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Medical Tourism

When multi-speciality hospi-tal Jaslok was launched in1973 in Bombay, its ritzyfacilities were scoffed at

for their classy comforts. It was unimag-inable that hospitals could offer such lux-ury at that time. Today, many private hos-pitals in India's major cities offer far morethan Jaslok did, but no one seems to takenotice. Affluent Indians have now becomeaccustomed to medical care that com-pares with the best globally.

Not long ago, wealthy Indians would zipto famous hospitals round the world fordelicate or risky surgery. That too is chang-ing. Patients are now trickling in for med-ical care from the US and Europe. The nextoutsourcing wave from the Western worldmay well be in medical care, which fits inwith India's focus on the hard currencyearnings potential of its skilled manpower.

The new private hospitals, with state-of-the-art facilities that are comparablewith the best in the world, are increasing-ly finding that the need for their servicesnow extends far beyond the local commu-nity they were initially envisaged to serve.According to Prathap Reddy, chairman ofthe Apollo Group, which is the largesthospital group in Asia and manages 35hospitals in India and Sri Lanka, one out

of every 10 patients in his hospitals isfrom abroad. That is roughly the propor-tion in another speciality hospital inMumbai; the Asian Heart Institute,according to its founder, cardiac surgeonRamakant Panda.

Reddy says that the number of foreignvisitors to India for medical treatment hasgrown from 10,000 to 100,000 in thelast five years. With an annual growth of30 per cent in the number of overseasresidents that visit India for medicare,India is emerging as a destination for med-ical tourism and gradually catching upwith Singapore — an established medicalhub that attracts over 150,000 medicaltourists annually from across the world.

Currently, the majority of patientscoming to India are from West Asia andAfrica and non-resident Indians fromeverywhere who are mixing a holiday inthe homeland with medical attention. Asyet, it is just a trickle from the US andEurope so far, due to the fact that insur-ance companies have yet to come to gripswith the facilities that are provided bymajor Indian hospitals. Those who comefrom these countries are predominantlythe uninsured — and they are a substan-tial grouping considering that medicalinsurance is very expensive — who are

paying their way through. In the UK, itspublic healthcare system, the NationalHealth Service, does not send patientsabroad for treatment. But things mightjust change. The NHS has indicated thatIndia is a 'favoured destination' for sur-geries.

A joint study by the Confederation ofIndian Industry (CII) and McKinsey & Co.shows that at the current pace of growth,healthcare for foreigners can rake in over$2 billion in additional revenue by 2012,up from its current level of $333 million.Much of this could come from patientsfrom the developed world.

The mood is upbeat about India'shealth care potential as the business, withover four million employees, is among thelargest in the services sector.Consequently, the central government,the state governments, private hospitalsand travel agencies are working overtimeto get their act together to cash in on thepotential. B Suman, director of KeralaTourism Board says, "We have shortlisted15 multi-speciality hospitals of interna-tional standards in Kerala. They are beingbrought together with the hotels and trav-el agencies to foster partnerships in orderto promote medical tourism to the state."

Maharashtra, among India's industri-WORLD CLASS MEDICARE FACILITIES AT THE NEW HOSPITALS: Surgeon Ramakant Panda with his patient at the Asian Heart Institute

Medicare is the latest reason to visit India. As speciality hospitals proliferate across the country offering

world-class surgery, many foreigners are checking in andavailing of the cost benefits. S Mrinal and Nandu Manjeshwar

report on a trend which is catching.

Drop By, It’s GoodFor Your Health

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MEDICAL TOURISMMEDICAL TOURISM

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alised states, also has a medical tourismcouncil that works closely with P DHinduja Hospital in Mumbai and other pri-vate hospitals in the state to promotemedical care for overseas patients. India'sIT hub, Karnataka, is setting up aBangalore International Health City whichwill cater to international patients.

The reasons for coming to India can bevaried. Gregory Bates, the former

power lifting champ from the UK, hadchest pain while holidaying in Goa lastyear. He agreed to be operated atMumbai's Wockhardt Hospital, rather thango back home and wait in a long queue."He wouldn't have agreed to be operatedhere, had he not been convinced of thequality of treatment here," says VishalBali, vice president, Wockhardt HospitalsLtd. After undergoing coronary by-passsurgery at Wockhardt, Bates said of hisexperience in India, "There are hospitalshere which give medical care similar towhat the best hospitals in the world offer."

