India's medical tourism needs a tonic

The number of Americans going abroad for treatment was set to reach 6 millon next year.

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Dr Ramakanta Panda, India's most famous heart surgeon, has just finished operating on one of the 400 international patients his Asian Heart Institute treats each year. Upstairs in one of the hospital's comfortable suites is the next in line, a senior business figure from Kenya, in for a bypass operation.

"We see a lot of government ministers and senior businessmen, from Africa and the Middle East - we will consult at least four or five patients daily, out of which we will operate on about one," Dr Panda says during a rushed break from the operating theatre. His institute, a modern building in the middle of Mumbai's new financial district, looks more like one of the investment banks nearby than a traditional hospital. It has been accredited by Joint Commission International for three years, meaning it more than matches standards at hospitals in the US or Europe.

When the Indian prime minister Manmohan Singh needed a heart bypass in January, it was Dr Panda who was flown to Delhi. Few hospitals in India could be better positioned for the surge in medical tourism business that consultants Deloitte said last year was expected to come from the US. According to the Deloitte study, the number of Americans going abroad for treatment was set to double from 75,000 last year to 150,000 this year, before zooming to 6 millon next year.

With a heart bypass costing up to US$80,000 (Dh293,840) in the US and as little as $10,000 in India, according to McKinsey, the economics are obvious. But if Deloitte's surge in treatment is actually happening, Dr Panda has not yet seen it. "Actual treatment, we probably do not do more than two or three American or European inpatients in a month," he estimates. "Health is something people are very scared to outsource. It's very easy to outsource IT Services, but outsourcing life seems very dangerous."

Sudarshan Mazumdar, the marketing director at Fortis Healthcare, India's second-largest hospital chain, is similarly circumspect about the long anticipated surge in American and European patients. "A lot of African countries or Middle East countries who used to look at London and the US are now looking more and more towards India. That's going to keep on happening. What isn't happening is Canada, Australia, US and Europe - that belt hasn't happened at all."

Estimates of the scale of medical outsourcing vary wildly. Within months of last year's Deloitte study, a study by McKinsey, using a tighter definition, put the number of medical tourists worldwide at just 60,000 to 80,000 a year, a tenth of Deloitte's estimate for the US alone. McKinsey estimated the US provided just 10 per cent of medical tourists. The number of medical tourists coming to India is similarly uncertain. At the Association of Indian Chambers of Commerce's medical tourism conference in January, a presentation from India's Institute for Clinical Research said India had treated 300,000 medical tourists back in 2006.

Another, citing McKinsey, said it had only received 150,000 as of last year. But seeing as Wockhardt, the Indian hospital group that has most enthusiastically targeted medical tourism, only treated 3,500 foreign patients last year - of which about half came from the US and Europe - the McKinsey figure seems more likely. Wockhardt expects the number of foreign patients to rise by 38 per cent this year. But that will still leave it a fraction of the company's 55,000 to 60,000 domestic patients. Revenues at Wockhardt's biggest rival, Apollo Hospitals, are similarly dominated by domestic business.

Predictions of a $2 billion industry by 2012, which McKinsey made back in 2004, also look a long way off. Apollo estimates that medical tourism totalled $330 million to India last year. Vishal Bali, the chief executive of Wockhardt Hospitals, one of the few Indian hospital groups to push hard for international business, believes that the long awaited take-off is finally here. "A lot of work had happened from 2004 to 2007, and that is beginning to show very positive results."

What could make this happen is if large US companies and insurance companies incorporated a medical tourism option. Apollo Hospitals in January signed a deal with the US insurer Anthem Well Point under which some of its customers would be sent to India for certain procedures. And Wockhardt has treated 12 employees of a US company in India, according to Mr Bali. A few insurers, such as the Pan-American Life subsidiary USNow, already offer overseas treatment options.

Dr Panda is in talks with two separate US insurers over new packages where customers would be offered a choice: either pay 30 per cent of the bill and have the operation in a US hospital, or do it at his clinic and be offered a cash rebate of up to $10,000. Even with flights and hotels thrown in, the insurer would still make a saving. India's hospitals are also signing deals with US and European medical tourism companies.

Prospects of the Indian industry depend partly on US President Barack Obama's new healthcare plan, although few Indian companies expect a new plan that will hurt the competitiveness of their hospitals. And while medical tourism has clearly not yet become the multibillion-dollar business as predicted, no one doubts that it one day will. "As soon as things settle down, in six months to one year, we will see a great change in this business," says Dr Panda. "Once a critical number of people get treated, then the floodgates are going to open out."