Business Patient Outsourcing

‘‘I am 20 years younger than your PM,’’ chuckles the former production manager for Gandhi on his ‘Vajpayee surgery’ for the left knee last October; the right knee went under the scalpel this January. His private insurance could have rolled him comfortably in and out of an operation theatre anywhere in the world. He chose Breach Candy Hospital, Mumbai.

The reason is simple. Surgery plus stay in a star hospital in India actually works out cheaper for foreign nationals in comparison with medical care in their home countries. The advantage of the rupee is sweeping: Weigh Rs 2 to 3 lakh for hip or knee replacement in Mumbai against Rs 10 lakh in USA, UK. Or Rs 1 crore in the US against Rs 11 lakh in India for a bone marrow transplant. For identical surgery, equipment, technology, drugs.

And then there are the perks of Indian medicine: Nice, chatty doctors with stints at American or European hospitals, non-existent waitlists, tie-ups with star hotels for recuperation and the bonus of a short holiday in Kerala or Rajasthan.

That’s why London resident Keith Deckinson is under therapy at the Escorts Heart Institute and Research Centre. Living in Delhi for a month in a Rs 35,000-apartment, Deckinson has been receiving daily therapy at the Enhanced External Counterpul- sation lab at Escorts. The treatment is a non-invasive procedure to reduce the symptoms of angina (heart pain), presumably by increasing coronary blood flow in the heart.

His medical tab: Rs 80,000. In the UK, it would have been closer to Rs 10 lakh.

‘‘Only two hospitals in London offer this treatment and the waitlist is huge,’’ says Deckinson from his bed at the diagnostic lab, compressive cuffs wrapped around his calves and thighs. He isn’t bothered that his air tickets cost as much as the medical treatment; those are minor extras.

For Deckinson and others jumping London queues for India, the difference in medical service is simple but glaring. ‘‘Here you get to speak to doctors,’’ says Deckinson. ‘‘In London that’s not possible.’’ He’s amazed his doctor has passed on a cellphone number that’s never switched off. ‘‘What else do I need?’’ he asks.

The 50-something patient has already squeezed in a dekko at the Taj Mahal and Goa, and plans to hit the Jaipur circuit too. ‘‘Treatment is so cheap, I can visit many more places,’’ he beams.

It’s a world apart from the UK’s National Health Service. Most western countries boast of something similar, ageing systems where doctors, consultants and hospital beds simply cannot keep up with increasing patients. The fallout: Basic surgery waiting lists that stretch from three months to two years.

To rescue patients waiting forever in NHS queues, joint replacement surgeon Dr Arun Mullaji recalls performing three or four surgeries daily during his NHS stint in the UK. ‘‘Every day I would have to tell grannies and grandpas that their turn would come two years later. It was depressing.’’

Nothing has changed about NHS queues. But patients who, a decade ago, would have been horrified to imagine surgery in a nation of flies, malaria and depressing drives from airport to hotel, now want to buy that return ticket to Mumbai, Delhi, Chennai.

‘‘I had a patient who thought it had been a mistake to choose India, as he drove from the airport to the hotel,’’ says Dr Naresh Trehan, CEO of Escorts Hospital, New Delhi. ‘‘When he checked into the hospital and saw the infrastructure, his doubts vanished.’’

The arrival of European patients may still be a trickle, but it is noticeable and regular. It’s no medical tourism gimmick. Yet. (See accompanying story).

Prominent on the atlas of medicine is the business of hip, knee, joint replacements in India, drawing visitors beyond traditional arrivals from Gulf and African nations.

AS word spreads on bulletin boards and online chat rooms, appointments are being booked over the Internet for cardiac surgery, angioplasty, cancer treatment, joint replacements, infertility treatments, skin problems, laser eye surgery, even dentistry.

An amateur cricket player from the UK recently flew out of Mumbai with a shoulder as good as new. He had quickly discarded his two choices — 18 to 24 months on the NHS waitlist or shelling out extra for private insurance — to opt for a one-night stay in a Mumbai hospital. The advanced arthroscopic shoulder surgery didn’t require his shoulder to be sliced open, and his medical bills were one-fifth of what they would have been in the UK.

‘‘They come from the West for elective or planned surgeries,’’ says Dr Sanjay Desai, a specialist in knee and shoulder surgery associated with three major Mumbai hospitals. ‘‘I worked with the NHS in the 1990s, and watched the delays, the hurdles before an appointment. Thirty years ago, our foreign patients were only from the Middle-East. Now there’s a small but regular flow from the West.’’

The shift of became noticeable about a year ago, says Dr Chetan Unadkat, joint replacement and orthopaedic surgeon at Breach Candy. ‘‘Some foreigners come only for comprehensive consultation and check-up, not for a holiday. They have a doctor or hospital in mind, chosen from the Net or by word of mouth from other patients.’’

Low-profile but distinct, neurosurgery in Mumbai or Chennai is quietly going under the scanner of doctors’ referrals worldwide. ‘‘Many patients receive medical consultation in UK and USA, and are told they would be better off travelling all the way to India for surgery,’’ says Dr B K Misra, head of neurosurgery at P D Hinduja National Hospital and Medical Research Centre.

Misra calculates a ‘‘tremendous’’ cost advantage. ‘‘A single room in a five star hospital will cost less than Rs 2.5 lakh for neurosurgery in Mumbai,’’ he points out. ‘‘In UK, it will cost Rs 15-20 lakh and nearly Rs 50 lakh in USA.’’

At Escorts, Dr Trehan has noticed that foreign clientele has spurted from five per cent three years ago to 10 per cent today. ‘‘More patients are coming from Thailand, Indonesia, Africa, and now Greece and UK,’’ he says. ‘‘The US and UK patients coming to India are those not covered by medical insurance back home, and they are convinced they’ll get quality medical care at low cost here.’’

A large chunk of the global clientele are still NRIs. ‘‘We had a bitter experience,’’ says an NRI couple from Lisbon, Portugal, in Mumbai. ‘‘For an MRI scan we had to wait 10 days in Lisbon. In Mumbai it takes just 24 hours,’’ says the husband, accompanying his wife for consultation for her back trouble.

Apollo Hospital’s chain of 38 hospitals — attractive to foreign nationals who are comfortable with an institutional system of medicare — has treated some 60,000 foreign patients from 55 countries over the last five years. ‘‘Most patients come specifically for treatment during the last six months of the year,’’ says Dr Anupam Sibal, medical director and senior paediatrician at Indraprastha Apollo Hospitals, New Delhi.

The bulk of their foreign patients, though, are drawn from Bangladesh, Sri Lanka, Oman, Nepal and Maldives. ‘‘Patients from the West are also coming,’’ says Sibal, ‘‘but their numbers will increase only if an accreditation system and awareness blitz is put in place.’’

Meanwhile, a task force at the Central government level is planning a medical tourism agenda. A recent McKinsey report pegs the growth rate of medical tourism at 15 per cent over the last five years. It promises hospitals attractive returns. Think $2 billion by 2012.