What can we learn from Indian healthcare?
Over the last few days, the Prime Minister has led a large, high-powered delegation to India promoting greater collaboration between the UK and India in areas as diverse as health and science to trade and climate change and education. Vince Cable, the Business Secretary, was very impressed by what he saw in the Narayana Health City (one of the largest medical facilities in the world) in Bangalore (one of the top four technological hubs in the world). The Narayana Hospitals (between Bangalore and Kolkata) currently have 5000 beds in India and aim to have 30,000 beds in the next 5 years in India. In terms of cardiac care they are doing some amazing work there against the odds: treating patients from 73 countries with complex heart disease and doing the largest number of heart surgeries on children in the world. No wonder Vince Cable was impressed.
In countries such as India, patients can have a massive array of procedures from cataract surgery to coronary artery bypass graft surgery at a fraction of the cost in the Western world. The massive growth of the private health sector in India has increased efficiency and quality. In the UK, medical tourism has been authorised for certain procedures as a way of reducing costs and waiting lists, and increasing consumer choice. This trend is set to increase after the European Court of Justice established the right of European citizens to seek treatment abroad if they are entitled to it in their own country but have suffered an unreasonable delay. There are now a massive number of medical tourism companies which will organise all aspects of healthcare abroad and a relaxing holiday afterwards. The Confederation of Indian Industry estimated that 150,000 medical tourists came to India in 2005, and the health care market, which includes health insurance, is set to expand by 2012 from US$22.2 billion (5.2% of GDP) to US$69 billion (8.5% of GDP).
There is another side to this coin. India has probably the worst health and wealth inequalities of any country in the world. The new “multidimensional poverty index” designed by the Oxford Poverty and Human Development Initiative showed that Bihar, the poorest state in India, has more poor people (95 million) living there than do nine of ten poorest countries in Africa. In 2001, India had only 35 well-equipped centres for modern diagnosis and treatment, mostly located in the six metropolitan cities; this is grossly inadequate for a vast country with an immense population such as India. The Narayana Hospitals currently do 12% of all cardiac surgery in India. That probably tells us that across the population there is not that much heart surgery going on.
The problem of inadequate resources is compounded by the fact that despite being one of the world’s major sources of medical staffing, the number of physicians per 100,000 population is less than 50. To plug the “brain drain”, the Indian government is starting a shortened, rural medical training programme to train and retain doctors in the poorest areas of the country. This is an innovative scheme which other developing countries will be watching closely.
So what can we learn from Indian healthcare? Firstly, sophisticated, world-class healthcare can be performed at a fraction of the cost of healthcare in the US and the UK with equal if not superior quality in the private sector of developing countries. Secondly, private healthcare does not at all reflect the health of the nation and often broadens health inequalities. On this point, the Narayana Hospitals are truly remarkable as they incorporate many societal initiatives such as microfinance and education. Thirdly, as flows of patients, doctors, and resources across country borders are all likely to increase in the future, improvements in the planning of our own healthcare resources and the way we interact with other countries (such as India) are a necessity.