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LETTER TO EDITOR  
Year : 2013  |  Volume : 38  |  Issue : 1  |  Page : 59-61
 

"All is not well" with medical tourism


Department of Community Medicine, VCSGGMS and RI, Srinagar-Garhwal (Uttrakhand), India

Date of Web Publication31-Jan-2013

Correspondence Address:
Rajesh Garg
Department of Community Medicine, VCSGGMS and RI, Srinagar-Garhwal (Uttrakhand)
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-0218.106631

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How to cite this article:
Garg R. "All is not well" with medical tourism. Indian J Community Med 2013;38:59-61

How to cite this URL:
Garg R. "All is not well" with medical tourism. Indian J Community Med [serial online] 2013 [cited 2019 Sep 22];38:59-61. Available from: http://www.ijcm.org.in/text.asp?2013/38/1/59/106631


Sir,

The article by Jose and Sachdeva titled "Keeping an eye on future: Medical tourism" makes an interesting reading regarding the current and future aspects of medical tourism in India. [1] It covers the bright prospects of medical tourism in terms of economic gain. Indeed, India's medical tourism sector is a growing source of foreign exchange as well as reputation and good will in other countries. A widerange of services is being offered by the Indian hospitals under medical tourism. The Ministry of Tourism, Government of India, in its brochures advertised cardiac surgery, minimally invasive surgery, oncology services, orthopedics and joint replacement and holistic health care as few of the quality facilities available. [2] The availability of modern assisted reproductive technology (ART) services has made India the preferred choice for infertility treatments.

The quality medical services provided by speciality hospitals with world class infrastructure at a reduced cost attract the patients world wide.The cost of medical services in India is almost 30% lower than that in Western countries, and the cheapest is South-east Asia. The cost of infertility treatments in India is almost 1/4 th of that in developed nations. India is not only cheaper but the waiting time is also very short for foreigners. This is due to the availability of the private corporate sector, which comprises of hospitals and clinics with the latest technology and adequate skilled manpower. Language is a major comfort factor that invites so many foreign tourists to visit India for medical and health tourism. India has a large populace of good English-speaking doctors, guides and medical staff. This makes it easier for foreigners to relate well to Indian doctors. [3] Apart from this, Ayurveda, Yoga and Naturopathy have been a great patient puller across the world and, in fact, have given a new identity to Indian medical tourism. India hosts medical tourists not only from industrialized countries, such as the United Kingdom and the United States, but also from its neighboring countries such as Bangladesh, China and Pakistan. [2] In 2007, India treated 450,000 foreign patients, ranking it second in medical tourism. [4] The government has also created a special medical visa that lasts up to 1 year to make it easier for patients to enter the country. [5]

As per the estimates by the Associated Chambers of Commerce and Industry of India (ASSCHOM), India's medical tourism sector is expected to grow at an annual rate of 30% to become a Rs 9500 crore industry by 2015. [6] The Confederation of Indian Industry (CII) predicts that India will see revenues of US $ 2 billion from medical tourism by 2012. [5] This success has been made possible by government support. The National Health Policy 2002 strongly encourages medical facilities to provide services to users from the overseas. [7]

After introduction of the National Rural Health Mission (NRHM) since 2005, a lot of work has been done to increase the health infrastructure and improve the health indicators. Up to the year 2010, a total of 9144 subcenters were constructed newly and 8997 were renovated under the NRHM. Similarly, 1009 and 2081 Primary Health Centres (PHCs) were constructed newly and renovated, respectively. About 4.5 lakh Village Health and Sanitation Committees (VHSC) were created along with 29, 223 Rogi Kalyan Samitis (RKS) under NRHM. To decrease maternal morbidity and mortality and promote institutional deliveries, around 86.22 lakh women were covered under the Janani Suraksha Yojana (JSY) in 2008-9. The maternal mortality ratio (MMR) decreased to 212 in 2007-9 after the introduction of the NRHM. On the family welfare front, the total fertility rate (TFR) decreased from 2.9 in 2005 to 2.6 in 2008. To provide health care to remote areas, 1031 mobile units were operationalised under the NRHM till 2010. As per the National Health Accounts of the Ministry of Health, there was an increase on health sector expenditure from 0.4% of GDP in 2004-5 to 1.1% in 2008-9. [8] All these achievements point toward the changing face of the Indian health care delivery system. These achievements aid the country to leap ahead for a world class health infrastructure in the near future and even earn dollars from it by promoting medical tourism.

But, there are some important issues and concerns related to medical tourism that have not been discussed by Jose and Sachdeva. With the passing times, India now has two types of prominent health care systems-a private/corporate segment and a public sector segment, the former concentrating on high-level technology and services that seldom address broader public health issues and commitments of the government. [9] The public health system has been deteriorated to such an extent that it will be injustice to expect something from it. The country has created such a system where those who need less but can pay more are served at the expense of the poor and more deserving. [10]

According to the National Family Health Survey-III (NFHS-III), in India, the private medical sector remains the primary source of health care for the majority of households in both urban areas (70%) and rural areas (63%). [11] The out-of-pocket expenses for treatment pull millions of people into the below poverty line (BPL) category. An estimated 3.3% of the population is estimated to be getting pushed into BPL category on account of medical treatment every year. [12] More than 40% of patients admitted to hospitals borrow money or sell assets, and 25% of peasant families with a member needing in-patient care are driven BPL. [13]

The authors (Jose and Sachdeva) observed in their article that "no waiting time for surgeries" in India as compared with surgeries in well-developed countries as one of the important reasons for increase in medical tourism. But, this is in sharp contrast to the report by NFHS-III, which says that in India, one-quarter of households reported too long waiting times at government facilities as the third most common reason for not using public health services. [11] On the issue of reversing the external brain drain, there are fears, however, that medical tourism could worsen the internal brain drain and lure professionals from the public sector and rural areas to take jobs in urban corporate and private hospitals. [2] This will further aggravate the situation as more and more experienced and qualified eminent doctors would be lured by the corporate sector. This will lead to an acute shortage of good doctors in public health institutions. Along with that, the country would also be deprived of the services of these doctors to teach and prepare good quality medical students.

