Bed with a View

The emergence of luxury hospitals in India

Having spent hours in severe pain at home, then in a hospital room, 83-year-old Saroj kept switching stares between the wooden floor and the red carnations on the table. Her daughter Mira Dasgupta called room service on the intercom and ordered mineral water and coffee. “I thought it was the effect of the medicines. Why would Mira and I be in a hotel with a drip attached to my wrist?” Saroj, diagnosed with gastric cancer, asks, recalling her experience a few months ago in the private suite that her son-in-law had booked for her in the hospital. She realised it was not the medicines when a nurse came in to check the intravenous fluid drip. When her dietician called for a butler and gave him instructions on what she would eat during her stay, she could not believe her ears.

Saroj had moved to the US nearly 25 years ago with her son and husband, a retired government employee. One night last year, on a visit to her daughter Mira in Delhi, she started throwing up and felt as if needles were pricking her stomach. She was rushed to Indraprastha Apollo hospital in the city.

At Apollo, she discovered that she had a private house-keeping service, a flat-screen TV and a visitors’ lounge. “They had sofas and blinds; everyone was so polite,” she says, “This is hard to find even in the States.”

The hospital’s room service menu for attendants of patients offered elaborate meals, including grilled fish with asparagus, shishtouk, and desserts like crème brulee whipped up by chefs who had worked with five-star hotels. There was also wi-fi, reading material and a pantry with a microwave oven and mini-fridge.

Saroj’s last memory of an Indian hospital was a rude nurse who refused to bring bedpans for patients. So her Apollo experience, naturally, left her astonished. “They are renovating the toilets on some floors,” she says, “The quality of marble tiles is as good as in any five-star hotel.”

In a bid to attract patients, upmarket private hospitals now boast of more than just state-of-the-art equipment. They have introduced services one would only find in hotels once, such as personalised housekeeping and concierge help. Some even have private suites with roof-top gardens for special ‘clients’ (as they are now called), even as branded coffee shops and fastfood joints—like Costa, Café Coffee Day, Subway and Haldiram’s—give their common areas the look of a mall. All this is in addition to the promise of technologically advanced medical services and the personalised attention of some of India’s best regarded doctors.

Fortis Memorial Research Institute recently raised the bar for luxury hospitals in India with the inauguration of a 36-seat cinema theatre that screens Bollywood potboilers for the entertainment of those accompanying patients, many of whom need relief from long waits, sleepless tension and extreme fatigue. The service is free right now, but Fortis may begin to charge a nominal fee later, say executives. The hospital, which is spread over 12 acres in Gurgaon, a Delhi suburb, and describes itself as a ‘next generation’ hospital and the ‘Mecca’ of healthcare in India, also houses retail outlets of Reebok, Chicos and a brand of organic food. The hospital also has a spa, gym and swimming pool.

Its sunlit lobby, called ‘Boulevard’, displays works of the noted sculptor Jitish Kalat. Valets, called ‘Genies’ and eager to help patients and visitors navigate the hospital, are posted at key points in the lobby—near lifts and escalators, apart from the eating bay. No part of the hospital smells of phenyl. Instead, odourless disinfectants and mild fragrances do the job. Hospital authorities claim that these services reduce the anxiety of patients and their attendants. “The infrastructure follows a philosophy of design that aims at reducing anxiety and creating a feeling of well-being,” says Dilpreet Brar, regional director, Fortis.

All this is not new to the world. Super-speciality hospitals in Singapore, Bangkok and New York have redefined luxury healthcare. Private hospitals in India, having spotted a market opportunity here as well, are playing catch up. In fact, say executives, sophisticated medical services are the least that people—especially those who frequently go overseas—expect nowadays of hospitals like Fortis, Apollo or Medanta. These hospitals are expected to address a wide range of allied customer needs, and some of them are doing just that through their comfort measures and boutique packages for expectant mothers, playroom facilities, and so on.

Pre-marriage makeovers are available too, and in lounges no less chic than you’d find in any upmarket mall. These ‘peripherals’ have gradually found prominence in newspaper ads and billboards of these hospitals. According to Charu Sehgal, a healthcare consultant at Deloitte, a global consultancy firm, big private hospitals have to court luxury to stay relevant to their core clientele. “The quest to offer ‘something more’ as a differentiator is one reason for shifting focus to the overall experience and comfort of patients and their attendants,” she says. “The days of hospitals being run by trusts or governments and being a sombre and almost depressing place are now over. The new-age hospital has reinvented itself, offering several more services, and for those who can pay, it is moving as close to a hotel as possible.” Also, since most high-end hospitals occupy prime real estate, it makes commercial sense for them to rent out parts of their premises to shops and restaurants, she says.

There are, of course, many families that can afford all this. While hospitals are reluctant to reveal their rate cards of luxury suites and rooms, a source says that a patient at Fortis’ presidential suite could run up bills of Rs 75,000 a day. The hospital’s Maharaja and Maharani suites would be more expensive still. Just a childbirth package at Fortis is in the region of Rs 2 lakh.

Baby deliveries were bitten by the luxury bug even earlier, given how much well-off parents have been willing to splurge on a highly pampered experience. Apollo’s chain of boutique childbirth centres called Cradle now has competition in Fortis’ Mama Mia, which offers workshops and Lamaze classes for expectant mothers. Fancy toys and cute room décor, even baby showers, are complimentary with big-fee packages.

