Description
introduction
swot analysis
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Introduction
Medical tourism in India
After the silicon rush India is now considered as the golden spot for treating patients mostly from the developed countries and far east for ailments and procedures of relatively high cost and complexity. India is also aggressively promoting medical tourism in the current years -and slowly now it is moving into a new area of "medical outsourcing," where subcontractors provide services to the overburdened medical care systems in western countries. India's ational !ealth "olicy declares that treatment of foreign patients is
legally an "export" and deemed "eligible for all fiscal incentives extended to export earnings." #overnment and private sector studies in India estimate that medical tourism could bring between $% billion and $& billion '( into the country by &)%&. #oing by the (tatistics and various studies it can be easily said that india would be the leader in medical tourism within the next decade if only it could improve the infrastructure and tour attractions. *he +uestion or rather the doubt that is often as,ed by critics is how can India provide top line medical care to outsiders while more than -). of its people languished below poverty line and less than &). of its people can actually afford medical services. /thically and morally this problem has to be solved if India has to move into the category of developed country and also as a place which provides medical care to both its own people and patients from other country *he aim of this pro0ect is to put a finger on the highly profitable service of medical care combined with tourism in which india is currently considered as a mar,et leader. It has been a ,nown fact for past many decades that Indian doctors are highly s,illful in their given field since all around the globe mot hospitals have doctors of Indian origin. *herefore it became almost natural that this trend extended to India.
Medical tourism in India
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*his pro0ect also aims to show why India is attracting medical tourists, is it really a secure destination and how India can promote and develop this particular activity in the coming years so as face competition given by other Asian and African options.
Medical tourism in India
3 Medical tourism: A Global perspective Medical tourism happens when patients go to a different country for either urgent or elective medical procedures. *his phenomenon is fast becoming a worldwide, multibillion-dollar industry. *he reasons patients travel for treatment vary. Many medical tourists from the 'nited (tates are see,ing treatment at a +uarter or sometimes even a %)th of the cost at home. 1rom 2anada, it is often people who are frustrated by long waiting times. 1rom #reat 3ritain, the patient can't wait for treatment by the ational !ealth (ervice but also can't afford to see a physician in private practice. 1or others, becoming a medical tourist is a chance to combine a tropical vacation with elective or plastic surgery. And moreover patients are coming from poorer countries such as 3angladesh where treatment may not be available and going for surgery in /uropean or western developed countries is expensive. *he interesting thing of Medical tourism is that it is a concept which is actually thousands of years old. In ancient #reece, pilgrims and patients came from all over the Mediterranean to the sanctuary of the healing god, Asculapius, at /pidaurus. In 4oman 3ritain, patients too, a dip in the waters at a shrine at Bath, a practice that continued for &,))) years as it was believed that the waters had a healing property . 1rom the %5th century wealthy /uropeans travelled to spas from #ermany to the ile. In the &%st century, relatively lowcost 0et travel has ta,en the industry beyond the wealthy and desperate. 2ountries that actively promote medical tourism include 2uba, 2osta 4ica, !ungary, India, Israel, 6ordan, 7ithuania, Malaysia and *hailand. 3elgium, "oland and (ingapore are now entering the field. (outh Africa speciali8es in medical safaris-visit the country for a safari, with a stopover for plastic surgery, a nose 0ob and a chance to see lions and elephants.
Medical tourism in India
4 Thailand 9hile, so far, India has attracted patients from /urope, the Middle /ast and 2anada, *hailand has been the goal for Americans. India initially attracted people who had left that country for the 9est: *hailand treated western expatriates across (outheast Asia. Many of them wor,ed for western companies and had the advantage of flexible, worldwide medical insurance plans geared specifically at the expatriate and overseas corporate mar,ets. 9ith the growth of medical-related travel and aggressive mar,eting, 3ang,o, became a centre for medical tourism. 3ang,o,'s International Medical 2entre offers services in &; languages, recogni8es cultural and religious dietary restrictions and has a special wing for 6apanese patients *he medical tour companies that serve *hailand often put emphasis on the vacation aspects, offering post-recovery resort stays. South Africa (outh Africa also draws many cosmetic surgery patients, especially from /urope, and many (outh African clinics offer pac,ages that include personal assistants, visits with trained therapists, trips to top beauty salons, postoperative care in luxury hotels and safaris or other vacation incentives. 3ecause the (outh African rand has such a long-standing low rate on the foreign-exchange mar,et, medical tourism pac,ages there tend to be perpetual bargains as well.
Medical tourism in India
5 Argentina Argentina ran,s high for plastic surgery, and !ungary draws large numbers of patients from 9estern /urope and the '.(. for high-+uality cosmetic and dental procedures that cost half of what they would in #ermany and America. Dubai 7astly, <ubai--a destination already ,nown as a luxury vacation paradise--is scheduled to open the <ubai !ealthcare 2ity by &)%). (ituated on the 4ed (ea, this clinic will be the largest international medical center between /urope and (outheast Asia. (lated to include a new branch of the !arvard Medical (chool, it also may be the most prestigious foreign clinic on the hori8on. Other countries =ther countries interested in medical tourism tended to start offering care to specific mar,ets but have expanded their services as the demand grows around the world. 2uba, for example, first aimed its services at well-off patients from 2entral and (outh America and now attracts patients from 2anada, #ermany and Italy. Malaysia attracts patients from surrounding (outheast Asian countries: 6ordan serves patients from the Middle /ast. Israel caters to both 6ewish patients and people from some nearby countries. =ne Israeli hospital advertises worldwide services, speciali8ing in both male and female infertility, in-vitro fertili8ation and high-ris, pregnancies. (outh Africa offers pac,age medical holiday deals with stays at either luxury hotels or safaris.
Medical tourism in India
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Indian tourism: An overview
*ourism will expand greatly in future mainly due to the revolution that is ta,ing place on both the demand and supply side. *he changing population structure, improvement in living standard, more disposable income, fewer wor,ing hours and long leisure time, better educated people, ageing population and more curious youth in the developed as well as developing countries, all will fuel the tourism industry growth. *he arrival of a large number of customers, better educated and more sophisticated, will compel the tourist industry to launch new products and brands and re-invents traditional mar,ets. *he established traditional destinations founded on sun-sea-sand products will have to re-engineer their products. *hey must diversify and improve the criteria for destinations and +ualities of their traditional offers. Alongside beach tourism, the tourism sector will register a steady development of new products based on natural rural business, leisure and art and culture. *hus the study of new mar,ets and emerging mar,ets and necessity of diversified products are the basis of our strategy, which can enhance and sustain, existing and capture new mar,ets. It is India>s vastness that challenges the imagination? the sub-continent, @&)),m A&))) milesB from the mountainous vastness of the !imalayas in the north to the tropical lushness of Cerala in the south, is home to one sixth of the world>s population, a diverse culture and an intoxicatingly rich history. <esert in 4a0asthan, tropical forests in the north eastern states, arid mountains in the delta region of Maharashtra and Carnata,a and vast fertile planes in northern states of 'ttar "radesh, !aryana etc are 0ust some of the geographical diversity that can be observed. 9e have a wealth of archeological sites and historical monuments. Manpower costs in the Indian hotel industry are one of the lowest in the world. *his provides better margins for any industry which relies on man power.
Medical tourism in India
7 =ne of the fascinations of India is the 0uxtaposition of old and new: centuries of history D from the pre-historic Indus civili8ation to the 3ritish 4a0 D rub shoulders with the computer age: and 3angalore's E(ilicon Falley> is as much a part of the world's largest democracy as the remotest village is. Wea nesses 7ac, of ade+uate infrastructure is the biggest problem that India faces. *he aviation industry in India, for example, is inefficient and does not provide even the basic facilities at airports. *he visitors are appalled by the poor sanitation in the public restrooms at the international airports. %G-H but we still use the same rail system constructed by the 3ritish. /ven now the government spends next to nothing on proper mar,eting of India>s tourism abroad. As a result foreigners still thin, of India as a country ridden by poverty, superstition, and diseases with sna,e charmers and sadhus at every noo, and cranny. 2ase in point *hailand: where in spite of the huge problem of bird flu disease the tourists arrival only dropped by less then %I. where as in India when cases of plague started occurring in (urat in %GG- the arrival of foreign tourists in India decreased by almost @;.. Opportunities More proactive role from the government of India in terms of framing policies. Allowing entry of more multinational companies into the country giving us a global perspective. #rowth of domestic tourism. *he advantage here is that domestic tourism and international tourism can be segregated easily owing to the different in the period of holidays. *he road condition in India is very worse. *he population has grown exponentially since
Medical tourism in India
8 Threats "olitical turbulence within India in Cashmir and #u0arat has also reduced tourist traffic. ot only that fear of epidemics such as for malaria, cholera, dengue, plague etc are foremost in the mind of /uropean and America patients .Aggressive strategies adopted by other countries li,e Australia, (ingapore in promoting tourism are also not helping.
Medical tourism in India
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What is India Offering:
A!"#$%DA India has a rich heritage in the areas of traditional and natural medicines. *he earliest mention of Indian medical practices can be found in the Fedas and (amhitas of 2hara,a, 3hela and (husruta. A systematic and scientific approach was adopted by the sages of the time leading to the development of a system that is relevant even today. India is the land of Ayurveda. It believes in removing the cause of illness and not 0ust curing the disease itself. It is based on herbals and herbal components without having side effects. Ayurveda considers that the base of life lies in the five primary elements: ether AspaceB, air, fire, water and earth. And the individual is made up of a uni+ue proportion of the five elements in uni+ue combinations to form three doshas Avata, pita and ,aphaB. 9hen any of these doshas become accute, a person falls ill. Ayurveda recommends a special life style and nutritional guidelines supplemented with herbal medicines. If toxins are abundant, then a cleaning process ,nown as "anch,arma is recommended to eliminate those unwanted toxins and revitali8e both mind and body. Ayurveda offers treatments for ailments such as arthritis, paralysis, obesity, sinusitis, migraine, premature aging and general health care. Cerala is a world tourist destination and part of the reasons lies with the well- ,nown stress-releasing therapies of famed Ayurvedic research centers. *he climate along with the blessing of nature has turned Cerala into the ideal place for ayurvedic, curative and re0uvenating treatments. !OGA If Ayurveda is the science of body, yoga is the science of the mind. "racticed together they can go a long way in ma,ing an individual fit. *he word yoga means to 0oin together. *he ultimate aim of yoga is to unite the human soul with the universal spirit. Joga was developed I))) years ago and the base of yoga is described in the Joga (utra of "atan0ali.
Medical tourism in India
10 *his describes eight stages of yoga. *hese are Jam Auniversal moral commandsB, iyam Aself purificationB, Asana ApostureB, "ranayama Abreathing <hyana AmeditationB, and (amadhi Astate of controlB, "rathyahara Awithdrawal of mind from external ob0ectsB, <harana AconcentrationB, superconsciousnessB. *o get the benefits of yoga, one has to practice Asana, "ranayama and Joganidra. 9ith the regular practice of asanas one can @&H control cholesterol level, reduce weight, normali8e blood pressure and improve cardiac performance. "ranayama helps to release tensions, develop relaxed state of mind and Joganidra is a form of meditation that relaxes both physiological and psychological systems. *oday, yoga has become popular in India and abroad and in a number of places including urban and rural areas yoga is taught and practiced. S&A T#%ATM%'T Most of the other parts of the world have their own therapies and treatment that are no doubt effective in restoring wellness and beauty. ew ,inds of health tours that are gaining popularity in India are spa tours. (pas offer the uni+ue advantages of ta,ing the best from the west and the east combining them with the indigenous system and offering best of the two worlds. In hydropathy, (wedish massages wor, with the 6avanese Mandy, lulur, aromatherapy, reflexology and traditional ayurveda procedures to help ,eep the tourist healthy and enhance beauty. 2ombining these therapies with meditation, yoga and pranayama ma,e the spa experience in India a new destination for medical tourism. *he spas are very useful for controlling blood pressure, insomnia, cure tension, depression, paralysis and number of other deadly diseases. Ananda 4esort in 4ishi,esh, Angsana 4esort, #olden "alm (pa and Ayurgram in 3angalore offer ayurveda, naturopathy, yoga and meditation pac,ages. A#aur CanchilalB Allopathy
Medical tourism in India
11 India has made rapid strides in advanced health care systems, which provides world-class allopathic treatment. *his has become possible because of the emergence of the private sector in a big way in this field. More and more foreign tourists are reali8ing that India is an ideal place for stopover treatment. Indian Multi-specialty hospitals are providing worldclass treatment at an ama8ingly economical cost as compared to the west. Kuality services and low price factor primarily go in favour of India. *he cardio care, bone marrow transplantation, dialysis, ,idney transplant, neuronDsurgery, 0oint replacement surgery, urology, osteoporosis and numerous diseases are treated at Indian hospitals with full professional expertise. Apollo hospital group, /scorts in <elhi, 6ason !ospital, #lobal !ospital, and Max !ealth 2are are catering to medical care for international patients in the areas of diagnostic, disease management, preventive health care and incisive surgeries. *he tourism department has devised websites in order to provide information. Many Ayurveda health resorts that are owned and rum by traditional Ayurveda Institutes have come up. Ayurgram is a novel concept that not only offers heritage accommodation but also offers a whole range of Ayurvedic treatments and re0uvenating pac,ages. (imilarly hotels have also included these types of pac,ages in their holidays. (ome of the tour operators have wor,ed out all-inclusive medical treatment pac,age that include treatment, accommodation, food, airport transfers, post operation recuperative holidays, along with a host of other facilities. @&5 *his in fact shows our product offers true value for money for service. Many world-class state-of-the-art furnishing and e+uipment are being added to our Ayurveda 4esorts to welcome international guests. Along with these hospitals there are many centers which offer not 0ust physical but emotional and spiritual healing to patients. 9ith all these India is going to be one of the leading medical health care destinations in the near future.
Medical tourism in India
12 S&I#IT"A( TO"#ISM #lobally people are increasingly mentally disturbed and loo,ing for solace in spiritual reading, meditation and moments of divine ecstasy. =ur country has been ,nown as the seat of spiritualism and India>s cosmopolitan nature is best reflected in its pilgrim centres. 4eligion is the life-blood for followers of ma0or religion and sects. !induism, Islam, 3uddhism, 6ainism, Loroastrianism and 2hristianity have lived here for centuries. *he visible outpouring of religious fervor is witnessed in the architecturally lavish temples, mos+ues, monasteries and 2hurches spreads across the length and breadth of the country. India is not only ,nown as a place rich in its culture with varied attractions but also for many places of worship, present itself as embodiments of compassion where one get peace of mind. *hus India has been respected as a destination for spiritual tourism for domestic and international tourists. (piritual tourism is also termed as religious heritage tourism. It includes all the religions mentioned above: religious places associated with, emotional attachment to these centers and infrastructure facilities for the tourists. *his can also be referred to as pilgrimage tourism, as clients are not loo,ing for luxury but arduous 0ourneys to meet the divine goal or simple life. *he essence of spiritual tourism is inner feeling through love. 7ove should not be rationed on the basis of caste, creed and economic status or intellectual attainment of the recipient. 4eligions come into existence for the purpose of regulating human life: what are common to all of them are the principles of love. *hus through religious tourism there is a sincere effort to bring better understanding among various communities, nations and thus foster global unity. !induism is one of the oldest religions of India. =ver I))) years of religious history created wonderful temples and survived through ages all over India. *he most popular spiritual tours are those that are centered on holy #anges 4iver. 3adrinath, Cedarnath, !aridwar, #angotri, Jamunotri, Allahabad, Faranasi. 6aganath temple at "uri, 3hubaneshwar, Conar, in =rissa, Mata Faishnodevi of 6ammu and Cashmir, are some of the important pilgrim centers in north India. *here are many spiritual sites in (outh India as well Medical tourism in India
13 which dates bac, beyond the %)th centaury. 4ameshwaram, Mahabalipuram, Madurai Meena,shi temple in *amilnadu and *irupati in Andhra "radesh are some pilgrim centers. /very year millions of tourists, both domestic and international, visit these places. India is special to 3uddhists all over the world and India is the destination for pilgrimage because 3uddhism emerged in India. *he country is dotted with places that are associated with the life and times of #utham 3uddha: 7umbini-the birthplace of 3uddha, (aranath where 3uddha delivered his first sermon, 3uddha #aya where lord 3uddha attained enlightenment and Faishali where he delivered his last sermon and announced his nirvana. (i,hism also emerged in India. *he #olden *emple in Amritsar, the !em,und (ahib, and #urunana, <ev0i #urudwara at Mani,aran, which is also ,nown for its hot water springs with healing properties, the holy city of "atna (ahib and Anandpur (ahib are important for (i,hs. *he 6ain temples of <ilwara and Mount Abu in 4a0asthan, the #omateswara temple at Carnata,a, draw thousands of 6ain followers. /ven small communities li,e the 3ahais have their own 7otus *emple at <elhi. *he (ultanate and Moghul empires built many historical monuments and mos+ues during their reign, all over the country. 4ed 1ort, 1atehapur (i,ri, 6ama Mas0id, *a0Mahal, 2harminar etc., bear testimony to the blend of the Indian and Islam traditions of architecture. *he followers of Islam have many mos+ues and shrines of (ufi (aints, li,e Moin-'ddin 2histi and i8amuddin Aulia. 1or 2hristians, spiritual tours to #oa among other place li,e Mumbai and Col,ata are must. Among the most popular sites in #oa is the church of =ur 7ady of 4osary, the 4achel (eminary, and 2hurch of 3om 6esus. In addition to pilgrim centers there are personalities li,e the (atya (ai 3aba, =sho, (hirdhi and others. *his shows that spirituality and religion in India is a serious pursuit. *he (tate #overnments concerned, charitable trusts, temple trusts have made elaborate arrangements for accommodation, transport and ritual ceremonies. *hese organi8ations are also running hospitals, educational institutes, ashrams, meditation centers which benefit local community. More than I)) religious places have been identified and efforts are being made to develop these centers by 2entral and (tate #overnments with private participation. Medical tourism in India
14 AD$%'T"#% TO"#ISM Jouth tourism has been identified as one of the largest segments of global and domestic tourism. *he young travellers are primarily experience see,ers, collecting, en+uiring uni+ue experiences. Adventure and ris, have a special role to play in the behaviour and attitudes of young travellers. *he growing number of young travellers is being fuelled by a number of factors such as increased participation in higher education, falling level of youth unemployment, increased travel budget through parental contribution, search for an even more exciting and uni+ue experience and cheaper long distance travel. Jouth and adventure tourism appears to have considerable growth potential. *he rising income in some ma0or potential source mar,ets such as the 2entral and /astern /urope, Asia and 7atin America, combined with the lower travel cost, growing student populations around the world particularly in developing countries, has fuelled the demand. India? a heaven for adventure tourism India has been an attraction for travellers from all over the world. *hough in the field of international tourism, the segment of adventure tourism in India is getting only a fraction of such traffic. *he trend has been showing an increased movement year after year with the development of facilities and greater awareness about adventure tourism options. Indian tourism offers both international and domestic adventurers a wide choice of adventures. 9ater sports, elephant safari, s,iing, yachting, hails,iing, gliding, sailing, tribal tours, orchid tours, scaling the high pea,s of !imalayas, tre,,ing to the valley of flowers, riding the waves in rapids, and camel safari in the deserts are breath ta,ing opportunities for nature enthusias. 7ada,h, the #arwal hills, the !imachal hills, <ar0eeling, #oa, 7a,shadweep, Andaman and icobar, 6aisalmer and wildlife sanctuaries and reserves are some of the places that offer adventure tourism.
Medical tourism in India
15 #"#A( TO"#ISM 4ural tourism has been identified as one of the priority areas for development of Indian tourism. 4ural tourism experience should be attractive to the tourists and sustainable for the host community. *he ob0ectives of rural tourism as? M Improve the +uality of life of rural people M "rovide good experience to the tourist M Maintain the +uality of environment. Indian villages have the potential for tourism development. 9ith attractive and uni+ue traditional way of life, rich culture, nature, crafts, fol,-lore and livelihood of Indian villages are a promising destination for the tourist. It also provides tourism facilities in terms of accessibility, accommodation, sanitation and security. 4ural tourism can be used as a means to?M Improve the well being of the rural poor M /mpower the rural people M /mpower the women M /nhance the rural infrastructure M "articipate in decision-ma,ing and implementing tourism policies M Interaction with the outside world M Improve the social condition of lower sections of the society. M "rotection of culture, heritage, and nature. inth "lan identified basic
Medical tourism in India
16 *o tap the immense opportunities, coordinated actives of all agencies involved in the development are re+uired. A carefully planned and properly implemented development will definitely benefit the community economically and improve the +uality of life in the villages. *he success of such development depends upon the people>s participation at grass root level for the development of tourist facilities and for creating a tourist friendly atmosphere. <evelopment of rural tourism is fast and trade in hotels and restaurants is growing rapidly. Increase in the share of earnings through rural tourism will no doubt: provide an attractive means of livelihood to the poor rural community. It increases the purchasing power at all levels of community and strengthens the rural economy. <evelopment of infrastructure facilities such as rail, electricity, water, health and sanitation will definitely improve the +uality of life.
Medical tourism in India
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India as a global destination for Medical Tourism
*ourism and healthcare, being an integral part of many economies services industry are both important sources of foreign exchange. #lobalisation has promoted a consumerist culture leading to the mushrooming of corporate healthcare settings sei8ed with the necessity to maximise profits and expand their coverage. !owever, the constraint lies in the fact that these services can be afforded by a relatively small si8e of population in developing countries. 7ow insurance penetration, lac, of standardisation of services, poor information base, ineffective monitoring leading to low +uality, high levels of fraud and corruption, misallocation of investments and low efficiency of existing hospitals have impeded effective performance leading to a stagnation of the healthcare sector. In this scenario, corporate interests in the medical care sector are loo,ing for opportunities beyond the national boundaries. *his is the genesis of NMedical *ourismO industry. *he term medical tourism refers to the increasing tendency among people from the 'C, the '( and many other third world countries, where medical services are either very expensive or not available, to leave their countries in search for more affordable health options, often pac,aged with tourist attractions. 7ong waiting lists, decline in public spending and rise in life expectancy and non-communicable diseases that re+uire specialist services are some of the factors directing a wave of medical tourists to more affordable healthcare destinations. Most countries are tapping the health tourism mar,et due to aggressive international mar,eting in con0unction with their tourism industry. In this rat race, *hailand, Malaysia, 6ordan, (ingapore, !ong Cong, 7ithuania and (outh Africa have emerged as big healthcare destinations.
Medical tourism in India
18 India is uni+ue as it offers holistic healthcare addressing the mind, body and spirit. 9ith yoga, meditation, ayurveda, allopathy and other Indian systems of medicine, India offers a vast array of services combined with the cultural warmth that is difficult to match by other countries. Also, clinical outcomes in India are on par with the world>s best centres, besides having internationally +ualified and experienced specialists. 2II believes that India should capitalise on its inherent strengths to become a world player in medical tourism. According to a 2II-Mc Cinsey study, medical tourism in India could become a '(< % billion business by &)%&. Instead of adopting a segmental approach of targeting a few states such as Maharashtra, Cerala, Andhra "radesh, 2hennai, efforts are now being made to pro0ect N<estination IndiaO as a complete brand ideal for medical tourists. 2ountries from where people head for India are the 'C, 3angladesh, =man, (ri 7an,a, Indonesia, Mauritius, igeria, Cenya, "a,istan, etc. Fisitors, especially from the 9est and Middle /ast find Indian hospitals a very affordable and viable option to grappling with insurance and national medical systems in their native lands. *here are thousands of expatriates without any social security and health insurance cover who usually compare the costs before going for treatment and India has a cost advantage for this segment. Although, the existing mar,et for medical tourism in India is small, it can grow rapidly if the industry reorients itself to lure foreign patients from all potential regions such as (AA42, 2entral Asia, Middle /ast, Africa, /urope, =/2< besides the 'C and the '(. *he annual health bill of people from Afro-Asian countries see,ing treatment outside their countries is '(< %) billion. If India can even tap a fraction of that mar,et, the potential is enormous. *he price advantage is however offset today for patients from the developed countries by concerns regarding standards, insurance coverage and other infrastructure.
