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Dr. Indrajit Hazarika, M.D M.P.H

Public Health Foundation of India
]lobalization and health services

6 A mixed blessing from a public health perspective

6 ]rowing cross-border delivery of health services
6 Trade in health services is estimated to be in excess of
$140 billion
6 Medical Tourism is a major component of the health
service sector
 Medical Tourism

ã ´Medical Tourismµ refers to patients going to a

different country for either an urgent or elective
medical procedure
ã It is fast becoming a multibillion-dollar industry
ã Trade in global medical tourism was estimated at
$20 billion and is expected to double by 2010
Medical Tourism in India

ã Approximately 1,50,000 patients arrived in India

in 2005 and this is expected to increase by 15%
each year
ã The medical tourism market in India was
estimated at US$ 333 million in 2004
ã It is growing at the rate of 30% a year and is
expected to generate revenues of US$ 2 billion by
2012 as per a study conducted by CII and
McKinsey.
Predicted growth of medical tourism
in India
30000

25000
25000

20000

15000

10000
7000

5000
2000
500
0
2007
K 2012 2017

2022


By 2012 India is likely to become the top medical destination

2

Advantage India
ã Well-trained health practitioners
ã Large populace of good english speaking
doctors, guides and medical staff
ã Availability of super-specialty centers
ã Availability of latest, technologically advanced
diagnostic equipments
ã Competitive cost of medical treatment
ã Provides a good mix of allopathic and alternative
systems of medicine
 ost USD ost Savings
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India as a ´global health destinationµ
ã Super-specialty hospitals in the private sector
offering services to medical tourists
ã The National Health Policy 2002 strongly
encourages medical facilities to provide services
to users from overseas
ã ´Mµ or medical-visas
ã Improve the infrastructure e.g. airports
 Major Players in the Indian Medical
Industry
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2

India as a ´global health destinationµ
ã Super-specialty hospitals in the private sector
offering services to medical tourists
ã The National Health Policy 2002 strongly
encourages medical facilities to provide services
to users from overseas
ã ´Mµ or medical-visas
ã Improve the infrastructure e.g. airports
Potential threats

ã Deepen inequities in the health systems

ã Intensify shortages of skilled health professionals
ã Promote unregulated growth of the private sector
ã Increase cost of medical treatment
ã Raise quality of care and accreditation issues
]rowth of the private sector

ã Private sector today accounts for 82% of OPD

visits, 58% of IPD expenditure and 40% of births
in institutions
ã Private hospitals earned US$ 15500 million in
fiscal year 2006 and revenues from the sector are
expected to rise up to US$ 32500 million in
2012, which represents an annual revenue
growth rate of about 19% a year
Failure of the public sector

ã low government expenditure on health

ã poor management of resources
ã acute shortage of skilled workforce
ã large-scaled absenteeism
ã corruption
ã lack of ownership
ã shortfalls in infrastructure
Shortfall in health infrastructure
-%& ' +:  6;% 

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&
& 


7 % '! '!! ! ' '

V.%  !  ' 

..% !' !'   

2


  


2
Hospitalized treatment (Urban)
70
60.3 61.
60 56.9

50
43.1
39.7 3 .

40

30

0

10

0
19 6- 7 1995-96
004
]overnment Private

2
22
Hospitalized treatment (Rural)
70

59.7 58.3
60 56.2

50
43.8
40.3 41.7
40

30

20

10

0
1986-87 1995-96 2004
Goernment riate

2
22
Potential threats

ã Deepen inequities in the health systems

ã Intensify shortages of skilled health
professionals
ã Promote unregulated growth of the private sector
ã Increase cost of medical treatment
ã Raise quality of care and accreditation issues
Shortages of skilled health
professionals
ã Acute shortage of medical and paramedical staff
ã Mal-distribution of the existing health personnel
ã Existing CHCs have a high shortfall of
specialists, such as obstetricians & gynecologists
(56%), pediatricians (67%), surgeons (56%) and
medical specialists (59%)
Shortages of skilled health
professionals
ã Over 75% of the human resources and advanced
medical technology, 68% of the estimated 15,097
hospitals and 37% of 623,819 total beds are in
the private sector
ã Shortages in the public health sector due to
bottlenecks in the recruitment process, poor
financial incentives, absence of a conducive work
environment and the prevalence of corruption
Potential threats

ã Deepen inequities in the health systems

ã Intensify shortages of skilled health professionals
ã Promote unregulated growth of the private
sector
ã Increase cost of medical treatment
ã Raise quality of care and accreditation issues
Promote unregulated growth of the
private sector
ã No policy framework to have a common set of
regulations for the private health care sector
ã Implementation and enforcement of rules and
regulations has been weak
ã Resistance from the private health care sector to
accept certain regulations
ã 100% FDI is permitted for all health-related services
ã Infrastructure status has been accorded to hospitals
ã Income tax exemption for 5 years to hospitals in
rural areas, Tier II and Tier III cities
Potential threats

ã Deepen inequities in the health systems

ã Intensify shortages of skilled health professionals
ã Promote unregulated growth of the private sector
ã Increase cost of medical treatment
ã Raise quality of care and accreditation issues
Increase cost of medical treatment

ã The health insurance market in India is very limited

covering about 10% of the total population
ã Out-of-pocket payment accounts for 72% of all
health expenditures
ã Around 24% of hospitalized patients in India fall
below the poverty line due to hospitalization
ã Lack of finances was a reason for untreated
episodes by 28% of persons in rural areas and
20% in urban areas
Average medical expenditure per
hospitalization
14000

12000 11553

10000

8000 7458

6000 5344
4300
4000 3238 2877
2080 2145
2000

0
1995-96 2004 1995-96 2004

Rural Urban

]overnment Non-government

Source: NSSO
Increase cost of medical treatment

ã A trade-off of the increase in medical tourism will

be the rise in the overall cost of health care
ã Increases in cost will make medical treatment
unaffordable
Potential threats

ã Deepen inequities in the health systems

ã Intensify shortages of skilled health professionals
ã Promote unregulated growth of the private sector
ã Increase cost of medical treatment
ã Raise quality of care and accreditation
issues
 Raise quality of care and
accreditation issues

ã ]overnment and CII have taken the lead in the

process of national accreditation and licensing for the
private sector
ã Many Indian hospitals have secured accreditation
from the British Standards Institute and Joint
Commission on Accreditation of Healthcare
Organizations
ã Few initiatives to standardize quality of care in the
public sector
Conclusion
ã India has the potential to become a ´global
health destinationµ
ã It is projected to become a billion dollar industry
in India
ã The private sector has undertaken initiatives to
capitalize on this opportunity and is the key
player
ã Its growth poses as a potential threat to the public
health system
Challenges

ã Harmonize regulations within the country

ü Regulate the growth of trade in this sector
ã Address the lack of availability of skilled health
professionals
ü Upscaleexisting and establish new institutes
ü Improve incentives for professionals in the public
sector
ã Reduce gaps in quality of care provided in both
the public and private sectors
ü Standardize the quality of care
Challenges
ã Provide affordable health services
ü subsidized treatment options for poor patients
ü increase the scope for health insurance

ã Facilitate public-private sector partnerships

ã Establish an information system