Tuesday, October 28, 2008

Long Stay in an Indian Hospital

I have been out of blog circulation for a while, having just returned from a five-plus week unscheduled trip to India. Anita joined me for three weeks in this period. We spent all our day time hours and half the nights as well in an Indian hospital in Pune where both of my parents-in-law were admitted. In the process I learned a lot about one of the many decent hospitals in India that would not make the cut as a medical tourism destination. Here's how it happened.

We heard in mid-September about how my mother-in-law's (Mummy's) health condition worsened after she was bedridden after a couple of falls in the bathroom. She also had difficulty swallowing and stopped eating. The doctor making house calls suggested that she be moved to a hospital for extensive tests and possible treatment. The only way we've moved her out of their second story apartment that lacks elevators is by stretcher and then transported her by ambulance.

My father-in-law (Daddy) simultaneously developed high fever caused by a suspected viral infection. This was followed by side effects of some nasty medication that was prescribed, but we expected this to pass relatively quickly.

Since Anita and her two brothers are all living in the US I left for Pune for what I thought would be a short trip to have Mummy and Daddy checked out and treated. My direct flight on Delta Airlines from JFK to Mumbai was surprisingly comfortable and I headed straight to Pune by road, arriving there within five hours.

While Pune doesn't have JCI accredited hospitals popular with medical tourists, it does have some decent private ones. The three we considered were Jehangir (now owned and run by the famed Apollo group), Ruby Hall (aka Grant Foundation) and Inlaks & Budhrani (run by the charitable Sadhu Vaswani Mission.)

The former two are reputedly more posh and professional, but I settled on Inlaks on the advice of two of my in-law's relatives who said (a) the doctors and staff there are more caring and less driven by profit, and (b) this hospital is run by the Sindhi community to which my in-laws belong, and they'd have more access and attention from the top operatives if this is needed.

My in-laws were admitted to Inlaks just a day apart. Contrary to expectations Daddy's case turned out to be far more serious. He had a large perforation of a duodenal ulcer that was building for years but one we were all unaware of. At age 89 he went through two emergency surgeries nine days apart, which were the first in his life. He spent 25 days in the hospital, and his situation looked grim for quite a bit of this time.

Fortunately, Daddy and Mummy are now home and recovering well. Here are some notable aspects of our experience:
  • The hospital costs were very low by US standards. Daddy's 25 day stay in a deluxe single occupancy room, a score of specialist consultations and two surgeries could have easily cost $200K in the US, even at negotiated rates. At Inlaks it came to about $6K. Similarly, Mummy's 19 day stay and treatment cost about $1,600.
  • In addition to these hospital costs, I also for good measure engaged round the clock help-maids (called "maussis" or "aunts" who help clean and care for the patient) privately for both Daddy and Mummy. They cost a total of about $20 per day and made things a lot easier.
  • A lot of the hospital staff was very caring. The nurses and aides would call elderly patients "Uncle" or "Aunty." Those in the ward would visit Daddy in the ICU the times he was moved there just to see how he was doing. When the time came somewhat to our amusement Daddy was reluctant to leave the comforting cocoon of hospital care.
  • I came to know many of the doctors and administrators, and developed distinct impressions about them. I was struck by the competence and humanity of a sizable number of them.
  • The hospital adjoins the Osho ashram founded by Swami Rajneesh (first made famous by the Beatles who visited it decades ago) and is popular with many Western visitors. I found several of them coming to Inlaks for medical attention and chatted with some of them. They seemed happy with the care overall. That said, I don't consider this hospital suitable for medical tourists, who should expect a more upscale, sterile and professional environment. But if you're not too choosy, you get decent care and can't beat the price.
  • A lot of the nurses had very arduous tasks and often seemed to be understaffed and under stress. I was surprised at how little they were paid - netting about $150 a month in cash or even less. There seems to be a strong case for paying them much more without hurting financial viability.
  • Anita has a phenomenal extended family. I joke that when I married her I didn't realize I'd get such good relatives as dowry. Her cousin Rita insisted on coming from Mumbai to Pune with maid in tow for 5 days and was invaluable in taking charge of Mummy's care in hospital while I dealt with Daddy's situation. Another set of cousins Ashok, his sister Indru and her husband Gul (who own the Sun-n-Sand hotel chain) came from Mumbai to visit. They gave us the penthouse suite of their Sun-n-Sand Pune 5 star deluxe hotel (located less than a mile from the hospital) and full run of all facilities and an army of liveried staff through our stay there. Gul specially called and Ashok threatened to "kill me" when I protested I couldn't accept such lavish help. But it made a huge difference. Then there's Meena and her parents Hira Uncle and Dru Aunty (Mummy's sister) who were always there with help and advice. The list goes on and we're blessed.
I intend to describe some aspects in more detail in the days to come. It's good to be back in the US. My brother-in-law Prakash who lives in Pittsburgh is now with my in-laws for the past few days and doing a great job caring for and settling them down.