Medical tourism in India
19 *he +uestion being as,ed by many is that how can India become an international destination in healthcare, when the clientele at home is bristling with dissatisfaction. !ence, arises the need to define minimum standards at national level, compulsory registration and adoption of these standards by all providers and regular monitoring and enforcing of such standards at the local level. Kuality assessment should combine evaluation of infrastructure as well as outcomes. An obvious answer to all this is accreditation. *his will ensure transparency in the way a hospital performs, and everything from the operating to the cleaning procedures will be monitored, audited and recorded. 9ith an aim to boost the much tal,ed about medical tourism, many corporate hospitals in India are loo,ing to international agencies such as 62A!=P62I for accreditation. Accreditation will even ma,e tie ups with overseas health insurance agencies such as 3'"A and 2!'3( easier to route patients to India. As the medical tourism industry is growing exponentially, government and the private players need to 0oin hands in order to act as a catalyst to build infrastructure for hospitals, create specialty tourist pac,ages to include medical treatment, promote accreditation and standardisation, enable access and tie-ups with insurance companies, provide state of art facilities and improve +uality of in-patient care and service to meet the re+uirements of foreign patients and to attain sustainable competitive advantage. Many fear about the serious conse+uences of e+uity and cost of services and raise a fundamental +uestion on the very existence of medical tourism- why should developing countries be subsidising the healthcare of developed nationsQ 1or them, medical tourism is li,ely to further devalue and divert personnel from the already impoverished public health system. !owever, with good planning and implementation, medical tourism besides being an economy booster can surely help India maintain good cross border and trade relations, exchange of manpower and technology among countries.
Medical tourism in India
20 (trategies are thus needed not 0ust to pro0ect India as a ma0or healthcare destination, but also to create a system to conduct proper mar,et research and feasibility studies in order to +uantify the N!ow manyO, N1rom whereO, N*o whereO, and most importantly the N!owO of medical tourism. =nly then can we leverage and channelise all efforts in the right direction. In the absence of proper planning, formulation, implementation and evaluation of coherent strategies, the much created hype and all the tal, may 0ust go in vain.
Medical tourism in India
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Wh) the world is moving towards medical tourism
Medical tourists have good cause to see, out care beyond the 'nited (tates for many reasons. In some regions of the world, state-of-the-art medical facilities are hard to come by, if they exist at all: in other countries, the public health-care system is so overburdened that it can ta,e years to get needed care. In 3ritain and 2anada, for instance, the waiting period for a hip replacement can be a year or more, while in 3ang,o, or 3angalore, a patient can be in the operating room the morning after getting off a plane. 1or many medical tourists, though, the real attraction is price. *he cost of surgery in India, *hailand or (outh Africa can be one-tenth of what it is in the 'nited (tates or 9estern /urope, and sometimes even less. A heart-valve replacement that would cost $&)),))) or more in the '.(., for example, goes for $%),))) in India--and that includes round-trip airfare and a brief vacation pac,age. (imilarly, a metal-free dental bridge worth $I,I)) in the '.(. costs $I)) in India, a ,nee replacement in *hailand with six days of physical therapy costs about one-fifth of what it would in the (tates, and 7asi, eye surgery worth $@,H)) in the '.(. is available in many other countries for only $H@). 2osmetic surgery savings are even greater? A full facelift that would cost $&),))) in the '.(. runs about $%,&I) in (outh Africa. *he savings sound very attractive, but a good new hip and a nice new face don>t seem li,e the sort of things anyone would want to bargain with. !ow does the balance of savings versus ris, pay off in terms of success rates Inferior medical care would not be worth having at any price, and some s,eptics warn that *hird 9orld surgery cannot possibly be as good as that available in the 'nited (tates. In fact, there have been cases of botched plastic surgery, particularly from Mexican clinics in the days before anyone figured out what a gold mine cheap, high-+uality care could be for the developing countries.
Medical tourism in India
22 Jet, the hospitals and clinics that cater to the tourist mar,et often are among the best in the world, and many are staffed by physicians trained at ma0or medical centers in the 'nited (tates and /urope. 3ang,o,>s 3umrundgrad hospital has more than &)) surgeons who are board-certified in the 'nited (tates, and one of (ingapore>s ma0or hospitals is a branch of the prestigious 6ohns !op,ins 'niversity in 3altimore. In a field where experience is as important as technology, /scorts !eart Institute and 4esearch 2enter in <elhi and 1aridabad, India, performs nearly %I,))) heart operations every year, and the death rate among patients during surgery is only ).5 percent--less than half that of most ma0or hospitals in the 'nited (tates. In some countries, clinics are bac,ed by sophisticated research
infrastructures as well. India is among the world>s leading countries for biotechnology research, while both India and (outh Corea are pushing ahead with stem cell research at a level approached only in 3ritain. In many foreign clinics, too, the doctors are supported by more registered nurses per patient than in any 9estern facility, and some clinics provide single-patient rooms that resemble guestrooms in four-star hotels, with a nurse dedicated to each patient &- hours a day. Add to this the fact that some clinics assign patients a personal assistant for the post-hospital recovery period and throw in a vacation incentive as well, and the deal gets even more attractive. Additionally, many Asian airlines offer fre+uent-flyer miles to ease the cost of returning for follow-up visits. Medical tourism trend and what statistics shows? *en years ago, medical tourism was hardly large enough to be noticed. *oday, more than &I),))) patients per year visit (ingapore alone--nearly half of them from the Middle /ast. *his year, approximately half a million foreign patients will travel to India for medical care, whereas in &))&, the number was only %I),))).
Medical tourism in India
23 In monetary terms, experts estimate that medical tourism could bring India as much as $&.& billion per year by &)%&. Argentina, 2osta 4ica, 2uba, 6amaica, (outh Africa, 6ordan, Malaysia, !ungary, 7atvia and /stonia all have bro,en into this lucrative mar,et as well, or are trying to do so, and more countries 0oin the list every year. Trends in medical tourism in the near future (ome important trends guarantee that the mar,et for medical tourism will continue to expand in the years ahead. 3y &)%I, the health of the vast 3aby 3oom generation will have begun its slow, final decline, and, with more than &&) million 3oomers in the 'nited (tates, 2anada, /urope, Australia and medical care. Medical tourism will be particularly attractive in the 'nited (tates, where an estimated -@ million people are without health insurance and %&) million without dental coverage--numbers that are both li,ely to grow. "atients in 3ritain, 2anada and other countries with long waiting lists for ma0or surgery will be 0ust as eager to ta,e advantage of foreign health-care options. ew Lealand, this represents a significant mar,et for inexpensive, high-+uality
Medical tourism in India
24
Advantage India
Indian corporate hospitals excel in cardiology and cardiothoracic surgery, 0oint replacement, eurology, 'rology, orthopedic eurosurgery, surgery, =ncology, gastroenterology, =phthalmology, ophthalmology, 4heumatology, eurology, transplants and urology to name a few. *he various specialties covered are /ndocrinology, / *, "ediatrics, "ediatric (urgery, "ediatric "ulmonology, "sychiatry, #eneral Medicine R #eneral (urgery *he various facilities in India include full body pathology, comprehensive physical and gynecological examinations, dental chec,up, eye chec,up, diet consultation, audiometry, spirometry, stress R lifestyle management, pap smear, digital 2hest S-ray, %& lead /2#, &< echo colour doppler, gold standard <SA bone densitometry, body fat analysis, coronary ris, mar,ers, cancer ris, mar,ers, carotid colour doppler, spiral 2* scan and high strength M4I. /ach test is carried out by professional M.<. physicians, and is comprehensive yet pain-free. *here is also a gamut of services ranging from #eneral 4adiography, 'ltra (onography, Mammography to high end services li,e Magnetic 4esonance Imaging, <igital (ubtraction Angiography along with intervention procedures, uclear Imaging. *he diagnostic facilities offered in India are comprehensive to include 7aboratory services, Imaging, 2ardiology, eurology and "ulmonology. *he 7aboratory services include biochemistry, hematology, microbiology, serology, histopathology, transfusion medicine and 4IA. All medical investigations are conducted on the latest, technologically advanced diagnostic e+uipment. (tringent +uality assurance exercises ensure reliable and high +uality test results.
ephrology, <ermatology, <entistry, "lastic (urgery, #ynecology,
Medical tourism in India
25
As Indian corporate hospitals are on par, if not better than the best hospitals in *hailand, (ingapore, etc there is scope for improvement, and the country may become a preferred medical destination. In addition to the increasingly top class medical care, a big draw for foreign patients is also the very minimal or hardly any waitlist as is common in /uropean or American hospitals. In fact, priority treatment is provided today in Indian hospitals. *he Apollo #roup, /scorts !ospitals in ew <elhi and 6aslo, !ospitals in
Mumbai are to name a few which are established names even abroad. A list of corporate hospitals such as #lobal !ospitals, 2A4/ and <r 7.F. "rasad /ye !ospitals in !yderabad, *he !indu0as and M /xcellence in Mumbai, also have built capabilities and are handling a steadily increasing flow of foreign patients. India has much more expertise than say *hailand or Malaysia. *he infrastructure in some of India's hospitals is also very good. 9hat is more significant is that the costs are much less, almost one-third of those in other Asian countries. India will soon become THE global health destination. It is replicating the *hai model, which has been the first Asian destination for International "atients. India benefits from a large staff of world class experts and the ultracompetitive cost advantage it offers. 9ith prices at a fraction Aless than %). for example in the treatment of gall stone $
) '( B of those in the '( or /', the concept has broad consumer appeal. Indian private facilities offer advanced technology and high-+uality treatment at par with hospitals in western countries. India is promoting "medical outsourcing" where subcontractors aim to provide services to the overburdened medical care systems in western countries. Medical tourism to India is growing by &). a year. Most non-urgent 9estern patients usually get a pac,age deal that includes flights, transfers, hotels, treatment and often a post-operative vacation. *here are many bro,ers speciali8ed on the Indian mar,et. Medical tourism in India
26
India has top-notch centers for open-heart surgery, pediatric heart surgery, hip and ,nee replacement, cosmetic surgery, dentistry, bone marrow transplants and cancer therapy, and virtually all of India>s clinics are e+uipped with the latest electronic and medical diagnostic e+uipment. 'nli,e many of its competitors in medical tourism, India also has the technological sophistication and infrastructure to maintain its mar,et niche, and Indian pharmaceuticals meet the stringent re+uirements of the '.(. 1ood and <rug Administration. Additionally, India>s +uality of care is up to American standards, and some Indian medical centers even provide services that are uncommon elsewhere. 1or example, hip surgery patients in India can opt for a hip-resurfacing procedure, in which damaged bone is scraped away and replaced with chrome alloy--an operation that costs less and causes less post-operative trauma than the traditional replacement procedure performed in the '.(. !ealthcare procedures across the world show a wide cost difference. It leads to a +uestion of affordability even to the developed country li,e the '( where significantly huge number of population is not covered under any insurance scheme. In some developed country, long waiting period for elective inpatient and outpatient care has created a situation where people do not hesitate to buy healthcare from other developing countries li,e India without compromising on +uality. 2omplimentary tourism pac,ages ma,e the entire offer more attractive to the people who are interested to travel for their healthcare. #lobalisation of healthcare industry has started in many level. 1or instance, Indian software companies li,e *2( and Maste, has signed I* contract recently worth more than '( $ &)) million.
Medical tourism in India
27
Scope * Opportunities
*hough the service sector has considerable contribution in India>s #<", it is negligible on the export front with only around &I per cent of total export. Falue added services generally exceed per cent of total output in the high income industrialised economy. In the global scenario, India>s share of services export is only %.@ per cent A&))@B i.e '(< &).H billion which has gone up from ).IH per cent A%GG)B. =verall service export growth rate in India is 5 per cent A&))&B against a global growth rate of I per cent. It had a tremendous impact on India>s 1orex reserve. 1orex reserve rise to '(< %%5.;&5 on May, &))- in comparison to '(< HG.&& for the same period in &))@. 3eing a service sector member, medical and tourism services export can further rise India>s 1orex 4eserve along with a ma0or contribution from software exports. In India, international tourist rose %I.@ per cent between 6anuary and <ecember, &))@. *hough tourism and travel industry contribution is &.I per cent to our countries #<" Ainternational ran,ing %&-B but recent initiative from the government li,e liberalised open s,y policy to increase flight capacity, lower and attractive fares, increase in hotel room capacity by nearly 5) per cent Afrom &)))B and better connectivity between ma0or tourist destination A/xpress !ighway pro0ectB has helped India to ran, among the top five international holiday destination when independent traveler conducted a poll in %@- countries. !ealthcare industry has shown considerable growth in last few years. /mergence of top notch corporate hospitals and continuous effort for improvement of +uality of care has placed Indian private healthcare in a respectable position on the global map.
Medical tourism in India
28 !igh ratio of foreign +ualified medical practitioners and well-trained nursing and paramedical staff have developed confidence amongst the people who are see,ing medical care from Indian !ospitals. If everything moves in the right direction, M* alone can contribute an additional revenue of 4s I))) - 4s %),))) crore for up mar,et tertiary centre by &)%& A@-I per cent of total delivery mar,etB.
Medical tourism in India
29
'eed +or Medical Tourism
Medical tourism can be broadly defined as provision of 'cost effective' private medical care in collaboration with the tourism industry for patients needing surgical and other forms of speciali8ed treatment. *his process is being facilitated by the corporate sector involved in medical care as well as the tourism industry - both private and public. Medical or !ealth tourism has become a common form of vacationing, and covers a broad spectrum of medical services. It mixes leisure, fun and relaxation together with wellness and healthcare. *he idea of the health holiday is to offer you an opportunity to get away from your daily routine and come into a different relaxing surrounding. !ere you can en0oy being close to the beach and the mountains. At the same time you are able to receive an orientation that will help you improve your life in terms of your health and general well being. It is li,e re0uvenation and clean up process on all levels - physical, mental and emotional. Many people from the developed world come to India for the re0uvenation promised by yoga and Ayurvedic massage, but few consider it a destination for hip replacement or brain surgery. !owever, a nice blend of top-class medical expertise at attractive prices is helping a growing number of Indian corporate hospitals lure foreign patients, including from developed nations such as the 'C and the '(.
Medical tourism in India
30 As more and more patients from /urope, the '( and other affluent nations with high medicare costs loo, for effective options, India is pitted against *hailand, (ingapore and some other Asian countries, which have good hospitals, salubrious climate and tourist destinations. 9hile *hailand and (ingapore with their advanced medical facilities and built-in medical tourism options have been drawing foreign patients of the order of a couple of la,hs per annum, the rapidly expanding Indian corporate hospital sector has been able to get a few thousands for treatment. In India, the Apollo group alone has so far treated GI,))) international patients, many of whom are of Indian origin. Apollo has been a forerunner in medical tourism in India and attracts patients from (outheast Asia, Africa, and the Middle /ast. *he group has tied up with hospitals in Mauritius, *an8ania, 3angladesh and Jemen besides running a hospital in (ri 7an,a, and managing a hospital in <ubai. Another corporate group running a chain of hospitals, /scorts, claims it has doubled its number of overseas patients - from ;HI in &))) to nearly %,&)) this year. 4ecently, the 4uby !ospital in Col,ata signed a contract with the 3ritish insurance company, 3'"A. *he management hopes to get 3ritish patients from the +ueue in the ational !ealth (ervices soon. (ome estimates say that foreigners account for %) to %& per cent of all patients in top Mumbai hospitals despite roadbloc,s li,e poor aviation connectivity, poor road infrastructure and absence of uniform +uality standards. Analysts say that as many as %I),))) medical tourists came to India last year. !owever, the current mar,et for medical tourism in India is mainly limited to patients from the Middle /ast and (outh Asian economies. (ome claim that the industry would flourish even without 9estern medical tourists. Afro-Asian people spend as much as $&) billion a year on health care outside their countries igerians alone spend an estimated $% billion a year. Most of this money would be spent in /urope and America, but it is hoped that this would now be increasingly directed to developing countries with advanced facilities. Medical tourism in India
31
India,s +uture &rospect
*he global healthcare mar,et is '(< @ trillion and si8e of the Indian healthcare industry is around %,%),))) crores accounting for nearly I.& per cent of #<". It is li,ely to reach ;.&- 5.I per cent of the #<" by &)%&. It is expected that medical tourism will account about @-I per cent of the total delivery mar,et. More than %,I),))) medical tourists came to India in &))@. Around H),))) people came from the Middle /ast for the medical treatment. *raditional system of medicine is able to attract a si8eable number of people from western countries ACerala, for instanceB. Most of the medical tourists are Indian in origin. 9e need to attract more number of people of foreign origin. International experience shows some of the countries li,e *hailand, (ingapore, 6ordan and Malaysia have done extremely well. *here is technical committee formed by 6ordan #overnment operating for the non-6ordanian Arab patients who visit 6ordan for healthcare. *his office regulates the healthcare institutions treating those patients and monitor the entire activity. Ma ing of a Medical Tourism destination =ur healthcare industry has some inherent drawbac,s. 7ac, of
standardisation in medical care and cost, lac, of regulatory mechanism, infrastructural bottlenec,s and poor medical insurance coverage are a few to mention here. =n the other hand, tourism and hospitality industries are facing some ma0or challenges to develop the infrastructure and services. Industry and government collaboration in terms of some incentives and creation of soothing environment can further ma,e this endeavor easy for both the service sector. *he immediate need is the establishment of health and tourism players consortium to discuss about all these issues and maintain closer interaction and co-ordination to develop medical tourism - a growth engine for 1orex earnings.
Medical tourism in India
32
&rice -omparison Overview
2=(* 2=M"A4I(= D I <IA F( ' I*/< (*A*/( =1 AM/4I2A A'(AB (ignificant cost differences exist between '.C. and India when it comes to medical treatment. India is not only cheaper but the waiting time is almost nil. *his is due to the outburst of the private sector which comprises of hospitals and clinics with the latest technology and best practitioners. &rocedure -harges in India * "SA
&rocedure
"nited States
India ."SD/
."SD/ Appro0 Appro0 3one Marrow transplant 7iver *ransplant !eart (urgery =rthopedic (urgery 2ataract (urgery (mile <esigning Metal 1ree 3ridge <ental Implants "orcelain Metal 3ridge "orcelain Metal 2rown '(< &,I),))) '(< @,)),))) '(< @),))) '(< &),))) '(< &,))) '(< 5,))) '(< I,I)) '(< @,I)) '(< @,))) '(< %,))) '(< ;G,&)) '(< ;G,@I) '(< 5,H)) '(< ;,@)) '(< %,@I) '(< %,%)) '(<) '(< G)) '(< ) '(< %))
Medical tourism in India
33
*ooth Impactions 4oot 2anal *reatment *ooth 9hitening
'(< &,))) '(< %,))) '(< 5))
'(< %&I '(< %%) '(< %&I '(< @) '(< G)
*ooth 2olored 2omposite '(< I)) 1illings P *ooth 2leaning '(< @))
&rocedure 7iver *ransplant !eart (urgery =rthopedic (urgery 2ataract (urgery
India @,)),))) @),))) &),))) &,)))
"SA ;G,))) ;G,))) 5,))) ;,))) %,&I)
3one Marrow *ransplant &,I),)))
Medical tourism in India
34
&rocedure 1reast : Mastopexy D 4eduction Mammoplasty D Mammoplasty Augmentation -4eplacement =f Implants +ace : 3lepheroplasty A'pper R 7owerB -2anthopexy wP=rbicularis suspension D !air *ransplant D /ndoscopic 3row lift D ec, lift D =toplastyA1or prominent /arsB 'ose : -"rimary 4hinoplasty -*ip 4hynoplasty
"nited states ."SD/ Appro0 '(< H,I)) '(< 5,))) '(< 5,))) '(< ;,I)) '(< ;,))) '(< ;,I)) '(< ;,))) '(< I) "er graft '(< I,5)) '(< ;,%)) '(< -,H)) '(< H,@)) '(< ;,@))
India ."SD/ Appro0 '(< &,5)) '(< @,@)) '(< &,HI) '(< @,))) '(< &,))) '(< &,5)) '(< &,%I) '(< &,&)) '(< @ "er graft '(< &,@)) '(< &,-)) '(< %,I)) '(< &,G)) '(< %,@))
-1acelift -<ermabrasion A*otal faceB '(< I,I))
1od) -ontouring : -Abdominoplasty '(< H,H)) '(< '(< @,&)) '(< -*high 7ift A3ilateralB -*otal 7ower 3ody 7iftA3elt 7ipectomyB -7iposuction A=ne 4egionB 'on 2 Surgical &rocedures : 7aser !air 4emoval D 7aser 4esurfacingP 9rin,le 4eduction D 7aser Acne *reatment D 7aser (car *reatment D 3otox '(< II) '(< IHI '(< I)) '(< H) "er 'nit '(< &&I '(< &@) '(< &%) '(< 5 "er 'nit '(< II) '(< &&I H,&)) '(< G,I)) @,%I) '(< ;,))) '(< ;,%)) '(< %,HI)
Medical tourism in India
35 -OST -OM&A#ISO' 2 I'DIA $S "'IT%D 3I'GDOM ."3/ (ignificant cost differences exist between '.C. and India when it comes to medical treatment. Accompanied with the cost are waiting times which exist in '.C. for patients which range from @ months to over months. India is not only cheaper but the waiting time is almost nil. *his is due to the outburst of the private sector which comprises of hospitals and clinics with the latest technology and best practitioners. "rocedure
&rocedure
"nited 3ingdom ."SD/ India ."SD/ Appro0 Appro0 '(< -,5)) '(< -,I))
=pen !eart (urgery 2ranio-1acial surgery and s,ull base euro- surgery with
'(< %5,))) '(< %@,)))
'(< &%,)))
'(< ;,5)) '(< -,)
!ypothermia 2omplex spine surgery with '(< %@,))) implants (imple (pine (urgery '(< ;,I))
'(< &,@)) '(<%,&)) '(< -,) '(< &,@)) '(< %H,5)) '(< -,I))
(imple 3rain *umor -3iopsy '(< -,@)) -(urgery "ar,insons 7esion <3( !ip 4eplacement '(< %),))) '(< ;,I)) '(< &;,))) '(< %@,)))
Medical tourism in India
36
-ost comparison between India4 "SA4 Thailand4 Singapore:
&rocedure 5eart 1)pass 5eart $alve #eplacement Angioplast) 5ip
"S -ost $%@),)))
India $%),)))
Thailand $%%,)))
Singapore $%5,I))
$%,))) $IH,))) $-@,)))
$G,))) $%%,))) $G,))) $@,))) $5,I)) $I,I))
$%),))) $%@,))) $%&,))) $-,I)) $%),))) $H,)))
$%&,I)) $%@,))) $%&,))) $;,))) $%@,))) $G,)))
#eplacement 5)sterectom) $&),))) 3nee $-),)))
#eplacement Spinal +usion $;&,)))
Medical tourism in India
37
Tapproximate retail costs, '( figures based on !2'" data, intl. figures based on hospital +uotes in named countries
!ere's a brief comparison of the cost of few of the <ental treatment procedures between '(A and India Dental &rocedure -ost in "SA .6/ General (mile designing Metal 1ree 3ridge <ental Implants "orcelain Metal 3ridge "orcelain Metal 2rown *ooth impactions Dentist %,5))) I)) Top %nd Dentist 5,))) I,I)) @,I)) @,))) %,))) &,))) Medical tourism in India -ost in India .6/ Top %nd Dentist %,))) I)) 5)) @)) 5) %))
38 4oot canal *reatment *ooth whitening *ooth colored composite fillings *ooth cleaning) @I) &)) %)) %,))) 5)) I)) @)) %)) %%) &I HI
#eneral cost sheet for a stay in <elhi ?