India is moving not only to western countries but also to the African world for attracting medical tourists. The Indian government is vigorously promoting medical tourism by providing tax concessions. [7] The government is putting red carpets for the foreigners lured by their dollars. Medical tourism is the mockery of that nation (India) that is still having one of the worst health indicators in the world, maximum number of malnourished children and maximum privatized health care delivery system in the world. On one hand, medical tourism is being promoted by newer concepts like surrogate mothers and on the other hand, diarrhea and pneumonia are still killing millions of children in our country every year. How can any one bring new children in the world by use of new technology and let the already born children die of minor treatable and preventable diseases? On one side, we have an ordinary unknown person named Rambhor, a poor rickshaw puller in Delhi, who died on 30 November 2010 because of want of treatment for his injuries in emergency departments of three big hospitals in the national capital and on the other side, we are promoting cosmetic surgeries and wellness therapies to others. [14]

It just indicates the intellectual and ethical bankruptcy of the system. The private/corporate hospitals refuses to treat the poor common man of this country in spite of being legally obliged to do so as they have been given lot of subsidies for running their " showrooms of health" by the tax payer money. Moreover, reserving a few beds for the poor in elite institutions does not address the problem of lack of quality a public health system. [7] Therefore, strict provisions would be needed to collect extra revenue from these corporate hospitals and use that money for rejuvenating the public health system. Lessons can be learnt from countries like Cuba, which has been a pioneer in medical tourism for almost four decades. It has hospitals for Cuban residents and others for foreigners and diplomats. Both kinds are managed by the government. Cubans receive free healthcare for life while foreigners have to pay for it. The Cuban government has developed medical tourism to generate income that is utilized to provide better facilities to its citizens. [7] It is time we set our priorities right and move ahead for universalization of quality and affordable health care services for our "aam aadmi"(common citizen) too.

 
   References Top

1.Jose R, Sachdeva S. Keeping an eye on future: Medical tourism. Indian J Community Med 2010;35:376-8.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Chinai R, Goswami R. Medical visas mark growth of Indian medical tourism.Bull World Health Organ 2007;85:164-5.  Back to cited text no. 2
[PUBMED]    
3.Government of India. National portal of india. medical tourism. Available from: http://india.gov.in/overseas/visit_india/medical_india.php [Last assessed on 2011 Sep 18]  Back to cited text no. 3
    
4.India-opportunities: A guide to do business in India. Health care.Embassy of India in Madrid. Available from: http://www.india-opportunities.es/healthcare.php?lang=ing and sub=tourism [Last assessed on 2011 Sep 21].  Back to cited text no. 4
    
5.Shetty P. Medical tourism booms in India, but at what cost? Lancet 2010;376:671-2.  Back to cited text no. 5
[PUBMED]    
6.The Economic Times. Indian medical tourism to touch Rs 9,500 cr by 2015: Assocham. New Delhi, 6 Jan, 2009. Available from: http://economictimes.indiatimes.com/Indian_medical_tourism_to_touch_Rs_9500_cr_by_2015_Assocham/articleshow/3943611.cms [Last assessed on 2011 Sep 18].  Back to cited text no. 6
    
7.Sen Gupta A. Medical tourism in India: winners and losers. Indian J Med Ethics 2008;5:4-5.  Back to cited text no. 7
[PUBMED]    
8.National Rural Health Mission. Meeting People′s health needs in Partnership with states. The journey so far.2005-10.Ministry of Health and Family Welfare, Government of India.New Delhi. 2010. Available from: http://mohfw.nic.in/NRHM/Documents/5_Years_NRHM_Final.pdf [Last assessed on 2011 Dec 20].  Back to cited text no. 8
    
9.Hazarika I. Medical tourism: its potential impact on the health workforce and health systems in India. Health Policy Plan 2010;25:248-51.  Back to cited text no. 9
[PUBMED]    
10.Chanda R. Trade in health services. Bulletin of the World Health Organization 2002;80:158-163. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2567734/pdf/11953795.pdf [Last assessed on 2011 Sep 21].  Back to cited text no. 10
    
11.National Family Health Survey (NFHS-III) 2005-06. Morbidity and Health care. International Institute for Population Sciences, Mumbai, India and ORC Macro International. Government of India. 2007;1:436-8.  Back to cited text no. 11
    
12.Report of the National Commission on Macroeconomics and Health. Conclusions and Recommendations. Ministry of Health and Family Welfare, Government of India: New Delhi; 2005. p. 125.  Back to cited text no. 12
    
13.Devraj R. Hunger haunts hospitals in India. One World South Asia: New Delhi. 04; 2010.Available from: http://southasia.oneworld.net/todaysheadlines/hunger-haunts-hospitals-in-india [Last assessed on 2011 Sep 21].  Back to cited text no. 13
    
14.Hindustan Times. Man dies as 3 hospitals refuse him treatment: New Delhi; 2010. Available from: http://www.hindustantimes.com/Man-dies-as-3-hospitals-refuse-him- treatment/Article1-632871.aspx [Last assessed on 2011 Sep 21].  Back to cited text no. 14
    




 

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