M e d i c a l

T o u r i s m

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The Medical Tourism Industry in India is poised to be the next big success story after software. According to a Mckinsey-CII study the market size is estimated to be Rs.5000-10000 Crores by 2012. The key competitive advantages of India in medical tourism stem from the following: low cost advantage, strong reputation in the advanced healthcare segment (cardiovascular surgery, organ transplants, and eye surgery) and the diversity of tourist destinations available in the country. The key concerns facing the industry include: absence of government initiative, lack of a coordinated effort to promote the industry, no accreditation mechanism for hospitals and the lack of uniform pricing policies and standards across hospitals. To realize the industrys full potential, a coordinated effort from the various players government, private players and the associated sectors is very essential. The government should help in instituting an accreditation mechanism and device policies to facilitate private investment in the sector. An apex body should be formed for the industry in the lines of NASSCOM and should focus on building the Indian Brand across the world and promote inter-sectoral cooperation. The private sector for its part, should invest more in infrastructure, horizontally integrate into related services and build joint ventures and alliances with overseas health institutions and insurance players.

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Feeling Gratitude and not expressing it is like wrapping a present and not giving it

So, I take the opportunity, while presenting this BOOK to express my deep gratitude to all those who offered their valuable help to me in completing the book successfully. A large number of people provided me with their assistance, encouragement and enthusiasm, without them this book would not have been possible.

First of all I am extremely grateful & thankful to the International Institute of Planning and Management, Ahmedabad, for instilling in me new and lively subjects which are practically observed in the Country today.

It is often said that When you do not know what you are doing and what you are doing the best that is inspiration. And this inspiration was given by Prof. Kaushik Das. I am extremely thankful to Prof. Kaushik Das for giving me the view of this topic and helping me at penning it down.

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Sr No. 1 2

Topics Introduction to Medical Tourism Medical Tourism and Medical Travelling in the World Emerging Medical Tourism Market Description Tourism of Medical

3 4

5 6 7 8 9 10

India gaining prominance SWOT Analysis Areas to Improve Medical Tourism in Gujarat Conclusion Reference

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he concept of medical tourism started thousands of years ago. People have been travelling across the continents in search of cures for any imaginable illnesses and making therapeutic trips for health wellness. In ancient Greece, pilgrims and patients came from all over the Mediterranean to the sanctuary of the healing god, Asklepios at Epidaurus, and from the 18th century wealthy Europeans have been travelling to spas from Germany to the Nile. In recent years, medical tourism is becoming more popular with patients seeking treatment for health and well-being purposes abroad. Why Are People Travelling? If you can get your ailing heart cured or get your flat-nose fixed at home, why bother to travel across the globe for medical treatment? Patients seeking treatment abroad are motivated to do so by various reasons. Many are attracted by the low cost factor or they are simply dissatisfy and with the existing medical care in their home country. Frustrated by the long waiting times, inadequate medical care and exorbitant medical expenses, many go abroad in search of medical care. The steep medical costs in America have contributed too many Americans flying to other countries in search of cheaper alternatives. According to the Census Bureau, as many as 46.6 million Americans were uninsured in 2005. As these uninsured Americans are not able to afford the costly medical care, many will jump at the opportunity of getting treatment abroad at a fraction of the price at home. Medical tourism (also called medical travel or health tourism) is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of traveling to another country to obtain health care. According to Mary Tabacchi, Health Tourism is any kind of travel to make yourself or a member of your family healthier. More recently the phrase "Global Healthcare" has emerged, and may replace the earlier terms. Such services typically include elective procedures as
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well as complex specialized surgeries such as joint replacement (knee/hip), cardiac surgery, dental surgery, and cosmetic surgeries. The provider and customer use informal channels of communication-connection-contract, with less regulatory or legal oversight to assure quality and less formal recourse to reimbursement or redress, if needed. Leisure aspects typically associated with travel and tourism may be included on such medical travel trips. Medical Tourism refers to movement of consumers to the country providing the service for diagnosis and treatment. During the past few years, the number of people going out of their home country to consume health services has significantly increased. The size of this market is estimated to be $40 billion based on a Saudi Report in 2000. During the past four years, the market grew at a whopping rate of 20-30% and is expected to grow further. Considering this growth the current market size is estimated to be $100 billion. Medical Tourism industry offers tremendous potential for the developing countries because of their low-cost advantage. The advantages of medical tourism include improvement in export earnings and healthcare infrastructure. No doubt a lot of countries India, Thailand, Malaysia, Singapore, South Africa, Cuba, Jordan and Lithuania are fighting for a share of the market. In order to realize the full potential of the industry, it is imperative for these countries to develop a strategic plan for coordinating various industry players the medical practitioners, private hospitals, policy makers, hotels, transportation services and tour operators. This book presents the strategy that needs to be implemented by India, one of the key destinations for Medical tourism, in order to achieve industry-leadership.

