Sonia Gandhi's surgery abroad points to medical tourism trend: quality over price

India’s ruling party said its leader, Sonia Gandhi, underwent surgery abroad yesterday and is recuperating in intensive care.

The country is watching developments closely. Ms. Gandhi wields tremendous power behind the scenes of her hand-picked prime minister, Manmohan Singh. During her hospitalization she has delegated party business to a committee of four that includes her son Rahul Gandhi, a descendent of three Indian prime ministers.

Few details have leaked. Her ailment remains unknown. Media reports here say she went to the United States for treatment. Among the mysteries being parsed by the press: Why did she travel abroad for care when India is itself a global medical destination?

Indeed, India has been touted as a major player in the emerging medical tourism field, with stories of budget-minded Americans traveling to India for super cheap hip replacements. But despite the hype, Gandhi’s reverse journey may still be more representative of what’s actually happening – medical travel for higher quality, not lower price.

“Most [medical travelers] seek the world’s most advanced technology, better quality, or quicker access to medical care,” reads a 2008 report from The McKinsey Quarterly.

The report found that 40 percent of medical travelers were seeking the world’s top technologies, mostly by going to the United States. Only 13 percent were looking for lower-cost care.

Americans, meanwhile, do not appear to be avid medical tourists yet. A survey of 45 medical travel firms turned up a total of only 13,500 American bookings since the firms opened for business, according to the May edition of the Journal of General Internal Medicine (JGIM).

Neither is there much evidence of many Americans at hospitals in India. A new survey of 35 major hospitals across the country found only 2 percent of the foreign patients came from America or Europe. Just over half came from Africa, found the Indian Institute of Tourism and Travel Management (IITTM).

But despite these snapshots, good data remain difficult to find in this field.

India grants medical visas but the government does not aggregate and provide it, says Manjula Chaudhary, IITTM’s director. The McKinsey and JGIM studies, meanwhile, are viewed as undercounts by many in the industry because of sampling bias and their restrictive definitions of a medical tourist or traveler. For instance, both studies do not include dental work, which constitutes a major chunk of health travel.

That said, some analysts accept that the market may be smaller and work differently than widely thought.

“The popular image of medical tourism is of someone flying to a distant country for low cost surgery,” wrote researcher Ian Youngman in the International Medical Travel Journal. “I believe this is a myth.”

Instead, most medical travel for elective surgery covers only a short distance. Those hopping on long flights are mostly doing so for cosmetic surgery, dentistry, fertility treatment, and rare diseases, he wrote. But in general, the greater the distance, the fewer the number of patients who will travel it.

“Many hospitals in Asia, despite what they say about wanting Europeans or Americans, do in fact realize that the vast majority of their medical tourism business comes from within their own country, or nearby countries,” he wrote.