Indian Health Care Sector

[vinodv]

Westerners Seek Cheap Medical Care in Asia

Yahoo link

excerpt
BOMBAY, India - Bradley Thayer, a retired apple farmer from Okanogan, Wash., traveled 7,500 miles to get his torn knee ligament fixed, and says he paid a third of what it would have cost him in a U.S. hospital. And that included air fare to Bombay.

Thayer, 60, had no health insurance when he fell and injured himself while summering in British Columbia. He says his U.S. doctors told him he would have to wait six months for surgery and pay bills totaling $35,000. So he joined a rising tide of American and European patients heading to India, Thailand and Singapore for top-class orthopedic surgery, plastic surgery, infertility treatment and cardiology that come much cheaper than in the West.

..............
Thayer, the retired farmer, has a suggestion for India: to anchor a cruise ship in international waters off Los Angeles, "One deck for orthopedic surgery, one deck for cardiology. We need a change in America, we need cheaper medical treatment. We need a big hospital ship from India."

That's a terrible idea.. the whole point of getting foriegners to India for medical treatment is that the doctors and hospitals make extra money and then they can give free health care to people who deserve it.

May be a cruise ship anchored just off the gateway to recuperate..

[Div]

India, best place for clinical trials
http://us.rediff.com/money/2005/sep/29t ... &file=.htm

[Nandu]

Candlewallah Kuldip Nayar being a moron again,

Keep [western] foreigners out of Indian hospitals: Nayar

http://in.news.yahoo.com/050930/43/60dew.html

[JE Menon]

The man is losing it... and I'm just about keeping my cool on this one. Instead of saying build more hospitals and graduate more doctors to accommodate all the Indians and foreigners who need treatment, he says stop foreigners from taking up places "at the expense of Indians" - whatever the fu(k that means.

I recently visited India and stayed nearly 2 weeks in a hospital (in Chennai) with my mother who had to undergo a heart bypass. There were foreigners there from Seychelles, Oman, some African countries, and I believe Iran as well. In fact they have an "Overseas Patient Officer" or something of the sort permanently employed. At another hospital where my mom got her cardiologist's evaluation and angiogram done, they had African nurses employed to take care of African patients.

[Paul]

on top of it he does mind BDs and Pakis being treated at the expense of Indians, what is with these dinosaurs...they just don't fade away. [/quote]

[Nandu]

Current Issue of the British medical journal The Lancet focuses on the issue of chronic diseases (heart disease, stroke, cancer) and how these are as much or more of a threat than the fashionable infectious diseases like HIV/AIDS, TB and malaria. They have case studies on India and China. (Before anybody thinks this is psyops, remember that heart disease etc.. are usually considered developed country problems).

http://www.thelancet.com/

A story on it:

http://www.newindpress.com/NewsItems.as ... 1005130036

[svinayak]

Indian standards for accreditation of hospitals coming soon

Our Bureau

Chennai , Oct. 6

THE Government is likely to announce within six months "standards for accreditation of hospitals in India," Ms Preetha Reddy, Managing Director, Apollo Hospitals, has said.

Speaking at a seminar on opportunities for partnership between Indian and British companies in healthcare, organised by the Confederation of Indian Industry, Ms Reddy said that Apollo Hospitals had secured the `JCI accreditation' (US accreditation) for its hospital in Delhi. (She later told Business Line that the Apollo Chennai would get it in another six months.)

Observing that many hospitals were aspiring for JCI accreditation, Ms Reddy said that evolving Indian standards was also necessary.

Later, answering a question as to whether `Indian standards' would help get foreign patients, she said that over a period of time, the standards were bound to gain acceptance from abroad as well. She said that several requirements of JCI (and other Western) standards were unnecessary in the Indian context. For example, the US had many requirements for safety from fire, although, unlike in the US, Indian hospitals used far lesser inflammable material such as carpets and wooden partitions.

Mr David Hawkins, Mission Leader, UK Trade and Investments, agreed with Ms Reddy that developing India's own standards was necessary.

Answering another question by Dr G Bakthavathsalam, Chairman, KG Hospitals, Mr Hawkins said that there was no political issue in the UK about sending patients to a developing country for treatment.

He later told journalists that the UK did not support any patient getting treatment overseas if the journey time was more than three hours.

Dr G.K.S. Velu, President, Association of Medical Devices and Suppliers of India, told the seminar that the demand for diagnostic equipment in India was growing at around 20 per cent.

He said that it was imperative that Indian corporates took up manufacturing of the equipment. Trivitron Medical Systems (P) Ltd, a company that Dr Velu is the Managing Director of, is in talks with potential collaborators for producing some of the equipment in India. Dr Velu is also one of the promoters of Metropolis chain of diagnostic centres.

Mr Mike Connor, British Deputy High Commissioner in Southern India, observed that the number of overseas patients visiting India for medical treatment had risen about 10 times to one lakh over the last five years.

[bala]

Bangalore cardiologist's technique draws attention worldwide

A city-based cardiologist has drawn the attention of the medical fraternity with a new technique in the field of valvuloplasty. The American Medical Journal has termed the new technique "Manjunath Technique."

