Laurence Vick
Posted on 30 Aug 2013

Passage to India – Medical Tourism on the Sub-Continent

The front pages of the newspapers bear the story: according to the press, discussions are underway for the NHS to begin exploiting the lower costs of healthcare in Indian clinics and hospitals. It has been reported that the former Labour health secretary Patricia Hewitt, now chair of the UK India Business Council, has intimated that around 20 NHS trusts were in talks with Indian healthcare providers. She sees this as an opportunity to resolve the UK health service's funding crisis, with concomitant benefits for both nations, although the Government has denied the claims.

Medical tourism and India

The Indian medical tourism industry is a major success story, with reported annual growth of 30% and earnings stretching into billions. With indemnity insurance for an Indian surgeon costing around 4% of that for a practitioner in New York, running costs are low, and this is reflected in the price of procedures. The owner of several Indian hospitals was quoted in the Daily Mirror as offering cardiac bypass surgery for as little as £1000, compared to a cost of around £35,000 in the UK.

The range of procedures available in India is also a lure. Operations such as hip replacements, angioplasty (artery widening) and complex spinal surgery are easily procured; more controversially, India boasts a rapidly expanding stem cell treatment industry, and is looking to expand its facilities for storing umbilical cord blood (from which stem cells can be harvested). Such procedures are often unapproved or illegal elsewhere in the world (the UK permits stem cell research for certain purposes only), potentially placing India in a services market lacking in competitors.

But at what cost?

Michelmores' Laurence Vick is widely regarded as an authority on medical tourism, and he acknowledges its inevitable expansion in India. 'Unlike some countries, the impressive growth of India's medical tourism industry has not been exaggerated,' he says. 'There has been a steady increase in people travelling to the country to access all kinds of treatments, and not just people from the Indian diaspora.' He also concedes that it is difficult to predict the development of such a rapidly growing industry, and emphasises that there are significant ethical issues at play.

In an article on the subject, Laurence writes that the fear that India's best services will be reserved for foreign nationals is not to be taken lightly. This is compounded by the fact that, as The Hindu newspaper recently reported, 40 million Indians are pushed into poverty as a result of their medical expenses; all this in a country where 80% of the population have to fund their own treatment. 'There is a counter-argument that says medical tourism will keep doctors in India,' Laurence adds. 'Realistically, though, it is debatable how much this will benefit ordinary people.'

More dramatically, there are concerns over the proliferation of antibiotic-resistant superbugs in India. The World Health Organization talks of the coming 'post-antibiotic era', in which these kinds of drugs have become entirely superannuated by bacterial resistance. A third of the world's antibiotics are produced in India, owing much to the Indian government's unsympathetic stance on patent laws, and their use is particularly liberal and not always carefully monitored. Resistant strains of diseases could pose a threat to the UK if carried back by travellers.

Arrivals, departures

Outsourcing healthcare and medical tourism are nothing new. According to official statistics, more people leave the UK for treatment than enter it, and different kinds of reciprocal healthcare agreements with non-European Economic Area countries have been in existence for some time. The UK has such agreements with countries including Montserrat, Turkmenistan and Australia, meaning that treatment received there on a holiday will be cheaper, or entirely free of charge. Outsourcing NHS services to India has also been mooted by officials in the past.

Borderless healthcare is still some way off, particularly as those borders are constantly being redrawn. However, it seems that if a global healthcare system does become a reality, it will come about exclusively through economic imperatives. How this will affect issues of patient care, medical standards and adequate indemnity in the case of negligence claims is yet to become clear.

Crucially, it needs to be shown that the NHS has a mechanism to recoup its outlay if it has to treat returning victims of failed overseas surgery, particularly where the victim has been successful in a compensation claim where the NHS is ultimately found liable. Given that medical regulatory standards differ from country to country, and from agency to agency, a comprehensive system needs to be in place, as both a source of redress for patients and a deterrent to poor performance from service providers.

Given his experience with cross-jurisdictional claims for compensation, Laurence is concerned that there will be added difficulties in the event of botched surgery abroad. 'Even if foreign clinics are indemnified to a sufficient standard,' he says, 'you're going to have questions of jurisdiction to contend with, not to mention the added contract law issues.'

'Primarily we don't want patients to suffer any harm, but there's a danger this could end up costing the NHS more than it bargained for - we've seen it happen in the UK already, with the NHS paying to terminate contracts with private providers whose service has been sub-standard.'  Laurence's advice to the Government? Like any discerning medical tourist, it should exercise caution when hunting for healthcare bargains abroad. 'If the buck stops with the NHS,' he says, 'it needs to be able to live up to its legal responsibility.'

Read the Daily Mirror article on the potential NHS healthcare agreement with India here.

Laurence's recent article on the lure of medical tourism can be found here.

Michelmores have particular expertise in cases involving failed medical treatment carried out abroad. If you would like to discuss a clinical negligence claim relating to overseas treatment, please contact us for a free initial discussion of your case.