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    MEDICAL TOURISM THE NEW FACE OF TOURISM

    HEALTHCARE INDUSTRY

    The health care industry is considered an industry orprofession which includes peoplesexercise of skill or judgment or the providing of a service related to the preservation orimprovement of the health of individuals or the treatment or care of individuals who areinjured, sick, disabled, or infirm. The delivery of modern health care depends on anexpanding group of trainedprofessionals coming together as an interdisciplinary team.

    HEALTHCARE IN INDIA

    Healthcare in India is the responsibility of the individual Indian states. The Indianconstitution charges those states with "the raising of the level of nutrition and the standardof living of its people and the improvement ofpublic health". There is also a National

    Health Policy, endorsed by Parliament in 1983.

    TOURISM IN INDIA

    Welcome to Incredible India, where culture echoes, tradition speaks, beauty enthralls anddiversity delights. Indian tourism is one of the most diverse products on the global scene.India has 26 world heritage sites. It is divided into 25 bio-geographic zones and has wideranging eco tourism products. Apart from this, India has a 6,000 km coastline and dozensof beaches.It also has one of the world's biggest railway systems opening possibilities for thoseinterested in rail tourism. India also has excellent hospitals offering affordable Medicare

    and traditional healthcare systems like Ayurveda.

    MEDICAL TOURISM

    Medical Tourism refers to movement of consumers to the country providing the service fordiagnosis and treatment. During the past few years, the number of people going out of theirhome country to consume health services has significantly increased. The size of thismarket is estimated to be $40 billion based on a Saudi Report in 2000. During the past fouryears, 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. MedicalTourism industry offers tremendous potential for the developing countries because of their

    low-cost advantage. The advantages of medical tourism include improvement in exportearnings and healthcare infrastructure.

    Medical tourism can be broadly defined as provision of cost effective private medicalcare in collaboration with the tourism industry for patients needing surgical and otherforms of specialized treatment. This process is being facilitated by the corporate sectorinvolved in medical care as well as the tourism industry - both private and public.

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    MEDICAL TOURISM - TRENDS

    Medical tourism is one of the newest trends in tourism industry. Rising costs in the field ofhealth and increase in waiting time has forced many people from the West to fly tocountries mainly in Asia and South America to get medical facilities.

    Medical tourism generally started with tourists who needed medical centers in visitingcountries for small procedures like some plastic surgery of minor nature. From there thetrend started to grow and ultimately reached its peak in terms of transparency, systems,services, processes, quality assurance, bench marks and continuity of care.

    Medical tourism has helped different sectors to grow. It has become a ray of hope forhealthcare organizations treating the tourists and increasing the standard of care for itspatients. Most of the medical costs in the US, UK and Canada is quite higher. For example,the cost of total hip replacement which is an orthopedic procedure costs about 50,000.00US Dollars, while same procedure is done at 10 to 15 thousand US Dollars in other placeslike India and Malaysia. Plus, the waiting time for this treatment involves six months to 18

    months in USA, but medical tourists can undergo this treatment over night with a highlycompetent doctor at a medical tourism destination like India, Malaysia and Panama. Plus,when tourists travel to other places, they mostly land in good hospitals with experienceddoctors.

    The increasing price is perhaps the main factor that is forcing patients to fly to othercountries. Even insurance providers are opting for overseas destinations than localhospitals.

    Insurance companies are not standing behind in offering some really innovated facilities tomedical tourism industry and increasing customized and tailor made packages are coming

    up. A popular American Insurance provider has introduced a plan for medical tourists fromUS that give them some cover against complications of procedures after they are hack fromtheir treatment done at overseas destinations. The insurance companies too are providingvariety of emergency plans for medical tourists at foreign destinations.

    WHY INDIA?

    The countries where medical tourism is being actively promoted include Greece, SouthAfrica, Jordan, India, Malaysia, Philippines and Singapore. India is a recent entrant intomedical tourism. According to a study by McKinsey and the Confederation of IndianIndustry, medical tourism in India could become a $1 billion business by 2012. The report

    predicts that: "By 2012, if medical tourism were to reach 25 per cent of revenues of privateup-market players, up to 2,297,794,117 USD will be added to the revenues of theseplayers". The Indian government predicts that India's $17-billion-a-year health-careindustry could grow 13 per cent in each of the next six years, boosted by medical tourism,which industry watchers say is growing at 30 per cent annually.

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    Price advantage is a major selling point. The slogan, thus is, "First World treatment' atThird World prices". The cost differential across the board is huge: only a tenth andsometimes even a sixteenth of the cost in the West.

    The Comparative rates of surgeries

    Surgeries India ($) USA ($) UK (GBP)

    Open Heart Surgery (CABG) 7,500 100,000 21,400

    Total Knee Replacement 6,300 48,000 25,700

    Hip Resurfacing 7,000 55,000 24,100

    LA Hysterectomy 4,000 22,000 11,800

    Lap Cholcystectomy 3,000 18,000 9,600

    Spinal Decompression Fusion 5,500 60,000 32,100

    Obesity Surgery (Gastric Bypass) 9,500 65,000 34,800

    Dental, eye and cosmetic surgeries in Western countries cost three to four times as much as

    in India.

