ECONOMIC ANALYSIS OF INDIAN MEDICAL TOURISM.pdf

(International Healthcare Destination)

1NTK Naik and 2B. Suresh Lal

1Professor, Department of Economics, Rayalaseema University, Kurnool-AP

2Programme Coordinator, National Service Scheme, Kakatiya University, Vidyaranyapuri

Warangal-506009. AP, E-mail: lalbsuresh@yahoo.co.in

Tourism is an important industry contributing to the growth of a country’s economy.

The tourism industry is closely linked to other industries factors such as promotion of tourism, medical industrial growth, globalization and liberalization of trade have given a burst to the health industry and made it competitive. Indian tourism provides employment opportunities, growth of GDP, promotion of healthcare and earning foreign exchange.

THE ORIGIN OF THE CONCEPT
In recorded history there have been instances whereby one is able to know that
man has been traveling through out the ages. Medical Tourism is a thousand of
years old service concepts. In ancient Greece, Pilgrims and Patients came from
all over the Mediterranean to the Sanctuary of the healing god, Asklepios at
Epidaurus. The concept of pleasure travel as it existed in the west can be
associated with the Roman Empire. In Roman Britain, patients took the waters
at a shrine at Bath – a practice that continued for 2000 years. Subsequent
development of spas, after their original use for recreational purposes by the
Romans, played a big role in the development of pleasure travel in many countries
in Europe. From the 18th century Wealthy Europeans traveled to Spas from
Germany to the Nile (1). Spas and seaside resorts which developed during this
period may be associated with pleasure travel. Medicinal baths and seaside
resorts which were named as Spas were popular with the Romans. The inland
Spas had its origin in a belief in the efficacy of its mineral waters for medical
purposes, the patients using the spas would require certain diversions, and
gradually, the spas resorts added facilities for pleasure and entertainment to
medical facility (2). The visitors now not only enjoyed medicinal baths but also
various forms of entertainments. As a result, people desire to seek good health.