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A recent trend has shown that people from developed countries are seeking treatment from the health professionals from developing countries. This preferential shift is broadly termed as Medical Tourism. The most important reason is the rising cost of medical care in developed countries. One wonders why people travel all the way to these nations, leaving behind the comfort of their superior technology. Well, its the cost factor that is six to ten times less in the countries where these health tourists decide to go. Its no longer India but Incredible India that is experiencing heights in the growth of the tourism industry since 2001. The ministry of tourism and cultures proved in the recent years that it is not only unity in diversity in India that has magnetized tourists from all over the world, but more than that. In order to boost different kinds of tourism globally conducted campaigning of Incredible India projected India as an attractive tourist destination by showcasing different aspects of Indian culture and history like yoga, spirituality, etc. Not only pilgrimage tourism, but India with its rich diversity has lot more to offer in its plate to tourists. It was also taken in to record that foreign tourists spend more in India than almost any other country worldwide. Among all kinds of tourism, Medical Tourism has won the race with over-theglobe appreciation and making it a part of national industry. India has become the medical destination for millions of tourists from all over the world. Internationallyrecognized healthcare professionals, holistic medicinal services with the availability of latest medical technologies, low cost of treatment, unique mix of indigenous system such as yoga, ayurveda, meditation and western medicinal systems like allopathy, all have added stars to the industry. As per the tourists convenience, medical tourism also offers packages like Health Tourism India, Dental Care Package India, Cosmetic Treatment Package India, Heart Surgery Package India, Orthopaedic Surgery Package India, Heart Care
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Package India, Health Check Up India include cardiac care, joint replacements, cancer care, kidney and liver transplants, neurological ailments, minimal access surgery, dental implants and cosmetic surgery. Major hospital groups in India include Fortis Escorts, Apollo Hospitals, Medanta-The Medicity, Max Healthcare and Manipal Hospitals estimated augmentation in the foreign patients since 2010. The nations charm, Yoga Guru Baba Ramdev, has also gained popularity by ailing millions of people, not only in India, but outside the country too. His dedication in teaching yoga has brought miraculous achievements in the medical world and sciences, and has given new ways and meanings to life and personal health. Apart from running yoga classes all over world, he also provides free ayurvedic consultancy, in the premises of yogpeeth. Recently, the Ruby Hall Clinic was also awarded for the Best Medical Tourism Facility in the country. Our President Pratibha Patil handed over the award, conferred by the Ministry of Tourism, Government of India, on the 29th of February. Remarkable efforts by the government, as well as the highly-capable doctors, have been responsible for the industrys substantial contribution to the nations GDP, and are thus aiding economic growth. Indian tourism industry contributes to around 5.9 percent of the countrys GDP and it provides employment to around 41.8 million of inhabitants. This only goes on to re-affirm the great progress tourism in India has made, and how hospitality in the country has accelerated its overall development.