    India have a lot of hospitals offering world class treatments in nearly every medical sectorsuch as cardiology and cardiothoracic surgery, joint replacement, orthopaedic surgery,gastroenterology, ophthalmology, transplants and urology to name a few. The variousspecialties covered are Neurology, Neurosurgery, Oncology, Ophthalmology,Rheumatology, Endocrinology, ENT, Paediatrics, Paediatric Surgery, PaediatricNeurology, Urology, Nephrology, Dermatology, Dentistry, Plastic Surgery, Gynaecology,Pulmonology, Psychiatry, General Medicine.

    For long promoted for its cultural and scenic beauty, India is now being put up on

    international map as a heaven for those seeking quality and affordable healthcare. Analystssay that as many as 150,000 medical tourists came to India in 2004. As Indian corporatehospitals are on par, if not better than the best hospitals in Thailand, Singapore, etc there isscope for improvement, and the country is becoming a preferred medical destination. Inaddition to the increasingly top class medical care, a big draw for foreign patients is alsothe very minimal or hardly any waitlist as is common in European or American hospitals.

    Leisure Tourism is already very much in demand in India as the country offers diversecultural and scenic beauty. India has almost all sort of destinations like high mountains,vast deserts, scenic beaches, historical monuments, religious temples etc. Known for itshospitality for tourists, the county has opened doors to welcome with the same hospitality

    for medical patients/ service seekers.

    MEDICAL TOURISM AS AN INDUSTRY

    Medical tourism can be broadly defined as provision of cost effective private medicalcare in collaboration with the tourism industry for patients needing surgical and otherforms of specialized treatment. This process is being facilitated by the corporate sectorinvolved in medical care as well as the tourism industry - both private and public.

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    In many developing countries it is being actively promoted by the governments officialpolicy. Indias National Health policy 2002, for example, says: To capitalise on thecomparative cost advantage enjoyed by domestic health facilities in the secondary andtertiary sector, the policy will encourage the supply of services to patients of foreign origin

    on payment. The rendering of such services on payment in foreign exchange will be treatedas deemed exports and will be made eligible for all fiscal incentives extended to exportearnings.

    GROWTH OF THE MEDICAL TOURISM INDUSTRY

    In India, the Apollo group alone has so far treated 150,000 international patients, many ofwhom are of Indian origin. Apollo has been a forerunner in medical tourism in India andattracts patients from Southeast Asia, Africa, and the Middle East. The group has tied upwith hospitals in Mauritius, Tanzania, Bangladesh and Yemen besides running a hospital inSri Lanka, and managing a hospital in Dubai.

    Another corporate group running a chain of hospitals, Escorts, claims it has doubled itsnumber of overseas patients - from 1785 in 2000 to nearly 3,200 this year. Recently, theRuby Hospital in Kolkata signed a contract with the British insurance company, BUPA.The management hopes to get British patients from the queue in the National HealthServices soon. Some estimates say that foreigners account for 10 to 12 per cent of allpatients in top Mumbai hospitals despite roadblocks like poor aviation connectivity, poorroad infrastructure and absence of uniform quality standards.

    Analysts say that as many as 250,000 medical tourists came to India last year. However,the current market for medical tourism in India is mainly limited to patients from theMiddle East and South Asian economies. Some claim that the industry would flourish evenwithout Western medical tourists. Afro-Asian people spend as much as $20 billion a yearon health care outside their countries Nigerians alone spend an estimated $1 billion ayear. Most of this money would be spent in Europe and America, but it is hoped that thiswould now be increasingly directed to developing countries with advanced facilities.

    CONTRIBUTION TO GNP

    According to the World Travel and Tourism Council, India' s travel and tourism (T&T)industry contributed 2.1 percent to Gross Domestic Product in 2006 (INR 713.8 billion orUS$16.3 billion).

    In the first half of the Annual Plan period of 2005-2006, the Ministry of Tourism had takenseveral initiatives in the field of infrastructure development and positioning Indian tourismas a major engine for economic growth. These include:

    Emphasis for developing the existing and new destinations to world-classstandards.

    Improvement of connectivity to important destinations.

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    Identification of 10-15 new destinations / circuits by each state / UT fordevelopment to world class standard with all the required infrastructurecomponents.

