Wednesday, August 30, 2017

India Medical Tourism: Pakistanis Spend the Most Per Patient

As Indian medical visas granted to Pakistani patients regularly make headlines in India, it is hard not to conclude that it's all part of a PR campaign by the Hindu Nationalist Modi government in India.

What is often left out of the media stories is the minor detail that Pakistanis pay more to use services of for-profit Indian hospitals than do people of other nationalities for such "humanitarian gestures".

Pakistan is an important and lucrative source of medical tourism dollars in India.  The kind of facilities Pakistanis pay to use in India are not accessible to poor Indian masses who must rely on India's decrepit public health system.

A 2017 report by Indian ministry of commerce and industry says an average Pakistani spends Rs 187,000 on treatment in India. Those from Bangladesh spend Rs 134,000 on an average, followed by those from Commonwealth countries (Rs 125,000), Russia (Rs 104,000) and Iraq (Rs 98,554).

Times of India quoted Manish Chandra of Vaidam medical travel agency as saying: "This is because Pakistani patients mostly come for organ transplants and heart surgeries for children that are costly." In 2015-16, he said, nearly 166 Pakistanis received treatment in India every month. Top Delhi hospitals, which are frequented by foreign nationals, confirmed this.

Most of the Pakistani patients suffering from liver and heart ailments go to major for-profit hospitals in Delhi, Mumbai, Chennai and other cities, according to TOI. The number of Pakistani patients, however, has seen a sharp drop since February this year when the Indian government decided to stop granting medical visas to retaliate after Pakistan handed out a death sentence to Indian spy Kulbhushan Jadhav.  In other words, humanitarian concerns take a back seat to Modi government's policies to assert India's dominance in the region.

The Times of India sums up the situation as follows: India's imposition of restrictions on the issue of medical visas to Pakistanis has not just affected hundreds of patients from across the border but also dealt a body blow to medical tourism in India.

Related Links:

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Is India Safe for Medical Tourism? 

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Indians Carry Heavy Disease Burdens

India Leads the World in Open Defecation

WHO Says India Leads the World in TB Cases

Infectious Diseases Kill Millions in South Asia

Infectious Diseases Cause Low IQ

Malnutrition Challenge in India and Pakistan

Hunger: India's Growth Story

Google Baby Boom in India

WHO Report on Medical Tourism in India

17 comments:

Riaz Haq said...

Why India should issue more medical tourism visas to Pakistani nationals

The highest average earnings per patient through export of health services from India comes from Pakistan at $2,906, says survey

http://www.livemint.com/Politics/07vBTKpgakjhxRCsZDwGyI/Why-India-should-issue-more-medical-tourism-visas-to-Pakista.html


The highest average earnings per patient through export of health services from India comes from Pakistan at $2,906. Pakistan is followed by Bangladesh ($2,084), CIS (Commonwealth of Independent States) countries ($1,950), Russia ($1,618) and Iraq ($1,530), according to a first of its kind survey on export of health services by Directorate General of Commercial Intelligence and Statistics, under the commerce ministry. This means a patient from Pakistan visiting a hospital in India spends more than people from any other country, boosting India’s foreign exchange reserves.

However, the number of medical visas issued to Pakistani patients in 2015-16 stood at a measly 1,921 compared to 58,360 to patients from Bangladesh and 29,492 to patients from Afghanistan. Due to the low number of medical visas issued, Pakistan contributed only $6 million to India’s services exports compared to $343 million by Bangladesh in 2015-16.

India has emerged as a top-notch destination for medical value travel because of its world-class healthcare facilities and affordable price. India aims to significantly promote medical tourism and has recently liberalized its e-visa system for most of the countries except Pakistan.

In the health tourism portal maintained by the services export promotion council as a one-stop for overseas patients, there is no specific information on how patients from Pakistan can obtain a medical visa. The same information is available for patients from 16 countries, including Bangladesh and Afghanistan.

The tension between the two South Asian neighbours has risen after a Pakistan military court handed a death sentence to captured Indian national Kulbhushan Yadav who Pakistan alleges is an Indian spy. India has denied the charge and has repeatedly asked for consular access to Yadav that Pakistan has refused time and again. There are reports that India may further restrict visas to Pakistani nationals, though another report claims visas will be issued to Pakistan nationals only on medical ground.

Pakistani nationals can get visitor visa of six months to meet relatives or friends or any other legitimate purpose and the duration of stay in India at a time shall not exceed three months. “However, senior citizens (above 65 years of age) or a Pakistan national married to an Indian and their children below 12 years of age accompanying parents may be granted two years visit visa with multiple entries subject to certain conditions,” minister of state in the ministry of home affairs Kiren Rijiju said in response to a question in Rajya Sabha earlier this month.

