A recent report by Deloitte Center for Health Solutions on medical tourism points out that health care costs in the US are increasing at 8 per cent per year thus eating into corporate profits and household disposable income. It also says with a growing number of healthcare facilities in other countries now accredited by Joint Commission International (JCI), perceptions about quality have undergone a radical shift. According to Deloitte’s report, two in five respondents surveyed said they would be interested in pursuing treatment abroad if quality was comparable and the savings were 50 per cent or more.

In Nov -2008 Wellpoint, the largest health benefits company in the US, announced a new international medical tourism product aimed at helping recession-struck American corporates cut their healthcare costs. The significant thing about this product is that members can opt for elective (non urgent and done by patient’s choice) procedures at healthcare facilities in India. Serigraph Inc., a Wisconsin-based specialty printer will become the first company to participate in Wellpoint’s pilot programme that kicks off in January 2009. Its employees have the choice of being treated at two Apollo group Hospitals, in Bangalore and New Delhi.

Another significant event last month(Nov-2008) was a tie-up between South Carolina-based Companion Global Healthcare, a medical travel facilitator, with Wockhardt Hospitals in Bangalore and Mumbai. The tie-up is noteworthy, as Vishal Bali, CEO of Wockhardt Hospitals, explains. Those insured with BlueCross BluesShield (one of the largest health insurer in the US), who are tied up with Companion Global Healthcare, can now exercise an option of getting treated at Wockhardt Hospitals.

Suddenly a whole new untapped market has opened up for Indian hospitals seeking to attract patients from the US — that of insured patients. Till now, corporate hospitals in India were pegging the opportunity size of patients from the US at 45 million uninsured individuals, or underinsured individuals. But now given the recessionary climate, and moves by US corporates to cut costs by outsourcing treatment overseas, India expects to be a key beneficiary. Pradeep Thukral, head of international marketing at Apollo Hospital, now estimates the opportunity size to have enlarged to at least 65 million Americans.

Worker healthcare costs are enormous for US companies and in fact, have been cited as one of the biggest reasons why American automakers, which are seeking $34 billion from the federal government, are in such trouble. Take General Motors, which has 479,000 retirees, who get an average pension of over $40,000 a year — together these retirees health insurance costs work out to about $5 billion a year. Now add to that the healthcare costs of serving employees, and it spells big expense for firms like GM. Obviously, then companies in other sectors are quickly exploring alternative options to cut healthcare costs before they join the troubled league of the automakers.

Rajesh Rao, CEO, of IndUShealth, a North Carolina-based company that facilitates medical travel of American patients to Indian hospitals, estimates that a company with 1,000 employees typically can hope to cut its healthcare costs by half a million dollars every year by outsourcing treatment options for its employees to India. Rao should know because even before the Serigraph announcement made headlines across the US, he has been helping American corporates send employees to India. Today, Rao, has at least 12 mid-sized employers availing his corporate programme (translating into 40,000-50,000 subscribers) and he says he has been tripling his volumes year on year since he started in 2005, when it was just a trickle.

As Rao points out the burgeoning healthcare costs have forced companies in the US to look at alternative options. “Out-of-pocket expenses have shot up phenomenally,” he says.

Even if you include airfare costs of a patient plus a companion, and accommodation costs in India, the cost of getting treated in India is significantly lower. For instance, US News & World Report, in its 12 May 2008 issue lists the cost of a coronary artery bypass surgery in a US hospital as anywhere between $70,000-133,000 whereas in India this same procedure would cost $7,000. Obviously even if you include airfare, accommodation, still there will be huge savings.

There is good news for medical tourists! Most insurers retreat when it comes to covering medical procedures performed overseas, but times are changing as some insurers are exploring the option.

Twenty years ago, an American needing knee surgery probably wouldn’t think of jetting off to India for the operation. But times keep changing, health insurance costs keep rising, and Kumar Jagadeesan can cite a statistic that has led many patients to jump aboard a plane.

“A knee surgery operation in the U.S. can cost $45,000 to $50,000,” says Jagadeesan, the vice-president and CEO of Star Hospitals.net, a medical travel company. “In India, the cost would be $10,000, plus the price of a plane ticket,” which could be as little as $1,330 for a round-trip.

Star Hospitals.net is one of several medical travel companies advertising inexpensive services where patients fly to India, Thailand, the Philippines, and other countries to have surgery. With a few notable exceptions, however, insurance companies aren’t eager to cover these trips, even while they acknowledge the cost savings may be great. So for now, most patients must put up their own cash or put down a credit card.