    BENEFITS OF MEDICAL TOURISM

    Tangible

    Foreign exchange earrings which enable economic wealth of nation Cost Advantage in Tariff over the Developed countries Improve information sharing Increase in efficiency of patient care process, cutting edge treatment. Improvement in hospital supply chain efficiency Strategic alliances with business partners within and outside the country Technology and Knowledge Transfer Better logistics performance both in internal and external

    Creation of employment opportunities in the industry Better utilization of Infrastructure and skilled manpower Opportunity for development in Infrastructure in Health, Tourism and Travel. Economies of scale. Connectivity with air, road, rail and information and communication industries Clustering of medical Travelers Health opportunities for foreign patients may lead to better standards at home. Scope for Research and Development to offer comprehensive medical solutions.Intangible

    International acceptance of country as a global healthcare provider

    Social and cross cultural experience International customer relations Global Marketing and Medical Trade relations Brand image of nation as world-class healthcare destination. Competitive advantage Better coordination among the partners i.e. hospital and hospitality industry. Public and Private Partnerships Patient satisfactionIS INDIA PREPARED FOR GLOBAL MEDICAL TOURISM BOOM?

    In recent years, India is being seen as an important player in the globally growing "MedicalTourism", which is projected as a new segment in travel and healthcare business.

    In simple words, medical tourism provides state-of-the-art private medical care incollaboration with tourism industry to patients from other countries at highly competitiveprice when compared to those prevalent in the western countries. The CII- McKinseyreport mentions that the medical tourism market has been growing at the rate of 15 per centfor past five years and by 2012, Rs 10,000 crore will be added to revenues of the private

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    players. Globally, medical tourism is said to be USD 40 billion industry and analysisavailable project that people from Afro-Asian countries spend as much as USD 20 billionevery year on healthcare services from outside their countries.

    Foremost, amongst the current private players, in medical tourism are hospitals in the

    Apollo chain. Main destinations are Delhi, Mumbai, Chennai, Bangalore and Hyderabad.These cities have private hospitals with medical expertise that can offer world classhealthcare that costs one fifth to one tenth of the cost in US or Europe depending on theintervention required.

    In addition to above destinations, the country has many cities with advanced medicalfacilities making India, a country with tremendous potential to capitalise on to increase itsearnings to more than USD 1 billion annually and create hundreds of thousands new jobs inmany sectors. This projection excludes earnings from other products included in thewellness tourism meant for rejuvenation of body and mind, eg herbal therapy, naturopathy,yoga, aromatherapy, reiki, music therapy which does not require advanced medical

    expertise.

    The apprehensions expressed by some sections that "systematic development of medicaltourism will boost up earnings by catering to the wealthy foreigners and Indians working inthe foreign countries but it may adversely hit the low income population" need to beaddressed for gaining approval of political opinions with varied views on liberalisation.From past ten years, India has entered a phase in medical expertise that is considered onpar with international standards. This is because of high quality doctors and medicalentrepreneurs who developed hospitals with required infrastructure and management style.Some of these hospitals have marketing departments to increase visibility and acceptanceof their products in some countries.

    MEDICAL TOURISM IN INDIA THE CURRENT SCENARIO

    Medical Tourism is poised to be the next Indian success story after InformationTechnology. According to a Mckinsey-CII study the industrys earning potential estimatedat Rs.5000-10000 Crores by 2012. Worldwide, healthcare is said to be a $3-trillionindustry, and India is in a position to tap the top-end segment by highlighting its facilitiesand services, and exploiting the brand equity of leading Indian healthcare professionalsacross the globe.Medical Tourism", the term refers to the increasing tendency among people from the UK,the USA and many other third world countries, where medical services are either veryexpensive or not available, to leave their countries in search for more affordable healthoptions, often packaged with tourist attractions.

    Tourism is an integral part of many economies services industry and is an importantsource of foreign exchange. The labour-intensive nature of the tourism industry also makesit an excellent generator of employment. In 2002, the travel-and-tourism industry generatedUS$3.3 trillion of GDP and almost 200 million jobs across the world economy.

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    Approximately one third of this would come directly from the industry itself and theremainder from the strong linkages to other related sectors such as entertainment, retail andconstruction.Medical Tourism is perceived as one of the fastest growing segments in marketing

    Destination India today. The equation is World Class Healthcare at 'Economical Price '.Stable economic growth will create an increase in freight flows from, towards, through, andinside the country. All this will stimulate the investments in roads and railroads. Asglobalization advances, both domestic and international tourism pose new andunprecedented challenges to the health sector and its various partners. The size of theMedical Tourism industry stands between Rs 1200 Crore to Rs 1500 Crore and is growingat rate of 30 percent annually.More importantly, Medical Tourism is growing rapidly and turning out to be an immensebusiness opportunity for nations that are positioning themselves correctly. Last year, justfive countries in Asia Thailand, Malaysia, Jordan, Singapore and India- pulled in over 1.3

    million medical travelers and earned over $1billion (in treatment costs alone). In each ofthese nations, medical travel spends are growing at 20% plus year-on-year. Elsewherearound the world, Hong Kong, Lithuania and South Africa are emerging as bigmedical/healthcare destinations. And a dozen other nations including Croatia and Greeceplan to make themselves attractive healthcare destinations.

    Five years ago, hardly 10000 foreign patients visited India for medical treatment. TodayIndia is a key player in medical tourism with 100,000 foreign patients coming in every yearand revenue of Rs.1500 Crores. The current market growth-rate is around 30% per year andthe country is inching closer to major players like Singapore and Thailand.

