Health Care
Tourists Seek Cheaper Medical Procedures in Asia
Listen to this story... by Fred de Sam Lazaro
All Things Considered, February 14, 2005 · Travel to the developing world has long been associated with health threats and advice on how to avoid becoming ill. But a growing number of tourists are now traveling to certain countries -- among them India, Malaysia and Thailand -- because they want medical care. Fred de Sam Lazaro of Twin Cities Public Television reports on what's being called medical tourism.
Sunday, May 27, 2007
Why Patients Are Flocking Overseas for Operations
Why Patients Are Flocking Overseas for Operations
Hospitals around the world are drawing new patients with topnotch doctors, high-tech equipment and low costs. These 10 are leaders in their fields.
By Joe Cochrane
Newsweek International
Oct. 30, 2006 issue - It's not a stretch to call Jamie Johnson an accidental tourist in Thailand. While touring with a Christian singing group last month, Johnson, a diabetic from the United States, developed an infection in her ankle that shut down her kidneys. She was evacuated by airplane from Malaysia to Bumrungrad International hospital in Bangkok—a facility she had ever heard of in a country she had never been to and in a city she had associated with sex shows in beer bars. "My husband back home was thinking, 'She's going to be in a straw hut'," she says.
Johnson, though, was lucky enough to land in Asia's first internationally accredited hospital and one of the most modern and efficient medical facilities in the world. Last year the hospital treated 400,000 foreign patients—the highest of any hospital in the world—from more than 150 countries, for everything from heart disease to hip replacements to breast implants. The attraction: world-class medicine at developing-world prices. And patients get velvet-glove treatment redolent of a five-star hotel. "We deliver the one thing that people want in health care but don't expect to get—service," says Ruben Toral, the hospital's marketing director.
As medical costs skyrocket—Americans spent 16 percent of GDP on health care last year, according to the OECD, and Europeans aren't far behind—the idea of going abroad to get healthy is becoming more and more attractive. More than 150,000 North Americans and Europeans currently seek medical treatment overseas each year, estimates Josef Woodman, author of the forthcoming "Patients Without Borders." For invasive surgeries, preferred destinations include India, Thailand, Singapore and Malaysia. Large hospitals, such as Bumrungrad and the Apollo chain in India, actively court American, European and Middle Eastern patients. Slick Web sites tout their partnerships with nearby luxury hotels for post-op recovery. Bumrungrad arranges limousines to pick up patients at the airport, and sheiks and princes congregate in the Platinum Lounge of Apollo's Delhi hospital. Abacas International, a leading travel facilitator, reports that medical tourism to Asia could generate up to $4.4 billion by 2012.
Businesses are taking notice. At least 40 corporations have signed on to the overseas plan that United Group Programs, a health insurer in Boca Raton, Florida, began offering six months ago. Sending an employee abroad can save 80 percent of the costs of a procedure; a $50,000 angioplasty in the United States costs less than $6,000 in Mohali, India, according to GlobalChoice Healthcare, a firm that arranges foreign medical procedures.
Bumrungrad officials insist that foreigners come not just for cheap bills and luxury accommodations. The hospital's doctors, they say, have been trained at the best Western medical schools and use the most advanced medical equipment. And the service is eye-opening for patients accustomed to public clinics. Walk-in patients see a specialist in 17 minutes on average. Since 75 percent of hospital revenues are paid by patients directly, health and insurance companies have no say in treatment. Low labor costs allow Thai hospitals to employ more staff.
Some health-insurance companies are embracing medical tourism to reduce costs and make policyholders happy. It is only a matter of time before the phenomenon evolves into medical outsourcing, says Mack Banner, Bumrungrad's CEO. "People are going to leave their country, they're going to go overseas and they're going to get health care," he says. To make room for them, Bumrungrad is building an 18-story outpatient center, which will double the hospital's capacity to 6,000 outpatients per day. That's room for a lot of tourists, accidental or otherwise.
With Barrett Sheridan in New York
© 2007 Newsweek, Inc.
URL: http://www.msnbc.msn.com/id/15365149/site/newsweek/
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Mount Sinai Medical Center
TAIWAN WELL QUALIFIED TO DEVELOP MEDICAL TOURISM
TAIWAN WELL QUALIFIED TO DEVELOP MEDICAL TOURISM
2007-05-24 20:34:42
Taipei, May 24 (CNA) Participants in an international seminar on the medical care industry held in Taipei agreed Thursday that Taiwan has good conditions for developing medical tourism.
They said Taiwan can achieve the goal of becoming a world-class medical care center and listed 10 areas in which Taiwan could have a competitive edge.
They are live liver transplant, bone marrow transplant, cardiovascular medicine, microsurgery and cosmetic surgery, breast magnetic resonance imaging and other advanced medical examinations, knee surgery, brain tumor medicine and immunology therapy, Parkinson's disease diagnosis, cost-efficient medical care and high-quality medical teams.
Ho Mei-yueh, chairwoman of the Council for Economic Planning and Development, said the council has listed the medical tourism as one of its flagship projects in its three-year economic development plan.
She said the council will integrate government agencies in charge of medical care, tourism, insurance and visa issuance to attract foreigners to Taiwan for low-cost high-quality medical services.
Ho noted that Singapore attracted 150,000 medical tourists in 2000 and that the number had ballooned to 400,000 by 2005. The medical care industry in Thailand created a production value of US$490 million in 2003, attracting 700,000 visitors seeking treatment, she added.
(By Lilian Wu)
2007-05-24 20:34:42
Taipei, May 24 (CNA) Participants in an international seminar on the medical care industry held in Taipei agreed Thursday that Taiwan has good conditions for developing medical tourism.
They said Taiwan can achieve the goal of becoming a world-class medical care center and listed 10 areas in which Taiwan could have a competitive edge.
They are live liver transplant, bone marrow transplant, cardiovascular medicine, microsurgery and cosmetic surgery, breast magnetic resonance imaging and other advanced medical examinations, knee surgery, brain tumor medicine and immunology therapy, Parkinson's disease diagnosis, cost-efficient medical care and high-quality medical teams.
Ho Mei-yueh, chairwoman of the Council for Economic Planning and Development, said the council has listed the medical tourism as one of its flagship projects in its three-year economic development plan.
She said the council will integrate government agencies in charge of medical care, tourism, insurance and visa issuance to attract foreigners to Taiwan for low-cost high-quality medical services.
Ho noted that Singapore attracted 150,000 medical tourists in 2000 and that the number had ballooned to 400,000 by 2005. The medical care industry in Thailand created a production value of US$490 million in 2003, attracting 700,000 visitors seeking treatment, she added.
(By Lilian Wu)
Medical tourism can be the next goldmine for India: CII
Medical tourism can be the next goldmine for India: CII
Our Bureau
Bangalore , Nov. 26
INDIA can turn medical tourism into its next goldmine, if it rightly projects its competences and improves the healthcare standards, said speakers at the CII-sponsored two-day quality summit on health tourism.
During the current season between now and March 2005 alone, some two million leisure and business travellers are expected into the country compared to 1.3 lakh tourists coming in the past 18 months. This is the time to encash it into a $1-billion medical tourism opportunity, catering to several foreigners who are seeking low-cost, but world-class medical treatment, said Mr Vishal Bali, Summit Chairman and VP, Wockhardt Hospitals.
He said no other country offers the unique mix of seven officially approved systems of medicine ranging from Ayurveda to naturopathy and Tibetan medicine. This industry is growing at 30 per cent annually and could easily add 40 million new jobs too.
"There is no reason why India should not become the healthcare destination of the world" by combining the best of specialty hospitals, hotels and spas, the State Tourism departments and travel agents, he said. South East Asia is the undisputed leader in the area, with Bangkok's famed Bumrungrad Hospital alone attracting 2.7 lakh international patients a year.
According to Mr Utkarsh Palnitkar, Partner, Ernst & Young, medical tourism could be a $30-40-billion proposition worldwide, with spends on hospitalisation rising; the Gulf region led by Saudi Arabia alone spends $20 billion on medical care. However, new entrants were emerging such as South Africa, Croatia and Greece, and "We have to wake up fast" to grab the pie.
Players such as Prestige group's joint venture Angsana Oasis, Dr Isaac Mathai's Soukya International Holistic Health Care Centre at Whitefield (near Bangalore), Ayurveda Gram Heritage Wellness Centre and Kerala-based Casino Group have scented early successes by offering Indian and Western therapies to a large number of foreigners.
According to Dr Mathai, if each of the 40,000 US physicians of Indian origin refers one person to India, the medical tourists could become a huge number. Ayurveda, spirituality, yoga, acupressure and naturopathy can be the unique selling propositions for foreigners who don't hesitate to spend $400 an hour on any of these systems. "If you play up Ayurveda the right way, an unbelievable number of people can come to India" seeking its benefits, said Dr Mathai.
Our Bureau
Bangalore , Nov. 26
INDIA can turn medical tourism into its next goldmine, if it rightly projects its competences and improves the healthcare standards, said speakers at the CII-sponsored two-day quality summit on health tourism.
During the current season between now and March 2005 alone, some two million leisure and business travellers are expected into the country compared to 1.3 lakh tourists coming in the past 18 months. This is the time to encash it into a $1-billion medical tourism opportunity, catering to several foreigners who are seeking low-cost, but world-class medical treatment, said Mr Vishal Bali, Summit Chairman and VP, Wockhardt Hospitals.
He said no other country offers the unique mix of seven officially approved systems of medicine ranging from Ayurveda to naturopathy and Tibetan medicine. This industry is growing at 30 per cent annually and could easily add 40 million new jobs too.
"There is no reason why India should not become the healthcare destination of the world" by combining the best of specialty hospitals, hotels and spas, the State Tourism departments and travel agents, he said. South East Asia is the undisputed leader in the area, with Bangkok's famed Bumrungrad Hospital alone attracting 2.7 lakh international patients a year.
According to Mr Utkarsh Palnitkar, Partner, Ernst & Young, medical tourism could be a $30-40-billion proposition worldwide, with spends on hospitalisation rising; the Gulf region led by Saudi Arabia alone spends $20 billion on medical care. However, new entrants were emerging such as South Africa, Croatia and Greece, and "We have to wake up fast" to grab the pie.
Players such as Prestige group's joint venture Angsana Oasis, Dr Isaac Mathai's Soukya International Holistic Health Care Centre at Whitefield (near Bangalore), Ayurveda Gram Heritage Wellness Centre and Kerala-based Casino Group have scented early successes by offering Indian and Western therapies to a large number of foreigners.
According to Dr Mathai, if each of the 40,000 US physicians of Indian origin refers one person to India, the medical tourists could become a huge number. Ayurveda, spirituality, yoga, acupressure and naturopathy can be the unique selling propositions for foreigners who don't hesitate to spend $400 an hour on any of these systems. "If you play up Ayurveda the right way, an unbelievable number of people can come to India" seeking its benefits, said Dr Mathai.
Medical tourism: Marketing India isn't a good idea
Dateline Mysore: Medical tourism: Marketing India isn't a good idea by G V Krishnan
Dateline Mysore Travelling to get a heart bypass can't be much fun. But then health and tourism ministries are reported to have joined hands to launch an international advt. campaign. A brochure suggests that overseas patients can combine medical treatment with trips to Taj Mahal, the Himalayas, and a host of places of tourist interest.
Dateline Mysore :: GVK's Archived Works :: GVK's Profile :: Email GVK
Head of cardiology at a corporate hospital in Chennai told me once (this was years ago) that they needed to do 12 surgeries a day to be able to maintain three operation theatres, meet loan repayment schedule on equipment, and fulfill dividend expectations of shareholders. He was not merely a reputed cardiac surgeon, but also a hospital management board member – 'I've to take care of the shareholders' interests'.
Specialty hospitals have emerged as good business, a sure-fire foreign exchange earners and have made India a destination for healthcare outsourcing. We hear hospital management circles talking of 'medical tourism', a term I despise. Overseas visitors in need of surgery and concerned companions on medicare trip to India do not exactly fit the definition of 'tourists', a word I would normally associate with vacationers and pleasure-seekers. Travelling to get a heart bypass can't be much fun. But then health and tourism ministries are reported to have joined hands to launch an international advt. campaign. A brochure suggests that overseas patients can combine medical treatment with trips to Taj Mahal, the Himalayas, and a host of places of tourist interest.
Union health minister Dr Anbumani Ramdoss reckons that 150,000 foreigners needing medical treatment visit India in a year and the healthcare tourism market is worth $333 mil. Projected growth is to make it a $2 billion industry by 2012. The idea is to target some 50 million Americans who are not covered by insurance. Most of those making the trip to India are folks who can't afford it in their own country. Heart surgery that costs $200,000 in the UScan be done in India for $10,000.
Hip resurfacing costs in Mumbai $6,000 while the same surgical procedure done in the US would set you back by $25,000. If you don't have insurance cover in the US, and can't raise that kind of money, even the Lord would be reluctant to help. I once met a lady at a Phoenix soup kitchen whose family became homeless, because her husband got pneumonia. His insurance cover had lapsed. And they had to sell their house to pay hospital bills. It was a matter of $11,000.
Thousands of US patients are said to be opting India as healthcare alternative, to take advantage of the cut-rate heart surgery, gastric bypass and hysterectomies. Economics professor Milica Bookman, of Philadelphia St. Joseph's University, was quoted in *People* magazine as saying, "from what we're hearing, the quality of care is certainly as good as what you find in an American hospital". The professor is writing a book on medical outsourcing.
