Retinoblastoma Screening : Indian scenario.  

India carries the biggest burden of Retinoblastoma globally, with an estimated 1500 new cases annually, which account for almost 20% of the total Retinoblastoma population. Regular screening of the children at risk is must for early identification and management.

Are the issue of cost and quality the only parameter which decides where a patient will go for medical tourism? Are these trends of medical tourism more universal? Is there any lesson to be learned?

I recently came across a YouTube video appreciating the health facilities in India, and discussing the difficulty faced by former Pakistan hockey player Mansoor Ahmed to come to India for treatment. It brought me to questions, why had he chosen India and what other options he had beside India. A recent report points to the fact large numbers of medical tourists are coming to Asian countries for the treatment, due to cheaper costs and high-quality healthcare services. India holds second place, after Thailand which is at first.

The regional trend of medical tourism.

International medical tourism: 

We all have heard politicians and film stars going abroad for medical treatment. For the last two decades, it has become an industry with an estimated business of 50 B US dollars. Americans, Canadians, and Europeans are mostly patients who travel to India, Thailand, Singapore, and other southeast Asian countries. Bumrungrad International Hospital, in Thailand, is the world’s largest international hospital. It sees more than a million patients a year, half of them are foreigners coming from more than 190 countries. India mostly receives patients from Africa and middle east countries. Affluent people from across the world flock to the US for treatment as its standards of healthcare are still the benchmark.

Medical tourism in India:

New Delhi is an epicenter of healthcare for people residing in north and central Indian states. Similarly, Hyderabad and Chennai act as similar epicenters for southern states. It is not uncommon to see people coming from Bihar and West Bengal to AIIMS New Delhi for cardiac and pediatric surgeries.

Medical tourism within states 

people from far off districts commonly come to the hospitals in state capitals for surgeries and other modern medical treatment often not available in peripheral districts of a state. all highways coming to any capital cities have clusters of private hospitals in the periphery of city limits , most of which primarily cater to peripheral patients only.

Specialty destinations of medical tourism.

The movement also follows a trend in the form of the destinations becoming popular for certain types of specialized medical care. Isreal is popular for in-vitro fertilization, Thailand for sex reassignment surgery, and India for bariatric surgery and cancer treatments. For cosmetic surgery, popular destinations are Argentina, Brazil, Costa Rica, Cuba, Ecuador, Mexico, Turkey, Thailand, and Ukraine. In India, we all know that Chennai, New Delhi, and Hyderabad are very popular destinations for Eye surgeries. Similarly, New Delhi and Bangalore are for cardiac surgeries. This pattern of specialty destinations could also be witnessed at the state level as well.

Shri Sadguru Seva Sangh Trust, a charity hospital located at a small town named Chitrakoot, in Madhya Pradesh, India is known to operate 1,43724 cataract patients in the year 2015-16. It attracts a lot of patients from many adjoining districts of Uttar Pradesh and Madhya Pradesh and Rajasthan. Similar examples can also be seen elsewhere in the country.

Reasons for Migration Of Patients

Cost of treatment of medical tourism.

Probably the most important reason for international medical tourism is the difference in the cost of the treatment for a similar or comparable quality. It is well known that the cost of treatment is very high in US. It is often higher than the combined cost of traveling and receiving medical care abroad. For example, hip replacement surgery costs $40,000 to $65,000 in the USA, whereas it costs about $8,000 to $18,000, abroad, which includes traveling expenses. This is the main reason why patients come to countries like India and South East Asian countries. The comparable prices in India usually vary from 0.25 to one 0.1 of the price of a similar medical procedure in the USA.

Quality of services in medical tourism.

Many of the specialized medical centers which are popular among patients have developed state-of-the-art facilities that use cutting edge technology and equipment. The doctors in these facilities are trained in good institutions and have excellent skills because of large patient inflow. Bumrungrad International Hospital has 39 speciality sub centre and provide services using cutting technologies like Robotic assisted spine surgery. Shri Sadguru Seva Sangh Trust, has fully developed sub specialties of eye and has Operation Theater Complex having 25 modular OT and a LASIK LASER suite.

