[lbo-talk] "First World Treatment at Third World Price"

[Yoshie Furuhashi]

Gary wrote:

> On 8/13/05, Sujeet Bhatt <sujeet.bhatt at gmail.com> wrote:
> > http://cities.expressindia.com/fullstory.php?newsid=143586
> >
> > UK teen's 7 month-wait ends with 5-hour surgery in city hospital
>
> > "The surgery went well. Better than what we expected," Dr Gulati  
> said.
> > The success is significant as Anil K Maini, president, corporate
> > development at Indraprastha Apollo, puts it: "As media is  
> covering it,
> > the success of the surgery would get more patients to India."
>
> does India need more patients? There aren't enough sick and injured  
> Indians ?
Of course, there are many more poor Indian patients in India than  
Indian doctors, nurses, and others can handle, but such poor domestic  
patients are unwelcome to India's for-profit health care wooing rich  
foreign patients, with the selling point of "first world treatment at  
third world price" in the words of Joy Chakraborty, "assistant  
administrator of Sri Ramachandra Medical College and Research  
Institute and regional director, Indian Society of Health  
Administrators" who "is passionate about selling medical  
tourism" ("We Need Formal Association between Health and Tourism,"  
Express Healthcare Management, <http://expresshealthcaremgmt.com/ 
20040815/conversation01.shtml>, 1-15 August 2005).

<blockquote>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.

. . . . .. . . . .. . . . .. . . . .

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.

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.

. . . . .. . . . .. . . . .. . . . .

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.

. . . . .. . . . .. . . . .. . . . .

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.

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.

. . . . .. . . . .. . . . .. . . . .

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."

(Rupa Chinai and Rahul Goswami, "Are We Ready for Medical Tourism?"  
<http://www.hindu.com/thehindu/mag/2005/04/17/stories/ 
2005041700060100.htm>, 17 April 2005)</blockquote>

As health care gets more expensive in the United States and become  
more underfunded in Canada, the United Kingdom, and elsewhere, no  
doubt more of the class of Westerners who can still afford to travel  
and pay for private health care abroad and yet are not so rich as to  
pay for private health care at home will overcome whatever they think  
of dirty roads and bad water in India.

Yoshie Furuhashi
<http://montages.blogspot.com>
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