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India - News
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31 May 2006
- News Updates
Outsourcing Your Heart As word has spread about the high-quality care and cut-rate surgery available in such countries as India, a growing stream of uninsured and underinsured Americans are boarding planes not for the typical face-lift or tummy tuck but for discount hip replacements and sophisticated heart surgeries. India's trade in international patients is increasing at the rate of over 30%. That's still a trickle compared with the millions of surgeries performed each year in the $2 trillion U.S. health-care system. But a significant shift is under way. It's one that could put greater competitive pressure on U.S. hospitals as some of their most lucrative patients are siphoned off. Elective surgeries are key moneymakers for hospitals, and even a small drop-off can cut deep into their profits. What may accelerate the trend is that some pioneering U.S. corporations, swamped by rising health-care costs, are taking a serious look at medical outsourcing. Employees who opt for India would get to take along a family member, says Darrell Douglas, vice president of human resources at Blue Ridge Paper, NC, and the whole experience, including a recuperative stay at a hotel, would be covered. IndUShealth, a medical tourism start-up in Raleigh, N.C., will make all arrangements and coordinate care between U.S. and Indian providers. The sweetener: the company will share with these intrepid employees up to 25% of savings garnered from the outsourcing. The calculus behind this interest isn't complicated. Many major employers in the U.S. are self-insured, which means they pick up the tab for much of their employees' medical care. That's why three major corporations that collectively cover 240,000 lives asked Dr. Arnold Milstein, national healthcare "thought leader" at the consultancy Mercer Health & Benefits, to assess the best places to outsource elective surgeries. Procedures in Thailand and Malaysia, he found, cost only 20% to 25% as much as comparable ones in the U.S.; top-notch Indian hospitals sell such services at an even steeper discount. The bottom line: If more private payers sent patients abroad for uncomplicated elective surgeries, the savings could be enormous. "This has the potential of doing to the U.S. health-care system what the Japanese auto industry did to American carmakers," says Princeton University healthcare economist Uwe Reinhardt. U.S. hospitals could certainly do with a little global competition. For years, their share of the national heath-care bill has grown at a rate far faster than inflation, and today they gobble up a third of all medical expenditures. At current rates, the U.S. will be spending $1 of every $5 of its GDP on health care by 2015, yet more than 1 in 4 workers will be uninsured. The ingrained inefficiency of most hospitals doesn't help. "A lot of them still don't know how to schedule their operating rooms efficiently," says Reinhardt. "They've never had to. They always get paid, no matter how sloppy they are." Get a new hip--and a rebate. Sounds like a bargain, but would people actually travel 10,000 miles for medical care just to make a few bucks? You bet. Polls commissioned by Milstein suggest that few consumers would opt for surgery abroad for incentives below $1,000. But raise the ante above $1,000, and the equation changes. Among people who have sick family members, about 45% of the underinsured or uninsured declare they would get on the plane; even 19% of those who have insurance say they're game. Above $5,000, the percentage of takers climbs to 61% and 40%, respectively. Is the quality of care in foreign hospitals high enough? To cater to an international clientele, many private hospitals abroad are applying for accreditation (many of them successfully) from the Joint Commission International, the global arm of the institution that accredits most U.S. hospitals. Many of the tourist hospitals teem with surgeons who have trained in the U.S. or Britain, which is a great comfort to American patients (the irony is that 25% of physicians in the U.S. got their M.D.s abroad). Escorts Heart Institute and Research Center in Delhi, for instance, was founded by an authority on robotic cardiac surgery, Dr. Naresh Trehan, formerly of New York University. Wayne Steinard, 59, a general contractor from Winter Haven, Fla., is one of those U.S. patients "who fall through the cracks" of the health-care system, as he says. Steinard landed in New Delhi last week with his daughter Beth Keigans to get a clogged artery cleared and a stent installed. Steinard, too rich for Medicaid and too poor for insurance, certainly didn't have the $60,000 he would have had to pay back home. So he contacted PlanetHospital, a Malibu, Calif., medical-tourism agency. The surgery was successful at Max Healthcare's Devki Devi Heart & Vascular Institute. The hospital's bill: $6,650. He says, "I'll be telling everyone I know, to come here if they need surgery. It's not just the price. They've made everything so easy for us." India's medical industry, like its other outsourcing segments, is booming. As the medical-cost crisis deepens, the corporations who pay insurers are likely to find the lure of outsourcing as irresistible in health care as it is in software.