One reason for the escalation in hospital bills, suspect observers, is the widening reach of health insurance in India. A report published in 2011 by the Insurance Regulatory and Development Authority (IRDA) says that in 2009-10, the average claim on major diseases was Rs 134,550, up from Rs 98,101 in 2007-08. The difference captures the sharp inflation of medical bills. Alarmed by fast-rising claims and increasing disputes over these claims, the IRDA is in the process of drafting revised guidelines to clarify which peripherals may be claimed from insurers and which not.

Hospital authorities and doctors, however, insist that the emphasis on comfort and general care is a response to market demand. Says a doctor, who has worked with top private hospitals and does not want to be identified: “The majority of patients who come to me today visit malls and shop at branded outlets now. They have an LCD TV at home and can afford courteous and efficient staff. Why would they not expect the same of a hospital and doctor they consult?”

What are considered ‘hygiene factors’—the bare minimum—have changed dramatically. “Standard eateries, courteous staff, cleanliness and efficiency are a mere given. The patient expects a little extra and is willing to pay more for that,” says the doctor, “The question is where to draw a line between comfort and luxury, which seems to be getting difficult these days.”

Prerna Thadani, a veterinary doctor and young mother who delivered her boy at Apollo last year, is among those who expect hospitals to be places of comfort. “For two days, they took special care of my diet and planned meals according to my needs and likes,” she says, “During the delivery, I was constantly given rose water to drink because a normal delivery [as opposed to a Caesarian section] can be exhausting.”

Alhaji Fatihu, A Nigerian businessman, looks around his Max Hospital room in Delhi and starts counting on his fingers. A few seconds later, he says, “In my country, you could put five beds for patients in this room. My wife would have slept under the bed because there is no extra bed for the companion. Hospitals there are that bad.”

His name is actually Fatihu. “Alhaji is a title given to those who have been on Hajj,” he says with pride, only to wince in pain. In India for the past eight days, Fatihu and his mother are at Max getting treated for their ailments—Fatihu for a perennial pain in his back and knees, and his mother for glaucoma. He had heard of Max from a Gujarati trader in Mumbai who supplies fabric to him for his business of garments back home. “Back home, they didn’t even have the right equipment to check my mother’s eye, let alone perform a surgery,” he says.

Fatihu and his mother are customers of a Rs 11,000 crore domestic industry that is expected to expand 30 per cent annually: ‘medical tourism’, as it is called. According to an Assocham study last year, as many as 850,000 foreign patients visited India in 2011. Most of these patients are like Fatihu, well-to-do visitors from countries like Nigeria, Kenya, Afghanistan and Uzbekistan, where healthcare services are abysmal.

Given the potential of earning foreign exchange this way, most luxury hospitals make special efforts to attract medical tourists. Max has concierge services for foreign patients that include making arrangements for stay and travel and doing their paperwork for India’s Foreign Regional Registration Offices. Max also has a team of interpreters and other staff members dedicated to foreign patients. They usually come for treatment by specialists of oncology (for cancer) and organ transplants (mainly liver and kidneys), apart from surrogate births and cosmetic surgeries.

Healthcare insiders, however, say that the mainstay of luxury hospitals are services aimed at well-off Indians. This is the market that has emerged over the past decade, and is expanding rapidly. “I think the primary target customer is the rich Indian,” says Sehgal, “as also the aspiring middle-class Indian on the cusp of striking it rich.”

According to a doctor who works with Fortis in Vasant Kunj, Delhi, “We barely get patients from the US or UK. Those of most other countries spend on medical services but avoid peripherals. It is the Indian patient who likes to be pampered in a swish room with an elaborate menu of food and facilities.”

The managing director of a large private hospital puts the matter in perspective. “Most hospitals invest heavily in technologically advanced medical treatment with super specialised equipment, apart from maintaining a team of skilled doctors, who are scarce now,” he says, “By investing a little extra on personalised staff and plush interiors, hospitals can charge their patients more and generate additional revenue that adds to business profits and also creates a pool for maintaining the quality of medical care.” He compares it to business class services of airlines. “It is the same airport, aircraft and staff that are used by economy fliers. You are simply providing additional personalised care to the customer who is willing to pay extra for those services. In turn, you generate revenue for your business.”

Private hospitals often get pulled up by governments and courts for the low quality of medical care they provide the poor, serving whom is typically mandated by land-lease agreements signed by hospital businesses (in lieu of prime land being made available by governments at discounted rates). The Supreme Court recently directed all government hospitals to refer patients to private hospitals if such a need arose, and ordered private hospitals to reserve 10 per cent of their beds for poor patients who are to be treated free of charge. 

Many of those who work at private hospitals see such impositions as unfair. Says Ajaya N Jha, a neurosurgeon who heads Medanta’s Neurosciences department, “The private healthcare system in India has reached a certain standard despite the absence of a sound healthcare system offered by the Government. If my daily electricity bill is close to Rs 5 lakh, as central airconditioning is imperative in today’s times, then I should be allowed to charge as much as I want,” he says. “Patients cannot get the best doctors and quality treatment at subsidised cost,” he adds, “It is just not possible.”

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