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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The Government’s Apathy to Healthcare in India

The Union budegt presented last month by the finance minister, Pranab Mukherjee, is hugely disappointing for the healthcare sector in the country. For many years now people associated with healthcare in the country have been waiting for big-ticket reforms in the sector, but the government has been turning a deaf ear. This year too, the story is no different.

The healthcare services in the country are not only woefully inadequate but also unevenly distributed. The healthcare industry, which is hugely dependent on private enterprise is just not attracting enough investments. Setting up and managing a hospital till it breaks even and makes money requires huge upfront investments. Presently, India has 860 beds for a million people, way below the WHO’s norm of  3960 beds for a million people. Studies by E&Y and KPMG have indicated that India needs to add 100000 beds per year for the next 20 years to reach close to this figure. This alone entails a spend of Rs. 50000 Cr. per annum. Compare this with what the government proposes to spend on healthcare in the next financial year, Rs. 22300 Cr. While this is 14% more than what the government spent last year, this amount is clearly insufficient.

The National Rural Health Mission, the flagship government programme for providing healthcare services in rural areas is riddled with inefficiencies. The government-run Primary Healthcare Centres are usually understaffed, ill-equipped and provide the most basic level of healthcare. Rural and semi urban India also needs good professionally managed secondary and tertiary care hospitals, which provide reasonably good quality healthcare at affordable rates. It seems that the government does not have the will power or the resources to usher in healthcare reforms.

Amazingly, the private sector entrepreneurs are willing to step in and bridge the gap.  All they need is a little help from the government in the form of tax holidays, duty reduction or abolition of duties on medical devices, easy availability of funding from government institutions at soft rates, longer payback periods and land at concessional rates. The government should also set up a regulatory body, a watchdog, which will keep an eye on hospitals being set up through this mechanism. The watchdog is critical as it will establish guidelines for setting up the hospitals, monitor progress, ensure quality through regular audits, lay down a fair pricing mechanism and in general ensure that the private sector, while availing of government policy benefits delivers on the promise of efficient, good quality and easily accessible care.

This is really not too difficult to achieve. Look at how private participation has revolutionized telecommunications in our country. Today India has more than half a billion mobile phone connections, the tariffs are the lowest in the world and even remote, far-flung and fairly inaccessible areas are connected (I had my phone working in the Nubra valley in Laddakh). The phones generally work, the services are efficient and the private sector companies, who had the foresight to start early are making profits. Some are even planning to go global and compete with the best in the world. The TRAI, which is the government watchdog is seen as an impartial and fairly efficient body, doing its job of advising the government on policy matters and ensuring compliance and a level playing field amongst all the operators.

No country can progress and aspire to be an economic superpower unless its citizens have access to good quality healthcare services. Considering India’s size and a population of over a billion people, (the majority living in rural areas), it is imperative that the government kick-start  reforms in this critical area sooner than later. If no significant policy initiatives have been announced this year, can the healthcare industry bodies (like those associated with CII and FICCI) lobby with the government, initiate debate and fuel informed discussion amongst all stake holders so that public opinion can be rallied in favour of these reforms.

Healthcare services impact the health of the nation. It is time all the healthcare stakeholders including the government sat together to prepare the blueprint for the next generation healthcare services for the country. This is very important because, unless we have robust, universally accessible, reasonably priced healthcare services for our citizens, all our claims about being an economic superpower will remain hollow and truly meaningless.

The Future of Medical Education in India – The Way to Go

rural medical collegesThe Union Health Minister Ghulam Nabi Azad appears to be busy shooting the breeze by announcing vague policy changes involving setting up of Medical Colleges through private capital and in collaboration with government run district hospitals. The minister who is well known for putting his foot in the mouth, recently announced at a FICCI conference that the government is considering relaxing the norms for setting up medical colleges by the private sector. He also announced that these colleges can be affiliated with the government owned district hospitals, thus doing away with the requirement of a teaching hospital to be attached with the medical college.

The minister is seeking private equity participation in rural, backward and far-flung areas of the country. He believes that the private players can be attracted to set up medical colleges in these parts of the country by offering concessions such as access to district hospitals.

Doesn’t this sound completely hare brained?   Continue reading