health.
In this 21st Century, half a million people travel across the globe for health purposes. Spirituality has been a strong motivation for travel and is the case
260 NTK Naik and B. Suresh Lal even now. People from developed and affluent countries are moving out of their
own countries to other destinations, seeking solitude, natural and holistic remedies, and eco-friendly experiences. Tourism is evolving into a more defined
activity while developing various niche areas. Medical tourism is one such new emerging area that is ripe with potential.
The paper is organized as follows:
The first section provides meaning and significance of medical tourism. The
second section deals with world wide market trends in the medical tourism.
The third section presents Tourism policy initiatives. Medical cost comparison
with Western countries is presented in the section four. The section five is
followed by medical tourism trends in India. Also presents major road bocks in
the tourism sector. The last section discusses the future prospects of the medical
tourism in India and some measures’ initiated for policy.
SECTION-I
The Meaning and Significance of 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 specialized treatment. This process is being facilitated
by the corporate sector involved in medical care as well as the tourism industry
– both private and public. Medical or health tourism has become a common
form of vacationing and covers a broad spectrum of medical services. It is a
combination of leisure or pleasure, fun and relaxation or rest together with
perfectness and healthcare.
Significance
Tourism is an important industry contributing to the growth of a country’s
economy. The tourism industry is closely linked to other industries factors such
as promotion of tourism, medical industrial growth, globalization and liberalization
of trade have given a burst to the health industry and made it competitive. Tourism
is an activity with very strong backward and forward linkages. The travelers
spend money to enjoy a variety of goods, services and experiences. The income
and employment generating capacity of this sector is immense.
In 2005, India’s travel and tourism market was valued at $ 42 billion, and
this is growing rapidly, India emerged as the fifth most preferred destination
by the world’s travelers in a survey conducted across 134 countries (3). In 2006,
tourism as an industry offered employment to 41.8 million people, and accounted
for 59 per cent of the GDP. (4). Also, tourism benefits are conferred on all classes,
sections and regions.
Economic Analysis of Indian Medical Tourism 261
Tourism in India is the third largest foreign exchange earner, accounting
for 2.5 per cent of the G.D.P. Medical tourism, according to some estimates, had
the potential to bring in an additional Rs.100bn in Foreign exchange into the
country annually. According to Confederation of Indian Industries (CII) report,
the numbers are growing at 15 percent per annum and by 2012. Medical tourism
is expected to generate $ 2.3 bn annually in India (5). Medical tourism is likely
to the next major foreign exchange earner for India as an increasing number of
patients, unwilling to accept long queues in Europe or high costs in USA, are
traveling to India to undergo surgery. Government and private sector studies
in India estimate that medical tourism could bring between $1 billion and $2
billion into the country by 2012. Medical tourism to India is growing by 30 per
cent a year.
According to study conducted by the confederation of Indian Industry and
McKinsey consultants, the size of the Indian Medical tourism sector is thought
to be about 1,00,000 to 1,50,000 patients a year. The Indian Health Care
Federation, consortium of non-governmental hospitals, diagnostic centres,
medical equipment manufacturers and pharmaceutical industries say that about
1,00,000 foreign patients are visiting India for treatment, with the number rising
by 15 per cent a year.
The CII-McKinsey report estimates that the annualized growth of the medical
tourism market was about 30 per cent in 2000, up from 15 percent in the five
previous years. The growth has been limited. CII-Mc Kinsey also forecasts up
market private care in India to be worth anywhere from Rs.15,000 crore to
Rs.10,000 crore. Medical tourism represents 25 percent of revenues of private
up market care in this estimate and three to five percent of the total delivery
market (6). The Indian government also predicts that India’s $17 billion of the
earning healthcare industry could grow 13percent in each of the next six years,
boosted by medical tourism with growth rate of 30 percent annually (7).CIIMcKinsey
say, that the allopathic system can offer treatment in specialties such
as cardiac, liver and orthopaedic procedures. While Indian systems of medicine
could attract from even the developed world to treat “Lifestyle diseases” such
as stress and rheumatism.
The Ministry of Tourism along with the Ministry of Family Welfare had set
up a task force to chalk out a strategy in this regard. A new category of Visa, the
M-visa, which allowed a medical tourist and his or her companion along stay in
the country, was introduced in 2005. However, an integrated communication
effort was still required to provide a boost to medical tourism.
The global health industry worth $ 4.5 trillion is the second largest industry
today, next to the agro industry. The world’s third largest employers are the
National Health Services of the UK. So, one can imagine the potential for
262 NTK Naik and B. Suresh Lal
employment of the healthcare industry in India. Over the year, more than 90
percent of the jobs in the healthcare sector have been found to be ideally suited
for women, especially from the lower socio-economic strata. The IT Industry
requires less than 10 people for a turnover of Rs. 1crore, while the healthcare
industry will require 200-250 people, typically from lower economic strata,
ensuring all round socio-economic development. In fact, in the US, healthcare
is the only industry to have registered growth and added millions of jobs in the
last five years (8).
India will with no doubt become the global health destination. It aims to
replicate the Thai model, which is still the first Asian destination for
International patients. The reality is that Indian private facilities offer advanced
technology and high quality procedures on par with hospitals in developed
nations. India is the leading country promoting medical tourism in the world. It
is even moving into a new area of “Medical out sourcing” where sub contractors
aim to provide services to the over burdened medical care systems in western
countries. Medical tourism to India is growing by 30 percent a year and the Indian
education system is churning out an estimated 20,000 to 30,000 doctors and nurses
each year. Thus, India could earn more than $1 bn annually and create 40 million
new jobs by sub contracting worth from the British National Health Service.
SECTION-II
World Wide Market Trends in Medical Tourism
It is ironic of neo-liberal economic reforms that inspite of fundamental policy
failures in public health, India has increasingly been an attractive international
healthcare destination. Yet, India’s tertiary healthcare sector is on the road to
global fame. A growing number of spotlessly clean private hospitals are on the
threshold of a boom in medical tourism, positioning themselves as the best
destinations for procedures ranging from coronary by passes to orthopaedics
surgery at the most affordable costs. These hospitals offer high quality care for
international patients, whose numbers are reportedly rising @ 15 per cent
annually. The prices that they charge are a fraction of what prevails in the
developed world. India’s Corporate hospitals are fully equipped upmarket and
efficient with their toll free lines, help interactive websites, online quotes, time
bound treatment access etc. They appear to be world apart from the over
burdened often badly managed and poorly funded health system.
There are three major corporate hospital groups such as;
? Forties Healthcare ? Wackhardt. ? Apollo.
These hospitals run 26 hospitals in the sub-continent and its numbers is
ever growing. They are forming partnerships with international insurance and
Economic Analysis of Indian Medical Tourism 263
tourism companies that will send both insured and uninsured patients for low
cost treatment. With friendly policies from the Government. The private
healthcare sector can transform the potential of medical tourism into a very
profitable reality. One of the cited report that endorses this optimistic
outlook is ‘jiltcare’ in India. The Road Ahead produced by the Confederation of
Indian Industries and McKinsey Company. It puts a number to the promise
tertiary hospitals, with a 25 per cent growth care in revenues from foreign
patients.
Foreign nationals undergoing complicated surgery in the country are
frequently featured in the media, those who come now are not just from the
developing countries, but also from the UK, Europe and North American
countries. The first lady of Guyana brought a group of 15 patients for cardiac
treatment to Frontier Life Line Hospital in Chennai, Tanzania and Lira have a
Memorandum of Understanding with Madras Medical Mission (MMM), many
opt to undergo surgery in India for reasons that range from long waiting time in
the UK, high costs or lack of insurance coverage in the US.
The island nation Singapore is focusing on medical tourism. Its three
agencies, The Economic Development Board (EDB), Singapore Tourism Board
(STB) and the International Enterprise Singapore (IES) have joined hands to
form a new initiative called Singapore Medicine to transform the nation as Asia’s
leading two-in-one destination for healthcare services and tourism (9). Countries
that actively promote medical tourism include Cuba, Costarica, Hungary, India,
Israel, Jordan, Lithuania, Malaysia and Thailand. Belgium, Poland and
Singapore are now entering the field. South Africa specializes in medical safarisvisit
the country for a safari with a stop over for plastic surgery. Countries like
India, Thailand, Singapore, Malaysia and the Philippines are aiming at becoming
Asia’s medical tourist hub.
India is pitted against Thailand, Singapore and Some other Asian countries,
which have good hospitals, salubrious climate and tourist destinations to attract
patients from Europe, USA and other affluent nations. While, Thailand and
Singapore, with their advanced medical facilities and built-in medical tourism
options, have been drawing lakhs of foreign patients per annum, the rapidly
expanding Indian corporate hospital sector has bee able to get a few thousands
for treatment.
Tourist Competence and the Ease of Foreign Travel
International tourism has expanded because tourists, in general, are more
competent at the business of International travel, with changes – both within
the industry and in the wider contexts of contemporary economy and society –
making foreign travel a much easier process than was once the case.
264 NTK Naik and B. Suresh Lal
? Post-1945 improvement in educational levels and better training of
personnel within the hospital industries mean that language is less of a
barrier.
? Travel procedures (customers, airport-check inc, etc.) are rapidly
becoming minimized, standardized and familiar.
? Computerized Reservation Systems (CRS) bring instant access to up to
date information on availability of flights, rooms or holiday packages
and the option of immediate, confirmed bookings.
? Credit cards that are valid world-wide simplify financial transactions
and purchases whilst minimizing the need to carry foreign currencies.
? Improved telecommunications make it simpler to keep in touch with
home, and
? Standardized forms of accommodation and other services in international
hotels, restaurant chains and car hire offices reduce the sense of
dislocation that foreign travel might otherwise generate (10).
SECTION-III
Indian Tourism Policy Initiatives
The Indian Government (2002) regularly formulated policies and prepared
pamphlets and brochures for the promotion of tourism. However, it did not
support tourism in a concerted fashion for the tourism policy initiatives of the
Government of India. As result, the country attracted very few tourists.
In 2004, in addition to launching a centralized electronic media campaign
under ‘Incredible India’ the Government of India announced its intention to
make efforts to improve tourist information facilities at important tourist
destinations and circuits, upgrade hotel infrastructure, improved approach roads
to important tourist sites and enhance connectivity as well as air seat capacity.
In this year also the campaign covered emerging economies like China and those
of Northeast-Asia and Southeast Asia. The Tourism Ministry also organized
road shows in Europe (11).
In March 2005, the Ministry of Tourism announced its proposal to form a
panel of ad agencies that would be responsible for the literature, brochures,
website, and other works related to the “Incredible India” campaign. In the
same year, a TV campaign “Let us go to India” was launched in Japan and a
campaign “Walk with Buddha”, in Thailand and China several road shows were
also organized as part of the campaign.
It reportedly became the talk of the town (Refer Table:1) for the top ten
countries of origin for tourists to India.
Economic Analysis of Indian Medical Tourism 265