Shukat Patel MBBS said...

When I was doing my residency we had a few genetic disorders from Pakistan and these are very difficult cases. There is high prevelance of consanguinity (intra-family) marriages in Pakistan.

Riaz Haq said...

SP: "There is high prevelance of consanguinity (intra-family) marriages in Pakistan"

It's true of larges parts of South Asia, including India.

Read the following report published in NY Times:

In South Asian Social Castes, a Living Lab for Genetic Disease
By STEPH YIN JULY 17, 2017

https://www.nytimes.com/2017/07/17/health/india-south-asia-castes-genetics-diseases.html

Along with David Reich, a geneticist at Harvard Medical School, Dr. Thangaraj led an effort to analyze data from more than 2,800 individuals belonging to more than 260 distinct South Asian groups organized around caste, geography, family ties, language, religion and other factors. Of these, 81 groups had losses of genetic variation more extreme than those found in Ashkenazi Jews and Finns, groups with high rates of recessive disease because of genetic isolation.

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South Asians should be viewed not as a single population but as thousands of distinct groups reinforced by cultural practices that promote marrying within one’s community. Although recent changes to cultural norms have resulted in more marriages between members of different groups like castes or subcastes, especially in some urban areas, gene flow between populations was restricted for millenniums, the authors report.

Marriage within a limited group, or endogamy, has created millions of people who are susceptible to recessive diseases, which develop only when a child inherits a disease-carrying gene from both parents, said Kumarasamy Thangaraj, an author of the study and a senior scientist at the Center for Cellular and Molecular Biology in Hyderabad.

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Today, South Asia consists of around 5,000 anthropologically well-defined groups. Over 15 years, the researchers collected DNA from people belonging to a broad swath of these groups, resulting in a rich set of genetic data that pushes beyond the field’s focus on individuals of European ancestry, Dr. Reich said.

The scientists then looked at something called the founder effect. When a population originates from a small group of founders that bred only with each other, certain genetic variants can become amplified, more so than in a larger starting population with more gene exchange.


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The strongest of these founder groups most likely started with major genetic contributions from just 100 people or fewer. Today, 14 groups with these genetic profiles in South Asia have estimated census sizes of over one million. These include the Gujjar, from Jammu and Kashmir; the Baniyas, from Uttar Pradesh; and the Pattapu Kapu, from Andhra Pradesh. All of these groups have estimated founder effects about 10 times as strong as those of Finns and Ashkenazi Jews, which suggests the South Asian groups have “just as many, or more, recessive diseases,” said Dr. Reich, who is of Ashkenazi Jewish heritage himself.

Rahul said...

Why do Pakistanis travel to India for medical treatment? Why don;t they build facilities at home?

Riaz Haq said...

Rahul: "Why do Pakistanis travel to India for medical treatment? Why don;t they build facilities at home?"

My answer to your questions is implicit in the following questions:

Why do so many Indians travel abroad for medical treatment? Why did Sonia Gandhi go overseas for treatment in March 2017?

Why do Indians import almost all of their surgical instruments from Pakistan? Why do Indians depend heavily on Chinese imports for almost everything? Why don't they do it all themselves?


Or for that matter, why do nations trade? Why does't each nation make everything and provide all services within the country? Surely, a nation as large as India with over a billion strong consumer market should be able to do that?

Why does US depend so heavily on Chinese imports? Even for critical parts of their advanced fighter jets and other defense equipment? Surely, a nation as advanced as US should do it all themselves.

Anonymous said...

India imports almost all surgical equipment from Pakistan..ROFL..got any proof?

Ranjit said...

"This is because Pakistani patients mostly come for organ transplants and heart surgeries for children that are costly."

Unlike other countries where even the more basic procedures and medical treatments are unavailable, Pakistanis only come for more complicated procedures that are not available in Pakistan. So fewer of them come and each spends more.

Riaz Haq said...

Anon: "India imports almost all surgical equipment from Pakistan..ROFL..got any proof?"

Here's a Times of India report on India's dependence on surgical equipment imports from Pakistan:

http://economictimes.indiatimes.com/news/politics-and-nation/here-is-one-surgical-strike-from-pakistan-indians-eagerly-await/articleshow/59837835.cms

Call it a case of surgical strikes with a difference. It involves Pakistan and cross-border targets, but in this case India is continually at the receiving end, and happily so.

Suppliers in India eagerly await the next consignments of surgical instruments from across the border, where a pre-Partition industry set up in what is now Pakistan's Punjab province continues to produce more competitive surgical instruments.

The worsening of political ties between the two countries notwithstanding, India imports scissors, forceps and other surgical instruments such as needle holders and retractors from Pakistan, not only for domestic use but also for export to Afri can countries, among others.

