DON BRUNELL for The Columbian

We often think of India as a magnet for customer call centers and high-tech development, but we don't think of India in terms of cutting edge health care.

Yet India, Thailand and even Cuba are luring visitors from around the world seeking reduced-cost medical treatment. In fact, many travel agents are marketing vacation packages featuring stays at foreign hospitals for major medical procedures.

It's called medical tourism, and thousands are flying to India for everything from cosmetic surgery to hip-resurfacing, a procedure not allowed in the U.S. It is particularly attractive to Canadians who want to avoid long waiting lines caused by government-run health care. For Americans, as well, it has become a cheaper alternative.

Here's how it works.
Someone in need of open-heart surgery can schedule that procedure in one of India's best hospitals. In our country, that procedure would cost up to $150,000, but in India it may ring up at $10,000. As an added bonus, medical tourism companies will book the flights, in-country transportation, and postoperative vacations in a four- or five-star hotel. Patients can even take their spouse or close friend and still save a bundle.

India is the leading promoter of medical outsourcing, but it is not alone. It is rapidly becoming a multi-billion dollar industry. Apollo Hospital Enterprises, India's largest medical corporation, treated an estimated 60,000 patients from 2001 to 2004. Apollo is aggressively moving into medical outsourcing, providing overnight information to American insurance companies, hospitals and pharmaceutical corporations.

Apollo's business grew rapidly after India deregulated its economy and drastically cut bureaucratic barriers, allowing importation of modern medical equipment. Major investors poured money into Apollo and other certified medical providers, and the company now has 37 hospitals with more than 7,000 beds.

Another reason for the surge in medical tourism is India's top-notch education system. Long known for graduating computer programmers and engineers, it is now churning out an estimated 20,000 to 30,000 doctors and nurses each year. Those medical professionals are choosing to stay in India to practice, rather than emigrate to countries such as the United States.

Another plus for these countries is a big cost savings on malpractice insurance, according to the Pacific Research Institute, a San Francisco think tank. PRI analysis shows that doctors practicing beyond our borders pay as little as $4,000 a year for malpractice insurance while American doctors can pay 25 times that amount.

Drawbacks exist
PRI research shows the U.S. dollar is more valuable in underdeveloped countries where pay is low and patient numbers are high. If people are concerned about quality of care or patient safety, many of these hospitals have U.S. hospital accreditation and U.S. certified surgeons. With those stamps of approval, Bangkok and Phuket in Thailand and India experienced a 30 percent rise in American patients.

Cost savings have not escaped lawmakers' attention, either. In West Virginia, a bill is pending in the Legislature that would allow private insurance companies to provide incentives for consumers to have cheaper surgeries in accredited hospitals abroad.

Outsourcing medical services is no panacea. It has its problems:
If a government or private medical health plan won't cover the costs, patients pony up the cash for the procedures.
Patients are usually in the hospitals for only a few days in a strange land far from their physician, family and friends. There is little follow-up care, and if there are complications or side effects, or if additional postoperative care is required, then the patient has to find that care back home.

Medical malpractice laws in many nations are weak. While our laws are costly, too aggressive and restrictive, foreign laws may be too lax.
Finally, despite all its problems, medical outsourcing and medical tourism are realities that we must deal with. We have to find ways to ensure that America's medical providers remain competitive. One way is to find the balance in the courts and regulatory system and fully realize that medicine, too, is a globally competitive industry.

Don Brunell is president of the Association of Washington Business, Washington State’s chamber of commerce.
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