A school bus driver in Lakeville, Minn., who had hip resurfacing done in Mumbai has set up a websiteto share her experience and offer guidance to those looking at healthcare options in India. Healthcare tourism may be good for our private hospitals. But the question is whether it is good idea for our government to promote it in a big way.
I would have thought our corporate health sector needs no government prodding to promote its own interests. Besides, there is a school of thought that believes governments should have no role in promoting healthcare tourism for it impacts negatively the interests of the people in India. The point is made by Prof.Prabhudev Konana, of University of Texas in a op-ed page article in The Hindu.
Five-star hospital services and advanced medical devices raise investment levels; and shareholders expect value for their investment. All this, and an aggressive promotion of healthcare tourism, could price out the middle-class in India from private healthcare facilities in their own country.
Medi-tourism promoters speak of trickle-down effect and say the high paying foreign clientele can subsidize the cost of providing the best of medical treatment to the local population. This sounds sensible, and even feasible on paper. But can we really hope for a well-functioning, subsidy-transfer system in place, working to the best advantage of the needy patients in India? In the prevailing shortage of hospital beds, doctors and trained para-medics aggressive marketing of healthcare tourism would amplify the demand-supply gap in the private healthcare sector,according to Prof. Konana.
Dateline Mysore Travelling to get a heart bypass can't be much fun. But then health and tourism ministries are reported to have joined hands to launch an international advt. campaign. A brochure suggests that overseas patients can combine medical treatment with trips to Taj Mahal, the Himalayas, and a host of places of tourist interest.
Dateline Mysore :: GVK's Archived Works :: GVK's Profile :: Email GVK
Head of cardiology at a corporate hospital in Chennai told me once (this was years ago) that they needed to do 12 surgeries a day to be able to maintain three operation theatres, meet loan repayment schedule on equipment, and fulfill dividend expectations of shareholders. He was not merely a reputed cardiac surgeon, but also a hospital management board member – 'I've to take care of the shareholders' interests'.
Specialty hospitals have emerged as good business, a sure-fire foreign exchange earners and have made India a destination for healthcare outsourcing. We hear hospital management circles talking of 'medical tourism', a term I despise. Overseas visitors in need of surgery and concerned companions on medicare trip to India do not exactly fit the definition of 'tourists', a word I would normally associate with vacationers and pleasure-seekers. Travelling to get a heart bypass can't be much fun. But then health and tourism ministries are reported to have joined hands to launch an international advt. campaign. A brochure suggests that overseas patients can combine medical treatment with trips to Taj Mahal, the Himalayas, and a host of places of tourist interest.
Union health minister Dr Anbumani Ramdoss reckons that 150,000 foreigners needing medical treatment visit India in a year and the healthcare tourism market
Hip resurfacing costs in Mumbai $6,000 while the same surgical procedure done in the US would set you back by $25,000. If you don't have insurance cover in the US, and can't raise that kind of money, even the Lord would be reluctant to help. I once met a lady at a Phoenix soup kitchen whose family became homeless, because her husband got pneumonia. His insurance cover had lapsed. And they had to sell their house to pay hospital bills. It was a matter of $11,000.
Thousands of US patients are said to be opting India as healthcare alternative, to take advantage of the cut-rate heart surgery, gastric bypass and hysterectomies. Economics professor Milica Bookman, of Philadelphia St. Joseph's University, was quoted in *People* magazine as saying, "from what we're hearing, the quality of care is certainly as good as what you find in an American hospital". The professor is writing a book on medical outsourcing.
A school bus driver in Lakeville, Minn., who had hip resurfacing done in Mumbai has set up a website
I would have thought our corporate health sector needs no government prodding to promote its own interests. Besides, there is a school of thought that believes governments should have no role in promoting healthcare tourism for it impacts negatively the interests of the people in India. The point is made by Prof.Prabhudev Konana, of University of Texas in a op-ed page article in The Hindu
Five-star hospital services and advanced medical devices raise investment levels; and shareholders expect value for their investment. All this, and an aggressive promotion of healthcare tourism, could price out the middle-class in India from private healthcare facilities in their own country.
Medi-tourism promoters speak of trickle-down effect and say the high paying foreign clientele can subsidize the cost of providing the best of medical treatment to the local population. This sounds sensible, and even feasible on paper. But can we really hope for a well-functioning, subsidy-transfer system in place, working to the best advantage of the needy patients in India? In the prevailing shortage of hospital beds, doctors and trained para-medics aggressive marketing of healthcare tourism would amplify the demand-supply gap in the private healthcare sector,according to Prof. Konana.
BlueCross BlueShield and BlueChoice HealthPlan Pioneer Global Healthcare Alternative
BlueCross BlueShield and BlueChoice HealthPlan Pioneer Global Healthcare Alternative
February 8, 2007
Contact: Elizabeth Hammond
803.264.4626
COLUMBIA - BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan of South Carolina are streamlining access to medical and surgical treatment at U.S.-accredited facilities overseas. Through BlueCross' Companion Global Healthcare, members will have a single launch point for appointments, information and travel services beginning Feb. 15.
Companion Global Healthcare recently affiliated with JCI-accredited Bumrungrad International Hospital in Bangkok, Thailand, as the first hospital in its overseas network, and with World Access for travel services. The Companion Global Healthcare model is the first of its kind in South Carolina and among the first in the United States.
BlueCross BlueShield and BlueChoice HealthPlan members will have access to the program by clicking on a link on the Discounts & Value-Added page on www.SouthCarolinaBlues.com or www.BlueChoiceSC.com or by calling 1-877-232-0765.
"Including a global healthcare alternative reflects our ongoing commitment to help members seek the services they want at competitive prices," said David Boucher, BlueCross assistant vice president of health care services. "In a flattened world of increased price transparency, an international surgical network is a natural next step for those in our membership who want to travel for medical care."
BlueCross BlueShield and BlueChoice HealthPlan went to great lengths to identify credible, experienced organizations to participate in this program. "Bumrungrad treats over 400,000 international patients annually, including 80,000 Americans in 2006, and has over 150 U.S. board-certified doctors," Boucher said.
Bumrungrad International Hospital (www.bumrungrad.com) is Thailand's premier private medical center, a regional referral center for specialty care and a leader in treating international patients. The hospital is a one-stop medical center with more than 750 doctors and 554 beds. It was featured on CBS' 60 Minutes and recently named by Newsweek magazine as one of the top 10 international destinations for medical services. It is Asia's first and Thailand's only hospital accredited by the Joint Commission International (JCI). JCI is the international arm of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which has accredited over 4,000 U.S. hospitals and over 110 facilities elsewhere.
A leading provider of specialty insurance and assistance, World Access (www.worldaccess.com) will arrange and assist with travel services, including transportation and accommodations, air ambulance, and international claims management. World Access is a member of the Mondial Assistance Group and part of the Allianz family of companies.
BlueCross BlueShield of South Carolina and BlueChoice HealthPlan of South Carolina are headquartered in Columbia, S.C. BlueChoice HealthPlan of South Carolina is a wholly owned subsidiary of BlueCross BlueShield of South Carolina, and both are independent licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. BlueChoice is a registered mark of the Blue Cross and Blue Shield Association.
February 8, 2007
Contact: Elizabeth Hammond
803.264.4626
COLUMBIA - BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan of South Carolina are streamlining access to medical and surgical treatment at U.S.-accredited facilities overseas. Through BlueCross' Companion Global Healthcare, members will have a single launch point for appointments, information and travel services beginning Feb. 15.
Companion Global Healthcare recently affiliated with JCI-accredited Bumrungrad International Hospital in Bangkok, Thailand, as the first hospital in its overseas network, and with World Access for travel services. The Companion Global Healthcare model is the first of its kind in South Carolina and among the first in the United States.
BlueCross BlueShield and BlueChoice HealthPlan members will have access to the program by clicking on a link on the Discounts & Value-Added page on www.SouthCarolinaBlues.com or www.BlueChoiceSC.com or by calling 1-877-232-0765.
"Including a global healthcare alternative reflects our ongoing commitment to help members seek the services they want at competitive prices," said David Boucher, BlueCross assistant vice president of health care services. "In a flattened world of increased price transparency, an international surgical network is a natural next step for those in our membership who want to travel for medical care."
BlueCross BlueShield and BlueChoice HealthPlan went to great lengths to identify credible, experienced organizations to participate in this program. "Bumrungrad treats over 400,000 international patients annually, including 80,000 Americans in 2006, and has over 150 U.S. board-certified doctors," Boucher said.
Bumrungrad International Hospital (www.bumrungrad.com) is Thailand's premier private medical center, a regional referral center for specialty care and a leader in treating international patients. The hospital is a one-stop medical center with more than 750 doctors and 554 beds. It was featured on CBS' 60 Minutes and recently named by Newsweek magazine as one of the top 10 international destinations for medical services. It is Asia's first and Thailand's only hospital accredited by the Joint Commission International (JCI). JCI is the international arm of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which has accredited over 4,000 U.S. hospitals and over 110 facilities elsewhere.
A leading provider of specialty insurance and assistance, World Access (www.worldaccess.com) will arrange and assist with travel services, including transportation and accommodations, air ambulance, and international claims management. World Access is a member of the Mondial Assistance Group and part of the Allianz family of companies.
BlueCross BlueShield of South Carolina and BlueChoice HealthPlan of South Carolina are headquartered in Columbia, S.C. BlueChoice HealthPlan of South Carolina is a wholly owned subsidiary of BlueCross BlueShield of South Carolina, and both are independent licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. BlueChoice is a registered mark of the Blue Cross and Blue Shield Association.
Are we ready for medical tourism?
Are we ready for medical tourism?
RUPA CHINAI and RAHUL GOSWAMI
The private healthcare industry is quietly facilitating a revolution to enable India to emerge as a health destination. Yet there are the sceptics.
`Nearly 82 per cent of all health spending in India is private.' World Bank study
PHOTO: VIVEK BENDRE
CONFIDENCE INSPIRING: A patient from West Asia at Mumbai's Jaslok Hospital.
STARK contrasts are no surprise in urban India, and in the healthcare sector, the difference between what is available (world-class techniques and service, at a price) and what the common denominator urgently needs is no less so. In Mumbai, as in New Delhi, Chennai and Hyderabad, private sector healthcare centres are gleaming "islands of excellence", as the industry calls them, all too often surrounded by seas of medical neglect.
These "islands" — the private healthcare industry in India — are quietly facilitating a revolution. Only seven years from now, the most optimistic industry forecast posits, medical tourists hosted by India can pump Rs. 10,000 crores into our economy. An estimated 1,50,000 such visitors a year already spend about Rs. 1,500 crores in India for treatment.
When the mix is just right (support from the government in the form of incentives and tax breaks, international healthcare accreditation standards in place, breakthroughs in insurance coverage for overseas patients, and savvy promotion of India as a tourism-plus-medical tech destination) the sector is certain the numbers will fall into place.
What's more, the beneficiary of such growth will be the country's desperately overburdened public health system, say industry associations such as the Confederation of Indian Industry (CII) and the Federation of Indian Chambers of Commerce and Industry (FICCI), which see medical tourism a mirror of the early years of India's info-tech growth.
The spin-off
Explaining the view, Anupam Verma, honorary secretary of the Medical Tourism Council of Maharashtra and a director of Mumbai's Hinduja Hospital, says, "Look at the possibility of the public hospitals being technologically upgraded to world-class standards with this source of income. Also, with exposure to the paid medical service market, the spirit of competition will germinate in public hospitals ...(to) enhance their efficiency and service delivery levels."
Such optimism apart, India's three-tier public health system — primary health centres (PHC) in villages, district hospitals, and tertiary care hospitals — is increasingly unable to attend to the medical needs of the population.
Government expenditure on public health infrastructure is shrinking. At present, India spends about a per cent of its gross domestic product (GDP) on healthcare, lower than the average of 2.8 per cent of GDP spent by some less developed countries.
Yet, as the National Human Development Report (2001) points out: "There has been a misplaced emphasis on maintenance and strengthening of private health care services ... at the expense of broadening and deepening of a public health care system targeted at controlling the incidence of disease, particularly of communicable diseases, in rural areas."
Private healthcare is indeed expanding rapidly to fill the need for services. According to a World Bank study released in January 2004, nearly 82 per cent of all health spending in India is private.
PHOTO: R.V. MOORTHY
A WIDENING GAP: Can public healthcare catch up?
The study also pointed to health inequities such as the poorest quintile getting only 10 per cent of subsidies, while the richest 20 quintile captures 33 per cent.
Jean Dreze of the Delhi School of Economics calls it a "paradox". Bed capacities in five-star private hospitals remain under-utilised, he has observed, forcing the industry and government to promote health tourism, and "on the other hand, PHCs are suffering due to lack of government patronage".
Dr. Nergis Mistry, scientific researcher with the Foundation for Medical Research, Mumbai, warns against a technology and urban-centred approach to delivering healthcare. "Medical tourism will force us towards the latest expensive technology that is demanded in the West," she says. Mistry believes that a technology-centric approach to healthcare, such as that promoted by the major private hospitals, will inevitably affect the cost of care to the common man.
Given the fiscal imperatives (healthcare is also an industry, after all) how does the private sector in India propose to make services accessible and affordable to the average Indian, and how does the private sector define its responsibility to public health care?