Indian artisans sought to compete with their Pakistani counterparts but eventually gave up, suppliers told ET. "These instruments are manufactured with the aid of hammer forging, a technique available in Pakistan," said Vipin Yadav, owner of Leo Manufacturer Manufacturers.

"Setting up an industry having this technique will entail substantial cost, which we won't be able to bear without government support. While we manufacture 50 pieces a day, Pakistan, with the help of hammer forging, produces 5,000 pieces a day. And at a much cheaper price."

Riaz Haq said...

Sialkot is the global centre of surgical instrument manufacture – around 80 per cent of the world’s supplies are made here, and then shipped abroad.

http://www.independent.co.uk/life-style/health-and-families/features/why-does-so-much-of-the-nhss-surgical-equipment-start-life-in-the-sweatshops-of-pakistan-9988885.html

Riaz Haq said...

The umbrella term “surgical instruments” summarises the specific and mostly hand-held instruments used during an operation or a surgery (e.g. scalpels, clamps and forceps). Worldwide these instruments are mainly produced in two traditional clusters – in Sialkot, Pakistan and in Tuttlingen, Germany. Together, these clusters supply up to 75 % of the world demand of traditional hand-held stainless steel surgical instruments [1]. As Figure 1 illustrates, not all of the instruments made in Pakistan are directly sold to the end customer. Instead, many of the Pakistani instruments are first transported to Germany where they often get final finishing and quality control [2].

http://www.sustainable-manufacturing.com/resources/982jgarg-review1-2012scissorsaug20127g0i26.pdf

Tambi Dude said...

"Sialkot is the global centre of surgical instrument manufacture – around 80 per cent of the world’s supplies are made here, and then shipped abroad."

And yet it hardly earns any forex for Pak , so that Pak stops begging every year to take care of balance of payment.

Can you be proud of something really worth to be proud of ?

Riaz Haq said...

TD: "And based on this article in https://www.dawn.com/news/1279191 it seems Pakistan's share of surgical equipment is 2%. Also what is this"

AS is your habit of trolling and spamming, you claim in above comments posted on Viewpoint From Overseas Youtube channel that Pakistan has only 2% marketshare of surgical instruments.

Your poor education shows through your comments like this one. Pakistan makes 75-80% of the world's supply of surgical equipment but gets only 2% of the value because the branding companies take most of the value....it's true of most branded products from iPhone to Nike where the manufacturer gets a tiny portion of the value and the brand gets most of it.

Riaz Haq said...

Home » OpinionLast Published: Tue, Sep 05 2017. 12 42 AM IST
Is India really cheaper than the US?

http://www.livemint.com/Opinion/SOLdzn4kNazkntcMSUF4CN/Is-India-really-cheaper-than-the-US.html

The Penn Effect is that prices of goods and services in developed countries (DCs) are, after using market exchange rates, substantially higher than those in less-developed countries (LDCs). The World Bank in 2015 estimated that prices are more than three times higher in the US than in India. This price differential is huge. This raises some interesting questions.

Why aren’t very many tourists from the US attracted to India, if the prices are very low in India? Also, the price differential can be attractive to migrants who had initially shifted from India. In their retirement years, the migrants could return home but this hardly happens.

Prices in the US are, as mentioned earlier, more than three times the prices in India. Let us consider this number in perspective. Pension funds in the US are, as discussed by Richard A. Marin, still going through a near-crisis as they have large unfunded liabilities. The size is still debated. If the shortfall is a quarter of the liabilities, then on one hand, a shortfall of 25% is viewed as a near-crisis. On the other hand, there is an opportunity to get 200% more by shifting to India! But we do not see this behaviour.

there is often a risk in purchases. For example, medical charges can be relatively low in India but there is a question mark about the competence of a medical practitioner (and even about the arrangements in many hospitals). So, the risk-adjusted price can be higher than the observed price.

quality is low in India. This is well known but not adequately appreciated. For example, while the cost of higher education in India is low, the quality too is typically quite low. So, the quality-adjusted price of education can be high in India.

It is true that the use of market exchange rates can underestimate the gross domestic product of a country like India relative to that of a DC. So many economists advocate the use of exchange rate based on PPP. However, this can overestimate the GDP in India. So, it may help to consider adjusted-PPP to get the correct picture.

Riaz Haq said...

India's healthcare: Private vs public sector

http://www.aljazeera.com/indepth/interactive/2017/08/india-healthcare-private-public-sector-170831125534448.html

In August, at least 386 children were reported to have died at a public hospital in the north Indian city of Gorakhpur in Uttar Pradesh. This sudden rise in fatalities at the Baba Raghav Das (BRD) Hospital placed India's healthcare system under scrutiny. Authorities attributed the increase to a seasonal encephalitis outbreak, but others have placed the blame on corruption within India's public healthcare system.

