Medical Tourism in Legal Prospective

Vinay K Narula*
*Research Scholar
Institute of Tourism & Hotel Management,
Bundelkhand University, Jhansi
Vin_nar@rediffmail.com, +91-9919383918
1. Introduction

While costs of many elective surgeries and medical procedures continues to rise in the
US, many people considering going under the knife are looking abroad for cost cutting
options. This blossoming industry, known as Medical Tourism, must be approached with
even greater caution than surgery in the United States. It is big business, and potential
patients are often lured overseas by the promise of quality medical care for as little as
one tenth the cost of the same procedure in the US.

“The cost of surgery in India, Thailand or South Africa can be one-tenth of what it is in
the United States or Western Europe, and sometimes even less. A heart-valve
replacement that would cost $200,000 or more in the US, for example, goes for
$10,000 in India--and that includes round-trip airfare and a brief vacation
package.”And also, “Similarly, a metal-free dental bridge worth $5,500 in the US costs
$500 in India, a knee replacement in Thailand with six days of physical therapy costs
about one-fifth of what it would in the States, and Lasik eye surgery worth $3,700 in
the US is available in many other countries for only $730. Cosmetic surgery savings are
even greater: A full facelift that would cost $20,000 in the US runs about $1,250 in
South Africa. [1]

What is Medical Tourism?

Medical tourism (also Known as medical travel, health tourism or global healthcare) is a

term initially coined by travel agencies and the mass media [2] to describe the rapidly-
growing practice of travelling across international borders to obtain health care. It also
refers pejoratively to the practice of healthcare providers travelling internationally to
deliver healthcare [3]. Services typically sought by travelers include elective
procedures as well as complex specialized surgeries such as joint replacement, cardiac
surgery, dental surgery, and cosmetic surgeries. However, virtually every type of
health care, including psychiatry, alternative treatments, convalescent care and even
burial services are available.
Over 50 countries have identified medical tourism as a national industry.
[4] However, accreditation and other measures of quality vary widely across the globe,
and some destinations may become hazardous or even dangerous for medical tourists.
In the context of global health, "medical tourism" is a pejorative because during such
trips health care providers often practice outside of their areas of expertise or hold
different[5] (i.e., lower) standards of care[6]. Greater numbers than ever before of
student volunteers, health professions trainees, and researchers from resource-rich
countries are working temporarily and anticipating future work in resource-starved
areas.[7]

2. Process
A medical tourism provider is to be consulted by the people who are seeking medical
treatment abroad. Then the patient is supposed to provide with a medical report,
including the nature of ailment, local doctor’s opinion, medical history, and diagnosis
to the provider who may request even the additional information. Certified medical
doctors or consultants then generally advice the concerned person on the medical
treatment. The approximate expenditure, and tourist destinations, choice of hospitals
and duration of stay, etc., is discussed so that the patient gets an approximate idea.
The patient is given recommendation letters for a medical visa after signing consent
bonds and agreements to be procured from the concerned embassy. The medical
tourism provider assigns a case executive after the patient travels to the destination
country that takes care of the patient's accommodation and treatment and any other
form of care. The patient can remain in the tourist destination or return home after
the treatment is done. [8]

3. India: Most preferred destination for Medical Tourism

India will with no doubt become the global health destination. It aims to replicate
the Thai model, which is still the first Asian destination for International Patients.

With prices at a fraction (sometimes only 1/10th!) of those in the US or EU, the
concept has broad consumer appeal – if people can overcome their prejudices about
health care in developing countries. The reality is that Indian private facilities offer
advanced technology and high-quality procedures on par with hospitals in developed
nations.

India is the leading country promoting medical tourism in the world. It is even moving
into a new area of "medical outsourcing" where subcontractors aim to provide services
to the overburdened medical care systems in western countries. Medical tourism to
India is growing by 30% a year and the Indian education system is churning out an
estimated 20,000 to 30,000 doctors and nurses each year.

India benefits from a large staff of world class experts and the ultra-competitive cost
advantage it offers. While a heart surgery costs $30,000 in the US, it costs $8,000 in
India. Similarly, a bone marrow transplant costs $26,000 here compared to $250,000 in
the US. You can add to this that Indian doctors are among the best in the world.

Howard Staab, a 53-year-old carpenter-contractor from North Carolina, was diagnosed

last year with a serious heart condition. Mr. Staab's doctor recommended surgery as
soon as possible. But he had no health insurance. The estimate for hospital care alone
was nearly $100,000. The cost for the surgeon, the cardiologist, the anesthesiologist,
the radiologist, and the pathologist, along with the cost of a heart valve and
prescription drugs, has brought the total up to a staggering $200,000 - assuming no
complications. Howard Staab did some research and decided to go to Escorts Hospital
in New Delhi, where the estimated cost was under $10,000, including airfare, surgery,
and rehabilitation! Howard Staab said, "I was apprehensive in the beginning because I
had no experience with India or about the quality of care, and the situation there. But
my experience was superb. From the time we arrived at the airport, Hospital people
escorted us to the hospital, gave us excellent care. The surgeons and all the staff were
extremely professional, kind and caring. Everything went very well and I was so
satisfied and impressed with the care".
Most non-urgent Western patients usually get a package deal that includes flights,
transfers, hotels, treatment and often a post-operative vacation. There are many
brokers specialized on the Indian market.

