Get well soon – in India

Over the last few years, the number of “medical tourists” has seen a big leap. Rolling out the red carpet are top-of-the-line hospitals. Armed with internationally-approved accreditation, these hospitals are providing quality healthcare at costs which are way below those charged in developing countries as Preeti Verma Lal found out when she spoke with a number of hospitals accredited by the National Accreditation Board for Hospitals and Healthcare Providers, a constituent board of the Quality Council of India.

Google ‘Medical Tourism’ and before you blink, 444,000 websites would be lined up for perusal. In precisely 0.11 seconds. Not so far in the hoary past ‘medical tourism’ was not even deemed obscure terminology. Flip through statistics and you would find it gloating about the incredible increase in international India for treatment ranging from surgery for that obdurate artery to that falcon nose that needs to be sutured to look like the one that Cleopatra had. Walk into any hospital and you might stumble upon countless faces that look different, most even whispering their pain in a language that not many Indians understand. Packing for partying in Goa is passé, tourists are opting for a ‘healthy holiday’ in an Indian spa. Look at the peripherals and each one would justify its reasons — from language interpreters to travel agents to cabs that are needed for pick up and drop offs, glib guides for that essential sightseeing after days in a room laden with the whiff of ether. So many professionals. So many hospitals. So many etceteras so that one ailing man from a foreign land can live happily ever after. All this without blowing a hole in his wallet. Put simply, cost-effective treatment.

Cost-effective? Well, that is the catch. Along with competency, of course. That is why India is fast becoming the favourite recuperating bed for thousands from across the world. The statistics of 2007 count more than 1.50 lakh health tourists coming to India for various treatments, the majority coming from the US, Britain, Africa and South Asian countries. With so many footfalls and occupied beds, the coffers are spilling with crisp dollars too. A recent study conducted by the Confederation of Indian Industry and McKinsey predicted that by 2012 the medical tourism sector would soarto a whopping $2.3 billion (roughly Rs 11,000 crore). And if 444,000 websites pop up in 0.11 seconds, is it any surprise?

Call it reverse brain drain or flying the other way syndrome. Not so many decades ago, the monied and the maharajas would pack their pills and their paraphernalia and head to London and New York for treatment, specially complex surgeries. Then, there were very few state-of-the-art hospitals in India and the best of doctors preferred to live and work abroad. But all this changed sooner than what most had imagined. As Yale Global puts it, “In a corporate hospital (in India), once the door is closed, you could be in a hospital in America.”

CALL IT REVERSE BRAIN DRAIN OR FLYING THE OTHER WAY SYNDROME. NOT SO MANY DECADES AGO, THE MONIED AND THE MAHARAJAS WOULD HEAD TO LONDON AND NEW YORK FOR TREATMENT, SPECIALLY COMPLEX SURGERIES. BUT ALL THIS CHANGED SOONER THAN WHAT MOST HAD IMAGINED.
The bar has been raised to international standards. Look at Max Healthcare with eight centres in Delhi and NCR offering services in over 30 medical disciplines. With a base of over 1000 leading doctors and 6 lakh patients, its bed count will grow to 1500 by 2011. Wockhardt, on the other hand, operates 16superspeciality hospitals across India with a combined bed capacity of 1500 beds. Its hospitals in Mumbai and Bangalore are accredited by the Joint Commission International (JCI), the gold Standard for US and European hospitals that reflects provision of the highest levels of patient care and patient safety. The Indraprastha Apollo Hospitals with 40 hospitals and 7000 beds is also accredited. On its roster are 6 lakh cardiac surgeries and 10,000 renal transplants. To take care of the international patients there is a fullfledged and dedicated International Patients Cell at Indraprastha Apollo Hospital, New Delhi. In India, certification and accreditation of hospitals is done by the National Accreditation Board for Hospitals & Healthcare Providers (NABH), a constituent board of Quality Council of India. The NABH was set up to establish and operate an accreditation programme for healthcare organizations.Since its launch in 2006, it has till date accredited 20 hospitals and 55 are in different stages in the process of accreditation. In addition, one Small Healthcare Organization (SHCO), has also been accredited Tapping into the growing market, Fortis has created a separate entity for the international patients. “We have created the
Fortis International Patient Services Centre (FIPSC) for taking care of the special needs of international patients,” says Sudarshan Mazumdar, Director, Marketing & Corporate Communications, Fortis Hospitals. This one certainly goes beyond the clichéd airport pick-up and drop-off services. Other than medical necessities like scheduling, coordination, and remote consultations via telemedicine, FIPSC takes care of visa assistance, language interpreters, religious arrangements, messages
of friends and family back home to even sight-seeing!Each hospital flaunts its specialties, its medical tourist his own specific need, but the treatments most opted for by international patients are cardiac care, orthopaedics and joint replacements, neurosciences, spine surgery, aesthetic and reconstructive surgery, internal medicine and minimally invasive surgeries. A cost comparison explains it all. A heart bypass surgery that, on an average, would cost US $ 1,00,000 in the US can be done at a Max Healthcare centre for US $7000 while a spine fusion cost of US$ 75000 would go down to an incredibly low US$ 6300 in India (see box). That is almost 1/10th the cost in the US!Cost, however, is not always the sole motivating factor. Waiting too long in the queue can also push patients for options. For example, in Britain, patients often have to wait months for a surgery appointment under the National Health Service. Tired of waitingf — or of the gnawing ailment — patients head to India to go under the scalpel immediately.Over the years, even the demands have become structured. If one were to look at the statistics, countries can be categorised according to their demands: US/Europe: Joint replacements, spine surgeries, cardiac care, aesthetic surgeries, dental treatment and bariatric (weight loss) surgeries; Africa: neuro surgeries, orthopaedics, cancer; Middle East: neuro and spinal surgeries, orthopaedic surgeries; SAARC: cardiac care, orthopaedics, neuro surgeries, spine surgeries, general and laparoscopic surgeries, critical care.