Worries About Credentials

Why are insurers reluctant to send policyholders overseas? “One of the biggest issues is credentialing claims,” says Scott Edelstein, a lawyer with the global law firm Squire, Sanders & Dempsey. “They have to take reasonable measures that the providers overseas have the credentials to provide adequate care.”

Most medical travel companies, including Star Hospitals, currently rely on the Joint Commission International (JCI), an American nonprofit that accredits hospitals in the U.S., to help find suitable medical centers overseas. Lately the number of international hospitals getting the thumbs-up from the JCI has been growing. “There is great potential for growth, which is being driven by the build out of high quality hospitals on the global scene,” says Josef Woodman, the author of Patients Without Borders. Kenneth A. Powers, the JCI’s media relation’s manager, said that in 2005, there were just 76 JCI-accredited hospitals. Now there are more than 220.

JCI accreditation will probably help insurers overcome fears of getting sued by injured patients. But there are other issues to worry about. The insurers “have to make sure there will be smooth claims processing,” says Woodman. And, he says, there are concerns about continuity of care. “What happens when the patient comes back? Even if there are no complications with a procedure, how much is the insurance company willing to cover for physical therapy back in the U.S.?”

Few Legal Options

Despite these lingering issues, a few insurers have been bold enough to dip their toes into medical tourism in the past year. In March 2008, Blue Cross & Blue Shield of South Carolina signed alliances with seven overseas hospitals (BusinessWeek, 03/13/08). And more insurers are in talks with medical tourism companies, attests Rudy Rupak, founder of the medical travel agency Planet Hospital. “Right now we’re having active discussions with insurance companies about adding us to their plan design,” he says.

Getting more insurers involved might help ease patients’ reluctance to fly to another country for a procedure. But lack of coverage is not the only deal-breaker. “What happens if there’s an adverse effect?” asks Edelstein. “Will they have any recourse? That’s a very hot area in the legal arena. For the most part, those patients are not going to have much recourse in the U.S.”

Nor will patients have many legal options in the country where they had the operation. “Access to the court system in countries like India is not as good as in the U.S.,” Edelstein adds. “And even if you do get a trial, the judgments tend to be much lower than they would be in the U.S.”"

Nevertheless, Woodman and others are optimistic about the changing world of medical tourism and the role of health insurers. “When you think of medical tourism 20 years ago, you picture the Beverly Hills crowd of upper-crust men and women going to Brazil for a procedure and coming back home to brag about it,” says Woodman. “The profile has changed. It’s becoming a middle-class and working-class phenomenon, where folks are being driven to seek cost-effective alternatives.”

Much before the credit crisis rocked the American economy and the world, Michigan-based Jill Howard (name changed) made up her mind to visit India during the Christmas holidays this year for a joint replacement surgery. The 58-year-old engineer had planned her surgery in India, because she knew that the costs for the treatment would be much lower here compared to the US.

What ensued in the following months was an economic mayhem with the rising number of pink slips, sky-rocketing fuel prices, sinking stock markets and dimming sentiments. Everything, from food prices to air fares hit the roof.

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However, all this had no affect on Howard’s plans for her surgery in India. In fact, now she had all the more reasons to get the surgery done in India as a joint replacement surgery in the US would have cost her a stupendous $50,000 against only $8,000 in India.

“So even if I were to add the airline expenses, travel and stay, it would be cheaper to fly to India for the same treatment,” she said.

Like Howard, several medical industry experts, too, believe that it couldn’t be a better time to fly to India for medical reasons. In fact, many say that the recession was a boon in disguise for the country’s medical tourism sector. (Medical tourism refers to travel undertaken for medical care.)

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According to experts, the immediate impact of any recession was cost cutting and cost rationalisation. So, with the US being the hardest hit by the current crisis, efforts to reign in costs would be the strongest in that country.

According to financial advisory, audit and consulting firm Deloitte, in 2007, about 4,50,000 patients from abroad visited India for medical treatment.

Experts peg the growth of the country’s medical tourism at about 30-35% in the financial year 2008-2009.

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Vishal Bali, managing director of corporate hospital chain Wockhardt, said India has been getting about 3,000 patients from abroad every year. “And we see this rising by 35% this year.”

According to Ankur Bharti, consultant, Technopak Health, cost-cutting would be the main growth driver for the country’s medical tourism this year. “Cost-cutting would be the main reason why more international patients would come to India, especially from the US as medical costs are four to five times lesser here,” he said.

Anupam Sibal, group medical director, Apollo hospitals, said a bypass surgery in the US could cost about $75,000. The cost could be around $8,000-9000 in India.