 
 
Source:Bureau of Immigration, Govt. of India
266 NTK Naik and B. Suresh Lal
In the year (2005) the tourism ministry launched several innovative schemes
such as “Athithidevo bhava”, ‘rural tourism “Priyadharshini” under the
“Incredible India” Umbrella. The ‘Athithidevobhava’ (The Guest is God)
programme was a social awareness initiative of the ministry to sensitize the
general Indian public to the importance of treating foreign tourists with respect
and courtesy.
In early 2006, the tourism ministry organized an online contest called” “come
to paradise”. The contest, co-sponsored by the domestic airline, India, required
participants to answer questions on the airline and on the Indian State of Jammu
and Kashmir. The ministry also engaged the services of Media Mindscapes
(Bangalore based out of home media service provider). For the display of
“Incredible India” advertisements in out of Home media in several cities around
the world.
The advertisements would be based on what the company (CNN) called the
‘Six pillars” of Indian tourism, namely, health and beauty, modern art, golfing,
fashion and shopping, cuisine and night life and ‘hip’ hotels. Tourism is one big
focus for us and the Department of Tourism is a big client. After the Incredible
India Campaign, Department of Tourism is focusing on the six pillars of tourism.
As a result of ‘Incredible India’ campaign, the foreign tourist arrivals
increased to 44,29,915 in 2006 up from 39,18,610 in 2005, and 34,57,477 in
2004. The foreign exchange earnings from tourism were Rs. 216,030 million in
2004, Rs. 251,720 million in 2005 and Rs. 2,96,030million in 2006.
The number of Indian nationals going abroad is also rising. It was 1.9 millions
in 1991, 4.1 millions in 1999, and 6.2 millions in 2004. Tourism has been a 14
percent growth in 2006-07, accounting for a Forex inflow of $14 million. Around
4.4 million foreign tourists arrived in India in 2006-07 (12).
SECTION-IV
Medical Cost Comparison with the Western Countries
The factors influencing the patients going to different countries for medical
treatment or medical procedures differ from country to country. Medical tourists
encounter many problems such as long waiting periods for surgery and
treatments that are very expensive in their home countries.
Many medical tourists from USA are seeking treatment at a quarter or
sometimes even a tenth of the cost at home. From Canada, it is often those
people who are frustrated by long waiting times. From Great Britain, the patients
can’t wait for treatment by the National Health Service but also can’t afford to
see a physician in private practice. For others, becoming a medical tourist is a
chance to combine a tropical vacation with elective or plastic surgery. More
Economic Analysis of Indian Medical Tourism 267
patients are coming from poor countries like Bangladesh where treatment may
not be available.
Instead of paying $200,000 for a mitral value surgery in USA, a patient
could travel to India and receive the same treatment for $6700. Similarly, rather
than paying 15,000 pounds sterling for hip resurfacing in the UK, a patient can
get the same procedure for 5000 pounds in India, including surgery, air fair and
hotel stay (13). Refer Table 2 for the Medical cost comparison among India,
USA and UK.

 
Price advantage is, of course, a major selling point. The slogan thus is ‘First-
World Treatment at Third world prices. The cost differential across the board is
huge, only a tenth and sometimes even a sixteenth of the cost in the west. India
benefits from a large staff of world class experts and the ultra-competitive cost
advantage it offers. While a heart surgery costs $30,000 in US it costs $6,000 in
India. Similarly, a bone marrow transplant $26,000 here compared to $2,50,000
in the US. You can add to this that Indian doctors are among the best in the
world (14).
Open heart surgery could cost up to $70,000 in Britain and up to $150,000
in USA. In India’s best hospital it would cost only between $3,000 and $10,000,
Knee surgery (on both knees) Costs Rs. 3,50,000 ($7,700) in India. In Britain
this costs ?10,000 ($16,950) – more than thrice as much Dental eye and cosmetic

surgeries in western countries cost there to four times as much as in India.

