Medical Trafficking and Medical Value Travel are very Different

I was recently in Kenya and learnt about a new term called “medical trafficking”.

This came up in discussions with a member of the Kenyan parliament, who is also an eminent clinician of Indian origin. The MP is a prominent citizen of Kenya, owns a chain of hospitals and believes that what passes for medical travel in Kenya is mostly medical trafficking.

Well, I wouldn’t agree entirely but there is more than a grain of truth in what the lawmaker is talking about. Essentially, he defines medical trafficking as dubious agents persuading gullible and sometimes desperate Kenyan citizens looking for the medical treatment to countries like India. He believes that many of the problems for which the Kenyans are travelling can be treated in his own and other hospitals in Kenya. However, ordinary Kenyan citizens, when faced with a medical crisis are lured away by unscrupulous medical travel agents with promises of magical cures at jaw-dropping prices in faraway places. This is largely achieved through an unholy nexus between local clinicians, hospitals, medical travel agents and hospitals in India and other countries.

The Hon’ble MP believes that Kenyan government should take steps to prevent exploitation of Kenyan patients in this manner. He is sponsoring a private member’s bill in the Kenyan parliament, which will regulate medical travel from Kenya and allow only patients, who have serious medical conditions and for which treatment is currently not available in Kenya to travel abroad.

I believe this is good.

However, there are a few caveats.

More than restricting patient travel for better medical care, Kenya needs to invest a lot more in building capacity and appropriate skills enhancement in the medical centre. The hospitals in Kenya, while making progress are still far behind those in India and elsewhere. The government hospitals are overcrowded, filthy and struggling. The hospitals in the private sector, barring a few are at best secondary care centres equipped to handle only routine surgeries. There is an all-pervasive shortage of clinicians, nurses and para-medical staff. The problem is a lot more acute outside of Nairobi. Unless, Kenya bridges this gulf, patients will always seek to travel abroad in search of better care.

This cannot be done overnight. Building new hospitals and finding highly trained and experienced clinicians will take years. In the short run, some gains can be made through collaborations with foreign hospitals, who might be willing to share their expertise with local Kenyan hospitals. It might also be possible to import a team of highly trained clinicians and allied technicians to be able to work in Kenyan hospitals for short periods. This will help Kenyan patients get access to high-quality care closer home and the local clinicians will be able to learn while working together with foreign experts.

Sure enough, some clinical work, particularly for higher-end tertiary care specialities, may still not get done with-in Kenya. Patients for these conditions will still need to travel abroad. These patients must be guided through proper well-established medical travel operators governed by suitable rules and regulations. These need to be framed urgently.

The medical travel industry continues to be largely unorganized not only in Kenya but in almost all parts of the world. Small-time operators with very little understanding and knowledge of the patient’s needs or the capabilities of the hospitals that they are being referred to continue to thrive. This is the soft underbelly of medical travel that the Kenyan lawmaker referred to as ”medical trafficking”.  This, of course, needs to be rooted out. It will be possible only when well-established medical travel operators employing doctors and other experts come into play. The government of Kenya should establish guidelines on who can be a medical travel operator, give them incentives to set up their offices in Kenya and let them effectively collaborate with Kenyan Hospitals, the NHIF and other large public sector undertakings for patient referrals. Only authorized medical travel operators should be allowed to facilitate patients for treatment abroad.

Finally, I must make a point about patient choice. The fact that a particular treatment is available in Kenya should not mean that the patient must be treated in Kenya. This will be clearly wrong. Availability of treatment does not guarantee quality. If a patient prefers to go abroad for her own treatment, she must be allowed to do so. After all, it is a matter of her own health and if she has the necessary wherewithal to pay for the treatment at a place of her choice, she must be allowed to do so.

Medical Trafficking is a result of unorganized, mercenaries masquerading as medical travel operators being allowed to work unchecked in Kenya. It must be curbed through effective legislation. However, patients genuinely needing high-end medical care or those who wish to travel abroad for treatment must be allowed to do so. They should be guided to bonafide and licensed medical travel operators who may help them seek the best possible care anywhere in the world.