Worldwide Medical Tourism Industry

Medical Tourism

$40 Billion(2004)

$100 Billion (2012)

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Source: McKinsey & Company and the Confederation of Indian Industry Medical tourism includes: Wellness Spas Lifestyle/Healthy vacations Nature tourism Ecotourism Community tourism Resorts Herbal Treatments Treatment Elective surgery Cosmetic surgery Rehabilitation Dialysis Addiction programs

Joint replacement Elderly care programs Cardiothoracic services Counseling services Eye surgery Diagnostic services Reproductive treatment Cancer treatment Delivery

The main reason for Indias emergence as a preferred destination is the inherent advantage of its healthcare industry. Today Indian healthcare is perceived to be on par with global standards. Some of the top Indian hospitals and doctors have strong international reputation. But the most important factor that drives medical tourism to India is its low cost advantage. Majority of foreign patients visit India primarily to avail of First World Service at Third World Cost. Medical tourism system
Business environment Natural/Cultural Attraction Attractions Healthcare Facilities Medical Tourist Destination

Industry Intermediation Travel Agents/Tour Operators

Medical tourist Originating Region

THE TRANSIT TRANS-BORDER Entry-Exit

Accommodation

Business Environment Shivangi Trivedi

Amenities

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As noted from above, medical tourists move from originating regions to destination regions. The transit refers to both the actual mode and trajectory of transportation used for this movement as well as the constraining and facilitating forces in the international travel. A destination is a medical tourism destination not just because of the healthcare facility available there but also because of the additional provision of destination attractions, both natural and cultural, accommodation and other amenities/ in the absence of these additional provisions, patients may still travel to destinations for healthcare, but the phenomenon resulting thus cannot be termed as medical tourism. The core product is definitely the healthcare facilities available, but touristic comforts form an important hygiene factor in medical tourism.

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1. Product: Researchers within field of medical tourism predict with more than 19million medical tourists reported in 2005, industry will amount to approximately 40million global medical tourists in 2010. While the medical tourism package may generally be divided into two main elements: the medical procedure and the holiday/leisure element. There are ancillary elements that make the package possible. An analysis of four medical groups websites indicates that the main consistent elements are of a package are:- medical treatment, personally tailored leisure packages to aid healing, translators, luxury accommodation during the course of the treatment, car rentals, visa and foreign exchange expertise, coordinators and emergency medical assistance. The medical component of the medical tourism package may include any one or more of the following services, which would be complemented by a leisure component as well, either after or before the medical procedure. 2. Social issues:
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Medical tourism yields many benefits for the economies of countries that choose to partake in the tourism industry. Apart from being good for the country's image, expenditures by in bound medical tourists contribute to national reserves of foreign currency thus increasing the host countries national income which ideally is reinvested into economy through the provision of public services. The rewards to the tourist industry, and especially the hotel sector, are considerable because of the often necessary stay required of the patient for recuperative purposes. 3. Legal framework: Given the anticipated growth of the medical tourism niche market by the corporate sector this suggests a need for the development of a framework of global standards or at least guiding legislative framework. 4. Consumer benefits: Untimely and rising medical care costs are the qualms that most would be medical tourists have with the health services in their own countries and are thus driving them to seek medical care abroad. A review of medical tourist packages and medical tourist testimonials reveals that there are many incentives for engaging in medical tourism. Perhaps the biggest incentive is there are no waiting queues for treatment as the medical tourism operators and intermediaries are not only working to deliver cost-effective procedures with leisure as an added feature but to provide the procedures in a timely manner. Research indicates that surgery is 30% to 70% cheaper than in the home country of the medical tourist. An indication of prices quoted on the Global Health Tours website as at the time of our research ranged from US$69,000 (India) for bone marrow transplant as opposed to US$250,000 (USA). 5. Target Market: Previous studies on health-care tourism identify two types of marketing segments; 1) health afflictions that prompt individuals to seek health-care tourism and 2) income levels. As a subset of health tourism this may be applied to medical tourism as well.
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6. Branding : As an extension of this destination branding, is the selection of a consistent element mix to identify and distinguish the destination through positive image building. While I agree with the provided definition of branding I found it somewhat lacking for the purposes of this study. I propose another element; pre awareness of the destination be it through 1) history; for example the historical connection between India and Britain and the attendant ethnic migration of Indians to Britain, and the reserve migration of Indian doctors armed with British medical qualifications and contacts setting-up medical facilities in India, 2) familiarity with the destination through previous visits or media representation, 3) or the close migratory patterns between Mexico and North America or Asia as an established destination of Western Europe holiday-makers. 7. Infrastructure: This not only refers to the actual construction of facilities, hotel/resort quality hospitals, but also externalities within the medical tourism framework such as the local community, medical advances in technology and intellectual capital. 8. Distribution channels: Within the tourism and hospitality industry, as modes of distribution, service intermediaries have a number of standard functions which include: 1) making services locally available when a geographic distance exists between the consumer and the producer, 2) gathering the appropriate service components to make packages and retailing them, 3) building relationships between the consumer and the producer and 4) to some extent co-producing the service.

