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HEALTH TOURISM

In good hands of high-calibre medical workforce

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On April 20, US president Barack Obama remarked that Americans need not travel to India to get "cheap healthcare". Forty-seven-year-old Guy Williams, a basketball coach from Alaska, could not help but laugh at the comment. "Obama must be crazy. Healthcare is extremely expensive in the US and so is health insurance, which is unaffordable for some 50 million Americans, " says Williams who underwent a hip-resurfacing surgery at the Apollo hospital in Chennai. He chose to come all the way to Chennai for the surgery because he could not afford to pay $58, 000 for the treatment in the US. In India, though, he had to pay just $8, 000 for the iPad navigated surgery which promises more precision and better results. Williams is so happy with the outcome of the procedure and his stay at the hospital that he now plans to get his brother to India for the same treatment.

Like Williams, lakhs of patients from around the world make a beeline for India to get high quality yet cost-effective healthcare. The hospital wards look like international air terminals, teeming with people from different races. The corridors echo with tongues of faraway lands. Soft dialects of Central Asia mingle with the guttural sounds of Africa. Women in blue burqas rub shoulders with Anglo Saxons tottering about on brand new hips and knees. Everyone's welcome to heal in India.

The latest Medical Tourism Climate Survey 2011, conducted for the European Medical Travel Conference, has revealed India to be the most popular destination for health travel in the world. Industry experts estimate that about 5 lakh foreigners fly to India for medical treatment every year and the industry is growing at a healthy annual rate of 30 per cent. The market is expected to reach the $2. 3-billion mark by 2012.

Although India is considered a relatively new entrant in this industry, it has already created a niche for itself as a country that offers quality healthcare at affordable prices. The journey to be a global medical hub started in 1997 - a time when many Asian countries, reeling from economic crises, opened up their healthcare to foreigners and applied for validation by the just-constituted Joint Commission International Accreditation and Certification system, which monitored and ensured a safe environment for patients, staff and visitors. Many hospitals in the region got the mandatory JCI accreditation. Thailand started offering attractive cosmetic and dental surgery packages to Americans at a fraction of what was charged in the US. India, riding high on the construction boom, joined in big time by the early 2000s.

Now, roughly 10 years after the first few corporate hospitals in Mumbai and Chennai started receiving international patients, 17 hospitals in India have JCI accreditation. The growth of medical tourism in India is set to establish new benchmarks even as the sector is witnessing interesting new trends.

THE NEW CLUSTERS


The health care market itself has been growing at 16 per cent a year. There are hospitals mushrooming everywhere. The spread of health infrastructure as well as better and more efficient modes of travel to cities beyond the metros has diverted the traffic of health travellers to newer hubs - from the older ones of Chennai and Mumbai - like Delhi, Pune, Goa and Hyderabad. No city demonstrates this shift better than Pune. The once laidback cantonment town, best known for its Shrewsbury biscuits and tolerable weather, now is in the news for its state-of-the-art organ and bone marrow transplants.

At Ruby Hall Clinic, there's a six-month-long waiting list for bone-marrow transplant procedures. "Right now, we have as many as eight to nine foreign patients who have already made the full payment, but are on the waiting list, " says Bhomi Bhote, chief executive officer at the hospital which started off in 1959 in a small bungalow owned by an army general. The procedure costs over Rs 30 lakh, but it is still much less than the Rs 70 to 80 lakh charged abroad.

Many medical travellers prefer Pune for its kidney, cardiac and oncology treatments. This is in addition to cosmetic procedures like liposuction. "Obesity surgeries find many international takers. We are scheduled to perform 125 bariatric surgeries this year and most of them on foreign patients, " says Bhote.

Apart from the weather, Pune has benefited from the overcrowding in Mumbai hospitals, something that pushed health care developers to exploit nearby untapped markets. With the opening up of corporate hospitals in the city, many doctors and specialists from Mumbai moved to Pune, taking their international patient database with them. The city gets most of its foreign patients from the UK, Kenya, Nigeria and Iraq. Now, with better air connectivity with Dubai, the hospitals expect a greater inflow of health travellers. "The treatment cost in Pune is 15 to 20 per cent less than what it is in the other metros. In addition, the city has many expats who tend to invite their relatives for treatment here. Foreigners come here mainly for neurosurgeries, " says George Eapen, CEO, Jehangir Hospital. Most hospitals in the city get around 50 international patients every month, and the numbers are growing. Jehangir Hospital has witnessed a 10 to 15 per cent increase over the past year. The Lokmanya Group of Hospitals, too, has seen a 100 per cent jump in numbers. But Pune faces stiff competition from Ahmedabad, which is shaping up as a big medical tourism centre in western India. In the past seven to eight years, the capital of Gujarat has seen tremendous growth in its medical infrastructure. Corporate hospitals like Shalby have put this culturally vibrant city on the international medical travel map. The city receives an estimated 6, 000 international patients every year, of which a large chunk comes for knee-replacement surgeries. Dr Vikram Shah, renowned orthopaedic surgeon and chairman of Shalby Hospitals, attracts a majority of medical travellers to the city. Medical tourism in Ahmedabad is largely fuelled by former citizens now settled abroad.

