Topic: Summit on India the Future Global Healthcare Hub

Date: 1^st May, 2015

Venue: PHD House

Organizers: PHD Chamber of Commerce

Attendee: Mr. Aritro Dasgupta

This summit was held to enable a discussion on the present scenario and projected future trends of the medical tourism field in India. The idea is that India is on the cusp of becoming a global healthcare hub and is increasingly attracting medical travelers from across various parts of the world. This poses certain challenges and throws up opportunities for the industry to ascertain advantage of. This write-up is going to explore the discussion this august forum threw up and recommendations which the PHD Chamber ought to forward ahead to.    

Inaugural Session

This session consisted of 5 panel members. They were as follows:

Mr. Saurabh Sanyal

Being in charge of the opening remarks, Mr. Sanyal introduced the members in the panel and set the tone for the discussions. He spoke about how PHD Chamber hopes to elicit lively discussion surrounding the topic and the points that will be generated will be further forwarded ahead for the national level policy makers to take notice of. 

Mr. Sanjeev Sardana

The speaker started of his talk by pointing towards a positive step that has emerged. The FDA (Food & Drug Administration) of the US Federal government has now allowed certain procedures to be outsourced. This provides a great opportunity for the Indian medical fraternity to further their reach and scope. Unfortunately though, medical care still forms a comparatively small portion of the vast Indian GDP. As of now only 4% of the total GDP is occupied by this sector. The average in OECD member countries is 9% and it is 11% and 16% respectively in Germany and the USA. If India is to reach the pinnacle of her potential in this industry, this percentage has got to rise to about double figures.

Nishant V Berlia

This speaker began his talk by paying homage to the thousands of innocent people who have perished due to the natural calamity of the earthquake in neighbouring country- Nepal. He also spoke about the active role which the PHD Chamber is playing in providing aid to Nepal. PHD Chamber has sent a team to help there as well as is developing policy papers to present to Indian government so that losses of life and property can be reduced by as much as possible in the event of another such calamity in the future.

H.E. Ms. Gennet Zewide

Her Excellency Ms. Genet Zewide spoke about the ongoing relations between India and Africa with particular focus on her country – Ethiopia- regarding the concept of medical tourism. She also lauded India’s position of leadership in the field of global healthcare. She feels that the title of the day’s meet was misleading as India is not the ‘future’ healthcare hub but indeed is already acting as such. By the year 2020, India will have a gross turnover of around US$ 280 million in this sector.

Her Excellency then mentioned that earlier Ethiopians used to visit countries like Thailand, Kenya or South Africa for medical value travel but now India is the preferred destination by some distance. Cultural differences with India do not amount to much as Indians have impeccable English and Ethiopians are increasingly taking to English as a language of communication. Ethipians and other Africans also love Indian food and their own food is spicy like Indian. Thus they feel comfortable on the culinary side in this country.

She then moved on to the cost part and said that while it was internationally acknowledged that costs for medical value travel were lower in terms of quality than elsewhere, yet some complications did exist. She gave a few pointers for our policy makers to act upon. She said that agents / touts were present across Ethiopia and other countries of Africa to recruit potential medial tourists to visit India. Africa being continent of rising economic power and mobility, has a large population of people who sign up for traveling to India to cure their medical ailments. Unfortunately what often transpires to these tourists on arrival to India, terms and conditions change. They were promised something, but on reaching India they realize wrong promises were made. Now nothing can be done as they are already in a foreign country and have spent a significant amount of money. Sometimes the hospitals do not release patients early leading to rise in costs. Also foreigners by policy at most hospital chains are charged 20% extra. This policy to some extent makes sense with nationals of western countries with high standards of living but not for the vast majority of medical travelers who come to India from the developing world, often from countries with a lower standard of living than India. The speaker recounted an incident where she went for a routine check-up and being a permanent resident in India, she had the rupees to pay, but the hospital authorities insisted that she pay in Dollars or some other such internationally accepted currency as she is a foreigner. There have even been some extreme cases where the passports of patients have been confiscated on failure to provide the exorbitant charges levied that were not specified earlier.

