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Swot Analysis On: Medical Tourism

Kalyan Chakravarthy K*, C H. Ravi Kumar* and Deepthi K*
Health is wealth! Without sound health we cannot achieve anything in our life, nor enjoy what ever we
have. In service sector the concept of Medical Tourism, which is catching up at lightning speed across the
world. The ultimate concept of medical tourism is a tour to surrounding destination, medical treatment and
savings. People from advanced countries, including the United States and Europe, see a benefit in travelling
to developing third world countries, like India, Thailand, Philippines, South Africa, etc.while combining
medical treatments with inexpensive vacation. The emergence of the medical tourism as a booming
industry and the key management aspects that will help India establish as Health Care Destination. The
total expenditure on health by the Centre and States together is only 1 percent of GDP. We should raise it
to 2-3 percent in2012, and 25 percent in 2020.

Table 1: Tourism in India

Tourists Arrivals Tourists Arrivals Percentage share
Year
to India At Global of India
1994 18,86,433 550.3 0.34
1995 21,23,683 564.4 0.38
1996 22,87,860 597.4 0.38
1997 23,74,094 618.2 0.38
1998 23,58,629 626.7 0.38
1999 24,81,928 650.0 0.38
2000 26,41,157 698.3 0.38
source: Market Research Division, Dept. of Tourism, Govt of India
The main demand for medical tourism is generated from millions of Indians who live abroad, though a
growing number of foreigners are also keen on speedy and in expensive treatment. They are influenced by
two important facts: India now has many world-class private hospitals and Indian doctors have experience
in abundance. Owing to India’s prodigious population, the strengths in health care sector is doctors treat
twice the number of patients in comparison to doctors in the west, domestic aviation has been opened to the
private sector, foreign investments are encouraged and a number of incentives are in place. India is
considered as a safe destination compared to other countries Foreigners are visiting India for serious
medical help as well as rejuvenation therapies and other specific purposes.

Definition of Medical Tourism

Medical Tourism may be defined as the “provision of cost-effective medical care with due consideration to
quality in collaboration with tourism industry for foreign patients who need specialized treatment and
surgery”.

Historical Back Ground

Medical tourism is thousands of years old service sector. In ancient Greece, pilgrims and patients came
from all over the Mediterranean to the sanctuary of the healing God, Asklepios, at Epidaurus. In Romed
Britain, patients took the waters at a shrine at bath – a practice that continued for 2000 years . From the
eighteenth century, wealthy Europeans travelled to Spas from Germany to the Nile. More than 5000 years
ago, it was believed that souls return to the earth in a different form to right the wrongs of their past life in
Hinduism. A three – dimensional purification of the soul is necessary to discharge the sins of each birth –
in physical, mental and spiritual planes. Yoga, meditation, pleasant demeanour and physical cleansing – all
part of Ayurveda – serve as a tools for purifying the soul, so future reincarnation will be necessary. In the
21st century, relatively low-cost jet travel has taken the industry beyond the wealthy and desperate. Later,
mostly wealthy people began travelling to tourist destinations like the Swiss lakes, the Alps and special
tuberculosis sanatoriums, where professional and often specialized medical care was offered. In this
century, however, medical tourism expanded to much larger scale. Thailand, followed by India, Puerto-
Rico, Argentina, Cuba and others quickly became the most popular destinations for medical tourists.
Complicated surgeries and dental works, kidney dialysis, organ transplantation and sex changes, topped the
list of the most popular procedures. It was estimated that in 2002, six hundred medical tourists came to

*Research Scholars, Acharya Nagarjuna University, Andhra Pradesh & Don Bosco PG College, Kornepadu (Mdl), Guntur (Dt) )
 IIMK Part IX – Medical Tourism IIML

Bangkok and Phulket medical centers in Thailand, while approximately one hundred and fifty thousand
foreign patients visited India during that time. .From Neolithic and Bronze age wherein people used to visit
neighbouring countries for Minerals and Hot Springs, today we have reached the era where Hospitals are
more like Spas and Spas more like hospitals.
In this digital era, half a million people travel across the globe for health purposes. 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. Medical Tourism is one such new area that is ripe with
potential.

