are fears that hospitals catering to
foreign clientele are likely to ignore the requirements
of the local population for whom the cost for such
treatment is not affordable.
"It is important
that a section of the money earned by the private
hospitals be channeled into building infrastructure
which will benefit the poor and the downtrodden," says
Arvind Bhardwaj, a physician who works for the Naz
Foundation, a leading community-based organization
involved with the AIDS virus in India. The real face of
Indian health care is pitiable. Villages and entire
districts often don't have primary health-care
facilities. According to the Human Development Report
2003, commissioned by the United Nations Development
Program, public health expenditure as a percentage of
GDP stood at a paltry 0.9 percent. As such, high-end
hospitals should be nurtured not just to satisfy the
health and lifestyle needs of a privileged few, but
ultimately, there would be a discernible trickle-down
effect on health care for the masses.
As far as
"patient outsourcing" goes, however, it does seem to be
a smooth ride to the top.
Siddharth
Srivastava is a New Delhi-based journalist.
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