Implications of Medical Tourism

Since time immemorial, tourism has played a very significant role. It has promoted cultural as well as economic ties among various countries and nations of the world. Besides, the accounts left by tourists have been an important source of historiography. From the economic point of view, its role has been tremendous and has gone on expanding with the development of better and swifter means of transport and communications. Instead of exporting goods to other countries, one brings buyers in the guise of tourists. Thus the country promoting tourism earns large amounts of foreign exchange by selling goods and services to them. Countries have been vying with one another in attracting foreign tourists by offering them all possible kinds of incentives such as comfortable hotel accommodation, good food, luxury bus and train transportation, places of historical and cultural importance to visit, clean beaches and so on.

Over the years, various kinds of tourism, ranging from eco-tourism and heritage tourism to agro-tourism, have come into existence. The latest addition is medical tourism. India has been hoping to earn billions of dollars in foreign exchange from this source as restrictions of travel are eased as globalisation gathers momentum.

A person in the United States has to spend an enormous sum on medical treatment or surgery. If he comes to India for the same kind of treatment, his benefits are three-fold. He gets the same kind of treatment at a much cheaper rate, he visits places of tourist interest and saves quite a significant sum of money. Thus he gets treatment, sightseeing and savings. Besides, in top private hospitals in India risks of death are lower. According to Dr. Naresh Trehan, the death rate for coronary bypass patients at Escorts is 0.8 per cent while it is three times more at New York-Presbyterian Hospital, where Bill Clinton recently received treatment for his heart ailment.

To illustrate this, let us refer to a typical example, recently cited by The Washington Post: “Three months ago, Howard Staab learned that he suffered from a life-threatening heart condition and would have to undergo surgery at a cost of up to $200,000—an impossible sum for the 53-year-old carpenter from Durham, N.C., who has no health insurance.

“So he outsourced the job to India.

“Taking his cue from cost-cutting U.S. businesses, Staab… flew about 7,500 miles to the Indian capital, where doctors at the Escorts Heart Institute & Research Centre…replaced his balky heart valve with one harvested from a pig. Total bill: about $10,000, including round-trip airfare and a planned side trip to the Taj Mahal.”

Here, people like Staab, coming as medical tourists, get First World treatment and nursing at Third World prices. The differences in cost may be indicated by citing just two examples. Heart surgery in America costs $30,000 while it costs just $6,000 in India. Bone marrow transplants cost $250,000 in USA as against $26,000 here.

Moreover, they seldom face any kind of hassle or discourteous behaviour from the staff. Tour operators properly plan everything after eliciting medical specialists’ considered opinion on the proposed line of treatment. English language, highly qualified doctors, trained nursing staff and a large variety of tourism options make India more attractive than other countries in the developing world. Quite a large number of doctors, technicians and nurses have the experience of working in the West. A significant number of medical tourists are non-resident Indians who feel homely here.

A number of government and private hospitals in India have joined hands to promote medical tourism. Prominent among them are AIIMS, Apollo Hospitals, B.M.Birla Heart Research Centre, Christian Medical College, Vellore, Tata Memorial Hospital, Mumbai, Apollo Cancer Hospital, Chennai, Indraprastha Medical Corporation, Delhi, and Institute of Cardiovascular Diseases, Chennai.

Besides appropriate allopathic treatment, rejuvenation through yoga and ayurvedic massage, a la Kerala style, is also offered to prospective takers. Arrangements are already in place to pick up medical tourists from airports and lodge them in luxury rooms of hospitals, having all the modern amenities like the Internet, television, fridge, air conditioner, telephone, etc.

Maharashtra is the first among Indian States to form Medical Tourism Corporation of Maharashtra (MTCM) in collaboration with FICCI to attract medical tourists from rich countries. The 830-bed Wockhard Hospital in Mumbai is due to the initiative of the MTCM. A director of the FICCI, one of the promoters of MTCM, hopes that India has the potential of becoming medical tourism capital of the world.

The CII (Confederation of Indian Industries) had commissioned McKinsey to prepare a study on the potential of medical tourism in the country. The study points out that India has potential to attract a million medical tourists every year (last year an estimated 150,000 foreigners came to India for medical treatment and this number is increasing by about 15 per cent annually) and its earnings could go up to $5billion. To exploit the potential the government and the corporate sector need to join their efforts. Hospitals and their medical and paramedical staff and tour operators need to be properly trained so that they handle the growing number of foreign tourists with care and courtesy.

The study says, medical tourism may contribute Rs 5,000 to Rs 10,000 crore as revenue by 2012. The Economic Times (October 3, 2004) thinks, medical tourism business, growing at 30 per cent annually, “has the potential to generate as much business as software exports, if not more.”

Now the question to be considered is: how will growing medical tourism affect people at large in India? The protagonists assert that it will bring huge foreign exchange resources to the country that will accelerate country’s economic growth. More jobs will be created and this will benefit people at large. A high up in the FICCI contends that the earnings from medical tourism will trickle down to health care infrastructure and services in rural areas, where more than 65 per cent of the people live. With the growth of medical tourism, infrastructure will expand. As the WHO estimates India will add at least 80,000 hospital beds annually for the coming five years. The level of doctors, technicians and nurses will go up. Hospitals will be able to provide themselves with latest machines and equipment. It is contended that all this will benefit common people of the country. They will not face difficulties in securing proper treatment and hospitalisation facilities.

The people, however, are sceptical. Their experiences point out that better hospitals in the government sector are available mostly to those who have some kind of influence, be it political, social or financial. The private sector hospitals and nursing homes that have got land and other infrastructural facilities at concessional rates from the government do not really take care of the needs of the weaker sections of the society. They have been perpetrating a fraud by setting apart some beds for the poor only on paper. In a country where malaria and TB are yet to be eradicated there does not seem much point in promoting medical tourism and alluring best talents in profit hungry hospitals. The nation spends huge amounts of money on preparing doctors and, after, they graduate they will surely migrate to them. At present there are hardly 4 qualified doctors per 10,000 population. If one looks at the situation in rural areas, the situation is quite deplorable as doctors do not want to go because of the lack of infrastructure and the amenities for their decent living. The country spends only around 5 per cent of GDP on health care. The country has a very high infant mortality rate.

Lastly, in the years to come, when medical tourism business flourishes, there is bound to be a boost to racketeering in human organs and the poor and the ignorant will be deprived of their organs by unscrupulous and greedy doctors and hospitals for the benefit of the rich.

It is high time that the pros and cons of medical tourism are debated in parliament as well as in other public forums.