Why Medical Tourism in India

Medical Tourism is poised to be the next Indian success story after Information Technology. According to
recent study the industry’s earning potential estimated at Rs.5000-10000 crores by2012. The main reason
for India emerging as a referred destination is the inherent advantage of its health care industry. India offers
a variety of services for overseas patients. Generation of foreign exchange, creation of income, generation
of employment, contribution to state revenue and its associated regional development can be cited as the
major economic benefits of tourism. The demand for Indian health care services primarily comes from
three types of consumers i) Non-Residential Indians ii) Patients from countries with underdeveloped
facilities iii) Patients from developed countries. Though tourism is not the primary need of these
consumers, it offers additional attraction particularly for people travelling for cosmetic surgery and less
complicated procedures.

Table 2: Foreign Exchange Earnings through Tourism

Years Earnings ( US $ million) Percent change
1991 1,861 -----
1992 2,126 14.20
1993 2,124 -0.10
1994 2,272 7.00
1995 2,583 13.70
1996 2,832 9.60
1997 2,889 2.00
1998 2,948 2.00
1999 3,009 2.10
2000 3,168 5.30
2001 3,042 -4.00
2002 2,923 -3.90
2003 3,533 20.90
Source: Market Research Division, Department of Tourism, GOI.

Medical Tourism In India

India’s health care sector is on the road to global fame. India is the seat of spiritualism. It is the confluence
of different religions: Hinduism, Sikhism, Christianity, Islam and Jainism etc. Medical tourism in India is
promoted as high-tech healing destinations, which provide world-class treatment at low cost, incorporating
the Indian Systems of Medicine. India offers world-class treatments and a leisure holiday at excellent
locations at almost 50 percent less than the total sum the foreign patients would spent on treatment in their
own country. Foreigners are attracted to Indian Systems of Medicine (ISM) and tourism. The Indian
Systems of Medicine include Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy together
characterized under the department of AYUSH in the union health and family welfare ministry. During the
ninth plan, with an expenditure of more than Rs.1,000 crore, a quantum jump in outlays on schemes for
development and promotion of AYUSH system of medicine has been achieved during Tenth Plan.
Indians are known for their hospitality and warmth.India has an incomparibly rich heritage in ancient
systems of medicine that make up a veritable treasure house of knowledge for both preventive and curative
health care. Around 1000 BC when Indian Systems of Medicine (ISM) were fully documented in Charaka
Samhita and Sushruta Samhita. Thus, ISM is considered to be one of the oldest organized systems of
medicine for positive health and cure of human sickness. The most important and massive ancient
compilation of the school of medicine is known as Charaka Samhita. It contains several chapters dealing at
length with internal medicine. About six hundred drugs of plant, animal and mineral origin are described in

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it. So far so good. But traditional medicine was ignored when western medical knowledge and procedures
were introduced into the country.

Ayurveda : Ayurveda means the “science of life” in Sanskrit. It is one of oldest and the best documented
among the ancient systems of medicine. From the Charaka Samhita (600 B.C) and the Susruta samhita.

Yoga & Naturopathy : Yoga is not really a system of medicine. Its objectives are self- realization and
spiritual union with all –pervasive divine cosmic power. But certain intermediary practices and yogic
attitudes have proved beneficial for reducing stress, preventing many lifestyle-related diseases, and
promoting general health and well being.
Naturopathy is based on the fundamental principles of ayurveda. The basic tenet of Naturopathy is to live
according to the laws of nature: disease occurs due to the accumulation of toxins in the body, and to cure
the ailment, the body is purified with the use of natural methods, dietary regulations and exercise.

Unani : The Unani system originated in the fourth and fifth century BC in Greece under the patronage of
Hippocrates (460BC-377)and Galen. The system is based on the humoural theory that good health depends
on the balance of the four humours: blood, phlegm, yellow bile and black bile.

Siddha : Siddha means a “master” thus the name denoted the mastery of such practices. The most famous
of the siddha was Nagarjuna, whose rasatantra forms the basis of this system. The distinctive features of
siddha are its reliance on minerals and metallic compounds, and its emphasis on rejuvenation therapies.

Homeopathy : The term homeopathy comes from the Greek word ‘ homios’ means like and ‘pathos’ means
suffering. Homeopathyworks by looking at the symptoms, will take into account the individual’s mental,
physical, emotional,and spiritual health before deciding the treatment. Homeopathy is based on the
principles that ‘like cures like’.