"The role and responsibilities of the government are clearly in the areas of primary healthcare, epidemics, public health and sanitation," says S.K. Venkataraman, chief financial officer of the Apollo Hospitals Group, "whereas the private sector can cater to secondary, tertiary and quaternary care and the increasing burden of diseases due to lifestyle factors, like cancer, cardiac ailments and diabetes."
Dr. Naresh Trehan, executive director of the Escorts Heart Institute and Research Centre, says the private sector can "contribute in small but significant ways given its resource constraints".
Escorts runs a rural healthcare programme under which it deputes specialists to conduct cardiology camps that examine patients free of cost, he says. Villages are "adopted" to "improve their basic levels of sanitation and health and awareness, which goes a long way towards improving the health index", Trehan adds.
But, what does medical tourism promise to deliver and why is the public sector not convinced? The dream of a million medical tourists, establishing India's status as a health hub and boosting an industry to growth rates rivalling that of info-tech, is seen as within reach by the private sector.
In the last two years, international news coverage of India's major private hospitals — Apollo, Asian Heart Institute, Escorts, Fortis, Hinduja, Max Healthcare, Wockhardt and Woodlands among them — has been upbeat and confidence-inspiring. At home, however, the question increasingly being asked by public health practitioners is: how will this affect the country's health indices?
The numbers that the industry can offer are internationally tempting, and not only for United States or United Kingdom-based patients. Heart surgery that would cost $30,000 (or approximately Rs. 12,90,000) in the U.S. or Britain costs approximately $14,000 (or Rs. 6,02,000) in Thailand (a major destination for medical tourists) and around $7,000 (or Rs. 3,01,000) in India. A bone marrow transplant procedure would run up a bill of $2,50,000 (or Rs. 1,07,50,000) in the U.S. or Britain, versus $60,000 (or Rs. 25,80,000) in Thailand and $30,000 (or Rs. 12,90,000) in India.
Despite these numbers, regional competition for medical tourists is fierce. Thailand is currently the Asian leader both in number of foreign patients and revenue. Malaysia and Singapore too have set in motion aggressive plans, with ambitious targets, for the years 2010-12, which is also seen as a defining period by CII and the Indian Health Care Federation (IHCF), an association of about 60 hospitals.
Now, private healthcare groups are lobbying for the adoption of measures they say will encourage growth — some of these are tax allowances for rural doctors, relaxations in the norms for setting up medical colleges, and relaxation in indirect taxes on purchase of equipment, medicines, medical consumables and devices.
"The challenge," says Dr. Trehan, "is to try and match the cost of creation with ability to pay. Thus to incentivise hospitals to come up in rural areas, the government needs to go much beyond this."
S.K. Venkataraman emphasises that the industry urgently needs infrastructure status "with attendant benefits like a tax holiday, concessional utilities and preferential land allotments, in order to create an enabling environment for the healthy growth of this sector".
These demands are questioned by health policy analysts. Ravi Duggal, health researcher with Mumbai's Centre for Enquiry into Health and Allied Themes, points out that private hospitals have obligations for their not-for-profit status under the Public Trust Act to provide healthcare free to the extent of 20 per cent of their resources. "Where is the accountability of this provision?" he asks.
Certainly, the view from ground zero of a public hospital's out-patient's department is uniformly grim. Under-funded, undermanned and under-equipped, Mumbai's severely overburdened public hospitals have borne the brunt of public rage.
`Will make no difference'
Dr. K.C. Ojha, financial director of the Bombay Hospital for 27 years (until 1994) says bluntly: "Medical tourism will not make any difference to Indian healthcare. It will mean greater profits for the private hospital sector and creation of Indian jobs. Hospitals that provide for medical tourism will not create subsidised treatment for Indians."
He is alarmed by symptoms of the widening gap between medical need and service — in the second half of 2004 there were at least seven reported incidents in Mumbai of patient's families assaulting hospital staff, both in State and municipal corporation-run hospitals, and private clinics, because of the perception that they were victims of medical negligence. "Their anger is spilling over in assaults on doctors, unheard of until now in a country where the medical profession is worshipped next to God," says Dr Armida Fernandes, former dean of the State government-run Sion Hospital in Mumbai.
With charges for speciality services steadily rising, healthcare moves out of the reach of the common man, she adds, often propelling them into either indebtedness or to quacks.
Nevertheless, Dr. Nilima Kshirsagar, dean of the King Edward Memorial Hospital in Mumbai, sees the possibility of leveraging the expertise and experience teaching hospitals have in clinical medicine and surgical skill.
"With augmented infrastructure we can provide services to foreign patients and revenues earned can subsidise poor Indian patients," she says, which is a view close to that of the CII and IHCF.
The bottom-line for Kshirsagar however is equity: "People are looking at health as a business. The government has not examined how our patients will benefit from medical tourism or whether they will lose out. The need to benefit Indian patients is the main goal, and medical tourism cannot be at their cost."
World-class care
CHENNAI's Frontier Lifeline Hospital (Dr. K.M. Cherian Heart Foundation) began healing the hearts of international patients on March 1, 2004.
PHOTO: VINO JOHN
ALL'S WELL: In Chennai.
"They were treated free of cost," says Dr. Cherian (in the picture, first row sitting, fourth from right). "That's when the foreign patients started coming in. Chennai is truly the health hub of Asia." Over the course of a year, Frontier Lifeline has seen more than 200 patients from Fiji, Iraq, Kenya, Malaysia, Mauritius, Palestine, Tanzania and Uganda.
In the first year of operations, Dr. Cherian says Frontier Lifeline generated $2,00,000 (or approximately Rs. 86,00,000). "If a small place like this can earn so much foreign exchange, imagine if we built dedicated health hubs with all the facilities."
Surgical procedures that cost upwards of 3,000 (or approximately Rs. 1,68,000) are available for Rs. 10,000 to Rs. 30,000 here. Recently, the hospital used an indigenously created bovine jugular conduit to connect the ventricle and the arteries of a 27-day-old Palestinian boy, Khalid. "These are the same techniques being used in Europe," he says. "The only other manufacturer of this conduit is a German company. We provide world-class treatment at a much lesser cost."
However, Dr. Cherian says, most of the patients are from Asia as India does not have the necessary infrastructure to cater to European and U.S. requirements. "Our roads are dirty, water is bad, even internet connectivity — which people from the West consider a must — is not up to their standards, despite all our claims of IT proficiency."
India has the cost advantage, the technology and clinical expertise and manpower to be an international health destination, but Government support is lacking. He advocates a holistic approach to healthcare, with entire complexes or resorts that provide the medical tourists all the facilities. The St. Gregorios Cardiovascular Centre in Parumala in Alleppey district, Kerala, set up by his institution could become such a holistic centre with the right kind of support. He describes it as a rural area with all the facilities of an urban hospital and just one hour from Kochi. "It's a 30-bed hospital, in one year, we have performed more than 500 angioplasties and 400 open-heart surgeries. It's set in the middle of a village by paddy fields and a river... it's the kind of place that is ideal for surgery, recovery and relaxation," he says.
SHALINI UMACHANDRAN
© Copyright 2000 - 2006 The Hindu
Controversy in India over medical tourism
Controversy in India over medical tourism
By Amelia Gentleman International Herald Tribune
FRIDAY, DECEMBER 2, 2005
NEW DELHI As foreigners flock to India to find lower health-care costs and avoid long waiting times, the rapid growth of this medical tourism has begun to create significant opposition among doctors here.
Providing cheap treatment for foreigners is becoming an important source of foreign revenue for India, and some doctors are growing angry at the government's focus on it while the health of a large portion of India's population is neglected.
This has prompted an argument between those who assert that medical tourism benefits the Indian health-care system by improving its standards and those who say the practice worsens disparities in the distribution of health care that are already critical.
Medical tourism is forecast to become a $2.3 billion business for India by 2012. Some analysts predict it will be the next major driver of the Indian economy after information technology. Already, about 150,000 visitors seek treatment every year, and this figure is rising at 15 percent annually.
Growing confidence abroad in the Indian system has meant that as health-care costs soar in the United States and as hospital waiting lists grow longer in Europe and elsewhere, more people are prepared to travel to cities like Delhi, Mumbai and Bangalore for major operations like heart surgery and organ transplants, as well as for more minor cosmetic treatments.
But the surge in the popularity of India as a place for treatment is triggering complaints among some leading members of the medical community, like Dr. Samiran Nundy, a gastrointestinal surgeon in New Delhi, and Amit Sengupta from the India's People's Health Movement, who wrote about it recently in The British Medical Journal.
"It is time," they said, "for the government to pay more attention to improving the health of Indians rather than to enticing foreigners from affluent countries with offers of low-cost operations and convalescent visits to the Taj Mahal."
They criticized the government as trying to capitalize on the medical tourism boom at a time when "the medical system is failing its own people," with tuberculosis killing half a million people and easily treatable diarrheal diseases killing 600,000 each year in India.
The authors wrote that public spending on health care, which is equivalent to nine-tenths of a percent of the Indian gross domestic product, was among the lowest in the world and ahead of only five countries: Burundi, Myanmar, Pakistan, Sudan and Cambodia.
"Spending on health has not been a priority for successive governments, and they have encouraged the growth of the private sector," the article said.
The article was an analysis of what the authors consider to be structural problems in health care. Subsidized land and tax exemptions have been given to those setting up private medical practices and nursing homes.
As medical workers trained by the state move on to work in the private sector, where conditions and pay are better, this creates an indirect annual subsidy of private health care worth about 4 billion to 5 billion rupees, or $87 million to $109 million, Nundy and Sengupta wrote.
"I am against the government focusing its attention on medical tourism at the expense of the public health system," Nundy said in an interview.
According to a 2005 World Health Organization report, India has only 4 doctors for every 10,000 people; in Britain, by contrast, there are 18. In rural India, state hospitals have little money for basic medical equipment or for maintenance of buildings, which are often filthy and overcrowded. India has less than one hospital bed and one physician for every 1,000 people, the World Health Organization said.
With the public health system faltering, more people are opting to go to private services, borrowing money or selling land to cover the cost.
Nundy's thesis has exacerbated the divide among doctors in India, many of whom take pride in the rising standards at the top end of the profession and see the arrival of medical tourists as an endorsement of health care excellence.
Dr. Naresh Trehan, a heart surgeon who set up a private cardiac hospital in New Delhi that attracts hundreds of foreign patients every year, dismissed the anxieties expressed in the British Medical Journal article.
"We hope that we can do this without affecting the treatment for the local population," Trehan said. "It's like space travel. People will always say 'There is so much hunger, why are you doing it?' That's not the point.
"I see this as a complement to internal health care. We are putting in infrastructure."
In a private room in Trehan's Escorts Hearts Institute, Carlo Gislimberti, a 60-year-old American, was convalescing recently after a triple heart bypass.
When he had his third heart attack in May, he was, like 50 million other Americans, without health insurance. His doctor told him a bypass would cost over $150,000.
Because he did not qualify for government assistance, he would have had to sell his Italian restaurant in Taos, New Mexico, to pay the bill.
The total cost of surgery and a 20-day stay in the New Delhi hospital was $10,000.
He was operated on by Trehan, who used the latest surgical technology. Gislimberti then recovered in a shining, marble-floored wing of the hospital, waited on by smiling staff wearing badges reading "May I help you?"
"I was facing financial death or death by heart attack," he said, "until my wife typed 'medical treatment in India' into a Google search. Twenty days later I was here."
He rejected the idea that he was absorbing medical time and space that might better be used for domestic patients.
"I hope that the rest of the Indian population will eventually benefit from what is being done here," Gislimberti said. "More new heart surgeons are being trained here. I hope that the little money I brought into the country will benefit the country in some way."
Advocates of medical tourism say it pushes up standards within the Indian medical profession and contend that there will be a trickle-down effect to local services from the high-class medical centers being built to cater to the elite of India and to foreigners.
"Medical tourism can also contribute to improving the health care infrastructure and services in rural areas," a paper published recently by the Indian Healthcare Federation said.
At a recent conference in New Delhi on medical tourism, a Tourism Ministry official said the Health Ministry was reluctant to publicize its work in this area out of worries over inequality of access.
A few kilometers from Trehan's institute, the All-India Institute of Medical Sciences, considered the best public hospital in India, underscores the divisions within the Indian health care system. Corridors are grimy and rooms are poorly lighted, patients crowd the waiting rooms and the staff looks harassed.
"Twenty years ago, most government ministers would have gone" to the All-India Institute, Nundy said. "Very few go there now. They go to private hospitals."
Nundy said it was "unlikely" that the money brought in by foreigners would raise standards and cross-subsidize the public sector.
"In India, all rich people now go private, so there is no pressure on the government to improve the public health system," he said.
NEW DELHI As foreigners flock to India to find lower health-care costs and avoid long waiting times, the rapid growth of this medical tourism has begun to create significant opposition among doctors here.
Providing cheap treatment for foreigners is becoming an important source of foreign revenue for India, and some doctors are growing angry at the government's focus on it while the health of a large portion of India's population is neglected.
This has prompted an argument between those who assert that medical tourism benefits the Indian health-care system by improving its standards and those who say the practice worsens disparities in the distribution of health care that are already critical.
Medical tourism is forecast to become a $2.3 billion business for India by 2012. Some analysts predict it will be the next major driver of the Indian economy after information technology. Already, about 150,000 visitors seek treatment every year, and this figure is rising at 15 percent annually.
