India: The financial crisis may benefit Indian medical tourism industry: A blessing in disguise, Religare picks, Narayana Hrudayalaya plans

The cost advantage will become a major factor for a lot of foreign patients to travel to India for medical treatment during the present economic downturn. Medical tourism may up the ante for reforms in healthcare services across countries. Illegal organ trade continues to be a major concern for India.

-Chillibreeze Business Research Team

Trends
Corporate Plans

Trends

‘Vanity’ tourism on the rise

Countries with advanced technologies for cosmetic surgeries are playing host to a new breed of tourists who plan their itinerary so as to include a facelift or a tummy-tuck in the midst of sightseeing. Let’s face it, going abroad to get some work done to your body is actually quite common, but what is unusual is that tour agents are now offering special packages for ‘enhancements’ while on a vacation. The new phenomenon is termed as ‘medical or vanity’ tourism.

Dr Mohan Thomas sets the record straight for us: “Let’s not refer to it as cosmetic surgery and use the term ‘image enhancement’ instead, because that’s what it really is.”

Dr Thomas returned to India in 2001 to start the Indian Society of Cosmetic Surgery. Since he has been here, he has noted about a 500 per cent rise in the number of surgeries taking place in India alone. “People are very conscious of how they look and are willing to explore more options these days,” he adds.

Nov 8, 2008
Source: DNA India
URL: http://www.dnaindia.com/report.asp?newsid=1204691

Medical tourism causes complications

Forty-five million Americans are currently uninsured and health expenditures in the United States are rising faster than wages and inflation. Despite spending more on health care than any other industrialized nation, the United States in 2000 ranked 37th in the World Health Organization's evaluation of health care systems around the globe. Reforming domestic health care was a big issue in the US presidential campaign, yet a growing number of Americans and insurance providers are turning to international solutions.

About 750,000 Americans traveled overseas for medical treatment in 2007, and the number of so-called medical tourists could increase to more than 15 million in 2017. In previous decades, the medical tourism industry was dominated by cosmetic and dental procedures. Today everything from knee replacements to major heart surgery can be obtained in developing countries where internationally accredited health centers provide high-quality treatment with lower costs and shorter waiting periods than in the United States.

A heart-valve replacement priced at US$200,000 or more in an American hospital can cost $10,000 in India, according to the University of Delaware, including airfare and a post-operative vacation package. Average savings in Thailand are about 70% compared with the United States, and between 50% and 75% in Latin America.

Thailand's Bumrungrad Hospital treated 400,000 international patients in 2007, including 65,000 Americans. Thanks to an increase in foreign patients, the hospital's total revenue for 2008 is predicted to rise to $618 million.

Overall the effects of medical tourism are mixed. On the one hand, the industry can boost a developing country's gross domestic product and investment in health facilities. Upgrades in a country's hospitals also tend to decrease external brain drain, as top physicians find local jobs instead of leaving for employment in developed nations.

A study by the Confederation of Indian Industry predicts that by 2012 the medical tourism industry could add up to $2.3 billion to the country's annual GDP. The head of India's Wockhardt hospitals, which cater to foreigners, reported two dozen Indian doctors returning from the United States and Britain to work in his facilities.

In many cases, however, medical tourism threatens to exacerbate unequal access to quality health care in developing countries. Although relatively cheap by most Western standards, the private hospitals that treat foreigners are out of reach for the majority of people, and the revenue they bring in rarely makes its way to the public sector. According to a 2006 report by the World Health Organization, less than 4% of India's total government spending in recent years has gone toward health.

External brain drain is often replaced by internal brain drain, as doctors leave public health care centers to work in private hospitals. Last year NPR reported on a shortage of Thai doctors in the capital's public hospital because of the higher pay offered at Bumrungrad.

Some doctors, however, split their time between public and private facilities to balance serving the public sector with earning enough income to support their families. An editorial in Thai English-language newspaper The Nation cites the promotion of medical tourism as a factor in the country's failure to meet its goal of providing one doctor per 1,800 citizens.

The situation in Cuba has been described as "medical apartheid". Top quality treatment that is available to foreigners and to the Cuban elite is off limits to most of the country's population who can't afford to pay for health care in dollars. Based on interviews with Cuban citizens, Canada's National Post reported that access to basic pharmaceuticals was severely limited, either priced in dollars or restricted to the black market.

Some countries are responding to this public health dilemma. Private hospitals in the Philippines have been asked to accommodate more local charity patients. India's Health Secretary Naresh Dayal has suggested that private hospitals should provide medical treatment to poor patients free of charge as revenues increase. Others have proposed that India tax the currently subsidized private hospitals to support public health initiatives.

So far, a set of best practices on balancing medical tourism with improvements in public health has yet to make its way into international agreements or hospital accreditation processes.