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“A liver transplant in the US would cost around Rs 1.5 crore. In UK, the cost would be around Rs 80 lakh. However, in India, a liver transplant costs only about Rs 18-20 lakh for adults and Rs 12-15 lakh for children. Since the difference is so huge, I think patients will prefer flying down to India,” Sibal said.

Kumar Menon, specialist, medical informatics and telemedicine at Amrita Institute of Medical Sciences (AIMS) at Kochi in Kerala, said the medical tourism sector would remain constant and largely unaffected by the global economic turmoil.

“At AIMS, we specifically get a huge chunk of Malayalees settled abroad, especially in the Gulf region, coming home for medical treatment during the holidays. This trend would remain unaffected by the crisis.”

Industry professionals, however, warn that treatment involving cosmetic surgery, including areas like cosmetic dentistry, dermatological treatment and ayurvedic massages, will witness a decline.

Menon said the number of patients coming to India for those medical conditions that were not so intense and a treatment for which could wait, will see a decline.

However, areas such as cardiology, neurology, ophthalmology and oncology will continue to get more patients from abroad.

Face lifts and medical tourism: Top five questions answered

1) What is facelift surgery? Are the signs of aging in your face bothering you?

Then facelift surgery may be the right solution for you. A facelift is a surgical procedure to improve visible signs of aging in the face and neck and is technically known as rhytidectomy.

2) Who is the right aspirant for face-lift?

Facelift surgery is a good choice for you if:
• You have down to earth goals in mind to enhance your appearance.
• You are physically healthy and have an optimistic outlook.
• You don’t smoke. Finally you should not go for a facelift to fulfill someone else’s desires or to fit into someone else’s image.

3) Will non-surgical rejuvenation treatments achieve the same results as that of a facelift?

Non-surgical rejuvenation treatments cannot achieve the same results as that of a face lift surgery, but may help delay the time at which a facelift becomes appropriate and complement the results of surgery.

4) How Competent Is My Doctor? How Safe and Hygienic Is The Facility?

However, when traveling outside of your country for a face-lift it can be harder to verify the authenticity of the doctor, hospital and surgical methods. In some places, medical qualification standards are very different than they are in your country. There are many free services online to check out on the medical certification of your doctor such as the

• ASPS Member Surgeon Abroad program and Corresponding Members Service
• Doctors practicing outside the U.S. can be Board Certified by the American Board of Plastic Surgery or the Royal College of Physicians and Surgeons of Canada/UK.
• Most important of all, check out with your friends who had already undergone face-lifts or the family doctor about the quality of treatment offered.

5) How do you protect yourself from complications after surgery?

• Make sure you are medically insured in your own country.
• Research all potential complications before surgery with your family doctor.
• Maintain contacts with the hospital and the doctor from where you underwent surgery.

What is cosmetic surgery?

Cosmetic surgery is a unique surgery that is done to enhance the physical appearance of our body. Cosmetic surgery utilizes some of the state of the art techniques in corrective procedures.

Cosmetic surgery in India: Overview

Cosmetic surgery package offered in many premier hospitals in India have attracted medical tourists and the elite Indians, as it is affordable.

Use of radioactive isotopes in small doses and utilization of Gamma camera in the treatment packages have added new dimension to the medical tourism in India.

Benefits of Cosmetic Surgery:

• Cosmetic surgery is a safe and smart way to get rid of certain shortcomings in our appearance. This makes us feel confident and enables us to lead happier lives.

• Cosmetic surgery is especially of use to those born with abnormal features like crooked noses, harelips, cleft lips, and so on. Cosmetic surgeries give these people a new lease of life as they do not have to put up with nasty remarks and ridicule.

• Cosmetic surgery takes years off our faces and other body parts. It can tighten the skin texture leading to an overall younger look. This is essential for people in professions, which require a person to look a certain way such as flight attendants, client service executives, and the like.

• Cosmetic surgery is also useful for those who have been through fatal accidents that have left them with a disfigured appearance. Cosmetic surgery helps such patients look the way they used to look before the tragedy struck.

Where is cosmetic surgery done in a specialized way?

In India, Apollo Hospitals excels in drawing the maximum number of successful cases in Cosmetic Surgery. Plastic surgeons of Apollo Hospitals are also heavily involved in clinical research to find new and better methods of surgery. They also volunteer to give reconstructive aid around the world.

VM plastic surgery in Chandigarh

where Dr V D Singh and his team offer specialized services.

To be continued….

A few years ago one frequently heard of patients from the middle east coming to India for quality medical treatment, but of late there seem to be a lot of people from developed countries like the US, UK and Canada coming here.