    HEALTH TOURISM IN INDIA ADVANTAGES AND OPPORTUNITIES

    The inflow of health tourists from the West, especially the UK, US and some of theEuropean countries has been on the rise for the last couple of years. Price difference oraffordability of the treatment, coupled with quality of doctors are the main reasons for thegrowing western traffic.

    The quality of Indian hospitals has improved significantly and now matches with the bestin any part of the world. India has more than 100 healthcare institutions, which are ofinternational standard.

    Many hospitals in India today have the infrastructure and equipment that match with thebest centers in the world, be it transplantations(liver/kidney/heart or bone marrow), cancertreatment, including radiotherapy, neurosurgery, including sterotactic surgery., angioplastyand cardiac surgery (bypass and paediatric)Public-Private Partnership combines internal hospital expertise with supply chain andlogistics expertise.

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    The medical tourism industry which is estimated to be worth Rs 1500 crores annually hasnot only the potential to generate substantial foreign exchange earnings but also provideemployment opportunities for the large pool of skilled labor available in India, accordingto Dr. PC Reddy, chairman, Apollo Hospitals Group, India.

    According to Group President Pratap C.Reddy, the annual health bill of people from Afro-Asian countries seeking treatment outside their country is $10 billion. If India can tap evena fraction of that market, the potential is enormous.

    The SWOT analysis of Indian medical tourism business is:

    Strength Weaknesses

    1) Quality of service2) Exquisite Locations3) Alternative medical cures like Yoga,Homeopathy and Ayurveda.

    1) Lack of infrastructure2) Lack of uniform pricing policy3) Poor infrastructure in Govt. Aided hospitals4) Lack of proper Institute on medical

    Instrumentation.Opportunities Threats

    1) Impact on Forex reserve2) Contributions in GDP3) Sharp rise in medical as well as tourismIndustry.

    1) Foreign players may enter into the market2) Lack of foreign accreditation

    INDIA - STRATEGIC THRUSTS FOR THE FUTURE

    The following section lays down the strategy for India to achieve leadership position inmedical tourism. The strategy largely draws from the discussions in previous section.

    ROLE OF GOVERNMENT

    The role of Indian Government for success in medical tourism is two-fold:

    Acting as a Regulatorto institute a uniform grading and accreditation system for hospitalsto build consumers trust.

    Acting as a Facilitatorforencouraging private investment in medical infrastructure andpolicy-making for improving medical tourism.

    For facilitating investment the policy recommendations include:

    Recognize healthcare as an infrastructure sector, and extend the benefits under sec80-IA of the IT Act. Benefits include tax holidays for five years and concessionaltaxation for subsequent five years.

    The government should actively promote FDI in healthcare sector.

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    Conducive fiscal policies - providing low interest rate loans, reducing import/exciseduty for medical equipment

    Facilitating clearances and certification like medical registration number, anti-pollution certificate etc.

    The above measures will kick-start hospital financing, which is struggling now due to

    capital intensive and low efficiency nature of healthcare business.

    For facilitating tourism the government should:

    Reduce hassles in visa process and institute visa-on-arrival for patients

    Follow an Open-Sky policy to increase inflow of flights into India

    Create Medical Attachs to Indian embassies that promote health services toprospective Indian visitors

    MAINTAINING HIGH QUALITY SERVICES IN THE MEDICAL TOURISM

    INDUSTRY

    One of the primary concerns for health travelers is whether foreign providers can offer thesame high-quality medical care they receive in their country of origin. This growingdemand for foreign healthcare providers has prompted the Joint Commission onAccreditation of Healthcare Organizations (JCAHO), the best known healthcareaccreditation group in the USA, to form an international offshoot known as the JointCommission International (JCI).

    In 1999, the JCI began surveying and accrediting hospitals and healthcare facilities outsideof the USA. There are now over 220 accredited hospitals worldwide and most are

    providing quality services for the medical tourism industry.

    Aside from the JCI, there are alternative non-profit groups providing accreditation forhealthcare organizations in the USA. These include but are not limited to:

    Community Health Accreditation Program (CHAP) The first accrediting

    body in the US that provides assessments for community based healthcareorganizations.

    Accreditation Commission for Health Care, Inc (ACHC) Was created by

    home care providers as an accreditation organization that caters to small healthinstitutions.

    The Compliance Team, Inc Is known for theirExemplary Provider Program.

    They are an accrediting body forDurable Medical Equipment (DME).

    Healthcare Quality Association on Accreditation (HQAA) Another

    accreditation body working with durable medical equipment (DME).

    National Committee for Quality Assurance (NCQA) Drives improvement in

    the health care system through the Healthcare Effectiveness Data andInformation Set (HEDIS) which is used by 90% of health plans in the USA.