The success rate was 99 per cent and the cost of the procedure had dramatically reduced by 50 per cent. From around Rs. 35,000 it has come down to Rs. 15,000 and in the case of very poor patients, the procedure could be done even for Rs. 8,000. Under the conventional technique, the procedure time is around three hours and this has now come down to 20 to 30 minutes.

[Div]

A healthcare plan for just Rs 89!
http://in.rediff.com/money/2005/oct/21health.htm

[Manu]

Now that the world knows that the Emperor has no clothes, the Pound is not so Sterling and - the British NHS is one big failure, the British Medical Journal uses two, well, people of Indian origin, to take a swipe at the fact that many bimaar angreez people come to India rather than die waiting for the NHS to help

The private health sector in India

The private health sector in India
Is burgeoning, but at the cost of public health care

Foreigners in increasing numbers are now coming to India for private health care. They come from the Middle East, Africa, Pakistan, and Bangladesh, for complex paediatric cardiac surgery or liver transplants—procedures that are not done in their home countries. They also come from the United Kingdom, Europe, and North America for quick, efficient, and cheap coronary bypasses or orthopaedic procedures. A shoulder operation in the UK would cost £10 000 ($17 460; 14 560) done privately or entail several months' wait under the NHS. In India, the same operation can be done for £1700 and within 10 days of a first email contact.

The recent remarkable growth of the private health sector in India has come at a time when public spending on health care at 0.9% of gross domestic product (GDP) is among the lowest in the world and ahead of only five countries—Burundi, Myanmar, Pakistan, Sudan, and Cambodia. This proportion has fallen from an already low 1.3% of GDP in 1991 when the neoliberal economic reforms began.

Yet India ranks among the top 20 of the world's countries in its private spending, at 4.2% of GDP. Employers pay for 9% of spending on private care, health insurance 5-10%, and 82% is from personal funds. As a result, more than 40% of all patients admitted to hospital have to borrow money or sell assets, including inherited property and farmland, to cover expenses, and 25% of farmers are driven below the poverty line by the costs of their medical care.

Despite the suspicions of the people who use the service that many private providers of health care perform unnecessary diagnostic tests and surgical procedures, Indians are choosing the private sector in overwhelming numbers. This is because the public alternative is so much worse, with interminable waits in dirty surroundings with hordes of other patients. Many medicines and tests are not available in the public sector, so patients have to go to private shops and laboratories. Each harassed doctor may have to see more than 100 patients in a single outpatient session. Some of these doctors advise patients, legally or illegally, to "meet them privately" if they want more personalised care. In a recent survey carried out by Transparency International, 30% of patients in government hospitals claimed that they had had to pay bribes or use influence to jump queues for treatment and for outpatient appointments with senior doctors, and to get clean bed sheets and better food in hospital.

This was not always so. When India became independent of British rule in 1947 the private health sector provided only 5-10% of total patient care. Today it accounts for 82% of outpatient visits, 58% of inpatient expenditure, and 40% of births in institutions. Spending on health has not been a priority for successive governments, and they have encouraged the growth of the private sector. They have subsidised the private sector by releasing prime building land at low rates (as long as a quarter of patients are treated free—a condition that is rarely met), by exemptions from taxes and duties for importing drugs and high tech medical equipment, and through concessions to doctors setting up private practices and nursing homes. Moreover, when medical staff trained in public institutions for fees of about 500 rupees ($11; £6; 9) a month move to work in private health care this represents indirect support for the private sector of some 4000m-5000m rupees per year. They leave not only for better salaries but also for better working conditions—the same reasons why they leave India to work abroad.

Until about 20 years ago the private sector comprised solo practitioners and small hospitals and nursing homes. Many of the services provided were of exemplary quality, especially those hospitals run by charitable trusts and religious foundations. As the practice of medicine has become more driven by technology, however, smaller organisations have become less able to compete in the private healthcare business. Large corporations, such as drug and information technology companies, and wealthy individuals—often from the Indian diaspora (commonly called non-resident Indians)—have started providing health care to make money. They now dominate the upper end of the market, with five star hospitals manned by foreign trained doctors who provide services at prices that only foreigners and the richest Indians can afford. These hospitals are largely unregulated, with no standardisation of quality or costs. Their success may be gauged by their large profits and ability to raise funds through foreign investments.

The medical system is failing its own people. Yet the government of India has stated: "To capitalize on the comparative cost advantage enjoyed by domestic health facilities in the secondary and tertiary sector, the policy will encourage the supply of services to patients of foreign origin on payment." Medical tourism to India is expected to become a billion dollar business by 2012 and is starting to change the financing and regulation of certain private hospitals by encouraging private health insurance and international accreditation.

The private health sector in India has made some impressive strides but has done so at the cost of the public sector. To regulate it may be, however, just another opportunity for bureaucratic delays and corruption. A better solution might be to impose greater social accountability on private providers, making a certain proportion of private services available to the poor.

The first priority must be to increase public expenditure on health care. The government's common minimum programme promises an increase in the spending on health care from 0.9% to 2-3% of GDP in five years with a health insurance scheme for poor families. In the past two years, although expenditure on health has increased in absolute terms, the proportion of GDP it represents has declined.

