INDIA: New academic study on medical tourism to India

The various claims of how many medical tourists a country attracts are notoriously unreliable, even where there are monitoring systems in place. A new academic study suggests one simple reason for this; even major international hospitals are pretty poor at keeping simple records of how many medical tourists they have. And it is not just the usual problem of counting in expatriates, travellers and non-resident nationals who are in the country for reasons other than being a medical tourist. It may be the result of poor recording by hospitals; whether or not a patient is a medical tourist is not at all important, to staff already busy with other duties.

A new academic study ‘Medical Tourism in India ? Economic Development and the Global Healthcare Industry’, by Kristen Smith from the Centre for Health and Society, University of Melbourne, has been published on Academia.edu, a platform for academics to share research papers.

The research explored how medical tourism as both an industry and a practice fits within the world system. Using multi-sited ethnography. it investigated five large private hospitals in Mumbai in affiliation with the Tata Institute of Social Science. Observations were conducted in hospital waiting rooms, board meetings, administrative meetings, hospital wards, waiting rooms and consultancy rooms. There were 15 semi-structured, in-depth interviews.

The paper says that levels of international medical tourism are largely unknown due to inconsistent and irregular data at national and global level. Even at a micro level, few hospitals keep correct records.

Researcher: “Medical tourism, how many cases do you get a month?”
Hospital administrator: “ Oh, not just this thing but also walk ins, okay and..from the other people too...so around ten patients a month..., so we don’t know this exactly. “ ?

Examination of a wide range of data shows increasing international patient mobility, but different patterns are emerging geographically and socially.

The five hospitals were one corporate and four trust hospitals. The four trust hospitals differed in their age, reputation, management (two were corporate outsourced) and size (bed capacity). Two of the hospitals were built in the last five to seven years. One hospital was in the midst of extensive renovations. One had a multi-tower building being built behind it to increase capacity from 400 to 700 beds. One was acquiring more land for further building.

None were specialist medical tourism hospitals. Three hospitals had official tie-ups with different consulates including: Oman, Japan, Saudi Arabia, Kuwait and the UAE. One or more consultant surgeons with rooms at each of the hospitals have their own websites marketing to international patients. They all left the marketing of medical tourism to their consultants and to medical tourism agents. Each hospital paid two or more agencies for referrals.

Of the five hospitals, only three had websites selling medical tourism on the expectation that people would somehow find their website. These rather basic websites employ different tools to advertise their services, such as: patient testimonials, video footage of the hospital and staff or virtual tours; photo galleries; details of packages and pricing; doctor profiles and publications. Three of the hospitals in the study had special international package deals for a range of treatments, but only one had significantly different pricing scales for international patients compared to local patients.

The paper looks at three ‘facts’ on Indian medical tourism:
??? ?Medical tourism is a revenue driving industry, as it will increase export earnings through attracting foreign exchange into the country, lowering fiscal deficit and assisting the economic development.

The paper argues that medical tourism is just part of a boom in the Indian healthcare industry. The government is spending lots of money on the infrastructure in a hope that it will increase medical tourism.

??? ?Medical tourism will improve local health systems. The economic growth medical tourism generates results in an overall increase of national income, thus creating equity in access through allowing more of the population access to private care and allow funds to go back into the health system.

The paper argues that the logic employs the widely critiqued notion of the trickle-down concept, but is thinly veiled. With no mechanisms in place to ensure any profits of medical tourism are directed towards public benefit, there is no validity to this claim.

??? ?Medical tourism will improve health care standards. The promotion of medical tourism will raise the standards of health care across the country through competitive market practices, which will translate to an increase of the standards in the public sector.

The paper argues that while this may be the case, it is difficult to separate the varying results from medical tourism, the rise in private health insurance, a move to international accreditations and national accreditation. The key concern is that a move to international standards is likely to increase costs for local patients, as the infrastructure costs are higher. Although medical tourism is not the only impetus for increase of standards and prices, it certainly is one key driver both directly and indirectly.

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