According to the United Nations, in India, about 48 out of every 1,000 newborns die before reaching the age of five. It is one of the highest under-five child mortality rates in South Asia (behind Afghanistan at 91 and Pakistan at 81). In terms of numbers, India has the largest share of global under-five deaths at 1.3 million annually.

About five percent of the Indian government's annual expenditure goes towards healthcare. According to the World Health Organization (WHO), most of the healthcare expenditure in India - which averages $75 per capita - comes from the private spending of households.

The standards of India's public healthcare system contrast starkly with its private counterpart, which generates billions of dollars annually from medical tourism.

For local Indians, the cost of private healthcare is about four times greater than the country's public healthcare. About 72 percent of residents of rural areas and 79 percent of residents of urban areas use private healthcare services.


Anonymous said...

Did this article:
http://christiandoctrine.com/christian-doctrine/anti-god-beliefs/1804-hindu-violence

cause this deportation?:

http://www.bbc.com/news/uk-england-manchester-40673111

Riaz Haq said...

India plans to lessen its drug reliance on China

http://economictimes.indiatimes.com/articleshow/60990092.cms

Currently, India gets 70-80% of its medicines and medical devices supplies, including raw material for pharmaceuticals (Active Pharmaceutical Ingredient) from China. This poses a major risk of severe drug shortage if India's diplomatic relations with China worsen.

In fact, in 2014, National Security Adviser Ajit Doval had also warned the government about India's over-dependence on China for API and how the tension between the two countries can cause a crisis in the public health ..

Riaz Haq said...


Swiss tourist couple badly injured in youth assault at #Agra #India. #Tourism #TajMahal

https://www.nytimes.com/2017/11/06/world/asia/taj-mahal-assault-tourism.html

Youths would later tell the police that the couple, both 24, had offended them by ignoring their greetings and kissing in front of them. Not so, Ms. Droz told The Times of India. They were trying to force her to take selfies with them, Mr. Clerc added. Eventually, they began beating the couple with sticks and rocks.

By the time a crowd had gathered and the youths had run away, he had a fractured skull and possibly permanent hearing damage and she had a fractured left arm. “The blood was flowing,” said Ram Kishor, a police constable in the area.

The assault late last month made headlines for several days in India. It was a fresh setback for tourism in this part of the country, which is home to some of the world’s most famous monuments but finds its status threatened by disputes about its Muslim heritage, amid reports of declining visitor numbers and of harassment of tourists.

Stops at Fatehpur Sikri and in the nearby city of Agra to see the Taj Mahal, all of which are in Uttar Pradesh State, are at the top of many itineraries for tourists in India. Built in the 17th century by the Muslim emperor Shah Jahan as a tomb for his wife, Mumtaz Mahal, the Taj Mahal attracts millions of visitors every year. Tour operators call it India’s monument to eternal love.

But Hindu nationalists, some of them aligned with the governing Bharatiya Janata Party, have taken aim at the Taj Mahal and its ties to a Muslim ruler.

During a trip to Agra in June, Yogi Adityanath, the chief minister of Uttar Pradesh, said at a rally that small replicas of the monument given to foreign dignitaries “did not reflect Indian culture.” Other far-right leaders went further, describing it as having been built by “traitors” who “wanted to wipe out Hindus.”

But Mr. Adityanath seems to be softening his stance, at least in public. When he visited Agra in late October, he called the Taj Mahal a “unique gem.” A tourism brochure published by the state government that initially omitted the Taj Mahal has been updated to include it.

Tour guides said the controversy had hurt their business.

--------


On a recent day, a throng of tourists formed a line at the mouth of the Taj Mahal complex, pressing their bodies forward. Among them was Vital Labonte, 66, a French Canadian visitor in hiking boots, who said the occasional jostle or appeal for money did not bother him.

“The kids run at you, they want money to better their life,” he said. “Just say no. I’m not worried with it.”

Viktoria Simeoni, 23, an Austrian visitor who had booked a trip to India on a whim, said she sometimes felt unsafe when men stared at her or asked for pictures, a request often made to foreign tourists in India.

“One lady gave me her baby,” she said. “I was just holding the baby, and then she took pictures of me. I didn’t feel so comfortable.”

The police found it necessary to crack down. In the days after the attack, they arrested over 50 people they accused of being touts with reputations for hounding tourists.

In Fatehpur Sikri, officials emphasized that the severity of the attack against the Swiss couple was rare. The crime that tourists report most often is theft.