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    http://www.jointcommissioninternational.org/http://www.jointcommissioninternational.org/http://www.chapinc.org/http://www.chapinc.org/http://www.achc.org/http://www.achc.org/http://www.complianceteaminc.com/http://www.cms.hhs.gov/center/dme.asphttp://www.hqaa.org/http://www.ncqa.org/http://www.jointcommissioninternational.org/http://www.jointcommissioninternational.org/http://www.chapinc.org/http://www.achc.org/http://www.complianceteaminc.com/http://www.cms.hhs.gov/center/dme.asphttp://www.hqaa.org/http://www.ncqa.org/
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    NON-US ACCREDITATION ORGANIZATIONS

    Aside from the accreditation bodies based in the USA, there are a number of internationalaccreditation organizations in the medical tourism industry that are based abroad. Theseorganizations perform a similar international role as the JCI, providing accreditation to

    international or regional health providers.

    Accreditation Canada -Formerly known as the Canadian Council on Health

    Services Accreditation (CCHSA) - focuses on improving patient safety.

    Trent Accreditation Scheme (TAS) A UK-based non-profit accreditation

    organization that performs surveying and accrediting to healthcare providers in theUK and around the world.

    The Australian Council on Healthcare Standards (ACHS) The leading health

    care and accreditation organization in Australia. It features the Evaluation andQuality Improvement Program (EQuIP) and acts as a consultant for severalcountries.

    International Society for Quality in Health Care (ISQua) With members from

    over 70 countries, ISQua has board members from North America, Europe andAsia-Pacific regions.

    European Society for Quality in Healthcare (ESQH) Is dedicated to improving

    the quality of healthcare in Europe. It consists of 19 member countries, all of whichare National Societies for Quality in Healthcare in their respective countries.

    The Society for International Healthcare Accreditation (SOFIHA) Is a group

    formed by providers of international healthcare accreditation. This forum is wherethey discuss and share ideas geared towards developing high-quality accreditationof medical facilities worldwide.

    The International Organization for Standardization (ISO) Is an international body formedby various national standards organizations. In the healthcare industry, ISO provides aframework in the design and improvement of quality management systems for healthcareproviders.

    INTERNATIONAL CERTIFICATION STATUS OF MEDICAL TOURISM

    PROVIDERS

    Destination countries for medical travelers that realize the impact of the medical tourismbusiness in the economies of their respective countries, strive to provide the highest qualityat the lowest possible cost. These countries are openly marketing medical tourism, withgovernments supporting these efforts by providing better facilities and seekinginternational accreditation.

    Part of these efforts include hiring or training physicians with international credentials,such as professionals who train and are board certified in the USA, Australia, Canada andEurope. For example:

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    http://www.accreditation-canada.ca/http://www.trentaccreditationscheme.org/http://www.achs.org.au/http://www.isqua.org/http://www.esqh.net/http://www.sofiha.co.uk/http://www.iso.org/iso/home.htmhttp://www.accreditation-canada.ca/http://www.trentaccreditationscheme.org/http://www.achs.org.au/http://www.isqua.org/http://www.esqh.net/http://www.sofiha.co.uk/http://www.iso.org/iso/home.htm
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    India Apollo Hospitals are the largest healthcare provider and the first JCI-

    certified hospitals in India. The Apollo Group is also connected with JohnsHopkins Medicine International on studies regarding heart diseases. On top ofthis, the Indian Healthcare Federation provides accreditation standards for its localproviders. Another provider, Wockhardt, is affiliated with the Harvard Medical

    School. Singapore This country provides state-of-the-art hospitals, three of which are

    accredited by the JCI. The International Medical Centre which is also affiliatedwith Johns Hopkins International, is the most notable.

    Panama With several Panamanian physicians trained and certified in the United

    States, Panama's top hospitals are comparable to the US. Foremost is the PuntaPacifica Hospital which is affiliated with Johns Hopkins International.

    Thailand There are over 1 million medical tourists going to Thailand each year.

    The fore-runner for Thailand's medical tourism industry is BumrungradInternational Hospital in Bangkok. Located in a modern hospital building that

    complies with US standards, they comprise of an American-managed medicalstaff that includes 200 US board-certified doctors and surgeons. The rest of thestaff members are licensed in Australia, Europe and Japan.

    There are other foreign hospitals that are owned, managed or affiliated with Americanhospitals, healthcare providers and prestigious universities. An example is the ClevelandClinic which owns and manages several facilities in other countries like Canada, Austriaand the United Arab Emirates. The International Hospital Group which is based in Dallasbuilds and operates US-standard hospitals in Mexico.

    INDIANMEDICALTRAVEL: A PRIORITY SECTOR

    The Indian economys steady growth rate is also being reflected in the Indianhealthcareand medical travel industry. Healthcare and medical health travel are priority areas forIndia, and the government has increased its budgetary outlay formedicaltravel and foreigninvestment. Customs duties on the import ofmedicalequipment have been slashed, andspecial incentives are being offered for future private healthcarefacilities.

    GOVERNMENT PLANS FOR ATTRACTING MEDICAL TOURISM TO INDIA

    To promote growth in the Indianmedicaltravelindustry, the Indian government has plansto improve health infrastructure. The government is currently in the process of increasingthe numberofhospitals, clinics, and clinical laboratories in urban as well as rural parts ofthe country. Incentives and tax holidays are being offered to hospitals and dispensariesproviding health travelfacilities.

