Escorts Heart Institute's Naresh Trehan: He wants accreditation and uniform pricing in the industry to attract more foreigners

Airport pick-up, a swank suite, interpreter service, home cuisine, home cable channels, a visit to the Taj Mahal... It is the Indian hospitality industry going out of its way to woo the foreign tourist, right? Well, actually, the industry in question is not that of hotels, but of hospitals (yes, you read that correctly). In a dozen or so state-of-the-art hospitals in the country, the number of foreigners coming for treatment is clipping. An estimated 100,000 "medical tourists" visited India last year, representing a 20 per cent jump over the previous year. A CII-McKinsey report suggests that medical tourism could fetch as much as $2 billion by 2012, compared to an estimated $333 million currently.

But what's new about people coming to India seeking wellness? After all, haven't they been coming to the country for decades now to experience yoga, Ayurveda and spirituality? Yes, but the medical tourists that we are talking about are those seeking critical medical care such as heart surgery, organ transplant, knee or hip replacement, or even something as simple as a root canal treatment. But a caveat may be in order here: It is not as if hospitals across India have suddenly become destination points for the ailing visitor. Most of the medical tourists end up going to a dozen or so hospitals, simply because these are the ones that have invested in state-of-the-art medical equipment, modern buildings, and world-class systems and practices, besides employing top-notch doctors, most of whom have worked abroad.

Take Escorts Heart Institute and Research Centre (EHIRC) as an example. It performs 4,000 heart operations every year, with an infection rate of less than 0.3 per cent and a mortality rate lower than 1 per cent. Or Apollo Hospitals, which is said to be the single-largest private hospital group in Asia with a network of 35 hospitals and 6,400 beds. It has performed more than 49,000 cardiac surgeries with a success rate of 98.5 per cent, and over 130 successful bone marrow transplants. There are 4,000 specialists and super-specialists and 3,000 medical officers (read: residents doing their specialisation) who work for Apollo in 53 different clinical departments. And there are at least a dozen other hospitals such as Wockhardt, Breach Candy, CARE, Narayana Hrudayalaya (See The Top Five), which are considered equally good.

WE LOVE INDIA: (L) Julia, a five-month-old baby from Tanzania with multiple holes in her heart, was successfully treated at EHIRC; (R) Kerry Dickson (standing) came all the way from Australia to Apollo Indraprastha for the treatment of his wife, who was suffering from multiple pelvic bone fracture

The result: A growing number of believers in India's medical capabilities. Says Gregory Bates, a former world powerlifting champ from the UK, who underwent a coronary bypass surgery at Wockhardt in Bangalore: "I have no hesitation in saying that I got the best treatment I could have anywhere in the world." Bates is now recuperating in Goa following his discharge. Frustrated by the quality of medical attention in his home country, Mohammad Zakir Hussain, a 36-year-old Bangladeshi turned to Apollo Gleneagles Hospital in Kolkata for a cure to his inflammatory skin disease called discoid lupus erythematosus (DLE). He was more than impressed with the attention he received at Apollo. Says Vijai Kumar, Medical Director, Jaslok Hospital, Mumbai: "Most of our patients come through word-of-mouth publicity."

Like Henry McInnes, a software engineer based in Seattle. After checking with his friends in Bangalore, McInnes decided to get his root canal treatment done in India. He figured that for the $4,000 he would have had to spend in the US, he could not just get the treatment done in Bangalore, but throw in a vacation too (now you know why they are called medical tourists!). A lack of reference, however, doesn't deter the determined. When Richard Ng'etich, a UNDP employee from Tanzania, discovered that his five-month-old daughter had multiple holes in her heart, he trawled the internet to find the best hospital, both in terms of quality and cost. He ended up at EHIRC in July, and now his baby girl, Julia, is recovering nicely. "I am glad we came here," says Ng'etich, also delighted that the surgery cost him half of what it would have in South Africa.

Indeed, that is the compelling proposition offered by the top hospitals in the country (that the quality will be world class is taken for granted), and what's helping them convince foreign patients to come to them for treatment is the soaring cost of healthcare in countries like the US and the UK. A cardiac surgery in the US costs anywhere between $40,000 and $50,000. In India, it costs a quarter or fifth of that in the best hospitals. Want a hip replacement done? It costs $10,000 in India compared to $50,000 in the US. What about neuro-surgery? Around $8,000 against the $29,000 it would cost in the US. Notes Anupam Verma, Director (Administration), P.D. Hinduja National Hospital and Medical Research Centre: "A foreign patient gets treated by a world-class doctor with the same GE machine and similar ambience at one-fifth the cost."

