Tonight, 60 Minutes showed medical tourists getting treatment at sleek new hospitals in Thailand and India. By showcasing ordinary Americans, the segment amounted to a giant infomercial for this practice. It’s especially salient given 60 Minutes’ demographic, older folks who are significant consumers of health care.
Download the video (49 MB; you need a BitTorrent downloader: Windows, Mac).
The Thai hospital they showed is designed like a hotel, with restaurants and boutique shops in the lobby. They also showed better treatment in India than in the U.S.: an advanced procedure, hip resurfacing, which is not yet available in the U.S.; a high ratio of nurses to patients; personal service; post-op recuperation at nearby resorts; and all for a tenth of the cost. A British medical tourist said that in the UK’s national health system, some women are pressured to leave the hospital just five hours after delivering a baby. In India there was no such pressure. On the flip side, the show noted that suing for malpractice in Indian courts is quite difficult.
The segment also interviewed Indian doctors returned from practicing in the U.S. who say they make only a tenth the money they used to make. One was quite earnest in wanting to help people: he said in the U.S., there are 1,500-2,000 pediatric cardiologists, but in India there were only four. I’ve also heard similar reasoning from eye surgeons.
The more video clips of modern India’s islands of quality are shown, the more respect desis in America will receive. Conversely, desi American doctors will face the same cost competition from India on high-end procedures that desi American programmers do now.
Manish I love your essay. I salute you sir! Fight the power!
All good, but I hope this doesn’t grow at the expense of deserving patients in India, and Thailand.
As a general rule,I would rather undergo any well established (>5 years old) medical procedure in India. You get real care, and doctors decide what type of treatment you should get instead of insurance companies.
Medical professionals in India are relatively unfettered by the fear of lawsuits, and are more willing to take calculated risks, unlike here. This is mostly good and helps keep the cost of medical care down, except that occasionally it leads to egregious errors.
A friend who got an expat assignment in South East Asia told me that he compared the survival rates for most major surgeries between the US and Asia, and that US hospitals always came out ahead. He attributed it to the better quality of equipment in US hospitals.
Well it depends pn the hospital too.
There are some hospitals which are reportedly “5 star” and have all the latest euiqpment and facilities. All you need to have is the money. An example is the Hinduja Hospital in Bombay.
I am extremely unsure if it is correct to say that there are only 4 pediatric cardiologists in India. With the world class Universities turning out highly specialized doctors that are extremely skilled? And also with the many people coming to India for medical help (and some mainly for that reason)? I asked Dr. Somshekhar Velury (a pediatrich cardiologist from Bhopal) and even he says that that number cannot be correct.
I agree that this type of media attention will garner more respect for doctors from India. Though I am not sure if it will make an impact. My family knew a cardiologist who taught at Oregon Health and Sciences University who felt the need to leave because he was not getting the respect he deserved. I was amazed that this could still happen, considering that an Indian heads the American Medical Association and some of the leading specialists in the nation are Indians (many of them trained in India). I guess all descrimination defies logic.
hmm… my personal experience with indian hospitals after sleeping/living in hospitals for around 2400hrs for my dads leukemia treatment (31/2 months in 3 different hospitals including jaslok hospital bombay which is supposed to be one of the best hospitals in india) Indian hospital services are horribly bad though they might be cheap compared to US.
nurses are poorely trained, they cannot even poke once well to do a regular blood test..at some place they poked my dad three or four times and left him with huge blood clots for a simple blood test. They donot wear gloves while doing injections or even while doing transfusions unless u force on them to wear gloves. They are incapable of doing even ordinary blood /platelet transfusions without dropping atleast 2 to 5ml of patients blood on the bed everytime. jaslok hospital nurses are a lil better but hyderabad hospitals are terribly bad and unhygenic.
doctors are irresponsible , they often give wrong medications as they are three days or four days behind in diagnosis and neglect patients symptoms ( I am in touch with US doctor friends who would just tell me whats wrong with my dad the minute they hear my fathers counts while indian doctors take 3 -4days to diagnose the same until the patient becomes seriously sick)
Indian Doctors still follow 30 yrs old technique ( like doctors in hyderabad still did bone marrow biopsy/aspiration from sternum near the heart which was banned in hospitals in US some 30 yrs back bec. its risky..
and most importantly doctors donot even read reports in the morning before they see patients. u need to look at reports urself and read on internet and try to make out what could be wrong…they donot turn up for emergencies until its too late..horribly bad ethics and morals. even in hospitals like jaslok where we got my dads treatment from a number 1 doctor in india for leukemia treatment, even his team was bad.
everyday I had to talk to doctors in US and read on internet and interpret my dads medical reports as the doctors are too sloppy here in india and donot bother to read reports well nor on the same day until the situation worsens, have no complete knowledge of the disease and have poor diagnosis skills. Doctors in india do not value patients lives as there is no good legal system in india to sue malpractising irresponsible doctors
And if anyone admits a patient in india, you need to be in the hospital 24hrs a day watching every medicine the doctors are giving and watching every nurse while they treat the patient and read every report urself personally.
