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.