As India celebrates the 75th year of its Independence, it is readying itself with a new slogan, ‘Heal in India’, to open its doors to the world for medical tourism. Medical tourism is a term used to describe the practice of travelling across international borders to seek healthcare services. There has been a sea change in medical tourism in the last four decades: from people travelling to the USA or Europe for heart surgery or cancer treatment to the current times when there is an increasing flow of patients from rich countries to developing ones.
The main reasons for seeking treatment overseas are cosmetic surgery (breast, liposuction), cardiology/cardiac surgery (bypass, stent placement), orthopaedic surgery (hip and knee replacement), bariatric surgery, fertility treatment, organ transplantation, dentistry and diagnostics. It is estimated that some 1.40 crore people travel to different countries for better medical treatment every year. In 2019, before Covid-19 struck, 6.97 lakh persons (seven per cent of the total international tourists) travelled to India on a medical visa. It is expected that these numbers will go up rapidly as international travel opens up. Actually, the pandemic has created more backlogs across the world for elective surgeries like joint replacement.
Different medical tourism destinations have acquired specialisations of sorts. Brazil is famous for cosmetic surgery, Mexico and Costa Rica for dentistry, Malaysia for dental and cosmetic surgery, Indonesia for health check-ups and Thailand for cosmetic and bariatric surgeries and wellness tourism. India has the unique distinction of the availability of all super-specialties, including organ transplantation. It also has a rich tradition of wellness centres and offers ayurveda, yoga etc.
For patients from the developed nations, the main reason to go to developing countries is the low cost. For instance, a joint replacement can cost $35,000-45,000 in the USA, $20,000-25,000 in Israel and $6,000-8,000 in India. A heart bypass would cost up to $9,000 in India against $10,000-12,000 in Thailand, $11,000-12,000 in Singapore and $45,000-50,000 in the USA.
Then, there are patients seeking cosmetic surgery, fertility treatment and other treatments not covered by health insurance. Canada and the UK have long waiting lists for elective surgeries, forcing many to seek treatment elsewhere. Some patients, particularly those undergoing plastic surgery or sex change procedures, choose foreign destinations to ensure privacy.
The strength of India lies in the skills of our doctors, support staff and nurses and the state-of-the-art infrastructure which is comparable to the best in the world. Many doctors are trained abroad and language is not an issue. India has excellent diagnostic and imaging services, which too are available at one-tenth to one-fifth of the cost in the USA. India has over 35 hospitals accredited by the JCI (Joint Commission International). This tag ensures quality, safety standards and adherence to international norms. India was ranked 10th among the 46 nations on the Medical Tourism Index 2020-21, released by independent information provider MedicalTourism.com.
Many countries are vying to have a greater share of the medical tourism pie. In Thailand, Singapore, Malaysia, Dubai and South Korea, the governments have facilitated medical tourism through initiatives like the Multi-agency Government-Industry Partnership (Singapore) and the National Committee for Promotion of Medical and Health Tourism (Malaysia). Germany and Hungary have broadened their ambit by including state and university hospitals into the game. There are examples of collaborations which transcend borders, like the Harvard Medical School, Dubai Center, and The Johns Hopkins Singapore International Medical Center.
So far, in India, it was left to individual hospitals to market themselves. They would advertise the foreign qualifications of their doctors to attract patients from abroad. In the last few years, however, the government has taken proactive steps to harness medical tourism. Since August 2019, foreigners can receive any treatment, except organ transplantation, without a medical visa.
In the last few months, a series of strategic moves has been initiated, such as streamlining Medical Value Travel (MVT) and the plan to launch a “Heal in India” project globally to showcase India’s expertise in healthcare. The government has identified over 40 countries from where large numbers of people visit India for medical purposes. The Health Ministry, along with the National Health Authority, has developed a multi-lingual portal which is a one-stop shop for services provided by medical travel facilitators and hospitals. Ten airports with the maximum inflow of patients will offer services like facilitation desks and translators.
Some other initiatives envisaged include health insurance portability by way of giving an extended insurance cover, development of medical enclaves for foreign patients and special wellness tourism zones and capacity-building. A nodal agency, the Medical Value Travel Council, co-chaired by the health and tourism ministries, has been formed to streamline the integration of all stakeholders. To complement these efforts, over 60 start-ups of medical facilitators have sprung up in key cities; they offer the choice of medical experts and hospitals. They also arrange for the patients’travel, stay, visa, financial aid and, at times, translators, drivers, cooks and even house help.
But, there are some flip sides too. Brain drain in the country towards private hospitals at the cost of the public sector is a concern in Thailand and it would apply to India as well. The risk of infections, including drug-resistant ones, shortened post-operative care, lack of follow-up, unwarranted surgery and medico-legal issues are the other concerns. The Australian Medical Association has warned its citizens to consider the risks. The Center for Disease Control, USA, has issued a ‘yellow book’advisory.
With no government hospital in India accredited to agencies like the JCI, the onus of medical tourism falls on the private sector which must deliver and stand up to scrutiny. To utilise the infrastructure and expertise in academic institutions, a public-private partnership model of some kind could be forged. The government must ensure that adequate safeguards are built in the system and proper regulatory control is in place. The sector must be organised by way of registration, accreditation and categorisation of MVT facilitators as well as medical service providers to create a trustworthy ecosystem and eliminate the undesirable elements. Indian hospitals could also liaise with overseas insurers and develop joint initiatives with international providers.
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