Learnings from the World Medical Tourism Congress

074Last month, I had the opportunity to represent Fortis Healthcare at the World Medical Tourism Congress, held at the Caesar’s Palace, in Las Vegas. The conference was organized by the World Medical Travel Association and had participants from across the world.

Here a few things that stuck me as relevant for a larger discussion.

Medical Travel is now such a huge global phenomenon that we had thousands of people assembling in the wonderful Vegas to discuss how to make sense out of all of this. The conference had the mammoth Caesar’s Palace full, with all rooms sold out. The conference was held simultaneously in multiple conference rooms across the hotel, with folks attending sessions that were of interest to them.

The Congress had various stakeholders in the Medical Travel arena coming on a single platform. These included hospitals, medical facilitators, insurance companies, third party administrators, health plan managers and benefit managers from large corporates interacting with each other. Since the conference was in the Us we had a large number of hospitals from the Latin American countries. These included hospitals from Mexico, Costa Rica, Colombia, Argentina and even the small Dominican Islands. Fortis and Apollo Hospitals were representing India, while we also had hospitals from Turkey, Thailand and even Poland setting up stalls in the display area of the conference.

The Medical Facilitators, whom I met were really from across the world. We had a fairly large number of these who are based in the US and are largely sending patients to Latin America. We also met facilitators from China, Kuwait, Ukraine, Uzbekistan, Colombia and Nigeria.

The US seems to be completely in the grip of Obamacare. The law has spawned a small industry of experts, each trying to interpret the complex law in their own way. many experts held forth on how the law was a great opportunity for reforming the healthcare environment in the US. Almost, everyone agreed that the present mess of huge costs and a very large population of the uninsured will certainly be addressed well by the law. There were a lot of doubts on the execution challenges confronting the law and with the health exchanges taking off, all kinds of plans were being bandied about. I believe the law will create new opportunities for medical travel and will open many doors for people to travel and save costs on their medical bills. The travel will probably be more domestic than international, but as time goes by the confusion will clear and this will turnout to be the game-changer in the US healthcare.

While representing an Indian hospital, I was very pleasantly surprised to see the immense goodwill Indian doctors enjoy in the US markets. Most people I met believed that the Indian doctors were the best. Many had seen them at work in their local hospitals and the doctors had apparently impressed with their knowledge, skills and compassion. The other things that stood out as a distinct advantage was the English language (of all things). many wondered at proficiency that we had in the Queen’s language. I sent silent prayers to Thomas McCaulay,who unknowingly and with a completely different intent had introduced the charms of the English language to the natives.

Strangely, while many whom I met were aware of the prowess of Indian doctors, they did not know too much about Indian hospitals. Several people had no idea as to who were the leading players in healthcare in India and what was the value proposition, apart from healthy outcomes. When, we shared our price list with the local facilitators, there were only gasps of complete surprise and disbelief. With a CABG in the US going for USD 105000, our price of USD 7500, was truly unbelievable.

I believe Indian Hospitals need to engage with the US market a lot more. They just don’t know much about us. The government of India and other industry chambers such as CII, FICCI etc. must help facilitate this dialogue. In the conference, many countries were actually represented by their trade bodies promoting Medical Travel and individual hospitals were represented under this broad umbrella.

Finally, my compliments to the organisers. They really put up a massive show, very well organized with clearly defined programs, relevant content and mostly expert speakers. I think we need to have more of these to happen, so that Medical Value Travel really takes off around the world.

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Where are the Healthcare Innovators?

When did you visit a hospital last and found a process, which made you sit up and take serious notice?

Hospitals in India are crying for serious innovations, yet we see so little of them. While, one keeps hearing about mind-boggling advances in medicine and technology, yet very little of that is reaching our hospitals. The largest and the most modern hospitals in India at best pay lip service to serious innovation. They do not even have innovation teams, which can identify and adopt innovative practices, which help cure faster, keep people healthy and provide a better customer experience at the hospital.

The reason for this are not far to seek.