Nonetheless, the major cost savings associated with medical tourism are attracting more patients and health insurance companies than ever before. Blue Cross & Blue Shield of South Carolina now facilitates travel from the United States to Thailand and other international hospitals through its Companion Global Healthcare subsidiary.

Legislation was introduced in West Virginia that would provide incentives to state employees who go abroad for medical treatment. According to Business Week, more and more insurers will be offering overseas options to their policyholders in the next five to 10 years.

Medical tourism is not an alternative to significant reform of the US health care industry. Aside from the negative effects on public health overseas - plus the environmental impact of long-distance air travel linked to the industry - medical tourism is not predicted to reduce the country's health spending by more than 1% to 2%. The overseas options will cost health care providers in the United States roughly $16 billion in 2008, according to the Deloitte Center for Health Solutions - a figure that may jump to $373 billion or more within a decade.

By introducing global competition to an industry that's long been considered immune to outsourcing, medical tourism may up the ante on reforming coverage, cost, and quality at home.
(Copyright 2008 Global Policy Innovations.)

Nov 7, 2008
Source: Asia Times
URL: http://www.atimes.com/atimes/Asian_Economy/JK07Dk01.html

A blessing in disguise for medical tourism

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.

However, with the turn of September, things began to shape differently across the world. The global crisis was now much palpable with the collapse of investment banks and the ensuing credit crunch. And as the crisis gnawed at the margins of some of the world’s top corporates, one could see the telltale signs of a global depression.

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.)

‘Scope of $700 b rescue fund may be broadened’
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.

Slowdown to last 15 months: Nasscom

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.
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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.

Under license from www.3dsyndication.com

Nov 5, 2008
Source: Sify
URL: http://sify.com/finance/fullstory.php?id=14790898

India's medical tourism: a tale of tainted blood, stolen kidneys and riches offshore

India's medical tourism has taken a hard knock in the tourism industry following the release of an Indian government "money trail" investigation linking it to a "multimillion dollar" international racket, spanning all the way to Hong Kong and Australia.

The scheme was exposed in January following complaints by impoverished Indian laborers who claimed doctors in the New Delhi suburb of Gurgaon had removed their kidneys "illegally."

News reports from India say India's Enforcement Directorate, the government agency probing the alleged racket, has been granted permission by a New Delhi court to follow the trail of part of the US$100 million in offshore bank accounts and properties "racket kingpin" Amit Kumar is alleged to have amassed in banks in Hong Kong and Australia.

Issuing his ruling on the issuance of letter of rogatory, which will allow authorities in other countries to collect evidence in a criminal case, Judge A K Pathak said, the letter to the competent authorities in Hong Kong and Australia will identify the ill-gotten money earned through unlawful means and for collection of evidence.

Kumar and his associates, according to Indian authorities, are alleged to have profited from performing more than 500 kidney transplant surgeries in the last decade by "procuring" organs for "paltry" sums from poor people and transplanting them on wealthy "clients".

In a "medical oversight," opposition lawmakers in India claim poor, unemployed laborers were held "captive" after being offered $6 a day while their blood was drained for sale to private clinics. "No one pays so much money to an illiterate person like me," Durga Prasad told police investigating the blood racket.

Earlier this year, police in the town of Gorakhpur, in West Bengal, raided a home where doctors were allegedly drugging the poor who had willingly sold their blood, but also had their kidneys stolen without their knowledge. When they asked for money they were beaten, claimed the victims.

Currently in an Indian jail, the legal move follows the arrest of Kumar in a Nepalese resort on February 7, along with “at least" eight others involved in the racket.

Since his arrest, Kumar has been charged among others for wrongful confinement, causing hurt by dangerous weapons, cheating and criminal conspiracy under the Indian Penal Code. The transplant racket served international clients from the UK, US, Greece, Turkey, Lebanon, Canada, Saudi Arabia and Arab states. "The clients flew into India as tourists and underwent transplants in New Delhi and in the suburbs, according to the police indictment. According to the Indian Express Group, in 2003 a "multi-core racket" involving about 480 illegal human organ transplants were "unearthed" in New Delhi.

"Amritsar is the hub of India's organ trade. Top doctors work in connivance with bureaucrats and politicians. It is synonymous with kidney scams, and has become the 'kidney bazaar' of India."

The medical establishment's complicity and lack of proper oversight over private hospitals and clinics has now raised serious concerns about India's so-called position as a leading destination for medical tourism, said an Indian lawmaker. "Doctors and middlemen with active involvement of bureaucrats were running the racket."

"It is a heinous crime," claimed Radha Agarwal, a doctor and an opposition lawmaker from Gorakhpur. "The doctors were literally playing with the lives of the people. We do not know how many people might have contacted diseases after transfusion of these blood, some of which might have been from drug addicts."