Medical tourism in India
39
Medical tourism in India
40
Ta0i fare from airport to hospital #egistration and consultation with senior consultant at hospital 8 ra) of chest Whole abdomen ultrasound (aparoscopic -holec)stectom) for Gall 1ladder Stones %ndoscopic Thoracic 5)perhidrosis Sta) at nearb) hotel 1ig Mac Meal combo at Mc Donald Tour of Delhi Tour to Agra . 9:; miles from Delhi/
on AP2 $%) $&I
AP2 $@)
$$%I /conomy 9ard (ingle 4oom $G)) $) A*otal 2ostB /conomy 9ard (ingle 4oom $%&)) A*otal $&))) A*otal 2ostB A*otal 2ostB
S)mpathectom) for 2ostB /conomy class - star $%I), $I)P day $& I star $&I)
$ I) by coach
$ %I) by personal
car $ %I) same day $ &I) with return overnight stay at I star hotel
Ma7or pla)ers offering Medical Tourism pac ages
Indian corporate hospitals excel in cardiology and cardiothoracic surgery, 0oint replacement, orthopedic surgery, gastroenterology, ophthalmology, transplants and urology to name a few. *he various specialties covered are Medical tourism in India
41 eurology, 'rology, eurosurgery, =ncology, =phthalmology, 4heumatology, eurology,
/ndocrinology, / *, "ediatrics, "ediatric (urgery, "ediatric "ulmonology, "sychiatry, #eneral Medicine R #eneral (urgery
ephrology, <ermatology, <entistry, "lastic (urgery, #ynecology,
*he various facilities in India include full body pathology, comprehensive physical and gynecological examinations, dental chec,up, eye chec,up, diet consultation, audiometry, spirometry, stress R lifestyle management, pap smear, digital 2hest S-ray, %& lead /2#, &< echo colour doppler, gold standard <SA bone densitometry, body fat analysis, coronary ris, mar,ers, cancer ris, mar,ers, carotid colour doppler, spiral 2* scan and high strength M4I. /ach test is carried out by professional M.<. physicians, and is comprehensive yet pain-free. *here is also a gamut of services ranging from #eneral 4adiography, 'ltra (onography, Mammography to high end services li,e Magnetic 4esonance Imaging, <igital (ubtraction Angiography along with intervention procedures, uclear Imaging. *he diagnostic facilities offered in India are comprehensive to include 7aboratory services, Imaging, 2ardiology, eurology and "ulmonology. *he 7aboratory services include biochemistry, hematology, microbiology, serology, histopathology, transfusion Medicine and 4IA
All medical investigations are conducted on the latest, technologically advanced diagnostic e+uipment. (tringent +uality assurance exercises ensure reliable and high +uality test results *he chief cities attracting foreign patients to India are Mumbai, 3angalore, !yderabad, Col,ata and 2hennai. (imilarly, the speciality hospitals excelling in the medical tourism industry in the country are? Medical tourism in India
42
T /scorts !eart Institute and 4esearch 2entre 7imited, ew <elhi T All India Institute of Medical (ciences, <elhi T Manipal !eart 1oundation, 3angalore T 3. M. 3irla !eart 4esearch 2entre, Col,ata T 3reach 2andy !ospital, Mumbai T 9oc,hardt !ospitals T 2hristian Medical 2ollege, Fellore T Asian !eart Institute, Mumbai T "< !indu0a ational !ospital and Medical 4esearch 2entre, Mumbai T 6aslo, !ospital, Mumbai T Apollo !ospital, <elhi T Apollo 2ancer !ospital, 2hennai
Medical &ac ages
*he health care sector in India has witnessed an enormous growth in infrastructure in the private and voluntary sector. *he private sector which was very modest in the early stages, has now become a flourishing industry e+uipped with the most modern state-of-the-art technology at its disposal. It is
Medical tourism in India
43 estimated that HI-5). of health care services and investments in India are now provided by the private sector. An added plus had been that India has one of the largest pharmaceutical industries in the world. It is self sufficient in drug production and exports drugs to more than %5) countries. T 3one Marrow *ransplant T 3rain (urgery T 2ancer "rocedures A=ncologyB T 2ardiac 2are T 2osmetic (urgery T <ialysis and Cidney *ransplant T <rug 4ehabilitation T #ynaecology R =bstetrics T !ealth 2hec,ups T InternalP<igestive "rocedures T 6oint 4eplacement (urgery T T uclear Medicine eurosurgery R *rauma (urgery
T "reventive !ealth 2are T 4efractive (urgery T =steoporosis T (pine 4elated T 'rology T Fascular (urgery
T #all 3ladder stones surgery A 7aparoscopic 2holecystectomy B T !ernia surgery A 7aparoscopic mesh repair B T "iles A (tapled !emorrhoidectomy B T Faricose Feins surgery T /ndoscopic *horacic (ympathectomy for !yperhidrosis T 7aparoscopic Appendicectomy Medical tourism in India
44 T 7aparoscopic Adrenalectomy T 7aparoscopic 1undoplication for !iatus !ernia T 7aparoscopic 3anding of stomach for Morbid =besity T 7aparoscopic splenectomy Other pac ages include:
•
!ip-Cnee replacement surgeries and other orthopedic surgeries. 3one marrow transplantation surgery. !eart surgery pac,ages li,e 2ardiac (urgery And 2ardiology, =pen !eart (urgery, Angiographies and Angioplasties.
•
•
•
*reatments of different s,in problems including s,in grafting.
The services provided b) the host countr),s hospital< organisation are:
•
"ut in touch with a world class "rivate hospital or
ursing home and the
doctor R fix up an appointment with the doctor at the hospital.
Medical tourism in India
45
•
4eceive you at the airport and provide transportation to the hotel and for the rest of the days during your stay here.
•
"rovide accommodation in a hotel as per your choice and budget near the ursing !ome or the "rivate hospital.
•
9e can arrange for another place to stay or a re0uvenating sight-seeing tour while your mother recovers after the treatment.
•
In addition to the increasingly top class medical care, a big draw for foreign patients is also the very minimal or hardly any waitlist as is common in /uropean or American hospitals. In fact, priority treatment is provided today in Indian hospitals.
ST%&S O+ S%%3I'G T#%ATM%'T WIT5 M%DI-A( TO"#ISM
Medical tourism in India
46 %. Is the medical ailment suitable for treatment in a country different from yours the patients own country. *he answer to this +uestion will be based on combined information from your own doctor and the overseas doctor. &. Ailments that re+uire a one shot treatment li,e surgery for gall stones, hernia, piles, varicose veins, hysterectomy, adrenalectomy, nephrectomy, thyroidectomy, 0oint replacement etc are more suitable for medical tourism. @. *he ailment should be such that a follow up should not be necessary and you should not need to visit the country again to E tie up loose ends. -. *he patientP tourist should be otherwise well enough to be able to utili8e the tourism part of it. =ther wise you could 0ust go to the hospital directly for treatment. I. Mostly planned elective surgery for which there may be a long waiting list in your country is best suited for medical tourism. ;. <ecide on the country, hospital and doctor who would be treating . *his information would be available through the net or from recommendation by another patient. Fisit the website of the hospital and doctor is the next step. 9riting and as,ing about their training and experience in the procedure along with the cost implications is vital. H. ext is sending a detailed note of the medical condition. "rior and complete information will insure that the treatment will get started immediately and without much delay. since the tourist comes from another country he cannot come again and again therefore he needs to include all reports of investigations and recommendations of any doctor who has seen him. 5. 3ased on this, the patient receives full information from specialist doctors P medical consultants advice on prevailing medical treatment, approximate
Medical tourism in India
47 cost for planning purposes and total duration of stay re+uired at the hospital with pre -operative and post operative extra stay re+uirement etc. G. *he patient must also chec, full details about cost of stay at respective treatment city using a hotel or service apartment or guest house. %). 2hec, with the doctor what all sight seeing P shopping P tourism is possible with the treatment patient is having and if this would be before or after the treatment. 3est time for this is after getting the preliminary chec, and tests done. 1ollowing the sight seeing etc, patient gets admitted for the surgery. %%. Ac+uire consent of local physician to fly down to IndiaP or selected destination. %&. Ac+uire visa for travel to the host country. %@. 2hec, immuni8ation re+uirements for going there. %-. 2arry a travel insurance . %I. 1ix up date of arrival, pic, up from airport. It is extremely re- assuring if a person from the hospital receives visitor at the airport and ta,es him to the hospital P hotel. %;. Meet the doctor and re-discuss the details of treatment, cost, stay etc as soon as possible to chart out the plan. %H. 4e-confirm return tic,et as per hisP her advice. %5. *reatment %G. <ischarge from hospital, with follow up advice and medications provided by the hospital.
Medical tourism in India
48 &). (tay in the city P sight seeing as discussed earlier for the re+uired time. &%. 4eview with the doctor for clearance &&. 4eturn !ome.
&rocedure followed b) the hospital< clinic: Farious steps to be followed are as follows Medical tourism in India
49
(*/" % ? Fisitor needs to send +ueries pertaining to their problems. (*/" & ? *he hospital will identify a suitable doctor and hospitals based on the +uery. (*/" @ ? <octors get bac, to patient with their suggestions and how to proceed ahead. (*/" - ? 1inali8e on which treatment to follow and how to go about it. (*/" I? !ospital will give the options such as where to stay prehospitali8ation R post hospitali8ation . (*/" ; ? "atientP visitor needs to payment. (*/" H ? Arrival in IndiaP host country. (*/" 5 ? *he hospital arranges Airport pic,-up and hotel chec,-in. they also arrange translator if re+uired. (*/" G ? !ospital arranges meetings with the re+uisite doctors. (*/" %) ? "roceed further with the treatment as discussed in (tep -. (tep %% ? "atientP visitor proceeds for short holiday brea, if re+uired. (tep %& ? !otel 2hec,-out, R return to visitor>s own country finali8e details and ma,e advance
(everaging -ompetencies +or Medical Tourism
Medical tourism in India
50
•
India has a huge potential of attracting medical tourist and medical tourism will contribute around '(< & million by year &)%&, as per 2II-Mc,insey report . 9ith a good amount of investment in the private sector, the growth of Indian healthcare is inevitable. India has the competitive advantage of price, outstanding human resource, state-of-the-art hospitals e+uipped with latest e+uipment, alternative medicine li,e Cerala>s health retreat, naturopathy and yoga, I)))-year-old civili8ation, traditional art and crafts and geographical landmar,s and coastlines.
•
In healthcare industry, it is said that a satisfied patient is the best source of referral to the hospital. In case if our hospitals wish to become leaders in medical tourism and achieve competitive advantage, it is very important that +uality service is provided on clinical dimensions as well as hospitality component. 9ea,ness of our hospitals lies in poor service culture +uotient in employees.
•
*o achieve service excellence, it is important that delivery of service is on the lips of everyone in the wor,force. *he importance of the contribution of each individual, the glory of the individual or a department should never be an issue nor be overshadowed by other focus. "atient>s wants are related to behavioral aspects of service li,e? spontaneity, warmth, concern and friendliness attention to individual needs.
•
*he total hospital is more successful, if a service is only as good as the people who deliver it and provide it. 9hen everyone wor,s smart, the collaboration needed to drive organisational performance increases. Also, the patient appreciates the way hePshe is treated.
•
1rom showing empathy and optimism to extreme self-awareness to ,nowing what>s going on around them, people competencies are an
Medical tourism in India
51 integral part of a progressive hospital. *he use of these s,ills is what elevates one>s organisation above the competition. In today>s wor,ing environment, where medical tourist are demanding more, instilling the use of people competencies in one>s team members is something one simply can>t survive without.
•
Indian hospitals do not face problem with the technical s,ills as they are ac+uired through education and training but the difficulty lies in leveraging the soft s,ills of the employees. (oft s,ills are the underlying principles that trademar, a hospital for professionalism and excellent customer service.
•
In today>s scenario, where it is predicted that medical tourism industry will grow by %I per cent annually, the real challenge lies in ac+uiring and developing a depository of people s,ill in the organisation.
5ospitals should focus on developing wor force with: %. &ositive attitude: NI can do itO is the first thought that an employee should get when he encounters a problem. !ePshe can thin, positively if hePshe is happy, cheerful with good sense of humor. &. Ingenuit): /mployees should possess natural incentive and creative abilities to solve unforeseen problems. *hey should be capable of coming up with satisfactory solutions instantaneously. @. Initiative: If a hospital has employees who are self-starters, then it is li,e a dream come true. If you empower people, then they show exceptional resourcefulness in handling unforeseen events or situations effectively.
-. (o)alt): =rganisation should value an employee who maintains service interest uppermost in his mind. /mployees who display a high degree of Medical tourism in India
52 sincerity and honesty of purpose and are upright in dealings with patients. (uperiors, e+uals and subordinates are asset to any organisation. I. Maturit): *act and maturity are the ,eys to handle difficult and demanding patients. /mployees who are considerate and understanding in dealing with patients can form the bac,bone of service excellence culture. ;. Team spirit: !ealthcare cannot be delivered by a single person: it is always a team wor, of people with diversified competencies. /mployees who find ready acceptance by others and ma,e good contribution towards functioning of the group are very good team players. *hey provide wholehearted co-operation to colleagues, superiors and subordinates. H. Interpersonal s ills: Interpersonal s,ills are of paramount importance. 9ritten and oral communication, listening s,ills and body language play a very important role in service delivery. It is important to be respectful and courteous with co-wor,ers and patients. 5. Appearance and 1earing: !ospitals should see that the appearance and bearing of employees is synchronised at all levels. It should not happen that support staff li,e ,itchen and cleaning staff does not follow any hygiene standard. It is not only the employee who is properly dressed draws attention but the employee who is not neatly dressed also excites discussion amongst the patient relatives. *he +uestion which ta,es paramount importance is N!ow to develop the inventory of these competencies in the organisationQ *he answer is very simple. !ire employees with competencies to meet the re+uirement of the organisation. !4 heads should focus on development of a recruitment tool which helps in identification of the re+uisite competencies and measurement of available degree of these competencies in the prospective employees.
Medical tourism in India
53 It should be very clearly understood that people with desired competency come at a cost and therefore entire manning plan and the compensation budget should be re-used. If re+uired people should be paid slightly more then the competing organisation as hiring is not the only issue, organisation has to also retain high performing individuals. Another solution to the problem is nurturing ,ey competencies in the wor,force and align individual competencies to the re+uirement of the organisation. %. Identification of individuals with desired competencies? 1irst and foremost, !4 department along with the line managers should identify people for selective retention so that they can be used as mentors for coaching and development. An employee with similar 0ob role and wor,ing conditions empathies with another employee better than anybody else. *he identified mentor should communicate effectively, ,now the 0ob profile thoroughly, demonstrate trust in improvisation, help individuals as and when needed. !e ,nows the constraints and the re+uirements of the 0ob. !e can also act as a role model and foster a feeling of constructive competition in other employees. &. *rain the identified individuals? *he identified individual has to act as an mentor and train other employees and therefore he has to lead by example. It is the responsibility of the !4 department to train him in conducting training sessions. !4 department should sensitise him with issues li,e how to conduct training. @. 2onduct on going training programme? =ngoing training programmes are very beneficial as no hospital is free of attrition rate. /xodus of well trained staff to middle east, the '( R the 'C cannot be stopped because of massive re+uirement in these countries, but whenever an employee 0oins an overseas hospital, the identity is always lin,ed with the past employer.
Medical tourism in India
54 2ontinuous training programme on communication, attitude and personality development should be carried out and mechanism should be set to analyse the impact of these programs. 2ompetencies and strengths vary from people to people and all the employees are never the same. 7everage their strengths and differences because these are the facts that will help distinguish you and your organisation from the competition. 7everage each other>s strengths inside the team to develop a new identity of the hospital. Indian healthcare is amongst the best in the world but to attract medical tourist it has to not only come up with world class infrastructure but India should focus on optimum utilisation of the talent pool. If it is done, the pro0ected medical tourism mar,et of '(< -) million can be easily achieved.
Medical tourism in India
55 &romotion Of Medical Tourism *he ,ey "selling points" of the medical tourism industry are its "cost effectiveness" and its combination with the attractions of tourism. *he latter also uses the ploy of selling the "exotica" of the countries involved as well as the pac,aging of health care with traditional therapies and treatment methods. "rice advantage is, of course, a ma0or selling point. *he slogan, thus is, "1irst 9orld treatment' at *hird 9orld prices". *he cost differential across the board is huge? only a tenth and sometimes even a sixteenth of the cost in the 9est. =pen-heart surgery could cost up to $H),))) in 3ritain and up to $%I),))) in the '
in India's best hospitals it could cost between $@,))) and $%),))). Cnee surgery Aon both ,neesB costs @I),))) rupees A$H,H))B in India: in 3ritain this costs U%),))) A$%;,GI)B, more than twice as much. <ental, eye and cosmetic surgeries in 9estern countries cost three to four times as much as in India. *he price advantage is however offset today for patients from the developed countries by concerns regarding standards, insurance coverage and other infrastructure. *his is where the tourism and medical industries are trying to pool resources, and also putting pressure on the government. 9e shall turn to their implications later. *he entire concept of medical tourism hangs on the efficiency, s,ill and competency level of the doctors, specialists and consultants etc. 9orld over patients and hospitals trust Indian doctors without doubt. *his is therefore an advantage for India. "atients from around the globe expect the best of services solely based on the reputation of doctors of Indian origin. 3ut so far the government has failed to reali8e the advantage of this important factor. *his reputation and goodwill that Indian doctors en0oy could be leveraged to attract and promote Indian medical tourism. *he other most important reason why India has not been able to attract more customers is that there is no specific campaign which only promotes medical Medical tourism in India
56 promotes medical tourism. *he incredible India campaign has catapulted India in the top I must visit uni+ue destination for lonely planet but so far as it goes *hailand, 3ang,o, and other east Asian countries are still mar,et leaders. *herefore there is still scope that with specific mar,eting, advertising and promotion campaigns considerable number of tourists can be attracted. In India the strong tradition of traditional systems of health care such as in Cerala, for example, is utilised. Cerala Ayurveda centres have been established at multiple locations in various metro cities, thus highlighting the advantages of Ayurveda in health management. *he health tourism focus has seen Cerala participate in various trade shows and expos wherein the advantages of this traditional form of medicine are showcased. A generic problem with medical tourism is that it reinforces the medicalised view of health care. 3y promoting the notion that medical services can be bought off the shelf from the lowest priced provider anywhere in the globe, it also ta,es away the pressure from the government to provide comprehensive health care to all its citi8ens. It is a deepening of the whole notion of health care that is being pushed today which emphasi8es on technology and private enterprise. *he important +uestion here is for whom the 'cost effective' services is to be provided. 2learly the services are "cost effective" for those who can pay and in addition come from countries where medical care costs are exorbitant because of the failure of the government to provide affordable medical care. It thus attracts only a small fraction that can pay for medical care and leaves out large sections that are denied medical care but cannot afford to pay. *he demand for cost effective speciali8ed care is coming from the developed countries where there has been a decline in public spending and rise in life expectancy and non-communicable diseases that re+uires specialist services. 'rban concentration of health care providers is a well-,nown fact - IG per cent of India's practitioners AH@ per cent allopathicB are located in cities, and especially metropolitan ones. Medical tourism promotes an "internal brain Medical tourism in India
57 drain" with more health professionals being drawn to large urban centres, and within them, to large corporate run specialty institutions. Medical tourism is going to result in a number of demands and changes in the areas of financing and regulations. *here will be a greater push for encouraging private insurance tied to systems of accreditation of private hospitals. *here is a huge concern in the developed countries about the +uality of care and clinical expertise in developing countries and this will push for both insurance and regulatory regimes. *he potential for earning revenues through medical tourism will become an important argument for private hospitals demanding more subsidies from the government in the long run. In countries li,e India, the corporate private sector has already received considerable subsidies in the form of land, reduced import duties for medical e+uipment etc. Medical tourism will only further legitimise their demands and put pressure on the government to subsidise them even more. *his is worrying because the scarce resources available for health will go into subsidising the corporate sector. It thus has serious conse+uences for e+uity and cost of services and raises a very fundamental +uestion? why should developing countries be subsidising the health care of developed countriesQ .
The Golden Goal = India,s 69 billion dream:
Medical tourism in India
58 India could earn more than $% billion annually and create -) million new 0obs by sub-contracting wor, from the 3ritish '( and /uropean states. Apollo !ospitals, which provides medical tourism pac,ages has put forth a suggestion and currently is awaiting a reply to carry out operations at a fraction of what they would cost in the 'nited Cingdom. *hey include surgery for hip and ,nee replacements and coronary bypass that would slash waiting times dramatically, reducing the +ueues of 3ritish patients waiting to see their doctors. *hey have well e+uipped, state-of-the-art hospitals and can offer the same level of care as anywhere else in the world. *here is no reason why India should not become the healthcare destination of the world. India's healthcare industry is growing at @) per cent annually and the Apollo group alone has so far treated GI,))) international patients, many of whom are of Indian origin. 4eddy cited two recent cases of 'C nationals who opted for private healthcare at the Apollo networ,. Medical treatment in the 'C is free under the !(, but because of the long !( and offer ational !ealth (ervice, the head of India's largest chain of private hospitals and other such organisations in the
waiting times some patients opt for expensive private care. *he advantage of 4eddy's offer is that is that it would reduce pressure on the sub-contracted healthcare at vastly cheaper rates. After this million people, there are thousands of expatriates. ot necessarily
Indian, but expatriates who may be given the opportunity to come and get themselves operated in India where we are planning to give them what is called health tourism."
Medical tourism in India
59
-riticism +aced b) Medical Tourism Industr):
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#overnment and basic medical insurance, and sometimes extended medical insurance, often does not pay for the medical procedure, meaning the patient has to pay cash.
•
*here is little follow-up care. *he patient usually is in hospital for only a few days, and then goes on the vacation portion of the trip or returns home. 2omplications, side-effects and post-operative care are then the responsibility of the medical care system in the patients' home country.
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Most of the countries that offer medical tourism have wea, malpractice laws, so the patient has little recourse to local courts or medical boards if something goes wrong.
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*here are growing accusations that profitable, private-sector medical tourism is drawing medical resources and personnel away from the local population, although some medical organi8ations that mar,et to outside tourists are ta,ing steps to improve local service.
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Inferior medical care would not be worth having at any price, and some s,eptics warn that *hird 9orld surgery cannot possibly be as good as that available in the 'nited (tates. In fact, there have been cases of botched plastic surgery, particularly from Mexican clinics in the days before anyone figured out what a gold mine cheap, high-+uality care could be for the developing countries.
Medical tourism in India
60
•
=n a national level, the Indian healthcare system is ill-e+uipped to cope with the rising number of elderly and the changing disease patterns, with an average of 0ust ).H hospital beds and ).; physicians per thousand population, according to the report. India faces the continuing challenge of fighting infectious diseases li,e malaria, tuberculosis and leprosy alongside increases in lifestyle related problems faced by the developed world, such as cancer, cardiovascular disease and diabetes.