After returning, Bates spread the mes-

sage of quality health care and three morepatients came to India for treatment fromthe UK. What makes Bates, and otherpatients from overseas comfortable inIndian hospitals, is that they are staffed bymedical experts who have worked either inUS, UK, Europe or Australia. They arefamiliar with medical standards and proce-dures in these countries. According to theCII report, the Indian specialists, who runtheir private hospitals, have performed over500,000 major surgeries and over a millionother surgical procedures (such as cardio-thoracic, neurological and cancer surgeries)in the last five years. Their success rate iscomparable with the best in the world.

For instance, at Asian Heart Institute,which on an average performs six heartsurgeries in a day, Panda says, "The suc-cess rate for coronary bypass surgery is99.5 per cent." This is the same as at Cleveland, with which it has an associ-ation. Last year Asian Heart got patientsfrom 38 countries. That included Belgium,Holland and the UK. Wockhardt had patients from US, Denmark andHolland besides the UK. Indian medicalexperts have been the main draw forpatients coming.

Be it the New Delhi's Escorts HeartInstitute and Research Centre which per-forms over 4,000 heart operations in ayear; the Apollo group which has 6,400beds spread over 35 hospitals, Mumbai'sWockhardt Hospital which is an associateof Harvard Medical International; Mumbai'sBreach Candy -- all of them have a crack-ing record. Whether it is a bone marrowtransplant, kidney transplant, hip joint orknee replacement, neurosurgery, ophthal-mology, spine surgery or minimal accesssurgery, Indian medical professionals are

"ESCORTS is the largest cardiac care hos-pital in the world," says Naresh Trehan,executive director and cardiac surgeon who has been associated with the insti-tute since its inception 16 years ago. The328-bed hospital has nine operation the-atres, five CAT labs, two heart commandcentres and a heart station besides a hostof other facilities. Over 88,000 angiogra-phies, 19,000 angioplasties and 48,000cardiac surgical procedures have beenperformed at Escorts since its inception.

Howard Staab, a 54-year old carpenterfrom Durham, North Carolina, became aninstant beacon for those seeking afford-able surgeries. His story appeared in theWashington Post titled ‘In India, FirstWorld Care, Third World Cost’ on October21, 2004. The Post wrote that the samesurgery would have cost Staab$200,000, an impossible sum to bear, 'sohe outsourced the job to India', at a costof just $10,000.

That included round-trip airfare, hospi-tal charges and a side-trip to the TajMahal! "We always ask our patients if

they would like to do any sightseeingafter their recuperation," says NavneetMalhotra, general manager (hospitality),Escorts Heart Institute & ResearchCentre.

Another recent patient was James

Flynn from Australia. Flynn underwentcardiac surgery at Escorts, and was satis-fied with the experience. “I’d certainlyrecommend Escorts to my friends backhome, if they ever need cardiac treat-ment,” says Flynn.

SURGERY AT ESCORTS: IT'S A HEART THING

SURGEON TREHAN (R) WITH JAMES FLYNN (C) AND MRS FLYNN AT ESCORTS

proving to be comparable to the best in the world.

But what is really bringing patients toIndia is the soaring cost of healthcare inmany Western countries. For example,Azim Premji, a Tanzanian politician ofAsian origin, had the option to go to UKbut came to India for his coronary by-passsurgery because his friends advised him,"India is the best for heart surgery." Thecost of treatment was an equally importantissue. "Europe would have been at leastthree to four times more expensive," hesays. Premji came to Mumbai's AsianHeart Institute with his wife and twodaughters and they were in the city forthree weeks. The total cost of the family'svisit, including Premji's hospital bill, wasmuch less than what Premji would havepaid for his surgery in the UK.

The long queues for cardiac and othersurgeries is another reason why patientshave preferred to come to India for privatemedical treatment from the UK. For exam-ple, the waiting list for angiogram is threemonths, for angioplasty it is six monthsand for a by-pass, it is a year or more in the UK.