In India, each year tuberculosis kills half a million people and diarrhoeal diseases more than 600 000. It is time for the government to pay more attention to improving the health of Indians rather than to enticing foreigners from affluent countries with offers of low cost operations and convalescent visits to the Taj Mahal.

Amit Sengupta, joint convenor

Peoples Health Movement, D-158, Lower Ground Floor, Saket, New Delhi-110 017, India
(ctddsf@vsnl.com)

Samiran Nundy, consultant

[Laks]

The same story picked up by Beeb. http://news.bbc.co.uk/2/hi/health/4447140.stm

Don't know what is the purpose of this article. I know Apollo and others are big time into telemedicine et al. I've also seen one hospital train (forgot the name), where city docs come and perform surgeries as the train travels through many villages.

I think with VAT many of the hospital service are taxable. Perhaps the govt. should invest a part of what it already collects into primary healthcare directly.

[George J]

There is nothing new about what this person has stated. If he had kept abreast with writings of Peter Bremen et al he would known this a good 8 years ago...like I did.

I dont understand how the spurt of pvt hospitals is a failure of the system. Public hospitals were/are set up to provide care to the lowest common denominator of that society. Those who cannot afford to pay for care, these are their safety nets.

If you can afford to pay for care then you SHOULD not draw from resources in the public system and use pvt hospitals. If you had to sell your property to pay for care you are plain dumb, they do have Mediclaim and other insurance JUST FOR THIS KINDA SITUATION. If you know enough to use a pvt hospital you should know enough to get catastrophic health insurance. If you dont then you should go to public hospitals and deal with the consequenes.

The more the middle class accept health insurance the faster it will spread. More lives it covers more market power you bestow on the payers and regulators. More power you bestow...faster they can come up with quality and costs solutions. Thats how ALL developed societies handle this problem. Its not perfect but its better than knowing whats the latest and greatest cellphone and Bollywood movie and knowing nothing about health and health insurance.

[Manu]

Foreigners go to India for cheap operations while locals suffer

Psy-Ops Continues, this time from LONDON (AFP).

[svinayak]

`Indians complacent about AIDS'

Staff Reporter

"It is necessary to converge AIDS awareness with family planning"

MADURAI: There is a degree of complacency among Indians with regard to AIDS, although the country is home to around five million people living with HIV, equalling the number of cases reported in South Africa. The relative percentage in accordance with the population is only a fraction of a per cent, compared to 24 per cent in South Africa.

And for this reason, India has a golden opportunity to lead the rest of the world in the fight against AIDS.

The only way to combat the spread of AIDS is to ensure awareness of it among the youth, and by providing treatment and counselling to the infected, said Kevin Osborne, senior adviser of International Planned Parenthood Federation, here recently, while addressing a meeting organised by the Family Planning Association of India.

He said while India had outlined a comprehensive plan for AIDS, the problem was in its implementation.

Rather than treating prevention and care as parallel means in the fight against AIDS, he stressed the need for regarding them as a continuum.

It was a worrying fact that only 10 per cent out of five million infected persons in India knew that they were HIV-positive, leaving 90 per cent of HIV carriers to spread the virus unaware.

The `AIDS message' remained the same, possibly resulting in the so called `AIDS fatigue,' said Mr. Osborne, stressing the importance of it to be reiterated in a different way so that it struck a chord with all generations.

Only 12 to 20 per cent of people opted for condoms, and it was necessary to converge `AIDS awareness with family planning' with stress on the use of safe contraception.

Even though AIDS was an incurable syndrome, a dramatic decrease was possible in India by preventing any future spread which could occur among younger generations, he said and suggested setting up an anonymous `post-box system' wherein students could drop their queries and concerns which would be later discussed in the class by roping in NGOs, saving the embarrassment often felt by both teachers and pupils.

[Gerard]

It was a worrying fact that only 10 per cent out of five million infected persons in India knew that they were HIV-positive, leaving 90 per cent of HIV carriers to spread the virus unaware.

This is a form of proctology, pulling "facts" out of your rear end.

You take the number of HIV confirmations and multiply by ten. You then announce that India has five million HIV cases.

[George J]

This is a form of proctology, pulling "facts" out of your rear end......You take the number of HIV confirmations and multiply by ten. You then announce that India has five million HIV cases.

Actually the # come from two independent GOI research institutions. I didnt look for the 90% folks not knowing that they had HIV.

From: http://www.nacoonline.org/facts_hivestimates04.htm

Estimation Process

In order to ensure independence and objectivity in the entire exercise (done as per laid down procedures and guidelines by WHO and UNAIDS), two independent institutions have been assigned this task. These institutes include Institute of Research in Medical Statistics (IRMS), New Delhi and National Institute of Health and Family Welfare (NIHFW), New Delhi.
Before finalizing the HIV estimate and results of the data analysis several steps are followed to ensure independent assessment.