 
It is estimated that medical tourism can alone contribute a good sum of Rs.
500 million to Rs. 100,000 million of additional revenue by way of super-specialty
hospitals by the year 2012. India can earn over $ 2 billion annually from medical
tourism. India’s healthcare industry is growing fast at 30 percent annually (15).
Thus, the Indian medical sector is attracting many foreign patients. They are
coming to India for bypass surgeries, dental problems, orthopaedic ailments and
even plastic surgery. A primary reason for this is cost effectiveness. For instance,
open heart surgery costs $4,500 in India, whereas in other healthcare destinations,
it may cost around $18,000. Analysts say, around 1,50,000 medical tourists visited
India in 2005. The number is likely to go up by 15 percent a year.
Significant cost differences exist between the UK and India when it comes
to medical treatment. Accompanied with the cost are waiting times existing in
the UK for patients, which range from 3 months to over 10 months. India is not
only cheaper but the waiting time is also almost nil. This is due to the outburst
of the private sector, which comprises hospitals and clinics with the latest
technology and best practitioners.
The estimate for hospital care alone was nearly $1,00,000. The cost of the
surgeon, the cardiologist, the anaesthesiologist, the radiologist and the
pathologist, along with the cost of a heart value and prescription drugs, has
brought the total upto a staggering $ 2,00,000 – assuming no complications. For
instance, Escorts Hospital in New Delhi, where the estimate cost was under
$10,000 including airfare, surgery and rehabilitation (16).
SECTION – V
Medical Tourism Trends in India
Health or Medical tourism is perceived as one of the fastest growing segments
in marketing. Destination India today, while this area has so far been relatively
Economic Analysis of Indian Medical Tourism 269
unexplored, now the Ministry of Tourism, various state tourism Boards and
even the private sector considering of travel agents, tour operators and
hospitality industry are all eying health and tourism as a segment with
tremendous potential for future growth. India’s health policy declares that
treatment of foreign patients is legally an ‘export’ and ‘eligible’ for all financial
incentives extended to export earnings.
Ayurveda State
Kerala and Ayurveda have virtually become synonymous with each other. Kerala
or God’s own country’s as its corporate slogan goes, has pioneered health and
medical tourism in India. They have made a concerted effort to promote health
tourism in a big way, which has resulted in a substantial increase a visitor
arrivals into the state. However, though Kerala has strongly focused on Ayurveda
and its wide array of treatments and medications, good facilities are also
available in the other traditional forms of medicine as well as in medical
treatment. The bias towards health tourism in Kerala is so strong that Kerala
Ayurveda centres have been established at multiple locations in various
metrocities, thus highlighting the advantages of Ayurveda in health
management. The health tourism focus has seen Kerala participate in various
trade shows and expos where in the advantages of this traditional form of
medicine are showcased.
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of ayurveda therapeuctics that can help cure various illness. You realize the
importance of the ancient form of medicine that has been practiced in India for
more than 3,000 years now and the fact that ayurveda is way of life. It is a
system that believes in preventing diseases.
Today there are various schools of Yoga around the world including Iyengar
Yoga and Bikaram Yoga. The practice of Yoga by celebrities has added to its
popular image. You can experience the healing powers of yoga in yoga ashrams
270 NTK Naik and B. Suresh Lal
in Kerala. On Kerala tours with Kerala backwaters (17). Many visitors who
come for such de-stressing and health building treatment may also choose to
visit tourist spots. Such tourism potential holds the key to Kerala’s plans. The
Ayurveda state has declared 2006 as the year of ‘Medical Tourism’ and is actively
supporting its well known traditional medicine and tourism sectors, as they
reach out to more potential visitors.
Golden Palms Spa & Resort State
Government of Karnataka, the Department of tourism has ambitious plans for
the state. The idea is to make Karnataka a top health tourism destination not
only in India but internationally. The state Government wants to lure foreigners
to Karnataka to avail of sophisticated facilities and subsequently induce them
to enjoy multiple tourism offerings. This endeavour will have a positive impact
on the entire economy of the state. Infact, the government is setting up a
Bangalore International Health City Corporation which will cater to patients
for a wide variety of health care products and treatments.
The recent operations of children from Pakistan, who have sought medical
treatment in Bangalore have not only helped to boost the state economy but
more importantly helped in fostering, good will, peace and harmony between
India and Pakistan. Without doubt, Indian doctors are among the best in the
world and given the right atmosphere and environment, they can enhance the
image of Incredible India as a health and tourism destination. The state also
boasts of having the unique property, Golden palms Spa & Resort, which is the
one and only resort in the country where a guest can have a complete range of
Diagnosis. To Crown it all, there is even a mini-operation theatre for cosmetic
surgery performed by world renowned surgeons in the field (18).
Development plans, both state led and in the private sector are being pursued
activities. Karnataka State, which gets about 8,000 patients a year forecasts an
annual growth rate of 25 per cent, purposes to promote a massive health park
near a new international airport in Bangalore. Non-Resident Indians (NRIs)
have formed a medical tourism Company Vadodara and International Property
elopers are venturing into the healthcare sector to participate in the construction
boom. Wackhardt hospital in Bangalore, which has a medical International tie
up with Harvard gets half of its foreign patients (about 900) from the UK. Another
35 percent of Wackhard’s patients come to Bangalore from the U.S. and the rest
from the European Union and South-East Asia. Another Healthcare Institution
in Bangalore, Narayana Hrudalaya has, a record of 15,000 surgeries performed
on patients from 25 foreign countries, half of them children.
Using ISRO satellite connectivity, Narayana Hrudalaya has treated over
22,000 heart patients in India through telemedicine and some of them are
Economic Analysis of Indian Medical Tourism 271
foreigners. This concept is based on the fact that in 99 percent of the cases of
illness, there is no need for surgery. So, unless an surgery is required, the doctor
does not need to be physically present to treat the patient. Technology as a
solution to disease and pain is gaining importance. ISRO has installed hundreds
of ECG machines costing Rs.10,000 each, in clinics in the remotest, parts of
Karnataka. Thus precious life being saved by simple technology that takes
advantage of the infrastructure of teleconnectivity.
