The business of medicine
Randeep Wadehra

Medical tourism in India: management and promotion
by Dr R. Kumar. Deep & Deep, N. Delhi.
Pages: ix+335. Rs 980.

Medical tourism in India: management and promotionMedical tourism is one of the countless concepts spawned by globalisation. It integrates international and domestic travel with the supply and consumption of medical services, thus making top-of-the-line healthcare available to anyone who needs it (and can afford it) transcending international boundaries. In the pre-globalisation days only a privileged few from Third World countries would travel to the West to avail of the latest, world-class medicare. Now, the trend is reversing. More and more medical tourists from Canada, USA and UK etc are visiting India. From a mere 1,50,000 in 2002, the number has already crossed the half-million mark.

What are the reasons for this trend? It is estimated that in the USA alone there are 47 million uninsured and 120 million under-insured people who cannot afford the high-cost local health facilities. India has state-of-the-art hospitals for open-heart surgery, pediatric heart surgery, hip and knee replacement, cosmetic surgery, dentistry, bone marrow transplants and cancer therapy; and the clinics are equipped with latest electronic and medical diagnostic equipment, facilitating healthcare at par with hospitals in the west at a fraction of what the latter charge. For example, a bone marrow transplant procedure that costs $250,000 in the US can be performed for $25,000 in Indian hospitals with facilities at par with the best in the West. Similarly, a heart surgery that costs $50,000 in USA can be availed of at $6,000 in Mohali and Chandigarh. A heart-valve replacement that would cost $200,000 or more in the US will cost $10,000 in India; and these include round-trip airfare and brief vacation packages. Similarly, a metal-free dental bridge worth $5,500 in the US costs $500 in India,

Our diagnostic facilities are attractive too. A regular medical check up, blood tests, X-rays and ultrasounds, which may cost more than $570 in London are available at less than $90 in India. Moreover, in countries like the UK and Canada the waiting period for a hip replacement can be a year or more, while in India, a patient can be in the operating room the morning after getting off a plane. Dr Kumar avers that, on an average, the waiting time for a walk-in patient to meet a specialist is only 17 minutes.

Additionally, some Indian medical centers even provide services that are uncommon elsewhere. For example, hip surgery patients in India can opt for a hip-resurfacing procedure, in which damaged bone is scraped away and replaced with chrome alloy – an operation that costs less and causes less post-operative trauma than the traditional replacement procedure performed in the USA. Not only does India have the necessary technological sophistication and infrastructure to offer best possible healthcare at affordable costs but also pharmaceuticals that meet the stringent requirements of the US Food and Drug Administration. And let’s not forget that our doctors, surgeons and paramedics are as good as the best anywhere else in the world.

But medical tourism is not about mainstream medicine and surgeries alone. Our ancient Ayurvedic system too offers therapeutic and recuperative services to medical tourists. The author has given a long list of various ayurvedic centres in different parts of the country along with their respective addresses and contact numbers.

So, medical tourism, at least prima facie, is proving to be a win-win proposition for the medical fraternity as well as the ailing humanity.

However, the phenomenon raises several questions: Should a nation, which can hardly afford a basic-minimum healthcare facility for its teeming millions, be going in for such luxurious amenities that only a few in the country can afford? Wouldn’t the government be better off spending funds on more egalitarian alternatives?

This book counters these arguments quite cogently. Firstly, since most, if not all, of these hospitals are in the private sector there should be no or minimal burden on the state exchequer. We have several cash rich shrines and religious organisations that can be encouraged to invest in developing medical infrastructure. Even the PPP arrangement can help the state and central governments to earn dividends if the relevant agreements are drafted wisely. Moreover, the fast growing industry can be a source of income to the government in the form of taxes. Experts estimate that medical tourism could bring India as much as $2.2 billion per year by 2012. And, it can generate the much needed employment avenues.

Admittedly India faces several challenges. First and foremost, its negative image as a nation that tolerates unhygienic conditions everywhere. The stinking and ill-kept public places, open-air latrines and all-pervasive pollution don’t do any good to our attempts at wooing medical tourists. Then, in order to reassure foreign patients, there is need for an independent mechanism for prompt resolution of litigations that may arise vis-`E0-vis the quality of services rendered. Much needs to be done in these spheres – Kumar could have come up with useful suggestions here.

Proof-reading too could have been better.

Nevertheless, this information-rich book, with relevant examples and case studies, is a valuable addition to the growing literature on medical tourism.