Not a magic pill

The term medical tourism conjures up visions of stressed-out or gravely ill foreigners coming to India, checking into state-of-the-art hospitals or ayurvedic spas to submit themselves to the ministrations of our gentle, caring medical personnel. Rejuvenated by an open-heart surgery, kidney transplant or, in the case of ayurveda, a cleansed system, they will go off into the western sunset singing the praises of India. And leaving our medical coffers overflowing. All part of the ‘Incredible India’ experience, all the better to cure you with, my dear.

For some years now, we have been striving almightily to stave off threats from Thailand and Singapore to project ourselves as the mecca of medical tourism. Now the Philippines has also got onto the bandwagon. So India really has to stay on its toes. Nothing wrong with that, as long as you show us the money. But, the logic that part of the money which comes in from medical tourism will somehow trickle down to the public health system is stretching it a bit too far. The horrific kidney racket that has been unearthed in Gurgaon shows, to some extent, the ugly manner in which this medical tourism is taking place and who the money goes to.

Those awaiting kidney transplants were foreign nationals who have now left the country. The money made from this gruesome business of trading in human organs did not go into the public health system but into the pockets of unscrupulous doctors. Let’s face it, many foreigners come to India not because they imagine that after getting top-class treatment, they can take in the sights and sounds of exotic India. They know full well that they may find themselves in the hands of quacks. The Gurgaon culprits, it now turns out, had nothing more than dodgy ayurveda degrees, yet those who came for their services did not even try to find out whom they were entrusting their lives to. These are desperate patients who have no hope of medical help in their own countries. Many of them come here because they know that organs are easily available, thanks to self-styled doctors preying on poor illiterate people, and no questions asked. Of course, the cut price also helps. For many of them, the question of ethics goes out of the window when it becomes a matter of life and death.

Both in the US and Britain, the cost of healthcare is prohibitively high, the waiting lists for surgeries and transplants life-threateningly long and the laws rigorous. India does offer state-of-the-art care in the upmarket superspeciality hospitals in the metros, but these are few and far between. Services in these facilities come cheaper than in the West but nevertheless not affordable to the clientele that accesses the black market.

The Gurgaon racket reveals that we have our own desi version of Robin Cook’s spine-chilling medical thriller Coma. While in the book, charlatan doctors turned healthy patients into vegetables to be kept alive to harvest their organs, here poor patients are lured with promises of riches to medical facilities. Once trapped, they are robbed of their kidneys, in some cases it is believed even eyes, which are then sold to the highest bidder. The hapless victim is left to his own devices with a paltry sum by way of a fee. The going rate, we learn from the Gurgaon incident, for a donor is Rs 60,000 and the rate the recipient is charged is upward of Rs 15 lakh.

Post-operative care, so vital for organ donors, is never offered and the victim returns to a life of debilitating ill-health. Thus robbed of his ability to earn a livelihood, his life is all but destroyed, for how long can Rs 60,000 stretch for a sick man with a family to support?

But, we hold that medical tourism is a panacea to the ills that beset our public health system. Let us look at the figures. Today, 150,000 foreigners come to India for healthcare and spend about Rs 1,500 crore. In ten years, this will rise to Rs 10,000 crore. Anticipating this rush of patients, the private health sector has effectively lobbied for lower tariffs for equipment and tax breaks. Already 100 per cent FDI is allowed in health-related services. Be assured that a considerable amount of this equipment will be to cater to the needs of foreign clientele and that this will in all likelihood push up costs even for the well-off Indian patient.

With a paltry one per cent of GDP spent on healthcare, it is little wonder that 82 per cent of health spending is in the private sector. While the private sector has a vital role in healthcare, let us be clear, it is in the game for profits not philanthropy. And why should anyone have a quarrel with that? The only bone of contention is the propagation of the myth that the money made from medical tourism will subsidise the poor. It will not and it is not likely to. In fact, as the private health sector grows, more and more trained personnel will move to it from an already hobbled public health system. So far, the government has been content to dabble, and that too badly, in the primary and tertiary health sector. It has been content to leave curative care to the private sector. Yet, it has barely been able to ensure that the private sector, the beneficiary of government largesse, allocates even a decent proportion of hospital beds for needy patients.

Now that we face stiff competition from Thailand and Singapore, it is likely that costs will be cut further for foreign patients. If their numbers increase, it is certain that private hospitals are even less likely to do their duty by the poor. This is not a scenario that will change. Instead of trying to impose restrictions on the private health system and failing, the government should take its own role in the business of healthcare a little more seriously. So far, all the resolve that we have seen is the indefatigable Minister for Health Anbumani Ramadoss firing in several directions. One day we hear him say that alcohol consumption is the result of a pernicious Western culture, the next we see him berated cine superstars for lighting up on screen. In his spare time, the good doctor has been trying to clean the augean stables of medical institutions even as he has floated a scheme of compulsory rural service for medical graduates.

But has he tried to lobby to increase health expenditure beyond the dismal one per cent of GDP that it is now? No, and this explains why we spend Rs 200 per capita when it should be Rs 1,400. As with all our development sectors, the health sector too suffers from the malaise of misplaced priorities. There is no magic pill for it, the remedy simply lies in beefing up the public health system while allowing the private sector to pursue its own path. It is foolish to expect the private sector to fill the vacuum in public health. So let’s get real. This worrying apathy could literally hold the difference between life and death for the majority of Indians who have no access to expensive private care.