'86% of all medical trips are made by rural Indians'

NEW DELHI: The story of India's international medical tourism industry is now well known, but the first ever figures on domestic medical tourism are simply staggering. Indians made 126 million domestic trips for medical purposes, spending over Rs 23,000 crore on such trips, over the span of one year (2008-9) alone. That, incidentally, is about 30% more than the Union health budget for the same year. Butjust as international migration into India largely reflects a choice of greenerpastures while domestic migration is more as a result of the lack of economicopportunity in rural areas, domestic medical tourism too is largely the outcomeof poor health infrastructure in rural areas and small towns. 86% of all tripstaken for medical purposes are by rural Indians and the poorest spend much moreproportionally.The data is part of the National Sample Survey Organisation's (NSSO) 65th round on tourism which estimates the number and purpose of "trips" taken by persons in its representative sample of seven lakh persons as well as the expenditure on them. The survey defines a "trip" as the movement - for a period of not more than six months - by one or more household members traveling to a place outside their usual environment and return to their usual place of residence for purposes other than migration or employment and which is outside their regular routine of life.The survey data showsthat trips for 'health and medical purposes' form 7% of overnight trips for therural population and about 3.5% for the urban population. While "social"purposes were the main reason for travel for both rural and urban residents,holidaying and leisure accounted for even less than medical travel - 2% and 5%for rural and urban India respectively. Similarly, 17% of same-day trips for inrural India and 8% in urban India were for health reasons.Whilecalculating the expenditure on a trip, the NSSO includes all goods and servicesbought or consumed by the traveler. The high cost of healthcare is borne out bythe fact that trips for health and medical purposes were four times as expensiveas the average trip for both rural and urban populations. Medical trips weremuch more expensive for the family than even shopping trips, where the moneyspent on purchasing goods is included in the total cost of the trip. Trips forhealth and medical purposes were the most expensive of all types of trips inboth urban and rural sectors.Expenditure on medical trips accountedfor 30% of all overnight trip expenditure for rural India and 15% for urban. Inaddition, a breakdown of expenditure by Monthly Per Capita Expenditure (MPCE)classes shows that in rural India, the poorer the person, the higher theproportion of all travel expenditure that goes to medical trips. Avisit to Delhi's public hospitals only bears out these statistics. On Tuesdayand Wednesday mornings, hundreds of people from all over the country throngedthe two hospitals' OPDs, with ailments ranging from tuberculosis to canceroustumours. Subhash Majhi (52) and his wife came here from Orissa's Sambalpurdistrict last week, seeking treatment for a tumour on his back. "I did not getgood treatment in Bhubaneshwar and the problem recurred. Our relatives told usthat we would have to go to AIIMS," said Majhi, who is living in west Delhi withacquaintances. AIIMS alone receives 10,000 patients every day, the bulk of themfrom outside Delhi, AIIMS officials said.Others have come here withno place to stay. Kanti Devi and her husband Gyanchand Kumar, both in their 30s,have left their children in the custody of their relatives in western UP'sMuzaffarnagar district. "It is harvest season at home and we are losing work,but I was not getting better, so we had to come to Delhi," says Kumar, anagricultural labourer, who has come here with respiratory problems. The couple,who were in Safdarjung's OPD having just arrived in the city, planned to sleepon the streets. Unlike in international medical tourism, wheretransport and accommodation expenditures also form a significant proportion ofthe trip's cost, three-fourth of the expenditure on a domestic medical trip ison medical expenses alone.There were roughly 300,000 internationalvisits into India for health treatments in 2009 and the size of the industry isestimated at Rs 8,500 crore, less than a third of domestic 'medical tourism'spending.