Table 3: Summary of Medical care, Medical Manpower facilities available under

Indian systems of Medicine
Facilities Ayurveda Unani Siddha Yoga Naturopathy Homeopathy Total
Hospitals 2398 268 231 8 18 230 3203
Beds 42963 4489 2401 135 722 10851 61561
Dispensaries 13914 1010 464 71 56 5836 21351
Registered 453661 46558 6381 0 888 217850 725338
Practitioners
Source: Department of Ayush, ---- Health & Family welfare, Government of India.

Medical Tourisim has been a popular concept in countries like Malaysia, Thailand, Singapore, Costa Rica,
Hungary, India, Israel, Jordan, Lithuania. South Africa specilises in medical Safaris-visit the country for a
safari, with a stock over for plastic surgery.
Due to liberlisation of our economy and internalization of health care profession, India has entered the
industry in only recent times. India’s corporate hospitals are fully equipped with up market and efficiency.
With their toll free lines, interactive websites, online quotes and time bound treatment access, they appear
to be a world apart from the over burden, often badly managed and poorly funded public health system.
Many opt to under go surgery in India for reasons that range from long waiting times in Canada and U.K,
high costs and lack of insurance cover in the U.S.A to plain lack of expertise in many Asian, African and
West Asian countries. Most patients are coming from poorer countries like Bangladesh, Iran and Pakistan
where treatment may not be available.
According to study conducted by the Confederation of Indian Industry and Mc Kinsey consultants, reported
that 1,50,000 foreigners visited India for treatment, with the number rising by 15 percent a year. The recent
operations of children from Pakistan, who have sought medical treatment in Bangalore, have helped not
only in boosting the state economy but more importantly fostering goodwill, peace and harmony with
neighbouring countries like Pakistan, China, Bangladesh and Ceylon etc.
The Indian Sytems of Medicine were given importance in southern India. The states like Kerala, Karnataka,
Tamil Nadu and other states in India plays a key role in medical tourisim.

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Kerala-The Pioneer State

Kerala has pioneer health tourisim in India. Kerala has strongly focused on Ayurveda and its wide array of
treatments and medications, good facilities are also available in other traditional forms of medicine as well
as in modern medical treatment.

Kerala is Capitalizing on its Rich Cultural Heritage and alternate Medical Therapies.

Karnataka’s Foray
The government of Karnataka has ambitious plans to make Karnataka the top health tourism destination not
only in India but internationally. In fact, the government is setting up a Bangalore International Health City
Corportation for provision of a wide variety health care products and treatments.

Tamil Nadu
Tamil Nadu has multi speciality hospitals that offer the best medical treatment at surprisingly low rates. In
the state various other forms of medicine, viz, Siddha, Ayurveda, Unani, Nature Therapy and Yoga are also
practiced, which the foreigners are inclined to patronize. The Tourism Department is taking steps to
promote the illness to wellness concept by developing tourism with health care.

Maharastra’s Unlimited Potential

This state, 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 preventive cardiological treatment to avoid heart
alignments and keep under control a host of heart problems. This institute in collaborating with the
Cleveland Institute, U.S.A offers ‘Five Star’ services at reasonable prices.

Other States of India

In other states of India also, a number of private hospitals offer packages designed to attract wealthy
patients, with airport-to-hospital bed car service, in-room Internet access and private chefs. Another trend is
to combine surgery in India with Yoga are 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.

Medical Infrastructure
In India, it is estimated that there are 15,000 hospitals, 8,75,000 hospital beds, 5,00,000 doctors, 7,37,000
nurses, 170 medical colleges,3,50,000 retail chemist outlets. Around 18,000 new doctors are added every
year. Almost 80,000 additional beds are still required.
Table 4 . Trends Health Care Infrastructure
1951 1991 2005( Period/Source)
SC/PHC/CHC 725 57353 171608*
Dispensaries & Hospitals 9209 23555 27770
Beds (Private& Public) 117198 569495 914543(all types)**
Nursing Personnel 185054 143887 865135 @
Doctors (Modern System) 61800 268700 656111 @
*RHS: Rural health Statistics, 2006 Sub Centres (SC)
** Health Information of India, 2004 Primary Health Centres (PHC)
@ National Health Profile, 2005 Community Health Centres (CHC)

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SWOT analysis
Business, service firms undertake Swot analysis to understand their external and internal environments.
SWOT, which is the acronym for strengths, weaknesses, opportunities and threats, is also known as
WOTS-UP or TOWS analysis. Through such an analysis, the strengths and weaknesses existing within the
medical tourism can be matched with the opportunities and threats operating in the Indian environment so
that an effective strategy can be formulated. Some of the primary environmental influences operating
currently in the context of the Medical Tourism in India.