Medical tourists are also increasingly coming as well for the renewal of Indian
traditional medicine such as yoga, ayurveda and meditation and combine this with the
western treatments they receive during their stay.[9]

4. Legal ethical Aspects of Medical Tourism

The illegal purchase of organs and tissues for transplantation had been alleged in
countries such as India[11][12] and China [13] prior to 2007. The Declaration of
Istanbul distinguishes between ethically problematic "transplant tourism" and "travel
for transplantation". [14] Medical tourism may raise broader ethical issues for the
countries in which it is promoted. For example in India, some argue that a "policy of
'medical tourism for the classes and health missions for the masses' will lead to a
deepening of the inequities" already embedded in the health care system.  In Thailand,
in 2008 it was stated that, "Doctors in Thailand have become so busy with foreigners
that Thai patients are having trouble getting care" [15] Medical tourism centered on
new technologies, such as stem cell treatments, is often criticized on grounds of fraud,
blatant lack of scientific rationale and patient safety. However, when pioneering
advanced technologies, such as providing 'unproven' therapies to patients outside of
regular clinical trials, it is often challenging to differentiate between acceptable
medical innovation and unacceptable patient exploitation.[16][17]
Receiving medical care abroad may subject medical tourists to unfamiliar legal issues.
[18] [19] the limited nature of litigation in various countries is one reason for the lower
cost of care overseas. While some countries currently presenting themselves as
attractive medical tourism destinations provide some form of legal remedies for
medical malpractice, these legal avenues may be unappealing to the medical tourist.
Should problems arise, patients might not be covered by adequate personal insurance
or might be unable to seek compensation via malpractice lawsuits. Hospitals and/or
doctors in some countries may be unable to pay the financial damages awarded by a
court to a patient who has sued them, owing to the hospital and/or the doctor not
possessing appropriate insurance cover and/or medical indemnity.[20][21][22][23]
5. Conclusion
Ministry of Tourism India (MoT) is planning to extend its Market Development Assistance
(MDA) scheme to cover Joint Commission International (JCI) and National Accreditation
Board of Hospitals (NABH) certified hospitals. A policy announcement of this effect is
likely soon.[24]
Hospitals groups like The Global Hospitals Group, MIOT Hospitals, Fortis Healthcare,
Apollo hospitals, Max Hospitals, Dharmashalas have increased their presence in
international market for medical tourism.
The south Indian city of Chennai has been declared India's Health Capital, as it nets in
45% of health tourists from abroad and 30–40% of domestic health tourists.[25] The
hospitals in Chennai are equipped with state of the art medical equipments and
Chennai is relatively inexpensive city compared to the other metropolitan cities
like Mumbai (Bombay) and Delhi. 
Nearly 450,000 foreigners sought medical treatment in India in 2007, with Singapore
not far behind and Thailand in the lead with over a million medical tourists As the
Indian healthcare delivery system strives to match international standards the Indian
healthcare industry will be able to tap into a substantial portion of the medical tourism
market. Already 13 Indian hospitals have been accredited by the Joint Commission
International (JCI).It is not uncommon to see citizens of other nations seek high quality
medical care in the US over the past several decades; however in recent times the
pattern seems to be reversing. As healthcare costs in the US are rising, price sensitivity
is soaring and people are looking at medical value travel as a viable alternative option.
In the past the growth potential of the medical travel industry in India has been
hindered by capacity and infrastructure constraints but that situation is now changing
with strong economic progress in India as well as in other developing nations. [26] With
more and more hospitals receiving JCI accreditations outside the US, concerns on
safety and quality of care are becoming less of an issue for those choosing to travel for
medical treatment at an affordable cost. The combined cost of travel and treatment in
India is still a fraction of the amount spent on just medical treatment alone in many
western countries.
In order to attract foreign patients many Indian hospitals are promoting their
international quality of healthcare delivery by turning to international accreditation
agencies to standardize their protocols and obtain the required approvals on safety and
quality of care

References:

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11.  Medical Protection Society | MPS UK
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14.  The Epoch Times | Transplants and Ethics in San Francisco
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16.  Indian Journal of Medical Ethics
17.  Medical Tourism Creates Thai Doctor Shortage : NPR
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19.  ISSCR Guidelines for the Clinical Translation of Stem Cells. 2008
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