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From traveller to patient: medical tourism in India

From traveller to patient: medical tourism in India
Author: Laura Wassell
1 Commentries
Abstract: Medical tourism is a fast growing part of the Indian tourism industry. Approximately 500,000 people travelled to India for medical care in 2005 (India Tourism Report 2010). In 2012 it is thought that number could reach 6 million (Underwood and Makadon 2010). Tourists travel the world in search of cosmetic and dental surgery to organ transplants (Horowitz, Rosenweig and Jeffrey 2007). This paper aims to discuss the issues surrounding medical tourism and the benefits and risks for patients and the host country.

Key Words: Medical tourism, India, healthcare, surgery

For generations people have travelled to receive medical care. Travel professionals and health care providers in India help promote the "tourism'" aspect of offshore care to patients. Medical tourism can be defined as "travel[ing] to another country to receive medical, dental, and surgical care while at the same time receiving equal to or greater care than they would have in their own country... because of affordability, better access to care, or a higher level of quality of care" (Underwood and Makadon 2010, pg112)

People who travel for medical care are driven by forces outside the typical medical referral systems; they want quick, affordable treatment even if there are uncertainties about the quality of care (Horowitz, Rosenweig and Jeffrey 2007). In India, procedures and treatments are a fraction of the cost than they are in countries such as the UK and the USA. In the USA a liver transplant costs around $300,000 whereas in India, a new liver transplant costs around $69,000 (India Tourism report 2010). Open heart surgery can cost $150,000 in the US but in India's best hospitals the surgery costs between $3,000 and $10,000 (Understanding medical tourism 2008). Mattoo and Rathindran (2006, in Vijaya 2010) suggest that a host economy could earn up to $400 million annually if it offered patients just 15 types of procedures and the Confederation of Indian Industry reported that medical tourism in India produces annual revenues of $300 million.

Medical tourism facilities are advertised directly to the patient through the internet or word of mouth. Also, unlike in the UK, you do not need a referral for treatment from a general practitioner (Horowitz, Rosenweig and Jeffrey 2007). Patients receive care in private hospital groups which are the leading players for medical tourism in India. Fortis healthcare, Wockhardt and Apollo Hospitals are the biggest private groups in India (India Tourism report 2010). These hospitals are promoting medical tourism through partners like Thomas Cook.

Although India is being promoted as a world-class medical destination, the medical care system for locals in India is crippled. It is viewed as a third world country which struggles to look after its own citizens (Vijaya 2010). It has associations with poverty, poor health and low hygiene standards and yet has been first to offer super-specialised surgeries (Stalker 2009). The hospitals that cater to most low-income Indians are overcrowded and understaffed with poor facilities: (Business India Intelligence 2005) India has only 1.5 beds per 1,000 people (India Tourism report 2010). It earned the poor ranking of 112 in the World Health Organisations survey of global health systems (WHO 2002, in Vijaya 2010) whereas the US ranked at number 37 according to the accessibility and reliability of health care. This poses many risks people travelling for care, however, patients feel pressed to balance their needs against uncertainties about their care. These include lower costs, shorter waiting lists, the option to have surgery not available routinely or not approved in the patients home country. Also, Doctors at home cannot access medical notes abroad meaning those having procedures such as gender reassignment surgery have the comfort of knowing it is completely untraceable back home. The luxury accommodation and state of the art care is sought after by many patients and the opportunity to experience an exotic destination whilst being treated (Horowitz, Rosenweig and Jeffrey 2007).

Travelling for care brings risks to the host nation and the patient. This includes legal issues such as the illegal purchasing of organs for transplants in India or lack of health insurance to cover aftercare. Patients may also spread disease; the most recent being the H1N1 virus. Also, a UK or US Doctor may refuse to provide follow-up care for a procedure done in another country due to legal issues as it was not originally their treatment (Understanding medical tourism 2008).