Moving away from this somewhat depressing trend, Her Excellency informed the audience that India was not just attracting medical travelers from the developing world but also from developed countries of North America and western Europe as healthcare was cheaper in India for them even after paying for the flights, visa, accommodation etc. She then informed that due to the rising income levels in the continent of Africa it is no longer only the very rich who wish to visit India for healthcare purposes but also the rising middle classes. To cater to this middle class, Indian hospital chains must consider setting up branches at certain hubs in Africa. Finally she promised that Indian hospital chains can set up their premises in her country. 100% FDI facility will be given to Indian concerns and the government will also help them secure land at affordable rates. This announcement led to a chorus of applause from the entire audience. 

Mr. Himanshu Baid

Mr. Baid recognized the important contributions of the panelists and handed out mementos to each of them. He declared special thanks for the chief guest of the day’s proceedings, the Ambassador from the Embassy of FDR Ethiopia.

This session was followed by a round of Networking Tea.

Technical Session 1: Care & Concern for Foreign Patients

This session consisted of 11 panel members. The panelists were as follows:

H.E. Mr. Ernest Rwamucyo

This speaker spoke about how his country- Rwanda- and India have signed MoU for mutual cooperation in the field of medical tourism. He also acknowledges that there are high end hospitals operated by Indians or Indian firms in the capital of his country- Kigali. Due to such high end hospitals sprouting up in his country, there has been a reduced requirement for Rwandans to travel abroad for such basic medial cures. He has visited hospitals in India seeking to develop strategic ties and one thing he has noticed is that most nurses in this country hail from the state of Kerala. He acknowledges the achievement of the state to develop such competence in this line and has thus help ink agreements with Kerala state government even to develop nurse training facilities in Rwanda.

As opposed to the usual reservations which the general public has towards paperwork, His Excellency feels that paper work is appropriate in India and double checks are indeed needed. He feels this bureaucratic system prevents a lot of otherwise wrong doings, and thus complaints are not valid. He also exclaimed that bills are often very long at hospitals and this may put some medical travelers off but this is actually a very good system as it ensures checks and balances. Transparency in the system is thus maintained. He however feels that there must increase the ease of contact between the doctors and patients as the latter then feel far more comfortable.  

H.E. Mr. El Hadj Ibou Boye

This speaker spoke about how infant mortality is one of the biggest afflictions in his country – Senegal- and that is one of the primary reasons why medical value seekers travel to India. India has better and cleaner services for such activities.

H.E. Mr. Maxwell Ranga

Mr. Ranga acknowledged that there are many Indian trained doctors working in Zimbabwe as India is a brand name in the medical field at every level. Zimbabwean hospitals also import drugs and medicines directly from Indian sellers, there is little bureaucracy involved in all this. He suggested the concept of hospital twinning where Indian hospitals can ‘twin’ with contemporaries in Zimbabwe or elsewhere in Africa. This will enable fruitful exchange of knowledge, ideas and business practices across the medical spectrum. His country welcomes investments in the medical field by India if Indian firms or government wish to. Finally he suggested that there ought to be tourism licensing agencies which have been granted charter for enabling medical travel to continue between these various countries. This will remove the unorganized system of touts.

Mr. Mongy Badr

Mr. Badr spoke about the unique challenges and opportunities which his country faces with relations to India. He spoke about how Egypt, while technically in Africa, is actually an Arab country but being close to Europe is also influenced by the same. Thus the country acts as a gateway to various parts of the world. Egypt’s rich history and heritage plus scenic natural beauty makes the country a tourism hub, the speaker informed that the problems which occurred 4 years back are now part of the past as the present is secure and safe. But he also warned that Egypt was growing its domestic organic healthcare at a much better rate than more wealthy economies Like the Kingdom of Saudi Arabia or the United Arab Emirates. So India will have to act fast in order to retain the top billing among Egyptian people for premium medical travel. Mr. Badr ended his talk by mentioning the Indian film industry especially Bollywood and how it holds sway in Egypt as well as much of north Africa and the broader Arab world and this in itself is a very positive branding for this country.

