A doctor friend suggested the slogan “Treat in India”. With the first meeting of the National Medical and Wellness Tourism Promotion Board (NMWTPB) held recently, I am surprised no one had thought of this expression earlier. In 2014, 7.7 million foreign tourists came to India (we don’t have full-year data for 2015). I don’t think we have a good handle on the number of tourists who come for medical purposes. The 1.3 million figure floating around is a bit of a guess and may well be an overestimate. There is a medical visa, or M-visa, issued subject to some conditions. There’s also a MX-visa, for attendants/ family members. Fast-track M/ MX visas exist for Saarc countries, although Bangladesh/ Pakistan warrant additional requirements.
However, there’s no reason to presume medical tourists necessarily use medical visas, since additional procedures are involved. For instance, I recall a recent Ficci report that documents problems with the visa system. Waiting periods for the grant of visas are long, the physical presence of patients is required at embassies, and there are restrictions on multiple-entry medical visas. This year’s Economic Survey also mentions “streamlining the medical visa process and extending eTV (e-tourist visa) to medical tourists”. If transaction costs are high, why will a patient necessarily use a medical visa? There’s no way of making the use of medical visas mandatory. Even if that were a good idea, one cannot enforce it, unless such a visa becomes self-enforcing because of the advantages it brings.
Hence, medical tourists often come on tourist visas. Immigration and visa forms don’t really capture the complete data on medical tourists. Historically, some information exists — in responses to questionnaires. One then gets a figure (depending on the year) — that 2-3 per cent of foreign tourists come to India for medical reasons. That 2-3 per cent is probably an underestimate, just as 1.3 million is an overestimate. A figure like 5,00,000 may be closer to the mark. There’s a related issue.
The ministry of health and family welfare now has a National Health Portal (NHP). As this, or the National Accreditation Board for Hospitals and Healthcare Providers (NABH) website indicates, we tend to often equate medical tourism with surgery and treatment in hospitals, although that’s not necessarily true. There can be wellness or rejuvenation centres too, or AYUSH centres. For instance, NABH accreditation now covers 99 medical, 28 AYUSH and 16 wellness and rejuvenation centres. Unfortunately, the NABH is still not marketed sufficiently well. Prospective patients don’t always know that the NABH is not inferior to other global standards. Indeed, NABH standards are recognised by the ISQua (International Society for Quality in Healthcare). Note that neither the NHP nor the NABH is specifically directed at medical tourism. There’s no specific medical tourism website. Perhaps the NMWTPB will recommend that.
It’s a segmented market and only a tiny bit is formalised. Here’s my doctor friend’s description of what can sometimes occur. A patient turns up, not necessarily on a medical visa. Therefore, there has been no prior tie-up with a hospital. Even if there’s a medical visa, there may have been problems with wire transfers of money. Hence, the patient carries cash, with possible violation of the law. There has been no advisory at the time of the grant of visa. The patient may not know the law on organ transplants, or that the non-near relationship clause between donor and recipient doesn’t apply to foreigners. Without a near relationship, organ transplants to foreigners are prohibited.
Yet another certain reason for the violation of the law: When the patient arrives at an Indian airport, with or without a medical visa, there’s no special immigration facility or information counter. If the airport authority provides a stretcher/ ambulance, that service ends as soon as you exit the airport. In any event, the patient now falls prey to a tout/ middleman. Middlemen can perform a useful intermediary service, but that’s not what these unregulated ones do. The tout quotes a scaled-up figure for treatment/ operation. In the absence of information, the patient (not necessarily very literate) doesn’t know that the hospital will get 30 per cent of this. Hospitals aren’t allowed to receive payments in foreign exchange. The tout converts foreign exchange to rupees at an unfavourable rate. There can be a tie-up with a hotel, with another cut for the tout. The words hospital and hotel have identical etymological roots. A hospital requires support infrastructure, not just inside, but outside too. A hotel for a relative/ attendant is an example.
I once asked someone in Agartala why patients from Tripura went to Tamil Nadu for treatment and not to West Bengal (Kolkata). He cited hotel availability, proximity to hospitals, and the clustering of hospitals. (If you don’t get admission in one, there’s always another in the immediate neighbourhood.)
For other than the high-end of medical tourism, I don’t think my doctor friend was exaggerating. At that first meeting of the NMWTPB, three sub-committees have been set up on regulation, accreditation and marketing. A data bank of service providers will also be created and disseminated. There’s no dearth of reports on India’s potential for medical tourism, citing various relative cost and non-cost advantages. The constraints are also known, as are two fundamental principles. First, break down silos in formulating and implementing policies. Second, regulate, don’t ban. Regulating a disintermediation service between patient and hospital is desirable and works. Banning touts is undesirable and doesn’t work, because it’s neither efficient nor enforceable. My doctor friend should be given less to complain about.