Medical Tourism: Bugged by the Superbug?

“A new superbug has surfaced in India, Pakistan and the UK, leading to an argument about the origin of DM-1 (New Delhi metallo-beta-lactamase 1). The worst possible impact on tourism is that it could lead to devastation in the field of medical tourism”

The fast growing Indian Medical Tourism Industry has been shaken by many such headlines since August 2010. In a study published on the 11th August 2010, in the Lancet Infectious Diseases journal, Dr. Prof Timothy Walsh and his team discovered that NDM-1 was spreading fast in Bangladesh, India, and Pakistan and was also imported back to Britain and other countries in patients returning after treatment. The team collected bacteria samples from hospital patients in Chennai and Haryana. They found 44 NDM-1-positive bacteria in Chennai, 26 in Haryana, 37 in Britain, and 73 in other sites in Bangladesh, India and Pakistan.

US health officials said that the patients affected by this disease were mostly the ones who had received some medication in Indian hospitals. The disease makes the bacteria highly resistant to most of the antibiotics, including strong class of carbapenems. Medical experts across the globe are of the opinion that there are no drugs presently to deal with the situation.

Delhi has been considered as pothole of many stomach infections, including the infamous “Delhi Belly”. Still the Indian doctors claim that the Indian Capital is not responsible for the spread of the new bug, as the name says.1 Many medical experts are also of the opinion that the disease was brought to India by British Medical Tourists.

Medical Tourism In India

Health tourism has always been an important section of the tourism market. A RNCOS research shows that the estimated value of the global medical tourism industry is US$ 60 billion and is expected to exceed US$100 in the next two years. People travel to foreign lands for medical treatment for a host of reasons including good quality treatment at a low cost combined with the opportunity to travel new places. People from west generally prefer Asian nations for the purpose.

Medical Tourism in India has seen exponential growth in the past few years. A study by McKinsey and the CII states that medical tourism in India could be a US$ 2 billion industry by 2012. Credit Suisse estimates say that medical tourism in India has been growing at between 25-30 per cent annually. Assocham, an industry body, says that the cost of surgery in India is one tenth of what it is in the western countries.

Ancient Indian Medicine is another reason why medical tourists flock to India. Ayurveda, Yoga, Homeopathy, Unani – are all catching up the fancies of the West. Quite many tourists visit Kerela for Panchkarma treatment for rejuvenation, orthopedic treatments, etc.

There are about 3000 hospitals and 7,26,000 registered medical practitioners in India that serve the needs of people. Some well-known hospitals are Apollo, Fortis, Sahara, Workhardt, etc. These hospitals also provide facilities for translators, private chefs, etc during the stay of foreign patients. All medical investigations in most of the Indian hospitals are done using state of the art technologies and hence very minimal chance of error is there. The medical specialists in India are available in all fields naming cardiology, gastroentology, dentistry, cosmetic surgery, body part implants, etc.

The Indian government has also been taking initiatives to promote medical tourism in the country. For example, the government has extended the medical visa limit to one year (from 3 months) and this is also extendable by another year. The government has also expedited visa processing. A major government initiative is coming in the form of Medi City in Gurgaon. the projects entails 900 bed hospital with 17 super specialties , a medical and paramedical college. The Medi City with have allopathic care clubbed with Unani, Ayurvedic and Homeopathic medicinal treatments as well.

But the concerns never die….

In spite of all the good things, there are problems that inflict the industry. To begin with, people coming for treatment have some basic concerns regarding the infrastructure of the country, language and cultural barriers while communicating with the medical practitioners and quality of the service being provided to name a few. They also have a perception that India is an unhygienic country. Medical tourists often complain on lack of coordination between the service providers starting from the airlines to the hotels and the hospitals.

The government aided hospitals lack proper infrastructure and a hygienic atmosphere in India. Though these hospitals are far cheaper in terms of cost still there is no proper regulatory body to look into the quality of these hospitals. They still follow a bureaucratic form of management. Another issue that comes out of this is that there is no uniformity in terms of cost across hospitals in India, and this confuses the medical tourists a little.

Infrastructural issues like low frequency of flights from certain countries, bad roads and poor power supply in some cities at times scare away the Indian medical tourist to the competing nations in the field like Thailand, Philippine, Malaysia, Singapore, etc.

Apart from the concerns of the tourists, the industry players also face certain problems. Industry players complain that the land reforms are very poor in the country and funding facility is also very less, which prohibits them from stimulating growth in the industry. The bureaucratic form of management in most of the places is an imperative for most of the industry players.

Providers of Medical Tourism

There are not many medical tour operators in India. Some of the names that come up in the area are Advent Medical Services, Indicure Limited, Erco Travels, Medispaces India Limited. But these companies are very limited in terms of the services they provide.

