Report – Incredible India: now for medical tourism
Is travelling abroad for treatment a good idea? That is what many westerners are doing—exploring cheap and world-class medical care in India. The western medical care system is so overburdened that some countries are out-sourcing medical treatment of their patients to India. The issue of allowing people to die at their own will also comes into the picture as this controversial and complex but fundamental issue cannot be wished away
A few years ago, the travel industry in Europe and America threw around phrases like “surgical safari” or “breast implants and tango” to promote the idea that people could combine travel experiences with affordable —and usually elective—medical procedures. After all, if you were going to spend three weeks recuperating from a face lift, why not do it in an exotic locale? (especially if no one there knew you!
More recently, the concept of medical tourism has evolved into something much more serious. The reasons patients travel for treatment vary. Many medical tourists from the United States are seeking treatment at a quarter or sometimes even a 10th of the cost at home. From Canada, it is often people who are frustrated by long waiting times. From Great Britain, the patient can’t wait for treatment by the National Health Service but also can’t afford to see a physician in private practice. For others, becoming a medical tourist is a chance to combine a tropical vacation with elective or plastic surgery.
And more patients are coming from poorer countries such as Bangladesh where treatment may not be available.
Patients going to a different country for either urgent or elective medical procedures is called ‘medical tourism’. There are an increasing number of companies abroad that help facilitate the process, as well as tighter restrictions and standards. Even the American Medical Association recently released its own guidelines on medical tourism.
How much is saved?
Countries that actively promote medical tourism include Cuba, Costa Rica, Hungary, India, Israel, Jordan, Lithuania, Malaysia and Thailand. Belgium, Poland and Singapore are now entering the field. South Africa specializes in medical safaris-visit the country for a safari, with a stopover for plastic surgery, a nose job and a chance to see lions and elephants.
Here’s a breakdown of prices for sample surgeries in various countries.
The appeal is obvious: Even when you factor in airfare and hotel costs, travelling outside of the U.S., especially to India, for medical care can result in significant savings. With world-class medical care facilities, top-of-the-line doctors and surgeons, India is the preferred medical care destination. And although one may not want to travel 20 hours if one is in need of a quadruple bypass, for safety reasons, it’s often the more invasive procedures that yield the greatest savings.
But it’s not just consumers who see the benefits of medical travel: Even insurance companies are starting to send patients out of the country for certain treatments. A US health-benefit provider WellPoint launched a program called the Global Health Care Partnership, which allows employees of a Wisconsin printing company to get certain elective procedures in select facilities in India.
India
India now is moving into a new area of “medical outsourcing,” where subcontractors provide services to the overburdened medical care systems in western countries.
India’s National Health Policy declares that treatment of foreign patients is legally an “export” and deemed “eligible for all fiscal incentives extended to export earnings.” Government and private sector studies in India estimate that medical tourism could bring between $ 1 billion and $ 2 billion US into the country by 2012. The reports estimate that medical tourism to India is growing by 30 per cent a year.
India’s top-rated education system is not only churning out computer programmers and engineers, but an estimated 20,000 to 30,000 doctors and nurses each year.
The largest of the estimated half-dozen medical corporations in India serving medical tourists is Apollo Hospital Enterprises, which treated an estimated 60,000 patients between 2001 and spring 2004. It is Apollo that is aggressively moving into medical outsourcing. Apollo already provides overnight computer services for U.S. insurance companies and hospitals as well as working with big pharmaceutical corporations with drug trials.
Apollo’s business began to grow in the 1990s, with the deregulation of the Indian economy, which drastically cut the bureaucratic barriers to expansion and made it easier to import the most modern medical equipment. The first patients were Indian expatriates who returned home for treatment; major investment houses followed with money and then patients from Europe, the Middle East and Canada began to arrive. Apollo now has 37 hospitals, with about 7,000 beds. The company is in partnership in hospitals in Kuwait, Sri Lanka and Nigeria.
Western patients usually get a package deal that includes flights, transfers, hotels, treatment and often a post-operative vacation
Voluntary death: the Indian way
At a time when modern laws did not apply, the Indian culture had different forms of voluntary death, which had religious sanction. Even now, although controversial in the present-day context, the Jain religion allows one to leave one’s body at will and as a considered decision.
The Santhara, or Sallekhana, is the Jain religious ritual of voluntary death by fasting. Supporters of the practice believe that Santhara cannot be considered suicide, but rather something one does with full knowledge and intent, while suicide is viewed as emotional and hasty. Due to the prolonged nature of Santhara, the individual is given ample time to reflect on his or her life. The vow of Santhara is taken when one feels that one’s life has served its purpose.
Modern day examples of well-known people opting for Santhara include Vinoba Bhave, UG Krishnamurti. Veer Savarkar and Chandragupta Maurya are also said to have died through Santhara.
