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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.

These private players, which receive tax breaks and purchase land from the government at subsidized rates, make much of the charitable work they perform for India's underprivileged. But a recent Delhi High Court judgment against Apollo Hospital and a subsequent health department investigation suggests that at least some of these claims may be exaggerated or even false.

In September, the Delhi High Court slammed Apollo for failing to live up to its commitment to provide free treatment for the poor in 40 percent of its outpatient and 33 percent of inpatient business in exchange for concessionary land rates, saying, “The hospital has made a complete mockery [of the agreement].” According to the All India Lawyers Union, which brought the suit against the hospital, the Delhi government granted Apollo 15 acres of land for the token price of one rupee and spent about $3.5 million in public funds on the construction of the facility.

“The entire purpose of giving them the public land was frustrated,” said Ashok Aggarwal, the lawyer who argued the case against the hospital.

According to a spokesperson for Apollo Hospitals, the corporation's charitable activities are significant — including the performance of more than 50,000 surgeries and other interventions for poor children suffering from heart disease — and the Delhi hospital in question averages about 60 patients admitted for free care every day. Apollo Delhi also operates a mobile clinic for the poor that has treated 26,000 patients over the past decade, the spokesperson added.

Apollo is by no means the only alleged violator, according to the Delhi government health department, though the hospital's $300 million parent company's fame in medical tourism makes it the most recognizable name of the bunch. A day or two after the judgment against Apollo, health department officials revealed that many of the 40-odd hospitals that were given government land at reduced rates were not utilizing the beds intended for providing free treatment for the poor. About 350 out of 500 beds intended for charity patients were empty. At least part of the problem is that poor people like Rajesh's parents don't know that these private hospitals are obligated to help them. But they may know the ground situation better than activists and writers.

“Even if knew they [private hospitals] were supposed to, do you really think they would let someone like me come through the door?” Rajesh's mother asks bitterly.

The privatization of health care has other dismal consequences, too.

Forty percent of the primary health centers are understaffed; India has fewer than one hospital bed per 1,000 people, compared with a world average of nearly four; and for huge swaths of the countryside medical treatment is simply not available.