Healthcare services in India are still in their infancy. While, large hospital chains like Fortis, Apollo and Max Healthcare have the latest equipment and the most sought after doctors, they are still not customer focussed. Innovations happen, when the customer is the focus of the organisation. Our healthcare services organisations are still mired in pandering to the egos of their senior doctors, guarding them like mother hen, lest they fly the coop. Since, there are only so many ‘star doctors’ and they are mostly responsible for pulling in the patients, one can not really fault the hospitals for focusing on their crown jewels rather than on patients. To make matters worse, most of these star doctors are older, quite often set in their ways, it is virtually impossible to make them innovate. They are wildly successful individuals, who have been at the top of their game for many years and see no reason to do things differently. Thus, in a Max Hospital in Delhi, you will have the younger doctors, using the Hospital Information System, the older and more senior ones, would still prefer a pen and paper, mindless of the fact that this means that every-time the patient comes to visit them, he would be carrying the past prescriptions and records in a file. And, this when Max has spent a fortune in putting in place a state of the art HIS!!!

The other driver of innovation is competition, which in the Indian context is sadly lacking. While, there are millions of mom and pop nursing homes and down the street clinics, good hospitals are few. With India growing close to 9%, many Indians can now afford good quality healthcare services. With health insurance also contributing its might, we have a situation, where there are too many patients chasing too few hospital beds. As the economy grows further and we see the benefits of our growth percolate down deeper, people would continue to move up from small and dodgy nursing homes to swanky, well organised hospitals. Thus, at the top end of the Indian healthcare market, serious competition is a long way off. This does not augur too well for healthcare innovations.

Health Insurance companies can drive serious healthcare innovations. They are always on the lookout of shaving costs and innovations often do that. However, in India, health insurance is still largely controlled by the state-owned general insurance behemoths, whose health insurance portfolio is a tiny fraction of the general insurance business that they handle. They themselves are riddled with inefficiency and corruption and can hardly be expected to drive healthcare innovations. The standalone health insurance companies in the private sector are still wobbly and are trying to find their feet. They too are quite clearly a long way off from driving innovations at our hospitals.

The only way we can possibly drive innovation in healthcare services in India is by becoming more demanding as patients. Impatient patients can bring about change in the delivery off at least the non medical services at our favourite hospitals. Thus, if a doctor is running late with his OPD appointments, patients can ask the hospitals to send sms’s in advance to patients, who are scheduled later in the day. If the hospital queuing system is inefficient, a patient can always suggest another system, which works better. (Check-out the new system at Max Medcentre in New Delhi, it is simple and efficient).

As far as bigger innovations are concerned, the hospitals and their various stakeholders have to drive those. Change inevitably brings pain in the shorter run, however those organisations, who have their eyes set on the horizon, cannot but embrace change. Even though, in India, the external circumstances may not be very conducive to innovations, we must remember, all great innovations are internally driven, largely rooted in a desire to be more efficient, more customer friendly, more differentiated and more profitable.

Indian hospitals must innovate to compete with themselves and to be better than what they were yesterday. That is the only way to long-term success.

Thank God we have Private Healthcare in India

Last week I came across a piece by Sopan Joshi in Tehelka. The story titled ‘No Place to be Sick’ (http://www.tehelka.com/story_main48.asp?filename=Ne050211coverstory.asp) appears to be a shallow piece intent on maligning private healthcare in India. Mr. Joshi’s central point ‘even if you could afford it, a private hospital may be the last place you would want to be in’ is completely flawed. While Mr. Joshi, cites a case of a cancer patient, who died at Max Hospital in New Delhi, after receiving chemotherapy, quotes the relatives and employers of the deceased, who believe that the hospital knowing well that the patient was unlikely to survive went ahead with chemotherapy and ran a bill of close to Rs. 8Lacs, which coincidentally was close to the insurance limit enjoyed by the patient. Basically Mr. Joshi is saying that Max Hospital unnecessarily treated a dying man because they wanted to make money.The hospital of course has denied the charge.

Now here is my point, who decides whether a patient should be treated or not? Isn’t it the job of his doctor to take this call? Isn’t the patient and his caregivers supposed to trust their doctors and if they do not trust the hospital or the doctor, isn’t it best that they find another doctor or a hospital for their treatment. In my many years in hospitals, I have seen patients and their attendants asking the doctors to do whatever they can to save a life of a loved one, they beg and plead that the doctors do something, anything to prolong a life. Now if the doctors, try something and the outcome turns out to be negative, how correct it is to say that the hospital deliberately over-treated just because it is a commercial enterprise and making money is in its DNA. Suppose in this particular case, had the doctor turned away the patient, wouldn’t that have left him open to the charge of not admitting and treating a seriously ill patient because no hospital wants a high mortality rate. From the hospital’s perspective this really is a catch 22 situation.