The assumptions used for sex and urban-rural differential and STD prevalence had been corroborated in 2003 and the suggestions were to continue the new assumptions till the time when fresh evidence of deviation is available.
Preliminary analysis of the data is carried out independently at two above-mentioned professional institutions, to minimize the error.
ICMR convened a series of meetings with a group of experts consisting of eminent Epidemiologists, Biostatisticians, Demographers and experts from international organizations such as WHO, UNAIDS etc.
A core committee set by DG, ICMR reviewed them in detail before finalisation of estimates.

HIV Estimates

HIV estimates are derived on the basis of HIV prevalence observed from STD, ANC, IDU, MSM and FSW sites.
The estimated number of HIV infections for the year 2004 is 5.134 million. In comparison to 2003 estimates, it has been observed that there are 28,000 added infections in 2004. In 2003, added infections were 5.2 lakhs.

[ASPuar]

Has anyone here ever heard of something called "Anaesthesia Awareness"?

Apparently it is a condition wherein the patient has been paralyzed with a muscle relaxant, but has not been "put to sleep" by a knock out gas. sometimes, it seems the relaxant kicks in but the compound meant to knock you out doesnt.

Naturally, the results are quite awful for the patient, who because he is paralzed can neither convey his plight, and yet can see or hear, and certainly feel the effects of surgery.


I am posting here an article from the Indian Journal of Anaesthesiology, by a professor from AIIMS.

Perhaps some medical types here can throw some light on the subject, and what to do presurgery to help ensure one doesnt end up in such a situation, extremely rare though it may be.

http://www.baskent.edu.tr/~mustafak/BME ... v/ilay.pdf

[ASPuar]

The man is losing it... and I'm just about keeping my cool on this one. Instead of saying build more hospitals and graduate more doctors to accommodate all the Indians and foreigners who need treatment, he says stop foreigners from taking up places "at the expense of Indians" - whatever the fu(k that means.

I recently visited India and stayed nearly 2 weeks in a hospital (in Chennai) with my mother who had to undergo a heart bypass. There were foreigners there from Seychelles, Oman, some African countries, and I believe Iran as well. In fact they have an "Overseas Patient Officer" or something of the sort permanently employed. At another hospital where my mom got her cardiologist's evaluation and angiogram done, they had African nurses employed to take care of African patients.

JEM, I really dont think encouraging medical tourism is a good idea. By all means, we should build more hospitals, graduate more doctors... but IMO even so we wont have enough space for everyone in India for a good long time. It justs seems wrong to me, that Indians dont receive treatment, while exclusive foreign patient officers are being deputed all over the place.

IMO, medical treatment for foreigners should only be on the grounds if it is unavailable in their country or something. And certainly not for Amrikis and Angrezes flocking to India because the medical system in their countries has gone haywire.

Im afraid I know quite well the mentality of several of my compatriots. Its not going to be long before we get firang only hospitals, just like goa has so man firnag only hotels and guest houses. If not officially, then at least through the use of rudeness and coercion.

Cant have silly dirt poor Indian patients mucking up our British patients healthcare holiday.

JEM, I know it seems you have strong views on the sub, but I think this really deserves a rethink. Im sorry, but I think that its going in a really bad direction, and will end in nothing good for Indian patients.

Doesnt detract from KN being a peacedancer lefty jholawalla though.

[George J]

Perhaps some medical types here can throw some light on the subject, and what to do presurgery to help ensure one doesnt end up in such a situation, extremely rare though it may be.

You can google more info.
Here is a reliable site with more info.
link

[ASPuar]

Thanks GeorgeJ.... first I had ever heard of such a thing was today. I must admit im rather curious. This site is good. It doesnt say much about what the patient can do to help the anaesthesiologist make his decisions, but maybe its one of those things about which there isnt much the patient can do, really.

Still. It must be an awful experience.

[JE Menon]

ASPuar

>>JEM, I really dont think encouraging medical tourism is a good idea. By all means, we should build more hospitals, graduate more doctors... but IMO even so we wont have enough space for everyone in India for a good long time.

Boss, I’ll have to clarify upfront that I don’t know a whole lot about the medical industry. So my views are limited to general observations which may be wrong for whatever reason and I’ll be happy to change my outlook on this. I feel that the medical industry should be allowed to develop with minimum interference. As such:

1. Enough space for everyone is something I think everybody would agree with as well, but it is a fact of life that not all will be able to afford equal access.

2. These are private hospitals, with no government financial input as far as I can tell. Their existence allows those who can actually afford it to benefit and perhaps frees up some space at the government facilities.

3. Thirdly, it is not that these hospitals will be able to accommodate those who cannot afford it (without themselves going into the red) if we decide that foreigners should not come in numbers. That is to say it is not a question of replacement.

4. As the profit motive drives these enterprises as much as the Hippocratic ideal, it is quite certain that the greater the demand the greater will become their ability to supply. In other words, if they are allowed to be profitable the prospect for them to treat greater numbers becomes higher. Their desire to make more money will prevail. At least we can be sure that this will be a far greater motivating factor to create space than pretty much anything else.

>>It justs seems wrong to me, that Indians dont receive treatment, while exclusive foreign patient officers are being deputed all over the place.