Ironically, even a century after the first heart surgery less than eight percent
of the world’s population can afford it. About 6.5 lakhs heart operations are
performed world wide every year, out of which the United States accounts for
5.4 lakh surgeries. It is estimated that India requires over 25 lakh heart operation
in a year. However, records show that only about 70,000 heart surgeries are
being performed across the country annually (19).
This gap can be met only if the medical industry in India starts
manufacturing products and other requirements for heart surgery. To make
this possible, the government should devise policies to promote investment in
this sector. The gestation period in the medical industry is particularly long,
which makes concessions even more important. Though India produces a large
number of doctors, nurses, and medical technicians lack of financial support is
a major hindrance to the health industry. With micro health insurance becoming
popular, this scenario should change soon.
Tremendous Potential State
The State Government of Maharashtra is part of the medical tourism council
that has members from association of Hospitals and FICCI and Western Regional
Council. It is indeed gratifying to note that well established chambers of
commerce are now seriously looking at medical tourism and infact, the
Federation of Indian Chambers of Commerce and industry, (FICCI) Western
Region Council (WRC) has taken the lead by setting up a task force for
the promotion of health and medical tourism in Maharashtra. This task
force has representatives from the Maharashtra Government. The medical
educational institutions and the drugs department, Maharashtra Tourism
Development Corporation, Pharmaceutical Companies, travel agents and tour
companies.
Maharashtra, as a gateway to India, offers tremendous potential to develop
medical tourism. The latest addition in Mumbai is the Asian Heart Institute at
Bandra Kurla Complex, which offers state of the art facilities for all types of
heart complications and even offers preventive cardiological treatment to avoid
heart ailments and also to keep under control a host of heart problems. This
institute which is in collaboration with the Cleveland Institute, USA, Offers
272 NTK Naik and B. Suresh Lal
‘Five-Star’ services at reasonable prices. There are even provisions for financial
assistance which is offered through various trusts associated with the Institute.
There are wide range of hospitals which help to promote medical tourism in
the state. Some of these are Lilavathi Hospital, Jaslok Hospital, Bombay
Hospital, Hinduja Hospital, Wackhardt Hospital, and Apollo NUSI Wellness
Retreat. Hotels like Hyatt Regency, JW Marriott, Renaissance and Resort, also
offer extensive Spa facilities aimed at rejuvenating both the domestic and
international tourists (20). It is estimated that foreigners account for around 12
percent of all patients in top hospitals of Mumbai.
Other States of India
In other states of India also, a number of private hospitals offer packages
designed to attract wealthy foreign patients, with airport to hospital bed car
service, in room. Internet access and private chiefs. An other trend is to combine
surgery in India with Yoga or holiday trip to the World Famous Taj Mahal,
Ellora etc., The Escorts Hospital group in Delhi completed 4200 heart operations
for foreign patients during 2004.
Global and Apollo Group of Hospitals
The Apollo Hospitals Group which hospitals are located at Delhi, Chennai,
Hyderabad and Madurai, is today recognised as the “Architect of Healthcare”
in India. It’s history of accomplishments, with its unique ability of resource
management and able deployment of technology and knowledge to the service
of its patients, justifies its recognition in India and abroad. Their mission is
“to bring healthcare of international stands within the reach of every
individual.
Private Hospitals in Hyderabad (Global Hospitals) some of which get 10
percent of their patients from abroad, are planning to open separate wards/
wings for foreigners. The Apollo Hospitals already has a ward and wants to
upgrade it to an international multi-speciality block. The Asian Institute of
Gastroenterology plans to create a separate wing for foreigners.
Ventures such as these draw encouragement for the National Health Policy-
2002 which endorses provision of health services on a payment basis to service
seekers from overseas. The Corporate healthcare sector views such support as
critical, considering that it is competing with Thailand, Singapore, Malaysia
and South Korea for a bigger share of Asia’s medical tourism market.
Medical Tourism can be a much bigger business, if we have infrastructure
and networking among hospitals hotels and tourism agencies. The Central and
State Governments must extend tax and other concessions, on the lines available
Economic Analysis of Indian Medical Tourism 273
to IT and BPO sectors. The key to a significant increase inpatient arrivals,
however, lies in becoming globally accredited. Corporate hospitals have begun
factoring this requirement into their medical tourism plans.
The corporate hospitals have not failed to recognize the opportunity. Many
of them are upgrading to offer the latest of medical diagnostic facilities to medical
tourists, which may also be packaged with vacations in a tie up with airline
companies. Some analysis believes that the input of this, phenomenon on national
healthcare needs careful study. Some observes fear an exodus of highly skilled
doctors from the trophied public health system to high paying private hospitals.
Many states are not even ready to fill vacancies in Government medical service,
compounding the problem.
Major Road Blocks in the Tourism Sector
It is often forgotten that in the last few years, more Indian traveled abroad
than to the inflow of foreign visitors, leading to a net outflow of foreign exchange
Our tourism plans keep in view only one class – the foreigners. Hence, the
governments gave more priority to airports than railway stations and bus
terminals, Luxury hotels get priority over budget accommodation.
The progress of the tourism industry is tardy. Out of the 1310 tourism projects
undertake in the tenth plan, 740 projects are still incomplete (21). India wants
to increase medical tourism, but it lacks the necessary tools to impress patients
looking abroad for healthcare. There are major problems in drawing patients
from abroad.
Although the Incredible India campaign was generally well received, industry
observers differed in their opinions on the positioning of India.
? One angry International Tourist Operator, who had to face the ire of
customers disappointed with their trip to India, Said “Indian should
first set its house in order before showcasing itself as an incredible
destination. Otherwise it will simply end up being an incredulous place
to visit” (22).
? One industry observer, said, “Indian tourism ails from a clear lack of
awareness of its true tourist potential. You would be surprised how many
people from developed countries still think of India as a country with a
billion poor people mixed in disease hunger and suffering. (23).
? Other analysts felt that, the need of the hour was not an experience ad
campaign but fundamental improvements in both general as well as