Medical Tourism : SWOT approach.

Given below is a SWOT analysis of the Indian Medical Tourism.

Strengths
A strength is an inherent capacity which an organization can use to gain strategic advantage. An example
of a strength is superior research and development for a new service industry development so that the
industry can gain a strategic advantage. The strengths in medical tourism are:
• Quality and Range of Services.
India has number 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 various specialities
covered are Neurology, Neurosurgery, Oncology, Ophthalmology, Rheumatology, Endocrinology,
ENT, Paediatrics, Paediatric Surgery, Paediatric Neurology, Urology, Nephrology, Dermatology,
Dentistry, Plastic Surgery, Gynaecology, Pulmonology, Psychiatry, General Medicine & General
Surgery. For its quality of services and the infrastructure available, India is attracting a vast pool of
tourists from the middle east, Africa etc.

• Affordable costs :
For a 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. With 50 million Amercians
without health insurance and waiting lists for state- run facilities often endless in the UK,Canada
and Europe, foreigners are increasingly flocking to India because it offers quality treatment at a
fifth of the cost abroad. In India, complicated surgical procedures are being dine at 1/10th the cost
as compare with the procedures in the developed countries.

Table – 5: Cost Comparison between India, USA & UK.

Nature of Treatment Approximate cost in Cost in other major health Approximate waiting periods
India ($) care destinations ($) in USA/UK ( in months)
Open heart surgery 4,500 > 18,000 9 – 11
Cranio- Facial surgery 4,300 > 13,000 6–8
Neuro-Surgery with 6,500 > 21,000 12 - 14
hypothermia
Complex Spine surgery with 4,300 > 13,000 9 – 11
implants
Simple spine surgery 2,100 > 6,500 9 - 11
Simple brain tumor 1,000 > 4,300 6- 8
Biopsy 4,300 >10,000 6- 8
Surgery 2,100 >6,500 9 – 11
Parkinsons
Lesion 17,000 > 26,000 9 - 11
DBS
Hip replacement 4,300 > 13,000 9 - 11
* These costs are an average and may not be actual costs to be incurred.
Source: The Guradian News, Feb. 1,2005.

Cost Comparison with the West

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 some times even a sixteenth
of the cost in the west.

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Open-heart surgery could cost up to $70,000 in Britain and upto $150,000 in USA, in India’s best hospitals
it would cost only between $3000 and $ 10,000. Knee surgery (on both knees) costs Rs 3,50,000 ($7700) in
India ; in Britain this cost----- 10,000 ($16,950)- more than twice as much. Dental, eye and cosmetic
surgeries in western countries cost three to four times as much as in India.

Table 6. Procedure charges in India, USA & UK

Procedure India USA
Bone 69,000 250,000
Liver 69,000 300,000
Heart 8,000 30,000
Ortho 6,000 20,000
Cataract 1,250 2,000

• Vast supply of qualified doctors: India has a Large pool of doctors (approx 600000), nurses & para
medics with required specialization and expertise and the language advantage ( English speaking
skills).The medical education system caters to the ever increasing demand for the delivery of the
quality healthcare services all over the country.
• Strong presence in advanced health care. Eg. Cardiovascular, Organ transplants-high success rate in
operations.
• International Reputation of hospitals and Doctors.

Internationally reputed hospitals are : Apollo hospitals group located at Delhi, Chennai, Hyderabad &
Madurai. Escorts heart institute & research centre located at Delhi and Faridabad. Dr, Vivek Sagar’s Dental
care & cure centre located at Ludhiana. PD. Hinduja National Hospital & Medical Research Centre located
at Mumbai. LV. Prasad Eye Institute located at Hyderabad.
• Diversity of tourism destinations and experiences.
• Top class luxury resorts
A destination resort provides a wide variety of experiences and facilities to keep guests occupied in one
location for a month or more. Luxury takes convenience to a level of utmost extravagance and soaks the
receipent in superior comfort . Mainly hired for enchanting business meets, luxury resorts denote finer
hospitality and best comfort that money can buy. The places are like man made heaven on the earth and
few hospitality places are :

Taj Excotica, Goa.