Thankfully, the timelines are not tardy. The first step is a query sent either to a medical tour operator or posted on the website of the particular hospital. According to Sanjay Rai, Director, Marketing & Customer Management, Max Healthcare, most queries are routed through medial tourism operators, with additional queries that they receive on their website. “Each query is responded to within 24 to 48 hours. In the event of a query getting materialized, appointments are scheduled in a week’s time,” says Rai. What about emergencies? “Usually influx of international customers happensfor elective/planned procedures. In the likelihood of emergency care being required, Max Healthcare has the bandwidth to even air-lift the patient from wherever the patients is and immediate medical care is administered,” adds Rai. Apollo, Wockhardt and Fortis also have air-lifting facilities for emergency cases.

It is in these timelines and legwork that the medical tour operator steps in efficiently. Explains Dr Arun Kumar, founder, Mediescapes, a medical tourism travel agency. “The first step is to send current medical records (clinical findings, diagnosis reports, radiology films, CT, MRI scans, lab. slides). We take the next step by getting opinion from highly experienced specialist with cost and duration estimations and the same are passed on to the medical tourist for approval and more questions and answers, if any. Once the final confirmation is given we make all arrangements in real-time basis at the shortest possible time.”“
Just what the doctor ordered

Medical tourism implies that the hospitals inviting patients from other countries should be able to demonstrate that they possess the processes necessary to achieve a high level of standard, says Dr Abdulla Cherayakkat, Chief Physician and Managing Director, Malabar Institute of Medical Sciences Ltd, Calicut. “To make these standards uniform and transparent, it is necessary to put in place a mechanism whereby such hospitals are able to demonstrate their ability to impart care of the standards required. The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) and its international arm Joint Commission International (JCI) as well as several other such organizations across the globe have laid down the standards required for providing healthcare and to put in place a mechanism to inject continual improvement into the system.

