Americans driving the market Americans lead the way in medical tourism partly because of the baby boomer generation and also because of sporadic healthcare cover. With 45 million Americans uninsured overseas treatment is the only way to avoid huge medical debts. Last year, the average healthcare expenditure for a family of four exceeded the total annual earnings of a minimum wage worker for the first time.
The medical tourism industry is worth $100bn – growing at 15 - 20 per cent per year Source: Ernst and Young
Howard Staab, a 56 year-old carpenter from North Carolina has become the industry’s poster boy. His local hospital demanded a $50,000 deposit from him for a mitral valve replacement before warning him that the cost of treatment could rocket to $200,000. He got change from $10,000 for a pig valve in New Delhi - and also a trip to the Taj Mahal. Differences in doctor’s salary partly explain why such considerable savings can be made. The average salary of a US family doctor is $161,000, compared to just $35,000 in India.
India With four doctors for every 10,000 people, compared with 27 in the US, India is hardly a healthcare model to be copied.
Cost comparisons The average procedure in India is one-tenth of the cost in the US. Singapore is a more expensive destination but the savings are still large - a liver transplant which costs $300,000 in the US is just $150,000 in Singapore. Partial hip replacement
• India $4,500 • US $18,000 Full hip replacement
• India $3000 • US $39,000 Orthopaedic surgery
• India $4500 • US $18,000 Knee surgery
• India £8000 • UK (Private) £20,000
Gall bladder surgery
• India $7500 • US $60,000 Figures are approximate. They do not include travel and accommodation costs.
Yet India is now seen to be leading the world as a medical tourism destination - with the finance minister calling for the country to become a ‘global healthcare destination’. Efforts have been made to improve infrastructure to help smooth the arrival and departure of medical tourists. Import duty on medical equipment has been slashed and the government has introduced a special medical visa which permits tourists to stay in the country twice as long as before. As a result India’s medical tourism industry is set to balloon to $2 billion by 2012, according to a joint report by the consultancy McKinsey and the Confederation of Indian Industry.
Effect on the NHS Many expected the boom in medical tourism to lead to a reduction in UK private healthcare prices - instead the effect has been largely an efflux of medical tourists. Fiona Harris, head of personal markets at BUPA, the UK’s largest private healthcare provider, denies that their business is threatened by the boom in medical tourism: “Sometimes BUPA customers will seek treatment abroad where it is not available in the UK; in these cases we meet the equivalent UK costs of the treatment.”
Social costs Often the last thing a patient planning an operation overseas considers is the affect on the local community but it’s one of the key concerns that objectors raise. Many fear an internal brain drain whereby doctors leave small rural practices to work in better equipped urban centres that cater for medical tourists. Anil Maini, director of corporate development at the Apol-
“Doctors who had gone overseas are now returning to India, even though they earn a fraction, maybe twenty times less than they earned in the West.” Anil Maini. Director of Corporate Development. Apollo Hospitals Group, India.
lo Hospitals group - India’s largest medical tourism organisation - doesn’t deny this is the case: “There is an internal brain drain but there are enough doctors available to serve both rural and urban populations,” he says. “Doctors who had gone overseas are now returning to India, even though they earn a fraction, maybe twenty times less, than they earned in the West.” There are many who believe medical tourism hails the beginning of a much broader overhaul in the world’s healthcare systems - the advent of medical outsourcing. Outsourcing means that it won’t be the patient who decides to travel for treatment, it will be your insurer or government who sends you abroad to save money. Just as manufacturing and call centre operations were relocated to countries such as India healthcare is likely to follow. References Burkett L (2007). Medical tourism. Concerns, benefits, and the American legal perspective. J. Leg. Med. 28: 223-45.
Junior DR magazine design and layout. Issue 15.