The Line Is Reversed

Patients from across the world now come to India for healthcare that is cheap and of high quality. The government even claims to promote this “medical tourism”. But what the world seeks out here, it seems, isn’t good enough for our IAS and IPS officers. Adding to the considerable privileges of this select band of some 8,4000, the government notified in the first week of September that they will be entitled to reimbursement for medical treatment abroad. The notification also allows for air-fare and the expenses of an attendant. Reimbursement for treatment abroad was earlier restricted to MPs and IFS officers working abroad. The new notification modifies rules that have been in force for 30 years. There are checks—treatment abroad must only be for complex procedures cleared by a medical panel—but even so the notification is drawing much flak.

Even IAS and IPS officers smell a fish. Many officers say they know of nobody in their batches who needed treatment abroad. “The rule,” they say, “is almost certainly meant to oblige one or two officers.” T.S.R. Subramanian, a former cabinet secretary who underwent minor surgery at Delhi’s Apollo Hospital earlier this month, says he was amazed to see patients from Russia, Africa and West Asia thronging the hospital. “Rem­ember,” he says, “even Atal Behari Vajpayee had his knee replacement done in India. There’s little justification for spending one or two crores on a single officer.” He also describes the move as discriminatory, for the Central Governm­ent Hea­lth Services or CGHS rules naturally cover all government servants; fav­ouring some will definitely inc­­r­ease the scope for misuse. The Centre may allow only a few to go abroad, but it’s a matter of time before officers in the states raise the demand and soon thousands will be lining up for permission. A post by Harsh Taneja on kafila.org des­cribed the new privilege as “unfair, undemocratic” and amounting to institutionalised corruption.

Senior doctors say there is virtually nothing that cannot be done in India today. A decade ago, medical technology would take a few years to travel to India. No longer. Medical breakthroughs are mostly available in India as soon as they are abroad—the lag now is no more than a month or two, says Dr Rajiv Sood, a urologist at a prominent Delhi hospital. The last time he advised a patient to go abroad was eight years ago—for robotic surgery, not available here then.

The tide has actually turned. Patients now travel to India for treatment. An Assocham study this year claimed a 40 per cent jump in medical tourism since March this year and put the current market size at Rs 7,500 crore. Basic neurological surgeries, say doctors, are now conducted in an estimated 2,000 hospitals in the country. Over 200 hospitals even carry out complex neurological procedures. Dr A.K. Dhar, an oncologist, does not remember any of his patients travelling abroad for medical treatment. “Besides being costly, there is no need to travel abroad because we in India have the equipment required for even the most complex procedures,” he says.

Another reason Indian doctors, especially surgeons, are at par with those abroad, and even better in many cases, is due to the sheer volume of the patients they attend to, says Dr Sood. Credible training programmes, many of them initiated by the government, have also added to the skill level of Indian doctors. “Even when you go abroad, chances are that you will be treated by Indian or Asian doctors,” he added.

Critics also say the decision could undermine the public health service in the country: politicians and bureaucrats will have little incentive to improve conditions in government hospitals! But did they care in the first place?

Why Go Abroad?
What some major treatments cost

Hip replacement

• $33,000-57,000 (US)
• $12,700 (Thailand)
• $8,800 (Taiwan)
• $7,200 (India)

Coronary artery bypass surgery

• $75,000-1,40,000 (US)
• $30,000 (Taiwan)
• $25,000 (Thailand)
• $9,500 (India)

Source: KPMG