    The Indian medical travel and health care sector offers plenty of opportunities forbusinessmen, medical equipment manufacturers, healthcare service providers, and touristagencies, and the government is encouraging them to invest in therapeutic and preventive

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    health services so as to increase medical travel to India. The government has publishedanalytical reports on the available opportunities in the Indian health care industry socorporate houses can make informed decisions regarding the Indian medical tourismsector.

    INITIATIVES OF PRIVATE HOSPITALS IN HEALTH TRAVEL PROJECTSOUTSIDE INDIA

    Recently, a memorandum of understanding (MoU) was signed between the famous ApolloHospitals and the American International Medical University (AIMU) for developingmedical tourism projects worth $200 Million in the Bahamas and St Lucia. According tothe MoU, the Apollo group will develop a super specialty teaching hospital, research, andtreatment facility for the AIMU group.

    In addition, Apollo will develop, manage, and monitor the healthcare facilities at theexisting AIMU groups medical education facilities at the Bahamas and St Lucia

    campuses. The AIMU group offers MD and PhD programs and offers $1.5 million inscholarships to Indian students every year. It is estimated that the AIMU group ofinstitutions will attract 500 Indian doctors to the US in the current year.

    Source: Apollo, AIMU mull medical tourism projects," Times News Network, January 12,2007

    THE MARKETING MIX OF INDIAN MEDICAL TOURISM

    Some of the exclusive medical packages offered by the Indian medical tourism are in the

    following treatments:

    MEDICAL PACKAGES

    HEART PACKAGES

    Cardiac surgery and cardiology

    Angioplasty

    Angiography

    Cardiology robotic surgery

    Open heart surgery

    Paediatric intervention ORTHOPAEDIC SURGERIES

    Joint Knee Replacement (Unilateral and Bilateral)

    NEURO SURGERY

    Parkinsons

    Epilepsy

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    Essential tumors

    Malignant tumors

    CARDIOLOGY

    ECG

    Doppler Test

    TEE

    Beating heart surgery

    Valve surgery

    Stenting

    Peripheral vascular surgery

    Congenitial heart disease

    NEPHROLOGY

    Dialysis

    Haemodialysis

    Slow continous ultrafication

    Plasmapherisis

    DENTAL CARE PACKAGES

    UROLOGY

    COSMETIC TREATMENT

    PRICE

    The price range offered by the Indian medical industry is unbelievable because India offers

    the most reasonable prices. India is not only cheaper but the waiting time is almost nil. This

    is due to the outburst of the private sector which comprises of hospitals and clinics with the

    latest technology and best practitioners.

    PROCEDURE CHARGES

    IN INDIA & USA

    US (USD)

    Approx

    India (USD)

    Approx

    Bone Marrow Transplant USD 2,50,000 USD 69,200

    Liver Transplant USD 3,00,000 USD 69,350

    Heart Surgery USD 30,000 USD 8,700

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    Orthopedic Surgery USD 20,000 USD 6,300

    Cataract Surgery USD 2,000 USD 1,350

    Smile Designing USD 8,000 USD 1,100

    Metal Free Bridge USD 5,500 USD 600

    Dental Implants USD 3,500 USD 900

    Porcelain Metal Bridge USD 3,000 USD 600

    Porcelain Metal Crown USD 1,000 USD 100

    Tooth Impactions USD 2,000 USD 125

    Root Canal Treatment USD 1,000 USD 110

    Tooth Whitening USD 800 USD 125

    Tooth Colored Composite USD 500 USD 30

    Fillings / Tooth Cleaning USD 300 USD 90

    PROCEDURE CHARGES IN INDIA & UK

    Significant cost differences exist between UK and India when it comes to medical

    treatment. Accompanied with the cost are waiting times which exist in UK for patients

    which range from 3 months to over months.

    Procedure

    UK (USD)

    Approx

    India (USD)

    Approx

    Open Heart Surgery USD 18,000 USD 4,800

    Cranio-Facial surgery and skull base USD 13,000 USD 4,500

    Neuro- surgery with Hypothermia USD 21,000 USD 6,800Complex spine surgery with implants USD 13,000 USD 4,600

    Simple Spine Surgery USD 6,500 USD 2,300

    Simple Brain Tumor- Biopsy- Surgery

    USD 4,300USD 10,000

    USD1,200USD 4,600

    Parkinsons

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    - Lesion- DBS

    USD 6,500USD 26,000

    USD 2,300USD 17,800

    Hip Replacement USD 13,000 USD 4,500

    Major players In Indian medical tourism:

    The National Health Policy actively promotes medical tourism. The main cities attractingforeign patients to India are:

    1) Kolkata2) Chennai3) Bengaluru4) Mumbai5) Delhi6) Jaipur

    The hospitals that attract large number of foreign tourist besides Indians are:

    01) Apollo Hospital, Delhi02) All India Institute Of Medical Sciences, Delhi03) AMRI, Kolkata04) Christian Medical college, Vellore05) Wockhardt Hospitals06) BM Birla Heart Research Centre, Kolkata07) Manipal Heart Foundation, Bengaluru08) Escort Heart Institute & Research Centre Limited, New Delhi09) Breach Candy Hospital, Mumbai

    10) Escorts Hospital, Jaipur11) Asian Heart Institute, Mumbai

    PROMOTIONAL ACTIVITIES TO PROMOTE MEDICAL TOURISM

    CME ( Continuous medical education for doctors)

    Patient Education Progress

    Free health Checkup camps.

