UK spikes India's medical tourism dream

Falaknaaz Syed - Mumbai

The Indian healthcare industry has failed to impress the British government's National Health Service (NHS) to outsource its patients to India. Sources attribute this to Indian hospitals' lacking accreditation from Joint Commission on Accreditation of Healthcare Organisations (JCAHO), lack of standards in terms of quality and rates for healthcare procedures, absence of gradation system and the far from perfect insurance sector here.

Explains Dr Dheeraj Bhujwani, CEO, Fore Runner Healthcare Consultants, "Unlike those in the UK, none of the hospitals in India are JCAHO-accredited--an imperative to win outsourcing contracts. Also, NHS patients are insured and the total health care expenditure is borne by the government, which does not apply here. Therefore, NHS is sending its patients to Spain and Germany which also offer free bed facilities.”

In stark contrast to the UK healthcare scenario, where hospitals are standardised, audits regularly performed and hospitals graded, the systems are completely absent in Indian hospitals. Top Indian hospitals have high infection and mortality rate, and do not want to share their data regarding these

Says Sushil Jiwarajka, chairman, Federation of Indian Chambers of Commerce and Industry (FICCI), “NHS has a long waiting list of patients. Even for a small cataract operation there are patients waiting since two years. Besides the cost at which healthcare services are offered here, are a fraction of the cost in UK, but our record keeping, software, and systems are not up to the mark.”

But Indian hospitals are too keen to get outsourcing contracts from the NHS and several hospitals like the Hinduja Hospital in Mumbai have placed advertisements in the NHS Family Choice directory, the yellow pages of world class health care facilities.

Experts say that acquiring JCAHO accreditation is a costly and a continuous process, costing around 50,000 to 200,000 USD. It takes around two years to get accredited by JCAHO. The Medical Tourism Council of Maharashtra is trying for it, so if 10 hospitals get together to get accredited, the cost incurred by each hospital would be much less. "We have tried getting ratings and standardisation through rating agency CRISIL but the problem is that no one recognises CRISIL abroad", informs Gawli.

If India wishes to get patients from the United States where healthcare is run by private players, the problems will be much the same. Dr Rajendra Sharma, director administrations of Bombay Hospital and Medical Research Centre says, "Our government should plan an accreditation body and a gradation procedure for our hospitals. We should have our own benchmarks and criteria to judge organisations. Why should we depend on the United States for it?"

When asked if other countries will recognise Indian gradation procedures, Dr Sharma said,"Our degrees like DM and MCH and our nurses are recognised abroad. Then why not our gradation procedure?"

In India, only five per cent Indians are insured and they are corporates. Less than 0.5 per cent individuals are insured. Awareness about healthcare is poor. Rules of reimbursement are stringent, performance of third party administrators (TPAs) are not satisfactory. Discharge details, disease codings, ICD codings and handling of medical records are not in place, making it difficult to get outsourcing contracts from the US.

S K Mahapatra, past general secretary, General Insurance Public Sector Association, GIPSA, echoes, "The Union Health Ministry has to take the initiative for a solution. There is no integrated legislation for healthcare providers, hospitals, nursing homes, laboratories, path-labs or for practitioners. Though we have the Indian Medical Association and state level organisations, they do not function satisfactorily. There has to be a common regulation for healthcare providers and health care practitioners. Since standardisation procedures are not in place, the insurance industry too is facing difficulties."

However, if the NHS would like to benchmark hospitals for outsourcing purposes, then they can engage a rating agency acceptable to them. In the interim, they could do this and on a pilot basis, selective hospitals in major cities could be rated and the NHS could have an MOU with these hospitals.