At first health insurance was thought of as an expense and while that does seem to play a role in driving medical tourism to poorer countries…to my surprise I found out that there are other complex reasons…

Patients in Canada (Canada has a free government run health system, something which India can only dream of) have to wait even for an x-ray or an MRI!! I couldn’t quite believe it because here, even though we are a poorer nation, people can can get an MRI almost instantly, if they can afford it. And for an operation a Canadian might have to wait for about 18 weeks. As its free, everyone has to wait, money or not. However Canada’s dental health system runs on private insurance and patients generally get faster treatment.

The Americans feel their system is better because it runs on private health insurance. But its been exposed to some extent by Michael Moore’s documentary Sicko. The film shows how “middle-class families cannot afford medical care and profit-driven insurance giants go to extraordinary lengths to limit payments.” He has also detailed the number of people without insurance and partial insurance and also deaths due to delays in treatment or lack of treatment.

But this is the system that India is heading for! Private health insurance companies here are struggling to keep their head above water and are being finicky about payments. Seeing America’s plight, I wonder what the future holds for us. Right now industry analysts here are saying that once the system stabilizes and more people join the health schemes (few people can afford private health insurance in India) then the insurance companies will make money and everything will be all right.

Medical or Health tourism covers a wide spectrum of medical services and is the most popular form of vacationing today. Wellness and healthcare is blended with leisure, fun and relaxation through medical tourism. Medical tourism provides a ‘cost effective’ solution to off shore patients needing surgery and other specialized treatment. Medical tourism is being made accessible by the corporate sector involved in medical care as well as the tourism industry. The idea of a healthy holiday is to offer you an opportunity to get away from your daily mundane routine and get into a relaxing ambience. Medical tourism provides an avenue to enjoy the beach and the mountains and also improve your quality of life in terms of health and general well being. It is like rejuvenation on all levels – physical, mental and emotional. Let us now get into a specific area, which is in great demand in India!

Dental Care in India

There are several Dental Care packages available. However, solutions will be based on the requirements of the person and his holiday needs. There is a huge difference between the pricing (about 7/8 times when we speak of Top-end dentists in US and India for the same dental treatment procedures. Some of the facilities offered by the dental clinics are:

• Dental Scanning – Intra mouth
• Whitening of teeth
• Surgical Intervention under general anesthesia
• Prosthesis on the implant
• Vertical and horizontal bone grafting
• Ceramic caps without gold under microscopic control
• Palatal orthodontics
• Fluoride treatment for children
• Gum Grafting
• Over denture
• Combined prostheses with milling
• Maxillary surgery

(to be continued)

India is considered the leading country promoting medical tourism-and now it is moving into a new area of medical outsourcing,” where subcontractors provide services to the overburdened medical care systems in western countries.
India’s National Health Policy declares that treatment of foreign patients is legally an “export” and deemed “eligible for all fiscal incentives extended to export earnings.” Government and private sector studies in India estimate that medical tourism could bring between $1 billion and $2 billion US into the country by 2012. The reports estimate that medical tourism to India is growing by 30 per cent a year. India’s top-rated education system is not only churning out computer programmers and engineers, but an estimated 20,000 to 30,000 doctors and nurses each year.
The largest of the estimated half-dozen medical corporations in India serving medical tourists is Apollo Hospital Enterprises, which treated an estimated 60,000 patients between 2001 and spring 2004. It is Apollo that is aggressively moving into medical outsourcing. Apollo already provides overnight computer services for U.S. insurance companies and hospitals as well as working with big pharmaceutical corporations with drug trials. Dr. Prathap C. Reddy, the chairman of the company, began negotiations in the spring of 2004 with Britain’s National Health Service to work as a subcontractor, to do operations and medical tests for patients at a fraction of the cost in Britain for either government or private care.

Apollo’s business began to grow in the 1990s, with the deregulation of the Indian economy, which drastically cut the bureaucratic barriers to expansion and made it easier to import the most modern medical equipment. The first patients were Indian expatriates who returned home for treatment; major investment houses followed with money and then patients from Europe, the Middle East and Canada began to arrive. Apollo now has 37 hospitals, with about 7,000 beds. The company is in partnership in hospitals in Kuwait, Sri Lanka and Nigeria. Western patients usually get a package deal that includes flights, transfers, hotels, treatment and often a post-operative vacation. Apollo has also reacted to criticism by Indian politicians by expanding its services to India’s millions of poor. It has set aside free beds for those who can’t afford care, has set up a trust fund and is pioneering remote, satellite-linked telemedicine across India.