    Tie ups with various hospitals and insurance companies abroad.

    Participation in Health Expos abroad.

    Tie ups with Embassies.

    Advertisement campaigns. Nodal centers in other countries.

    Reduction of Excise duty from 17% to 8% on all goods produced in thepharmaceutical sector as per the Budget 2008-2009.

    FACTORS ENHANCING MEDICAL TOURISM IN INDIA

    a) Cost Competitiveness The Key driver

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    The main reason for Indias emergence as a preferred destination is the inherent advantageof its healthcare industry. Today Indian healthcare is perceived to be on par with globalstandards. Some of the top Indian hospitals and doctors have strong internationalreputation. But the most important factor that drives medical tourism to India is its low costadvantage. Majority of foreign patients visit India primarily to avail of First World

    Service at Third World Cost.

    Source: Business World India and Indian Brand Equity Foundation

    As the table above shows, India has significant cost advantages in several healthprocedures making it a preferred destination

    b)The Service Spectrum

    India offers a variety of services for overseas patients. The table below presents aclassification of the service spectrum.

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    c) Consumer Profile

    The demand for Indian healthcare services primarily comes from three types of consumers.The table below presents the profile of these three consumer groups:

    Though tourism is not the primary need of these consumers, it offers additional attractionparticularly for people traveling for cosmetic surgery and less complicated procedures.

    KEY CHALLENGES BEFORE INDIAN MEDICAL TOURISM:

    1) Lack of Government support to promote medical tourism

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    2) Lack Of medical Infrastructure3) Lack of international accreditation4) Perception among the foreign tourist as an unhygienic country5) Strong competition from Malaysia, Thailand and Singapore

    CONCLUSION

    However, Medical tourism is the next best thing for India. According to the CII Mackinseyreport, Medical Tourism in India is expected to bring revenue of over $2 billion by2012.The object is to capitalise the low cost advantage and to attract medical tourist byproviding attractive packages. Indian tourism Industry should work more in collaborationwith the Government department in order to implement the concept-"Atithi devo Bhavo" (aguest is a form of God) as major marketing mantras.

    Medical Tourism in India is booming and can be witnessed by the huge number of

    International tourist visiting this region. India is one of the worlds most preferred region ofthe world in the case of medical tourism due to the low cost of treatment, no waiting time,approachability, tourists spots in India and other value added services. As the Indianeconomy of growing so worlds best hospitals are coming to India to encash theopportunity.

    The healthcare industry has successfully managed to maintain the interest and attention ofnot only the Indian government, but also the common man. The top Indian hospitals suchas Apollo, Escorts, Max, etc, are investing immense time, effort, manpower and money intheir R&D. As a matter of fact, several new innovative products have been launched in theIndian market and have been patented.

    The Indian consumer has ready access to new innovations in the field of health andmedicine. The companies are constantly acquiring latest technology either throughpartnerships or developing them indigenously. The government is fully supporting thecause of state of the art infrastructure by providing support in setting up new hospitals andfinancing them.

    BIBLIOGRAPHY

    Davenport Karen, Health Care Benefits, (2007)Daschle Tom, Achieving Universal Health Coverage, (2007)Seshamani Meena, Opportunity Costs and Opportunities Lost: Businesses Speak Out

    About Health Care, (2007)CII and Mekinsey, Healthcare In India The Road Ahead, (2006)Alvarez, David P.; Connecting people to the promise of healtchare, No. 15 (2000)Sonam Jagasia, A Report on Medical Tourism in India Issue 2 (2008)Hautea, Dr. Randy A.; Krattiger, Dr. Anatole F. And Van Zanten, Ir. Jasper E; Healthcarecosts comparisons, No. 18 (2000)http://en.wikipedia.org/wiki/Healthcare_in_Indiahttp://www.nature.com/nm/journal/v9/n4/full/nm0403-377a.html

    18

    http://www.americanprogress.org/issues/2007/04/health_business_case_study.htmlhttp://www.americanprogress.org/issues/2007/04/health_business_case_study.htmlhttp://www.americanprogress.org/issues/2007/04/health_business_case_study.htmlhttp://www.americanprogress.org/issues/2007/04/health_business_case_study.html
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    http://www.cbc.ca/news/background/healthcare/medicaltourism.htmlhttp://timesofindia.indiatimes.com/More_options_for_health_insurance/articleshow/1982238.cmshttp://www.who.int/mediacentre/factsheets/fs172/en/index.htmlhttp://www.indiatogether.org/2007/jan/hlt-hltcare.htm

    http://www.deloitte.com/dtt/whitepaper/0,1017,sid%253D34239%2526cid%253D71669,00.html