Only good thing is these days hospitals serve good food following dieticians advice and according to patients wishes.
anyways I read an article in hindu newspaper too about the same but my personal experience after living in hospitals for four months at a stretch is be careful..its a scary system out here and is dangerous too though it might be cheap..
The hospitals profiled on 60 Minutes seem to cater to foreign patients. But while we may initially decry this catering to foreigners at the expense of many needy Indians, keep in mind that these foreign patients provide the money that many Indians simply do not have. So American patients are being overcharged by Indian standards, but this can help subsidize some health care for India’s poor.
Part of the problem is that while most Indians live in villages, most Indian doctors live in cities. In the U.S., you will find many foreign doctors in small towns, because the visa regime encourages foreign doctors to go to these underserved areas. Perhaps India can offer similar incentives for Indian doctors to serve the countryside.
Manish, Little India also had a feature on this, in this month’s issue…
It is heartening to see people from all over the world flocking to India for medical care – the rich Pakistanis I have met here tell me of the time when they used to fly specialists in from Bombay – and you do hear of the people from Bangladesh, Pakistan, Iraq, and Palestine flying in. But what is being provided is surgery only one link in the chain of health and wellness care. Arogya as defined by the ancients is being free of disease and not only a surgical procedure. On that count India has a very long way to go. With embarassingly high rates of infant mortality, maternal morbidity, maternal undernourishment and chidhood undernourishment (the big four problems) Indians (me included) shd be cautious about such glowing accounts on CBS. It is not that health indicators aren’t improving and in several states it is possible to find enclaves where despite low per capita income the big four indicators are quite good. But for every good enclave there are several troubled ones. Take TamilNadu headed by a woman CM – contrast the miserable female foeticide and infanticide practice of Salem vs. the improving picture of health around Madurai, Coimbatore/Erode and Tiruchi/Tanjavur. Take Punjab as a whole and contrast the robust health indicators with the abysmal gender ratio. Or even Kerala where the contrast between Idukki and the rest of State is sharp. Afew years ago in Madras our Ironing Service Provider’s (yes you have a push cart Iron/Istriwallah on your street who presses your clothes anytime between 1000 to 1900hrs, 7 days a week) pregnant daughter was found to be carrying a breech baby (foetus carried feet down/head up). The Primary Health Care center around the corner from our street was found to be too risky for the delivery for certain reasons. So she approached a private ObGyn (as most people in India end up doing) who demanded a princely sum for the procedure – so we had this poor girl’s mother having to ask her customers to pitch in. I am sure at the same time some patiens from Europe and the US must have been planning to make their medical visits to India. I am not criticising anybody here. The private healthcare sector exists in India as it fulfils a legitimate market need – the foreign patients visit these hospitals as they have and continue to receive good treatment and will stop at the first sign of trouble. The government run healtcare system is suffering from low credibility – although Kanshi Ram and former President KR Narayanan chose to be operated upon in India they did not have it done at AIIMS – it was done at Apollo Hospitals in Madras. There is plenty of money in India but spent unwisely and very inefficiently. The solution is not privatisation – it already exists and is not making much of an impact on health as opposed to medical complication. There are a few cases here and there where the private non-prpofit sector has played a stellar role. Sankara Netralaya and Arvind Eye Hospital in Eye Care; and Baba Amte in leprosy treatment and rehabilitation; CMC Vellore and Ludhiana; St.John’s Bangalore; and the Cancer Institute in Madras. But some of the earlier institutions that began as non-profits with a charitable mission have fallen behind the times in administration, and method. Others such as Sri Ramachandra MEdical College in the South and Escorts Heart in the North although non-profits are very expensive ones on the lines of the ones here in the US – with little or no room for the indigent ones and not gered up towards community health – a role played by the Christian mission run teaching hospitals, county hospitals and public University hospitals here in the US. A few institutions under build-up may emerge as role models in the future if things go the right way. Kanchi Kamakoti Childs Trust Hospital and the planned Kamakoti general hospital – may if the current troubles of the Kanchi Math are resolved may yet make a difference – as the mission of these hospitals reaches far beyond surgery and extends to community wellness, nutrition, and female literacy and health.
This post describes my experience with India’s medical system during my visit there.
I saw this, and the infomercial aspects aside, I thought it was an interesting report. I think it’s terribly smart to do this, and yes, I say this even as these hospitals may serve as competition for myself in the future, pathologist that I am. I mean, either you believe in the market or you don’t. The hospitals don’t really relate to Indian health care, per se, but they provide jobs and may serve as an impetus for a better infrastructure. The biggest problem with Indian hospitals is standardization and access to care. I’ve seen this in people trained in India or Pakistan with whom I’ve worked. Some are really spectacular, on par with the best of the best around the world, but some (and in my little anecdotal experience, they seem to come from the same institution which shall be unnamed by me) are really very weak and have poor medical knowledge. It seems to come from the institution – the kids are smart, they just don’t have good training. The well-meaning ones catch up with a lot of hard work, others should just not be practicing. And yes, you can say that about some physicians trained in the West, as well. Really, we can do better at training residents, all around.