The right to die?
Euthanasia has been the topic of many heated debates. On the one hand, it is only human to allow the terminally-ill to die at a time when they wish to die instead of forcefully prolonging their agony when they have no chance to live healthy lives. On the other hand, human greed is such that there is always the possibility that if assisted suicide is legalised, grasping relatives will force their old and ill relatives to die, so that their assets are not wasted on medical fee and caring for them. After Euthansia, now “assisted suicide” has come to grab attention. Assisted suicide is when patients end their own lives, with help from doctors/experts. With very few countries like Switzerland, the Netherlands, Belguim and Luxembourg allowing some leeway, people from around the world are travelling to places like Dignitas clinics in Switzerland to die. Dignitas is a Swiss organisation that operates a specialist euthanasia service. The organisation charges $ 9,300 for the procedure.
Dignitas was in international news recently as one of Britain’s most respected conductors, Sir Edward Downes, and his wife, Joan, a choreographer and TV producer, chose to die together as Sir Edward was 84 and nearly blind and Joan was 74 and had terminal cancer.
“After 54 happy years together, they decided to end their own lives rather than continue to struggle with serious health problems”, said a family statement. The couple’s son and daughter were with their parents at the clinic.
While the couple have died on their own terms, the British CID has launched an investigation into their deaths as assisted suicide as anyone assisting a person to end their life could face up to 14 years in prison in Britain.
Medical tourism is catching on in a big way, but organised assisted suicide is an entirely new avenue.
Ref: The Economist, Volume 392, Number 8640; The Guardian, UK
What is the difference between euthanasia and assisted suicide?
One way to distinguish between euthanasia and assisted suicide is to look at the last act – the act without which death would not occur.
Using this distinction, if a third party performs the last act that intentionally causes a patient’s death, euthanasia has occurred. For example, giving a patient a lethal injection or putting a plastic bag over her head to suffocate her would be considered euthanasia.
On the other hand, if the person who dies performs the last act, assisted suicide has taken place. Thus it would be assisted suicide if a person swallows an overdose of drugs that has been provided by a doctor for the purpose of causing death. It would also be assisted suicide if a patient pushes a switch to trigger a fatal injection after the doctor has inserted an intravenous needle into the patient’s vein.
Heart valve replacement
U.S.
$ 160,000
India
$ 9,000
Thailand
$ 10,000
Singapore
$ 12,500
Costa Rica
$ 15,000
South Korea
$ 29,500
Angioplasty
U.S.
$ 57,000
India
$ 7,500
Thailand
$ 13,000
Singapore
$ 11,200
Costa Rica
$ 9,000
South Korea
$ 19,600
Hip replacement
U.S.
$ 43,000
India
$ 7,100
Thailand
$ 12,000
Singapore
$ 9,200
Costa Rica
$ 12,000
South Korea
$ 11,400
Hysterectomy
U.S.
$ 20,000
India
$ 6,000
Thailand
$ 4,500
Singapore
$ 6,000
Costa Rica
$ 4,000
South Korea
$ 12,700
To read more log on to www.consumer-voice.org
Consumer VOICE was founded by teachers and students at the University of Delhi in the beginning of the academic year 1983-84. Till mid 1986, Consumer VOICE functioned as an unregistered voluntary consumer association.
On 28 June 1986, it was registered as a Public Charitable Trust with noted jurist, Justice (retd.) V.M. Tarkunde and Prof. P.K. Ghosh of the Delhi School of Economics as founder donors and Dr. Sri Ram Khanna and Mr Rajan Karanjawala as Trustees.
In 1988 the Dept of Company Affairs Govt. of India accorded recognition to Consumer VOICE under the MRTP Act. The trust has since been granted exemption under section 80-G of the Income Tax Act and, donations made to the Trust are exempt from Tax. However the organization does not accept donations from private enterprise in order to ensure objectivity, or from individuals except when the donor is genuinely committed to espouse the cause of consumer protection.
As one of its first consumer-rights initiative, VOICE filed a suit against the ‘Wills Made for Each Other’ tobacco campaign, as it was monopolistic and discriminated against consumers who did not smoke. VOICE also challenged television manufacturers which were selling colour television sets at a premium to consumers during the Asiad Games.
In 1997, VOICE started to publish Consumer VOICE, a bi-monthly magazine that focused on bringing consumers information on product performance. ‘Voltage Stabilisers’ were one of the first product tests to be published in Consumer VOICE magazine.
The publisher of Consumer VOICE magazine since 1999 it is currently working in close co-ordination with the Dept of Consumer Affairs, Govt of India, on a comparative product testing project. The project aims to test a wide range of products most commonly used by Indian consumers in NABL-accredited laboratories. The test results are then published in Consumer VOICE magazine.
To know more log on to www.consumer-voice.org
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