Mr. Alieu Bah

Being located strategically in west Africa, Gambia is a country which can act as a hub for medical travel towards India. A lot of locals have recently taken interest but there is a need for organizing everything under a proper umbrella so that local small time touts cannot exploit needy patients whether back home in Gambia or on reaching India. 

Mr. Syed Zirgham Raza

Being from neighbouring Pakistan, this speaker’s talk felt great resonance with the audience as people were better able to relate exactly what Mr. Raza was speaking about. He spoke about how India and Pakistan share the same culture and history and how whatever happens in India affects Pakistan in more ways than one. He also said that political matters apart, the Pakistani people feel a great deal of affection for India. He then moved on to the specific topic of medical tourism and how a number of Pakistanis come to India for curing their medical ailments. These people do not come for any politics but indeed purely for medical reasons. Unfortunately, purely by virtue of holding Pakistani passports, these medical travelers face a lot of harassment in crossing the border. While at some stage, Mr. Raza understands the reason at this caution, but he also believes that efforts must be taken at improving the cooperation between these countries. Finally he complimented India on having developed such highly efficient and sophisticated mechanisms at hospitals. The facilities are world class. If there is one thing that India’s medical fraternity lacks, that is a bit of spirituality or empathy. A bit more of these elements and India will become a true superpower in the field of global healthcare.  

Dr. Avnish Kumar Seth

The speaker is an expert on vital organs’ transplant. He says that this entire line is disrupted by having middlemen who advise their clients wrongly. He speaks about patients having terminal cancer who flew from other countries to get some organ transplanted. Dr. Seth says that is not possible as there is no reliable cure to that kind of severe ailment but the patient and family were duped by the agents. Similarly sometimes hospitals also provide false hope to patients’ families where they must know that the patient is facing a condition where there is no cure. In that case, they must just let the patient leave and prolong the happiness during the remainder of life.

The speaker also spoke about a list of priorities that every hospital in India needs to follow while facilitating organ transplants. The hierarchy comprises in order of preference: state list- regional list- national list- PIO (Person of Indian Origin)- foreigner. Thus a foreigner cannot expect to get a liver transplant if there are 20,000 Indian patients in line waiting. This is a realistic number quoted. Dr. Seth also advised foreign travelers seeking transplants to not directly contact hospitals but route their requests for such sensitive matters via their respective embassies or consulates. They will provide a Form 21 which includes a significant fee waiver along with guarantee of all procedures followed.   

Dr. H Jauhri

Dr. Jauhri was somewhat critical during his talk about the state of Indian medical practice with regards to handling foreign patients. He says that accurate statistics are required but not readily available. Tourists who visit foreign countries for holiday also encounter a sense of anxiety, thus the speaker pondered how much anxiety medical travelers and their families would be feeling on coming to a new country. As it is they themselves or they are accompanying someone who has a very severe ailment because of which one has to spend so much money and travel to a foreign country. On top of that the culture is new and conditions are alien. They travel purely based on faith. Thus these people needed to be treated with kindness. A bit of psychology must also be applied on such medical travelers. He also spoke about hospital chains catering to a substantial number of foreign clients and yet sticking to pure Indian food whereas they have the means to provide food that travelers are comfortable with. He desired us to imagine ourselves in a position where we are in foreign country requiring help and we do not even get to consume familiar food. He also then spoke about how insurance policies for medical travelers need to be amended to suit them more. 

Dr. H.S. Chhabra

This speaker is an expert on spinal injuries. He says that in spite of being so critical to humans, very little attention was paid to spinal injuries until very recently. They were in fact considered untreatable not so long back. 90% of soldiers who had spinal injuries during the First World War died within 1 year of suffering those wounds, and less than 1% actually survived 20 years post the cataclysmic event. Now things are improving as substantial advancements have been made in treating spinal cord related injuries.  