    ANNEXURE

    INBOUND TOURISM STATISTICS

    Foreign Tourists In India (Number)

    2001 2002 2003 2004 2005 2006 2007 2008

    January 283750 228150 274215 337345 385977 459489 532088 584765

    February 262306 227529 262692 331697 369844 439090 498806 560658

    March 248965 225558 218473 293185 352094 391009 444186 509926

    April 185338 155378 160941 223884 248416 309208 333945 369677

    May 151098 132998 141508 185502 225394 255008 267758 290785

    June 176716 143100 176324 223122 246970 278370 310104 344526

    July 224432 186432 225359 272456 307870 337332 377474 -

    August 196517 161477 204940 253301 273856 304387 360089 -

    Septembe

    r

    162326 151721 191339 226773 257184 297891 325893 -

    October 181605 212191 260569 307447 347757 391399 440715 -

    November 209685 243566 290583 385238 423837 442413 510987 -

    December - - 319271 417527 479411 541571 575148 -

    Total 2282738 2073025 2726214345747

    7

    391861

    0

    444716

    7

    497719

    32660337

    Percentage Changes in foreign tourists arrival

    2002/01 2003/02 2004/03 2005/04 2006/05 2007/06 2008/07

    January -19.6 22.0 23.0 14.5 19.0 15.8 9.9

    February -13.3 13.1 26.3 17.3 18.7 13.6 12.4

    March -9.4 1.6 34.2 25.2 11.1 13.6 14.8

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    April -16.2 5.0 39.1 16.5 24.5 8.0 10.7

    May -12.0 0.2 31.1 23.8 13.1 5.0 8.6

    June -19.0 27.5 26.5 16.0 12.7 11.4 11.1

    July -16.9 22.5 20.9 7.3 9.6 11.9 -

    August -17.8 26.91 23.6 6.9 11.1 18.3 -

    Septembe

    r-6.5 26.11 18.5 11.4 15.8 9.4 -

    October 16.8 22.11 18.0 7.0 12.5 12.6 -

    November 16.2 19.40 32.6 7.8 4.4 15.5 -

    December - - 30.8 11.0 13.0 6.2 -

    Total 9.2 13.1 26.8 13.2 13.5 11.9 11.5

    International Tourists Arrivals to India

    2001 2002 2003 2004 2005 2006

    Arrivals from

    Region/ Country

    USA32914

    7

    34818

    2

    41080

    3526120

    61116

    5696739

    UK 405472 387846

    430917

    555907

    651803

    734240

    Canada 88600 9359810767

    1

    13588

    4

    15764

    3176567

    Germany 80011 64891 7686811667

    9120243 156808

    France10243

    478194 97654

    13182

    4152258 175345

    Australia 52691 50743 58730 81608 96258 109867

    Italy 41351 37136 46908 65561 67642 79978

    Japan 80634 59709 77996 9685110308

    2119292

    Malaysia 57869 63748 70750 84390 96276 107286

    Singapore 42824 44306 48368 60710 68666 82574

    Nepal 41135 37136 42771 51534 77024 91552

    20

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    Sri Lanka11281

    3

    10800

    8

    10909

    8

    12871

    1

    13640

    0154813

    Netherlands 42368 31669 40565 51211 52755 58611

    China 13901 15422 21152 34100 44897 62330

    South Korea 27150 29374 35584 47835 49895 705407

    OUTBOUND TOURISM STATISTICS

    Destination Wise Outbound Travel of Indian Nationals2000 2001 2002 2003 2004 2005

    Canada 52071 54742 55492 57010 68315 77849

    USA 274202 26967 257271 272161 308845 344926

    Bangladesh 74268 78090 80415 84704 80469 86231

    Maldives 10616 8511 11377 11502 10999 10260

    Nepal 96995 63722 65743 86578 89861 95685

    Pakistan 66061 58378 2618 7096 19658 59560

    Sri Lanka 31860 33924 69960 90603 105151 113323

    Malaysia 132127 143513 183360 145153 172966 225789

    Singapore 346356 339813 375658 309446 471196 583543

    Thailand 224104 206132 253110 230316 300163 352766

    China 120930 159361 213611 219097 309411 356460

    Australia 41452 48227 45022 45597 55603 67951

    Hong Kong 131368 161752 193705 178130 244364 273487

    Japan 38767 40345 45394 47520 53000 58572

    Statistics of Indian National Going Abroad

    Year

    No of Outbound

    Indians

    Percentage Change over the

    previos year

    2000 4415513 7.3

    2001 4564477 3.4

    2002 4940244 8.2

    2003 5350896 8.3

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    2004 6212809 16.1

    2005 7184501 15.6

    2006 8339614 16.1

    Source- Ministry of Tourism, Govt of India