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India is encouragingly less "scary" now. I think a lot of entrusting medical care to different locations is about a psychological fear of the unknown. An important strategic challenge for developing-country hospitals is to reduce the psychological fear. In addition, India is rising because there's just a ton of very well-trained doctors just like there is a ton of well-trained engineers. Over the decades, many engineers have relocated to Silicon Valley, but for doctors it remains the case that barriers to entering the U.S. medical profession are still large. In India, the same depth of pool of engineering and mathematical talent for software, off-shoring, and outsourcing is there for medicine, too. In the 1950s and '60s, the Indian government invested a lot in tertiary education. By now there are at least a small handful of medical institutes that are really first-rate, and the doctors they produce are extremely well trained. When I began to research this case, some other countries had already stolen a march on IndiaSingapore, and Malaysia in particular, and areas of the Middle Eastyet there was still a lot of room for growth. India has had a unique competitive advantage as a result of this deeper pool of technical knowledge and the fact that it is simply a large country and has more people. I would expect to see dynamics in China similar to what is happening in other parts of Southeast Asia. China frequently makes the news for stem cell therapies that are not allowed in the West. So while I think India has some unique features it is not strictly unique.

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Holistic medicinal services

Experienc ed and qualified specialists

No waiting list

English widely spoken

Cost benefits

Medical Tourism Key Drivers in India Advantage Airports and rail-road connectivity

multispecialty hospitals International patients are increasing

32% of NRI are Gujarati

Gujarat contributes 25-31%

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In order to be global leader in Medical Tourism:1. Engineer an image revolution: The government, the healthcare, and the travel industry have to work together to change the predominant image in the minds of the average public in the medical tourist originating countries that India is a country where medieval technologies are still being employed; it is unsafe to travel in India; doctors are not trained properly; unwelcome local attitude; poor hygiene; poor communication and transportation infrastructure; and so on. 2. Raise the quality standards: While perception change-over can be achieved by the effective use of advertising and other promotional tools, one cannot hide forever the problems that really exist. It is high time hospitals in India benchmark themselves up for international quality accreditation standards. Healthcare is a credence service wherein the customer cannot judge the service quality, because of which he looks for cues like the seals of approval of internationally recognized quality control agencies. 3. Improve infrastructure: There has been a lot of hue and cry from the activist groups against opening up hospitals for medical tourism for the reason that the available facilities are not even sufficient for the domestic patients. It is real menace to see the poor Indian citizen dying on the streets while the wealthy foreigners getting five-star hospitality in addition to medical treatment. Healthcare facilities need not only to be scaled up, but also to be upgraded. Thus rather than having too many units of an archaic x-ray machine, the hospital should acquire the latest imaging machines. The number and competencies of the specialists and super-specialists and so also the para-medical staffs have to be increased. The sheer number of beds and physical healthcare infrastructure available in India as of now is abysmally low given the size of its population. 4. Simplify the procedures: Many procedures that are being done manually as of now can be simplified, standardized, and automated. If the information system that an Indian hospital designs is interoperable with similar systems
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in the West, electronic transferability of data like past medical records of a patient can be done fast. Sometimes, it takes even hours for a patient to register himself and more so to complete the formalities before getting discharged. Then, of course, comes easing the travel formalities. This issue has been highlighted by the industry for so long as the severest pricking thorn in crossborder travel. The potential harm of easing international travel related procedures for the medical tourist segment is relatively less and the government should take a proactive attitude in this regard. A special medical tourist visa may be mooted of. 5. Provide quick legal remedies: The Indian legal infrastructure is not at all geared up to handle healthcare specific litigations in a speedy manner. Internationally, legal redressal is a routine affair, which, in India, is considered as against ethics. Though there exists a mechanism to deal with medical insurance related cases, the redressal is so much time consuming, often extending to a few years.