•
ot everyone is enthusiastic about India's push to become a health care destination. Indian hospitals should start focusing and investing huge amounts of money on treating overseas patients. India should first, or in parallel, meet the needs of the country. In India, insurance plans cover %percent of the more than % billion people, leaving almost G)) million without protection, according to the McCinsey-2II report. As many as @I) million people live on less than $% a day, according to the 9orld 3an,. India spends I.& percent of its $I5) billion #<" on health care and still lags behind *hailand, 3ra8il and (outh Corea in life expectancy. "eople live ;% years on average in India, less than ;5.G years for a developing country such as 3ra8il and HH.@ years for a developed country li,e the '.(., according to the 9orld !ealth =rgani8ation. India has G% infant deaths per %,))) births compared with @5 deaths for 3ra8il and eight for the '.(.
•
*he patient is provided limited information other than an introductory phone call to the intended physician and having medical records electronically sent to the doctor or hospital via the internet by the medical tourism agency. *he patient has a choice of physicians, but unli,e in the '.(. where there is easy access to a doctor>s medical status by medical boards and organi8ations, other than ,nowing whether the doctor may have practiced medicine in the '.(., there is little information to come by. 9ithout standardi8ed protocols it is difficult for the patient to ma,e a correct assessment.
Medical tourism in India
61
Where does India need to improve
!igh !urdles !urdles to India's medical ambitions abound. 9ith %)),))) patients a year traveling to the country -- up from %),))) five years ago -- hospitals are struggling to remedy first impressions that can turn people off. /uropean people are aware of the poverty and decrypt state of the infrastructure but this ,nowledge is second hand gained through boo,s and other media as such it really as a reality chec, when these visitors are faced with streets overflowing with people and bicycles and by neighborhoods where new offices butt up against tarpaulin-covered slums. It is a ma,e or brea, situation, on one hand they are promised with world class health care at nominal costA as per their standardB but on the other hand they face reality with in your face human degradation and surreal poverty. "atients can sometimes decide not to go through with the process 0ust loo,ing at the general state of the local people of the host country. *hey wonder whether the price of their operation with an Indian hospital compared with five times more in their home country is worth the ris,. *herefore the logical thing for India is to strive for a massive Image Improvement plan, the medical industry in itself is banding together to improve its image. *he Indian !ealthcare 1ederation, a group of about hospitals, is developing accreditation standards. In the '.(., organi8ations such as the 6oint 2ommission on Accreditation of !ealthcare =rgani8ations, based in =a,broo, *errace, Illinois, assess infection rates, the width of hospital corridors and the capacity of elevators. In India, there's no accreditation, and hospitals aren't re+uired to provide information on the outcomes of treatments. *here is nothing as far as +uality standards go. !ospitals ,eep data, but they don't need to share it
Medical tourism in India
62
(,etchy Information *he leading +uestion that any potential medical tourist will as, himself is -where is the information, how detailed is the information and whether it is easily available or not: for eg /scorts' 9eb site lists only the number of procedures it has performed. *hought they do not mention the obvious and important fact that *rehan, /scorts' hospital had a mortality rate of ).5 percent and an infection rate of ).@ percent in &))@. *hat compared with an observed mortality rate, or the rate of actual deaths, of -.HH percent for heart valve surgery or coronary artery bypass surgery that included heart valves at Jor,-"resbyterian !ospital from &))) to &))&, according to a ew ew Jor, (tate
<epartment of !ealth report is much better. (uch facts not only need to be told but they also need to unashamedly promoted if India has to attract more overseas patients. Infrastructural mess India competes for foreign patients with Malaysia, (ingapore and *hailand but it offers less in some areas where it matters such as infrastructure. 9e can almost call it as the curse of India since no matter what the problem we try to resolve on the national scale the first and most formidable issue is the infrastructure or rather the lac, of it. *hus if we are to improve the basic re+uirement of having wide roads, electricity, grounded electric wiring, information system in place etc then most of our problems will be resolved including that of medial tourists. *hailand's airports and roads are in better shape than India's because *hailand is a ma0or vacation destination. In &))@, %) million tourists traveled there, according to the *ourism Authority of *hailand's 9eb site. *hat was more than triple the number for India that year. 3umrungrad !ospital "cl, which runs 3umrungrad !ospital in 3ang,o,, started courting overseas patients during the Asian economic crisis in %GGH as the devaluation of the baht drove down costs for visitors.
Medical tourism in India
63 *hat year, 3umrungrad treated I),))) foreigners. It handled seven times as many in &))-, accounting for @I percent of its patients. In &))@, 3umrungrad hosted %I) Indian delegations, including one led by 9oc,hardt's 3ali, showing them intensive care units, recovery rooms and the (tarbuc,s cafe in the lobby. International 1ocus *he focus on international patients screams at us. !aving interpreters and instructions in multiple languages such as Arabic, /nglish, #erman, and (panish etc is a must. *he patient must feel that whatever he is trying to convey goes across and all the communication must be clear. 9hat it shows is that convenience offsets most other things for an international patient. At the end of the day the patient must feel sure is that he is treated for the right ailment and his consultant understands him perfectly. 9e 2are attitude? Indian hospitals are countering with per,s of their own. *his is due to the fact that India believes in N atithi devo bhavaO and using this to best their own cause. !ospital>s representatives meet the patients at the airport , help them through immigration and drive them to the hospital in a private vehicle. *heir room was stoc,ed with fruit and drin,s. *hey have on call consultants with arrangements made for pre and post treatment sight seeing, shopping and other tourist activites. !ospitals even loan a mobile phone so they can stay in touch once they left the hospital.
Medical tourism in India
64 More 1oreigners 1oreign patients are still far from the norm. =perations on non-Indians accounted for %) percent of the more than -,))) surgeries at /scorts in &))@. 1oreign surgeries will pic, up as rising health costs and long waiting lists provide incentives to travel to India and its low-priced rivals. In the '.(., health-related spending climbed H.; percent to $%.;5 trillion in &))@, consuming almost %I.@ percent of the $%% trillion gross domestic product. It was the fifth consecutive year that the cost of medical care expanded faster than the economy. '.(. employer-paid health insurance premiums have soared IG percent since &))), according to the !enry 6. Caiser 1amily 1oundation and the !ealth 4esearch and /ducational *rust, nonprofit groups that study medical care. In &))-, premiums averaged $G,GI) for families and $@,;GI for individuals, the groups found. 9hat all this means is that no matter what happens the number of foreign tourists will ,eep on increasing and India should be ready or atleast get ready to attract these patients. Accidental "atient In the '.C., the waiting list for the government-funded ational !ealth (ervice
prompts some patients to loo, elsewhere. 7ast year, the lag averaged less than nine months for surgery, about half the %5 months in %GGH. 'nli,e people who chose India after deciding not to pursue an operation through the ational !ealth (ervice, there are others who have discovered India by accident.
Medical tourism in India
65 2ase in point ? In 6uly &))-, Ian 3rown, a director at !arrogate, /nglandbased electronics company (urevision 7td., suffered chest pain and went to his local doctor. *he ational !ealth (ervice told him he'd have to wait as long as four months for a test and then, if re+uired, two years for an angioplasty to open bloc,ed arteries. =n vacation in India in (eptember, 3rown experienced chest pain again and was rushed to 9oc,hardt !ospital in 3angalore. 9oc,hardt performed an angioplasty the next day, inserting a wire mesh tube called a stent to prop open an artery. 3ac, in /ngland, 3rown got a letter from the (ervice in after he'd had the surgery in India. In this instance an accidental discovery proved to be a life saver. ational !ealth ovember as,ing him to come in for his initial test -- two months
$5)) vs. $%5 2harging foreigners more than Indians is one way hospitals can ma,e money to treat the poor. An echocardiogram machine, used to picture the heart, costs about $&)),))) anywhere in the world. <octors can charge $5)) per scan in the '. in India, they charge 5)) rupees, or $%5. *he difference ma,es it tough to recoup costs. *he reason why hospitals are so excited about overseas patients is that in India there are more than enough Indians to fill the nation's hospitals. India has enough volumes but what we don>t get is pricing. India should and is charging for the value rater than the concentrating on volume based profit alone.
Medical tourism in India
66 2atering to the middle /ast tourists (ome Middle /astern patients began choosing India after the (ept. %%, &))%, attac,s on ew Jor, and 9ashington, =man hospitals often refer patients to India for complicated procedures because the country is familiar, closer than the '.(. or /urope and cheap. Also after GP%%, people are scared to go to the '.( not only due to fear of terrorist attac,s but mainly due to the fact that they feel threatened because of racial discrimination be it overt or subtle. *he fact that people in '( loo, at a turbaned and bearded man as a potential terrorist is an unsettling experience. discrimination. 3rain drain reversal Indian doctors are returning home again .and offering medical procedure which they performed abroad in their home country itself. *here are many Indian patients who had to go abroad for medical reasons this is one of the factors that influenced doctors to return home. *he other reason is that the pay in India is gradually rising and the lure to bac, in one>s own homeland is +uite strong. ot only in the '( but even in 'C and other /uropean countries people of coloured s,in and religion are facing
/asy *ransition Indian hospitals are wor,ing to ma,e the transition easier. Apollo is setting up a 7ondon clinic to attract people see,ing alternatives to the ma,e all arrangements to get them to India. ational !ealth (ervice. *he idea is that a doctor would loo, at patients find the problem and
Medical tourism in India
67 2hanging the trend 6ust as Indian software companies started with small programming 0obs and expanded to become a $%; billion global industry, India's international health care initiative is in its early stages. 1or patients and profits to increase, India must remedy negative first impressions and persuade doubters that millions of the country's poor and ailing won't be left behind.
Medical tourism in India
68
Initiative b) Indian Government to &romote Medical Tourism:
*he medical tourism industry in India is presently earning revenues of $@@@ million. /ncouraged by the incredible pace of growth exhibited by the industry, the 2onfederation of Indian Industry A2IIB and McCinsey have predicted that the industry will grow to earn additional revenue of $&.& billion by &)%&. 9ith a view to facilitating the medical tourism industry to achieve the targets and to give greater momentum for its growth, the Ministry of !ealth and 1amily 9elfare together with the Ministry of *ourism of the #overnment of India has set up a *as, 1orce. *he *as, 1orce will evaluate the opportunities in the industry and formulate a policy for accrediting healthcare institutions in the country. *he accreditation programme is aimed at classifying health service providers on the basis of infrastructure and +uality of services offered. It is expected to standardise procedures and facilitate foreign patients in selecting the best hospitals. Meanwhile, several hospitals in the country are see,ing to ta,e advantage of the booming medical tourism industry. *hey are investing largely in ac+uiring e+uipments, si8e and s,ills. *o provide for brighter prospects for the industry, the hospitals can also ac+uire international accreditation, integrate traditional and clinical treatments and offer end-to-end value added services by tying up with tour operators, airline carriers and hotel companies. !ospitals can also allow foreign patients to pay through credit and ensure proper support services to foreign patients after they return to their native countries. 7astly, the #overnment of India can also reinforce its support through +uic, visa processing, improved flight connectivity and infrastructure development.
Medical tourism in India
69
-urrent initiatives b) various state governments and organisations: Government Initiatives: 2entral #overnment and (tate #overnments have been encouraging rural handicrafts and fairs and festivals that have direct impact on preservation of heritage and culture of rural India. It also draws tourists from all over the world. 4egional fairs, festivals help the growth of tourism, provide a ready mar,et for the handicrafts, alternative income to the community, and facilitate regional interaction within the country. 7eading states such as Cerala, #oa, Maharashtra etc have ta,en the initiative to promote medical tourism as a pac,age in itself rather then 0ust a side issue or an added benefit. *he effect has apparently been a success a medical tourism has pic,ed up in these states. *he state governments have been monitoring closely the ecological relationship, socio cultural impact and conducting feasibility studies before selecting tourist sites. *he state governments also ensure that? *ourism D M <oes not cause the tension for the host community M o adverse impact on the resources M "sychological satisfaction for the tourist. M *he large inflow of tourists would not put a stress on the local system M 7ocal community should not be deprived of basic facilities for the benefits of tourist M *he rural tourism does not disrupt the rhythm of community life *hus the 2entral
Medical tourism in India
70 #overnment and (tate #overnments have ta,en various steps for the promotion of tourism and attainment of the goal of sustainable tourism development.
•
TO"#ISM MI'IST#! &#OMOT%S I'DIA AS A >?;=DA! D%STI'ATIO': *he
ministry of tourism in an effort to promote India as a @;I-day destination launched three 2<s on MI2/, adventure sports and cruises. *he ministry is showcasing India as a world-class MI2/ destination with many convention halls coming up in the line of !yderabad International 2onference 2entre A!I22B. *he 2<s also give details about all the adventure sports facilities available in the country and the many cruising options that are coming up.
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TO"#ISM MI'IST#! ISS"%S G"ID%(I'%S +O# AD$%'T"#% S&O#TS: *he
ministry of tourism recently issued special guidelines for adventure sports activities in the country. *he guidelines are regarding land activities li,e mountaineering and tre,,ing: water sports li,e river running: and air sports li,e parasailing, paragliding and bungee 0umping. *he ministry has laid down the basic minimum standards for adventure tourism related activities that are underta,en in different parts of the country.
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3%#A(A TO"#ISM #%$I$% T5% "#" < A#A1 D5OW: Cerala *ourism has
plans to start '4' cruises to replicate the spice route travel of the %;th century. *he uru is a home made colossal sailing vessel made out of timber which used to ply the Indo "ersian routes in times gone by. It is the Indian e+uivalent of the Arab <how. 9hen launched they will operate on the 3e,al - 2ochin sector. *his has been +uite a crowd puller for medical tourists who floc, to Cerala especially for the Aurvedic and relaxing treatments offered. *he curious mix of vegetarian food, exotic bac, waters, courteous and pleasant people and not to mention extremely smart doctors had made Cerela a very popular destination
Medical tourism in India
71
•
5%(I-O&T%# TO"#ISM S%#$I-% I' 3%#A(A: #od's =wn 2ountry Cerala
will be luring tourists by launching a ''!elicopter tourism'' service. Fisitors will be ta,en from one tourist spot to the other in a seven-seater helicopter to save time and also discomfort on the roads. A number of cost-effective pac,ages have been designed in the helicopter tourism segment li,e ''2apital by Air'', ''3ac,waters by Air'', ''1ly the !ills'' and ''(horeline 1lights''. *he ''2apital by air'' offers sightseeing ta,es trips around around *hiruvananthapuram. *he bac,water trip tourists
Cumara,om, while the ''1ly the hill'' provides tourists a taste of the hill stations at *he,,ady and Munnar. It will also touch Cochi and Cumara,om. *he ''(horeline'' flights offer sightseeing to Canya,umari along the pictures+ue coastline. *his service is extremely helpful to the patients who are unfit for long 0ourneys by road or rail. ot only that it is very fast and and the medical tourist also gets to have his own privacy. In times of emergency the patient can be immediately flown to and from the nearest airport or heli pad.
•
&A(A-% O' W5%%(S ADDS S%$%#A( ("8"#I%S: *he second "alace on
wheels to be launched in 4a0asthan early next year ie &))H will have a dance floor, a massage center, a conference room and bars. It will be the third tourist train to be operated by 4a0asthan *ourism after "alace on 9heels and !eritage on 9heels Aon the (he,hwati sectorB. *he second "alace on wheels will also have special suites. *his has been a great success with post operative tour patients ie to travel in a princely way. It brings in the nostalgia about the past eras when the prince and ,ings and heads of states traveled in a grand way.
•
M%DI-A( TO"#ISM 1#O-5"#% #%(%AS%D: *he Ministry of *ourism is
aggressively promoting India as a global healthcare destination and has recently released the EIncredible India Brochure on Medical Tourism’ . *he government has also started issuing M AmedicalB visas to the medical patients, and MS visas to the dependent accompanying them, which are
Medical tourism in India
72 valid for a year. Around &))))) medical tourists visited India last year, and the figure will grow by I). this year.
•
GA#I1 #AT5S .&("S5 T#AI' +O# &OO#/? *he Indian 4ailways has
introduced the ''#arib 4aths'', a maiden scheme to provide plush rail services to the poor at affordable rates in the year &))- - &))I, and plans to lin, all state capitals with express trains, with the induction of &--coach trains. *he success of the #arib 4aths, can already be seen in the rail operating between (aharsa A3iharB and Amritsar A"un0abB which is a boon to the traveler especially during the festival season. 3ut as of current reports the country has not ta,en well to the #aribh 4ath and is ma,ing losses for unforeseeable reasons. Medical patients usually s,ip on rail travel as it ta,es a longer time and is a bit more exhausting.
•
T#AI' TO 3AS5MI# 5ITS T5% 5IG5WA!: /ver heard of a train running on
a roadQ It does in 6ammu and Cashmir. (et to chug in Cashmir's bewitching landscape in snowy 1ebruary &))H, the first-ever trial train to Cashmir too, off for the Falley on ovember H, not on traditional trac,s but on the @)) ,m-long 6ammu-(rinagar national highway. It has added another chapter to the history of Indian 4ailways and Cashmir's national rail pro0ect, as the first trial diesel mobile unit coach, a @; tyre wheeled train pulled by a - !" engine, drove up the 6ammu-(rinagar !ighway at )H)) hrs and headed toward Cashmir's 3udgam railway station by ta,ing a road route and not a train trac,. *he world recogni8es Cashmir as the paradise on earth or the (wiss alps of the east. It is especially targeted to overseas visitors.
•
@AI&"# TO S%(( 5%#ITAG% (IA"O#: (hops all over 4a0asthan will sell
heritage li+uor, made from age old recipes of 4a0asthan 4oyals. It is made from dry fruits, nuts, herbs and spices with a touch of saffron sometimes. *o begin with, shops in 6aipur, 6odhpur, Cota, 3i,aner, A0mer, 'daipur and 3haratpur will sell the special li+uor. #eneral as well as medical tourists can now ta,e these away as souvenirs.
Medical tourism in India
73
•
BCCC D#"MM%#S TO D#"M "& A #%-O#D I' M%G5A(A!A: A band of
5))) drummers is set to brea, a record for I minutes of synchroni8ed drum beats set by !ong Cong. *he band will play a newly composed piece, ""ositive Fibration" to enter the #uinness 3oo, of 9orld 4ecords. *he ensemble will play at Meghalaya's autumn festival which expects to have entertainers from Australia as well. A great way to pull in the tourist in search of the curious and uni+ue experience. ot only that the eastern states till now have been in the shadows so this is a great way to bring the extremely beautiful and lush eastern states on to the world map. Also it is a great location for retreat for the ailing patients who want calm and +uite surrounding.
•
+AI#! A"%%' 1%GI'S D%(5I=A(WA#=D%(5I #"' +#OM 99 'O$%M1%#:
3uilt in %5II, the 1airy Kueen is the oldest steam engine in wor,ing condition. /very year it ta,es visitors on a <elhi-Alwar-<elhi trip. *his year the schedule has been announced. It will ply twice a month Abeginning %% ovemberB in ovember, <ecember &)); 6anuary and 1ebruary &))H. to experience the past that too in a luxurious way is the cherry on the ca,e for the tourists who have been operated upon. *hey ta,e with them not only a healed body but a beautiful train 0ourney to remember.
Medical tourism in India
74
-onclusion
India is a developing country and a lot needs to be done before we can call ourselves as a developed country, all we can claim is to be a progressive one. After the dotcom com boom in the nineties we have gone through a lean patch as such. India as an emerging nation needs to grow both from with in and outside: in the sense development needs to done both for the Indian <iaspora and at the same time opportunities need to be grasped and developed so that foreign investment pours in. After the dotcom rush India has again got the opportunity to earn billions of dollars with medical tourism . 9e have all the bases coved in the sense we have the +ualified doctors and consultants, we have already developed the trust of people the world over in the past decades and we also have the exotic environment meant for tourism. All that we do need is to ma,e the transition from being a potential destination to a fully rewarding and sound medical tourism destination which is e+uivalent to or better than any service offered world over. *he +uestion that India will have to handle in the coming years is how to 0ustify giving world class medical care to visitors where as it spends 0ust %.- . of its #<" on medical care of its own people. !ealth of its own people will reflect on the robustness of the general state of the country. (o unless this is balanced off the issue of biasness will ,eep on cropping up. *ime and again we see that the root of all our national issues and problems arise from having an inherently wea, infrastructure with poorly executed law and order and political red tape. 2ompounded with the problem of over population, dwindling natural resources and rec,less disregard for the environment we stand at a 0unction where things can go haywire or they might
Medical tourism in India
75 become extremely successful if we only start resolving them. 2urrently it is li,e moving % step ahead and then going @ steps bac,wards. Medical tourism is based on having a well oiled networ, of tour operators, medical facilities, hotels, conventional tour pac,ages and infrastructure tools such as electronic connectivity, air networ, and good sanitation. =nly then we can compete with already established mar,ets such as in *hailand , south American states such as Mexico and 2osta 4ica etc. Although the situation appears to be grim there is still hope. =ne step at a time is all that is needed. 1irst and foremost is to have the basic infrastructure in place such as having proper road and rail connectivity, having a good networ, of airports to all the ma0or states and cities and with the countries from where the potential tourists will arrive such as the '( the middle east and western /urope and also the ma0or African and Islamic countries in Asia. (econdly but more importantly there is a need to put ot forward the information re+uired by the tourists. Aggressive mar,eting is the only way to go as seen in the case of *hailand, (ingapore , malyasia etc. only that there should be government authori8ed websites where people can get all the information regarding surgeries, hotels, cost comparison etc . they have to be developed exclusively for the medical tourism purpose. *wenty four hours helpline, television advertisements, getting information and advertisements published in medical 0ournals and popular maga8ines etc is a worthwhile investment. 9e have already seen how successful the Incredible India campaign is. 3ased on similar line but exclusively for medical tourism other such campaigns must be developed. (ince India already has the advantage of having highly +ualified, /nglish spea,ing doctors and medical staff it seems 0ust a matter of time when medical tourism will ta,e off in a big way. 9e have the cost advantage, we have the s,ills advantage we even have world class facilities and so all we need is a better image, a functional infrastructure and some clever promotional campaign. *his is a golden opportunity which we cannot pass up. ot only that the foreign currency that we earn is going to give our own
Medical tourism in India
76 people various benefits. It 0ust seems li,e a circle in which all the bodies who participate have a win win situation on hand. *he idea of doing this pro0ect was to bring to light how medical tourism is the &%st century>s golden goose for India. 3ringing out all the true facts, the wea, points and in general trying to understand the phenomenon itself of medical tourism has been insightful. *his pro0ect has been laborious since finding out relevant information is difficult and there are very few sources to find it out from. It has been worthwhile doing this pro0ect on medical tourism since it is an upcoming industry with lots of potential and also facing various difficulties. *he main idea behind doing this pro0ect was to highlight all the important features and data and give atleast a birds eye view over the concept of tourism for medical purpose. In conclusion I can easily say that medical tourism for India is a once in a life time opportunity and we certainly need to ta,e up on our strong points in order to become the leading nation in this area. I hope I have done 0ustice to my pro0ect and based on the data collected I might easily say that India is the place where people come to heal themselves since god>s grace seeps and flows through all the pores of India. 9e are a nation of people who feel honor in helping out and healing the mind and the spirit. I therefore dedicate this pro0ect to all the worthy doctors and medical professionals and to India my mother and may gods will guide us to to a better and prosperous era. NAtithi <evo 3havaO
Medical tourism in India
doc_273423298.doc
introduction
swot analysis
1
Introduction
Medical tourism in India
After the silicon rush India is now considered as the golden spot for treating patients mostly from the developed countries and far east for ailments and procedures of relatively high cost and complexity. India is also aggressively promoting medical tourism in the current years -and slowly now it is moving into a new area of "medical outsourcing," where subcontractors provide services to the overburdened medical care systems in western countries. India's ational !ealth "olicy declares that treatment of foreign patients is
legally an "export" and deemed "eligible for all fiscal incentives extended to export earnings." #overnment and private sector studies in India estimate that medical tourism could bring between $% billion and $& billion '( into the country by &)%&. #oing by the (tatistics and various studies it can be easily said that india would be the leader in medical tourism within the next decade if only it could improve the infrastructure and tour attractions. *he +uestion or rather the doubt that is often as,ed by critics is how can India provide top line medical care to outsiders while more than -). of its people languished below poverty line and less than &). of its people can actually afford medical services. /thically and morally this problem has to be solved if India has to move into the category of developed country and also as a place which provides medical care to both its own people and patients from other country *he aim of this pro0ect is to put a finger on the highly profitable service of medical care combined with tourism in which india is currently considered as a mar,et leader. It has been a ,nown fact for past many decades that Indian doctors are highly s,illful in their given field since all around the globe mot hospitals have doctors of Indian origin. *herefore it became almost natural that this trend extended to India.