They come here for treatment, go back and spread the good word about doctors and hospitals. Dr Mahendra Narwaria, a bariatric surgeon, gets up to 50 per cent of his patients from the UK, the US and African countries. Apart from Shalby, other private hospitals like Apollo, Sterling, SAL, Mayflower, HCG Medisurge and various fertility centres cater to large numbers of international patients. The hospitals - which have also been consistently demanding direct flights from various African countries to Ahmedabad to facilitate larger inflows of patients - are aggressive with their marketing and many have opened clinics in African countries.
A crucial factor that directs foreign patients to smaller cities is personal attention. Doctors in bigger, more crowded centres like Mumbai and Chennai don't always have enough time for the patients. But in smaller hospitals, the doctors patiently hear out their problems, clear doubts and even lend emotional support. This makes a huge difference to the patient's experience and stay in India.

Even Manipal, a small university town in Karnataka, gets around 4, 500 foreign patients every year;60 to 70 per cent are from the US. "In the past couple of years, the inflow of medical travellers to Manipal has been increasing at about 30 per cent annually. Patients from the US and the UK come here because they get better care as well as cost benefits, " says Dr Nagendra Swamy, group medical health director, Manipal Health Enterprises. For similar reasons, Goa and Hyderabad also lure patients from abroad.

FIGHTING BACK


Even as medical tourism is thriving in smaller centres, traditional hubs like Chennai are experiencing a dip in the number of international patients. Of course, Chennai hospitals deny it. But if 10 years ago Chennai received 80 per cent of the medical travellers coming to India, now its share is down to 60 per cent, say some doctors and hospital managers. To retain their hold on the market, Chennai hospitals now are upgrading existing facilities to address infection concerns, acquiring cutting-edge technology from the West and developing niches within their core competence of heart and orthopaedic surgeries.

The management at MIOT Hospital, for instance, is building an international block that boasts of world-class standards. Many
hospitals regularly send their staff to the West for recruitment drives. Forty per cent of doctors hired last year by the city-based
Global Hospitals were from the US and the UK. Getting medical staff with international work experience enables the hospitals to
expand into super-specialties, control infection rates and prevent antibiotic abuse. "We are always in need of trained doctors in certain specialties. Last year, we employed doctors with training in paediatric behavioural sciences, paediatric intensive therapy and transplant surgeries, " says Dr Sathya Bhama, medical superintendent, Apollo Hospital, Chennai.

Chennai is also known for cadaver organ transplants (it has carried out the highest number of transplants in India) that attract recipients from all over the world.

Of course, preference is given to Indians, but if a hospital does not find any suitable Indian recipient the organs are offered to foreigners. In 2010, 65-year-old American Ronald Lemmer underwent a successful heart transplant in Chennai. Lemmer was transplanted with the heart of a 36-year-old accident victim in an eight-hour surgery on July 21, 2010. "The doctors in the US told me that I would have to wait a year to get a donor. I decided to come to India for the transplant after some research on the internet. Indians gave me their heart, " says Lemmer, who runs a glass business.

LOCALISED ACTION


Lemmer chose India to get a second lease of life, but there aren't many Americans like him. Contrary to the popular perception, Americans and Europeans form a tiny percentage of the health travellers visiting India. "Patients from the developed world form less than five per cent of the traffic, " says Hari S Boolchandani, head, international patient services, Max Healthcare. Most of the international patients who come to India are from the SAARC countries and Africa. "Countries like Bangladesh, Malaysia, Indonesia and those from Africa lack good medical infrastructure. That's why patients from these nations come to India, " says Dr Ashutosh Raghuvanshi, group CEO, Narayana Hrudalaya, Bangalore, famous for its Rs-10-per-month heart surgeries.

Recently, Artemis Health Insitute, Gurgaon, received Omar, a 19-year-old patient from Iraq who had been advised leg amputation for a cancerous tumour growing inside his left thigh. It had almost eaten into his lower thigh and knee joint, resulting in a painful swelling that made walking very difficult. But his parents didn't have the heart to take such a life-altering step for their teenaged son who loved to play football. Their friends suggested an India visit. Doctors here managed to remove the eight-kilo tumour during the course of a two-hour surgery, saving his limb.

Victims of the on-going war in Iraq regularly turn up at Indian orthopaedic wards for corrective surgeries. "We get many patients from Iraq and Afghanistan with serious injuries from land mine blasts and bomb blasts, " says Bhote.
Unlike the war-ravaged nations, Gulf countries have always enjoyed highend health infrastructure. But now they lack skilled manpower to run these institutions, most of which were managed by Indian doctors. However, after the health boom in India these specialists came back home to work at senior positions, and very handsome salaries, in various private and corporate hospitals. Their patients followed them here.