Found your report interesting, Ashish.
MD; I hope I’m not misunderstanding you, but I think that the outsourcing of medical care to India has the potential, in the short term at least, to adversely affect patients in India.
I know a pathologist who works at one of the “stellar” hospitals mentioned by shiva. This hospital provides quality care to many poor patients. The hospital was identified by the British NHS as a center where the NHS could outsource some pathology to. The path department is already swamped with work (I’m certain the number of slides seen by pathologists there per day is several times that seen by their colleagues in the west). So accepting NHS-outsourced work would mean that many indian patients would probably lose out.
Also, a more indirect result is in their ability to retain their staff. In the past this hospital has been able to attract a decent staff, despite their low salaries, because of the non-monetary benefits of the place : a good work environment etc. But now it is finding it harder to compete with the 5-star hospitals that pay much higher salaries (presumably because they’re partially funded by foreign exchange via outsourced work).
Health care is one area where, i’m strongly inclined to believe, the free-market doesn’t solve everything.
Ashvin, Market solutions have never worked in improving health indicators. States in India where health indicators have moved up steeply are the ones where a robust public health system has taken the lead. At the risk of drawing sniggers from doctors and public health specialists on this site; let it be noted that to improve life expectancy and build up a more productive and socially progressive polity; extensive investments must be made at the foetal and neo-natal stages for both child and mother. The task of public health is much, much larger than providing medicines and surgery. The extensive need for surgical and medical interventions now being seen in the first world is an outcome of increasing life expectancy. People in their 60s, 70s and 80s need extensive maintenance. Probably because our body structures aren’t equipped by evolution to work satisfactorily beyond the age of 60? For much of human history – bar the last 100 years – on average it has been a privilege to live longer than 20 and 40 has been a stroke of fortune.
Well, first of all, I should have said the market doesn’t solve all problems, so you are correct. I should have put it differently so that I was more clear 🙂 I was really speaking to people in the US who are afraid of outsourcing with that comment.
As for the problem with pathologists, the answer isn’t to close down the private hospital but to train more pathologists in India! More jobs for more pathologists! If the NHS is sending pathology to India, then isn’t that a source of money for India and Indians that they didn’t have before? Why should you cut off this revenue stream? And why shouldn’t Indian pathologists make more money if they want to? They’ll spend it in India, won’t they? So won’t you have a net flow of money from foreign sources (if that is who most of the patients are in the private hospital) to Indian ones? I’m sure there will be short term problems (in this instance a shortage of pathologists because there is more work), but there will be long term benefits. How else is the economy supposed to grow? Train more pathologists.
Yes, public health programs are very important: it seems in India the infrastructure is relatively neglected. Roads, sanitation, more access to health care, yes, all of these are important and the goverment must take a leading role. But creating wealth isn’t a zero sum game: why can’t you have both these private hospitals and better public health care in India?
Hey, this is fun ashvin! I’ll have to learn more about the NHS pathology thing: thanks for bringing it to my attention.
It is interesting that 60 Minutes did not cover the original source of “medical tourism”- CUBA. Our nearby nemesis has welcomed foreigners to use their superior medical facilities for less cost than that of the Yankees and of high quality. And this sunny haven done longer and before any other nation. Furthermore, Cuba has invited tragic victims of international calamities, such child cancer patients from Chernobyl and mine amputees from Africa. Cover the full story about Cuba’s pioneering “medical tourism”- or is the Bush State Department dictating your content???
I am an American seeking treatment for lung cancer overseas. Can anyone direct me to the appropriate organization to begin inquiry? Thank you. Tom Malato
Please try the Breach Candy Hospital in Bombay: a nice place near the sea with very qualified staff. Or the Jaslok Hospital or th Tata Memorial Hospital. See if u can find them on the internet. If not write back, I’ll locate them for you. However I would personally try a good Ayurvedic doc like Dr Pankaj Naram: holistic, comforting tretments.
Three times I have used America’s Medical Solutions (www.americasmedicalsolutions.com) for my healthneeds, and I would crawl back to India if I had to for their free help and the healthcare needs I have received. I can’t say anything about the hospitals mentioned above, but the ones I’ve been treated in are in a class of their own. Both the hospitals and the doctors are world-class, and nothing like described above. I know there is a difference between the “costly” hospitals that I’ve been in which are very inexpensive and the ordinary Indian hospital. AMS got me to all the right ones! Three different ones. Dan
tel no : 9928804126
1 and a 2 months female kid can’t hear anything . doctors say that her inner membrane of hear is either not developed or not present. this has to be done urgently. breach candy or manipal or apppollo or tata memorial or jaslok or nair or kind edward memorial or else?