Medical tourism in India
2
*his pro0ect also aims to show why India is attracting medical tourists, is it really a secure destination and how India can promote and develop this particular activity in the coming years so as face competition given by other Asian and African options.
Medical tourism in India
3 Medical tourism: A Global perspective Medical tourism happens when patients go to a different country for either urgent or elective medical procedures. *his phenomenon is fast becoming a worldwide, multibillion-dollar industry. *he reasons patients travel for treatment vary. Many medical tourists from the 'nited (tates are see,ing treatment at a +uarter or sometimes even a %)th of the cost at home. 1rom 2anada, it is often people who are frustrated by long waiting times. 1rom #reat 3ritain, the patient can't wait for treatment by the ational !ealth (ervice but also can't afford to see a physician in private practice. 1or others, becoming a medical tourist is a chance to combine a tropical vacation with elective or plastic surgery. And moreover patients are coming from poorer countries such as 3angladesh where treatment may not be available and going for surgery in /uropean or western developed countries is expensive. *he interesting thing of Medical tourism is that it is a concept which is actually thousands of years old. In ancient #reece, pilgrims and patients came from all over the Mediterranean to the sanctuary of the healing god, Asculapius, at /pidaurus. In 4oman 3ritain, patients too, a dip in the waters at a shrine at Bath, a practice that continued for &,))) years as it was believed that the waters had a healing property . 1rom the %5th century wealthy /uropeans travelled to spas from #ermany to the ile. In the &%st century, relatively lowcost 0et travel has ta,en the industry beyond the wealthy and desperate. 2ountries that actively promote medical tourism include 2uba, 2osta 4ica, !ungary, India, Israel, 6ordan, 7ithuania, Malaysia and *hailand. 3elgium, "oland and (ingapore are now entering the field. (outh Africa speciali8es in medical safaris-visit the country for a safari, with a stopover for plastic surgery, a nose 0ob and a chance to see lions and elephants.
Medical tourism in India
4 Thailand 9hile, so far, India has attracted patients from /urope, the Middle /ast and 2anada, *hailand has been the goal for Americans. India initially attracted people who had left that country for the 9est: *hailand treated western expatriates across (outheast Asia. Many of them wor,ed for western companies and had the advantage of flexible, worldwide medical insurance plans geared specifically at the expatriate and overseas corporate mar,ets. 9ith the growth of medical-related travel and aggressive mar,eting, 3ang,o, became a centre for medical tourism. 3ang,o,'s International Medical 2entre offers services in &; languages, recogni8es cultural and religious dietary restrictions and has a special wing for 6apanese patients *he medical tour companies that serve *hailand often put emphasis on the vacation aspects, offering post-recovery resort stays. South Africa (outh Africa also draws many cosmetic surgery patients, especially from /urope, and many (outh African clinics offer pac,ages that include personal assistants, visits with trained therapists, trips to top beauty salons, postoperative care in luxury hotels and safaris or other vacation incentives. 3ecause the (outh African rand has such a long-standing low rate on the foreign-exchange mar,et, medical tourism pac,ages there tend to be perpetual bargains as well.
Medical tourism in India
5 Argentina Argentina ran,s high for plastic surgery, and !ungary draws large numbers of patients from 9estern /urope and the '.(. for high-+uality cosmetic and dental procedures that cost half of what they would in #ermany and America. Dubai 7astly, <ubai--a destination already ,nown as a luxury vacation paradise--is scheduled to open the <ubai !ealthcare 2ity by &)%). (ituated on the 4ed (ea, this clinic will be the largest international medical center between /urope and (outheast Asia. (lated to include a new branch of the !arvard Medical (chool, it also may be the most prestigious foreign clinic on the hori8on. Other countries =ther countries interested in medical tourism tended to start offering care to specific mar,ets but have expanded their services as the demand grows around the world. 2uba, for example, first aimed its services at well-off patients from 2entral and (outh America and now attracts patients from 2anada, #ermany and Italy. Malaysia attracts patients from surrounding (outheast Asian countries: 6ordan serves patients from the Middle /ast. Israel caters to both 6ewish patients and people from some nearby countries. =ne Israeli hospital advertises worldwide services, speciali8ing in both male and female infertility, in-vitro fertili8ation and high-ris, pregnancies. (outh Africa offers pac,age medical holiday deals with stays at either luxury hotels or safaris.
Medical tourism in India
6
Indian tourism: An overview
*ourism will expand greatly in future mainly due to the revolution that is ta,ing place on both the demand and supply side. *he changing population structure, improvement in living standard, more disposable income, fewer wor,ing hours and long leisure time, better educated people, ageing population and more curious youth in the developed as well as developing countries, all will fuel the tourism industry growth. *he arrival of a large number of customers, better educated and more sophisticated, will compel the tourist industry to launch new products and brands and re-invents traditional mar,ets. *he established traditional destinations founded on sun-sea-sand products will have to re-engineer their products. *hey must diversify and improve the criteria for destinations and +ualities of their traditional offers. Alongside beach tourism, the tourism sector will register a steady development of new products based on natural rural business, leisure and art and culture. *hus the study of new mar,ets and emerging mar,ets and necessity of diversified products are the basis of our strategy, which can enhance and sustain, existing and capture new mar,ets. It is India>s vastness that challenges the imagination? the sub-continent, @&)),m A&))) milesB from the mountainous vastness of the !imalayas in the north to the tropical lushness of Cerala in the south, is home to one sixth of the world>s population, a diverse culture and an intoxicatingly rich history. <esert in 4a0asthan, tropical forests in the north eastern states, arid mountains in the delta region of Maharashtra and Carnata,a and vast fertile planes in northern states of 'ttar "radesh, !aryana etc are 0ust some of the geographical diversity that can be observed. 9e have a wealth of archeological sites and historical monuments. Manpower costs in the Indian hotel industry are one of the lowest in the world. *his provides better margins for any industry which relies on man power.
Medical tourism in India
7 =ne of the fascinations of India is the 0uxtaposition of old and new: centuries of history D from the pre-historic Indus civili8ation to the 3ritish 4a0 D rub shoulders with the computer age: and 3angalore's E(ilicon Falley> is as much a part of the world's largest democracy as the remotest village is. Wea nesses 7ac, of ade+uate infrastructure is the biggest problem that India faces. *he aviation industry in India, for example, is inefficient and does not provide even the basic facilities at airports. *he visitors are appalled by the poor sanitation in the public restrooms at the international airports. %G-H but we still use the same rail system constructed by the 3ritish. /ven now the government spends next to nothing on proper mar,eting of India>s tourism abroad. As a result foreigners still thin, of India as a country ridden by poverty, superstition, and diseases with sna,e charmers and sadhus at every noo, and cranny. 2ase in point *hailand: where in spite of the huge problem of bird flu disease the tourists arrival only dropped by less then %I. where as in India when cases of plague started occurring in (urat in %GG- the arrival of foreign tourists in India decreased by almost @;.. Opportunities More proactive role from the government of India in terms of framing policies. Allowing entry of more multinational companies into the country giving us a global perspective. #rowth of domestic tourism. *he advantage here is that domestic tourism and international tourism can be segregated easily owing to the different in the period of holidays. *he road condition in India is very worse. *he population has grown exponentially since
Medical tourism in India
8 Threats "olitical turbulence within India in Cashmir and #u0arat has also reduced tourist traffic. ot only that fear of epidemics such as for malaria, cholera, dengue, plague etc are foremost in the mind of /uropean and America patients .Aggressive strategies adopted by other countries li,e Australia, (ingapore in promoting tourism are also not helping.
Medical tourism in India
9
What is India Offering:
A!"#$%DA India has a rich heritage in the areas of traditional and natural medicines. *he earliest mention of Indian medical practices can be found in the Fedas and (amhitas of 2hara,a, 3hela and (husruta. A systematic and scientific approach was adopted by the sages of the time leading to the development of a system that is relevant even today. India is the land of Ayurveda. It believes in removing the cause of illness and not 0ust curing the disease itself. It is based on herbals and herbal components without having side effects. Ayurveda considers that the base of life lies in the five primary elements: ether AspaceB, air, fire, water and earth. And the individual is made up of a uni+ue proportion of the five elements in uni+ue combinations to form three doshas Avata, pita and ,aphaB. 9hen any of these doshas become accute, a person falls ill. Ayurveda recommends a special life style and nutritional guidelines supplemented with herbal medicines. If toxins are abundant, then a cleaning process ,nown as "anch,arma is recommended to eliminate those unwanted toxins and revitali8e both mind and body. Ayurveda offers treatments for ailments such as arthritis, paralysis, obesity, sinusitis, migraine, premature aging and general health care. Cerala is a world tourist destination and part of the reasons lies with the well- ,nown stress-releasing therapies of famed Ayurvedic research centers. *he climate along with the blessing of nature has turned Cerala into the ideal place for ayurvedic, curative and re0uvenating treatments. !OGA If Ayurveda is the science of body, yoga is the science of the mind. "racticed together they can go a long way in ma,ing an individual fit. *he word yoga means to 0oin together. *he ultimate aim of yoga is to unite the human soul with the universal spirit. Joga was developed I))) years ago and the base of yoga is described in the Joga (utra of "atan0ali.
Medical tourism in India
10 *his describes eight stages of yoga. *hese are Jam Auniversal moral commandsB, iyam Aself purificationB, Asana ApostureB, "ranayama Abreathing <hyana AmeditationB, and (amadhi Astate of controlB, "rathyahara Awithdrawal of mind from external ob0ectsB, <harana AconcentrationB, superconsciousnessB. *o get the benefits of yoga, one has to practice Asana, "ranayama and Joganidra. 9ith the regular practice of asanas one can @&H control cholesterol level, reduce weight, normali8e blood pressure and improve cardiac performance. "ranayama helps to release tensions, develop relaxed state of mind and Joganidra is a form of meditation that relaxes both physiological and psychological systems. *oday, yoga has become popular in India and abroad and in a number of places including urban and rural areas yoga is taught and practiced. S&A T#%ATM%'T Most of the other parts of the world have their own therapies and treatment that are no doubt effective in restoring wellness and beauty. ew ,inds of health tours that are gaining popularity in India are spa tours. (pas offer the uni+ue advantages of ta,ing the best from the west and the east combining them with the indigenous system and offering best of the two worlds. In hydropathy, (wedish massages wor, with the 6avanese Mandy, lulur, aromatherapy, reflexology and traditional ayurveda procedures to help ,eep the tourist healthy and enhance beauty. 2ombining these therapies with meditation, yoga and pranayama ma,e the spa experience in India a new destination for medical tourism. *he spas are very useful for controlling blood pressure, insomnia, cure tension, depression, paralysis and number of other deadly diseases. Ananda 4esort in 4ishi,esh, Angsana 4esort, #olden "alm (pa and Ayurgram in 3angalore offer ayurveda, naturopathy, yoga and meditation pac,ages. A#aur CanchilalB Allopathy
Medical tourism in India
11 India has made rapid strides in advanced health care systems, which provides world-class allopathic treatment. *his has become possible because of the emergence of the private sector in a big way in this field. More and more foreign tourists are reali8ing that India is an ideal place for stopover treatment. Indian Multi-specialty hospitals are providing worldclass treatment at an ama8ingly economical cost as compared to the west. Kuality services and low price factor primarily go in favour of India. *he cardio care, bone marrow transplantation, dialysis, ,idney transplant, neuronDsurgery, 0oint replacement surgery, urology, osteoporosis and numerous diseases are treated at Indian hospitals with full professional expertise. Apollo hospital group, /scorts in <elhi, 6ason !ospital, #lobal !ospital, and Max !ealth 2are are catering to medical care for international patients in the areas of diagnostic, disease management, preventive health care and incisive surgeries. *he tourism department has devised websites in order to provide information. Many Ayurveda health resorts that are owned and rum by traditional Ayurveda Institutes have come up. Ayurgram is a novel concept that not only offers heritage accommodation but also offers a whole range of Ayurvedic treatments and re0uvenating pac,ages. (imilarly hotels have also included these types of pac,ages in their holidays. (ome of the tour operators have wor,ed out all-inclusive medical treatment pac,age that include treatment, accommodation, food, airport transfers, post operation recuperative holidays, along with a host of other facilities. @&5 *his in fact shows our product offers true value for money for service. Many world-class state-of-the-art furnishing and e+uipment are being added to our Ayurveda 4esorts to welcome international guests. Along with these hospitals there are many centers which offer not 0ust physical but emotional and spiritual healing to patients. 9ith all these India is going to be one of the leading medical health care destinations in the near future.
Medical tourism in India
12 S&I#IT"A( TO"#ISM #lobally people are increasingly mentally disturbed and loo,ing for solace in spiritual reading, meditation and moments of divine ecstasy. =ur country has been ,nown as the seat of spiritualism and India>s cosmopolitan nature is best reflected in its pilgrim centres. 4eligion is the life-blood for followers of ma0or religion and sects. !induism, Islam, 3uddhism, 6ainism, Loroastrianism and 2hristianity have lived here for centuries. *he visible outpouring of religious fervor is witnessed in the architecturally lavish temples, mos+ues, monasteries and 2hurches spreads across the length and breadth of the country. India is not only ,nown as a place rich in its culture with varied attractions but also for many places of worship, present itself as embodiments of compassion where one get peace of mind. *hus India has been respected as a destination for spiritual tourism for domestic and international tourists. (piritual tourism is also termed as religious heritage tourism. It includes all the religions mentioned above: religious places associated with, emotional attachment to these centers and infrastructure facilities for the tourists. *his can also be referred to as pilgrimage tourism, as clients are not loo,ing for luxury but arduous 0ourneys to meet the divine goal or simple life. *he essence of spiritual tourism is inner feeling through love. 7ove should not be rationed on the basis of caste, creed and economic status or intellectual attainment of the recipient. 4eligions come into existence for the purpose of regulating human life: what are common to all of them are the principles of love. *hus through religious tourism there is a sincere effort to bring better understanding among various communities, nations and thus foster global unity. !induism is one of the oldest religions of India. =ver I))) years of religious history created wonderful temples and survived through ages all over India. *he most popular spiritual tours are those that are centered on holy #anges 4iver. 3adrinath, Cedarnath, !aridwar, #angotri, Jamunotri, Allahabad, Faranasi. 6aganath temple at "uri, 3hubaneshwar, Conar, in =rissa, Mata Faishnodevi of 6ammu and Cashmir, are some of the important pilgrim centers in north India. *here are many spiritual sites in (outh India as well Medical tourism in India
13 which dates bac, beyond the %)th centaury. 4ameshwaram, Mahabalipuram, Madurai Meena,shi temple in *amilnadu and *irupati in Andhra "radesh are some pilgrim centers. /very year millions of tourists, both domestic and international, visit these places. India is special to 3uddhists all over the world and India is the destination for pilgrimage because 3uddhism emerged in India. *he country is dotted with places that are associated with the life and times of #utham 3uddha: 7umbini-the birthplace of 3uddha, (aranath where 3uddha delivered his first sermon, 3uddha #aya where lord 3uddha attained enlightenment and Faishali where he delivered his last sermon and announced his nirvana. (i,hism also emerged in India. *he #olden *emple in Amritsar, the !em,und (ahib, and #urunana, <ev0i #urudwara at Mani,aran, which is also ,nown for its hot water springs with healing properties, the holy city of "atna (ahib and Anandpur (ahib are important for (i,hs. *he 6ain temples of <ilwara and Mount Abu in 4a0asthan, the #omateswara temple at Carnata,a, draw thousands of 6ain followers. /ven small communities li,e the 3ahais have their own 7otus *emple at <elhi. *he (ultanate and Moghul empires built many historical monuments and mos+ues during their reign, all over the country. 4ed 1ort, 1atehapur (i,ri, 6ama Mas0id, *a0Mahal, 2harminar etc., bear testimony to the blend of the Indian and Islam traditions of architecture. *he followers of Islam have many mos+ues and shrines of (ufi (aints, li,e Moin-'ddin 2histi and i8amuddin Aulia. 1or 2hristians, spiritual tours to #oa among other place li,e Mumbai and Col,ata are must. Among the most popular sites in #oa is the church of =ur 7ady of 4osary, the 4achel (eminary, and 2hurch of 3om 6esus. In addition to pilgrim centers there are personalities li,e the (atya (ai 3aba, =sho, (hirdhi and others. *his shows that spirituality and religion in India is a serious pursuit. *he (tate #overnments concerned, charitable trusts, temple trusts have made elaborate arrangements for accommodation, transport and ritual ceremonies. *hese organi8ations are also running hospitals, educational institutes, ashrams, meditation centers which benefit local community. More than I)) religious places have been identified and efforts are being made to develop these centers by 2entral and (tate #overnments with private participation. Medical tourism in India
14 AD$%'T"#% TO"#ISM Jouth tourism has been identified as one of the largest segments of global and domestic tourism. *he young travellers are primarily experience see,ers, collecting, en+uiring uni+ue experiences. Adventure and ris, have a special role to play in the behaviour and attitudes of young travellers. *he growing number of young travellers is being fuelled by a number of factors such as increased participation in higher education, falling level of youth unemployment, increased travel budget through parental contribution, search for an even more exciting and uni+ue experience and cheaper long distance travel. Jouth and adventure tourism appears to have considerable growth potential. *he rising income in some ma0or potential source mar,ets such as the 2entral and /astern /urope, Asia and 7atin America, combined with the lower travel cost, growing student populations around the world particularly in developing countries, has fuelled the demand. India? a heaven for adventure tourism India has been an attraction for travellers from all over the world. *hough in the field of international tourism, the segment of adventure tourism in India is getting only a fraction of such traffic. *he trend has been showing an increased movement year after year with the development of facilities and greater awareness about adventure tourism options. Indian tourism offers both international and domestic adventurers a wide choice of adventures. 9ater sports, elephant safari, s,iing, yachting, hails,iing, gliding, sailing, tribal tours, orchid tours, scaling the high pea,s of !imalayas, tre,,ing to the valley of flowers, riding the waves in rapids, and camel safari in the deserts are breath ta,ing opportunities for nature enthusias. 7ada,h, the #arwal hills, the !imachal hills, <ar0eeling, #oa, 7a,shadweep, Andaman and icobar, 6aisalmer and wildlife sanctuaries and reserves are some of the places that offer adventure tourism.
Medical tourism in India
15 #"#A( TO"#ISM 4ural tourism has been identified as one of the priority areas for development of Indian tourism. 4ural tourism experience should be attractive to the tourists and sustainable for the host community. *he ob0ectives of rural tourism as? M Improve the +uality of life of rural people M "rovide good experience to the tourist M Maintain the +uality of environment. Indian villages have the potential for tourism development. 9ith attractive and uni+ue traditional way of life, rich culture, nature, crafts, fol,-lore and livelihood of Indian villages are a promising destination for the tourist. It also provides tourism facilities in terms of accessibility, accommodation, sanitation and security. 4ural tourism can be used as a means to?M Improve the well being of the rural poor M /mpower the rural people M /mpower the women M /nhance the rural infrastructure M "articipate in decision-ma,ing and implementing tourism policies M Interaction with the outside world M Improve the social condition of lower sections of the society. M "rotection of culture, heritage, and nature. inth "lan identified basic
Medical tourism in India
16 *o tap the immense opportunities, coordinated actives of all agencies involved in the development are re+uired. A carefully planned and properly implemented development will definitely benefit the community economically and improve the +uality of life in the villages. *he success of such development depends upon the people>s participation at grass root level for the development of tourist facilities and for creating a tourist friendly atmosphere. <evelopment of rural tourism is fast and trade in hotels and restaurants is growing rapidly. Increase in the share of earnings through rural tourism will no doubt: provide an attractive means of livelihood to the poor rural community. It increases the purchasing power at all levels of community and strengthens the rural economy. <evelopment of infrastructure facilities such as rail, electricity, water, health and sanitation will definitely improve the +uality of life.
Medical tourism in India
17
India as a global destination for Medical Tourism
*ourism and healthcare, being an integral part of many economies services industry are both important sources of foreign exchange. #lobalisation has promoted a consumerist culture leading to the mushrooming of corporate healthcare settings sei8ed with the necessity to maximise profits and expand their coverage. !owever, the constraint lies in the fact that these services can be afforded by a relatively small si8e of population in developing countries. 7ow insurance penetration, lac, of standardisation of services, poor information base, ineffective monitoring leading to low +uality, high levels of fraud and corruption, misallocation of investments and low efficiency of existing hospitals have impeded effective performance leading to a stagnation of the healthcare sector. In this scenario, corporate interests in the medical care sector are loo,ing for opportunities beyond the national boundaries. *his is the genesis of NMedical *ourismO industry. *he term medical tourism refers to the increasing tendency among people from the 'C, the '( and many other third world countries, where medical services are either very expensive or not available, to leave their countries in search for more affordable health options, often pac,aged with tourist attractions. 7ong waiting lists, decline in public spending and rise in life expectancy and non-communicable diseases that re+uire specialist services are some of the factors directing a wave of medical tourists to more affordable healthcare destinations. Most countries are tapping the health tourism mar,et due to aggressive international mar,eting in con0unction with their tourism industry. In this rat race, *hailand, Malaysia, 6ordan, (ingapore, !ong Cong, 7ithuania and (outh Africa have emerged as big healthcare destinations.
Medical tourism in India
18 India is uni+ue as it offers holistic healthcare addressing the mind, body and spirit. 9ith yoga, meditation, ayurveda, allopathy and other Indian systems of medicine, India offers a vast array of services combined with the cultural warmth that is difficult to match by other countries. Also, clinical outcomes in India are on par with the world>s best centres, besides having internationally +ualified and experienced specialists. 2II believes that India should capitalise on its inherent strengths to become a world player in medical tourism. According to a 2II-Mc Cinsey study, medical tourism in India could become a '(< % billion business by &)%&. Instead of adopting a segmental approach of targeting a few states such as Maharashtra, Cerala, Andhra "radesh, 2hennai, efforts are now being made to pro0ect N<estination IndiaO as a complete brand ideal for medical tourists. 2ountries from where people head for India are the 'C, 3angladesh, =man, (ri 7an,a, Indonesia, Mauritius, igeria, Cenya, "a,istan, etc. Fisitors, especially from the 9est and Middle /ast find Indian hospitals a very affordable and viable option to grappling with insurance and national medical systems in their native lands. *here are thousands of expatriates without any social security and health insurance cover who usually compare the costs before going for treatment and India has a cost advantage for this segment. Although, the existing mar,et for medical tourism in India is small, it can grow rapidly if the industry reorients itself to lure foreign patients from all potential regions such as (AA42, 2entral Asia, Middle /ast, Africa, /urope, =/2< besides the 'C and the '(. *he annual health bill of people from Afro-Asian countries see,ing treatment outside their countries is '(< %) billion. If India can even tap a fraction of that mar,et, the potential is enormous. *he price advantage is however offset today for patients from the developed countries by concerns regarding standards, insurance coverage and other infrastructure.