tourism related infrastructure. These infrastructure problems not only
inconvenienced tourists who actually choose to visit the country but also
caused negative word of mouth”.
274 NTK Naik and B. Suresh Lal
? One traveler wrote “It look almost two hours to travel about 50 miles.
This was typical of most of our driving experiences in India. The roads
are in varying states of disintegration and must be driven very slowly to
keep passengers from being bounced out of the car windows” (no seat
belts) (24).
? Most tourist operators felt that, “tourist related infrastructure was not
existent of many tourist destinations in India. Even, wherever it did exist,
it was inferior quality”
? Bureaucratic hurdles in the issuing of ‘visas’ also worked to keep the
number of tourists down. Tourists from West European countries,
however, faced fewer problems. Also politically sensitive areas like the
North-East required special entry permits. Which caused problems for
genuine tourists.
? The Government of India was aware of the problems that the tourism
industry in the country faced. The Indian Planning Commission’s (IX
plan) eloquently states that India’s tourism woes were caused by “a lack
of professionalism, unhygienic conditions, lack of easily available
information: poor infrastructure; lack of safety; poor visitor experience;
restrictive air transport policy; inadequate facilitation services,
multiplicity of taxes, and low priority accorded to tourism”.
? Ravi Raghavendra, creative Director, contract an advertising agency,
said,’ one “Incredible India’ campaign can not change the system. It is
not a question of budget or innovation, but it is a matter of creating a
serious brand out of India as tourist destination. There are countries
such as Thailand, Malaysia, Singapore etc. which are extremely
aggressive in promoting the tourism options of the region. This drive is
lacking in India, and should be spearheaded by the Government”.
? Subhash Goyal, Chairman, Stic. Travels Group, and President, Indian
Association of Tour Operators (IATO) said, “India’s failure to compete
successfully withour neighbors is not so much because of our failure on
marketing front as it is because of poor infrastructure, multiplicity of
taxes. Complexities and complications involved in issuance of ‘Visa’ and
general poor law and order and order situation besides the undue
publicity that the country get’s due to incidents of terrorism in some parts
of the country,” (25).
SECTION – VI
Concluding Observations and Some Measures Initiated for Policy
The analysis of the study reveals that the Information Technology (IT) which is
the part of globalization has brought about certain changes in healthcare sector.
Economic Analysis of Indian Medical Tourism 275
Today, India is in a position to extend its medical services to other countries
particularly, the Gulf and European countries. Further, US and the European
countries are depending on Indian Information Technology (IIT) sector, for
outsourcing of medical expertise.
Due to the globalization of Indian economy there is an enormous increase in
the Foreign Direct Investment (FDI) from 39 per cent to 100 per cent in India.
This has also given scope for establishment of Pharmaceutical industry and
corporate hospitals. Priority for research on certain diseases like cancer, AIDS
has also boosted up. Transplantation of heart, eyes, kidneys, cosmetic surgeries
and exchange of medical expertise between different countries, extension of
medical services and development of medical tourism. All these factors are
contribution for extension of better healthcare services not only for Indian people
but also foot other countries.
In India, the service sector is growing very fast. It now accounts for 55 percent
of the GDP. India has made rapid progress in respect of biotechnology and IT
related services. It has now become famous from healthcare too. Medical tourism
is a concept that is attractive to visitors who lone comprising well-being and life
style healthcare services with the strong desire to travel overseas. With the
cost of medical care being about 10 times cheaper in India, health tourism is
also emerging as an important segment.
According to government sources, the country’s $17 billion a year healthcare
industry could grow at 13 per cent annually during the next five years. Medical
tourism is said to be growing at 30 per cent annually. It could provide the biggest
boost to the healthcare industry and become a $2 billion industry in the next
five years.
India offers world-class medical facilities with state of the art hospitals and
the best qualified doctors; with the proper infrastructure in place; and the best
possible medical facilities; accompanied with the most competitive prices; the
patients can get the treatment done in India at the lowest charges; and enjoy
the Indian tourist and pilgrim destinations. By earning accreditations,
standardizing medical practices; and getting the support of the government;
hospitals and tourism agencies; India can increase its medical tourism industry
to $2.2 billion per year.
Policy Initiatives
Encouraging the prospects for the Medical Tourism: the public sector, the private
sector also needs to be focused in the growth and development of medical tourism.
There is a fair measure of political stability, changing and cheaper flights this
can be attributed to the entry of low-cost carries in India and liberalized aviation
policies. The growth of the health sector requires well integrated and coordinated
276 NTK Naik and B. Suresh Lal
policies and stability in approach, There are insufficient connections to the
medical tourism destinations, the number of regional airports could open up as
international airports, The lack of a visa on arrival regime on account of security
considerations places India at a disadvantage vis-à-vis its competitors, the need
for medical tourism development and reviews its ‘visa’ policy to permit tourists
from its major source markets to obtain visas on arrival, The Government may
introduce a new category of ‘Medical Visas’ to promote medical tourism,
Telemedicine provides clinical support and acumen along with remote radiology
and pathology facilities to far-off places, Tour operators market, the products,
sell the packages including services like travel documentation, reservations,
assistance at the airport transfers, accommodation in selected hotels or resorts,
escorting, coordination with the hospital, local assistance, etc. the services of
the tour operators and hospitals should be synchronized, The lack of quality
infrastructure, uncompetitive rates, in different or poor product quality,
difficulty, in getting access to information on travel and tourist destinations,
Accreditation of health providers is a critical requirement for enabling quality
benchmarking of services and healthcare facilities, All hospitals that want to
be centres for Medical tourism need to increase their exposure and be constantly
updated on internationally accepted standards of health care services delivery
to the international clientele, With virtual absence of a public health security
system and a high proportion of nation health spending being met by households,
the need for a widespread World Health Insurance System (WHIS) is urgent
and pressing.
References

