"The medical system is failing its own people"

The Private Health Sector in India
 By AMIT SENGUPTA
Published: November 19, 2005
British Medical Journal

It is interesting that this article is also from the British Medical Journal. In fact, many of the sources that I found are from the BMJ, which makes me think that perhaps medical tourism is a more marked force in the UK than it is in the US.

This article is very compelling because it analyzes all the problems with the public-private sector relationships in India to show that medical tourism can in fact wreak havoc on the Indian public. The main points of the article were:

• India is among the bottom 5 countries in the world on public health care spending and among the top 20 countries in the world in private health care spending
• The public sector of health care doesn't even have basic technologies or capabilities, the doctors are so strained that they see more than 100 patients in a typical round at an outpatient clinic, and bribery is rampant. In fact, 30% of Indians seeking public health care say that they had to bribe their doctor, who told them to visit him in his private practice in off-hours.
• There is a huge brain drain in India in two capacities: first, talent in medicine is going abroad at an alarming rate; then, of the individuals who stay on to practice in India, a large percentage practice exclusively in the private setting, which is unaccessible to the poor majority.
• Another major problem in India is a new trend marked by Non-Resident Indians (NRIs): NRIs are educated and often live abroad, but return to India to cash in on the lucrative private sector by catering to India's wealthiest patients, who seek the best care by the best Western trained doctors. NRIs also invest a lot of money in some private sector practices, attracting talented doctors from the public sector with better working conditions and higher salaries. Finally, NRIs also have political clout, so they are able to maneuver easily through the bureacracy to meet their often money-driven goals.
  
• This article had the same quote as the previous article (Wooing Patients) by the same guy about not fishing for patients abroad, only telling them about the available opportunities for medical tourists in India.
• 500,000 Indians die every year from tuberculosis, while another 600,000 die from diarrheal disease.

This is most certainly alarming, and paints a picture that few people searching for better medical care abroad see. Of course, few patients trying to save time and money by going abroad will care about the detriments to India's poor; but someone along the chain has to care. Unfortunately, the Indian government seems to be heading away from the direction of caring, individual doctors are following suit, and the poor have no leveraging power.

While the numbers of patients going abroad for medical care are substantial, I wonder if they are large enough (or if the increase will be large enough) that the hordes of public sector doctors abandoning their work for that of the private will have work available for them. Also, as hospitals in India compete to offer the lowest cost surgeries in order to attract more foreign patients, will the situation ever result in only minor marginal benefit for the hospital providing surgeries? Does it have to get to such a far-flung economic low to reverse the tide of doctors back to the public sector?

While the NYT article offered an overall backdrop and the previous BMJ article focused on India's possibilites, this article really illustrates all of the problems specific to India. This fits into what we already know by elaborating on and reinforcing the many possibilities that India has been experimenting with, and it adds new knowledge by showing that only very few Indians are benefited by what is a loudly touted phenomenon.