Mumbai has 10 to 15 major privatehospitals, many more than in London. TheLondon hospitals, like Cromwell and PrinceGrace, are small — between the size ofhospitals and nursing homes — and costly."It costs a patient going to private health-care for heart surgery around 25,000pounds. In India its just 4,300 pounds,including the cost of travel," says SudhirVaishnav, cardiologist at Asian HeartInstitute.

Healthcare in India is the cheapest inthe world, say many medical experts. Aprominent Indian business magazinereported the case of Henry McInnes, asoftware engineer based in Seattle, whonot only had his root canal treatment donein Bangalore last year, but also enjoyed avacation for just $4000 - the amount thathe would have otherwise spent in US forhis treatment.

A little known aspect of Indian medicalcare is its state-of-the-art diagnostic setup. While all major hospitals have theirown pathological labs, very specialisedcentral reference laboratories like SRL,Ranbaxy and Nicholas Piramal & DrPhadke's Labs (NPPL) have come up. Theyoffer the testing facilities that require spe-cialised skills and technology that hospitals

themselves can't afford, as volumes aresmall and it doesn't pay to maintain the fullfledged set up. While NPPL is accredited bythe National Accreditation Board ofLaboratories in India, SRL has in additionaccreditation from the College of AmericanLaboratories. This has enabled the lab to tieup with institutions in the UK and Europefor its services.

For all its advantages, India still gets onlya trickle of medical tourists from US

and Europe. So what's holding them back?Until recently there wasn't much of anattempt to promote Indian medical care inthese countries. While each hospital had atravel desk arrangement with travel agen-cies, there was no formal tie-up for pro-moting medical tourism.

This is changing now. Cox & King, aMumbai-London based travel group, hastied-up with Vedic India, a medical bodythat promotes medical tourism to India.Thomas Cook is studying possible tie-upswith various hospitals carefully beforelaunching its service.The Swiss travelmajor Kuoni and its Indian subsidiary SitaTravels have tied up with overseas agen-cies that focus on medical tourism.

Hospitals themselves are now beefingup their marketing teams. Apollo has aninternational marketing team that managesin-bound patients from various countries.Asian Heart Institute is launching its coor-dination centre in London in the currentyear. And, Wockhardt has recruited anexecutive to head its division for promot-ing its services abroad.

However, the ultimate baseline for glob-al promotion is accreditation, as withoutaccreditation, health insurance majors willnot reimburse patients. The Apollo groupand Escorts Heart Institute are seeking cer-tification from the US-based JointCommission on Accreditation of HealthcareOrganisations. But, despite not havingaccreditation from the JCI, there are hospi-tals that have managed tie-ups with insur-ance companies in US. For example,Wockhardt has a tie-up with the largesthealth insurance company in the US, BlueCross & Blue Shield Association.

India has the right mix of medical skillsand value-for-money offerings. And it hasdoctors with good bedside manners. It isjust a matter of time before that healthycombination opens up to the vast opportu-nities in medical tourism.

NAND

U M

ANJE

SHW

AR

Comparative Price ListCost in the Cost in

Surgery US ($) India ($)

Bone Marrow Transplant 400,000 30,000

Liver Transplant 500,000 40,000

Open Heart Surgery (CABG) 50,000 4,400

Neuro surgery 29,000 8000

Knee Surgery 16,000 4,500

Source: IBEF

SPECIALITY HOSPITALS

BREACH CANDY, MUMBAINo. of beds: 173

www.breachcandyhospital.org

WOCKHARDT HOSPITALSNo of hospitals 3 No. of beds: 420

www.wockhardthospitals.com

JASLOK HOSPITAL, MUMBAINo. of beds: 376

www.jaslokhospital.net

PD HINDUJA NATIONAL HOSPITAL & MEDICAL RESEARCH CENTRE, MUMBAI

No. of beds: 351www.hindujahospital.com

APOLLO HOSPITALSNo. of hospitals: 35 No. of beds: 6400

www.apollohospitals.com

ASIAN HEART INSTITUTE, MUMBAINo. of beds: 250www.ahirc.com

ESCORTS HEART INSTITUTE & RESEARCHCENTRE LTD, NEW DELHI

No. of beds: 325www.ehirc.com

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