As I understand it, it is not that Indians do not receive treatment per se it is that Indians who cannot afford these hospitals do not while foreigners who can do. I am aware that there are situations where there is no room because of the demand, but this is a function of supply issues that are far more easily remedied by the profit incentive than any legislative action. I am not aware that foreigners actually get a preference over Indians willing to pay the same amount of money. It is probably first come first served.

On the question of healthcare for the poor who cannot afford these hospitals anyway, i.e. whether or not foreigners are treated there, the answer must touch a whole different set of issues – ranging from social welfare to what not, where the government may more accurately be said to have a role.

>>IMO, medical treatment for foreigners should only be on the grounds if it is unavailable in their country or something. And certainly not for Amrikis and Angrezes flocking to India because the medical system in their countries has gone haywire.

I am in comprehensive disagreement here . This will only succeed in creating a whole satellite industry dedicated to the circumvention of loopholes to show that such treatment is unavailable in their countries. There is no harm whatsoever in foreigners spending their money in India to get treated. It will create a whole new set of jobs for Indians who can then afford better healthcare (OK, I’m being rhetorical here, but you get my drift). Not to mention the positive psyops. My point is that, beyond the market dictated supply/demand gap that may exist in flux for Indians able to pay, there is nothing inherently wrong in having foreigners treated in India. In any case, why make things easier for the Thais and the Filipinos.

>>Im afraid I know quite well the mentality of several of my compatriots. Its not going to be long before we get firang only hospitals, just like goa has so man firnag only hotels and guest houses. If not officially, then at least through the use of rudeness and coercion.

I agree fully with the mentality issue, having experienced it myself. However, so long as the market is allowed to dictate the environment, this is not likely to occur in a manner or to a degree that it becomes disgraceful. No hospital, or hotel for that matter, can discriminate obviously. As you said, it would have to be a discrimination of the “non-tariff barrier” sort. I don’t know but have any of the hotels in Goa been taken to court? It would be fairly easy to prove that they have acted in a discriminatory way. A few such cases, which no doubt the judges will handle with the zeal one can expect in these situations plus the attendant bad publicity, and the owners will be disinclined to continue with the overt and covert discrimination.

The other issue is one of money. If these hotels/hospitals raise their fees to a degree only firangs can afford – then the motive for the firangs to come to India will be removed. So they have to price competitively. Moreover, increasingly there are Indians who can afford anything the firangs can. I’m also not sure many hospitals will want a bad reputation of the sort associated with discrimination of this nature.

>>JEM, I know it seems you have strong views on the sub, but I think this really deserves a rethink. Im sorry, but I think that its going in a really bad direction, and will end in nothing good for Indian patients.

No I don’t really have especially strong views on this. I just got pissed off by KN’s moral masturbation, which is in fact a sophisticated commie wank. I do know that I had a very positive experience when I went to one of these hospitals to have my mother’s heart issues settled. The vast majority of clients there were and I expect are Indians. But they did have quite a number of foreigners as well.

As a matter of principle I agree with you, every Indian should have access to healthcare and definitely any Indian discriminating on the basis of skin colour or whatever should have his ass sued to hell – in any industry. I just don’t agree that preventing foreigners from getting treatment in India will actually help in achieving that.

[ASPuar]

JEM, two major points come to mind:

1.

2. These are private hospitals, with no government financial input as far as I can tell. Their existence allows those who can actually afford it to benefit and perhaps frees up some space at the government facilities.

Again, it is difficult to quantify such a thing. The majority of doctors in India, through lack of an other option, (at least in the past) have been educated through enormous central and state government subsidised largesse, in the belief that they weil serve the country.

Many hospitals (such as indraprastha apollo in delhi) have been given land at concessional rates or even free in exchange for promising a certain number of beds for free patients. The hospitals have devised comprehensve means to get around these restrictions.

The issue is not as clear cut as one may imagine.


2.

As I understand it, it is not that Indians do not receive treatment per se it is that Indians who cannot afford these hospitals do not while foreigners who can do

This is the more important issue, IMO. As I see it, the problem is that hospital pricing is going to start being geared towards Firangi pockets. If a hospital sees it can charge a foreign patient more, then it will. Costs of healthcare will rise. Unfortunately the gap between the cost of healthcare in America and India is so large, that a charge can be made that is considered a great bargain by an American, and yet unaffordable even by the majority of upper middle class Indians.

Finally, if we end up with a dual cost system healthcare system (Please remember that the majority of hospitals worth going to even in a city like delhi are private, so they also constitute the healthcare system), with one price for fireigners and another for Indians (perhaps insisted upon by the government), the results will be as I mentioned before, rudeness, disdain for Indian patients, and fawning loveydoveyness on the white boob-job candidate.

Just my two cents.

[JE Menon]

ASPuar,

>>As I see it, the problem is that hospital pricing is going to start being geared towards Firangi pockets. If a hospital sees it can charge a foreign patient more, then it will.

Absolutely no question about it. What I'm saying is that the price they charge will still be accessible to a group of Indians and that it is highly unlikely that hospitals will be able to deny Indians willing to pay that amount access to its facilities.

