India Report

Expertise and low cost makes
sub-continent an attractive healthcare destination


Middle East Health visited several leading hospitals in key cities in India to assess the current status of health tourism to the sub-continent. We discovered that although the country struggles with widespread poverty and pervasive pollution – two hindrances to attracting patients from overseas – a number of top hospitals do manage to attract patients from abroad largely because they have the medical expertise and the cost of specialist healthcare procedures is very competitive compared to other countries where advanced healthcare is available.

India is a vast country with a population in excess of one billion people. It rivals China for the country with the largest population in the world. This is manifest in several congested mega cities – Delhi, the capital, Mumbai on the west coast, and Chennai and Kolkata on the east coast. There are others, but these are the ones we visited. The first-time visitor from the developed world is usually in for a bit of a shock. From their perspective the country can appear extremely congested, chaotic, polluted, unhygienic and generally in a state of disrepair – none of which is conducive to attracting people in ill health from economically advanced countries like the US, Canada or those in Western Europe. But with such a large population and a rapidly growing middle class, does India need to attract foreign patients? In reality the answer is no – as several doctors told us on our tour of the country. They have more than enough local patients to fill their hospital beds – even in the private sector.

Doctors and marketing managers we spoke to at most of the hospitals we visited said they had initially tried to attract patients from the United States and Europe using the massive price differential for treatment as the key attraction, but had given up on this idea after not achieving much success. However, most said that they were receiving foreign patients and that the numbers were growing exponentially year on year – but the patients mostly came from the developing world, from countries lacking good quality healthcare.

“They come from the Middle East and several African countries, as well as from Russia and the former soviet states to the north and Bangladesh to the east,” we were told.

All the hospitals we spoke to have established International Patient Services departments offering – with varying degree – a complete package of services for prospective patients, including initial consultation with the patient while still in their home country, flight and medical visa arrangements, airport pick-up, accommodation for accompanying relatives, hospital admission procedures, co-ordination with the patient’s insurance for billing – if the patient is not paying out of pocket (most foreign patients do pay out of pocket) – hospital discharge , follow-up (with video conferencing) with the patient and their doctor in their home country.

So it clearly a combination of the available expertise and the cost-effectiveness of treatment, that is attracting patients to India, particularly those from the developing world where good healthcare is not readily available. However, patients from economically advanced countries tend to avoid India – even though the cost of healthcare may be extremely attractive – because of the general malaise from which Indian cities suffer as a whole – that is population congestion and pervasive pollution.

Nonetheless, it is a vast country and there is a large choice of excellent hospitals which, combined, cover all healthcare specialties – from heart transplant to world-class cancer care. Once you have entered the domain of one of these fine hospitals, you can put the ills of India behind you and you could well imagine you’re in a hospital on par with the best in Europe. Following is a brief look at some of the private hospitals we visited.

The Hospital Tour

S.L. Raheja Hospital

We started our journey in Mumbai at the S.L. Raheja Hospital – a 140-bed, multi-specialty tertiary care facility. The hospital is part of the large India-wide Fortis Group. We spoke to George Alex, the head of sales and marketing.

He explained that although the hospital did have an International Patient Services setup, only about 2% of the hospital’s patients came from other countries for treatment.

S. L. Raheja Hospital is one of India’s leading hospitals for advanced management in diabetes and oncology, as well as trauma and cardiology. S.L. Raheja is a Centre of Excellence for oncology with some of India’s leading cancer specialists, such as Dr Suresh Advani, practicing at the hospital. The hospital is also a Centre of Excellence for diabetes. In this regard, Alex pointed out that gastric bypass surgery – for weight loss and as a cure for diabetes – has become increasingly popular at the hospital.

“[International] business has not picked up in the past five years,” Alex explained, adding that foreign patients were now no longer a key focus for them.

“We are in two minds about marketing internationally or investing locally. In the past 3 to 5 years quite a few corporate hospitals have sprung up in the city. There is a lot of demand locally.”

S.L. Raheja Hospital

Wockhardt Hospital

Our next point of call was Wockhardt Hospital in Mumbai. This state-of-the-art hospital is one of eight Wockhardt hospitals in India and is part of Wockhardt Limited, one of India’s largest pharmaceutical companies.

This ‘super-specialty’ hospital network works closely with Harvard Medicine which serves as the hospital’s clinical and technical partner, according to Leo Varghese, assistant manager, marketing for Wockhardt hospitals.

Discussing health tourism, he explained that most of their patients are domestic with only around 3-4% visiting from abroad. “They come mainly from Africa,” he said, “from countries such as Nigeria, Kenya, Tanzania, Zimbabwe and the Democratic Republic of Congo.” He said they do receive some patients from the Middle East, which accounts for about 5% of their total number of international patients.