Medical tourism in India
19 *he +uestion being as,ed by many is that how can India become an international destination in healthcare, when the clientele at home is bristling with dissatisfaction. !ence, arises the need to define minimum standards at national level, compulsory registration and adoption of these standards by all providers and regular monitoring and enforcing of such standards at the local level. Kuality assessment should combine evaluation of infrastructure as well as outcomes. An obvious answer to all this is accreditation. *his will ensure transparency in the way a hospital performs, and everything from the operating to the cleaning procedures will be monitored, audited and recorded. 9ith an aim to boost the much tal,ed about medical tourism, many corporate hospitals in India are loo,ing to international agencies such as 62A!=P62I for accreditation. Accreditation will even ma,e tie ups with overseas health insurance agencies such as 3'"A and 2!'3( easier to route patients to India. As the medical tourism industry is growing exponentially, government and the private players need to 0oin hands in order to act as a catalyst to build infrastructure for hospitals, create specialty tourist pac,ages to include medical treatment, promote accreditation and standardisation, enable access and tie-ups with insurance companies, provide state of art facilities and improve +uality of in-patient care and service to meet the re+uirements of foreign patients and to attain sustainable competitive advantage. Many fear about the serious conse+uences of e+uity and cost of services and raise a fundamental +uestion on the very existence of medical tourism- why should developing countries be subsidising the healthcare of developed nationsQ 1or them, medical tourism is li,ely to further devalue and divert personnel from the already impoverished public health system. !owever, with good planning and implementation, medical tourism besides being an economy booster can surely help India maintain good cross border and trade relations, exchange of manpower and technology among countries.
Medical tourism in India
20 (trategies are thus needed not 0ust to pro0ect India as a ma0or healthcare destination, but also to create a system to conduct proper mar,et research and feasibility studies in order to +uantify the N!ow manyO, N1rom whereO, N*o whereO, and most importantly the N!owO of medical tourism. =nly then can we leverage and channelise all efforts in the right direction. In the absence of proper planning, formulation, implementation and evaluation of coherent strategies, the much created hype and all the tal, may 0ust go in vain.
Medical tourism in India
21
Wh) the world is moving towards medical tourism
Medical tourists have good cause to see, out care beyond the 'nited (tates for many reasons. In some regions of the world, state-of-the-art medical facilities are hard to come by, if they exist at all: in other countries, the public health-care system is so overburdened that it can ta,e years to get needed care. In 3ritain and 2anada, for instance, the waiting period for a hip replacement can be a year or more, while in 3ang,o, or 3angalore, a patient can be in the operating room the morning after getting off a plane. 1or many medical tourists, though, the real attraction is price. *he cost of surgery in India, *hailand or (outh Africa can be one-tenth of what it is in the 'nited (tates or 9estern /urope, and sometimes even less. A heart-valve replacement that would cost $&)),))) or more in the '.(., for example, goes for $%),))) in India--and that includes round-trip airfare and a brief vacation pac,age. (imilarly, a metal-free dental bridge worth $I,I)) in the '.(. costs $I)) in India, a ,nee replacement in *hailand with six days of physical therapy costs about one-fifth of what it would in the (tates, and 7asi, eye surgery worth $@,H)) in the '.(. is available in many other countries for only $H@). 2osmetic surgery savings are even greater? A full facelift that would cost $&),))) in the '.(. runs about $%,&I) in (outh Africa. *he savings sound very attractive, but a good new hip and a nice new face don>t seem li,e the sort of things anyone would want to bargain with. !ow does the balance of savings versus ris, pay off in terms of success rates Inferior medical care would not be worth having at any price, and some s,eptics warn that *hird 9orld surgery cannot possibly be as good as that available in the 'nited (tates. In fact, there have been cases of botched plastic surgery, particularly from Mexican clinics in the days before anyone figured out what a gold mine cheap, high-+uality care could be for the developing countries.
Medical tourism in India
22 Jet, the hospitals and clinics that cater to the tourist mar,et often are among the best in the world, and many are staffed by physicians trained at ma0or medical centers in the 'nited (tates and /urope. 3ang,o,>s 3umrundgrad hospital has more than &)) surgeons who are board-certified in the 'nited (tates, and one of (ingapore>s ma0or hospitals is a branch of the prestigious 6ohns !op,ins 'niversity in 3altimore. In a field where experience is as important as technology, /scorts !eart Institute and 4esearch 2enter in <elhi and 1aridabad, India, performs nearly %I,))) heart operations every year, and the death rate among patients during surgery is only ).5 percent--less than half that of most ma0or hospitals in the 'nited (tates. In some countries, clinics are bac,ed by sophisticated research
infrastructures as well. India is among the world>s leading countries for biotechnology research, while both India and (outh Corea are pushing ahead with stem cell research at a level approached only in 3ritain. In many foreign clinics, too, the doctors are supported by more registered nurses per patient than in any 9estern facility, and some clinics provide single-patient rooms that resemble guestrooms in four-star hotels, with a nurse dedicated to each patient &- hours a day. Add to this the fact that some clinics assign patients a personal assistant for the post-hospital recovery period and throw in a vacation incentive as well, and the deal gets even more attractive. Additionally, many Asian airlines offer fre+uent-flyer miles to ease the cost of returning for follow-up visits. Medical tourism trend and what statistics shows? *en years ago, medical tourism was hardly large enough to be noticed. *oday, more than &I),))) patients per year visit (ingapore alone--nearly half of them from the Middle /ast. *his year, approximately half a million foreign patients will travel to India for medical care, whereas in &))&, the number was only %I),))).
Medical tourism in India
23 In monetary terms, experts estimate that medical tourism could bring India as much as $&.& billion per year by &)%&. Argentina, 2osta 4ica, 2uba, 6amaica, (outh Africa, 6ordan, Malaysia, !ungary, 7atvia and /stonia all have bro,en into this lucrative mar,et as well, or are trying to do so, and more countries 0oin the list every year. Trends in medical tourism in the near future (ome important trends guarantee that the mar,et for medical tourism will continue to expand in the years ahead. 3y &)%I, the health of the vast 3aby 3oom generation will have begun its slow, final decline, and, with more than &&) million 3oomers in the 'nited (tates, 2anada, /urope, Australia and medical care. Medical tourism will be particularly attractive in the 'nited (tates, where an estimated -@ million people are without health insurance and %&) million without dental coverage--numbers that are both li,ely to grow. "atients in 3ritain, 2anada and other countries with long waiting lists for ma0or surgery will be 0ust as eager to ta,e advantage of foreign health-care options. ew Lealand, this represents a significant mar,et for inexpensive, high-+uality
Medical tourism in India
24
Advantage India
Indian corporate hospitals excel in cardiology and cardiothoracic surgery, 0oint replacement, eurology, 'rology, orthopedic eurosurgery, surgery, =ncology, gastroenterology, =phthalmology, ophthalmology, 4heumatology, eurology, transplants and urology to name a few. *he various specialties covered are /ndocrinology, / *, "ediatrics, "ediatric (urgery, "ediatric "ulmonology, "sychiatry, #eneral Medicine R #eneral (urgery *he various facilities in India include full body pathology, comprehensive physical and gynecological examinations, dental chec,up, eye chec,up, diet consultation, audiometry, spirometry, stress R lifestyle management, pap smear, digital 2hest S-ray, %& lead /2#, &< echo colour doppler, gold standard <SA bone densitometry, body fat analysis, coronary ris, mar,ers, cancer ris, mar,ers, carotid colour doppler, spiral 2* scan and high strength M4I. /ach test is carried out by professional M.<. physicians, and is comprehensive yet pain-free. *here is also a gamut of services ranging from #eneral 4adiography, 'ltra (onography, Mammography to high end services li,e Magnetic 4esonance Imaging, <igital (ubtraction Angiography along with intervention procedures, uclear Imaging. *he diagnostic facilities offered in India are comprehensive to include 7aboratory services, Imaging, 2ardiology, eurology and "ulmonology. *he 7aboratory services include biochemistry, hematology, microbiology, serology, histopathology, transfusion medicine and 4IA. All medical investigations are conducted on the latest, technologically advanced diagnostic e+uipment. (tringent +uality assurance exercises ensure reliable and high +uality test results.
ephrology, <ermatology, <entistry, "lastic (urgery, #ynecology,
Medical tourism in India
25
As Indian corporate hospitals are on par, if not better than the best hospitals in *hailand, (ingapore, etc there is scope for improvement, and the country may become a preferred medical destination. In addition to the increasingly top class medical care, a big draw for foreign patients is also the very minimal or hardly any waitlist as is common in /uropean or American hospitals. In fact, priority treatment is provided today in Indian hospitals. *he Apollo #roup, /scorts !ospitals in ew <elhi and 6aslo, !ospitals in
Mumbai are to name a few which are established names even abroad. A list of corporate hospitals such as #lobal !ospitals, 2A4/ and <r 7.F. "rasad /ye !ospitals in !yderabad, *he !indu0as and M /xcellence in Mumbai, also have built capabilities and are handling a steadily increasing flow of foreign patients. India has much more expertise than say *hailand or Malaysia. *he infrastructure in some of India's hospitals is also very good. 9hat is more significant is that the costs are much less, almost one-third of those in other Asian countries. India will soon become THE global health destination. It is replicating the *hai model, which has been the first Asian destination for International "atients. India benefits from a large staff of world class experts and the ultracompetitive cost advantage it offers. 9ith prices at a fraction Aless than %). for example in the treatment of gall stone $
) '( B of those in the '( or /', the concept has broad consumer appeal. Indian private facilities offer advanced technology and high-+uality treatment at par with hospitals in western countries. India is promoting "medical outsourcing" where subcontractors aim to provide services to the overburdened medical care systems in western countries. Medical tourism to India is growing by &). a year. Most non-urgent 9estern patients usually get a pac,age deal that includes flights, transfers, hotels, treatment and often a post-operative vacation. *here are many bro,ers speciali8ed on the Indian mar,et. Medical tourism in India26
India has top-notch centers for open-heart surgery, pediatric heart surgery, hip and ,nee replacement, cosmetic surgery, dentistry, bone marrow transplants and cancer therapy, and virtually all of India>s clinics are e+uipped with the latest electronic and medical diagnostic e+uipment. 'nli,e many of its competitors in medical tourism, India also has the technological sophistication and infrastructure to maintain its mar,et niche, and Indian pharmaceuticals meet the stringent re+uirements of the '.(. 1ood and <rug Administration. Additionally, India>s +uality of care is up to American standards, and some Indian medical centers even provide services that are uncommon elsewhere. 1or example, hip surgery patients in India can opt for a hip-resurfacing procedure, in which damaged bone is scraped away and replaced with chrome alloy--an operation that costs less and causes less post-operative trauma than the traditional replacement procedure performed in the '.(. !ealthcare procedures across the world show a wide cost difference. It leads to a +uestion of affordability even to the developed country li,e the '( where significantly huge number of population is not covered under any insurance scheme. In some developed country, long waiting period for elective inpatient and outpatient care has created a situation where people do not hesitate to buy healthcare from other developing countries li,e India without compromising on +uality. 2omplimentary tourism pac,ages ma,e the entire offer more attractive to the people who are interested to travel for their healthcare. #lobalisation of healthcare industry has started in many level. 1or instance, Indian software companies li,e *2( and Maste, has signed I* contract recently worth more than '( $ &)) million.
Medical tourism in India
27
Scope * Opportunities
*hough the service sector has considerable contribution in India>s #<", it is negligible on the export front with only around &I per cent of total export. Falue added services generally exceed
per cent of total output in the high income industrialised economy. In the global scenario, India>s share of services export is only %.@ per cent A&))@B i.e '(< &).H billion which has gone up from ).IH per cent A%GG)B. =verall service export growth rate in India is 5 per cent A&))&B against a global growth rate of I per cent. It had a tremendous impact on India>s 1orex reserve. 1orex reserve rise to '(< %%5.;&5 on May, &))- in comparison to '(< HG.&& for the same period in &))@. 3eing a service sector member, medical and tourism services export can further rise India>s 1orex 4eserve along with a ma0or contribution from software exports. In India, international tourist rose %I.@ per cent between 6anuary and <ecember, &))@. *hough tourism and travel industry contribution is &.I per cent to our countries #<" Ainternational ran,ing %&-B but recent initiative from the government li,e liberalised open s,y policy to increase flight capacity, lower and attractive fares, increase in hotel room capacity by nearly 5) per cent Afrom &)))B and better connectivity between ma0or tourist destination A/xpress !ighway pro0ectB has helped India to ran, among the top five international holiday destination when independent traveler conducted a poll in %@- countries. !ealthcare industry has shown considerable growth in last few years. /mergence of top notch corporate hospitals and continuous effort for improvement of +uality of care has placed Indian private healthcare in a respectable position on the global map.Medical tourism in India
28 !igh ratio of foreign +ualified medical practitioners and well-trained nursing and paramedical staff have developed confidence amongst the people who are see,ing medical care from Indian !ospitals. If everything moves in the right direction, M* alone can contribute an additional revenue of 4s I))) - 4s %),))) crore for up mar,et tertiary centre by &)%& A@-I per cent of total delivery mar,etB.
Medical tourism in India
29
'eed +or Medical Tourism
Medical tourism can be broadly defined as provision of 'cost effective' private medical care in collaboration with the tourism industry for patients needing surgical and other forms of speciali8ed treatment. *his process is being facilitated by the corporate sector involved in medical care as well as the tourism industry - both private and public. Medical or !ealth tourism has become a common form of vacationing, and covers a broad spectrum of medical services. It mixes leisure, fun and relaxation together with wellness and healthcare. *he idea of the health holiday is to offer you an opportunity to get away from your daily routine and come into a different relaxing surrounding. !ere you can en0oy being close to the beach and the mountains. At the same time you are able to receive an orientation that will help you improve your life in terms of your health and general well being. It is li,e re0uvenation and clean up process on all levels - physical, mental and emotional. Many people from the developed world come to India for the re0uvenation promised by yoga and Ayurvedic massage, but few consider it a destination for hip replacement or brain surgery. !owever, a nice blend of top-class medical expertise at attractive prices is helping a growing number of Indian corporate hospitals lure foreign patients, including from developed nations such as the 'C and the '(.
Medical tourism in India
30 As more and more patients from /urope, the '( and other affluent nations with high medicare costs loo, for effective options, India is pitted against *hailand, (ingapore and some other Asian countries, which have good hospitals, salubrious climate and tourist destinations. 9hile *hailand and (ingapore with their advanced medical facilities and built-in medical tourism options have been drawing foreign patients of the order of a couple of la,hs per annum, the rapidly expanding Indian corporate hospital sector has been able to get a few thousands for treatment. In India, the Apollo group alone has so far treated GI,))) international patients, many of whom are of Indian origin. Apollo has been a forerunner in medical tourism in India and attracts patients from (outheast Asia, Africa, and the Middle /ast. *he group has tied up with hospitals in Mauritius, *an8ania, 3angladesh and Jemen besides running a hospital in (ri 7an,a, and managing a hospital in <ubai. Another corporate group running a chain of hospitals, /scorts, claims it has doubled its number of overseas patients - from ;HI in &))) to nearly %,&)) this year. 4ecently, the 4uby !ospital in Col,ata signed a contract with the 3ritish insurance company, 3'"A. *he management hopes to get 3ritish patients from the +ueue in the ational !ealth (ervices soon. (ome estimates say that foreigners account for %) to %& per cent of all patients in top Mumbai hospitals despite roadbloc,s li,e poor aviation connectivity, poor road infrastructure and absence of uniform +uality standards. Analysts say that as many as %I),))) medical tourists came to India last year. !owever, the current mar,et for medical tourism in India is mainly limited to patients from the Middle /ast and (outh Asian economies. (ome claim that the industry would flourish even without 9estern medical tourists. Afro-Asian people spend as much as $&) billion a year on health care outside their countries igerians alone spend an estimated $% billion a year. Most of this money would be spent in /urope and America, but it is hoped that this would now be increasingly directed to developing countries with advanced facilities. Medical tourism in India
31
India,s +uture &rospect
*he global healthcare mar,et is '(< @ trillion and si8e of the Indian healthcare industry is around %,%),))) crores accounting for nearly I.& per cent of #<". It is li,ely to reach ;.&- 5.I per cent of the #<" by &)%&. It is expected that medical tourism will account about @-I per cent of the total delivery mar,et. More than %,I),))) medical tourists came to India in &))@. Around H),))) people came from the Middle /ast for the medical treatment. *raditional system of medicine is able to attract a si8eable number of people from western countries ACerala, for instanceB. Most of the medical tourists are Indian in origin. 9e need to attract more number of people of foreign origin. International experience shows some of the countries li,e *hailand, (ingapore, 6ordan and Malaysia have done extremely well. *here is technical committee formed by 6ordan #overnment operating for the non-6ordanian Arab patients who visit 6ordan for healthcare. *his office regulates the healthcare institutions treating those patients and monitor the entire activity. Ma ing of a Medical Tourism destination =ur healthcare industry has some inherent drawbac,s. 7ac, of
standardisation in medical care and cost, lac, of regulatory mechanism, infrastructural bottlenec,s and poor medical insurance coverage are a few to mention here. =n the other hand, tourism and hospitality industries are facing some ma0or challenges to develop the infrastructure and services. Industry and government collaboration in terms of some incentives and creation of soothing environment can further ma,e this endeavor easy for both the service sector. *he immediate need is the establishment of health and tourism players consortium to discuss about all these issues and maintain closer interaction and co-ordination to develop medical tourism - a growth engine for 1orex earnings.
Medical tourism in India
32
&rice -omparison Overview
2=(* 2=M"A4I(= D I <IA F( ' I*/< (*A*/( =1 AM/4I2A A'(AB (ignificant cost differences exist between '.C. and India when it comes to medical treatment. India is not only cheaper but the waiting time is almost nil. *his is due to the outburst of the private sector which comprises of hospitals and clinics with the latest technology and best practitioners. &rocedure -harges in India * "SA
&rocedure
"nited States
India ."SD/
."SD/ Appro0 Appro0 3one Marrow transplant 7iver *ransplant !eart (urgery =rthopedic (urgery 2ataract (urgery (mile <esigning Metal 1ree 3ridge <ental Implants "orcelain Metal 3ridge "orcelain Metal 2rown '(< &,I),))) '(< @,)),))) '(< @),))) '(< &),))) '(< &,))) '(< 5,))) '(< I,I)) '(< @,I)) '(< @,))) '(< %,))) '(< ;G,&)) '(< ;G,@I) '(< 5,H)) '(< ;,@)) '(< %,@I) '(< %,%)) '(<
) '(< G)) '(< ) '(< %))Medical tourism in India
33
*ooth Impactions 4oot 2anal *reatment *ooth 9hitening
'(< &,))) '(< %,))) '(< 5))
'(< %&I '(< %%) '(< %&I '(< @) '(< G)
*ooth 2olored 2omposite '(< I)) 1illings P *ooth 2leaning '(< @))
&rocedure 7iver *ransplant !eart (urgery =rthopedic (urgery 2ataract (urgery
India @,)),))) @),))) &),))) &,)))
"SA ;G,))) ;G,))) 5,))) ;,))) %,&I)
3one Marrow *ransplant &,I),)))
Medical tourism in India
34
&rocedure 1reast : Mastopexy D 4eduction Mammoplasty D Mammoplasty Augmentation -4eplacement =f Implants +ace : 3lepheroplasty A'pper R 7owerB -2anthopexy wP=rbicularis suspension D !air *ransplant D /ndoscopic 3row lift D ec, lift D =toplastyA1or prominent /arsB 'ose : -"rimary 4hinoplasty -*ip 4hynoplasty
"nited states ."SD/ Appro0 '(< H,I)) '(< 5,))) '(< 5,))) '(< ;,I)) '(< ;,))) '(< ;,I)) '(< ;,))) '(< I) "er graft '(< I,5)) '(< ;,%)) '(< -,H)) '(< H,@)) '(< ;,@))
India ."SD/ Appro0 '(< &,5)) '(< @,@)) '(< &,HI) '(< @,))) '(< &,))) '(< &,5)) '(< &,%I) '(< &,&)) '(< @ "er graft '(< &,@)) '(< &,-)) '(< %,I)) '(< &,G)) '(< %,@))
-1acelift -<ermabrasion A*otal faceB '(< I,I))
1od) -ontouring : -Abdominoplasty '(< H,H)) '(< '(< @,&)) '(< -*high 7ift A3ilateralB -*otal 7ower 3ody 7iftA3elt 7ipectomyB -7iposuction A=ne 4egionB 'on 2 Surgical &rocedures : 7aser !air 4emoval D 7aser 4esurfacingP 9rin,le 4eduction D 7aser Acne *reatment D 7aser (car *reatment D 3otox '(< II) '(< IHI '(< I)) '(< H) "er 'nit '(< &&I '(< &@) '(< &%) '(< 5 "er 'nit '(< II) '(< &&I H,&)) '(< G,I)) @,%I) '(< ;,))) '(< ;,%)) '(< %,HI)
Medical tourism in India
35 -OST -OM&A#ISO' 2 I'DIA $S "'IT%D 3I'GDOM ."3/ (ignificant cost differences exist between '.C. and India when it comes to medical treatment. Accompanied with the cost are waiting times which exist in '.C. for patients which range from @ months to over months. India is not only cheaper but the waiting time is almost nil. *his is due to the outburst of the private sector which comprises of hospitals and clinics with the latest technology and best practitioners. "rocedure
&rocedure
"nited 3ingdom ."SD/ India ."SD/ Appro0 Appro0 '(< -,5)) '(< -,I))
=pen !eart (urgery 2ranio-1acial surgery and s,ull base euro- surgery with
'(< %5,))) '(< %@,)))
'(< &%,)))
'(< ;,5)) '(< -,
)!ypothermia 2omplex spine surgery with '(< %@,))) implants (imple (pine (urgery '(< ;,I))
'(< &,@)) '(<%,&)) '(< -,
) '(< &,@)) '(< %H,5)) '(< -,I))(imple 3rain *umor -3iopsy '(< -,@)) -(urgery "ar,insons 7esion <3( !ip 4eplacement '(< %),))) '(< ;,I)) '(< &;,))) '(< %@,)))
Medical tourism in India
36
-ost comparison between India4 "SA4 Thailand4 Singapore:
&rocedure 5eart 1)pass 5eart $alve #eplacement Angioplast) 5ip
"S -ost $%@),)))
India $%),)))
Thailand $%%,)))
Singapore $%5,I))
$%
,))) $IH,))) $-@,)))$G,))) $%%,))) $G,))) $@,))) $5,I)) $I,I))
$%),))) $%@,))) $%&,))) $-,I)) $%),))) $H,)))
$%&,I)) $%@,))) $%&,))) $;,))) $%@,))) $G,)))
#eplacement 5)sterectom) $&),))) 3nee $-),)))
#eplacement Spinal +usion $;&,)))
Medical tourism in India
37
Tapproximate retail costs, '( figures based on !2'" data, intl. figures based on hospital +uotes in named countries
!ere's a brief comparison of the cost of few of the <ental treatment procedures between '(A and India Dental &rocedure -ost in "SA .6/ General (mile designing Metal 1ree 3ridge <ental Implants "orcelain Metal 3ridge "orcelain Metal 2rown *ooth impactions Dentist %,5))
) I)) Top %nd Dentist 5,))) I,I)) @,I)) @,))) %,))) &,))) Medical tourism in India -ost in India .6/ Top %nd Dentist %,))) I)) 5)) @)) 5) %))38 4oot canal *reatment *ooth whitening *ooth colored composite fillings *ooth cleaning
) @I) &)) %)) %,))) 5)) I)) @)) %)) %%) &I HI#eneral cost sheet for a stay in <elhi ?
