April 7, 2005
Low Costs Lure Foreigners to India for Medical Care
By SARITHA RAI
BANGALORE, India, April 6 - Until recently, Robert Beeney, a 64-year-old real estate consultant from San Francisco, lived in pain. But when he finally decided to do something about the discomfort, he spurned all the usual choices.
His doctors advised that he get his hip joint replaced, which his insurer would pay for, but after doing some research on the Internet, he decided to get a different procedure - joint resurfacing - not covered by his insurance. And instead of going to a nearby hospital, he chose to go to India and paid $6,600, a fraction of the $25,000 he would have paid at home for the surgery.
This winter, Mr. Beeney flew to Hyderabad, in southern India, and had the surgery at Apollo Hospital by a specialist trained in London, Dr. Vijay Bose. Two weeks later, Mr. Beeney said that he was walking around the Taj Mahal "just like any other tourist."
Mr. Beeney's story is becoming increasingly common, as Europeans and Americans, looking for world-class treatments at prices a fourth or fifth of what they would be at home, are traveling to India. Modern hospitals, skilled doctors and advanced treatments are helping foreigners overcome some of their qualms about getting medical treatments in India. Even as politicians and workers' groups are opposing the corporate practice of outsourcing, Mr. Beeney and patients like him are literally outsourcing themselves - not only to India but also to Thailand, Singapore and other places - for all kinds of medical services from cosmetic to critical surgeries.
About 150,000 foreigners visited India for medical treatments in the year ending in March 2004, the Confederation of Indian Industry, a leading industry group, said. That number was projected to rise by 15 percent each year for the next several years. The consulting firm McKinsey & Company, a management consultant based in New York, said foreign visitors would help Indian hospitals earn 100 billion rupees (about $2.3 billion) by 2012.
"Health is an emotional issue; it's not like buying a toy or a shirt made abroad," said a health care analyst for McKinsey, Gautam Kumra, who is based in New Delhi. "Nevertheless, you cannot deny the power of economics."
For some foreigners, like George Marshall, a 73-year-old violin restorer from Yorkshire, England, India's hospitals also offer speedier treatments. Last year, Mr. Marshall said that he started having trouble finishing a round of golf. An angiogram showed two blocked arteries in his heart. With the British National Health Service, Mr. Marshall would have had to wait three weeks to see a specialist, and six more months for coronary bypass surgery. "At 73, I don't have the time to wait," Mr. Marshall said. "Six months could be the rest of my life." Nor could he afford the £20,000 ($38,000) for surgery at a private hospital.
After an Internet search and a chance meeting with a businessman who had gone to India for surgery, Mr. Marshall traveled to the Wockhardt Hospital in Bangalore in southern India last winter. His surgeon, Vivek Jawali, had trained at Great Ormond Street Hospital in London. The men chatted about British politics and Dr. Jawali gave Mr. Marshall his cellphone number and said that he was available 24 hours. A surprised Mr. Marshall said that in the British health system, "you are just a number, but here you are a person." Travel expenses included, the surgery cost him £4,500 ($8,400).
While the number of patients from the West is still small in India, the trend is expected to grow as populations age and health costs balloon. In India, cardiac surgeries cost about one-fifth of what they would in the United States; orthopedic treatments cost about one-fourth as much and cataract surgeries are as low as one-tenth of their cost at American hospitals.
Mr. Kumra, the McKinsey health consultant who also advises the auto industry, noted that a corporation like General Motors spends $5 billion on health care annually. "When you buy a G.M. car, you are helping G.M. fund $2,000 or $3,000 towards health care costs of retired workers," Mr. Kumra said.
To curb spending, corporations are being forced to look at creative low-cost solutions. For instance, radiologists working for Wipro, a software and information technology company based in Bangalore, analyze X-rays and scans from United States hospitals for a fraction of the cost. A diagnostics firm, SRL Ranbaxy, based in New Delhi, tests blood serum and tissue samples from British hospitals. Health specialists say that sending patients to India for treatment is not as unthinkable as it was 20 years ago.
"India is well-positioned to expand into this area of outsourcing," said John Lovelock, an analyst in Ontario on global industries for Gartner. "India is equipped to provide long-term in-patient rehabilitation services, which are very labor intensive, require large facilities and are under serviced in North America," he said.
In the last four years, the Apollo Hospital chain, which has 18 hospitals throughout Asia, has treated 43,000 foreigners, mainly from nations in southern Asia and the Persian Gulf. Last year, 7 percent of its 5 billion rupees ($114.9 million) in revenue came from medical services provided to foreigners.
Apollo's founder, Dr. Prathap C. Reddy, 73, a surgeon trained at Massachusetts General Hospital in Boston, said that health care in India had drastically changed from the time he returned to open his first hospital in 1983. "Then, all rich Indians rushed overseas for medical help," Dr. Reddy said. Now, he has 200 doctors on his staff who are qualified to work in the United States, and has many wealthy Indian expatriates as clients.
Still, some hospitals in India are discovering that affordable costs and foreign-trained doctors may not be enough to make India a global health care destination. The country's dilapidated airports, garbage-strewn streets and overcrowded slums can put off even the hardiest foreigners.
"Some foreign patients arrived at the airport and took the next flight back," said Dr. Reddy, who has been trying to persuade the local government in Chennai, formerly known as Madras, to clear a slum next to his hospital there. "I can change the insides of my hospitals, but I cannot change the airports and roads," Dr. Reddy said,
The challenge, said Harpal Singh, chairman of Fortis Healthcare, a chain of hospitals based in New Delhi, is to get the world to understand that India is a complex country. Acknowledging that foreigners might feel more at home having surgery in sleek hospitals in Singapore or Thailand, which are competing to woo them, Mr. Singh said, "We have to project that India is capable of delivering first-rate as well as shoddy work." Fortis, part owned by the country's biggest drug firm, Ranbaxy Laboratories, has a chain of four hospitals in India and another six on the way.
Indian hospitals are also working to ensure that they meet international standards. The Indian Healthcare Federation, a group of 50 hospitals led by Dr. Reddy, is developing accreditation standards for hospitals.
One doctor in India held up as first rate is Dr. Naresh Trehan, a cardiac surgeon based in New Delhi and the executive director of Escorts Heart Institute and Research Center. Dr. Trehan, 58, who studied cardiac surgery at the New York University School of Medicine and worked there for a decade, returned to India in 1988 to open his own cardiac hospital in New Delhi. The hospital now conducts 4,000 heart surgeries a year with 0.8 percent mortality rates and 0.3 percent infection rates, on par with the best of the world's hospitals.
Last October, Dr. Trehan performed surgery on Howard Staab, 53, an uninsured self-employed carpenter from Durham, N.C., to repair a leaking mitral heart valve. Mr. Staab paid $10,000 for his surgery, his round-trip fare to India and for a visit to the Taj Mahal. In the United States, his options included surgery costing $60,000 at Duke University Medical Center in Durham, N.C.
To take advantage of patients like Mr. Staab, Indian hospitals are expanding. In the Gurgaon suburbs of New Delhi, Dr. Trehan is building a $250 million multispecialty hospital modeled after the Cleveland Clinic in Ohio. In the same neighborhood will be Fortis Healthcare's Medicity, a 43-acre hospital complex for foreign patients, which will have special immigration and travel counters and interpreters, with the idea of branding itself the Johns Hopkins Hospital of the East.
"We're gearing up, and the doors of Indian hospitals are wide open to the Western world," Dr. Trehan said.