>>Unfortunately the gap between the cos of healthcare in America and India is so large, that a charge can be made that is considered a great deal by an American, and yet unaffordable even by middle class Indians.

Provided market forces are allowed to prevail, then those middle class Indians who cannot afford the hospitals mentioned above will create a demand that will be catered by lower priced hospitals by doctors who sense a profit in this untapped segment.

Ironically, there's a strong parallel to the hotel industry here it seems (not that I know anything about that either). The super deluxe hotels get a lot of firangis and may be not so many Indians except those who can afford it and wish to partake of the luxuries. For the rest of the junta in declining order of income there's a whole range of hotels starting from 5* and working its way down... I suspect the medical services will thus in some ways at least emulate the hospitality services (not to put too much of a pun on it).

Now that I think about it, ditto with schools it seems. I was stunned to my knees nearly when I heard about some of the private schooling facilities available in Chennai/Bangi metros...

Sorry saw the below comments later…

>>Again, it is difficult to quantify such a thing. The majority of doctors in India, through lack of an other option, (at least in the past) have been educated through enormous central and state government subsidised largesse, in the belief that they weil serve the country.

As such, I have no problem with state subsidization of education for doctors any more than I would for the other fields where the govt puts money. On the other hand it would be futile for it to do so in the belief that they will serve the country – I figure most doctors feel they are, only perhaps not in the way they were expected to; for instance, bringing in money to the country by treating foreigners.

>>Many hospitals (such as indraprastha apollo in delhi) have been given land at concessional rates or even free…The issue is not as clear cut as one may imagine.

Did not know that. but perhaps it goes to show that the preferential treatment should be discontinued after a certain critical mass has been obtained in any industry. I don’t think this directly impacts on the treatment of foreigners in medical facilities. I guess our main difference is that I tend to see this as a business as much as a public good; in other words, I tend to see it as the same as the software industry, for instance. Imagine telling these guys write code but don’t do it for foreigners… or make car parts, but for Indians first or something of that nature, or grow rice but don’t sell it overseas….

>>Finally, if we end up with a dual cost system healthcare system…. with one price for fireigners and another for Indians (perhaps insisted upon by the government),

More than dual cost, it will be “multiple cost” if there is such a thing – i.e. different levels of medical service for different levels of payment. It would be foolish IMHO for GoI to mandate one price for foreigners and another for Indians – if the private hospitals do it on their own for whatever profitability reasons they may calculate, that’s another matter.

>>the results will be as I mentioned before, rudeness, disdain for Indian patients, and fawning loveydoveyness on the white boob-job candidate.

In a market driven environment, few will be able to afford this sort of behaviour towards the customer and survive for long. In fact I expect that the mid-range healthcare sector will boom like nobody’s business in the coming decades far more than perhaps the “elite” hospitals.

ASPuar, I know where you are coming from on this. I hate the shit where Indians treat other Indians like dirt while groveling before the foreigner. My point is that such behaviour will manifest itself in virtually any circumstance and that it is more likely to do so when the circumstances are not dictated by market forces. This is where Indians have the killer advantage. No Indian business will in future be able to treat Indians (regardless of how SDRE he/she is) with disdain – especially if it wants a repeat visit. Now Indians have choices.

[ASPuar]

I may have my doubts about the internationalization and "industrialization" of an essential good like healthcare, but:

This is where Indians have the killer advantage. No Indian business will in future be able to treat Indians (regardless of how SDRE he/she is) with disdain – especially if it wants a repeat visit. Now Indians have choices.

Amen.

[JE Menon]

To be frank, I'm not exactly wearing the t-shirt on this either. May well not work out as hoped - but let us hope that the average Yindoo's greed gets the better of his/her discriminatory tendencies.

[George J]

The cost of healthcare will rise...so will the uptake of Health Insurance. And this most jingos (who think that India's Neta-Baboo are useless off course) dont realize is that there are already institutions like the IRDA that have been established to continuously look at the issues of premium, quality and charges.

But health insurance mkt is in its infancy its still providers mkt (i.e. the hospitals and docs are very much in control coz their major source of revenue is still self-paying patients). You dont need to be a soothsayer to predict what will happen to the Indian healthcare market. Just look at the US mkt from 1969 to 1984 and then from 84 to current.

69 the introduced medicare and medicaid...and there was a boom in hospitals, docs and all kinds of services coz it was fee for service (FFS). Doc would charge what they want and the medicare would pay the prevailing "usual and customary charges". Then all kinds of screwy things began to happen...they were hemorrhaging cash with every service.

But at the same time their uptake increased (more folks joined in), more uptake more market clout and finally in 84 they went into a prospective payment system (PPS). This means that Medicare decide BEFORE the service what they will pay for the service based on a complex payment structure. The hospitals howled...but by then Medicare had become a monsters (it had the lives and it controlled the mkt) and the had to buckle.

Many hospitals closed, downsized, merged and finally the mkt reached it curent equilibrium.

Same thing will happen with India, as the updake of health insurance goes up. Fortunatley we still have strong socialistic leanings (read vote banks of poor) that govt will always have maintain the its current safety net hospitals (govt and municipal). This is a good thing for those who will fall through the cracks in the system.