Growing confidence abroad in the Indian system has meant that as health-care costs soar in the United States and as hospital waiting lists grow longer in Europe and elsewhere, more people are prepared to travel to cities like Delhi, Mumbai and Bangalore for major operations like heart surgery and organ transplants, as well as for more minor cosmetic treatments.
But the surge in the popularity of India as a place for treatment is triggering complaints among some leading members of the medical community, like Dr. Samiran Nundy, a gastrointestinal surgeon in New Delhi, and Amit Sengupta from the India's People's Health Movement, who wrote about it recently in The British Medical Journal.
"It is time," they said, "for the government to pay more attention to improving the health of Indians rather than to enticing foreigners from affluent countries with offers of low-cost operations and convalescent visits to the Taj Mahal."
They criticized the government as trying to capitalize on the medical tourism boom at a time when "the medical system is failing its own people," with tuberculosis killing half a million people and easily treatable diarrheal diseases killing 600,000 each year in India.
The authors wrote that public spending on health care, which is equivalent to nine-tenths of a percent of the Indian gross domestic product, was among the lowest in the world and ahead of only five countries: Burundi, Myanmar, Pakistan, Sudan and Cambodia.
"Spending on health has not been a priority for successive governments, and they have encouraged the growth of the private sector," the article said.
The article was an analysis of what the authors consider to be structural problems in health care. Subsidized land and tax exemptions have been given to those setting up private medical practices and nursing homes.
As medical workers trained by the state move on to work in the private sector, where conditions and pay are better, this creates an indirect annual subsidy of private health care worth about 4 billion to 5 billion rupees, or $87 million to $109 million, Nundy and Sengupta wrote.
"I am against the government focusing its attention on medical tourism at the expense of the public health system," Nundy said in an interview.
According to a 2005 World Health Organization report, India has only 4 doctors for every 10,000 people; in Britain, by contrast, there are 18. In rural India, state hospitals have little money for basic medical equipment or for maintenance of buildings, which are often filthy and overcrowded. India has less than one hospital bed and one physician for every 1,000 people, the World Health Organization said.
With the public health system faltering, more people are opting to go to private services, borrowing money or selling land to cover the cost.
Nundy's thesis has exacerbated the divide among doctors in India, many of whom take pride in the rising standards at the top end of the profession and see the arrival of medical tourists as an endorsement of health care excellence.
Dr. Naresh Trehan, a heart surgeon who set up a private cardiac hospital in New Delhi that attracts hundreds of foreign patients every year, dismissed the anxieties expressed in the British Medical Journal article.
"We hope that we can do this without affecting the treatment for the local population," Trehan said. "It's like space travel. People will always say 'There is so much hunger, why are you doing it?' That's not the point.
"I see this as a complement to internal health care. We are putting in infrastructure."
In a private room in Trehan's Escorts Hearts Institute, Carlo Gislimberti, a 60-year-old American, was convalescing recently after a triple heart bypass.
When he had his third heart attack in May, he was, like 50 million other Americans, without health insurance. His doctor told him a bypass would cost over $150,000.
Because he did not qualify for government assistance, he would have had to sell his Italian restaurant in Taos, New Mexico, to pay the bill.
The total cost of surgery and a 20-day stay in the New Delhi hospital was $10,000.
He was operated on by Trehan, who used the latest surgical technology. Gislimberti then recovered in a shining, marble-floored wing of the hospital, waited on by smiling staff wearing badges reading "May I help you?"
"I was facing financial death or death by heart attack," he said, "until my wife typed 'medical treatment in India' into a Google search. Twenty days later I was here."
He rejected the idea that he was absorbing medical time and space that might better be used for domestic patients.
"I hope that the rest of the Indian population will eventually benefit from what is being done here," Gislimberti said. "More new heart surgeons are being trained here. I hope that the little money I brought into the country will benefit the country in some way."
Advocates of medical tourism say it pushes up standards within the Indian medical profession and contend that there will be a trickle-down effect to local services from the high-class medical centers being built to cater to the elite of India and to foreigners.
"Medical tourism can also contribute to improving the health care infrastructure and services in rural areas," a paper published recently by the Indian Healthcare Federation said.
At a recent conference in New Delhi on medical tourism, a Tourism Ministry official said the Health Ministry was reluctant to publicize its work in this area out of worries over inequality of access.
A few kilometers from Trehan's institute, the All-India Institute of Medical Sciences, considered the best public hospital in India, underscores the divisions within the Indian health care system. Corridors are grimy and rooms are poorly lighted, patients crowd the waiting rooms and the staff looks harassed.
"Twenty years ago, most government ministers would have gone" to the All-India Institute, Nundy said. "Very few go there now. They go to private hospitals."
Nundy said it was "unlikely" that the money brought in by foreigners would raise standards and cross-subsidize the public sector.
"In India, all rich people now go private, so there is no pressure on the government to improve the public health system," he said.
By Amelia Gentleman International Herald Tribune
FRIDAY, DECEMBER 2, 2005
NEW DELHI As foreigners flock to India to find lower health-care costs and avoid long waiting times, the rapid growth of this medical tourism has begun to create significant opposition among doctors here.
Providing cheap treatment for foreigners is becoming an important source of foreign revenue for India, and some doctors are growing angry at the government's focus on it while the health of a large portion of India's population is neglected.
This has prompted an argument between those who assert that medical tourism benefits the Indian health-care system by improving its standards and those who say the practice worsens disparities in the distribution of health care that are already critical.
Medical tourism is forecast to become a $2.3 billion business for India by 2012. Some analysts predict it will be the next major driver of the Indian economy after information technology. Already, about 150,000 visitors seek treatment every year, and this figure is rising at 15 percent annually.
Growing confidence abroad in the Indian system has meant that as health-care costs soar in the United States and as hospital waiting lists grow longer in Europe and elsewhere, more people are prepared to travel to cities like Delhi, Mumbai and Bangalore for major operations like heart surgery and organ transplants, as well as for more minor cosmetic treatments.
But the surge in the popularity of India as a place for treatment is triggering complaints among some leading members of the medical community, like Dr. Samiran Nundy, a gastrointestinal surgeon in New Delhi, and Amit Sengupta from the India's People's Health Movement, who wrote about it recently in The British Medical Journal.
"It is time," they said, "for the government to pay more attention to improving the health of Indians rather than to enticing foreigners from affluent countries with offers of low-cost operations and convalescent visits to the Taj Mahal."
They criticized the government as trying to capitalize on the medical tourism boom at a time when "the medical system is failing its own people," with tuberculosis killing half a million people and easily treatable diarrheal diseases killing 600,000 each year in India.
The authors wrote that public spending on health care, which is equivalent to nine-tenths of a percent of the Indian gross domestic product, was among the lowest in the world and ahead of only five countries: Burundi, Myanmar, Pakistan, Sudan and Cambodia.
"Spending on health has not been a priority for successive governments, and they have encouraged the growth of the private sector," the article said.
The article was an analysis of what the authors consider to be structural problems in health care. Subsidized land and tax exemptions have been given to those setting up private medical practices and nursing homes.
As medical workers trained by the state move on to work in the private sector, where conditions and pay are better, this creates an indirect annual subsidy of private health care worth about 4 billion to 5 billion rupees, or $87 million to $109 million, Nundy and Sengupta wrote.
"I am against the government focusing its attention on medical tourism at the expense of the public health system," Nundy said in an interview.
According to a 2005 World Health Organization report, India has only 4 doctors for every 10,000 people; in Britain, by contrast, there are 18. In rural India, state hospitals have little money for basic medical equipment or for maintenance of buildings, which are often filthy and overcrowded. India has less than one hospital bed and one physician for every 1,000 people, the World Health Organization said.
With the public health system faltering, more people are opting to go to private services, borrowing money or selling land to cover the cost.
Nundy's thesis has exacerbated the divide among doctors in India, many of whom take pride in the rising standards at the top end of the profession and see the arrival of medical tourists as an endorsement of health care excellence.
Dr. Naresh Trehan, a heart surgeon who set up a private cardiac hospital in New Delhi that attracts hundreds of foreign patients every year, dismissed the anxieties expressed in the British Medical Journal article.
"We hope that we can do this without affecting the treatment for the local population," Trehan said. "It's like space travel. People will always say 'There is so much hunger, why are you doing it?' That's not the point.
"I see this as a complement to internal health care. We are putting in infrastructure."
In a private room in Trehan's Escorts Hearts Institute, Carlo Gislimberti, a 60-year-old American, was convalescing recently after a triple heart bypass.
When he had his third heart attack in May, he was, like 50 million other Americans, without health insurance. His doctor told him a bypass would cost over $150,000.
Because he did not qualify for government assistance, he would have had to sell his Italian restaurant in Taos, New Mexico, to pay the bill.
The total cost of surgery and a 20-day stay in the New Delhi hospital was $10,000.
He was operated on by Trehan, who used the latest surgical technology. Gislimberti then recovered in a shining, marble-floored wing of the hospital, waited on by smiling staff wearing badges reading "May I help you?"
"I was facing financial death or death by heart attack," he said, "until my wife typed 'medical treatment in India' into a Google search. Twenty days later I was here."
He rejected the idea that he was absorbing medical time and space that might better be used for domestic patients.
"I hope that the rest of the Indian population will eventually benefit from what is being done here," Gislimberti said. "More new heart surgeons are being trained here. I hope that the little money I brought into the country will benefit the country in some way."
Advocates of medical tourism say it pushes up standards within the Indian medical profession and contend that there will be a trickle-down effect to local services from the high-class medical centers being built to cater to the elite of India and to foreigners.
"Medical tourism can also contribute to improving the health care infrastructure and services in rural areas," a paper published recently by the Indian Healthcare Federation said.
At a recent conference in New Delhi on medical tourism, a Tourism Ministry official said the Health Ministry was reluctant to publicize its work in this area out of worries over inequality of access.
A few kilometers from Trehan's institute, the All-India Institute of Medical Sciences, considered the best public hospital in India, underscores the divisions within the Indian health care system. Corridors are grimy and rooms are poorly lighted, patients crowd the waiting rooms and the staff looks harassed.
"Twenty years ago, most government ministers would have gone" to the All-India Institute, Nundy said. "Very few go there now. They go to private hospitals."
Nundy said it was "unlikely" that the money brought in by foreigners would raise standards and cross-subsidize the public sector.
"In India, all rich people now go private, so there is no pressure on the government to improve the public health system," he said.
NEW DELHI As foreigners flock to India to find lower health-care costs and avoid long waiting times, the rapid growth of this medical tourism has begun to create significant opposition among doctors here.
Providing cheap treatment for foreigners is becoming an important source of foreign revenue for India, and some doctors are growing angry at the government's focus on it while the health of a large portion of India's population is neglected.
This has prompted an argument between those who assert that medical tourism benefits the Indian health-care system by improving its standards and those who say the practice worsens disparities in the distribution of health care that are already critical.
Medical tourism is forecast to become a $2.3 billion business for India by 2012. Some analysts predict it will be the next major driver of the Indian economy after information technology. Already, about 150,000 visitors seek treatment every year, and this figure is rising at 15 percent annually.
Growing confidence abroad in the Indian system has meant that as health-care costs soar in the United States and as hospital waiting lists grow longer in Europe and elsewhere, more people are prepared to travel to cities like Delhi, Mumbai and Bangalore for major operations like heart surgery and organ transplants, as well as for more minor cosmetic treatments.
But the surge in the popularity of India as a place for treatment is triggering complaints among some leading members of the medical community, like Dr. Samiran Nundy, a gastrointestinal surgeon in New Delhi, and Amit Sengupta from the India's People's Health Movement, who wrote about it recently in The British Medical Journal.
"It is time," they said, "for the government to pay more attention to improving the health of Indians rather than to enticing foreigners from affluent countries with offers of low-cost operations and convalescent visits to the Taj Mahal."
They criticized the government as trying to capitalize on the medical tourism boom at a time when "the medical system is failing its own people," with tuberculosis killing half a million people and easily treatable diarrheal diseases killing 600,000 each year in India.
The authors wrote that public spending on health care, which is equivalent to nine-tenths of a percent of the Indian gross domestic product, was among the lowest in the world and ahead of only five countries: Burundi, Myanmar, Pakistan, Sudan and Cambodia.
"Spending on health has not been a priority for successive governments, and they have encouraged the growth of the private sector," the article said.
The article was an analysis of what the authors consider to be structural problems in health care. Subsidized land and tax exemptions have been given to those setting up private medical practices and nursing homes.
As medical workers trained by the state move on to work in the private sector, where conditions and pay are better, this creates an indirect annual subsidy of private health care worth about 4 billion to 5 billion rupees, or $87 million to $109 million, Nundy and Sengupta wrote.
"I am against the government focusing its attention on medical tourism at the expense of the public health system," Nundy said in an interview.
According to a 2005 World Health Organization report, India has only 4 doctors for every 10,000 people; in Britain, by contrast, there are 18. In rural India, state hospitals have little money for basic medical equipment or for maintenance of buildings, which are often filthy and overcrowded. India has less than one hospital bed and one physician for every 1,000 people, the World Health Organization said.
With the public health system faltering, more people are opting to go to private services, borrowing money or selling land to cover the cost.
Nundy's thesis has exacerbated the divide among doctors in India, many of whom take pride in the rising standards at the top end of the profession and see the arrival of medical tourists as an endorsement of health care excellence.
Dr. Naresh Trehan, a heart surgeon who set up a private cardiac hospital in New Delhi that attracts hundreds of foreign patients every year, dismissed the anxieties expressed in the British Medical Journal article.