ƒ Kumarakom Lake Resort in Kerala, is a wonderful blend of traditional architecture, natural beauty and
great service and as close to nature as it can get.
ƒ The Leela, Goa designed to reflect Goa’s Portuguese and Indian heritage, The Leela, Goa, pampers
guests with a choice of luxurious villas, suites or rooms characterized by plush furnishings and serene
ocean views.The Leela Palace, Goa, has won the World Travel Awards as Asia’s leading luxury resort
for three years in a row.
ƒ The Oberoi Rajvilas, Jaipuir is an oasis of elegance and luxury, offering consistently high standards of
facilities and services.
ƒ Taj Exotica, Goa a tranquil corner of the world steeped in sepia-tinted romantic history. With tropical
décor, its grand architecture, a lush sun-drenched atrium, wide shady corridors and flower-lined patios,
every corner of the Taj Exotica is a retreat itself. One of the highlights at the Taj Exotica is that each

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room offers a panoramic view of the sea, whetherit is from one’s own private balcony or from the
generously appointed terraces.
• India’s most economic assets are its outstanding archaelogical sites and ancient town scapes.
• In India adventure tourism and nature tourism have been identified as the largest segment of global and
domestic tourism.
• Indian doctors treat twice the number of patients in comparison to doctors in the west.

Weakness
A weakness is an inherent limitation or constraint which creates strategic disadvantages. An example of a
weakness is overdependence on a single service line, which is potentially risky for a service industry in
times of crisis. The weakness are as follows :
• No strong government support/ initiative to promote medical tourism.
• Low coordination between the various players in the industry- airline operators, hotels, and
hospitals.
• Lack of uniform pricing policies across hospitals.
• Cheating
• Political problems etc.

Opportunities
An opportunity is a favorable condition in the service industry which enables it to consolidate and
strengthen its position. The following are opportunities in medical tourism.
• Increased demand for healthcare services from countries with aging population (US, UK)
• Fast-paced life style increases demand for wellness tourism and alternative cures.
• Shortage of supply in National Health Systems in countries like UK, Canada.
• Demand from countries with underdeveloped healthcare facilities.
• Demand for retirement homes for elderly people especially Japanese.
• Personal touch by the doctors in India.
• Traffic system is well developed and easy to go from one country to another country.
• Medicines and lab our cost is low as compared to developed countries.

Threats
A threat is an unfavourable condition in the industry’s environment which creates a risk for, or causes
damage to, the industry. They are :
• Strong competition from countries like Thailand, Malaysia and Singapore.
• Lack of international accreditaion – a major inhibitor.
• Overseas medical care not covered by insurance providers.
• Under – investment in health infrastructure.
• Exorcism is more in India, foreigners may attract.
• Identifying a real practitioner is a major problem in India.
• Exploitation of tourists by illegal money changers.

India - Strategic Thrusts for the Future

The following section lays down the strategy for India to achieve leadership position in medical 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 Regulator to institute a uniform grading and accreditation system for hospitals to build
consumers’ trust.
• Acting as a Facilitator for encouraging private investment in medical infrastructure and policy-
making for improving medical tourism.

For facilitating investment the policy recommendations include:

• Recognize healthcare as an infrastructure sector, and extend the benefits

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Under sec 80-IA of the IT Act. Benefits include tax holidays for five years and concessional
taxation for subsequent five years.
• The government should actively promote FDI in healthcare sector.
• Conducive fiscal policies - providing low interest rate loans, reducing import/excise duty 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 Attachés to Indian embassies that promote health services
to prospective Indian visitors.

Conclusion
The medical tourism industry offers high potential for India primarily because of its inherent advantages in
terms of cost and quality. However the competition is getting heated up and the success in future will
largely be determined by development and implementation of a joint strategy by various players in the
industry. India is emerging as an attractive, affordable for healthcare & BUT there are some challenges that
the country has to overcome to become a tourist destination with competent health care industry. The
government should step in the role of a regulator and a facilitator of private investment in healthcare. An
apex body for the industry needs to be formed to promote the India brand abroad and aid inter-sectoral
coordination. Joint ventures with overseas partners and establishment of MEDICITIES will help in India
building a significant advantage and leadership position in the industry.

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