Be Strategic, Not Opportunistic : By Ramesh Krishnan, Parkway Pantai

India needs to devise long-term strategies with partner countries to build platforms of their own :  By Ramesh Krishnan, 

1. Indian doctors are sent in groups to conduct surgical camps at the local hospitals

Is price the only ticket to play in the so called space of ‘treatment beyond borders? Are healthcare services so perfectly linear in their price elasticity? Just as we were pondering over these questions, medical tourism got re-launched as medical value travel! So it’s the ‘value’ card which will make patients travel across borders. Fair enough! But can even value have a perfectly linear relation to a patient’s propensity to travel to an alien country to fix his health issues? I’m not sure – let alone how we go around defining value which is so subjective.

I am an eternal optimist and a firm believer in disruptive innovation in business models. But I still cannot help wonder why several reports by leading and reputed think tanks that were published on the prospects of medical value travel to India have not been proven even half right after so many years. To my mind, I think, we have far undermined the power of access (or the lack of it in the local country) which is the first driver while value or affordability is only a far second.

Africans travel to India for treatment, of course, because it is more affordable than going to Europe. But what gets them to first of all think of leaving their own country is the lack of healthcare provision in their country. Contrast this with Americans travelling to India. They sure travel only for price-value, as we would like to call it. But how many of them do we get? Most Arabs don’t face a problem of affordability. But the lack of quality tertiary healthcare institutions in the region is what fundamentally makes them move out. Their high affordability, of course, makes Singapore and Thailand their first choice as destination before they think of India.

Of the few American patients that we get in India, I was privy to one particular account that got to a point when the economics of healthcare delivery in India almost pushed the access factor aside completely. A self insured (a firm which collects its own corpus from amongst its own employees for their healthcare needs) mid-sized private firm started promoting the prospects of healthcare in India for its employees. It was, as we know, not an easy sell given that access to quality healthcare in the US is not that big a problem albeit the wait times which could be staggering sometimes. But the company started selling the idea based on the following: You are going to be operated by an American board certified surgeon in a JCI accredited hospital.

2. Africans travel to India for treatment, as it is more affordable than going to Europe

It’s just that the hospital is circa 12,000 miles away! So what’s the big deal? You are still in safe hands as you would be at home. But here’s the positive side: (a) You save almost 2/5 th of the cost of treatment for the company’s corpus (b) You get to travel business class with your companion half the way around the world (c) You get a wonderful holiday at the end of the treatment along with your companion.

People started experimenting first. But it did make sense. More people followed. The company got even more innovative. They took it to a point when they said they are even ok to share the money that they save for the corpus with the patients. So it almost got to a point when the slogan was – you get your hip replaced in India and you will get a $5000 cash reward! I thought that was some real disruptive innovation – the first time my belief that access is a bigger pull factor got shaken- I have to confess.

Having been a part of the M&A activity in the Indian healthcare industry, I am still to come across an IM (information memorandum) that does not hype the prospects of medical value travel for the asset that is up for sale. It almost sounds like the hospital was built only for foreign patients. Really? Healthcare is a very local and regional subject even in this era of globalisation. Even the best of the players in the MVT space do not have more than 25% coming from international patients. So it would be a bad idea to work on a feasibility for a hospital that is overly dependent on MVT.

I am not someone who is against medical tourism. But the limited point I would like to make is that I can’t help assume that it still remains a hype to a large extent in our country and our dependence and focus on promoting this, despite the fact that provision for 1.3 billion local people has a long way to go, is rather hypocritical.
But, I suppose, this is one of the many dichotomies of an industry which is still to achieve its steady state.

What is encouraging and interesting is how the market has started adjusting itself for this arbitrage around access. There are groups who have started providing parallel training to local clinical groups, so as to bring them to a self-sustainable level of clinical care in their own countries. There are Indian organisations which have started trying models like doing the ‘routine’ procedures at the local hospitals in the respective countries while transferring only high-end complex cases back to India. There is even a model in which Indian doctors are sent in groups to conduct surgical camps at the local hospitals.

3. Singapore and Thailand continue to be the first choice as MVT destination for many.

All of these instill a collaborative spirit that builds a long-lasting relationship with the local doctors as well as governments. They start seeing that our intent is not only to simply take away patients to India but also help them build their own platforms. Ultimately, these are the models which are going to pass the test of time. There will always be enough of high-end work to bring to India. The willingness of the local doctors and governments to send them our way depends on the openness we show towards helping their societal cause while encouraging our own medical tourism. The conversions of such models may well be slow but they will sure be sustainable relationships that will yield highend clinical work coming to India.

Our medical talent and outcomes have always been nothing to be scoffed at. And we are getting even better as time progresses. With private equity and even foreign strategic operators infusing investments into the sector, our capacity is increasing. There is almost no time lag with the developed world nowadays when it comes to the introduction of new technology. The continuing effect of reverse brain drain by which year-on-year we are having more western trained Indian doctors heading back home is also encouraging. With this, we are indeed uniquely poised to offer MVT to the world.

It’s important that we devise long-term strategies with our partner countries which do not adopt an approach of just moving every patient to India. On the contrary, the strategies should help our partners build platforms of their own. While this may on the face of it look counter productive to our MVT business, it is actually the approach which will help us sustain longer in this game. There will always be things that our partners cannot handle in their own domain for a long time to come. We are way ahead as an industry – both in talent and in technology. Until every country achieves an equilibrium in this, the arbitrage is always there – call it value if you want to. It is just a question of how we position ourselves as not being opportunistic but strategic.

Ramesh Krishnan is 
India CEO of Parkway
Pantai Limited.

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