Medical Travel Must Come of Age

Medical Travel to India has now reached a certain level of maturity and business size and it has started getting serious attention from all manner of people. Back of the envelope calculations indicate that the opportunity today is approx. USD 500 mn and growing at least 30% or more pa. And these numbers are only the revenue that Indian Hospitals generate from patients traveling to India for medical treatment. Add to this the possible revenue from their stay in hotels in India and the airfare, we are perhaps staring at a business opportunity worth close to USD 1 bn today.

Strangely, for a business opportunity of this size, we still do not have organised players in the market. Almost all the patients traveling to India are being facilitated by small time medical travel operators, who make a commission in the process. Sadly most of these facilitators are completely unorganized, bring in patients through their personal contacts in places like Iraq and Nigeria and have very little resources to support or provide a vow experience to the patients. Many of them started as translators, who were hired by the hospitals as they received the first wave of foreign patients. They interacted with these hapless patients and earned their trust, branched off on their own and started getting patients referred by those who had come earlier.

While, these folks have so far done a reasonable job of patient facilitation, the time is ripe for the advent of the new generation of medical travel operators. These would in all likelihood be young entrepreneurs, tech-savvy and more in tune with the needs of our ”experiences” driven service economy. They would probably be initially supported by some of the larger Indian Hospitals, who would of course benefit immensely from foreign patients reaching their doors much better looked after. They would also hope to benefit from more patients coming through.

At Fortis Healthcare, which is India’s largest healthcare company and where I work, we are encouraging this trend. We would like to work with and support medical travel operators, who are professionally driven and are much better organised in joining us in sourcing international patients. We are identifying potential partners in various parts of the world and beginning to work with them in an effort to create a new and a different kind of eco-system. Hopefully, this would allow for a far better and a completely seamless experience to the patients who are traveling to us from all parts of the world.

I also believe that very soon we will have large travel operators also entering the business. The business case is so compelling that they can not really afford to stay out. Recent reports have indicated that Thomas Cook has decided to enter the market and I have had several discussions with Abercrombie and Kent, who are already setting up the medical travel infrastructure that they need, to roll out the business across multiple continents. They are exploring markets as far as Eastern Africa and Middle East where they are setting up information and patient facilitation centres to help connect patients to hospitals.

At the global level with medical travel destinations like Jordan and Turkey in Asia, Costa Rica and Panama in Central and Latin America, China and South Korea in the far East emerging as the new medical travel destinations (Thailand and India being there for several years now) the sky is really the limit. A global operator can easily facilitate patients into hospitals in any of these countries. Moreover, this would also provide their existing travel businesses a significant bump up as patients traveling to hospitals are usually accompanied by family and friends. Thus more air tickets and more hotel nights will directly contribute to their existing travel businesses.

Honestly, I have been quite baffled that large travel companies have so far not stepped in. My best guess is that they haven’t really looked upon medical travel as a large enough a business for them to get into. Medical travel in India has grown quietly. Not many people outside the healthcare industry, fully know about the extent of the business today even less about its potential. Also, they are is still a serious lack of awareness about the profile of medical travelers. Today we have patients in our hospitals at Fortis who have traveled thousands of miles and have come for extremely high-end medical procedures such as transplants and challenging paediatric cardiac surgeries.

Something in my bones tells me all this is about to end. Patients, should now be able to choose their hospitals and doctors anywhere in the world a lot more transparently, have their travel arrangements done professionally and receive the world’s finest medical care without the worries of a rickety and unreliable system which exists today.

Patients should be able to travel to their doctors and their hospitals a lot more sure about what they truly are getting into free of worries from everything except their medical condition.

‘Insurer Offers Option for Surgery in India’

 It has finally begun.

 A story in the New York Times last week, captioned ‘Insurer  Offers Option for Surgery in India’ caught my eye. Rewind to the summer of 2006, when I was in New  York trying to convince some of the leading health insurers to consider developing a  new low premium health insurance product for the huge numbers of uninsured in the US. Everybody I met heard me out patiently but was not willing to take the plunge. I tried hard but success eluded me. Some of my colleagues consoled me by saying that maybe I am ahead of the times.

Now it seems they were right. The New York Times report says that ‘the health insurer Wellpoint is testing a new program that gives covered patients the option of going to India for elective surgery, with no out of pocket medical costs and free travel for both the patient and a companion’.  

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.