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Surgeries, Side Trips for 'Medical Tourists'

Although they are equipped with state-of-the-art technology, hospitals such as Escorts typically are able to charge far less than their U.S. and European counterparts because pay scales are much lower and patient volumes higher, according to Trehan and other doctors. For example, a magnetic resonance imaging (MRI) scan costs $60 at Escorts, compared with roughly $700 in New York, according to Trehan.

Moreover, he added, a New York heart surgeon "has to pay $100,000 a year in malpractice insurance. Here it's $4,000."

Howard Staab, who had a life-threatening heart condition requiring surgery, went to India with his partner, Maggi Grace, in search of affordable care. (John Lancaster -- The Washington Post)

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In addition to patients from other developing countries, top Indian hospitals derive a significant share of foreign business from people of Indian origin who live in developed countries but maintain close ties to their homeland. But the same hospitals now are starting to attract non-Indian patients from industrialized countries, and especially from Britain and Canada, where patients are becoming fed up with long waits for elective surgery under overstretched government health plans.

"If you can wait for two years for a bypass surgery, then you don't need it or you're dead -- one of the two," Trehan said. "Similarly, if you're wobbling on your frozen joints for two years because of a waiting list, it's a human tragedy."

One such patient is Tom Raudaschl, an Austrian who lives in Canada and earns his living as a mountain guide. Suffering from osteoarthritis in his hip, Raudaschl last year decided to undergo "hip resurfacing," a relatively new procedure that involves scraping away damaged bone and replacing it with chrome alloy. He learned he would have to wait as long as three years if he wanted to have the operation under Canada's national health plan, a delay that would have cost him his job, Raudaschl said. In the United States, the procedure would have cost $21,000, he said.

So this month, Raudaschl flew from Calgary to Chennai, on India's east coast, where a surgeon at Apollo Hospital performed the operation Wednesday for $5,000, including all hospital costs, Raudaschl said by telephone from his hospital bed.

"As soon as you tell people that you're going to India, they frown," Raudaschl said. But he said he could not be more pleased with the service. "They picked me up at the airport, did all the hotel bookings, and the food is great, too," said Raudaschl, whose private room was equipped with Internet service, a microwave and a refrigerator. Most important, Raudaschl said the surgeon told him he would be "skiing again in a month."

To cope with its backlog of cases, Britain's National Health Service has begun referring patients for treatment to Spain and France, although for now, the health service limits referrals to hospitals within three hours' flying time, according to Anupam Sibal, a British-trained pediatrician and Apollo's director of medical services.

"Nobody even questions the capability of an Indian doctor, because there isn't a big hospital in the United States where there isn't an Indian doctor working," he said.

Before they would admit him for surgery, Staab, the heart patient, said hospital officials at Durham Regional Hospital asked for a $50,000 deposit and warned that the entire cost of treatment could run as high as $200,000.

Katie Galbraith, a hospital spokeswoman, confirmed in an e-mail that hospital costs in such cases typically are in the neighborhood of $100,000; the surgeon's bill, which is charged separately, would have added tens of thousands more. Patients such as Staab who do not qualify for charity care often are offered a payment plan, she said.

Staab was discharged from the Indian hospital Monday and was recuperating at a nearby hotel. He planned to return to Durham after visiting the Taj Mahal.

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