Why is the Indian health system more privatized

Medical tourism in India

Medical tourism is the new privatization 'mantra' of Indian health care. People from rich countries travel to poorer countries to get medical care and - to kill two birds with one stone - to experience the tourist attractions of the destination country.

In India, foreigners take advantage of the subsidized medical services of the large private hospitals and then enjoy their vacation. What they leave behind is a few dollars for private institutions, and a pile of rubbish for the poor, three-quarters of whom cannot dream of such medical care.

First class medical care at “Third World” prices

Many emerging countries also actively promote medical tourism as part of their official tourism policy. In India, the government is trying to advance the country with “first-class medical care at Third World prices”. Many Indian private clinics meet international standards, but the cost of treatment is only about one-fifth to one-eighth of what patients in the US, UK or other developed countries pay.

In a study by McKinsey and the Confederation of Indian Industry (CII), it is estimated that medical tourism will bring Indian hospitals revenue of $ 2.2 billion per year by 2012 . Tour operators and hotel companies have introduced medical tourism package deals. They often include airport pick-up, bedside service, Internet access in the hospital room, international cuisine, and post-medical leave.

The Indian Health Policy of 2002 states: “To capitalize on the comparative cost advantages of most domestic health care institutions in the secondary and tertiary sectors, this policy will promote provision for foreign patients for a fee. The provision of such services against payment in a foreign currency is regarded as an export and benefits from all tax incentives that apply to export earnings ".

World-class doctors, an excellent medical infrastructure and technology, Ayurveda and other Indian knowledge in the health sector as well as expertise in western conventional medicine are among the strategic advantages of India. Many Indian health sector experts work abroad. This increases the confidence of foreign patients to travel to a “third world” country for treatment.

Medical tourists in India

There are mainly three categories of medical tourists who come to India. The largest group are the non-resident Indians (NRI), who visit their homeland regularly and take advantage of cheaper medical services, such as dental care, here. The second group are citizens from rich countries like the USA or Great Britain who combine their vacation with medical treatment at low prices. This group includes non-insured persons who cannot afford treatment in their home country and insured persons who want to avoid long waiting times, e.g. for organ transplants or operations (e.g. in Great Britain). Still others come for cosmetic surgeries that are not covered by insurance, or as “reproductive tourists” in order to circumvent the sometimes stricter (often ethical) legal regulations in their home countries. The third group are patients from Africa or South Asian Association for Regional Cooperation (SAARC) countries where first class medical care is not available.

On risks and side effects ...

However, there are a number of risks and side effects associated with the medical tourism boom in a country like India. This includes, for example, the problem of the environmentally friendly disposal of hospital waste or the illegal trade in organs. While the medical care of the Indian population leaves a lot to be desired, private clinics for the rich are subsidized with scarce tax revenues.

Hospital waste: Infectious and hazardous to health

It is well known that the modern healthcare system generates large amounts of hospital waste, and today's disposal system raises many questions. According to the Indian non-governmental organization “Toxics Link”, each hospital bed generates an average of one kilogram of waste per day. Ten to 15 percent of this is classified as infectious, five percent as hazardous to health and the rest as household waste. A large private clinic in an urban setting produces up to two million tons of waste per year.

Many hospitals incinerate all types of waste - from office waste to pathological waste from the operating room - in incinerators. This is an effective method: effective for blowing into the air highly toxic dioxins, mercury, lead and other dangerous substances that threaten human health and the environment.

The costs of environmentally friendly disposal of hospital waste are not included in the price that foreigners pay for their medical tourism package deals. This is one of the reasons why these offers are so “inexpensive” for foreigners.

Organ transplants: anything but "donations"

To prevent illegal organ transplants, the Indian government passed a law in 1994 that makes the sale of organs a criminal offense. With this law, standards are set for the first time for hospitals that carry out organ transplants and who is legally eligible as an organ donor. However, illicit organ trafficking is widespread in India due to inefficient regulation and corruption in the health system. In a study of the kidney trade in India, Dr. Madhav Goyal of Geisinger Health System in the US in 2002 found that 96 percent of the study participants had sold their kidney for around $ 1,000 to pay off debts. A few years after this “organ donation”, most of the subjects' health had deteriorated significantly, and often their economic situation as well. At the time of organ donation, 54 percent of the subjects were living below the poverty line. At the time of the investigation, a few years later, it was 71 percent.

According to a report in the magazine “Frontline”, around 100,000 people in India urgently need a kidney transplant every year. In addition, there are an estimated two million people with kidney problems. However, transplants performed in India are estimated to be less than 3,000 per year - a fraction of the cases that require a kidney transplant. This shows that there is a large, unmet demand in India itself. Only those who can pay for it get a chance, and this is not the broad middle and lower classes. At the same time, India “exports” organs in order to achieve more economic growth.

Another notorious country for organ transplants is China. According to a report in “NewScientist.com”, China bowed to international pressure last November and agreed to give up the practice of transplant tourism. In China, wealthy Westerners were treated with "donated" organs believed to have come from death row inmates.

Access to health care for the local population

If the number of medical tourists continues to grow, the cost of the private health system in India is very likely to skyrocket. As a result, even fewer people will have access to adequate health care. With some treatments, such as dialysis, this is already the case today.

The demand for the services of private clinics as a result of the medical tourism boom will in all probability lead to these clinics being expanded further. More medical staff is needed for this. In the short term, one solution is to recruit doctors from the public health system, or to attract qualified medical staff from small towns or smaller hospitals to the metropolitan areas where almost all large private clinics are located. As a result, more and more people are losing access to affordable medical services. According to the UN, there are currently around 60 doctors available for every 100,000 people in India. There are 256 in the US, 230 in the UK and 337 in Germany. Failure to provide medical care that poorer populations can afford will only worsen the current situation.

Pressure on the government

In India, the private health sector is already heavily subsidized - for example with reduced import duties on medical devices and tax breaks. This sector will demand even more subsidies from the government and will justify this with higher revenues from medical tourism. A worrying development because subsidizing the private sector will further reduce the government's limited resources for public health. According to the United Nations Development Program (UNDP) 2006 Human Development Report, government spending on public health in India is $ 82 per year (purchasing power parity) (or 1.2 percent of gross domestic product) compared to $ 5,711 in the US, $ 2,389 in the UK, and $ 3,001 in Germany. Under these conditions, why should Indian taxpayers subsidize private medical care for rich countries?

Nikhila M. Vijay is an engineer for medical device technology and a member of "Kabani - the other direction", an initiative from Kerala (India) that advocates more sustainable tourism development.

Editing and translation from English: Christina Kamp

(10,382 characters, 137 lines, March 2007)