Varghese told Middle East Health a new Wockhardt Hospital was due to open around November this year in downtown Mumbai. The 23-storey hospital “will be a state-of-the-art, hi-tech hospital, with a focus on stem cell regenerative medicine”, among other specialties.

He said the Wockhardt Hospital in Goa, was making a concerted effort to attract international patients – “in line with what Bumrungrad hospital in Bangkok is doing so successfully”. Bumrungrad is well known for its success in medical tourism.

Wockhardt in Mumbai specialises in cardiology, cardiac surgery, neurology, neurosurgery, orthopaedics, joint replacement surgery, and cosmetic surgery.

The hospital targets patients in Africa, the United States and Canada, according to Varghese.

He explained that before offering a price for certain procedures, the hospital requests all medical reports from the prospective international patient. Based on these the doctor can determine the treatment and estimate the price.

Wockhardt Hospital

Ambani Hospital

Still in Mumbai, we visited Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute. The 750-bed hospital has more than 103 full-time doctors and 520 nurses. It is new, having been inaugurated in 2009 and has several centres of excellence including the Centre for Brain and Nervous System, the Centre for Cancer, the Centre for Cardiac Sciences, and the Children’s Heart Centre, among others.

The hospital is ideal for health tourism. It’s clean, modern and has the clinical expertise.

“We have an intraoperative MRI for brain tumour operations and we have a very good spine unit,” Zubin Daruwalla, vice president, marketing & business development at the hospital, told Middle East Health. He said the hospital is well known for its paediatric heart surgery and is considered a place of choice in India for congenital heart disease treatment. “We can operate on children as young as one day old,” he emphasised.

The hospital is conveniently situated near Mumbai’s Sahar International airport and, for accompanying relatives, it is close to beaches, parks and shopping malls.
The hospital’s International Patient Services department is well established and has a strong online presence. Although the web has been used more for facilitation purposes, Daruwalla explained that this year they intended to embark on a more active marketing strategy. “Up to this point we have mostly relied on ‘wordof- mouth’ and the web to attract foreign patients,” he said.

Ambani Hospital International Patient Services

Batra Hospital

In Delhi we visited Batra Hospital and Medical Research Centre and spoke to Sanoj Kumar, the deputy general manager and Saba Zareen Khan, marketing co-ordinator. They explained that they get around 1,000 foreign patients a year from Africa, Afghanistan, Iraq and Iran as well as from neighbouring countries like Nepal.

“The hospital opened in 1987, so it has had time to establish its good reputation and is now well respected in India. Awareness of the hospital is high,” explained Kumar. He said foreign patients mostly visited for cardiac surgery, oncology, plastic surgery, dental procedures and neurosurgery.

The multi-specialty hospital has 495 beds, 14 operation theatres, 112 ICU beds, 24x7 emergency facilities, a full range of state-of-the-art diagnostic laboratories and comprehensive rehabilitation facilities.

The hospital has a well-established International Patient Services department which provides the complete ‘concierge’ service for foreign patients.

“We even have a guest house on the grounds of the hospital for relatives accompanying the patient,” said Kumar. “We also provide a dedicated guest relations officer to accompany and guide the patient throughout their stay at the hospital.” The hospital has a strong presence on the web and this serves as a key portal for potential foreign patients to get in touch with the hospital.

“For marketing we travel and provide consultancy services overseas. We also attend health tourism exhibitions and conferences around the world in an effort to promote Batra Hospital,” Kumar explained.

“We were the first private hospital in Delhi to do heart bypass surgery,” Kumar adds proudly, “as well as the first private hospital in the city to do renal transplants.”

Batra Hospital in Delhi

Max Healthcare Institute

Max Hospital in Delhi opened in 2004. As a relatively new hospital its design is modern, giving it the same look and feel of modern hospitals in economically advanced countries. At Max we spoke to Arpita Mukherjee who told us around 8-10% of their patient population are foreigners who come to India specifically to seek healthcare. “Most of our foreign patients come from Iraq, Afghanistan, Libya, Bangladesh and Pakistan. We do get some patients from Africa and from Oman,” he said.

There are 10 hospitals in the network spread across 5 states. The network has a total of 1,800 beds and is completely digitised including Electronic Medical Records.

He said foreign patients account for about 10% of their revenue.

“Max is the exclusive hospital recommended by foreign embassies in the city for their employees or travellers who need emergency healthcare. These embassies include Canada, Australia, New Zealand and the United States,” he said.

Mukherjee said they plan to build a university for medical research which will be operated in collaboration with Harvard Medicine. It is due to open in 2015.