It is not my case that private healthcare services in India are perfect. They are not. However, by highlighting stray cases of wrong diagnosis and hospital borne infections, Mr Joshi can hardly make a sweeping conclusion that all private healthcare in India is driven by greed and little else. While, I would be the first to admit that there are many hospitals, who try to fleece patients it certainly does not mean that most private healthcare service providers are out to rob the patients blind. In fact corporate hospital chains like Max, Apollo and Fortis (to name a few) are trying hard to provide world-class healthcare services and while they are expensive by Indian standards, they still are amongst the cheapest in the world.

The problem with private healthcare in India is that it is completely amorphous and unregulated. While there is world class medical services being offered by some hospitals, there are millions of mom and pop shops, usually owned by a doctor and his family, which also provide healthcare services. These so-called nursing homes usually have very basic facilities and since they are completely unregulated, they get away literally with murder. This huge underbelly of private healthcare in India is the soft spot, which the government needs to fix immediately. To make matters worse, the average Indian consumer knows very little about his rights as a patient and is too overawed by the highly educated, English sprouting doctors to ask too many questions and ends up getting a raw deal. What we really need is a much more organised and accountable healthcare services.

Let us now look at what the government has to offer. In the city of Delhi, the government owns many hospitals, which are all large tertiary care centres. These are incredibly filthy, overcrowded (often two patients on a bed), stinking and staffed with callous government employees, who care two hoots about a patient. The doctors, while extremely competent, are under such a huge workload that its is just not humanly possible for them to provide good quality care to so many. My words may seem harsh, but the reality is much worse. Most people seeking care in the government-run hospitals use their ‘contacts’, with the powers that matter, to secure a bed and a surgery for themselves. In smaller towns and cities the situation is much worse, with the district hospitals being poorly equipped, saddled with obsolete equipment and with doctors who consider their responsibilities as punishment postings.

The solution really lies in a Public Private Partnership and increased regulation. We must have a healthcare services regulator (pretty much like the insurance or telecom regulator), who should lay down guidelines and rules for private and public hospitals and ensure that these are stringently followed. Hospitals outcomes, its systems and processes and its people must be periodically audited for quality. The regulator should be empowered to act without fear or favour to weed out the laggards and the unscrupulous.

And now to revert to Mr. Joshi again, let me ask a simple question,  God forbid if he or someone in his family needs a hospital, where will he go-to a private hospital or to a government-run public hospital? To me the answer is quite obvious, we need more Max, Fortis and the like.

 

 

Marketing Maternity Programs

maternity1Fortis La Femme, a boutique hospital for women is running a promotional campaign on a local radio station for their IVF program and the venerable Moolchand Hospital has launched ‘Mother’s Nest’ a maternity services program targeting would be parents. A full page advertisement announcing the new program was carried in HT City a few days ago.

Fortis La Femme, which was known as Cradles earlier was a brain child of Ratan Jalan, the CEO of Apollo Health and Lifestyle Ltd. (AHLL) who was my boss, when I headed marketing at AHLL. The Cradles was set up as a franchised operation and was later bought over by Fortis. It was conceived by Mr. Jalan as a high end birthing centre and has now been repositioned a s a hospital for women, with Maternity Services being one of the several service lines.

Moolchand Hospital has of course been a fixture in Delhi’s firmament for decades and is undergoing a complete makeover under the guidance of Shravan and Vibhu Talwar, the present owners. Both of them are well known to me.   Continue reading

Around the World For a Cure – The Big Opportunity in Medical Travel

Medical Tourism is a much reviled word, in many ways an oxymoron. Tourism is all about holidays to be enjoyed with family and friends, while ‘medical’ connotes ill health, hardly conducive to travel. Maybe Medical Travel might be a more appropriate word.That as it may, medical tourism has gained wide currency and captured the world’s attention.

It is viewed as the next big opportunity for countries like Thailand, Malaysia, India, Singapore in Asia and Costa Rica, Panama, The Bahamas and Peru in Latin America.

The reasons for Medical Travel are not difficult to understand.

People travel in search of good quality medical care. In the past business tycoons, politicians with ill gotten wealth, businessmen, aging filmstars and shaikhs from the Middle East would typically travel to foreign shores seeking high quality medical care. Most of them traveled from the lesser developed countries like Middle East, India and Latin America. The destination usually was the United States.   Continue reading