where can i find the article about the globalization of health care?

Answer 1

A hitch in globalization of health care
By Saritha Rai The New York Times

Published: October 11, 2006


BANGALORE, India A few weeks ago, Carl Garrett, a 60-year-old North Carolina resident, was packing his bags to fly to New Delhi and check into the plush Indraprastha Apollo Hospital to have his gall bladder removed and the painful muscles in his left shoulder operated on.

Garrett was to be a test case, the first company-sponsored worker in the United States to receive medical treatment in low-cost India.

But instead of making the 20-hour flight, Garrett was grounded by a stormy debate between his employer, who saw the benefits of using the less expensive hospitals in India, and his union, which raised questions about the quality of health care overseas and the issue of medical liability should anything go wrong.

"I was looking forward to the adventure of being treated in India," Garrett said the other day. "But my company dropped the ball."

The union, the United Steelworkers, stepped in after it heard about Garrett's plans, saying it deplored a "shocking new approach" of sending workers to low-cost countries as a way to cut health care costs.

Its officials insisted that Garrett find a health care option within the United States.

"No U.S. citizen should be exposed to the risks involved in traveling internationally for health care services," Leo Gerard, union president, said in a recent letter to the Senate and House committees that oversee health care. He described the willingness of employers to offer incentives to employees to go overseas as "frightening."

Garrett, who works for Blue Ridge Paper Products in Canton, North Carolina, had volunteered to get his treatments in India in return for a share in the company's savings. Blue Ridge now says it will find Garrett a treatment alternative in the United States and offer the overseas health care option only to its salaried employees.

Indus Health, the health care service provider in North Carolina that would have chosen the hospital, arranged the trip and paid for Garrett's treatment in India, acknowledged that its plan to send Blue Ridge workers to India was "on hold" but said it was exploring deals with other companies.

The union's resistance highlights a critical hurdle in the globalization of the health care industry: Who is liable if something goes wrong in a distant Indian hospital?

Underlying the debate is the even more explosive issue of potential job losses in health care in a country already sensitive to the large-scale shift of white-collar service jobs to cheaper overseas locations.

Even as the debate continues about insurers' role in health care outsourcing, hundreds of uninsured and underinsured Americans have already gone on their own to India for treatments.

With medical costs in India routinely 80 percent lower than in the United States, experts predict that globally standardized health care delivered in countries like India and Thailand will eventually change the face of the health care business.

Providing health care to foreigners could generate $20 billion for India by 2012, according to a study by the consulting firm McKinsey, although McKinsey did not say how many people that figure represented.

With 150,000 overseas patients last year - though only a small fraction of them Americans - India is already the global leader in importing foreign patients for low-cost treatment. Its best hospitals have Western-trained doctors and modern equipment.

Still, cross-border medical liability in countries like India could prove the hurdle, the experts say. In the case of Garrett, Blue Ridge Paper asked him to sign a release saying that he "is on his own as far as medical liability," said Bonnie Blackley, the benefits director at Blue Ridge.

Zubin Daruwalla, a health care analyst at the consultant Frost & Sullivan, said there was no uniform code in India on what could be considered medical negligence and what compensation ought to be paid.

"Compared with the huge payouts in the United States, Indian courts award small amounts," Daruwalla said.

Companies have been trying to curb their employees' health care costs and the pressure to outsource health care is inevitable, predicted Aaditya Mattoo, an economist with the World Bank in Washington who specializes in global services trade.

But United Steelworkers, the largest industrial union in North America with more than 850,000 members, said it would fight any effort by American companies to send employees abroad for treatments.

"We are confident that we are in a position to block any employees being exported to India, Thailand or Mexico," said Stan Johnson, a spokesman, adding, "The ailing American health care system cannot be cured by sending patients abroad."

Harpal Singh, chairman of Fortis Healthcare, a large New Delhi-based chain with several sophisticated hospitals that was set up by Ranbaxy Laboratories, the largest drug maker in India, said U.S. companies would not resist for long the lure of overseas hospitals offering first-world health care at third- world costs.

McKinsey has forecast that by 2008, top companies in the United States will spend as much on health care on average as they make in profit. As insurance costs become unaffordable, companies are scaling back or dropping health benefits.

Fortis runs a dozen hospitals catering to foreigners in and around New Delhi, including a state-of-the art 250-bed cardiac hospital in neighboring Mohali where uninsured Americans represent a fifth of all patients. The chain plans to add 35 hospitals in the next five years.

Many of these, and those by rival chains like Wockhardt and Apollo, will be built to the specifications of international hospital certification agencies.

To be sure, swarms of employer- sponsored patients are unlikely to descend on India soon. Crowded airports, traffic-clogged streets, distressing poverty and the general reputation for grime can put off even the average Western tourist, let alone a patient arriving for treatment.

But as far as Garrett is concerned, if there was a benefit to the cancellation, he said he could not see it. He was all set to go to India with his fiancée and then return in good health to marry her. Instead, his treatment has been delayed and he is now left to pay high incidental expenses and a higher co-payment for his treatment in the United States. "I've been left out in the cold," he said.