[ASPuar]

Frankly the US healthcare market is nothing to be proud of, ior to be emulated.

A system which forces the healthcare provider to cut costs at the expense of his patient (who is certainly not being treated for free!) strikes me as the last thing one should ever try to emulate.

[George J]

Frankly the US healthcare market is nothing to be proud of, ior to be emulated.....A system which forces the healthcare provider to cut costs at the expense of his patient (who is certainly not being treated for free!) strikes me as the last thing one should ever try to emulate.

From someone who makes a living researching, using and changing the US healthcare system (in specific areas, off course), its not as cut and dry as you make it out to be. There are cost cutting measures in place coz the system itself is very very wasteful and expensive. They have to cut cost coz the patient is not really paying for the care someone else is and its that someone else who is worried about their bottom line.

Its too complicated to be explained in a few words and without addressing the concerns of ALL stakeholders. I aint gonna type all that.

[ASPuar]

GJ,

Its is scarcely true that the patient doesnt pay for his healthcare. Your average worker pays quite a lot every year in insurance premiums. Call it deferred payment, but the guy pays for his treatment through and through, else the insurance companies wouldnt be in business.

As for wastage, I believe it. I can scarcely understand how hospitals in the US manage to suck up such huge sums of money and yet be bankrupt.

At any rate, the crux of my thinking is, that their shouldnt be a third party between the patient and his or her treatment, butting in with their concerns, and pretending to be a financial stakeholder in the patients health. There shouldnt have to be. And in India, presently there isnt. (for the msot part). Thats just how I like it, and want it to stay.

[George J]

Your average worker only pays for THEIR portion of the premiums, most employers pay 50-90% of the total premium (see the mess that GM is in). Everytime you goto the doc you pay a 10-20 copay, the remaing 140-130 is picked upby the insurer. Now if you are prefectly healthy you are not going to use the system, but for every 1 of you there will 5 others who will need to use the system in your own company. Your premiums are based on a "experience rating" for your employer's demographics. Most super duper employers are self insured and the the health plans only adminster the system (keeps costs down in the long run, but not for GM).

Talking about administration, thats what third partys are, they are at the least the people who process the claims and make sure that payments are made. They have evoloved into one stop shops which now take care of all aspects including negotiating payments and offering a spectrum of benefits.

You can avoid having a third party if the patient can afford to pay for all services out of his pocket. Healthcare is NOT cheap, even when you walk into the filthiest municipal hosptials and yet get substandard care...someone has still paid for that care. You can walk into Escorts and pay 5 lakhs for the same care, but how many people have 5 lakhs lying around?

I believe in India, if the hospitals know you hv insurance they tend to overcharge (coz its FFS system). In the US too there is a significant amout of fraud to game the system. No one in this game is saint or a sinner.

Wheather you like it or not, there is going to a third party and that third party for the better or worse will have a lot of say in the quantity and quality of care.

[ASPuar]

AFAIK, you can get a very significant discount if you offer to pay cash in many US hospitals and doctors offices as well.

PArt of this may of course be because you cut don on the administrative overheads like processing of claims and so forth. But a lot of it is that hospitals just inflate costs on consumables so that they can stick it to the insurer, while the insurer sticks it to them somewhere else.

I visited a major hospital in Delhi recently, and it seems if you have insurance, they will keep you longer in the hospital than if not. I dont know if its based on a prearrangement with insurers, or its just a way to charge room rent for an extra day.

[George J]

AFAIK, you can get a very significant discount if you offer to pay cash in many US hospitals and doctors offices as well.

I have not heard of any such thing. They will give you what looks like a discount off the "list price" but the insurers usually pay using a PPS method and these are very very different from the list price.

I visited a major hospital in Delhi recently, and it seems if you have insurance, they will keep you longer in the hospital than if not......

Thats coz its a FFS system. Which means they will pay for everything that was done during the length of stay. So if the hospital says that patient need some extra stuff they will stay longer, have a bigger bill that the insurer has to pay. Under PPS the hospital gets paid for the "Diagnosis Related Group" DRG which does not care if you have a patient in for 1 day or 10 days you will be paid x amount associated with the diagnosis responsible for the admission (this is a bit simplistic...but for our discussion it should suffice).

[Atish]

GeorgeJ,

With a lot of wastage and slack, there must be good moneymaking opportunities in the healthcare sector in the US. Whaddya think? Educate me Boss I really wanna learn.

Atish.

[George J]

You cannot stem the waste and inefficiencies of the system without actually doing some radical redesign.....off course that not gonna happen. I understand that you are curious to know how insititutional level business process wastage can be stemmed, I am talking a bit more clinical here....like following evidence based quality of care, clinical practice guidelines etc.

The current system has incentivized this by offering monitary rewards for the plans. But the providers (read docs) are resisting any sort of mkt. segmentation of their professions into good docs, ok docs, and bad docs. They cant even agree on the metrics or how to deal with these segments of docs.

And boss this all I know from reading about it in my ine of work. I wont tell you how to improve the pharmaceutical side of things....coz thats what I do...and I wanna make money doing it.