Max is well recognised for neuro-spinal surgery; orthopaedics and joint replacement; paediatric cardiology and cardiac surgery; kidney transplants; and aesthetic and reconstructive surgery.

“In bariatric and weightloss surgery we have Dr Pradeep Chowbe who is considered one of the top laparoscopic surgeons in the country,” he added.

He explained that with regards marketing the hospital network to potential foreign patients they focus on the internet and use Search Engine Optimisation techniques to raise their profile in internet search engines such as Google.

“We also network with embassies and work closely with healthcare facilitators.”

Healthcare facilitators act as agents to bring patients from foreign countries to hospitals in India. As independent operators they try to match a patient’s medical needs with the most suitable hospital in India. Mukherjee said they plan to set up our own facilitator operations in other countries to direct even more foreign patients to their network.

The hospital has a fully-fledged International Patient Services department with a specific team that takes care of foreign patients including interpreter services and tele-consultants. He said they have experienced remarkable growth in foreign patient numbers. “In 2010-2011 foreign patients grew between 50-60% over the previous year.

Max Hospitals

Apollo Hospital

In Delhi we also visited the Apollo Hospital which receives around 100 foreign patients a day, according to Raj Rainer, of International Patient Services at the hospital.

“Rather than medical tourism, we prefer to call it Medical Value Travel,” he pointed out.

He said their foreign patients tend to come from countries in Africa such as Kenya and Nigeria as well as the former CIS countries and Afghanistan.

The Apollo Hospitals Group is one of the largest healthcare groups in Asia with more than 8,500 beds across 54 hospitals within and outside India.

He said the hospital is recognised for its high quality standards and was the first hospital in India to receive the prestigious Joint Commission International (JCI) accreditation.

“Of the 54 hospitals in the network, seven now have JCI accreditation,” Rainer noted. “There is also an Apollo hospital in Dhaka, Bangladesh with JCI accreditation.

We also have a hospital in Sana’a, Yemen, and one in Mauritius.”

“We have leading doctors and clinicians and all major specialties,” he said. Apollo Hospitals has dedicated centres of excellence for several key specialties and superspecialties, including cardiology, oncology, neurosciences, orthopaedics, transplant institutes, and spine surgery, among others.

“We have excellent infrastructure and use the latest technology,” Rainer pointed out.

Apollo Hospitals has established the Apollo Institute of Robotic Surgery in collaboration with the Vattikuti Foundation of Michigan, USA. Robotoc surgery is currently available at Apollo Hospitals Chennai and Gleneagles Apollo hospitals Kolkata. This multi-speciality, multi-modality institute offers roboticassisted surgeries – with the Da Vinci robotic surgical system – of world-class standards at costs which are just a fraction of what is charged in hospitals in economically advanced countries.

He explained that for marketing to foreigners they use healthcare facilitators based in various countries. The group has a comprehensive International Patient Services division and this is well represented on their website – with explanations of how to plan your visit, the specialties they offer, the facilities they have and the insurance companies they partner with.

Apollo Hospitals

Medanta, the medicity

While in Delhi we visited Medanta, the medicity, which is one of India's largest multi-super specialty institutes located in Gurgaon, on the outskirts of the city.

This is an impressive facility – modern, clean and sophisticated. It has been envisioned with the aim of bringing to India the highest standards of medical care along with clinical research, education and training.

We spoke to Brijash, a representative of the hospital, who told us that around 18-20% of their patients originate from overseas.

Spread across 43 acres, the institute includes a research centre, medical and nursing school. It has 1,250 beds and over 350 critical care beds with 45 operation theatres catering to over 20 specialties. Medanta houses six centres of excellence.

The medicity has the following institutes: the Heart Institute; the Institute of Neurosciences; Bone and Joint Institute; Kidney and Urology Institute; Cancer Institute; and the Institute of Critical Care and Anesthesiology.

The hospital has a comprehensive International Patient Services department and makes use of a ‘buddy’ system where a hospital representative remains at the side of each foreign patient and serves as their translator and go-between for all interactions in the hospital.

“Our International Patient Services will organise your treatment packages, visa assistance, airport pick up, hotel reservations and any sightseeing trips you may want to add after your recovery. These services include coordinating scheduling of appointments, medical care and advice and ensuring your comfort and wellbeing,” explained Brijash.

Information about their International Patient Services is available on their website.

Also located in Gurgaon is Medanta

Artemis Health Institute

Also located in Gurgaon is Artemis Hospital. This is another impressive facility which has been treating foreign patients for the past four years through its International Patient Services division and has acquired a very good reputation.

“Most of our foreign patients come from Iraq,” Deepak Chawla, the team leader of the International Team at the hospital, told Middle East Health.