Homework Help, From a World Away It was almost 3 a.m., Alex Del Monte recalled, and he was cramming like crazy. He gulped can after can of Red Bull to stay awake, but the George Washington University sophomore knew he would flunk his Statistics 52 exam later that day if he didn't call his tutor for help. But so late at night? Not a problem if your tutor works 8,500 miles away and 9 1/2 hours ahead in Bangalore, India. In an hour-long session that cost just $18, the Indian tutor, who said his name was Mike, spent an hour walking Del Monte through such esoteric concepts as confidence intervals and alpha divisions, Del Monte recalled. He got an A on the final exam. "Mike helped me unscramble everything in my mind," the 20-year-old said. Thousands of U.S. students such as Del Monte are increasingly relying on overseas tutors to boost their grades and SAT scores. The tutors, who communicate with students over the Internet, are inexpensive and available around the clock, making education the newest industry to be outsourced to other countries. But educational outsourcing has sparked a fierce response from teachers and other critics who argue that some companies are using unqualified overseas tutors to increase their profit margins. "We don't believe that education should become a business of outsourcing," said Rob Weil, deputy director of educational issues at the American Federation of Teachers. "When you start talking about overseas people teaching children, it just doesn't seem right to me." 400 students have enrolled with Growing Stars, a California-based company whose 50 tutors, most of them with master's degrees, work in an office in Cochin, India. The overseas tutors work hard to seem as American as possible. Kamalasan, who has master's degrees in business administration and mathematics, went through two weeks of accent reduction and cultural training. She learned for the first time about baseball and ice skating and had to memorize strange-sounding American holidays. And when she signed off, she said, "Good night!" even though it was just the start of her graveyard shift in India, running from 1:30 a.m. to 9:30 a.m. But Kamalasan, 33, doesn't mind because she makes $300 a month, double what she made as a high school teacher. "This is a very good salary," she said. When Studyloft.com, a Chicago-based tutoring company with more than 6,000 clients, advertised in Bangalore for tutors with master's degrees, more than 500 people applied for 38 spots, according to Bikram Roy, the firm's founder and chief executive. "There is just a huge hotbed of talent there in math and science," he said. "India has the best tutors -- the best teachers -- in the world." Online tutoring company Smarthinking’s, chief executive and co-founder Burck Smith says he believes that eventually schools will outsource their office hours, review sessions and other aspects of instruction to teachers that might be located anywhere in the world. Smarthinking's works with 70,000 students at 300 schools across the country with about 20 percent of its 500 tutors are in countries such as India, the Philippines, Chile, South Africa and Israel. But when Alex Del Monte called up his Studyloft.com tutor right before his exam last semester, he didn't ponder any grand theories about outsourcing. He just wanted help. "All I know is that the tutor's name is Mike and that he helped me ace my test," he said. Del Monte has used the service about every other week this semester, and he vowed that he would finish his studying well before finals this month. "But realistically," he laughed, "I'll most likely be up again at 2 a.m., calling my Indian tutor for help."
Why there are no Indian WalMarts Walk into the Big Bazaar store in Inderlok, a lower-middle-class neighborhood in Delhi, and you can see the business opportunity as clearly as you can see the merchandise. Electronic equipment is displayed alongside women's panties, bags of rice are spilling out of packing cases, tennis balls are piled next to handbags. "It's a typical bazaar feeling," says store manager Nitin Anand. "A little bit of clutter attracts customers." Indeed, the store, one of 90 owned by Pantaloon, India's largest retail group, pulls in up to 8,000 customers a day with its two-for-one offers, its air conditioning, and its wide array of merchandise. Inderlok is at the heart of India's growing middle class, which makes up a third of the country's 1.1 billion population. And that's exactly where international retailers like Wal-Mart, Tesco, and Carrefour want to be. But those companies' stores, ubiquitous in other countries, are nowhere to be found in India, thanks to restrictions on foreign investment. Even the promise of lower prices and more efficient supply chains isn't enough to offset the political power of India's 12 million shopkeepers, who account for 97 percent of the country's $258 billion in annual retail sales, employing 25 million people. Or the muscle of large Indian companies that have recently realized the potential of moving into retail and are urging the government to slow down reforms that would open the sector to foreign competition. "Make it difficult - then the foreigners will have to pay more," says Kishore Biyani, founder, chairman, and managing director of Pantaloon. "Why should we make it easy for them?" Biyani, who plans to expand the floor space of his $450 million retail empire fivefold over the next three years. But there's no denying that retailers such as Pantaloon and RPG Enterprises are rapidly expanding their operations - and that Reliance, the Indian conglomerate, plans to spend up to $2.5 billion over the next two years to open 1,500 supermarkets and hypermarkets - in advance of an anticipated Western retail onslaught. The only opening in the retail sector so far has been to allow 51 percent foreign stakes in single-brand consumer stores, such as those selling only Nokia, Reebok, or Cartier products. But policy changes planned just before Manmohan Singh visited the U.S. last July had to be shelved, partly because India's two Communist parties have taken up the twin issues of upto 8 million job losses and small shopkeepers' losing their livelihoods. Officials in Singh's government, which depends on those parties for its parliamentary majority, say they hope the Communists will allow the Prime Minister to take some initiatives after regional elections in two of their strongholds in May. But Prakash Karat, leader of the main Communist Party, says that he has no intention of relaxing his position and does not expect government reforms in this area "in the foreseeable future." Administration officials also acknowledge that moves could be delayed by the business lobby. Wal-Mart, Tesco, and Carrefour would not discuss their India investment strategies but all have been talking to possible partners. Wal-Mart already buys Indian goods worth more than $1.5 billion a year, ranging from bath towels to jewelry. Tesco also sources in India and has an IT center in Bangalore. Tesco is believed to be closest to Bharti Enterprises, which is diversifying into agribusiness and wants a retail joint venture when the policy allows it. With retail sales increasing by an average of 10 percent a year, spending on luxury goods rising nearly twice as fast, and two-thirds of India's population under 35, consumer demand is clearly growing. Whether that demand is met over the next few years by Reliance, Pantaloon, and other homegrown retailers or by the Wal-Marts of the world depends on how successful India's Communist parties and its leading capitalists are in delaying the inevitable opening of the doors to foreign investment.
Yoga's fresh blend - ANUSARA ANUSARA students will tell you their style of yoga is more than just exercise. It's a community — one of like-minded people who accentuate the positive as the route toward spiritual and physical well-being. Among the believers is B.J. Galvin, who last month drove six hours from Carefree, Ariz., with her two sons so that they could attend founder John Friend's weekend workshop in Los Angeles. The L.A. stop of what Friend called his "Align With the Divine" tour packed students into the ballroom of the Park Plaza Hotel like sardines (or string beans, for the vegetarians). The 280 attendees came not just from Los Angeles, but also from San Diego, Yosemite, Vermont and even Spain — all wanting to study at the feet of the guy who in 1997 trademarked his brand of yoga, Anusara. Anusara is one of the fastest-growing styles of yoga — but not one without criticism. Nine years ago there were only 160 certified Anusara teachers. That number has swelled to 1,200, as the number of students has grown to nearly 200,000. And Southern California, which has more than 50 teachers, is one of Anusara's biggest markets. Los Angeles Anusara teacher Hillary Rubin attributes Friend's popularity to his humility and humor. "There's nothing pretentious about him," she said. "Other teachers can make you feel like they're above you or make you afraid when they walk around the room. John's right there with you." At the same time, he took Hindu tantra philosophy — which promotes the belief that everyone has the freedom to see and experience the intrinsic good in themselves, in their lives, in others — and made it accessible. Followers of Friend, like Galvin, are sometimes called "Friend heads," an affectionate term for people who revere him (he gets standing ovations) and are attracted by the spirituality. In Anusara, the body is something to celebrate — providing a connection with inner divinity, or goodness. "In classical yoga, it's all about renouncing and giving up materialism. Then you go into these fancy studios and they're selling $70 yoga shirts. It was confusing to me," said Galvin, a commercial real estate manager who is working toward getting an Anusara teaching certificate. "With Anusara, we acknowledge that we live in this world where I have kids, a car payment, a mortgage and a job, but I can look at my life and try to make it better by embracing what's good and by aligning to something that's greater than me," Galvin said. Friend, who is on the road 200 days a year teaching workshops and training teachers, emphasized such a worldview when his friend and collaborator Douglas R. Brooks, a Hindu tantra scholar at the University of Rochester in New York, helped him name his yoga style Anusara, which in Sanskrit means "to flow with grace." Anusara is based primarily on Iyengar yoga, which emphasizes precise body alignment and was founded by B.K.S. Iyengar, who has an institute in Pune, India. Friend taught Iyengar yoga for more than a decade. “I wanted to emphasize that the physical practice and the technical stuff were a way to foster spirit and celebrate the tantric view that the body is a magnificent embodiment of supreme consciousness. I don't care if you're at the computer, or lifting weights, spinning, doing Pilates or yoga, it's all about good alignment as it affects the body, the mind and the spirit." he said recently by phone from Anusara headquarters in the Woodlands, Texas. |