"We hope that we can do this without affecting the treatment for the local population," Trehan said. "It's like space travel. People will always say 'There is so much hunger, why are you doing it?' That's not the point.
"I see this as a complement to internal health care. We are putting in infrastructure."
In a private room in Trehan's Escorts Hearts Institute, Carlo Gislimberti, a 60-year-old American, was convalescing recently after a triple heart bypass.
When he had his third heart attack in May, he was, like 50 million other Americans, without health insurance. His doctor told him a bypass would cost over $150,000.
Because he did not qualify for government assistance, he would have had to sell his Italian restaurant in Taos, New Mexico, to pay the bill.
The total cost of surgery and a 20-day stay in the New Delhi hospital was $10,000.
He was operated on by Trehan, who used the latest surgical technology. Gislimberti then recovered in a shining, marble-floored wing of the hospital, waited on by smiling staff wearing badges reading "May I help you?"
"I was facing financial death or death by heart attack," he said, "until my wife typed 'medical treatment in India' into a Google search. Twenty days later I was here."
He rejected the idea that he was absorbing medical time and space that might better be used for domestic patients.
"I hope that the rest of the Indian population will eventually benefit from what is being done here," Gislimberti said. "More new heart surgeons are being trained here. I hope that the little money I brought into the country will benefit the country in some way."
Advocates of medical tourism say it pushes up standards within the Indian medical profession and contend that there will be a trickle-down effect to local services from the high-class medical centers being built to cater to the elite of India and to foreigners.
"Medical tourism can also contribute to improving the health care infrastructure and services in rural areas," a paper published recently by the Indian Healthcare Federation said.
At a recent conference in New Delhi on medical tourism, a Tourism Ministry official said the Health Ministry was reluctant to publicize its work in this area out of worries over inequality of access.
A few kilometers from Trehan's institute, the All-India Institute of Medical Sciences, considered the best public hospital in India, underscores the divisions within the Indian health care system. Corridors are grimy and rooms are poorly lighted, patients crowd the waiting rooms and the staff looks harassed.
"Twenty years ago, most government ministers would have gone" to the All-India Institute, Nundy said. "Very few go there now. They go to private hospitals."
Nundy said it was "unlikely" that the money brought in by foreigners would raise standards and cross-subsidize the public sector.
"In India, all rich people now go private, so there is no pressure on the government to improve the public health system," he said.
'Medical Tourism' Industry Grows Rapidly
Oxford Analytica
'Medical Tourism' Industry Grows Rapidly
Oxford Analytica 10.26.06, 6:00 AM ET
In a global economy characterized by better access to information and lower transportation costs, North American consumers are discovering that they can get high-quality health care more cheaply and more quickly in some developing countries. However, such "medical tourism" may only have a marginal effect on health costs in North America.
Rising health care costs in the United States and longer waiting times in Canada are inducing patients to seek treatment overseas. The appeal of this phenomenon is driven by cost savings as high as 90%, depending on the procedure and the country in which it is performed, and virtually no wait times.
There are more than 45 million U.S. citizens without health insurance, and even more with health coverage that they consider inadequate. While U.S. consumers are concerned mainly with the exorbitant cost of care, Canadians are more troubled by wait times for certain treatments. Indeed, approximately 1 million Canadians claim to be experiencing difficulties in access to care.
Official statistics on medical tourism have not been collected, but an estimated 150,000 foreigners sought care in 2004 in India alone--and this number is growing at a rate of about 15% annually. Most of these patients are from the Middle East or Asia, but the proportion of U.S. citizens and Canadians is rising. Although providers offer a diverse range of services, the most common procedures are elective.
The benefits go beyond cost:
--Consumers gain from cost savings, but may also receive excellent care from highly qualified doctors.
--Many providers offer more personalized care--i.e., a higher physician-to-patient ratio--than is commonly available in the United States or Canada.
--Some services that are not yet approved by the U.S. Food and Drug Administration, such as certain hip replacement surgery techniques, are available overseas.
However, consumers also face risks when undergoing treatment in a foreign country:
--Follow-up is difficult when the patient returns home, and expensive care may be required if complications occur.
--Quality assessment is problematic, and the language barrier can complicate matters.
--Malpractice laws in other countries are different.
Foreign providers stand to gain from the looming demand and are eager to increase supply. Nevertheless, competition is fierce, leading to consumer-directed advertising campaigns. This burgeoning international market for medical care may also drive U.S. providers to respond to the increase in competition:
--Overseas impact. Hospitals, physicians and medical staff are benefiting from higher revenues. For example, medical tourism in India is forecast to generate over $2 billion in revenue by 2012, according to a study by McKinsey and the Confederation of Indian Industry.
--Domestic changes. U.S. hospitals make most of their money on high-margin elective surgeries not typically covered by insurance plans. They may need to become more efficient and affordable to avoid losing business overseas.
Some U.S. employers, concerned about rising health care costs, are using financial incentives to encourage employees to experiment with medical tourism. This is an especially common practice at large firms that self-insure and pay directly for their employees' medical expenses. Opponents, including unions, argue that it exposes employees to greater uncertainty and risk.
Medical tourism will continue to expand rapidly. However, its long-term growth rate depends on several factors:
--Insurance market. While companies specializing in arranging trips for medical tourists are flourishing, insurers have been slow to adapt to this new market.
--Legislation. North American governments may consider facilitating this assimilation of foreign care into domestic insurance plans--both private and public--through legislative action. Such legislation will face stiff opposition from unions and domestic medical groups.
--Image problem. Rich world consumers will have to overcome stereotypes of developing world poverty, lack of education and hygienic problems in order for the industry to thrive. Positive outcomes for those patients who do venture overseas may help to quell these fears.
--Inelastic demand. Uninsured U.S. citizens represent the largest group of prospective medical tourists. However, research shows patient demand tends to be relatively price inelastic for procedures that cost under $1,000 dollars. As median annual health care expenditures per capita for the uninsured are well under this level, more than half may have no interest in medical tourism.
The knowledge that the same care is available elsewhere at a much lower cost may encourage consumers to be more price-sensitive about certain medical procedures, increasing transparency, lowering costs and improving quality. However, this is unlikely to benefit most consumers--particularly the poor and uninsured.
To read an extended version of this article, log on to Oxford Analytica's Web site.
Oxford Analytica is an independent strategic-consulting firm drawing on a network of more than 1,000 scholar experts at Oxford and other leading universities and research institutions around the world. For more information, please visit www.oxan.com. To find out how to subscribe to the firm's Daily Brief Service, click here.
'Medical Tourism' Industry Grows Rapidly
Oxford Analytica 10.26.06, 6:00 AM ET
In a global economy characterized by better access to information and lower transportation costs, North American consumers are discovering that they can get high-quality health care more cheaply and more quickly in some developing countries. However, such "medical tourism" may only have a marginal effect on health costs in North America.
Rising health care costs in the United States and longer waiting times in Canada are inducing patients to seek treatment overseas. The appeal of this phenomenon is driven by cost savings as high as 90%, depending on the procedure and the country in which it is performed, and virtually no wait times.
There are more than 45 million U.S. citizens without health insurance, and even more with health coverage that they consider inadequate. While U.S. consumers are concerned mainly with the exorbitant cost of care, Canadians are more troubled by wait times for certain treatments. Indeed, approximately 1 million Canadians claim to be experiencing difficulties in access to care.
Official statistics on medical tourism have not been collected, but an estimated 150,000 foreigners sought care in 2004 in India alone--and this number is growing at a rate of about 15% annually. Most of these patients are from the Middle East or Asia, but the proportion of U.S. citizens and Canadians is rising. Although providers offer a diverse range of services, the most common procedures are elective.
The benefits go beyond cost:
--Consumers gain from cost savings, but may also receive excellent care from highly qualified doctors.
--Many providers offer more personalized care--i.e., a higher physician-to-patient ratio--than is commonly available in the United States or Canada.
--Some services that are not yet approved by the U.S. Food and Drug Administration, such as certain hip replacement surgery techniques, are available overseas.
However, consumers also face risks when undergoing treatment in a foreign country:
--Follow-up is difficult when the patient returns home, and expensive care may be required if complications occur.
--Quality assessment is problematic, and the language barrier can complicate matters.
--Malpractice laws in other countries are different.
Foreign providers stand to gain from the looming demand and are eager to increase supply. Nevertheless, competition is fierce, leading to consumer-directed advertising campaigns. This burgeoning international market for medical care may also drive U.S. providers to respond to the increase in competition:
--Overseas impact. Hospitals, physicians and medical staff are benefiting from higher revenues. For example, medical tourism in India is forecast to generate over $2 billion in revenue by 2012, according to a study by McKinsey and the Confederation of Indian Industry.
--Domestic changes. U.S. hospitals make most of their money on high-margin elective surgeries not typically covered by insurance plans. They may need to become more efficient and affordable to avoid losing business overseas.
Some U.S. employers, concerned about rising health care costs, are using financial incentives to encourage employees to experiment with medical tourism. This is an especially common practice at large firms that self-insure and pay directly for their employees' medical expenses. Opponents, including unions, argue that it exposes employees to greater uncertainty and risk.
Medical tourism will continue to expand rapidly. However, its long-term growth rate depends on several factors:
--Insurance market. While companies specializing in arranging trips for medical tourists are flourishing, insurers have been slow to adapt to this new market.
--Legislation. North American governments may consider facilitating this assimilation of foreign care into domestic insurance plans--both private and public--through legislative action. Such legislation will face stiff opposition from unions and domestic medical groups.
--Image problem. Rich world consumers will have to overcome stereotypes of developing world poverty, lack of education and hygienic problems in order for the industry to thrive. Positive outcomes for those patients who do venture overseas may help to quell these fears.
--Inelastic demand. Uninsured U.S. citizens represent the largest group of prospective medical tourists. However, research shows patient demand tends to be relatively price inelastic for procedures that cost under $1,000 dollars. As median annual health care expenditures per capita for the uninsured are well under this level, more than half may have no interest in medical tourism.
The knowledge that the same care is available elsewhere at a much lower cost may encourage consumers to be more price-sensitive about certain medical procedures, increasing transparency, lowering costs and improving quality. However, this is unlikely to benefit most consumers--particularly the poor and uninsured.
To read an extended version of this article, log on to Oxford Analytica's Web site.
Oxford Analytica is an independent strategic-consulting firm drawing on a network of more than 1,000 scholar experts at Oxford and other leading universities and research institutions around the world. For more information, please visit www.oxan.com. To find out how to subscribe to the firm's Daily Brief Service, click here.
Dangers of holiday surgery
Dangers of holiday surgery
THE Australian Society of Plastic Surgeons has warned of the dangers of undergoing cosmetic surgery overseas following a survey of its members that revealed patients had sought consultations related to complications occurring on their return home.
Of the 68 surgeons who responded to the survey, 40 said they had seen patients with problems.
Perth reported the highest number of cases, with 66, most relating to breast surgery carried out in Thailand.
Society president Bill Cockburn says that while complications can arise with any surgery, people having treatment abroad have no recourse.
"There are huge advantages in being able to get back to your treating surgeon," he says. "If an infection develops or you're not happy with the result of your surgery it's too late. We've had patients come to us in tears saying that when things went wrong there was nobody there for them.
"Unfortunately, there will always be people lured overseas if they think they can save money. We want to remind them that it could end up costing a lot more."
The society offers the following advice to people considering cosmetic surgery abroad:
o Surgery is never a holiday; it's a serious undertaking and every operation has risks.
o Follow-up care and monitoring is an important part of any surgery.
o Australian hospitals and anaesthetists are among the best in the world and your risk of serious complications is lowest here.
o Beware of slick advertising that promises the earth. You get what you pay for.
Barry Oliver
THE Australian Society of Plastic Surgeons has warned of the dangers of undergoing cosmetic surgery overseas following a survey of its members that revealed patients had sought consultations related to complications occurring on their return home.
Of the 68 surgeons who responded to the survey, 40 said they had seen patients with problems.
Perth reported the highest number of cases, with 66, most relating to breast surgery carried out in Thailand.
Society president Bill Cockburn says that while complications can arise with any surgery, people having treatment abroad have no recourse.
"There are huge advantages in being able to get back to your treating surgeon," he says. "If an infection develops or you're not happy with the result of your surgery it's too late. We've had patients come to us in tears saying that when things went wrong there was nobody there for them.
"Unfortunately, there will always be people lured overseas if they think they can save money. We want to remind them that it could end up costing a lot more."
The society offers the following advice to people considering cosmetic surgery abroad:
o Surgery is never a holiday; it's a serious undertaking and every operation has risks.
o Follow-up care and monitoring is an important part of any surgery.
o Australian hospitals and anaesthetists are among the best in the world and your risk of serious complications is lowest here.
o Beware of slick advertising that promises the earth. You get what you pay for.
Barry Oliver
Medical tourism warts-and-all
Medical tourism warts-and-all
By Libby Peacock
Article from: The Australian
LINDA Beier, an expatriate living in Hong Kong, was unhappy with the appearance of her teeth, so when she had the chance to join a friend for a 10-day break in Thailand she included a visit to a well-known Bangkok dental practice, where the problem was fixed for a fraction of the cost in her adopted home.
Beier's dental procedure was just a tiny cog in the global medical tourism wheel which, according to some estimates, is a $50 billion global industry.
