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The dark side of medical tourism

India's showcase private hospitals have made it easier for the country to forget about the poor.

A man takes a shower under a leaking water pipeline in New Delhi, Sept. 13, 2009. (Parth Sanyal/Reuters)

NEW DELHI, India — Seema sits cross-legged on a filthy sheet of cardboard next to a crumbling concrete planter in the central square of Nehru Place, New Delhi's computer and electronics hub. Four years ago, at the age of about 14, she gave birth to a son on this very spot, without the aid of a kettle of boiling water or a clean blanket, much less anesthesia or a doctor. Four days ago, the same little boy, Rajesh, died here, on the same slab of pavement.

Suffering from pneumonia, Rajesh never saw a real doctor, even though his mother and the community of rag pickers who live here scraped together everything they had to collect 500 rupees ($12) to pay for treatment. Not knowing any better, Rajesh's family took him to an informal medical clinic on the outskirts of town — the only private medical care that they thought they could afford. The staff there gave them some medicine. But nobody on site had any medical qualifications, so Rajesh wheezed and coughed himself to death.

“I gave birth right here,” Seema said. “It was in winter. That's how Rajesh got sick in the first place. We took him to the doctor so many times. So many people's children I've seen die. They collect money from various places and go to the doctor, and the children still die.”

Seema's grief echoes across the country. According to a new report by Save the Children, nearly 2 million children under 5 die every year in India — one every 15 seconds — the highest number anywhere in the world. More than half die in the month after birth and 400,000 in their first 24 hours. Devastating poverty is the root cause. But the full story is even more grim.

India has swiftly gained a global reputation for excellence in health care thanks to the thriving business of “medical tourism.” But the patients jetting in from the U.K., the U.S. and other wealthy nations to take advantage of relatively low costs for planned surgeries like knee and hip replacements and cosmetic procedures have drawn attention away from the disastrous conditions at most hospitals — not to mention the total dearth of health care for hundreds of millions of Indians.

And medical tourism has a dark side: it has encouraged wealthy and influential Indians to forget about the crumbling and overburdened government-run health system, because they now believe they have access to the world's best care from private hospitals.

As a result, the Indian government spends only 0.9 percent of its gross domestic product on health care, ranking 171st out of 175 countries in public health spending, according to the World Health Organization. It relies on the private sector, which contributes another 4.3 percent of GDP, to make up the shortfall. So even though state-run hospitals like the All India Institute of Medical Sciences (AIIMS) — a renowned center that treats about 3.5 million patients a year for less than a dollar apiece — do their best to care for everybody, the rich and poor alike often turn to private clinics.