While patients from the Middle East prefer getting treated in Mumbai and Chennai, Delhi, which in recent years has been attracting large numbers of global health travellers, is the preferred destination for patients from Afghanistan, Pakistan, Bangladesh, Nepal and Bhutan. "SAARC countries account for 30 to 35 per cent of patient traffic to Delhi, followed by 20 to 25 per cent from the Gulf and CIS countries. These places have almost no speciality hospitals. There are no good cancer hospitals in Pakistan and Afghanistan, " says Boolchandani of Max. "Earlier, people in the Gulf used to travel to Egypt for medical treatment, but now India offers them better doctors and overall healthcare, " he adds. Delhi got 15, 000 international patients last year, and the numbers would be higher if patients who come for consultations and diagnostics are counted in.

PROGNOSIS


Hospital managers have now set their eyes on the US and European markets. "We have been pitching India as a medical destination which will offer world class healthcare at one-third of the cost, " says Dr Devlina Chakravarty, medical director at the Artemis Health Institute, Gurgaon. She says the next wave of medical tourism will see Indian hospitals adding frills like spas, pools and gymnasiums to attract Americans and Europeans, and developing centres for cosmetic and dental surgeries. "India needs to topple regional competitors like Singapore (best known for transplants) and Thailand (for cosmetic surgeries) and emerge as the leader in Asia, " says Vijay Gupta, deputy director, marketing, Hinduja hospitals. He feels India is trapped in its image as a cheap destination. "We need to demolish this stereotype as our manpower and facilities are comparable to the best in the world. We need to take a position in the global market of medical tourism and present ourselves as a country that offers specific skills which can command a premium, " says Gupta. His point is underscored by Dr Sujit Chatterjee of Hiranandani Hospitals. Chatterjee admits that medical tourism in India has not kicked off as well as it should have by now. "We still lack high-degree super speciality. For instance, there are good doctors to treat Parkinson's, but we don't have highly-skilled physiotherapists required for such patients. "

To achieve this image makeover, Indian hospitals need to polish up paramedical infrastructure, reduce infection rates and develop super-specialties. Sunil Kapoor, chief (sales), Fortis Healthcare (India), also stresses the need to develop cities simultaneously. Hospitals have also been in talks with the government for faster issuance of visas for medical travellers as the current process is tardy and slow. Healing hearts and bodies, they say, is the best diplomatic move a country can make. Many of the patients coming in from abroad and carrying tales of cheer and hope from India would readily agree with that.

VITAL SIGNS


In 2009, 2. 2 per cent of the total foreign tourists who visited India came for medical treatment. These medical tourists came primarily from South Asia with Maldives being the leading country followed by West Asia where Oman sent the maximum number of medical tourists to India. Africa was the next highest source - about 4. 5 per cent of the tourists from Africa come for medical treatment

The share of India in foreign tourist arrivals in the world increased from 0. 39 per cent in 1998 to 0. 58 per cent in 2009

India is now handling more than 5 lakh foreign patients annually compared to 12 lakh patients who flock to the current world leader in medical tourism, Thailand


FICCI-YES Bank report on medical tourism

- WITH INPUTS FROM PUSHPA NARAYAN, CHENNAI;NEHA MADAN, PUNE;RADHA SHARMA, AHMEDABAD AND JAYASHREE NANDI BANGALORE

Reader's opinion (8)

Anil BankarJun 4th, 2011 at 14:56 PM

Medical Tourism is lucrative industry but there should be regulatory body, Ministry of Tourism, Ministry of Health has to work together, then we will be a Global leader player in Medical Tourism

Suchitra MohantyMay 25th, 2011 at 14:35 PM

Good. This shows our doctors are more experienced and more skilled. East and West. Indian doctos are the best (except few who are not following the basic ethics of their profession).

Ayyappan ThangavelMay 25th, 2011 at 08:55 AM

Gujarat is poised to redefine medical tourism,it is a matter of time before India overtakes Thailand,Singapore etc...I believe Cosmetic surgery in particular will be the focus as it is ideally suited for medical tourism
Dr.Ayyappan

Ayyappan ThangavelMay 25th, 2011 at 08:54 AM

Gujarat is poised to redefine medical tourism,it is a matter of time before India overtakes Thailand,Singapore etc...I believe Cosmetic surgery in particular will be the focus as it is ideally suited for medical tourism
Dr.Ayyappan

Amit RoyMay 24th, 2011 at 15:33 PM

Ahmedabad is not the capital of Gujrat its Gandhinagar.

Surya BhattMay 23rd, 2011 at 09:02 AM

Rightly stated medical tourism can be a big helping hand in the nation's development. It is also important for a country like ours diplomatically, since the patients reaching recovered to their home countries act as goodwill bearers of India as a messiah for ailment removal.

Chandraprakash KamleMay 21st, 2011 at 20:04 PM

While skills of our medical specialists are enviable assets ...the rusty and fragile infra-structure & greed (treat but cheat mentality of a few)are our deplorable liabilities.

Santosh May 21st, 2011 at 16:38 PM

Wishing Good Luck to Medical Tourism in India, and hats off to our Dear Doctors

 
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