The 5 best countries for medical tourism and overseas healthcare

by Andrew Henderson | Jan 5, 2014

Medical tourism is on the rise, and dozens of countries around the world – from Asia to South America to eastern Europe – are getting in on the act. Agencies are being set up to promote less expensive health care costs to potential foreign visitors from developed countries where health care costs are through the roof.

And with Obamacare, this trend is sure to continue.

Like anyone else we discuss on this site, the best countries for medical tourism – or anything else – are often those you would have never thought of. Emerging countries have built great health care infrastructure while minimizing costs, allowing them to deliver care for as little as five to ten cents on the dollar in some cases.

Procedures that cost into the six figures in the US or the UK cost as little as four figures in these countries. All the while, the best hospitals in these medical tourist hot spots have highly-trained, English-speaking doctors just like you’d find at home.

So, where are the best countries to get that expensive surgery, the routine checkout, or the plastic surgery makeover? To be honest, there are so many potential countries that it was hard to narrow it down to just five. Let’s find out which made the cut…

Singapore, while expensive, has one of the most sophisticated hospital systems in the  world

5. Singapore
Singapore’s status as one of the world’s freest economies and a highly developed nation has made it a medical tourism hub for both Asians and westerners for years. Cancer treatment is a top speciality there. Gleneagles Hospital was ranked in the top ten hospitals globally by a health travel group, but many other hospitals offer excellent care, also. The World Health Organization ranks Singapore the best health care system in Asia, and sixth in the world. And while socialists claim that Singapore’s efficient, rather socialist health care model is a model for the rest of the world, personal responsibility is a key driver that keeps health care costs in here reasonably low.

You will pay more in Singapore than in places like Thailand, but the quality of life in Singapore is second to none. One US-based grocery chain had a policy of paying the entire hospital bill, with travel costs for two, for employees who got hip and knee replacements in Singapore. Life expectancy in Singapore is several years longer than that of the UK. By many standards, the city-state has the world’s lowest infant mortality rate. If you’re looking for the most developed country for less expensive surgery, Singapore might be for you. However, there are stories of excessive costs, which together with rising health care standards in other countries, are causing medical tourism to shift to other parts of Asia.

Brazil is the world capital for plastic surgery medical tourism, owing to the country’s image-conscious culture.

4. Brazil
While Mexico is the best known country in the Americas for foreigners seeking care, Brazil stands out one of the most advanced in the region. Looking good and feeling sexy is important in Brazil – almost to extremes, so it’s no wonder the country is home to more cosmetic surgeons than anywhere else on earth. Plastic surgery is done in a hospital, not in an office, in Brazil, and doctors are highly trained in such procedures. Up until recently, medical tourism in Brazil was largely relegated to elective procedures. However, the country has the first JCI-accredited hospital in the world outside of the United States – Hospital Israelita Albert Einstein in Sao Paolo – and now has more than 40 JCI-accredited hospitals.

Brazil has the least efficient medical system on this list, although it is nearly tied with the United States in terms of medical efficiency. Costs for plastic surgery can be as much as 60% less than in western countries, and surgeons can handle just about any procedure you can dream up. There are even veterinarians offering cosmetic surgeries on pets. Brazil is home to perhaps the world’s most renowned plastic surgeon, Ivo Pitanguy, and prices for top doctors can be as high as those in the US, so make sure to shop the lesser-known clinics if you want to save money. However, Brazil’s beauty consciousness surely can’t hurt anyone looking to save money on a nip and tuck.

India specializes in inexpensive bypass surgeries and other high-end medical procedures for medical tourists.

3. India
Yes, really; India has become a top health tourism destination for high-end surgeries at inexpensive prices. Two of the top ten medical tourism hospitals are in India. Stories of westerners traveling to India and saving 75% over home country costs for large procedures – travel costs included – are not uncommon. India is anticipated to have a $2 billion industry serving overseas patients by 2015, thanks to well over 100,000 patients who visit each year. The Indian government is easing restrictions on citizens of many countries, making it easier for them to travel to India visa-free and with fewer restrictions (US citizens do need a visa to enter India, which costs $67 plus any agency service fees).

India is widely known for its advanced medicine services and advanced equipment. Doctors tend to be highly trained due to large medical tourism cities like Chennai and Noida having foreign patients fill half their hospital beds. Also, the language barrier is lower for English speakers, and Indian hospitals are bringing in translators for non-English speaking foreigners. Health care costs in India can run as low as ten cents on the dollar compared to the US or the UK. Popular treatments include bone-marrow transplants, eye surgery and hip grafting and replacement. India is also a top destination for cardiac bypass surgery at facilities like the Asian Heart Institute; the procedure can cost less than $10,000 as compared to more than $100,000 in the west.

Thailand has long been one of the best medical tourism destinations in the world, with low health care costs and excellent service.

2. Thailand
Thailand is world-renowned for its medical tourism and expat health care services. So much so that medical tourism is growing by 16% a year. Bangkok is home to Bumrungrad Hospital, where I myself went for a total health check-up after losing a bit of weight – and paid very, very little. The hospital was largely modeled after the Mayo Clinic, and their electronic medical record service impressed Microsoft so much they bought the whole thing. While I’m not a fan of Thailand in general, there is no denying that their medical system is prized for offering a wide range of surgeries and other procedures at cheap prices. One of my expat friends said he’d get “any surgery” in Thailand due to the high quality of care. Many doctors in Thailand have been trained in western countries or Singapore and speak excellent English; nurses tend to speak English relatively well, also.

