The Telegraph
Since 1st March, 1999
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UK glare on Indian healthcare warts

London, Nov. 19: Two Indian doctors have written a whistle-blowing article in the current edition of the British Medical Journal, alleging that while rich foreigners receive excellent medical treatment when they come to India, most poor Indians have to put up with an appalling level of care.

“The private health sector in India is burgeoning, but at the cost of public healthcare,” claims the article by Dr Samiran Nundy, a consultant from Sir Ganga Ram Hospital in Delhi, and Amit Sengupta, joint convener of the People’s Health Movement in India.

Their article comes against a background of increasingly frequent reports in British newspapers, such as the popular Daily Mail, which speak of the high level of satisfaction expressed by UK patients who have gone to India for a wide range of surgical operations.

These reports are not intended to project India in a positive light but to embarrass the Labour government by arguing that conditions in Britain are apparently so bad that even a Third World country like India offers a better alternative.

One of the biggest problems in Britain is the waiting period, which patients can circumvent by flying to India. Rates are much cheaper for equivalent private treatment in India.

Poor Indians, of course, do not need to be told of the conditions they face in government hospitals, but the attack by Nundy and Sengupta may come as a revelation to the British.

The Telegraph can disclose that the British Medical Journal did not commission the article, but Nundy was so enraged by the inequality he has witnessed that he decided to put the scalpel into the medical establishment in India.

One of the journal’s deputy editors, Dr Trish Groves, said the idea for the article was suggested by Nundy, who is on the journal’s editorial board. “We were happy to publish it.”

While the West has been concerned about the brain drain and the recruitment of nurses from Africa, less attention has been focused on India. Groves did not want to pass a moral judgement on the twin-tier health service available in India, but said the country needed to give urgent attention to serious new problems.

In India, diseases such as diabetes and of the heart, more usually associated with the affluent West, are becoming more common. “India has a very, very high standard of private care. It has been on the cutting edge in things like IVF. But India is facing more and more diseases, not just the traditional infectious diseases, but also things like HIV,” said Groves.

She acknowledged that while some might believe in the benefits of the “trickle-down” effect, good healthcare should be available to all.

Nundy and Sengupta say in their article: “Foreigners in increasing numbers are now coming to India for private healthcare. They come from West Asia, Africa, Pakistan and Bangladesh for complex paediatric cardiac surgery or liver transplants ' procedures that are not done in their home countries.”

They point out: “They also come from the United Kingdom, Europe and North America for quick, efficient and cheap coronary bypasses or orthopaedic procedures. A shoulder operation in the UK would cost '10,000 done privately or entail several months’ wait under the NHS (National Health Service). In India, the same operation can be done for '1,700 and within 10 days of a first email contact.”

The authors say that not enough money is spent in India on healthcare. “The recent remarkable growth of the private health sector in India has come at a time when public spending on healthcare at 0.9 per cent of gross domestic product is among the lowest in the world. This proportion has fallen from an already low 1.3 per cent of GDP in 1991.”

The contrast between what is realistically available to rich foreigners and to Indians could not be greater. “In a recent survey carried out by Transparency International, 30 per cent of patients in government hospitals claimed that they had had to pay bribes or use influence to jump queues for treatment and for outpatient appointments with senior doctors, and to get clean bed sheets and better food in hospital. The medical system is failing its own people.”

According to Nundy and Sengupta, who feel that foreigners are distorting healthcare, “medical tourism to India is expected to become a billion-dollar business by 2012”.

Their solution' “The first priority must be to increase public expenditure on healthcare. In India, each year, tuberculosis kills half-a-million people and diarrhoeal diseases more than 600,000. It is time for the government to pay more attention to improving the health of Indians rather than to enticing foreigners from affluent countries with offers of low cost operations and convalescent visits to the Taj Mahal.”

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