Foreign patients account for around 20-25% of their total patient population.

The 300-bed multi-specialty hospital is well known for neuro-spinal surgery (treating brain tumours, performing spinal fusions, for example), for cardiology and oncology, as well as for orthopaedic surgery and joint replacement. It has recently launched a liver transplant centre.

A new tower with a further 250 beds is being built and is expected to be completed in about two years, according to Chawla. The institution is equipped with the latest technology in preventive, diagnostic and therapeutic imaging, along with the highest levels of in-patient monitoring, and a paperless and filmless Hospital Information System.

Artemis provides an intelligent critical patient monitoring system with clinical decision support application backed by portal imaging technology. Other highlights include: Functional MRI scanning using Non-Contrast Imaging for Cancers (DWIBS). It is the first hospital in India to install state-of-the-art Image Guided Radiation Therapy for cancer treatment.

Artemis has a technology tie-up with Philips Healthcare which enables early and exclusive access to the latest global imaging and monitoring equipment.

Its top procedures are: liver transplant, angioplasty, cardiac artery bypass surgery, kidney transplant, knee joint replacement, spine surgery, hip replacement, gastric bypass surgery and lap band surgery.

It offers a long list of specialties – which are outlined on its website.

Appealing to international patients, the hospital offers globally benchmarked healthcare services administered by surgeons and physicians trained in international medical practices. Additionally, the hospital offers a host of exclusive services for international patients including teleconsulting with specialists, all necessary travel arrangements, airport pickup and hospital transfer services, availability of international cuisines, arranging lodging for attendants, connectivity through mobile phones and wifi environment within the hospital. Artemis Health Institute

Fortis Malar Hospital

We stopped at Chennai on the coast of southeast India and visited the Fortis Malar Hospital, formerly the wellknown Malar Hospital which was acquired by the Fortis Group.

We spoke to Sneha S., assistant manager International Business, and Dr Sajan Nair, the medical director, who told Middle East Health that the International Patient Services department was setup three years ago.

“Most of our patients come from Iraq and Sudan,” Sneha said. “It’s a booming market.”

She said they see around 100 international patients per month.

Fortis Malar Hospital provides comprehensive medical care in the areas of cardiology, cardiac surgery, neurology, neurosurgery, orthopaedics, nephrology, gynaecology, gastroenterology, paediatrics and diabetics.

The hospital is particularly well known for its paediatric cardiology. The renowned Dr KR Balakrishnan is the chief cardiothoracic surgeon at the hospital.

“Many international patients come to see him,” explained Dr Nair. “And he travels regularly to Africa to do consultations and screening.

“In particular, he sees kids with congenital heart disease. Around 50% of them will need cardiac intervention. Even though the surgeries are sometimes small, they are generally complicated.

“We have set up a charity, so we can keep the cost of these interventions really low – and generally charge only US$1,000-$2,000 for these surgeries. The balance is paid by the charity for patients that cannot afford it. The surgery would normally cost around $7,000.

“From 2009-2011 more than 400 children were provided this surgery under the charitable – Aishwarya Trust. Twenty-one of these children came from Burundi, for example,” Dr Nair told Middle East Health.

The hospital also specialises in surgery for epilepsy and says that between 30% and 40% of epilepsy cases can be cured with neurosurgery. Here too, the hospital has established an epilepsy foundation to help offset some of the costs of this complicated treatment.

Fortis Malar Hospital

Apollo Gleneagles Hospitals

In Kolkata we checked in on the 425-bed Apollo Gleneagles Hospitals. This is a campus of several hospitals with many centres of excellence, including cardiology, gastroenterology, neurology & neurosurgery, orthopaedics, oncology (at the Apollo Gleneagles Cancer Hospital, which also houses the bone marrow transplant unit), nephrology and more.

The campus was established as a joint venture between the Apollo Group and Singapore’s Parkway Group, which has a network of hospitals throughout Asia and provides more than 70% of private healthcare in Singapore.

Apollo Gleneagles Hospital, Kolkata is the only hospital in Eastern India to be accredited by Joint Commission International. Being part of the wider Apollo Hospitals Group, the Apollo Gleneagles Hospital, shares the group’s International Patient Services division, providing comprehensive medical concierge services to visiting foreign patients.

The hospital recently opened the Apollo Gleneagles Children’s Centre. This multi-specialty centre, within the campus of Apollo Gleneagles Hospitals, provides a range of services in the specialties of cardiology, neurology, nephrology, orthopaedics, paediatric surgery, neonatal medicine, adolescent medicine, radiology and dentistry for newborns, children and adolescents all under a single roof.

Apollo Gleneagles Hospital

 Date of upload: 26th Jul 2012


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