Medical tourism allows healthcare to be seen as a luxury to be had by those who have the ability to pay. The risk of this continuing to grow could take resources away from those who cannot afford private healthcare and create inequality in the already struggling Indian health system. Chanda, (2002 in Hazarika 2010) believes it will aid those who need less but can pay more at the expense of the poor and more deserving.

• Horowitz, M., Rosenweig, M., Jeffrey, A.(2007).Medical Tourism-Health care in the global economy.Physician Executive. [Online]33(6)pp24-30.[Accessed 18 April 2011].Available at< http://web.ebscohost.com/>

• India Tourism report (2010).Medical Tourism in India. Businesses monitor international [Online].January 2010. Pp31-34[Accessed 21 April 2011].Available at<www.businessmonitor.com>

• Vijaya, R.(2010).Medical Tourism: Revenue Generation or International transfer of healthcare problems? Journal of Economic Issues (M.E Sharpe Inc.)[Online].44(1).pp53-69[Accessed 19 April 2011].Available at<http://web.ebscohost.com/>
From traveller to patient: medical tourism in India- commentary by Abubaker Patel (WLV) 0622122
Author: Abubaker Patel
This paper made an appropriate start (in its abstract) by defining figures around medical tourism in India. There has also been a relevant and academic, if not entirely correct definition of what medical tourism is. However, the author proceeds to state within this definition that medical tourists travel to another country to receive equal or greater care than their own country. The following statement then seems to contradict this by stating that medical tourists want quick, affordable treatment even if there are uncertainties about the quality of care.

The author states in the 5th paragraph that the Indian medical industry poses many risks on people travelling for care, however, patients feel pressed to balance their needs against uncertainties about their care. However, Bookman and Bookman (2007) argued that when shopping around for medical services, potential patients seek evidence of quality. To the extent, that, if the supplying physician, institution, or country cannot provide satisfactory demonstration of quality, consumers will take their business elsewhere.
Within the third paragraph, the author has highlighted the difference in costs of medical treatments between India and western countries. This information may have been unnecessary although recognising this as general fact was correctly outlined.

Paragraph 4 also, significantly recognises the fact that private hospitals lead the way in India's medical tourism industry. This would be inextricably linked to later statements made by the author discussing severe flaws in the public healthcare system. In addition to this statement made, it has been contradicted in the previous paragraph that actually medical tourists mainly rely on private healthcare; therefore, on this basis, the statement of the public healthcare posing 'many' risks to the tourist is surely out of the question.

The same paragraph talks about the flaws of India's local healthcare system. However it fails to identify the other sides to these issues as Indian research and development in biotech and pharmacy industries is geared at satisfying domestic needs and thereby reducing the need to import foreign products and techniques (Bookman and Bookman, 2007). Whats more, medical tourism has created many jobs across the country and has created global awareness (amongst the western health industry) of the highly professional and skilled workforce available (Bookman and Bookman, 2007).

It has been mentioned in the second to last paragraph that travelling for healthcare brings many risks to both the tourist and host destination. This has been well justified through its proceeding facts (organ transplant, US/UK follow-up and spread of disease). However, the statement that lack of insurance to cover aftercare is a risk is arguable. In fact, the author herself states that a high level of care is one of the primary reasons of medical tourism and is part of the definition of medical tourism given by the author (as of first paragraph).

Conclusion; the author has interestingly talked about the negative aspects of medical tourism; specifically the negative impacts upon the destination and the risks and benefits upon tourists. Alarmingly however, the author has failed really to discuss the positive impacts of medical tourism upon India (although the $300 million dollar revenue figure was given). This approach would have given the paper a more balanced approach and would have introduced the reader to both sides of the topic.

Key reference:
Bookman, M.Z. and K.R. Bookman (2007) Medical tourism in developing countries [Online] New York: Palgrave Macmillan [Accessed 11th May 2011]. Available at <http://www.ebrary.com>