Mr. Navneet Bali

In reference to what H.E. the Ambassador from Ethiopia spoke in the inaugural session, he agreed that costs rise for foreign tourists but not just 20%, in fact up to 30%. He feels that this trend can be reversed if these patients route their treatments directly via their embassies, then instead of paying more, they will need to pay less than the average Indian will be paying. A substantial portion will be covered by the embassy in cases where those countries have prior bilateral agreements on medical tourism with India. He however, proudly announced that the cases of passports being confiscated of foreign nationals is not a widespread malaise and he has not heard of any such event for a significant period of time. He spoke about how robots are creating a revolution in the business of healthcare as they are replicating a lot of sophisticated, routine operations which earlier required the human hand.  

Mr. Sanjay Beswal

This speaker informed his own opinion that he would rather be treated by experts such as Dr. Jauhri or Dr. Seth than robots. He also concluded the entire session by summing up the points and declaring how PHD Chmaber would put ahead these points to the concerned ministries and industry bodies. Finally mementos were distributed to all members.

This session was followed by the Networking Lunch. Thus all delegates came to know each other better over this session.

Technical Session 2: Advancements in Medical Technologies in Indian Hospitals in Tier 1 & Tier 2 Cities

This session consisted of 9 panel members. The panelists were as follows:

Major points discussed at this session were as follows:

$1· Dr. Popli spoke convincingly for significant amount of time and she spoke about the regulations presently in place which must be tightened. Unlike other industries where industry leaders urge policy makers to relax regulations, here she feels that it is time for the government to tighten agent norms so that patients are routed through regulated agencies only.

$1·  A major improvement cited is the presence of blood banks and other banks for medical emergencies. It was however lamented that more on the same lines will be required.

$1·   Mr. Multani did the Vote of Thanks, acknowledging the members for their contribution to the discussion.

This session was followed by another round of Networking High Tea.

Valedictory Session: Future of Ayurveda , Yoga, Unani, Siddha and Homeopathy (AYUSH) & Industry Perspective for Promoting its Global Access

This session consisted of 4 panel members. The panelists were as follows:

Mr. Sanjay Aggarwal

This speaker being in charge of the welcome address for the valedictory, set the tone for the discussions ahead. He spoke about AYUSH and the concepts it encapsulates. He also introduced the panel members including the chief guest.

Mr. Pradeep Multani

This speaker spoke about how India is a country famous for herbs and medicinal plants found across the subcontinent. However India’s contribution to the global herbal market was a whopping low of 0.2%. This has to change soon and significantly, if India is to position itself as a leader in global healthcare.

H.E. Dr. Sudarshan Seneviratne

His Excellency introduced himself by saying that he was educated in the arts of history and archaeology and thus was not a typical diplomat with answers to all business related questions. He however had studied in India- Delhi University and JNU- and thus understood Indian culture extremely well. He said that Sri Lanka was also culturally quite close to India and other countries in the region like Pakistan, Nepal and Bangladesh. Recently he had visited Punjab and feels the colours and smells everywhere felt familiar to back home. Even Buddhism the main religion of his country is an import from India.

His Excellency then moved on to provide us some pointers for developing tourism. He spoke about how Sri Lanka was enmeshed in a bloody civil war which lasted for 3 decades. During that period, bullets would fly frequently on all directions and bombs would burst at uneven times rippling through places of human occupation. Yet during that period Sri Lanka continued receiving high net inbound tourists who would stay at the best places. This is something that puzzled him as he was certain beaches weren’t the reason for the same. He felt there were better beaches in places like Maldives, Thailand or Jamaica for the kind of wealthy tourists that were arriving. When he spoke to the lot, he realized the major reason was that Sri Lanka provided a package which included natural beauty, history- heritage and wellness. The wellness concept including yoga and Ayurveda was a big attraction to a lot of foreigners. And this is where he feels India can leverage off. He feels India must not concentrate only on big 5 star hotels as the kind of foreigners he spoke of, can easily afford such places. They wanted to see the real India. If they could stay at a place where nearby a potter was using the traditional wheel to create something organic, their visit would be more wholesome. His Excellency confirmed that Sri Lanka being a much smaller country than India meant that the exact model may not be replicable, but something on those terms may work very well for India.

Mr. Sastry

This speaker announced a vote of thanks for all members present during the panel discussion. He then felicitated the panelists with mementos for their contributions.