"A lot of money is involved in this racket," said retired judge Ajit Singh Bains, who heads the Punjab Human Rights Organization (PHRO ) which had carried out its own investigation into the human organ sale scandal. "The high and mighty take advantage of legal anomalies."

PHRO has filed a legal writ in the Punjab and Haryana High Court against SIT, claiming the agency "failed to nab the judicial officers, political leaders, lawyers and other influential persons."

The middlemen who are freed, doctors who are on bail or released, were also found involved in other such rackets elsewhere, said PHRO principal investigator, Sarbjit Singh Verka. "There is no end to the organ transplant business."

Nov 4, 2008
Source: Travel Daily News
URL: http://www.traveldailynews.com/pages/show_page/27789

Corporate Plans

Religare picks up stake in Dubai-based firm

Super Religare Labs, promoted by the Singh brothers, has acquired Dubai-based Mena Healthcare for $20 million. This is the group’s second acquisition after the promoter’s sold their stake in Ranbaxy Laboratories.

Super Religare Labs, formerly SRL Ranbaxy CEO Sanjeev Chaudhry told ET, “We have acquired Mena Healthcare facility in Dubai for $20 million. This is the company’s first overseas acquisition.” In August, Religare Wellnness, (formerly Fortis Healthworld) the pharma retail arm of the group acquired rival firm CRS Health.

Malvinder Singh, the joint promoter of the group had earlier said that the group would aggressively pursue expanding in the financial and healthcare services space — both through organic and inorganic route. It is learnt that Super Religare, Religare Wellness and Fortis Healthcare are all scouting for acquisitions in the healthcare space in the domestic market also. The rapid expansion of the group marks a distinct change in the company’s business strategy. Religare has rechristened all its group companies, except Fortis Healthcare, under the Religare brand.

Mena Healthcare has a reference laboratory in the Dubai Healthcare city, an ambitious healthcare project jointly undertaken by the UAE government and Harvard Medical School. In addition, Mena Healthcare has four network laboratories across UAE.

“The acquisition will enable Super Religare to expand it footprint globally,” Mr Chaudhry added. The company plans to establish its presence in Europe and South East Asia by setting up reference laboratories. It is also looking for outsourcing opportunities in Africa and North America, among others.

According industry experts, this is the most appropriate time for India Inc to go in for acquisition and expand its operation. “Companies across sectors are evaluating options to scale up investment activities in India and globally. Valuations are extremely attractive now and are down by almost two-thirds globally, “ said a source. The promoters who recently sold their stake in India’s largest drug company Ranbaxy has a cash reserve of Rs 10,000 crore.

Nov 9, 2008
Source: Economic Times
URL: http://economictimes.indiatimes.com/stocks_in_news_home/Religare_picks_up_stake_in_Dubai-based_firm/articleshow/3690241.cms

Narayana Hrudayalaya plans health city in Mexico

Indian hospital major Narayana Hrudayalaya plans to set up a health city in Mexico that will also cater to patients from the US. "Our next project will be a health city in Mexico. We may tie up with some American hospitals for this project," said Devi Shetty, eminent cardiologist and chairman of the Narayana Hrudayalaya group of hospitals.

Shetty was addressing a news conference here to announce the setting up of a health city - a multispecialty hospital with research facilities - in Hyderabad on the lines of the group's famous facility in Bangalore.

"The health city in Mexico will be a 3,000 to 5,000-bed facility and we are looking for joint ventures," he said adding that the government of Mexico had requested the group to set up a large health facility.

Sources said the health city would come up either in Mexico City, the capital of Mexico or at Guadalajara, the second largest city in Mexico.

Shetty said the proposed health city would also cater to the requirements of patients from America.

"We foresee healthcare delivery problems in the United States. They also have problems in undertaking a 20-hour journey to India for heart and other surgeries. As Mexico is closer to America, they will find it easy to undergo treatment there," he said.

The chain of hospitals, which has already built one of the world's biggest cardiac hospitals in Bangalore and is planning similar facilities in other cities, is reportedly in talks with the US-based Sutter Health for the Rs.10 billion health city project in Mexico.

The Rs.16 billion group, which currently has two hospitals in Bangalore and Kolkata, plans to invest Rs.50 billion over next five years in expanding its operations to six other Indian cities.

Nov 8, 2008
Source: Economic Times
URl: http://economictimes.indiatimes.com/News/News_By_Industry/Healthcare__Biotech/Healthcare/Narayana_Hrudayalaya_plans_health_city_in_Mexico/articleshow/3689236.cms

Narayana Hrudayalaya to set up health city in Hyderabad

Narayana Hrudayalaya Group of Hospitals, which has the world's largest heart hospital in Bangalore, Saturday announced its plans to set up a 5,000 bed multi-specialty health city here.