Patient’s affordability in medical tourism

The number of American people seeking treatment abroad is increasing because 1 out of six American is uninsured and there are many medical conditions which are not covered by medical insurance. It is these types of people who make the bulk of those who travel abroad for treatment and hospitals like Bumrungrad International Hospital offers a good bargain. Shri Sadguru Seva Sangh Trust, offers services to the poor people living in the adjoining area, and most of the surgeries are done free of cost. Even those opting for the paid services, the rates are very affordable.

Superior brand value in medical tourism

The majority of foreign patients come to hospitals that have a great reputation in their field. Bumrungrad International Hospital is the first hospital in Asia to be accredited by the American-based Joint Commission International (JCI), one of the groups providing international healthcare accreditation services. For three consecutive years, from 2004 to 2006, it was featured on CBS’s 60 Minutes and NBC’s Today Show as a leader in medical tourism and international hospitals. Among the patients which receive the treatment there, Shri Sadguru Seva Sangh Trust enjoys the reputation second to none. The Lion Club International Humanitarian Award, 1993 is to name a one, the actual list is a page long. Former president of India, A P J Abdul Kalam has written a testimonial of their mission.

Patient care in medical tourism

At Bumrungrad International Hospital they take care of each and every possible issue one can face if one is traveling to another place for treatment. That includes, food, language, stay before and after the hospital, finance, insurance, airport transfer, etc. If their website is to be believed they provide cultural support services in as many as 18 languages. Shri Sadguru Seva Sangh Trust provides free cataract surgical services through eye camps. Obviously the services may not actually match a corporate hospital, but it includes transport to and fro from the home, lodging and boarding, food, surgery, and post-operative medication. Even those opting for the paid services, the patient has to arrange his/her own transport and pay for the surgery and treatment, which very much subsides. Services are appreciated by all.

Connectivity and outreach in medical tourism

 Bumrungrad International Hospital has its international offices in 22 countries across the world, even in Iraq and Pakistan. The website of the hospital is comparable to amazon.com in functionality and details. Thailand is a major international tourist destination, which gives it an additional advantage. Shri Sadguru Seva Sangh Trust has a simple but functional website which provides all the relevant information. One can have an online appointment. It even provides a contact number for patients to contact in an emergency, something amazing for a charity eye hospital. They have 26 visions Centre, in 12 adjoining districts which is the main drainage area for the hospital. Plus it organizes 1500-2000 free screening eye camps to identify patients. Chitrakoot is an important religious tourist destination for the adjoining Hindu population.

Lesson from medical tourism.

These migration patterns and underlying reasons offer insight into the way the health services delivery models should be planned. With increasing internet penetration, increasing disposable income, decreasing travel costs, and free information flow, the physical proximity of the services is not the actual criteria on which a patient accesses a health facility. This seems to be more valid in the case of the public-funded health care facilities. The majority of investment goes into the construction of facilities, manpower hiring, and equipment purchase. The intangible qualities like patient care, connectivity, outreach, and brand building are often ignored. I could not find a single government-funded hospital in UP, in the list of NABH accredited hospitals. It is uncommon to see government hospitals having a functional website. If at all there are one, it mostly displays the achievements of the office bearers rather than the services and contact details. It is very difficult to locate the facilities, services, and service providers as most of the government hospitals do not have anything like a patient reception and information system. The patient’s care is unsatisfactory. All these services and accreditation do warrant additional financial resources. These facilities continue to be underutilized in spite of significant budgetary outlay. Facilities lacking a result-oriented corporate work environment could not deliver the services demanded by the patients. Health care is very labor-intensive, is difficult to manage in a government setting because of administrative inertia.

A health facility is rated not by what it has, but by what it delivers.

What are the issues I failed to identify? Please share your views in the comments below.