8 comments:

Anonymous said...

Your description of an Indian hospital is accurate! The Indian doctors and nurses seem to be more experienced than what I find in Singapore. The overall cleanliness is not as good. Seems like they did a good job of bringing both the parents back to good health.
-NS

Sandip Madan said...

Thanks for the inputs, NS. Yes, overall they did a good job though there was a slip-up that I'll describe in a subsequent post. Fortunately the surgeon and other doctors made every effort to compensate for it, and we are happy with the overall treatment and care. My in-laws are especially so.

Anonymous said...

I'm glad to hear all went well for Anita's parents in the end. As I'd mentioned previously, there are many hospitals even in the US, that have Indian doctors and surgeons visiting throughout the year, and from what I hear, they are really sought out by the Americans. This was as far back as the early 90's, too.

Rene.

Sandip Madan said...

Thanks, Rene. As you say many doctors of Indian or South Asian origin enjoy great reputations in the US, and are disproportionately represented in this profession.

Ashok Sadhwani said...

A very good description. Makes me think of the high health insurance premiums my wife and I are paying in the U.S. and whether we will receive the needed care (without, of course, the hospital visits from an extended family that always include relatives, friends, neighbors and acquaintances) at the same level of quality Indian hospitals are now increasingly capable of offering.

Shall we as a couple, buy Indian health insurance coverage, considering we travel to Asia quite a bit, that would cover us for medical treatments there, as well as cover us for emergency treatments while in the U.S.?

Sandip Madan said...

Ashok, you need to consider a couple of things before buying Indian health insurance coverage.

First, insurance companies all over typically accept customers and premiums without asking too many questions up front. But when the time comes for any payouts they examine eligibility and closely follow the fine print. So satisfy yourself that you are covered in the way you want.

Second, treatment in most Indian and some other international hospitals is very cheap by US standards, and cash-paying customers have a lot of flexibility and quick access to care. Insured patients may find there are some required pre-approvals or preferred providers that can constrain care. So the benefits and the security of insurance coverage needs to outweigh such concerns.

Lastly, though my information is dated, I had come across horror stories of how some Indian insurance companies simply did nothing when their customers were treated in the US, leaving the latter to face the enormous medical bills that they'd wracked up. The Indian legal system is weak and slow, and these rogue insurance companies (even public ones) apparently relied upon that to avoid fulfilling their obligations. Ideally, the company insuring you should have a substantive US presence and can be held to contractual obligations in the this legal system.

Kronik-HCA said...

My support for single payer financing of healthcare evolved from my personal health experiences and my professional experiences. I have had insulin dependent diabetes for 37 years so I have dealt with medical providers and private insurers for many years. I have lived in Europe for six years and I have been a Veterans Administration patient for five years so I have seen multiple approaches to healthcare financing.

I earned my CPA license 2 years before I became diabetic and I audited company health benefit plans before I ever had to make a claim for insurer reimbursement. Auditing these benefit plans was an eye opening experience. There were so many provisions, exclusions, exemptions, deductibles, caps, and co-pay provisions that it seemed I would need a Master's degree to figure it out. This audit was before spreadsheets had been developed so plotting the overall impact on an employee's needs was very difficult. Later in my career I administered employee benefit plans and selected the health insurers for our needs.

My career evolved into specializing in analyzing processes and costs. So those experiences, including the fact that I could not get health insurance coverage until I joined the VA, made it abundently clear that a single payer system is more equitable, more transparent, more efficient, and more accountable because it is integrated and aligned into the effort to provide social security and safety for our population. Additionally, medical providers benefit because reimbursement claims costs which currently average 9-13% of reimbursement revenue would fall to less then 1% under a single payer system.

My observations and experiences with private health insurers can be summarized, "their primary business practice is CAPITALIZING DECEPTION".

Sandip Madan said...

Interesting. Thanks for these inputs, Kronik-HCA.