Vijai Kumar, Medical Director, Jaslok Hospital: Jaslok counts on word-of-mouth publicity to do the trick

Patients covered under insurance progammes like the National Insurance of Health (NIH) or the National Health Services (NHS) in the UK have long waiting periods, ranging from six to 18 months. To beat the queue, most patients are forced to go in for private health insurance, which costs a bomb. Patients who can't wait or opt for private insurance, then, end up coming to a country like India, where they get pampered silly at bargain prices. A case in point: Anette Ulstrup, a 46-year-old nurse from Denmark, who came to Apollo Indraprastha in Delhi for an adrenalectomy (surgical removal of one or both adrenal glands). At the price she was willing to pay, she got to stay in a hospital suite that cost Rs 12,000 a day, besides which the hospital even organised a trip for the Ulstrups to the Taj Mahal.

Bring 'Em On

To increase the flow of medical tourists, the top hospitals are beefing up their marketing. Apollo, which has an international marketing team that manages in-bound patients from arrival to departure, has offices in the Middle East and Mauritius, and is opening newer ones in Sri Lanka, Nigeria, and Malaysia. The Hinduja hospital has a coordination centre in London, which facilitates registration of patients from Europe. Sankara Nethralaya has tie-ups abroad that channelise patients to itself. EHIRC has two facilitation centres with limited diagnostic capabilities in Bangladesh, and two more are to be opened in Kabul and the UAE. Manipal Hospital, on the other hand, has set up information centres in several countries, including the UK and the UAE, while Narayana Hrudayalaya has a tie-up with the government of Kenya, besides information centres in Bangladesh and Malaysia.

Interestingly enough, the leading hospitals are even considering tying up with hotel chains to make the description medical tourism, literal. Apollo Gleneagles, which plans to double its revenues from foreign patients to Rs 8 crore in 2005-06, is in talks with Hyatt Regency to offer its foreign patients a comprehensive medical-cum-tourism package. Apollo Gleneagles, of course, is just one example. Says Pratap C. Reddy, Chairman of Apollo Hospitals and the man who corporatised health care in India: "We have the best healthcare professionals in the world and super-speciality hospitals. What we need is aggressive and concerted marketing."

Pratap C. Reddy, Chairman, Apollo Hospitals: He already runs the biggest chain of corporate hospitals in India, but wants to market more aggressively

With medical tourist numbers clipping at 30 per cent a year, there is a rush to add beds, rope in doctors with international experience, and stay up to date with advances in medical technology. Manipal Hospital has started work on the US Joint Commission International Accreditation, an industry certification for quality standards. It already has an iso certification for meeting European quality standards. Narayana Hrudayalaya is increasing its bed count from 460 to 780, and the number of operating theatres from 10 to 30. Fortis Health Care, awarded the Best New Hospital Designed Worldwide by the American Association of Architects in 1999, has four facilities in operation, but plans to add three new hospitals in and around Delhi.

There's another reason why international patients are being wooed with such fervour. The rates for them are higher. Apollo and Manipal have dollar rate cards, where the charges work out to 10-12 per cent higher than the rupee rates. Hinduja levies a 25 per cent surcharge on foreign patients and Jaslok, 20 per cent. Even Fortis has a differential rate. Needless to say, all value-added services such as airport pick-up, translator services, or home cuisine are billed separately.

Some in the industry, however, think that differential pricing is not a good practice. Also, there's the issue of different hospitals charging different rates for the same procedure-something that leaves international patients confused. According to Naresh Trehan, Executive Director of EHIRC and a top-notch surgeon, "accreditation of hospitals, uniform price banding like in the developed countries and organised campaigns will encourage more overseas patients to get treated here."

The industry is working on creating some kind of standards. "We are talking to various agencies, including credit rating agencies, insurance companies, CII for standardising different functions," informs Dr Ramakant Panda, CEO, Asian Heart Institute of Mumbai. Then, there is the need for external auditing and monitoring of doctors' performance-something unheard of in India. "We want to make it a big game, to use the clear advantage for the next five decades," says Reddy of Apollo. "(India is) now ready to heal the world." As the numbers show, more and more medical tourists are veering round to Reddy's point of view.

-additional reporting by Arnab Mitra, E. Kumar Sharma, Nitya Varadarajan, Shilpa Nayak
and Venkatesha Babu