Several hospitals in Asia have carved out such outstanding reputations that medical tourism has become a big money-spinner; the typical combined hospital and doctors' charges are 60 per cent to 85 per cent lower than those in, say, US hospitals.
In Singapore and Thailand, government agencies have been set up to help market their expertise globally. Medical travel agencies have sprung up and top Asian hospitals routinely have international desks and services to assist overseas patients with everything from doctors' appointments to accommodation.
Thailand
Bangkok's Bumrungrad International Hospital has won international acclaim and is Thailand's best-known facility for health tourism. It was the first hospital in Asia, and the only one in Thailand, to be accredited by the US-based Joint Commission International, an organisation aiming to elevate healthcare delivery standards through an evaluation and accreditation process.
Last year, 435,000 international patients from more than 150 countries were treated at Bumrungrad, with surgeries ranging from comprehensive check-ups and cardiac surgery to cancer treatment and plastic surgery. An elective coronary artery bypass operation that would typically cost $70,000 is about one-quarter of that fee at Bumrungrad.
The hospital's group marketing director Ruben Toral says: "We deliver a Mercedes product at a Toyota price." He's referring to the three things Bumrungrad prides itself on: high-quality, international-standard medical services, immediate access to those services and specialists, and affordable prices.
Mr Toral says the hospital is a one-stop medical centre with more than 900 internationally trained medical specialists under one roof. Patients arriving for treatment might well be guests checking in at a five-star hotel; there are concierge-style services and an electronic medical-records system that eliminates paper and waiting.
Like other top Asian hospitals, Bumrungrad works with the travel industry to promote medical tourism and the hospital has a partnership with Diethelm Travel, Thailand's largest inbound tour operator, which has an office in the hospital; the hospital also has a new kiosk at Bangkok's international airport.
All Bumrungrad's doctors are Thai, but more than half have international training or overseas board certification.
Another Thai institution providing international services is the Bangkok International Hospital, which boasts a considerable portion of foreign patients. Its International Medical Centre features a team of multilingual interpreters.
Also in Bangkok, the BNH Hospital offers a range of medical services, from orthopedic surgery and ophthalmology to pediatrics. Various check-up programs are on offer for set package prices (a general heart check-up including a chest X-ray, electrocardiogram, a blood test and tests for blood pressure and diabetes costs the promotional fee of $165 until June 30). The hospital's International Travel Medicine Clinic provides full medical services and immunisations and the "first comprehensive spine centre in Thailand".
Southern Thailand's Phuket may be famous for its beaches and warm seas, but to some tourists it has another attraction: sex-change surgery. (This is one of the top 10 procedures attracting foreign patients to Thailand.) The Bangkok Phuket Hospital is part of the Bangkok Hospital Group, a network of 15 private hospitals. The hospital offers sexual reassignment surgery, as well as extensive health-check facilities (it has the equipment to perform full-body CT scans and 4D ultrasounds). Years ago the hospital set up a subsidiary travel agency, Phuket Health and Travel, offering packages for procedures such as plastic surgery, dialysis, hip or knee replacements and annual check-ups.
Singapore
Singapore is another player in the Asian medical tourism market, which is unsurprising given the super-efficient city-state's reputation for sophisticated facilities and advanced technology. Critics say costs are 30 per cent to 50 per cent higher than those in Thailand but, even so, they remain appreciably lower than in the US and Australia.
In 2003, Singapore created Singapore Medicine, a government-industry partnership to develop Singapore as an international hub for medical travellers, research, conventions and education.
According to Singapore Medicine director Jason Yap, Singapore received 374,000 healthcare visitors in 2005 and services ranged from transplants and hip replacements to fringe procedures.
The eMenders group consists of more than 50 specialists based at the Mount Elizabeth Medical Centre in Singapore, covering more than 25 specialty areas. All the doctors have internationally recognised qualifications and have received their specialty training, or additional training, at leading institutions in those countries.
Medical tourism vs medical travel
According to eMenders chief executive Moonlake Lee, it is important to differentiate between the terms medical tourism and medical travel. Most eMenders patients fall into the category of medical travel (they go to Singapore primarily because of medical reasons). For other patients, medical services may be incidental to their trip; those in this category mainly have elective, cosmetic or minimally invasive procedures, such as dermatology, dental, general health screening and aesthetic procedures. Many patients also come to seek second opinions on treatments or on diagnoses made by their doctors back home.
The Mount Elizabeth Hospital is owned by the Parkway Group, which also owns the East Shore and Gleneagles hospitals in Singapore and a network of hospitals in Asia. Parkway's International Patient Assistance Centre helps patients to access the right channel of expertise and assists with travel and other necessary arrangements.
Dentistry also draws international patients to Singapore. Doctor Ansgar Cheng of Henry Lee Dental Surgery says dental services have been provided at the Mount Elizabeth Medical Centre for more than 27 years and overseas patients come from throughout Asia, Australia and New Zealand.
The practice also has a growing number of clients from Russia, Canada, Britain and the US, says Dr Cheng, who has fellowships in Singapore, Canada and Australia. Typically, international patients seek procedures such as dental implants, crowns, veneers and dentures.
Another Singapore hospital with an international patients' centre is Raffles Hospital, which offers fixed-price packages, from screening for osteoporosis for about $S100 ($80) to total knee replacements. The package price for a coronary artery bypass graft runs at $14,000 for up to an eight-night stay with two nights in the intensive care unit.
India
Think of India and images of ancient temples, tigers, call centres and the information technology boom may jump to mind. These days, health care is also on the list. India has some excellent medical care providers; in 2004, Indian facilities treated an estimated 150,000 medical tourists.
Cardiac care is one specialty drawing overseas patients to India. The Escorts Heart Institute and Research Centre in Delhi is a state-of-the-art institute where more than 35,000 open-heart operations have been performed.
At Escorts, open-heart surgery costs about 200,000 rupees ($6000). Like most international hospitals in Asia, the centre helps foreign patients with visa arrangements, airport pick-ups and accommodation.
The Apollo Hospitals Group runs hospitals across India, including in Delhi, Hyderabad, Chennai, Bangalore and Kolkata. Some patients are also drawn to India's holistic approach to healing, where disciplines such as yoga and meditation may be used alongside the latest medical techniques. Various city hospitals across India have ayurveda natural healing centres.
The Wockhardt Hospitals Group has a chain of super-specialty hospitals, such as the Wockhardt Eye Hospital, Wockhardt Bone and Joint Hospital and Wockhardt Heart Hospital in Mumbai, and others in Bangalore, Hyderabad, Kolkata and Nagpur. The group has an association with Harvard Medical International, an arm of the Harvard Medical School.
Other Indian hospitals treating increasing numbers of foreign patients include Global Hospitals, a dedicated centre in Mumbai for multi-organ transplants also focusing on cardiology, liver diseases, oncology and haematology. There is also the well-regarded L. V.
Prasad Eye Institute in Hyderabad. The Ruby Hospital in Kolkata even has an exclusive lifestyle floor, The Enclave, housing private apartments.
Malaysia
At the forefront of medical tourism in Malaysia is the state of Penang, where the Government is actively promoting its private facilities for cosmetic surgery. Hospitals drawing international patients include the Gleneagles Medical Centre with its own foreign patients' service and a range of services and packages (a standard executive health screening test including examination, electrocardiogram, chest X-ray and blood and other tests runs at about 455 ringgit or $160).
The 258-bed Penang Adventist Hospital is a private hospital that is part of an international network of more than 500 facilities and claims to be the first private hospital in northern Malaysia to have performed procedures such as coronary bypass and laser heart surgery.
Another Penang hospital that has established an international reputation in Southeast Asia is the modern Island Hospital which, apart from the usual facilities, also has a heart centre, urology centre, fertility centre and laser vision-correction centre. A standard executive screening program here costs $100.
Philippines
The Philippines is also starting to cash in, with an official Philippines medical tourism program running in co-operation with its Department of Tourism. The first Philippines Medical Tourism Congress was held in Manila late last year and it's hoped patients from the US and Australia will be attracted in the future. Several healthcare facilities are participating in the program, but so far St Lukes Medical Centre in Quezon City is the Government's only full medical tourism partner.
Pre-travel warning
A word of warning: do your homework before you fly. Asia is home to many international-standard hospitals, but if you don't choose well your medical holiday could end in disaster.
Related story Botched: Warning on cheap 'holiday surgery' fixes »
In the southern Chinese city of Shenzhen, for example, there are thousands of unlicensed centres offering all sorts of plastic surgery. But don't fall for it. Elective treatments at overseas hospitals or clinics are not claimable from Australian health funds and, if post-operative problems or negligence issues arise, suing a foreign doctor is likely to be a labyrinthine process. That bargain procedure may just be the final cut.
By Libby Peacock
Article from: The Australian
LINDA Beier, an expatriate living in Hong Kong, was unhappy with the appearance of her teeth, so when she had the chance to join a friend for a 10-day break in Thailand she included a visit to a well-known Bangkok dental practice, where the problem was fixed for a fraction of the cost in her adopted home.
Beier's dental procedure was just a tiny cog in the global medical tourism wheel which, according to some estimates, is a $50 billion global industry.
Several hospitals in Asia have carved out such outstanding reputations that medical tourism has become a big money-spinner; the typical combined hospital and doctors' charges are 60 per cent to 85 per cent lower than those in, say, US hospitals.
In Singapore and Thailand, government agencies have been set up to help market their expertise globally. Medical travel agencies have sprung up and top Asian hospitals routinely have international desks and services to assist overseas patients with everything from doctors' appointments to accommodation.
Thailand
Bangkok's Bumrungrad International Hospital has won international acclaim and is Thailand's best-known facility for health tourism. It was the first hospital in Asia, and the only one in Thailand, to be accredited by the US-based Joint Commission International, an organisation aiming to elevate healthcare delivery standards through an evaluation and accreditation process.
Last year, 435,000 international patients from more than 150 countries were treated at Bumrungrad, with surgeries ranging from comprehensive check-ups and cardiac surgery to cancer treatment and plastic surgery. An elective coronary artery bypass operation that would typically cost $70,000 is about one-quarter of that fee at Bumrungrad.
The hospital's group marketing director Ruben Toral says: "We deliver a Mercedes product at a Toyota price." He's referring to the three things Bumrungrad prides itself on: high-quality, international-standard medical services, immediate access to those services and specialists, and affordable prices.
Mr Toral says the hospital is a one-stop medical centre with more than 900 internationally trained medical specialists under one roof. Patients arriving for treatment might well be guests checking in at a five-star hotel; there are concierge-style services and an electronic medical-records system that eliminates paper and waiting.
Like other top Asian hospitals, Bumrungrad works with the travel industry to promote medical tourism and the hospital has a partnership with Diethelm Travel, Thailand's largest inbound tour operator, which has an office in the hospital; the hospital also has a new kiosk at Bangkok's international airport.
All Bumrungrad's doctors are Thai, but more than half have international training or overseas board certification.
Another Thai institution providing international services is the Bangkok International Hospital, which boasts a considerable portion of foreign patients. Its International Medical Centre features a team of multilingual interpreters.
Also in Bangkok, the BNH Hospital offers a range of medical services, from orthopedic surgery and ophthalmology to pediatrics. Various check-up programs are on offer for set package prices (a general heart check-up including a chest X-ray, electrocardiogram, a blood test and tests for blood pressure and diabetes costs the promotional fee of $165 until June 30). The hospital's International Travel Medicine Clinic provides full medical services and immunisations and the "first comprehensive spine centre in Thailand".
Southern Thailand's Phuket may be famous for its beaches and warm seas, but to some tourists it has another attraction: sex-change surgery. (This is one of the top 10 procedures attracting foreign patients to Thailand.) The Bangkok Phuket Hospital is part of the Bangkok Hospital Group, a network of 15 private hospitals. The hospital offers sexual reassignment surgery, as well as extensive health-check facilities (it has the equipment to perform full-body CT scans and 4D ultrasounds). Years ago the hospital set up a subsidiary travel agency, Phuket Health and Travel, offering packages for procedures such as plastic surgery, dialysis, hip or knee replacements and annual check-ups.
Singapore
Singapore is another player in the Asian medical tourism market, which is unsurprising given the super-efficient city-state's reputation for sophisticated facilities and advanced technology. Critics say costs are 30 per cent to 50 per cent higher than those in Thailand but, even so, they remain appreciably lower than in the US and Australia.
In 2003, Singapore created Singapore Medicine, a government-industry partnership to develop Singapore as an international hub for medical travellers, research, conventions and education.
According to Singapore Medicine director Jason Yap, Singapore received 374,000 healthcare visitors in 2005 and services ranged from transplants and hip replacements to fringe procedures.
The eMenders group consists of more than 50 specialists based at the Mount Elizabeth Medical Centre in Singapore, covering more than 25 specialty areas. All the doctors have internationally recognised qualifications and have received their specialty training, or additional training, at leading institutions in those countries.
Medical tourism vs medical travel
According to eMenders chief executive Moonlake Lee, it is important to differentiate between the terms medical tourism and medical travel. Most eMenders patients fall into the category of medical travel (they go to Singapore primarily because of medical reasons). For other patients, medical services may be incidental to their trip; those in this category mainly have elective, cosmetic or minimally invasive procedures, such as dermatology, dental, general health screening and aesthetic procedures. Many patients also come to seek second opinions on treatments or on diagnoses made by their doctors back home.
The Mount Elizabeth Hospital is owned by the Parkway Group, which also owns the East Shore and Gleneagles hospitals in Singapore and a network of hospitals in Asia. Parkway's International Patient Assistance Centre helps patients to access the right channel of expertise and assists with travel and other necessary arrangements.