BANGALORE, India A few weeks ago, Carl Garrett, a 60-year-old North Carolina resident, was packing his bags to fly to New Delhi and check into the plush Indraprastha Apollo Hospital to have his gall bladder removed and the painful muscles in his left shoulder operated on.

Garrett was to be a test case, the first company-sponsored worker in the United States to receive medical treatment in low-cost India.

But instead of making the 20-hour flight, Garrett was grounded by a stormy debate between his employer, who saw the benefits of using the less expensive hospitals in India, and his union, which raised questions about the quality of health care overseas and the issue of medical liability should anything go wrong.

"I was looking forward to the adventure of being treated in India," Garrett said the other day. "But my company dropped the ball."

The union, the United Steelworkers, stepped in after it heard about Garrett's plans, saying it deplored a "shocking new approach" of sending workers to low-cost countries as a way to cut health care costs.

Its officials insisted that Garrett find a health care option within the United States.

"No U.S. citizen should be exposed to the risks involved in traveling internationally for health care services," Leo Gerard, union president, said in a recent letter to the Senate and House committees that oversee health care. He described the willingness of employers to offer incentives to employees to go overseas as "frightening."

Garrett, who works for Blue Ridge Paper Products in Canton, North Carolina, had volunteered to get his treatments in India in return for a share in the company's savings. Blue Ridge now says it will find Garrett a treatment alternative in the United States and offer the overseas health care option only to its salaried employees.

Indus Health, the health care service provider in North Carolina that would have chosen the hospital, arranged the trip and paid for Garrett's treatment in India, acknowledged that its plan to send Blue Ridge workers to India was "on hold" but said it was exploring deals with other companies.

The union's resistance highlights a critical hurdle in the globalization of the health care industry: Who is liable if something goes wrong in a distant Indian hospital?

Underlying the debate is the even more explosive issue of potential job losses in health care in a country already sensitive to the large-scale shift of white-collar service jobs to cheaper overseas locations.

Even as the debate continues about insurers' role in health care outsourcing, hundreds of uninsured and underinsured Americans have already gone on their own to India for treatments.

With medical costs in India routinely 80 percent lower than in the United States, experts predict that globally standardized health care delivered in countries like India and Thailand will eventually change the face of the health care business.

Providing health care to foreigners could generate $20 billion for India by 2012, according to a study by the consulting firm McKinsey, although McKinsey did not say how many people that figure represented.

With 150,000 overseas patients last year - though only a small fraction of them Americans - India is already the global leader in importing foreign patients for low-cost treatment. Its best hospitals have Western-trained doctors and modern equipment.

Still, cross-border medical liability in countries like India could prove the hurdle, the experts say. In the case of Garrett, Blue Ridge Paper asked him to sign a release saying that he "is on his own as far as medical liability," said Bonnie Blackley, the benefits director at Blue Ridge.

Zubin Daruwalla, a health care analyst at the consultant Frost & Sullivan, said there was no uniform code in India on what could be considered medical negligence and what compensation ought to be paid.

"Compared with the huge payouts in the United States, Indian courts award small amounts," Daruwalla said.

Companies have been trying to curb their employees' health care costs and the pressure to outsource health care is inevitable, predicted Aaditya Mattoo, an economist with the World Bank in Washington who specializes in global services trade.

But United Steelworkers, the largest industrial union in North America with more than 850,000 members, said it would fight any effort by American companies to send employees abroad for treatments.

"We are confident that we are in a position to block any employees being exported to India, Thailand or Mexico," said Stan Johnson, a spokesman, adding, "The ailing American health care system cannot be cured by sending patients abroad."

Harpal Singh, chairman of Fortis Healthcare, a large New Delhi-based chain with several sophisticated hospitals that was set up by Ranbaxy Laboratories, the largest drug maker in India, said U.S. companies would not resist for long the lure of overseas hospitals offering first-world health care at third- world costs.

McKinsey has forecast that by 2008, top companies in the United States will spend as much on health care on average as they make in profit. As insurance costs become unaffordable, companies are scaling back or dropping health benefits.

Fortis runs a dozen hospitals catering to foreigners in and around New Delhi, including a state-of-the art 250-bed cardiac hospital in neighboring Mohali where uninsured Americans represent a fifth of all patients. The chain plans to add 35 hospitals in the next five years.

Many of these, and those by rival chains like Wockhardt and Apollo, will be built to the specifications of international hospital certification agencies.

To be sure, swarms of employer- sponsored patients are unlikely to descend on India soon. Crowded airports, traffic-clogged streets, distressing poverty and the general reputation for grime can put off even the average Western tourist, let alone a patient arriving for treatment.

But as far as Garrett is concerned, if there was a benefit to the cancellation, he said he could not see it. He was all set to go to India with his fiancée and then return in good health to marry her. Instead, his treatment has been delayed and he is now left to pay high incidental expenses and a higher co-payment for his treatment in the United States. "I've been left out in the cold," he said.