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edical facilities in Gujarat is well advanced with world class health facilities, zero waiting time and most importantly one tenth of medical costs spent in the US or UK, Gujarat is evolving into a preferred medical tourist destination. According to a rough estimate, about 1,200 to 1,500 NRI's, NRG's and a small percentage of foreigners come every year for different medical treatments, the majority being cardiac patients and a good number of patients coming for joint replacement, plastic surgery and In-vitro fertilization. The medical tourism is increasing at a very fast rate and it is being pursued by a strong vision of the Medical professionals and the Government. The state has various advantages and the large NRG population living in the UK and USA is one of the major ones. Out of the 20 million-plus Indians spread across the globe, Gujarati's boasts 6 million, which is around 30 per cent of the total NRI population. Nonresident Gujaratis or popularly known as NRG's coming to India for personal and medical visits are also marketing the health services available in the state. The specialized clinics and hospitals especially in the private sector is gaining popularity through word of mouth, and this is contributing to the inflow of medical tourists. Among the other advantages are the highly qualified specialists in the field of Ophthalmology, Urology, Embryology, Orthodontics, Oncology and Orthopedics. The facilities and equipment available at the hospitals are comparable with the best hospitals in the country and even the world. All this is due to the strong economic level in the state. In the services front Medical tourism in Gujarat comes in a package combining medical treatment and tourism services.
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Apart from low cost and best world class medical facilities, the hospitals are offering pick and drop services, ambulance services etc. Such health facilities are attracting the patients from Africa, America and the UK where waiting the standard period is between 6 to 18 months. Apollo Hospitals, Ahmedabad receives high number of foreign tourists for all types of surgeries and health checkups. People are now aware of the health facilities being provided in Gujarat and knowledge of English language is another major advantage, along with a zero waiting period. The major factor for radiation and other medical services, which are one tenth of the costs incurred abroad. For instance, joint replacement costs 1.25 to 1.50 lakhs in Gujarat and the same surgery is done for $20,000 in America. Similarly a cardiac surgery is done for $4000 in our state and the same is done for $ 25,000 in the US. Similarly In-Vitro Fertilization costs one-fifth in Gujarat when compared to the USA. Medical tourism is a recent concept in India and Gujarat has been able to match world standards in almost all areas of treatment. Until recently the capital city, Delhi, ruled as the commercial capital along with Mumbai as the most preferred medical tourist destinations. Specialized medical treatment for Cancer, in Ahmedabads Medical Cancer & Research Institute receive lot of inquiries from foreign countries specially from NRI's who cannot afford high costs of treatment or lack sufficient medical facilities like Uganda, Chicago, Nigeria, and the Middle East. The costs are almost 1/20th of the costs incurred in the USA or UK. Medical tourism in Gujarat: The opportunities Some of the key growth facilitators for Advantage Gujarat are: Zero waiting periods for all patient either requiring emergency treatment or otherwise One tenth to one twentieth of the costs involved for medical treatment in USA or UK Specialized hospitals and clinics Gujarati doctors participating in world medical conferences help them to know about the latest developments in the medical field.
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Knowledge of English language Large percentage of NRG's among NRI's Direct air connectivity between Ahmedabad and London Well connected with the base metros like Delhi and Mumbai Good roads and infrastructure compared to other states of India