Narayana Hrudayalaya Malla Reddy Hospitals is coming up over 40 acres of land belonging to Malla Reddy Group of Institutions at Jedimetla.

Devi Shetty, eminent cardiac surgeon and chairman Narayana Hrudayalaya Institute of Cardiac Sciences, told a news conference that the group would invest Rs.2 billion over next three years on the first phase to create the 3,000 bed facility. The entire project is expected to be completed in five years.

The hospital for adult and paediatric cardiac surgeries will commission in four months from the 500 bed facility already created by Malla Reddy group.

Modelled on the lines of Narayana Hrudayalaya health city in Bangalore, it will also have cancer and kidney hospitals and research laboratories.

Narayana Hrudayalaya has partnered with governments of West Bengal, Rajasthan, Gujarat and Orissa to set up health cities but in Hyderabad they chose Malla Reddy as its partner.

Narayana Hrudayalaya, which currently has a bed strength of 6,000 at its facilities in Bangalore and Kolkata, plans to invest Rs.50 billion over the next five years in various centres to increase the bed strength to 30,000. This will make it the largest healthcare group in India.

The group, which was valued at Rs.16 billion last year, is building 5,000 bed health cities at Jaipur, Kolkata, Ahmedabad, Jamshedpur and Bhubaneswar.

"Why we are so obsessed with building health cities is that this model can alone make treatment affordable, ensure better results and address the huge health requirements of this country," he said.

Already patients from 26 countries are coming to Narayana Hrudayalaya, Bangalore for treatment. The facility is performing 30 heart surgeries a day.

"Twelve percent of all the heart surgeries done in India every year are being done by our heart hospitals in Bangalore and Kolkata," said Devi Shetty. He pointed out that India needs to perform 250,000 heart surgeries every year but was doing only 80,000 surgeries because majority of the patients could not afford it.

Narayana Hrudayalaya, which charges Rs.65,000 for a heart surgery on poor and working class patients, promised that the cost will be brought down to Rs.45,000 once it reaches a bed strength of 30,000.

The group, which has an agreement with the Malaysian government to treat 1,000 children from Malaysia and with the Iraqi government to treat 2,500 children from Iraq, plans to divert some of these child-patients to their proposed facility in Hyderabad.

Narayana Hrudayalaya, which implanted artificial hearts in four patients in Bangalore, will also bring the same technology to Hyderabad. Artificial heart costs Rs.5 million but Shetty promised that the first implantation in Hyderabad facility would be free of cost.

The health city in Hyderabad will also have a laboratory to preserve homograph heart valve for replacements in patients. Homograph heart valves are collected during postmortem on victims of road accidents.

Indians are genetically three times more vulnerable to heart diseases than Europeans. Thrombosis Research Institute, London, has set up a lab at Narayana Hrudayalaya, Bangalore to develop a vaccine to prevent heart attacks.

A group of 32 scientists are working in the lab. Shetty said the lab has collected blood samples of 6,000 people who suffered pre-mature heart attacks.

"We are far away from reality," Shetty said on the status of the vaccine.

Nov 8,2008
Source: Fresh news
URL: http://www.freshnews.in/narayana-hrudayalaya-to-set-up-health-city-in-hyderabad-97146

Fifth Apollo hospital in India gains international accreditation

Apollo Hospitals, Bangalore is the latest of Apollo’s offerings and is in one of the most vibrant and dynamic cities in India - Bangalore. The hospital is equipped with some of the most advanced facilities in the world and some of the most eminent names in several medical specialties. It has just received international accreditation from the JCI, an international organisation that has now accredited more than 200 hospitals worldwide.

Apollo Hospitals is one of the leading healthcare providers in Asia and has played a pioneering role in helping India become a global healthcare hub. The group includes 43 hospitals in India and overseas, and diagnostic clinics.

The group’s other four Indian hospitals with JCI status are-

• Indraprastha Apollo Hospitals, New Delhi, a joint venture between Apollo and the Government of Delhi. Founded in 1996, it is the largest hospital in the group and has 560 beds. The hospital handles 200,000 patients a year, of which 12,000 are international patients.

• Apollo Hospitals, Chennai, which has pioneered many revolutionary procedures and technologies in India.

• Apollo Hospitals, Hyderabad, a 550-bed hospital treating
100,000 patients a year, many from overseas.

• SPS Apollo Hospital, Ludhiana, a state-of-the-art 350-bed multi-speciality hospital.

Apollo has a health tourism division to deal with international patients.

Nov 7, 2008
Source: Treatment Abroad
URL: http://www.treatmentabroad.net/medical-tourism/news/?EntryId82=82666