Ever since the crash of the baht in the nineties, Thailand used its currency crisis to attract medical tourists from around Asia, mainly for cosmetic surgeries. Today, Thailand is a haven for inexpensive plastic surgery, but also non-elective procedures. A facelift that might cost $15,000 in The Land of the Free would cost $2,500-3,000 in Thailand. Meanwhile, bypass surgery could cost around $25,000, an 80% discount over US prices. Experts recommend sticking to Bangkok rather than the coastal resort towns for access to the best doctors and care.

Malaysia has built medical facilities that rival Singapore at much lower price points, and has set up agencies to attract hundreds of thousands of medical tourists for procedures from burns to heart conditions.

1. Malaysia
Malaysia sees well over half a million medical tourists – most from around Asia – each year due to the country’s developed infrastructure and low costs. The general consensus is that, as Singapore gets more expensive, Kuala Lumpur is picking up the slack with facilities that are just as good. English is more widely spoken in Malaysia than in Thailand, and infrastructure is better than countries like India.

Like other countries in Asia, Malaysia saw medical tourism as a way to diversify its economy during the Asian financial crisis. Prince Court Medical Center, where I easily saved $2,000 when I got sick in Kuala Lumpur, was ranked the number one hospital for “patients without borders” by the Medical Travel Quality Alliance. Malaysian hospitals offer services such as in vitro fertilization at around one-fifth the price of western facilities, as well as offering sophisticated treatment for burn victims. Malaysian hospitals also offer total physicals that would cost several thousand dollars in the US, with blood work, for a few hundred dollars.

Other countries are joining in to grab their share of foreign patients, as well. Jordan has seen millions of patients cross into its borders, and has received a top five ranking for medical tourism from the World Bank, while Colombia is fast rising as a medical tourism hub.

Would you go overseas for inexpensive health care? Share your comments below.

医疗旅游：又一个“印度辉煌” 
日期：2015-07-22 作者：吴永年 来源：文汇报

除了瑜伽、软件业之外 医疗旅游：又一个“印度辉煌”

　　■吴永年

　　印度的瑜伽文化已被世界所接受,并赞言不绝。而它的国际医疗文化,如今也进入国际舆论的视线，并被津津乐道。椐有关资料显示,近年来,印度医疗旅游文化业的收入以15%的速度持续增长,2012年已达400亿美元,2015年保守估计可达600亿美元，故被舆论称之为印度优质产业群中的一朵奇葩。也有舆论认为,这是继印度软件业后的又一个“印度辉煌”。

　　作为一个经济还比较落后的发展中国家,印度何以能吸引成千上万的西方国家的富人来治病或疗养？笔者在经过了一番调查研究之后认为,印度国际医疗旅游业成就如此骄人事出有因。　　

印度医学自古闻名于世

　　据记载，早在公元前2500-1700年的哈拉帕文化年代,古印度己用五灵脂治消化不良、肝病,乌贼骨外敷治耳、眼和咽喉等疾病；利用头盖骨穿孔术治疗头痛和脑外伤等疾病。

　　在古吠陀年代,在《阿达婆吠陀》与《爱达罗氏奥义书》等书中,印医入药的植物有2000多种,动物有200多种,矿物药也有数十种。那时印医以摸脉、看舌苔、望气色来诊断疾病,与中国中医治病类似。后吠陀年代,古印度己建有专门的印医学校,阿特里亚的医学著作《阿特里雅集》最为著名,还有人体健康与自然界结合的三活力与七要素之说。公元2世纪的《妙闻集》是古印度最为著名的外科医学著作,其中的病理学、解剖学、胚胎学等至今仍用,其中还有121种类型的外科医疗器械,300种手术方法,42种外科处置方法。另外,公元八九世纪的《八科精华》和《疾病研究》对今日世界医学界产生了不可低估的重大影响。　　

医术高收费低最吸引人

　　有人认为.印度经济不发达，老百姓生活水平普遍低下,其医疗技术不可能与西方发达国家相比。可出人意料的是，事实恰恰相反。早在英国殖民时期，印医开始吸收西方医术,融会贯通,医术有了长足的进步。如今，印度各大医院的医生大部分从欧美国家的医学院取得博士学位后归国工作。这批精英人才将印医传统和现代先进技术相结合,使得印度的医疗技术水平不仅不落后于西方国家,有些指标甚至还遥遥领先。比如,据报道，2004年印度的斯科特医院完成的4200例心脏手术中,死亡率只有0.8%,感染率0.3%；而同比西方发达国家，心脏手术死亡率则高达1.2%,感染率1%。近几年斯科特医院的手术死亡率、感染率仍在世界属最低的,其死亡率和感染率不会高于0.9%与0.4%。

　　除了高超的医疗水平，印度医院便宜的手术费或许是吸引西方国家病人源源不断来印度就医的最吸引人的因素。在西方发达国家,做一例心脏手术、血管成形手术、脊柱融合等大手术,一般费用都要在10万至27万美元之间,而在印度的费用只有它们的十分之一,有的甚至更低。另外,印度护士小姐温柔的服务态度，精心的呵护照料,也为病人带来一种不同文化的精神享受。

　　除此之外，印度已是除了美国之外的世界第二大生物药品制造国。目前印度具有世界级的大型生物制药企业350多家,小型的生物制药厂及仿制制药企业5600多家。这些药厂生产的药品,疗效好,价格便宜,有的仅是西方同类药价格的十分之一。可见,如果一个国家独特的文化底蕴,若能够与现代科技和社会需求紧密地结合在一起，那么,其迸发出的力量和形成的硕果也一定是耀眼的。（作者系上海外国语大学南亚东南亚研究所首席顾问、教授）