By Dinesh C Sharma
Tourism Minister Mahesh Sharma on Wednesday launched the National Medical and Wellness Tourism Board to promote medical tourism from foreign countries into India. While the move fulfils a long-standing demand of tour operators and corporate hospitals which want a greater share of medical services outsourcing market, it raises several questions regarding the impact of medical tourism on the domestic health care system.
Ever since the government opened up healthcare to the private sector in the Sixth Five Year Plan in the 1980s, the country has seen tremendous growth in corporate hospitals. India has emerged as a low-cost destination for costly medical procedures such as bypass surgery, kidney and liver transplant, hip replacement, dental services, cosmetic surgery, bariatric surgery and assisted reproduction. India, along with Singapore and Thailand, has become a hot medical tourism market for patients from America, Britain and other countries where health costs are too high.
The medical tourism board is supposed to boost this growing industry by marketing India as a preferred medical tourism destination and facilitate greater inflow of medical tourists. This makes sense from a point of view of pure economics. However, it would be wrong to compare this kind of outsourcing with Business Process Outsourcing or legal process outsourcing though both are based largely on cost difference. Unlike BPO and other outsourcing businesses where manpower is not a major issue and training costs are low, medical tourism requires high class infrastructure and well trained manpower (both of which are in short supply in the health sector).
The state support to medical tourism has to be viewed in the light of the availability of health manpower in India. On the one hand, the Tourism Ministry wants to promote medical tourism which necessarily means deployment of trained manpower in this export-oriented business. On the other hand, the Ministry of Health has been grappling with shortages in the government health system.
Though the number of health facilities has risen in the past one decade, manpower shortages are staggering. Over 8% of 25300 primary health centres (PHCs) are without a doctor, 38.1% without a lab technician and 21.9% have no pharmacist as on March 31, 2015, according to ministry data. The shortfall of doctors in PHCs is 11.9% of the total requirement. In community health centres (CHCs), the shortfall is huge - surgeons (83.4%), obstetricians and gynecologists (76.3%), physicians (83.0%) and pediatricians (82.1%).
This is despite the fact that we have one of the largest medical education systems with over 410 government and private medical colleges producing 50,000 doctors a year. Clearly, a bulk of them is being absorbed in more lucrative medical tourism business. This was amply clear by the remark of Sharma, who chairs the new board, that “India’s competitive advantage, which lies in a large pool of well trained medical professionals, and its cost competitiveness compared to other countries, will certainly take this niche segment of tourism to greater heights.” Clearly, two wings of the government – health and tourism ministries – are working at cross purposes. The absence of any representative of the Ministry of Health or a public health expert in the medical tourism board is conspicuous.
The board, as Sharma pointed out, will only act as a facilitator and medical tourism business will be led by the private sector. This gives an incorrect impression that the government’s role is limited and private sector will only benefit from promotional and marketing efforts of the government. This masks the fact that medical tourism is, in fact, being subsidized by the government in many direct and indirect ways. Private hospital chains, catering to medical tourists, have benefited from subsidies in the form of cheap land, tax concessions for equipment and drug import, shifting of government insurance schemes to private hospitals, besides trained manpower from state-run or supported medical colleges and nursing institutes.
Shifting of scarce resources to cater to foreign tourists can have deleterious effects on the state health system, as has been reported in Thailand which has a robust medical tourism industry. Costs of care, procedures and consultation can go up substantially in the private sector for domestic patients. Already India has one of the most privatized – yet unregulated – health markets in the world. In addition, there could be a negative fallout in the society, as visible in the case of fertility business where poor women are being lured into surrogacy for money and also for harvesting eggs for medical tourists. Kidney donation rackets are often linked to medical tourists.
It would be great for India to market Ayurveda, yoga, naturopathy and other such systems under the umbrella of ‘wellness’ and facilitate the spa business for foreigners, but combining wellness with medical tourism raises several uncomfortable questions. Given its present state of development, India’s top priority should be universal health care for its own citizens.