//Foreigners taking advantage of cheap, high-quality medical care in India

Foreigners taking advantage of cheap, high-quality medical care in India

The Yomiuri Shimbun

The following is the fifth installment in a series of articles reporting on new developments in India, which celebrates the 60th anniversary of its independence this year, and where the nation is heading.

Doctors wearing masks moved their hands without uttering a word. Data traces on four monitors moved up and down. White walls and bright lights–the operation room, sparklingly clean and dominated by silence, was in a stark contrast to the noisy streets outside the hospital.

At the Escorts Heart Institute and Research Center Ltd., a private hospital specializing in cardiac diseases in New Delhi, about 5,500 operations are conducted annually. The success rate of the operations stands at 99.2 percent. The hospital has 332 beds and is fully air-conditioned. At the reception desk on the first floor, a woman wearing a dark-blue uniform efficiently handles visitors to the hospital. In the lobby, there is a coffee shop with glass walls. The hospital is not unlike those in advanced nations.

But a crucial difference is that the cost of treatment at the hospital is much cheaper than in other countries. Of about 150,000 patients using the hospital annually, about 10 percent come from about 60 nations around the world.

James Shipp, 50, who came from Houston to accompany his 58-year-old cousin who underwent a cardiac operation at the hospital, was relieved. He had been at a loss over what to do about his cousin's ailment, but everything had worked out well.

Several years ago his cousin, who was a heavy smoker experienced chest, pains but since he was not subscribing to any medical insurance he could not afford treatment. Shipp's wife found the hospital in India on the Internet, and Shipp and his cousin decided to come to India. They had been told in the United States that it would cost 150,000 dollars to 200,000 dollars for an operation. But in India, it cost only about 20,000 dollars.

The Indian government has been advertising internationally for several years that people can enjoy "First World treatment at Third World prices."

A pamphlet for foreign patients states that it costs only 6,000 dollars in India for a cardiac operation, which costs 30,000 dollars in the United States, and that it costs 26,000 dollars in India for a bone marrow transplant, whereas it costs 250,000 dollars in the United States. The huge price differentials result from lower personnel costs in India as well as surging operation costs in the United States in the wake of a series of medical lawsuits.

From 2006, India started to issue "medical visas" for foreign patients and those who accompanied them. Such visas are valid for a year, but can be extended if doctors issue certificates.

Indian Tourism Minister Ambika Soni, who doubles as culture minister and promoted the creation of such a new type of visa, said the nation intends to make medical tourism a driving force for the nation's tourism industry. The minister said foreign patients and those accompanying them should enjoy playing golf or visiting places of scenic beauty and historic interest after operations in India, using money that would otherwise have been used for treatment in their own country.

But it also is true that advanced medicine only benefits foreigners and a handful of affluent people in India. On the streets outside the best hospitals, ordinary people are unable to receive satisfactory treatment and are worried about dengue fever or Japanese encephalitis on streets that attract flies and mosquitoes.

Medical tourism itself also is concerned with compensation in cases of medical malpractice. Hospitals therefore are trying to remove such worries by obtaining certification from the Joint Commission International, an international mission unit of the Joint Commission on Accreditation of Healthcare Organizations, an organization that ranks hospitals in the United States. According to the JCI, five hospitals already have obtained certification.

India, whose population is known for its scientific and mathematic skills, produces many capable doctors every year. Some of them are taking active roles in such advanced nations as Britain and the United States. The level of the pharmaceutical industry also is high. India is thus becoming "a medical power."

While medical tourism hosted by private hospitals in India is attracting attention globally, there is concern over that medicine at public institutions has seriously deteriorated, due to factors such as insufficient funding and a lack of doctors. A number of doctors working at national or other public hospitals are moving to private hospitals, where salaries are higher. As gaps between rich and poor widen in society as a whole, the situation likely will get worse.

Outside a small, dirt-floor consultation room, which has only one desk, more than 50 people, including women in saris and children, were lining up. A city-run clinic in the Madanpur Khader district in southern New Delhi is always crowded with poor patients as the clinic provides free treatment and medicine.

Arun Kachhaaha, 52, is the only full-time doctor at the clinic. The number of patients the physician sees reaches as many as 300 per day, with the time spent for one patient about a minute. "I can't handle them all by myself," the doctor says.

According to the World Health Organization, the number of doctors in India stands at 645,825. The number of doctors per 1,000 people is 0.6, a figure much lower than 2.1 in Japan and 2.56 in the United States.

The number of beds in hospitals per 10,000 people is merely 6.9 in India, while the figure stands at 127.7 in Japan and 33 in the United States.

Samiran Nundy, 69, a former professor at a medical university in India, said that the state budgetary allocation related to medicine accounts for a mere 0.9 percent of the nation's gross domestic product, and that there are only five nations, including Brundi and Myanmar, whose figures are below that of India.

Yoichi Yamagata, 60, a Japan International Cooperation Agency staffer engaged in reproductive health-related services in the central Indian city of Bhopal, said: "There aren't even sufficient drugs at public hospitals. There are large gaps between urban and rural areas," he added.

A survey shows the ratio of doctors to patients as high as six times that in rural villages as a result of the concentration of doctors in urban cities. There is also a trend for doctors at public hospitals to move to overseas or private hospitals.

Applications for the All India Institute of Medical Sciences in New Delhi, which is seen as one of the country's top schools, number about 70,000, although only 35 can be admitted. But 70 percent of graduates from the school get jobs outside the country, such as in Europe and the United States.

At AIIMS Hospital, 75 doctors have resigned over the past 10 years. The biggest reason for them to leave is the poor salary. Doctors at Escorts Health Institute could earn as much as 1.2 million rupees, or about 3 million yen, per month, while salaries for doctors at AIIMS Hospital stand at about 20,000 to 28,000 rupees, or about 50,000 yen to 70,000 yen.

In India, there is no public health insurance system as there is in Japan. As a result of economic growth, the gap between the affluent, who can receive advanced medical treatment, and the poor, has widened.

The Indian government is said to be providing preferential treatment, such as subsidies on imports of highly advanced medical devices for private hospitals that offer medical tourism services. Nundy is critical of this, saying that the government would "not be interested in helping the public sector. The private health sector in India made some impressive strides, but did so at the cost of the public sector."

Rama Baru, 47, an assi
stant professor at Center of Social Medicine and Community Health of Jawaharlal Nehru University, said "active state intervention" is indispensible in the area of medical services as it is hard to say that "trickle down" of benefits resulting from economic growth has been seen in the area.

She also argues that the government should make private hospitals that have profited from medical tourism provide free treatment for people with low incomes and contribute part of their profits from medical tourism to public medical services.
(Feb. 4, 2007)

Daily Yomiuri, Japan