Dentistry also draws international patients to Singapore. Doctor Ansgar Cheng of Henry Lee Dental Surgery says dental services have been provided at the Mount Elizabeth Medical Centre for more than 27 years and overseas patients come from throughout Asia, Australia and New Zealand.
The practice also has a growing number of clients from Russia, Canada, Britain and the US, says Dr Cheng, who has fellowships in Singapore, Canada and Australia. Typically, international patients seek procedures such as dental implants, crowns, veneers and dentures.
Another Singapore hospital with an international patients' centre is Raffles Hospital, which offers fixed-price packages, from screening for osteoporosis for about $S100 ($80) to total knee replacements. The package price for a coronary artery bypass graft runs at $14,000 for up to an eight-night stay with two nights in the intensive care unit.
India
Think of India and images of ancient temples, tigers, call centres and the information technology boom may jump to mind. These days, health care is also on the list. India has some excellent medical care providers; in 2004, Indian facilities treated an estimated 150,000 medical tourists.
Cardiac care is one specialty drawing overseas patients to India. The Escorts Heart Institute and Research Centre in Delhi is a state-of-the-art institute where more than 35,000 open-heart operations have been performed.
At Escorts, open-heart surgery costs about 200,000 rupees ($6000). Like most international hospitals in Asia, the centre helps foreign patients with visa arrangements, airport pick-ups and accommodation.
The Apollo Hospitals Group runs hospitals across India, including in Delhi, Hyderabad, Chennai, Bangalore and Kolkata. Some patients are also drawn to India's holistic approach to healing, where disciplines such as yoga and meditation may be used alongside the latest medical techniques. Various city hospitals across India have ayurveda natural healing centres.
The Wockhardt Hospitals Group has a chain of super-specialty hospitals, such as the Wockhardt Eye Hospital, Wockhardt Bone and Joint Hospital and Wockhardt Heart Hospital in Mumbai, and others in Bangalore, Hyderabad, Kolkata and Nagpur. The group has an association with Harvard Medical International, an arm of the Harvard Medical School.
Other Indian hospitals treating increasing numbers of foreign patients include Global Hospitals, a dedicated centre in Mumbai for multi-organ transplants also focusing on cardiology, liver diseases, oncology and haematology. There is also the well-regarded L. V.
Prasad Eye Institute in Hyderabad. The Ruby Hospital in Kolkata even has an exclusive lifestyle floor, The Enclave, housing private apartments.
Malaysia
At the forefront of medical tourism in Malaysia is the state of Penang, where the Government is actively promoting its private facilities for cosmetic surgery. Hospitals drawing international patients include the Gleneagles Medical Centre with its own foreign patients' service and a range of services and packages (a standard executive health screening test including examination, electrocardiogram, chest X-ray and blood and other tests runs at about 455 ringgit or $160).
The 258-bed Penang Adventist Hospital is a private hospital that is part of an international network of more than 500 facilities and claims to be the first private hospital in northern Malaysia to have performed procedures such as coronary bypass and laser heart surgery.
Another Penang hospital that has established an international reputation in Southeast Asia is the modern Island Hospital which, apart from the usual facilities, also has a heart centre, urology centre, fertility centre and laser vision-correction centre. A standard executive screening program here costs $100.
Philippines
The Philippines is also starting to cash in, with an official Philippines medical tourism program running in co-operation with its Department of Tourism. The first Philippines Medical Tourism Congress was held in Manila late last year and it's hoped patients from the US and Australia will be attracted in the future. Several healthcare facilities are participating in the program, but so far St Lukes Medical Centre in Quezon City is the Government's only full medical tourism partner.
Pre-travel warning
A word of warning: do your homework before you fly. Asia is home to many international-standard hospitals, but if you don't choose well your medical holiday could end in disaster.
Related story Botched: Warning on cheap 'holiday surgery' fixes »
In the southern Chinese city of Shenzhen, for example, there are thousands of unlicensed centres offering all sorts of plastic surgery. But don't fall for it. Elective treatments at overseas hospitals or clinics are not claimable from Australian health funds and, if post-operative problems or negligence issues arise, suing a foreign doctor is likely to be a labyrinthine process. That bargain procedure may just be the final cut.
Medical tourism: Need surgery, will travel
Medical tourism: Need surgery, will travel
CBC News Online | June 18, 2004
A worldwide market
What's called medical tourism – patients going to a different country for either urgent or elective medical procedures – is fast becoming a worldwide, multibillion-dollar industry.
The reasons patients travel for treatment vary. Many medical tourists from the United States are seeking treatment at a quarter or sometimes even a 10th of the cost at home. From Canada, it is often people who are frustrated by long waiting times. From Great Britain, the patient can't wait for treatment by the National Health Service but also can't afford to see a physician in private practice. For others, becoming a medical tourist is a chance to combine a tropical vacation with elective or plastic surgery.
And more patients are coming from poorer countries such as Bangladesh where treatment may not be available.
Medical tourism is actually thousands of years old. In ancient Greece, pilgrims and patients came from all over the Mediterranean to the sanctuary of the healing god, Asklepios, at Epidaurus. In Roman Britain, patients took the waters at a shrine at Bath, a practice that continued for 2,000 years. From the 18th century wealthy Europeans travelled to spas from Germany to the Nile. In the 21st century, relatively low-cost jet travel has taken the industry beyond the wealthy and desperate.
Countries that actively promote medical tourism include Cuba, Costa Rica, Hungary, India, Israel, Jordan, Lithuania, Malaysia and Thailand. Belgium, Poland and Singapore are now entering the field. South Africa specializes in medical safaris-visit the country for a safari, with a stopover for plastic surgery, a nose job and a chance to see lions and elephants.
India
India is considered the leading country promoting medical tourism-and now it is moving into a new area of "medical outsourcing," where subcontractors provide services to the overburdened medical care systems in western countries.
India's National Health Policy declares that treatment of foreign patients is legally an "export" and deemed "eligible for all fiscal incentives extended to export earnings." Government and private sector studies in India estimate that medical tourism could bring between $1 billion and $2 billion US into the country by 2012. The reports estimate that medical tourism to India is growing by 30 per cent a year.
India's top-rated education system is not only churning out computer programmers and engineers, but an estimated 20,000 to 30,000 doctors and nurses each year.
The largest of the estimated half-dozen medical corporations in India serving medical tourists is Apollo Hospital Enterprises, which treated an estimated 60,000 patients between 2001 and spring 2004. It is Apollo that is aggressively moving into medical outsourcing. Apollo already provides overnight computer services for U.S. insurance companies and hospitals as well as working with big pharmaceutical corporations with drug trials. Dr. Prathap C. Reddy, the chairman of the company, began negotiations in the spring of 2004 with Britain's National Health Service to work as a subcontractor, to do operations and medical tests for patients at a fraction of the cost in Britain for either government or private care.
Apollo's business began to grow in the 1990s, with the deregulation of the Indian economy, which drastically cut the bureaucratic barriers to expansion and made it easier to import the most modern medical equipment. The first patients were Indian expatriates who returned home for treatment; major investment houses followed with money and then patients from Europe, the Middle East and Canada began to arrive. Apollo now has 37 hospitals, with about 7,000 beds. The company is in partnership in hospitals in Kuwait, Sri Lanka and Nigeria.
Western patients usually get a package deal that includes flights, transfers, hotels, treatment and often a post-operative vacation.
Apollo has also reacted to criticism by Indian politicians by expanding its services to India's millions of poor. It has set aside free beds for those who can't afford care, has set up a trust fund and is pioneering remote, satellite-linked telemedicine across India.
Thailand
While, so far, India has attracted patients from Europe, the Middle East and Canada, Thailand has been the goal for Americans.
India initially attracted people who had left that country for the West; Thailand treated western expatriates across Southeast Asia. Many of them worked for western companies and had the advantage of flexible, worldwide medical insurance plans geared specifically at the expatriate and overseas corporate markets.
With the growth of medical-related travel and aggressive marketing, Bangkok became a centre for medical tourism. Bangkok's International Medical Centre offers services in 26 languages, recognizes cultural and religious dietary restrictions and has a special wing for Japanese patients.
The medical tour companies that serve Thailand often put emphasis on the vacation aspects, offering post-recovery resort stays.
Specialty care
Other countries interested in medical tourism tended to start offering care to specific markets but have expanded their services as the demand grows around the world. Cuba, for example, first aimed its services at well-off patients from Central and South America and now attracts patients from Canada, Germany and Italy. Malaysia attracts patients from surrounding Southeast Asian countries; Jordan serves patients from the Middle East. Israel caters to both Jewish patients and people from some nearby countries. One Israeli hospital advertises worldwide services, specializing in both male and female infertility, in-vitro fertilization and high-risk pregnancies. South Africa offers package medical holiday deals with stays at either luxury hotels or safaris.
Visiting the dentist
The newest and fastest-growing area of medical tourism is a visit to the dentist, where costs are often not covered by basic insurance and by only some extended insurance policies. India, Thailand and Hungary attract patients who want to combine a filling, extraction or root canal with a vacation.
The downsides of medical tourism
Experts have identified a number of problems with medical tourism
* Government and basic medical insurance, and sometimes extended medical insurance, often does not pay for the medical procedure, meaning the patient has to pay cash.
* There is little follow-up care. The patient usually is in hospital for only a few days, and then goes on the vacation portion of the trip or returns home. Complications, side-effects and post-operative care are then the responsibility of the medical care system in the patients' home country.
* Most of the countries that offer medical tourism have weak malpractice laws, so the patient has little recourse to local courts or medical boards if something goes wrong.
* There are growing accusations that profitable, private-sector medical tourism is drawing medical resources and personnel away from the local population, although some medical organizations that market to outside tourists are taking steps to improve local service.
Across Canada, thousands are on waiting lists for surgeries. In some cases those waits can last for years.
A year ago, Aruna Thurairajan of Calgary was becoming resigned to the idea of living in pain. At the age of 50, a spinal condition was making tasks like reaching over her head impossible.
"I had almost 20 to 40 painkillers a day," she says.
Her doctors in Alberta said there would be a three-year wait for corrective surgery.
"I went over to India... and I had the surgery, " Thurairajan says.
Six weeks later not only could she lift her arm, she could also endorse this cheque from the province of Alberta, reimbursing her for almost the entire cost of the surgery despite the fact it was done in a foreign private hospital.
"I had a legitimate claim, I processed it just the way they wanted, I didn't make any unreasonable demands," she says,
An out of country health services claim is little known, little used. Alberta only had 45 cases last year. It's an option for patients who simply can't get into a hospital quick enough.
"The basic criteria are [that] it be an insured medically necessary service unavailable in Alberta or elsewhere in Canada," says Howard May of Alberta Health. "After that we look at each case on a case-to-case basis."
It's not just Alberta; each province has a similar process. The catch is patients often pay up front.
Enter the great Canadian health dilemma. Are Canadians "jumping the queue" for free?
Sharon Sholzberg-Gray speaks for the Canadian Healthcare Association.
"Certainly it's a form of 'queue-jumping,' but if someone went and got the treatment and it was medically necessary, and they can show it was, one could argue it was just to reimburse them," she says
"There is no thing called queue-jumping when it comes to your own health. You don't want to end up paralysed or dead," Thurairajan says.
She'd rather have had the surgery at home, around family and friends, but on the end she's living pain-free.
All she had to do was write a cheque... that she'd gladly write again.
Medical tourism growing worldwide
Medical tourism growing worldwide
Futurist Marvin Cetron, founder and president of Forecasting International, serves on the advisory board of UD’s Department of Hotel, Restaurant and Institutional Management.
11:34 a.m., July 25, 2005--Falling ill while abroad seems like the worst sort of traveling nightmare. Yet, for growing numbers of travelers, the lure of combining affordable medical care with attentive room service is a chief draw for packing a suitcase and boarding a plane.
Here, UDaily previews excerpts from an article by Frederick J. DeMicco, ARAMARK Chair in Hotel, Restaurant and Institutional Management and department chairperson, and Marvin Cetron, founder and president of Forecasting International, on the growing trend of medical tourism. In Q&A format, both experts share abridged portions of their views from an article soon to be published in the FIU (Florida International University) Hospitality Review.
DeMicco and Cetron, along with Owen Davies, a consultant for Forecasting International, also have coauthored a recently published book on tourism trends titled, Hospitality 2010: The Future of Hospitality and Travel.
Medical tourists have good cause to seek out care beyond the United States for many reasons. In some regions of the world, state-of-the-art medical facilities are hard to come by, if they exist at all; in other countries, the public health-care system is so overburdened that it can take years to get needed care. In Britain and Canada, for instance, the waiting period for a hip replacement can be a year or more, while in Bangkok or Bangalore, a patient can be in the operating room the morning after getting off a plane.
For many medical tourists, though, the real attraction is price. The cost of surgery in India, Thailand or South Africa can be one-tenth of what it is in the United States or Western Europe, and sometimes even less. A heart-valve replacement that would cost $200,000 or more in the U.S., for example, goes for $10,000 in India--and that includes round-trip airfare and a brief vacation package. Similarly, a metal-free dental bridge worth $5,500 in the U.S. costs $500 in India, a knee replacement in Thailand with six days of physical therapy costs about one-fifth of what it would in the States, and Lasik eye surgery worth $3,700 in the U.S. is available in many other countries for only $730. Cosmetic surgery savings are even greater: A full facelift that would cost $20,000 in the U.S. runs about $1,250 in South Africa.