In India, in 2005 the Quality Council of India was driven to standardize the quality of care provided by hospitals and healthcare providers. The National Accreditation Board, NABH therefore came into being and started accrediting hospitals. The first such accreditation for a multi specialty hospital came to MIMS. It is also necessary that the standards recommended by NABH should be in consonance with international standards. Therefore accreditation of the NABH standards by International Society for Quality in Healthcare (ISQua) is a necessary step to align the healthcare provider in India with the rest of the advanced world. This has now been achieved. Such alignment is a necessary step towards assuring the international community of the available standards in the community. Therefore it can be safely presumed that the quality of care imparted by the accredited institutions of India is on par with what is available in advanced countries.
If all medical records are available it takes under 20 days to arrange all services. On an average a medical tourism patient takes roughly 35 days to decide/arrange all resources to put into trip format with assistance from us,” adds Kumar. He surely knows the logistics, on an average he handles 330 medical tourists annually.
Like the choice of hospital, the Average Length of Stay (ALOS) also depends on the procedure. For example, Cardiac surgery: eight days in hospital, 10 days in the city; Joint replacement (unilateral), neuro and spinal surgeries: seven days in hospital, 10 days in city; Joint replacements (bilateral): 10 days in hospital, 10 days in the city; Cosmetic procedures: 2-3 days in the hospital, seven days in the city.
However low the comparative costs in India, for those with thin wallets even that can be a burden. “Most of the patients currently are either self pay or funded by some of the corporates in their home countries. The next phase of medical tourism will involve the treatment of insured and third party covered patients. This phase has already started at Wockhardt Hospitals and we do have a tie up with Bluecross and Blueshield of South Carolina for treatment of their patients,” says Vishal Bali, CEO,Wockhardt Hospitals Group, India.
Indraprastha Apollo Hospitals is also empanelled by Insurance majors like Cigna, World Access-Blue Cross & Blue Shield, Aetna, BUPA, Vanbreda International, GMC, Mondial and also offer services to patients referred by Thomas Cook, International SOS etc.
The private sector has pumped in lots of effort - and money — but with so much happening, the government is not sitting and twiddling its thumb either. The foreign health tourists have had so many coffers jingling with cash that the Maharashtra government has set up a Medical Tourism Council that would not only facilitate but also regulate medical tourism. The Federation of Indian Chambers of Commerce and Industry, Western Region Council (FICCI-WRC) has initiated a medical tourism task force in Maharashtra that would include representatives from the Maharashtra government, the medical educational institutions and the drugs department, Maharashtra Tourism Development Corporation, pharmaceutical companies, travel agents and tour companies. The Karnataka government is setting up the Bangalore International Health City Corporation which will cater to the varied heath care needs of the patients.
Beyond the impetus, the government is also mooting regulatory statutes to weed out seedy spas and fly-by-night operators that not only do more harm than good to the patients but also tarnish the industry’s reputation. For example, the spas in Kerala are now being classified and categorized according to the level of facilities and treatments offered, while the Union Health Ministry is building a regulatory framework to keep at bay the institutions with suspect credentials. The guidelines wouldinclude not just classification and categorization of spas and health resorts but also a committee to certify the spas and a redressal cell to listen to the grievances of the consumers.
It is for this reason that accreditation becomes imperative. “Accreditation is necessary both for our domestic and international patients since it sets a standard of care. It is beneficial for hospitals which treat international
patients to be accredited by Joint Commission International,” says Bali.

Subsequent to accreditation of Apollo Hospitals in New Delhi, Chennai and Hyderabad, the company’s laboratory services have been recommended for NABL Accreditation. NABL (National Accreditation Board for Testing and Calibration Laboratories) provides laboratory accreditation services to laboratories that are performing tests/calibrations in accordance with the criteria based on internationally accepted standards and guidelines.

According to Dr Abdulla Cherayakkat, Chief Physician and Managing Director, Malabar Institute of Medical Sciences Ltd (MIMS), Calicut, the first accredited hospital, “The increasing trends of tourism coupled with health treatments abroad have led to a growth in the health tourism phenomenon. Trends clearly point to a continued expansion of medical tourism in the coming years. We are now at the dawn of a new era in health tourism worldwide, where citizens have more options as regards where they choose to be treated and how to spend their money.” The MIMS MD believes that “medical tourism will certainly generate good share within a short span of time for the hospitals like us but this won’t be the largest revenue earner since we are committed to provide quality healthcare at affordable cost to the masses.”

As I write this, my American friend from Honolulu called. She is single, hurtling towards menopause and in desperate need of a nip and tuck. She does not have much stashed in the bank, the cost of treatment in the local hospital is threatening to devour all her savings. She is smart: she wants to look svelte with that nip and tuck, yet going broke is not her definition of that hour-glass figure that she so covets. “Should I come to India?” she shrilled over the phone in excitement. “I read somewhere that the costs are tempting and the doctors world-class,” she rattled. Before I could say a loud yes, she had made up her mind. Last I heard, she is flying in. That she would go back looking willowy, I know that much. That she would not go broke, I am so certain of that. Thank god for small mercies. Thank god for medical tourism!