India's low price, high-tech care draw "medical tourists"

By John Lancaster
The Washington Post

JOHN LANCASTER / THE WASHINGTON POST Last month, Howard Staab, who had a life-threatening heart condition, flew to India from North Carolina with his partner, Maggi Grace, so surgeons could replace his heart valve.

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Taking his cue from cost-cutting U.S. businesses, Staab last month flew about 7,500 miles to New Delhi, where doctors at the Escorts Heart Institute & Research Centre replaced his balky heart valve with one harvested from a pig. Total bill: about $10,000, including round-trip airfare and a planned side trip to the Taj Mahal.

"The Indian doctors, they did such a fine job here and took care of us so well," said Staab, a bicycling enthusiast who was accompanied to India by his partner, Maggi Grace.

Staab is one of a growing number of people known as "medical tourists" who are traveling to India in search of First World health care at Third World prices. Last year, about 150,000 foreigners visited India for medical procedures, and the number is increasing at about 15 percent a year, said Zakariah Ahmed, a health-care specialist at the Confederation of Indian Industries.

Eager to cash in on the trend, posh private hospitals are beginning to offer services tailored for foreign patients, such as airport pickup, Internet-equipped private rooms and package deals that combine, for example, tummy-tuck surgery with several nights in a maharajah's palace. Some hospitals are pushing treatment regimens that augment standard medicine with yoga and other forms of traditional Indian healing.

The phenomenon is another example of how India is profiting from globalization — the growing integration of world economies — just as it has in such other service industries as insurance and banking, which are outsourcing a growing assortment of office tasks to the country. A recent study by the McKinsey consulting firm estimated India's medical-tourist industry could yield up to $2.2 billion in annual revenue by 2012.

"If we do this right, we can heal the world," said Prathap Reddy, a physician who founded Apollo Hospitals, a 6,400-bed chain that is headquartered in the coastal city of Chennai and is one of the biggest private health-care providers in Asia.

Robotic surgery

The trend is in its early stages. Most foreigners treated in India come from other developing countries in Asia, Africa or the Middle East, where top-quality hospitals and health professionals are often hard to find.

Patients from the United States and Europe are relatively rare because of the distance they must travel and, hospital executives acknowledged, because India continues to suffer from an image of poverty and poor hygiene.

As a whole, India's health-care system is hardly a model, with barely four doctors for every 10,000 people, compared with 27 in the United States, according to the World Bank. Health care accounts for 5.1 percent of India's gross domestic product compared with 14 percent in the United States.
 
On the other hand, India offers a growing number of private "centers of excellence," where the quality of care is as good or better than that of big-city hospitals in the United States or Europe, said Naresh Trehan, a cardiovascular surgeon who runs Escorts and performed the operation on Staab.

Trehan said, for example, that the death rate for coronary-bypass patients at Escorts is 0.8 percent. By contrast, the 1999 death rate for the same procedure at New York-Presbyterian Hospital, where former President Bill Clinton recently underwent bypass surgery, was 2.35 percent, according to a 2002 study by the New York State Health Department.

Escorts is one of a handful of facilities worldwide specializing in robotic surgery, which is less invasive than conventional surgery because it relies on tiny, remote-controlled instruments that are inserted through a small incision.

"Our surgeons are much better," boasted Trehan, 58, a former assistant professor at New York University Medical School, who said he earned nearly $2 million a year from his Manhattan practice before returning to India to found Escorts in 1988.

Although they are equipped with state-of-the-art technology, hospitals such as Escorts typically are able to charge far less than their U.S. and European counterparts because pay scales are much lower and patient volumes higher, said Trehan and other doctors. For example, a magnetic resonance imaging (MRI) scan costs $60 at Escorts, compared with roughly $700 in New York, Trehan said.

"Food is great, too"

Tom Raudaschl is an Austrian patient who lives in Canada and earns his living as a mountain guide. Raudaschl, who has osteoarthritis in his hip, decided last year to have "hip resurfacing," a relatively new procedure that involves scraping away damaged bone and replacing it with chrome alloy.

He learned he would have to wait up to three years to have the operation under Canada's national health plan, a delay that would have cost him his job, Raudaschl said. In the United States, the procedure would have cost $21,000, he said.

So this month, Raudaschl flew from Calgary to Chennai, where a surgeon at Apollo Hospital performed the operation Wednesday for $5,000, including all hospital costs, Raudaschl said by phone from his hospital bed.

"As soon as you tell people that you're going to India, they frown," Raudaschl said. But he said he could not be more pleased. In India, "They picked me up at the airport, did all the hotel bookings, and the food is great, too," said Raudaschl, whose private room was equipped with Internet service, a microwave and a refrigerator. Most important, Raudaschl said the surgeon told him he would be "skiing again in a month."