In the recent past, some new names have been coming up like Mediscapes India Limited and Sahara Medical Tourism that provide complete medical tour facility to the tourists. The facilities are providing a International Patient Care Coordinator, providing special phones to patients, etc. But the problem is the these facilities require a large infrastructure, which is not available with most of the service providers.

Some of the major hospitals and hotels also have plans to venture in the area. Apollo Hospitals is in talks with Taj group to provide better service to medical tourists. Same deals are underway between ITS and Jupiter Hospitals. But still there is a long way to go from here.

References

  • New Superbug to threaten Indian medical tourism, 23rd August, 2010 www.tourism-review.com

  • Scientists find new superbug spreading from India, 12th August 2010 http://in.reuters.com

  • Medical Tourism Trends, November 2010, RNCOS Industry Research Solutions

  • Government says superbug not linked to India, 12th August 2010 www.ndtv.com

  • www.health-tourism-india.com

  • www.medical-tourism-india.com

  • Is health tourism the future? www.guardian.co.uk


Appendix 1

Cost Comparison for Select Health Care Services
Screen Shot 2015-09-01 at 1.47.46 pm

Appendix 2

Government says superbug not linked to India


New Delhi: 
India has rejected a controversial study linking a new superbug in UK to surgeries in the country.

The bug NDM-1 or New Delhi Metallo-1, said to be resistant to the most powerful antibiotics, has even been named after New Delhi.

India says it's an attempt to target the flourishing medical tourism industry, which is making rapid progress providing treatment and surgeries to global patients at significantly lower costs. The sector has been estimated at Rs.1,200 crore.

"This phenomena is not India centric, the superbug is everywhere. It is wrong to blame India, its hospitals, and our drug policy. Indian hospitals are world class. This gives a very wrong message. We will register protest,"  said V M Katoch, Secretary of Health Research. According to a paper published in scientific journal 'Lancet', the new Superbug has entered UK hospitals and is travelling with patients who had gone to countries like India and Pakistan for surgical treatments.

The health ministry said the conclusions of the article are loaded with inference that these resistance genes or organisms possibly originated in India and it may not be safe for patients in the United Kingdom to opt for surgery in India.

It said the contents of the article present a "frightening picture" which is not supported by any scientific data.

Questions are also being raised about why the research was sponsored by two big pharma companies who may gain from the findings.

"When India is emerging as a medical tourism destination, this type of news is unfortunate and may be a sinister design of multinational companies to defame the Indian medical sector," BJP leader S S Ahluwalia said in the Rajya Sabha.
 
The superbug gene, which can be swapped between different bacteria to make them resistant to most drugs, has so far been identified in 37 people who returned to the UK after undergoing surgery in India or Pakistan.

The threat is being seen as a serious global public health problem as there are few suitable new antibiotics in development and none that are effective against NDM-1. The Department of Health in Britain has already put out an alert on the issue.


Appendix 3

UK patient avoided the NHS list and flew to India for a heart bypass. Is health tourism the future?


Three months ago George Marshall fretted about the choice offered by his doctor in Britain. Diagnosed with coronary heart disease, the violin repairer from Bradford was told he could either wait up to six months for a heart bypass operation on the National Health Service or pay £19,000 to go under the scalpel immediately.

In the end, Mr Marshall chose to outsource his operation to India. Last month he flew 5,000 miles to the southern Indian city of Bangalore where surgeons at the Wockhardt hospital and heart institute took a piece of vein from his arm to repair the thinning arteries of his heart. The cost was £4,800, including the flight.

"Everyone's been really great here. I have been in the NHS and gone private in Britain in the past, but I can say that the care and facilities in India are easily comparable," says Mr Marshall, sitting in hospital-blue pyjamas. "I'd have no problem coming again."

The 73-year-old found the hospital in Bangalore after a few hours surfing the internet. Mr Marshall decided to come after an email conversation with Wockhardt's vice-president and a chat with other "medical tourists" from Britain who had undergone surgery in the hospital.

"Once I knew others had come I thought, why not? In Europe hospitals in Germany and Belgium would do the operation for less than doctors in Britain. But Europe was still more expensive than here. And the staff speak English in India."

With patients such as Mr Marshall willing to travel across the globe to get treatment sooner or more cheaply than they could at home, Indian hospital groups see a huge market for their services

Heart bypass UK: £15,000 France: £13,000 US: £13,250 India: £4,300
Hip replacement UK: £9,000 France: £7,600 US: £15,900 India: £3,180
Cataract operation UK: £2,900 France: £1,000 US: £2,120 India: £660





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