Gujarat government has Medical Tourism Policy which will be implemented by Gujarat Medical Tourism Council. The policy is aimed at making Gujarat ultimate destination for people seeking medical facility world over. Gujarat boosts of growth of 33 percent registered in the number of medical tourist in the state while the country has registered growth of 20 percent. The policy also envisages worldclass medical facilities with public participation. It will also set up standards of hospital accreditation and entrepreneurs in the field of medical tourism. The state health ministry has begun planning NABH certification for its hospitals as the first serious step to enhance Medical tourism.

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The number of uninsured and self-pay patients traveling abroad for health care has grown rapidly over the past few years. This trend is likely to continue as medical care becomes more expensive or difficult to obtain in countries such as the United States where third-party payment is the norm. It is unrealistic to assume that every American will travel abroad for medical care. But it doesnt require huge numbers to induce change. If only 10 percent of the top 50 low-risk treatments were performed abroad, the U.S. health care system would save about $1.4 billion annually. As more insured patients begin to travel abroad for low-cost medical procedures, medical tourism will result in competition that is sorely needed in the Indian health care industry.

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1. ^ Jones CA, Keith LG. Medical tourism and reproductive outsourcing: the dawning of a new paradigm for healthcare. Int J Fertil Womens Med, 2006;51:251-255 2. ^ Jones C, "Ethical and legal conundrums of post-modern procreation" Int J Gynaecol Obstet Dec 4, 2007 3. ^ a b c d Gahlinger, PM. The Medical Tourism Travel Guide: Your Complete Reference to Top-Quality, Low-Cost Dental, Cosmetic, Medical Care & Surgery Overseas. Sunrise River Press, 2008 4. ^ Lagace, Martha "The Rise of Medical Tourism", Harvard Business School Working Knowledge, December 17,2007. Accessed July 1, 2008. 5. ^ Linda A. Johnson, "Americans look abroad to save on health care: Medical tourism could jump tenfold in next decade," The San Francisco Chronicle, August 3, 2008 6. ^ "Health Tourism 2.0". World Health Tourism Congress. Retrieved on 2007-04-13. 7. ^ a b "Medical tourism growing worldwide" by Becca Hutchinson, UDaily, July 25, 2005, retrieved September 5, 2006 8. ^ "Medical tourism: Need surgery, will travel" CBC News Online, June 18, 2004, retrieved September 5, 2006 9. ^ a b Laurie Goering, "For big surgery, Delhi is dealing," The Chicago Tribune, March 28, 2008 10. ^ "INDIA: Accreditation a must",International Medical Travel Journal 11. ^ "Medical Tourism Magazine", Medical Tourism Association, February 2008 12. ^ http://www.worldhospitalmonitor.com 13. ^ "TB Often Misdiagnosed". American Lung Association of Illinois. Retrieved on 2007-03-10. 14. ^ "Incision Care", American Academy of Family Physicians, July, 2005, retrieved September 18, 2006

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15. ^ [1] 16. ^ Ahc | Hot Topics 17. ^ Medical Protection Society | MPS UK 18. ^ "eworld press release- Aos Assurance Company limited" 19. ^ IFTF's Future Now: The dark side of medical tourism 20. ^ Organ-transplant black market thrives in India 21. ^ The Epoch Times | Transplants and Ethics in San Francisco 22. ^ Indian Journal of Medical Ethics 23. ^ Medical Tourism Creates Thai Doctor Shortage : NPR 24. ^ McGinley, Laurie, [http://online.wsj.com/article/SB120283288380762505.html "Health Matters The next wave of medical tourists might include you"], Wall Street Journal, February 16, 2008. Accessed March 13, 2008. 25. ^ Mini-Meds: Limited benefit plans provide cost-effective compromise - Houston Business Journal: 26. ^ Bruce Einhorn, "Outsourcing the Patients," BusinessWeek, March 13, 2008

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