The savings sound very attractive, but a good new hip and a nice new face don’t seem like the sort of things anyone would want to bargain with. How does the balance of savings versus risk pay off in terms of success rates?
Inferior medical care would not be worth having at any price, and some skeptics warn that Third World surgery cannot possibly be as good as that available in the United States. In fact, there have been cases of botched plastic surgery, particularly from Mexican clinics in the days before anyone figured out what a gold mine cheap, high-quality care could be for the developing countries.
Yet, the hospitals and clinics that cater to the tourist market often are among the best in the world, and many are staffed by physicians trained at major medical centers in the United States and Europe.
Bangkok’s Bumrundgrad hospital has more than 200 surgeons who are board-certified in the United States, and one of Singapore’s major hospitals is a branch of the prestigious Johns Hopkins University in Baltimore. In a field where experience is as important as technology, Escorts Heart Institute and Research Center in Delhi and Faridabad, India, performs nearly 15,000 heart operations every year, and the death rate among patients during surgery is only 0.8 percent--less than half that of most major hospitals in the United States.
In some countries, clinics are backed by sophisticated research infrastructures as well. India is among the world’s leading countries for biotechnology research, while both India and South Korea are pushing ahead with stem cell research at a level approached only in Britain. In many foreign clinics, too, the doctors are supported by more registered nurses per patient than in any Western facility, and some clinics provide single-patient rooms that resemble guestrooms in four-star hotels, with a nurse dedicated to each patient 24 hours a day.
Frederick J. DeMicco, ARAMARK Chair in Hotel, Restaurant and Institutional Management and department chairperson
Add to this the fact that some clinics assign patients a personal assistant for the posthospital recovery period and throw in a vacation incentive as well, and the deal gets even more attractive. Additionally, many Asian airlines offer frequent-flyer miles to ease the cost of returning for follow-up visits.
How is the medical tourism trend being tracked and what trends, if any, do gathered statistics show?
Ten years ago, medical tourism was hardly large enough to be noticed. Today, more than 250,000 patients per year visit Singapore alone--nearly half of them from the Middle East. This year, approximately half a million foreign patients will travel to India for medical care, whereas in 2002, the number was only 150,000.
In monetary terms, experts estimate that medical tourism could bring India as much as $2.2 billion per year by 2012. Argentina, Costa Rica, Cuba, Jamaica, South Africa, Jordan, Malaysia, Hungary, Latvia and Estonia all have broken into this lucrative market as well, or are trying to do so, and more countries join the list every year.
What sort of trends in medical tourism do you foresee in the near future?
Some important trends guarantee that the market for medical tourism will continue to expand in the years ahead. By 2015, the health of the vast Baby Boom generation will have begun its slow, final decline, and, with more than 220 million Boomers in the United States, Canada, Europe, Australia and New Zealand, this represents a significant market for inexpensive, high-quality medical care.
Medical tourism will be particularly attractive in the United States, where an estimated 43 million people are without health insurance and 120 million without dental coverage--numbers that are both likely to grow. Patients in Britain, Canada and other countries with long waiting lists for major surgery will be just as eager to take advantage of foreign health-care options.
Which countries are significant leaders in the medical tourism industry?
Major centers for medical tourism are Bangkok and Phuket, with six medical facilities in Bangkok boasting hospital accreditation from the United States.
As in most tourist-oriented medical communities, the major attractions are cosmetic surgery and dental treatments. However, eye surgery, kidney dialysis and organ transplantation also are among the most common procedures sought by medical vacationers in Thailand.
Cetron and DeMicco, along with Owen Davies, a consultant for Forecasting International, coauthored the recently published ‘Hospitality 2010: The Future of Hospitality and Travel.’
For a few patients, Phuket has another attraction as well: Bangkok Phuket Hospital is the premier place to go for sex-change surgery. In fact, that is one of the top 10 procedures for which patients visit Thailand.
India is a relative newcomer to medical tourism, but is quickly catching up with Thailand, and recent estimates indicate that the number of foreign patients is growing there by 30 percent each year.
Looking ahead, are there any medical technologies or procedures in which particular countries excel?
India has top-notch centers for open-heart surgery, pediatric heart surgery, hip and knee replacement, cosmetic surgery, dentistry, bone marrow transplants and cancer therapy, and virtually all of India’s clinics are equipped with the latest electronic and medical diagnostic equipment.
Unlike many of its competitors in medical tourism, India also has the technological sophistication and infrastructure to maintain its market niche, and Indian pharmaceuticals meet the stringent requirements of the U.S. Food and Drug Administration. Additionally, India’s quality of care is up to American standards, and 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 U.S.
For North American patients, Costa Rica is the chosen destination for inexpensive, high-quality medical care without a trans-Pacific flight, and it is the particular mecca for westerners seeking plastic surgery.
South Africa also draws many cosmetic surgery patients, especially from Europe, and many South African clinics offer packages that include personal assistants, visits with trained therapists, trips to top beauty salons, post-operative care in luxury hotels and safaris or other vacation incentives. Because the South African rand has such a long-standing low rate on the foreign-exchange market, medical tourism packages there tend to be perpetual bargains as well.
Additionally, Argentina ranks high for plastic surgery, and Hungary draws large numbers of patients from Western Europe and the U.S. for high-quality cosmetic and dental procedures that cost half of what they would in Germany and America.
Lastly, Dubai--a destination already known as a luxury vacation paradise--is scheduled to open the Dubai Healthcare City by 2010. Situated on the Red Sea, this clinic will be the largest international medical center between Europe and Southeast Asia. Slated to include a new branch of the Harvard Medical School, it also may be the most prestigious foreign clinic on the horizon.
Article by Becca Hutchinson
Photos by Kathy F. Atkinson and Jack Buxbaum
Futurist Marvin Cetron, founder and president of Forecasting International, serves on the advisory board of UD’s Department of Hotel, Restaurant and Institutional Management.
11:34 a.m., July 25, 2005--Falling ill while abroad seems like the worst sort of traveling nightmare. Yet, for growing numbers of travelers, the lure of combining affordable medical care with attentive room service is a chief draw for packing a suitcase and boarding a plane.
Here, UDaily previews excerpts from an article by Frederick J. DeMicco, ARAMARK Chair in Hotel, Restaurant and Institutional Management and department chairperson, and Marvin Cetron, founder and president of Forecasting International, on the growing trend of medical tourism. In Q&A format, both experts share abridged portions of their views from an article soon to be published in the FIU (Florida International University) Hospitality Review.
DeMicco and Cetron, along with Owen Davies, a consultant for Forecasting International, also have coauthored a recently published book on tourism trends titled, Hospitality 2010: The Future of Hospitality and Travel.
Medical tourists have good cause to seek out care beyond the United States for many reasons. In some regions of the world, state-of-the-art medical facilities are hard to come by, if they exist at all; in other countries, the public health-care system is so overburdened that it can take years to get needed care. In Britain and Canada, for instance, the waiting period for a hip replacement can be a year or more, while in Bangkok or Bangalore, a patient can be in the operating room the morning after getting off a plane.
For many medical tourists, though, the real attraction is price. The cost of surgery in India, Thailand or South Africa can be one-tenth of what it is in the United States or Western Europe, and sometimes even less. A heart-valve replacement that would cost $200,000 or more in the U.S., for example, goes for $10,000 in India--and that includes round-trip airfare and a brief vacation package. Similarly, a metal-free dental bridge worth $5,500 in the U.S. costs $500 in India, a knee replacement in Thailand with six days of physical therapy costs about one-fifth of what it would in the States, and Lasik eye surgery worth $3,700 in the U.S. is available in many other countries for only $730. Cosmetic surgery savings are even greater: A full facelift that would cost $20,000 in the U.S. runs about $1,250 in South Africa.
The savings sound very attractive, but a good new hip and a nice new face don’t seem like the sort of things anyone would want to bargain with. How does the balance of savings versus risk pay off in terms of success rates?
Inferior medical care would not be worth having at any price, and some skeptics warn that Third World surgery cannot possibly be as good as that available in the United States. In fact, there have been cases of botched plastic surgery, particularly from Mexican clinics in the days before anyone figured out what a gold mine cheap, high-quality care could be for the developing countries.
Yet, the hospitals and clinics that cater to the tourist market often are among the best in the world, and many are staffed by physicians trained at major medical centers in the United States and Europe.
Bangkok’s Bumrundgrad hospital has more than 200 surgeons who are board-certified in the United States, and one of Singapore’s major hospitals is a branch of the prestigious Johns Hopkins University in Baltimore. In a field where experience is as important as technology, Escorts Heart Institute and Research Center in Delhi and Faridabad, India, performs nearly 15,000 heart operations every year, and the death rate among patients during surgery is only 0.8 percent--less than half that of most major hospitals in the United States.
In some countries, clinics are backed by sophisticated research infrastructures as well. India is among the world’s leading countries for biotechnology research, while both India and South Korea are pushing ahead with stem cell research at a level approached only in Britain. In many foreign clinics, too, the doctors are supported by more registered nurses per patient than in any Western facility, and some clinics provide single-patient rooms that resemble guestrooms in four-star hotels, with a nurse dedicated to each patient 24 hours a day.
Frederick J. DeMicco, ARAMARK Chair in Hotel, Restaurant and Institutional Management and department chairperson
Add to this the fact that some clinics assign patients a personal assistant for the posthospital recovery period and throw in a vacation incentive as well, and the deal gets even more attractive. Additionally, many Asian airlines offer frequent-flyer miles to ease the cost of returning for follow-up visits.
How is the medical tourism trend being tracked and what trends, if any, do gathered statistics show?
Ten years ago, medical tourism was hardly large enough to be noticed. Today, more than 250,000 patients per year visit Singapore alone--nearly half of them from the Middle East. This year, approximately half a million foreign patients will travel to India for medical care, whereas in 2002, the number was only 150,000.
In monetary terms, experts estimate that medical tourism could bring India as much as $2.2 billion per year by 2012. Argentina, Costa Rica, Cuba, Jamaica, South Africa, Jordan, Malaysia, Hungary, Latvia and Estonia all have broken into this lucrative market as well, or are trying to do so, and more countries join the list every year.
What sort of trends in medical tourism do you foresee in the near future?
Some important trends guarantee that the market for medical tourism will continue to expand in the years ahead. By 2015, the health of the vast Baby Boom generation will have begun its slow, final decline, and, with more than 220 million Boomers in the United States, Canada, Europe, Australia and New Zealand, this represents a significant market for inexpensive, high-quality medical care.
Medical tourism will be particularly attractive in the United States, where an estimated 43 million people are without health insurance and 120 million without dental coverage--numbers that are both likely to grow. Patients in Britain, Canada and other countries with long waiting lists for major surgery will be just as eager to take advantage of foreign health-care options.
Which countries are significant leaders in the medical tourism industry?
Major centers for medical tourism are Bangkok and Phuket, with six medical facilities in Bangkok boasting hospital accreditation from the United States.
As in most tourist-oriented medical communities, the major attractions are cosmetic surgery and dental treatments. However, eye surgery, kidney dialysis and organ transplantation also are among the most common procedures sought by medical vacationers in Thailand.
Cetron and DeMicco, along with Owen Davies, a consultant for Forecasting International, coauthored the recently published ‘Hospitality 2010: The Future of Hospitality and Travel.’
For a few patients, Phuket has another attraction as well: Bangkok Phuket Hospital is the premier place to go for sex-change surgery. In fact, that is one of the top 10 procedures for which patients visit Thailand.
India is a relative newcomer to medical tourism, but is quickly catching up with Thailand, and recent estimates indicate that the number of foreign patients is growing there by 30 percent each year.
Looking ahead, are there any medical technologies or procedures in which particular countries excel?
India has top-notch centers for open-heart surgery, pediatric heart surgery, hip and knee replacement, cosmetic surgery, dentistry, bone marrow transplants and cancer therapy, and virtually all of India’s clinics are equipped with the latest electronic and medical diagnostic equipment.
Unlike many of its competitors in medical tourism, India also has the technological sophistication and infrastructure to maintain its market niche, and Indian pharmaceuticals meet the stringent requirements of the U.S. Food and Drug Administration. Additionally, India’s quality of care is up to American standards, and 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 U.S.
For North American patients, Costa Rica is the chosen destination for inexpensive, high-quality medical care without a trans-Pacific flight, and it is the particular mecca for westerners seeking plastic surgery.
South Africa also draws many cosmetic surgery patients, especially from Europe, and many South African clinics offer packages that include personal assistants, visits with trained therapists, trips to top beauty salons, post-operative care in luxury hotels and safaris or other vacation incentives. Because the South African rand has such a long-standing low rate on the foreign-exchange market, medical tourism packages there tend to be perpetual bargains as well.
Additionally, Argentina ranks high for plastic surgery, and Hungary draws large numbers of patients from Western Europe and the U.S. for high-quality cosmetic and dental procedures that cost half of what they would in Germany and America.
Lastly, Dubai--a destination already known as a luxury vacation paradise--is scheduled to open the Dubai Healthcare City by 2010. Situated on the Red Sea, this clinic will be the largest international medical center between Europe and Southeast Asia. Slated to include a new branch of the Harvard Medical School, it also may be the most prestigious foreign clinic on the horizon.
Article by Becca Hutchinson
Photos by Kathy F. Atkinson and Jack Buxbaum
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