Medical tourism in India
39
Medical tourism in India
40
Ta0i fare from airport to hospital #egistration and consultation with senior consultant at hospital 8 ra) of chest Whole abdomen ultrasound (aparoscopic -holec)stectom) for Gall 1ladder Stones %ndoscopic Thoracic 5)perhidrosis Sta) at nearb) hotel 1ig Mac Meal combo at Mc Donald Tour of Delhi Tour to Agra . 9:; miles from Delhi/
on AP2 $%) $&I
AP2 $@)
$$%I /conomy 9ard (ingle 4oom $G)) $
) A*otal 2ostB /conomy 9ard (ingle 4oom $%&)) A*otal $&))) A*otal 2ostB A*otal 2ostBS)mpathectom) for 2ostB /conomy class - star $%I), $I)P day $& I star $&I)
$ I) by coach
$ %I) by personal
car $ %I) same day $ &I) with return overnight stay at I star hotel
Ma7or pla)ers offering Medical Tourism pac ages
Indian corporate hospitals excel in cardiology and cardiothoracic surgery, 0oint replacement, orthopedic surgery, gastroenterology, ophthalmology, transplants and urology to name a few. *he various specialties covered are Medical tourism in India
41 eurology, 'rology, eurosurgery, =ncology, =phthalmology, 4heumatology, eurology,
/ndocrinology, / *, "ediatrics, "ediatric (urgery, "ediatric "ulmonology, "sychiatry, #eneral Medicine R #eneral (urgery
ephrology, <ermatology, <entistry, "lastic (urgery, #ynecology,
*he various facilities in India include full body pathology, comprehensive physical and gynecological examinations, dental chec,up, eye chec,up, diet consultation, audiometry, spirometry, stress R lifestyle management, pap smear, digital 2hest S-ray, %& lead /2#, &< echo colour doppler, gold standard <SA bone densitometry, body fat analysis, coronary ris, mar,ers, cancer ris, mar,ers, carotid colour doppler, spiral 2* scan and high strength M4I. /ach test is carried out by professional M.<. physicians, and is comprehensive yet pain-free. *here is also a gamut of services ranging from #eneral 4adiography, 'ltra (onography, Mammography to high end services li,e Magnetic 4esonance Imaging, <igital (ubtraction Angiography along with intervention procedures, uclear Imaging. *he diagnostic facilities offered in India are comprehensive to include 7aboratory services, Imaging, 2ardiology, eurology and "ulmonology. *he 7aboratory services include biochemistry, hematology, microbiology, serology, histopathology, transfusion Medicine and 4IA
All medical investigations are conducted on the latest, technologically advanced diagnostic e+uipment. (tringent +uality assurance exercises ensure reliable and high +uality test results *he chief cities attracting foreign patients to India are Mumbai, 3angalore, !yderabad, Col,ata and 2hennai. (imilarly, the speciality hospitals excelling in the medical tourism industry in the country are? Medical tourism in India
42
T /scorts !eart Institute and 4esearch 2entre 7imited, ew <elhi T All India Institute of Medical (ciences, <elhi T Manipal !eart 1oundation, 3angalore T 3. M. 3irla !eart 4esearch 2entre, Col,ata T 3reach 2andy !ospital, Mumbai T 9oc,hardt !ospitals T 2hristian Medical 2ollege, Fellore T Asian !eart Institute, Mumbai T "< !indu0a ational !ospital and Medical 4esearch 2entre, Mumbai T 6aslo, !ospital, Mumbai T Apollo !ospital, <elhi T Apollo 2ancer !ospital, 2hennai
Medical &ac ages
*he health care sector in India has witnessed an enormous growth in infrastructure in the private and voluntary sector. *he private sector which was very modest in the early stages, has now become a flourishing industry e+uipped with the most modern state-of-the-art technology at its disposal. It is
Medical tourism in India
43 estimated that HI-5). of health care services and investments in India are now provided by the private sector. An added plus had been that India has one of the largest pharmaceutical industries in the world. It is self sufficient in drug production and exports drugs to more than %5) countries. T 3one Marrow *ransplant T 3rain (urgery T 2ancer "rocedures A=ncologyB T 2ardiac 2are T 2osmetic (urgery T <ialysis and Cidney *ransplant T <rug 4ehabilitation T #ynaecology R =bstetrics T !ealth 2hec,ups T InternalP<igestive "rocedures T 6oint 4eplacement (urgery T T uclear Medicine eurosurgery R *rauma (urgery
T "reventive !ealth 2are T 4efractive (urgery T =steoporosis T (pine 4elated T 'rology T Fascular (urgery
T #all 3ladder stones surgery A 7aparoscopic 2holecystectomy B T !ernia surgery A 7aparoscopic mesh repair B T "iles A (tapled !emorrhoidectomy B T Faricose Feins surgery T /ndoscopic *horacic (ympathectomy for !yperhidrosis T 7aparoscopic Appendicectomy Medical tourism in India
44 T 7aparoscopic Adrenalectomy T 7aparoscopic 1undoplication for !iatus !ernia T 7aparoscopic 3anding of stomach for Morbid =besity T 7aparoscopic splenectomy Other pac ages include:
•
!ip-Cnee replacement surgeries and other orthopedic surgeries. 3one marrow transplantation surgery. !eart surgery pac,ages li,e 2ardiac (urgery And 2ardiology, =pen !eart (urgery, Angiographies and Angioplasties.
•
•
•
*reatments of different s,in problems including s,in grafting.
The services provided b) the host countr),s hospital< organisation are:
•
"ut in touch with a world class "rivate hospital or
ursing home and the
doctor R fix up an appointment with the doctor at the hospital.
Medical tourism in India
45
•
4eceive you at the airport and provide transportation to the hotel and for the rest of the days during your stay here.
•
"rovide accommodation in a hotel as per your choice and budget near the ursing !ome or the "rivate hospital.
•
9e can arrange for another place to stay or a re0uvenating sight-seeing tour while your mother recovers after the treatment.
•
In addition to the increasingly top class medical care, a big draw for foreign patients is also the very minimal or hardly any waitlist as is common in /uropean or American hospitals. In fact, priority treatment is provided today in Indian hospitals.
ST%&S O+ S%%3I'G T#%ATM%'T WIT5 M%DI-A( TO"#ISM
Medical tourism in India
46 %. Is the medical ailment suitable for treatment in a country different from yours the patients own country. *he answer to this +uestion will be based on combined information from your own doctor and the overseas doctor. &. Ailments that re+uire a one shot treatment li,e surgery for gall stones, hernia, piles, varicose veins, hysterectomy, adrenalectomy, nephrectomy, thyroidectomy, 0oint replacement etc are more suitable for medical tourism. @. *he ailment should be such that a follow up should not be necessary and you should not need to visit the country again to E tie up loose ends. -. *he patientP tourist should be otherwise well enough to be able to utili8e the tourism part of it. =ther wise you could 0ust go to the hospital directly for treatment. I. Mostly planned elective surgery for which there may be a long waiting list in your country is best suited for medical tourism. ;. <ecide on the country, hospital and doctor who would be treating . *his information would be available through the net or from recommendation by another patient. Fisit the website of the hospital and doctor is the next step. 9riting and as,ing about their training and experience in the procedure along with the cost implications is vital. H. ext is sending a detailed note of the medical condition. "rior and complete information will insure that the treatment will get started immediately and without much delay. since the tourist comes from another country he cannot come again and again therefore he needs to include all reports of investigations and recommendations of any doctor who has seen him. 5. 3ased on this, the patient receives full information from specialist doctors P medical consultants advice on prevailing medical treatment, approximate
Medical tourism in India
47 cost for planning purposes and total duration of stay re+uired at the hospital with pre -operative and post operative extra stay re+uirement etc. G. *he patient must also chec, full details about cost of stay at respective treatment city using a hotel or service apartment or guest house. %). 2hec, with the doctor what all sight seeing P shopping P tourism is possible with the treatment patient is having and if this would be before or after the treatment. 3est time for this is after getting the preliminary chec, and tests done. 1ollowing the sight seeing etc, patient gets admitted for the surgery. %%. Ac+uire consent of local physician to fly down to IndiaP or selected destination. %&. Ac+uire visa for travel to the host country. %@. 2hec, immuni8ation re+uirements for going there. %-. 2arry a travel insurance . %I. 1ix up date of arrival, pic, up from airport. It is extremely re- assuring if a person from the hospital receives visitor at the airport and ta,es him to the hospital P hotel. %;. Meet the doctor and re-discuss the details of treatment, cost, stay etc as soon as possible to chart out the plan. %H. 4e-confirm return tic,et as per hisP her advice. %5. *reatment %G. <ischarge from hospital, with follow up advice and medications provided by the hospital.
Medical tourism in India
48 &). (tay in the city P sight seeing as discussed earlier for the re+uired time. &%. 4eview with the doctor for clearance &&. 4eturn !ome.
&rocedure followed b) the hospital< clinic: Farious steps to be followed are as follows Medical tourism in India
49
(*/" % ? Fisitor needs to send +ueries pertaining to their problems. (*/" & ? *he hospital will identify a suitable doctor and hospitals based on the +uery. (*/" @ ? <octors get bac, to patient with their suggestions and how to proceed ahead. (*/" - ? 1inali8e on which treatment to follow and how to go about it. (*/" I? !ospital will give the options such as where to stay prehospitali8ation R post hospitali8ation . (*/" ; ? "atientP visitor needs to payment. (*/" H ? Arrival in IndiaP host country. (*/" 5 ? *he hospital arranges Airport pic,-up and hotel chec,-in. they also arrange translator if re+uired. (*/" G ? !ospital arranges meetings with the re+uisite doctors. (*/" %) ? "roceed further with the treatment as discussed in (tep -. (tep %% ? "atientP visitor proceeds for short holiday brea, if re+uired. (tep %& ? !otel 2hec,-out, R return to visitor>s own country finali8e details and ma,e advance
(everaging -ompetencies +or Medical Tourism
Medical tourism in India
50
•
India has a huge potential of attracting medical tourist and medical tourism will contribute around '(< & million by year &)%&, as per 2II-Mc,insey report . 9ith a good amount of investment in the private sector, the growth of Indian healthcare is inevitable. India has the competitive advantage of price, outstanding human resource, state-of-the-art hospitals e+uipped with latest e+uipment, alternative medicine li,e Cerala>s health retreat, naturopathy and yoga, I)))-year-old civili8ation, traditional art and crafts and geographical landmar,s and coastlines.
•
In healthcare industry, it is said that a satisfied patient is the best source of referral to the hospital. In case if our hospitals wish to become leaders in medical tourism and achieve competitive advantage, it is very important that +uality service is provided on clinical dimensions as well as hospitality component. 9ea,ness of our hospitals lies in poor service culture +uotient in employees.
•
*o achieve service excellence, it is important that delivery of service is on the lips of everyone in the wor,force. *he importance of the contribution of each individual, the glory of the individual or a department should never be an issue nor be overshadowed by other focus. "atient>s wants are related to behavioral aspects of service li,e? spontaneity, warmth, concern and friendliness attention to individual needs.
•
*he total hospital is more successful, if a service is only as good as the people who deliver it and provide it. 9hen everyone wor,s smart, the collaboration needed to drive organisational performance increases. Also, the patient appreciates the way hePshe is treated.
•
1rom showing empathy and optimism to extreme self-awareness to ,nowing what>s going on around them, people competencies are an
Medical tourism in India
51 integral part of a progressive hospital. *he use of these s,ills is what elevates one>s organisation above the competition. In today>s wor,ing environment, where medical tourist are demanding more, instilling the use of people competencies in one>s team members is something one simply can>t survive without.
•
Indian hospitals do not face problem with the technical s,ills as they are ac+uired through education and training but the difficulty lies in leveraging the soft s,ills of the employees. (oft s,ills are the underlying principles that trademar, a hospital for professionalism and excellent customer service.
•
In today>s scenario, where it is predicted that medical tourism industry will grow by %I per cent annually, the real challenge lies in ac+uiring and developing a depository of people s,ill in the organisation.
5ospitals should focus on developing wor force with: %. &ositive attitude: NI can do itO is the first thought that an employee should get when he encounters a problem. !ePshe can thin, positively if hePshe is happy, cheerful with good sense of humor. &. Ingenuit): /mployees should possess natural incentive and creative abilities to solve unforeseen problems. *hey should be capable of coming up with satisfactory solutions instantaneously. @. Initiative: If a hospital has employees who are self-starters, then it is li,e a dream come true. If you empower people, then they show exceptional resourcefulness in handling unforeseen events or situations effectively.
-. (o)alt): =rganisation should value an employee who maintains service interest uppermost in his mind. /mployees who display a high degree of Medical tourism in India
52 sincerity and honesty of purpose and are upright in dealings with patients. (uperiors, e+uals and subordinates are asset to any organisation. I. Maturit): *act and maturity are the ,eys to handle difficult and demanding patients. /mployees who are considerate and understanding in dealing with patients can form the bac,bone of service excellence culture. ;. Team spirit: !ealthcare cannot be delivered by a single person: it is always a team wor, of people with diversified competencies. /mployees who find ready acceptance by others and ma,e good contribution towards functioning of the group are very good team players. *hey provide wholehearted co-operation to colleagues, superiors and subordinates. H. Interpersonal s ills: Interpersonal s,ills are of paramount importance. 9ritten and oral communication, listening s,ills and body language play a very important role in service delivery. It is important to be respectful and courteous with co-wor,ers and patients. 5. Appearance and 1earing: !ospitals should see that the appearance and bearing of employees is synchronised at all levels. It should not happen that support staff li,e ,itchen and cleaning staff does not follow any hygiene standard. It is not only the employee who is properly dressed draws attention but the employee who is not neatly dressed also excites discussion amongst the patient relatives. *he +uestion which ta,es paramount importance is N!ow to develop the inventory of these competencies in the organisationQ *he answer is very simple. !ire employees with competencies to meet the re+uirement of the organisation. !4 heads should focus on development of a recruitment tool which helps in identification of the re+uisite competencies and measurement of available degree of these competencies in the prospective employees.
Medical tourism in India
53 It should be very clearly understood that people with desired competency come at a cost and therefore entire manning plan and the compensation budget should be re-used. If re+uired people should be paid slightly more then the competing organisation as hiring is not the only issue, organisation has to also retain high performing individuals. Another solution to the problem is nurturing ,ey competencies in the wor,force and align individual competencies to the re+uirement of the organisation. %. Identification of individuals with desired competencies? 1irst and foremost, !4 department along with the line managers should identify people for selective retention so that they can be used as mentors for coaching and development. An employee with similar 0ob role and wor,ing conditions empathies with another employee better than anybody else. *he identified mentor should communicate effectively, ,now the 0ob profile thoroughly, demonstrate trust in improvisation, help individuals as and when needed. !e ,nows the constraints and the re+uirements of the 0ob. !e can also act as a role model and foster a feeling of constructive competition in other employees. &. *rain the identified individuals? *he identified individual has to act as an mentor and train other employees and therefore he has to lead by example. It is the responsibility of the !4 department to train him in conducting training sessions. !4 department should sensitise him with issues li,e how to conduct training. @. 2onduct on going training programme? =ngoing training programmes are very beneficial as no hospital is free of attrition rate. /xodus of well trained staff to middle east, the '( R the 'C cannot be stopped because of massive re+uirement in these countries, but whenever an employee 0oins an overseas hospital, the identity is always lin,ed with the past employer.
Medical tourism in India
54 2ontinuous training programme on communication, attitude and personality development should be carried out and mechanism should be set to analyse the impact of these programs. 2ompetencies and strengths vary from people to people and all the employees are never the same. 7everage their strengths and differences because these are the facts that will help distinguish you and your organisation from the competition. 7everage each other>s strengths inside the team to develop a new identity of the hospital. Indian healthcare is amongst the best in the world but to attract medical tourist it has to not only come up with world class infrastructure but India should focus on optimum utilisation of the talent pool. If it is done, the pro0ected medical tourism mar,et of '(< -) million can be easily achieved.
Medical tourism in India
55 &romotion Of Medical Tourism *he ,ey "selling points" of the medical tourism industry are its "cost effectiveness" and its combination with the attractions of tourism. *he latter also uses the ploy of selling the "exotica" of the countries involved as well as the pac,aging of health care with traditional therapies and treatment methods. "rice advantage is, of course, a ma0or selling point. *he slogan, thus is, "1irst 9orld treatment' at *hird 9orld prices". *he cost differential across the board is huge? only a tenth and sometimes even a sixteenth of the cost in the 9est. =pen-heart surgery could cost up to $H),))) in 3ritain and up to $%I),))) in the '
in India's best hospitals it could cost between $@,))) and $%),))). Cnee surgery Aon both ,neesB costs @I),))) rupees A$H,H))B in India: in 3ritain this costs U%),))) A$%;,GI)B, more than twice as much. <ental, eye and cosmetic surgeries in 9estern countries cost three to four times as much as in India. *he price advantage is however offset today for patients from the developed countries by concerns regarding standards, insurance coverage and other infrastructure. *his is where the tourism and medical industries are trying to pool resources, and also putting pressure on the government. 9e shall turn to their implications later. *he entire concept of medical tourism hangs on the efficiency, s,ill and competency level of the doctors, specialists and consultants etc. 9orld over patients and hospitals trust Indian doctors without doubt. *his is therefore an advantage for India. "atients from around the globe expect the best of services solely based on the reputation of doctors of Indian origin. 3ut so far the government has failed to reali8e the advantage of this important factor. *his reputation and goodwill that Indian doctors en0oy could be leveraged to attract and promote Indian medical tourism. *he other most important reason why India has not been able to attract more customers is that there is no specific campaign which only promotes medical Medical tourism in India56 promotes medical tourism. *he incredible India campaign has catapulted India in the top I must visit uni+ue destination for lonely planet but so far as it goes *hailand, 3ang,o, and other east Asian countries are still mar,et leaders. *herefore there is still scope that with specific mar,eting, advertising and promotion campaigns considerable number of tourists can be attracted. In India the strong tradition of traditional systems of health care such as in Cerala, for example, is utilised. Cerala Ayurveda centres have been established at multiple locations in various metro cities, thus highlighting the advantages of Ayurveda in health management. *he health tourism focus has seen Cerala participate in various trade shows and expos wherein the advantages of this traditional form of medicine are showcased. A generic problem with medical tourism is that it reinforces the medicalised view of health care. 3y promoting the notion that medical services can be bought off the shelf from the lowest priced provider anywhere in the globe, it also ta,es away the pressure from the government to provide comprehensive health care to all its citi8ens. It is a deepening of the whole notion of health care that is being pushed today which emphasi8es on technology and private enterprise. *he important +uestion here is for whom the 'cost effective' services is to be provided. 2learly the services are "cost effective" for those who can pay and in addition come from countries where medical care costs are exorbitant because of the failure of the government to provide affordable medical care. It thus attracts only a small fraction that can pay for medical care and leaves out large sections that are denied medical care but cannot afford to pay. *he demand for cost effective speciali8ed care is coming from the developed countries where there has been a decline in public spending and rise in life expectancy and non-communicable diseases that re+uires specialist services. 'rban concentration of health care providers is a well-,nown fact - IG per cent of India's practitioners AH@ per cent allopathicB are located in cities, and especially metropolitan ones. Medical tourism promotes an "internal brain Medical tourism in India
57 drain" with more health professionals being drawn to large urban centres, and within them, to large corporate run specialty institutions. Medical tourism is going to result in a number of demands and changes in the areas of financing and regulations. *here will be a greater push for encouraging private insurance tied to systems of accreditation of private hospitals. *here is a huge concern in the developed countries about the +uality of care and clinical expertise in developing countries and this will push for both insurance and regulatory regimes. *he potential for earning revenues through medical tourism will become an important argument for private hospitals demanding more subsidies from the government in the long run. In countries li,e India, the corporate private sector has already received considerable subsidies in the form of land, reduced import duties for medical e+uipment etc. Medical tourism will only further legitimise their demands and put pressure on the government to subsidise them even more. *his is worrying because the scarce resources available for health will go into subsidising the corporate sector. It thus has serious conse+uences for e+uity and cost of services and raises a very fundamental +uestion? why should developing countries be subsidising the health care of developed countriesQ .
The Golden Goal = India,s 69 billion dream:
Medical tourism in India
58 India could earn more than $% billion annually and create -) million new 0obs by sub-contracting wor, from the 3ritish '( and /uropean states. Apollo !ospitals, which provides medical tourism pac,ages has put forth a suggestion and currently is awaiting a reply to carry out operations at a fraction of what they would cost in the 'nited Cingdom. *hey include surgery for hip and ,nee replacements and coronary bypass that would slash waiting times dramatically, reducing the +ueues of 3ritish patients waiting to see their doctors. *hey have well e+uipped, state-of-the-art hospitals and can offer the same level of care as anywhere else in the world. *here is no reason why India should not become the healthcare destination of the world. India's healthcare industry is growing at @) per cent annually and the Apollo group alone has so far treated GI,))) international patients, many of whom are of Indian origin. 4eddy cited two recent cases of 'C nationals who opted for private healthcare at the Apollo networ,. Medical treatment in the 'C is free under the !(, but because of the long !( and offer ational !ealth (ervice, the head of India's largest chain of private hospitals and other such organisations in the
waiting times some patients opt for expensive private care. *he advantage of 4eddy's offer is that is that it would reduce pressure on the sub-contracted healthcare at vastly cheaper rates. After this million people, there are thousands of expatriates. ot necessarily
Indian, but expatriates who may be given the opportunity to come and get themselves operated in India where we are planning to give them what is called health tourism."
Medical tourism in India
59
-riticism +aced b) Medical Tourism Industr):
•
#overnment and basic medical insurance, and sometimes extended medical insurance, often does not pay for the medical procedure, meaning the patient has to pay cash.
•
*here is little follow-up care. *he patient usually is in hospital for only a few days, and then goes on the vacation portion of the trip or returns home. 2omplications, side-effects and post-operative care are then the responsibility of the medical care system in the patients' home country.
•
Most of the countries that offer medical tourism have wea, malpractice laws, so the patient has little recourse to local courts or medical boards if something goes wrong.
•
*here are growing accusations that profitable, private-sector medical tourism is drawing medical resources and personnel away from the local population, although some medical organi8ations that mar,et to outside tourists are ta,ing steps to improve local service.
•
Inferior medical care would not be worth having at any price, and some s,eptics warn that *hird 9orld surgery cannot possibly be as good as that available in the 'nited (tates. In fact, there have been cases of botched plastic surgery, particularly from Mexican clinics in the days before anyone figured out what a gold mine cheap, high-+uality care could be for the developing countries.
Medical tourism in India
60
•
=n a national level, the Indian healthcare system is ill-e+uipped to cope with the rising number of elderly and the changing disease patterns, with an average of 0ust ).H hospital beds and ).; physicians per thousand population, according to the report. India faces the continuing challenge of fighting infectious diseases li,e malaria, tuberculosis and leprosy alongside increases in lifestyle related problems faced by the developed world, such as cancer, cardiovascular disease and diabetes.