[Atish]

Thats shortsighted GeorgeBhai.

Atish.

[George J]

Its not its actually bahut door ki soch. I am sure I will need skillz that I dont have to impliment my grand vision and if you got them skillz, I know who to turn to.

[Laks]

The story on Indian medical tourism industry is now picked up by Ms. Gentleman of IHT. Atleast this one is gives a more balanced opinion. So to traceback: BMJ->BBC->AFP->IHT.

As foreigners flock to India to find lower health-care costs and avoid long waiting times, the rapid growth of this medical tourism has begun to create significant opposition among doctors here.

What significant? did someone do a survey among Indian docs? The paper is from one Dr. Samiran Nundy and Amit Sengupta. There is a paper cited below which concludes differently.

In a private room in Trehan's Escorts Hearts Institute, Carlo Gislimberti, a 60-year-old American, was convalescing recently after a triple heart bypass.

When he had his third heart attack in May, he was, like 50 million other Americans, without health insurance. His doctor told him a bypass would cost over $150,000.

Because he did not qualify for government assistance, he would have had to sell his Italian restaurant in Taos, New Mexico, to pay the bill.

The total cost of surgery and a 20-day stay in the New Delhi hospital was $10,000.

He was operated on by Trehan, who used the latest surgical technology. Gislimberti then recovered in a shining, marble-floored wing of the hospital, waited on by smiling staff wearing badges reading "May I help you?"

"I was facing financial death or death by heart attack," he said, "until my wife typed 'medical treatment in India' into a Google search. Twenty days later I was here."

He rejected the idea that he was absorbing medical time and space that might better be used for domestic patients.

"I hope that the rest of the Indian population will eventually benefit from what is being done here," Gislimberti said. "More new heart surgeons are being trained here. I hope that the little money I brought into the country will benefit the country in some way."

Advocates of medical tourism say it pushes up standards within the Indian medical profession and contend that there will be a trickle-down effect to local services from the high-class medical centers being built to cater to the elite of India and to foreigners.

"Medical tourism can also contribute to improving the health care infrastructure and services in rural areas," a paper published recently by the Indian Healthcare Federation said

Controversy in India over medical tourism

[George J]

........Advocates of medical tourism say it pushes up standards within the Indian medical profession and contend that there will be a trickle-down effect to local services from the high-class medical centers being built to cater to the elite of India and to foreigners.

Controversy in India over medical tourism

From by brief encounter with the Indian medical system and from anecdotal evidence. The Indian docs seem to be very much upto speed with the latest techniques and equipments when it comes to the practice of medicine. Sure they dont always have the priciest of diagnostic equipment but they do a lot of pioneering work in the fields of cardiac and orthopedic surgery and seem to be well published and well discussed.

So its only the quality of the infrastructure that needs to be brought upto speed. This is one area where for most conditions there is no dearth of skills.

About medico-tourism: the only ppl affected by this are the middle middle and the upper middle class (BR Jingo families). No self respecting tourist will ever goto a municipal or govt hospital for treatment (he/she wont be eligible) so they are not exactly taking away from the those who need it the most.

Sure they will compete with us jingos for the same docs and rooms in escorts and apollos, but that will only create more demand....more demand will mean more hospitals and its not like we have an overcapacity of hospitals, our beds per 1000 population is really appalling.

Will it drive up prices? Umm yes and no. It might if demand outstrips supply (econ 101 stuff) but I dont see a steady stream of NHS, Medicare and Canadian patients just yet. So there still an equilibrium. Will it improve quality of care? Yeah I hope so.

Will they get the best doc for their money???Now thats the $64,000 question!!! Do the best docs in India really practice in pvt sector or the public sector. One of the coolest things in India is that most of higher education including medical education is subsidized by the govt. And you are not going to India for a cough and cold you are going their for super speciality surgery and 95% of that kinda training is still given in govt hospitals.

Sure the MS an MCH folks then branch out to make the moolah but the poor still get the best trained proffs and assistant proff taking care of them. Thats why a long time ago I had stated that for the atrocious conditions that exist in Indian govt hospitals they do wonders with the most minimal of resources. Ironic.

Personal anecdote: Recently someone had a surgery done in a govt hospital coz the BEST neurosurgeon in the city was in that hospital. This dude literally has an assembly line of this kinda surgery on any given day. Went to see the patient in recovery room, there were cobwebs form the cealing fan of whats supposed to be one of the cleanest room in the entire faciltiy. But the neurosurgeon was so good that he had neurosurgeons from Japan and UWash (which has a top 10 medical school in the US) learning some new-fangled technique developed by him.

Patient was kicked out of the hospital in 72 hours, no infection, minimal/normal discomfort, excellent outcomes.

[Div]

Gates Foundation funds health effort for newborns
http://www.ciol.com/content/news/2005/105120212.asp

[Shalav]

Perlecan starts clinical trials of obesity drug - The Hindu

CHENNAI: Perlecan Pharma, promoted by Dr. Reddy's Laboratories, has announced the commencement of phase I clinical trials of its new generation pan-PPAR activator drug candidate DRL 11605 in Canada.