•
ot everyone is enthusiastic about India's push to become a health care destination. Indian hospitals should start focusing and investing huge amounts of money on treating overseas patients. India should first, or in parallel, meet the needs of the country. In India, insurance plans cover %percent of the more than % billion people, leaving almost G)) million without protection, according to the McCinsey-2II report. As many as @I) million people live on less than $% a day, according to the 9orld 3an,. India spends I.& percent of its $I5) billion #<" on health care and still lags behind *hailand, 3ra8il and (outh Corea in life expectancy. "eople live ;% years on average in India, less than ;5.G years for a developing country such as 3ra8il and HH.@ years for a developed country li,e the '.(., according to the 9orld !ealth =rgani8ation. India has G% infant deaths per %,))) births compared with @5 deaths for 3ra8il and eight for the '.(.
•
*he patient is provided limited information other than an introductory phone call to the intended physician and having medical records electronically sent to the doctor or hospital via the internet by the medical tourism agency. *he patient has a choice of physicians, but unli,e in the '.(. where there is easy access to a doctor>s medical status by medical boards and organi8ations, other than ,nowing whether the doctor may have practiced medicine in the '.(., there is little information to come by. 9ithout standardi8ed protocols it is difficult for the patient to ma,e a correct assessment.
Medical tourism in India
61
Where does India need to improve
!igh !urdles !urdles to India's medical ambitions abound. 9ith %)),))) patients a year traveling to the country -- up from %),))) five years ago -- hospitals are struggling to remedy first impressions that can turn people off. /uropean people are aware of the poverty and decrypt state of the infrastructure but this ,nowledge is second hand gained through boo,s and other media as such it really as a reality chec, when these visitors are faced with streets overflowing with people and bicycles and by neighborhoods where new offices butt up against tarpaulin-covered slums. It is a ma,e or brea, situation, on one hand they are promised with world class health care at nominal costA as per their standardB but on the other hand they face reality with in your face human degradation and surreal poverty. "atients can sometimes decide not to go through with the process 0ust loo,ing at the general state of the local people of the host country. *hey wonder whether the price of their operation with an Indian hospital compared with five times more in their home country is worth the ris,. *herefore the logical thing for India is to strive for a massive Image Improvement plan, the medical industry in itself is banding together to improve its image. *he Indian !ealthcare 1ederation, a group of about
hospitals, is developing accreditation standards. In the '.(., organi8ations such as the 6oint 2ommission on Accreditation of !ealthcare =rgani8ations, based in =a,broo, *errace, Illinois, assess infection rates, the width of hospital corridors and the capacity of elevators. In India, there's no accreditation, and hospitals aren't re+uired to provide information on the outcomes of treatments. *here is nothing as far as +uality standards go. !ospitals ,eep data, but they don't need to share itMedical tourism in India
62
(,etchy Information *he leading +uestion that any potential medical tourist will as, himself is -where is the information, how detailed is the information and whether it is easily available or not: for eg /scorts' 9eb site lists only the number of procedures it has performed. *hought they do not mention the obvious and important fact that *rehan, /scorts' hospital had a mortality rate of ).5 percent and an infection rate of ).@ percent in &))@. *hat compared with an observed mortality rate, or the rate of actual deaths, of -.HH percent for heart valve surgery or coronary artery bypass surgery that included heart valves at Jor,-"resbyterian !ospital from &))) to &))&, according to a ew ew Jor, (tate
<epartment of !ealth report is much better. (uch facts not only need to be told but they also need to unashamedly promoted if India has to attract more overseas patients. Infrastructural mess India competes for foreign patients with Malaysia, (ingapore and *hailand but it offers less in some areas where it matters such as infrastructure. 9e can almost call it as the curse of India since no matter what the problem we try to resolve on the national scale the first and most formidable issue is the infrastructure or rather the lac, of it. *hus if we are to improve the basic re+uirement of having wide roads, electricity, grounded electric wiring, information system in place etc then most of our problems will be resolved including that of medial tourists. *hailand's airports and roads are in better shape than India's because *hailand is a ma0or vacation destination. In &))@, %) million tourists traveled there, according to the *ourism Authority of *hailand's 9eb site. *hat was more than triple the number for India that year. 3umrungrad !ospital "cl, which runs 3umrungrad !ospital in 3ang,o,, started courting overseas patients during the Asian economic crisis in %GGH as the devaluation of the baht drove down costs for visitors.
Medical tourism in India
63 *hat year, 3umrungrad treated I),))) foreigners. It handled seven times as many in &))-, accounting for @I percent of its patients. In &))@, 3umrungrad hosted %I) Indian delegations, including one led by 9oc,hardt's 3ali, showing them intensive care units, recovery rooms and the (tarbuc,s cafe in the lobby. International 1ocus *he focus on international patients screams at us. !aving interpreters and instructions in multiple languages such as Arabic, /nglish, #erman, and (panish etc is a must. *he patient must feel that whatever he is trying to convey goes across and all the communication must be clear. 9hat it shows is that convenience offsets most other things for an international patient. At the end of the day the patient must feel sure is that he is treated for the right ailment and his consultant understands him perfectly. 9e 2are attitude? Indian hospitals are countering with per,s of their own. *his is due to the fact that India believes in N atithi devo bhavaO and using this to best their own cause. !ospital>s representatives meet the patients at the airport , help them through immigration and drive them to the hospital in a private vehicle. *heir room was stoc,ed with fruit and drin,s. *hey have on call consultants with arrangements made for pre and post treatment sight seeing, shopping and other tourist activites. !ospitals even loan a mobile phone so they can stay in touch once they left the hospital.
Medical tourism in India
64 More 1oreigners 1oreign patients are still far from the norm. =perations on non-Indians accounted for %) percent of the more than -,))) surgeries at /scorts in &))@. 1oreign surgeries will pic, up as rising health costs and long waiting lists provide incentives to travel to India and its low-priced rivals. In the '.(., health-related spending climbed H.; percent to $%.;5 trillion in &))@, consuming almost %I.@ percent of the $%% trillion gross domestic product. It was the fifth consecutive year that the cost of medical care expanded faster than the economy. '.(. employer-paid health insurance premiums have soared IG percent since &))), according to the !enry 6. Caiser 1amily 1oundation and the !ealth 4esearch and /ducational *rust, nonprofit groups that study medical care. In &))-, premiums averaged $G,GI) for families and $@,;GI for individuals, the groups found. 9hat all this means is that no matter what happens the number of foreign tourists will ,eep on increasing and India should be ready or atleast get ready to attract these patients. Accidental "atient In the '.C., the waiting list for the government-funded ational !ealth (ervice
prompts some patients to loo, elsewhere. 7ast year, the lag averaged less than nine months for surgery, about half the %5 months in %GGH. 'nli,e people who chose India after deciding not to pursue an operation through the ational !ealth (ervice, there are others who have discovered India by accident.
Medical tourism in India
65 2ase in point ? In 6uly &))-, Ian 3rown, a director at !arrogate, /nglandbased electronics company (urevision 7td., suffered chest pain and went to his local doctor. *he ational !ealth (ervice told him he'd have to wait as long as four months for a test and then, if re+uired, two years for an angioplasty to open bloc,ed arteries. =n vacation in India in (eptember, 3rown experienced chest pain again and was rushed to 9oc,hardt !ospital in 3angalore. 9oc,hardt performed an angioplasty the next day, inserting a wire mesh tube called a stent to prop open an artery. 3ac, in /ngland, 3rown got a letter from the (ervice in after he'd had the surgery in India. In this instance an accidental discovery proved to be a life saver. ational !ealth ovember as,ing him to come in for his initial test -- two months
$5)) vs. $%5 2harging foreigners more than Indians is one way hospitals can ma,e money to treat the poor. An echocardiogram machine, used to picture the heart, costs about $&)),))) anywhere in the world. <octors can charge $5)) per scan in the '.
in India, they charge 5)) rupees, or $%5. *he difference ma,es it tough to recoup costs. *he reason why hospitals are so excited about overseas patients is that in India there are more than enough Indians to fill the nation's hospitals. India has enough volumes but what we don>t get is pricing. India should and is charging for the value rater than the concentrating on volume based profit alone.Medical tourism in India
66 2atering to the middle /ast tourists (ome Middle /astern patients began choosing India after the (ept. %%, &))%, attac,s on ew Jor, and 9ashington, =man hospitals often refer patients to India for complicated procedures because the country is familiar, closer than the '.(. or /urope and cheap. Also after GP%%, people are scared to go to the '.( not only due to fear of terrorist attac,s but mainly due to the fact that they feel threatened because of racial discrimination be it overt or subtle. *he fact that people in '( loo, at a turbaned and bearded man as a potential terrorist is an unsettling experience. discrimination. 3rain drain reversal Indian doctors are returning home again .and offering medical procedure which they performed abroad in their home country itself. *here are many Indian patients who had to go abroad for medical reasons this is one of the factors that influenced doctors to return home. *he other reason is that the pay in India is gradually rising and the lure to bac, in one>s own homeland is +uite strong. ot only in the '( but even in 'C and other /uropean countries people of coloured s,in and religion are facing
/asy *ransition Indian hospitals are wor,ing to ma,e the transition easier. Apollo is setting up a 7ondon clinic to attract people see,ing alternatives to the ma,e all arrangements to get them to India. ational !ealth (ervice. *he idea is that a doctor would loo, at patients find the problem and
Medical tourism in India
67 2hanging the trend 6ust as Indian software companies started with small programming 0obs and expanded to become a $%; billion global industry, India's international health care initiative is in its early stages. 1or patients and profits to increase, India must remedy negative first impressions and persuade doubters that millions of the country's poor and ailing won't be left behind.
Medical tourism in India
68
Initiative b) Indian Government to &romote Medical Tourism:
*he medical tourism industry in India is presently earning revenues of $@@@ million. /ncouraged by the incredible pace of growth exhibited by the industry, the 2onfederation of Indian Industry A2IIB and McCinsey have predicted that the industry will grow to earn additional revenue of $&.& billion by &)%&. 9ith a view to facilitating the medical tourism industry to achieve the targets and to give greater momentum for its growth, the Ministry of !ealth and 1amily 9elfare together with the Ministry of *ourism of the #overnment of India has set up a *as, 1orce. *he *as, 1orce will evaluate the opportunities in the industry and formulate a policy for accrediting healthcare institutions in the country. *he accreditation programme is aimed at classifying health service providers on the basis of infrastructure and +uality of services offered. It is expected to standardise procedures and facilitate foreign patients in selecting the best hospitals. Meanwhile, several hospitals in the country are see,ing to ta,e advantage of the booming medical tourism industry. *hey are investing largely in ac+uiring e+uipments, si8e and s,ills. *o provide for brighter prospects for the industry, the hospitals can also ac+uire international accreditation, integrate traditional and clinical treatments and offer end-to-end value added services by tying up with tour operators, airline carriers and hotel companies. !ospitals can also allow foreign patients to pay through credit and ensure proper support services to foreign patients after they return to their native countries. 7astly, the #overnment of India can also reinforce its support through +uic, visa processing, improved flight connectivity and infrastructure development.
Medical tourism in India
69
-urrent initiatives b) various state governments and organisations: Government Initiatives: 2entral #overnment and (tate #overnments have been encouraging rural handicrafts and fairs and festivals that have direct impact on preservation of heritage and culture of rural India. It also draws tourists from all over the world. 4egional fairs, festivals help the growth of tourism, provide a ready mar,et for the handicrafts, alternative income to the community, and facilitate regional interaction within the country. 7eading states such as Cerala, #oa, Maharashtra etc have ta,en the initiative to promote medical tourism as a pac,age in itself rather then 0ust a side issue or an added benefit. *he effect has apparently been a success a medical tourism has pic,ed up in these states. *he state governments have been monitoring closely the ecological relationship, socio cultural impact and conducting feasibility studies before selecting tourist sites. *he state governments also ensure that? *ourism D M <oes not cause the tension for the host community M o adverse impact on the resources M "sychological satisfaction for the tourist. M *he large inflow of tourists would not put a stress on the local system M 7ocal community should not be deprived of basic facilities for the benefits of tourist M *he rural tourism does not disrupt the rhythm of community life *hus the 2entral
Medical tourism in India
70 #overnment and (tate #overnments have ta,en various steps for the promotion of tourism and attainment of the goal of sustainable tourism development.
•
TO"#ISM MI'IST#! &#OMOT%S I'DIA AS A >?;=DA! D%STI'ATIO': *he
ministry of tourism in an effort to promote India as a @;I-day destination launched three 2<s on MI2/, adventure sports and cruises. *he ministry is showcasing India as a world-class MI2/ destination with many convention halls coming up in the line of !yderabad International 2onference 2entre A!I22B. *he 2<s also give details about all the adventure sports facilities available in the country and the many cruising options that are coming up.
•
TO"#ISM MI'IST#! ISS"%S G"ID%(I'%S +O# AD$%'T"#% S&O#TS: *he
ministry of tourism recently issued special guidelines for adventure sports activities in the country. *he guidelines are regarding land activities li,e mountaineering and tre,,ing: water sports li,e river running: and air sports li,e parasailing, paragliding and bungee 0umping. *he ministry has laid down the basic minimum standards for adventure tourism related activities that are underta,en in different parts of the country.
•
3%#A(A TO"#ISM #%$I$% T5% "#" < A#A1 D5OW: Cerala *ourism has
plans to start '4' cruises to replicate the spice route travel of the %;th century. *he uru is a home made colossal sailing vessel made out of timber which used to ply the Indo "ersian routes in times gone by. It is the Indian e+uivalent of the Arab <how. 9hen launched they will operate on the 3e,al - 2ochin sector. *his has been +uite a crowd puller for medical tourists who floc, to Cerala especially for the Aurvedic and relaxing treatments offered. *he curious mix of vegetarian food, exotic bac, waters, courteous and pleasant people and not to mention extremely smart doctors had made Cerela a very popular destination
Medical tourism in India
71
•
5%(I-O&T%# TO"#ISM S%#$I-% I' 3%#A(A: #od's =wn 2ountry Cerala
will be luring tourists by launching a ''!elicopter tourism'' service. Fisitors will be ta,en from one tourist spot to the other in a seven-seater helicopter to save time and also discomfort on the roads. A number of cost-effective pac,ages have been designed in the helicopter tourism segment li,e ''2apital by Air'', ''3ac,waters by Air'', ''1ly the !ills'' and ''(horeline 1lights''. *he ''2apital by air'' offers sightseeing ta,es trips around around *hiruvananthapuram. *he bac,water trip tourists
Cumara,om, while the ''1ly the hill'' provides tourists a taste of the hill stations at *he,,ady and Munnar. It will also touch Cochi and Cumara,om. *he ''(horeline'' flights offer sightseeing to Canya,umari along the pictures+ue coastline. *his service is extremely helpful to the patients who are unfit for long 0ourneys by road or rail. ot only that it is very fast and and the medical tourist also gets to have his own privacy. In times of emergency the patient can be immediately flown to and from the nearest airport or heli pad.
•
&A(A-% O' W5%%(S ADDS S%$%#A( ("8"#I%S: *he second "alace on
wheels to be launched in 4a0asthan early next year ie &))H will have a dance floor, a massage center, a conference room and bars. It will be the third tourist train to be operated by 4a0asthan *ourism after "alace on 9heels and !eritage on 9heels Aon the (he,hwati sectorB. *he second "alace on wheels will also have special suites. *his has been a great success with post operative tour patients ie to travel in a princely way. It brings in the nostalgia about the past eras when the prince and ,ings and heads of states traveled in a grand way.
•
M%DI-A( TO"#ISM 1#O-5"#% #%(%AS%D: *he Ministry of *ourism is
aggressively promoting India as a global healthcare destination and has recently released the EIncredible India Brochure on Medical Tourism’ . *he government has also started issuing M AmedicalB visas to the medical patients, and MS visas to the dependent accompanying them, which are
Medical tourism in India
72 valid for a year. Around &))))) medical tourists visited India last year, and the figure will grow by I). this year.
•
GA#I1 #AT5S .&("S5 T#AI' +O# &OO#/? *he Indian 4ailways has
introduced the ''#arib 4aths'', a maiden scheme to provide plush rail services to the poor at affordable rates in the year &))- - &))I, and plans to lin, all state capitals with express trains, with the induction of &--coach trains. *he success of the #arib 4aths, can already be seen in the rail operating between (aharsa A3iharB and Amritsar A"un0abB which is a boon to the traveler especially during the festival season. 3ut as of current reports the country has not ta,en well to the #aribh 4ath and is ma,ing losses for unforeseeable reasons. Medical patients usually s,ip on rail travel as it ta,es a longer time and is a bit more exhausting.
•
T#AI' TO 3AS5MI# 5ITS T5% 5IG5WA!: /ver heard of a train running on
a roadQ It does in 6ammu and Cashmir. (et to chug in Cashmir's bewitching landscape in snowy 1ebruary &))H, the first-ever trial train to Cashmir too, off for the Falley on ovember H, not on traditional trac,s but on the @)) ,m-long 6ammu-(rinagar national highway. It has added another chapter to the history of Indian 4ailways and Cashmir's national rail pro0ect, as the first trial diesel mobile unit coach, a @; tyre wheeled train pulled by a -
!" engine, drove up the 6ammu-(rinagar !ighway at )H)) hrs and headed toward Cashmir's 3udgam railway station by ta,ing a road route and not a train trac,. *he world recogni8es Cashmir as the paradise on earth or the (wiss alps of the east. It is especially targeted to overseas visitors.•
@AI&"# TO S%(( 5%#ITAG% (IA"O#: (hops all over 4a0asthan will sell
heritage li+uor, made from age old recipes of 4a0asthan 4oyals. It is made from dry fruits, nuts, herbs and spices with a touch of saffron sometimes. *o begin with, shops in 6aipur, 6odhpur, Cota, 3i,aner, A0mer, 'daipur and 3haratpur will sell the special li+uor. #eneral as well as medical tourists can now ta,e these away as souvenirs.
Medical tourism in India
73
•
BCCC D#"MM%#S TO D#"M "& A #%-O#D I' M%G5A(A!A: A band of
5))) drummers is set to brea, a record for I minutes of synchroni8ed drum beats set by !ong Cong. *he band will play a newly composed piece, ""ositive Fibration" to enter the #uinness 3oo, of 9orld 4ecords. *he ensemble will play at Meghalaya's autumn festival which expects to have entertainers from Australia as well. A great way to pull in the tourist in search of the curious and uni+ue experience. ot only that the eastern states till now have been in the shadows so this is a great way to bring the extremely beautiful and lush eastern states on to the world map. Also it is a great location for retreat for the ailing patients who want calm and +uite surrounding.
•
+AI#! A"%%' 1%GI'S D%(5I=A(WA#=D%(5I #"' +#OM 99 'O$%M1%#:
3uilt in %5II, the 1airy Kueen is the oldest steam engine in wor,ing condition. /very year it ta,es visitors on a <elhi-Alwar-<elhi trip. *his year the schedule has been announced. It will ply twice a month Abeginning %% ovemberB in ovember, <ecember &)); 6anuary and 1ebruary &))H. to experience the past that too in a luxurious way is the cherry on the ca,e for the tourists who have been operated upon. *hey ta,e with them not only a healed body but a beautiful train 0ourney to remember.
Medical tourism in India
74
-onclusion
India is a developing country and a lot needs to be done before we can call ourselves as a developed country, all we can claim is to be a progressive one. After the dotcom com boom in the nineties we have gone through a lean patch as such. India as an emerging nation needs to grow both from with in and outside: in the sense development needs to done both for the Indian <iaspora and at the same time opportunities need to be grasped and developed so that foreign investment pours in. After the dotcom rush India has again got the opportunity to earn billions of dollars with medical tourism . 9e have all the bases coved in the sense we have the +ualified doctors and consultants, we have already developed the trust of people the world over in the past decades and we also have the exotic environment meant for tourism. All that we do need is to ma,e the transition from being a potential destination to a fully rewarding and sound medical tourism destination which is e+uivalent to or better than any service offered world over. *he +uestion that India will have to handle in the coming years is how to 0ustify giving world class medical care to visitors where as it spends 0ust %.- . of its #<" on medical care of its own people. !ealth of its own people will reflect on the robustness of the general state of the country. (o unless this is balanced off the issue of biasness will ,eep on cropping up. *ime and again we see that the root of all our national issues and problems arise from having an inherently wea, infrastructure with poorly executed law and order and political red tape. 2ompounded with the problem of over population, dwindling natural resources and rec,less disregard for the environment we stand at a 0unction where things can go haywire or they might
Medical tourism in India
75 become extremely successful if we only start resolving them. 2urrently it is li,e moving % step ahead and then going @ steps bac,wards. Medical tourism is based on having a well oiled networ, of tour operators, medical facilities, hotels, conventional tour pac,ages and infrastructure tools such as electronic connectivity, air networ, and good sanitation. =nly then we can compete with already established mar,ets such as in *hailand , south American states such as Mexico and 2osta 4ica etc. Although the situation appears to be grim there is still hope. =ne step at a time is all that is needed. 1irst and foremost is to have the basic infrastructure in place such as having proper road and rail connectivity, having a good networ, of airports to all the ma0or states and cities and with the countries from where the potential tourists will arrive such as the '( the middle east and western /urope and also the ma0or African and Islamic countries in Asia. (econdly but more importantly there is a need to put ot forward the information re+uired by the tourists. Aggressive mar,eting is the only way to go as seen in the case of *hailand, (ingapore , malyasia etc. only that there should be government authori8ed websites where people can get all the information regarding surgeries, hotels, cost comparison etc . they have to be developed exclusively for the medical tourism purpose. *wenty four hours helpline, television advertisements, getting information and advertisements published in medical 0ournals and popular maga8ines etc is a worthwhile investment. 9e have already seen how successful the Incredible India campaign is. 3ased on similar line but exclusively for medical tourism other such campaigns must be developed. (ince India already has the advantage of having highly +ualified, /nglish spea,ing doctors and medical staff it seems 0ust a matter of time when medical tourism will ta,e off in a big way. 9e have the cost advantage, we have the s,ills advantage we even have world class facilities and so all we need is a better image, a functional infrastructure and some clever promotional campaign. *his is a golden opportunity which we cannot pass up. ot only that the foreign currency that we earn is going to give our own
Medical tourism in India
76 people various benefits. It 0ust seems li,e a circle in which all the bodies who participate have a win win situation on hand. *he idea of doing this pro0ect was to bring to light how medical tourism is the &%st century>s golden goose for India. 3ringing out all the true facts, the wea, points and in general trying to understand the phenomenon itself of medical tourism has been insightful. *his pro0ect has been laborious since finding out relevant information is difficult and there are very few sources to find it out from. It has been worthwhile doing this pro0ect on medical tourism since it is an upcoming industry with lots of potential and also facing various difficulties. *he main idea behind doing this pro0ect was to highlight all the important features and data and give atleast a birds eye view over the concept of tourism for medical purpose. In conclusion I can easily say that medical tourism for India is a once in a life time opportunity and we certainly need to ta,e up on our strong points in order to become the leading nation in this area. I hope I have done 0ustice to my pro0ect and based on the data collected I might easily say that India is the place where people come to heal themselves since god>s grace seeps and flows through all the pores of India. 9e are a nation of people who feel honor in helping out and healing the mind and the spirit. I therefore dedicate this pro0ect to all the worthy doctors and medical professionals and to India my mother and may gods will guide us to to a better and prosperous era. NAtithi <evo 3havaO
Medical tourism in India
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