ZENITH

International Journal of Multidisciplinary Research

Vol.1 Issue 3, July 2011, ISSN 2231 5780

MEDICAL TOURISM IN INDIA: ISSUES, OPPORTUNITIES AND DESIGNING

STRATEGIES FOR GROWTH AND DEVELOPMENT

DR. SUMAN KUMAR DAWN *; SWATI PAL **

* Asst. Professor , Centre for Management Studies, JIS College of Engineering (Under West
Bengal University of Technology), Block ―A’, Kalyani , Nadia -741235 , West Bengal.

** Asst. Professor , Centre for Management Studies, JIS College of Engineering (Under West
Bengal University of Technology), Block ―A’, Kalyani , Nadia -741235 , West Bengal.

ABSTRACT

Medical tourism is becoming a popular option for tourists across the globe. It encompasses
primarily and predominantly biomedical procedures, combined with travel and tourism. The term
medical tourism has been coined by travel agencies and the mass media to describe the rapidly
growing practice of travelling across international borders to obtain hi-tech medical care.
Various countries like Thailand, Malaysia, India, etc are promoting medical tourism
aggressively. The key competitive advantages of India in medical tourism stem from the
following: low cost advantage, strong reputation in the advanced healthcare segment
(cardiovascular surgery, organ transplants, eye surgery etc.) and the diversity of tourist
destinations available in the country. The key concerns facing the industry include: absence of
government initiative, lack of a coordinated effort to promote the industry, no accreditation
mechanism for hospitals and the lack of uniform pricing policies and standards across hospitals.
Medical tourism or health care tourism is fast growing multibillion-dollar industry around the
world. It is an economic activity that entails trade in services and represents the mixing of two of
the largest world industries: medicine and tourism. The paper identifies the strengths of India’s
medical tourism service providers and points at a number of problems that may reduce the
growth opportunity of this industry. This paper focuses on the key issues and opportunities
possessed by Indian medical tourism sector that enable it to overcome domestic and international
barriers on upgrading its medical services. Finally, this paper analyses and concludes the main
reasons why the developing country like India attracts foreign tourists for the medical treatment. www.zenithresearch.org.in
KEYWORDS: Medical Tourism, SWOT, Yoga, Unani, Siddha, Ayurvedic, Naturopathy.
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INTRODUCTION AND SIGNIFICANCE OF MEDICAL TOURISM

Medical tourism is a new form of a niche tourism market which has been rapidly growing in the recent
years. The term medical tourism is the act of traveling to other countries to obtain medical, dental and
surgical care. According to Goodrich & Goodrich (1987), medical tourism is the attempt to attract tourists
by deliberately promoting its health-care services and facilities, in addition to its regular tourist amenities.
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Laws (1996) has defined medical tourism as a travel from home to other destination to improve one’s
health condition as one type of leisure. This includes getting indigenous and alternative medical services,
and any other form of tourism undertaken with the purpose of addressing a health concern. .

Connell (2006) describes medical tourism as a popular mass culture where people travel to overseas
countries to obtain healthcare services and facilities such as medical, dental and surgical care whilst
having the opportunity to visit the tourist spots of that country. Carrera and Bridges (2006) have defined
medical tourism as travel which is systematically planned to maintain one’s physical and mental health
condition.

According to GATS (General Agreement on Trade and Services), medical tourism is the second mode of
trade in health services. In this mode, customers (patients) leave their home country to obtain health care
services with high quality and affordable prices Blouin et al., (2006). Monica (2007) has defined that
medical tourism occurs when international patients travel across boundaries for their healthcare and
medical needs. It can be 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.

Bookman & Bookman (2007) have defined medical tourism as travel with the aim of improving one’s
health, and also an economic activity that entails trade in services and represents two sectors: medicine
and tourism. Medical tourism according to Dhaene (2009) is looking for available quality combined with
cost effective and low price health services while offering a similar level of safety to the patient. It has
become 60 billion US dollar a year business with growing rate about 20% by a year which could increase
to 100 billion US dollar by 2012. (Herrick, 2007)

Normally, the majority of medical tourists come from the industrialized countries of the world especially
Europe, the UK, Middle East, Japan, U.S. and Canada where the cost of medical treatment is very
expensive and there are often long waiting times for treatments. Other than India, countries that are
currently promoting medical tourism are Thailand, Malaysia, Singapore, South Korea Bolivia, Brazil,
Belgium, Cuba, Costa Rica, Hungary, and Jordan. Private sector development in emerging economies—
such as India, Thailand, Singapore, and certain Latin American nations—attracts foreign patients for
relatively cheaper care: the uninsured, the underinsured, or those who prefer not to wait for treatment
under a national health insurance system.

The main reasons for the growing popularity in medical tourism in India are: (a.) the long waiting lists in
the developed countries, (b) the low cost of medical treatments in India than the other developed
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countries. In India, complicated surgical procedures are being done at one-tenth of the cost as compared
to the procedures in the developed countries, ( c) The affordable international air fares and favorable
exchange rates, (d) the Internet; with the development of communications, new companies have emerged
who acts as middlemen between international patients and hospital networks, giving patients easy access
to information, prices and option, (e) the state-of-art technology, specialist doctors, nurses and para-
medical staffs that has been adopted by the big hospitals and diagnostics centers in India. In India, the
medical education system also caters to the ever increasing demand for the delivery of the quality health
care services all over the country ( Suthin et al., 2007).
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In order to realize the full potential of this industry, it is needed to develop a strategic plan on medical
tourism in India. This paper highlights the strategy that needs to be implemented for shaping India as one
of the key destinations for medical tourism across the globe.

OBJECTIVES OF THE STUDY

This research works explores opportunities, discusses its key challenges and designing the suitable
strategies for developing medical tourism in India.. It is based on a review of the literature, including
published research, web sites, newspapers, and the travel and tourism magazines that carry medical tourism
related information. This helps to design the strategies being used for promoting medical tourism in India.
This research work also strives to understand why some developing countries like India are more successful
in promoting medical tourism than others. In other words, it also emphasizes over the competitive
advantages of India over other countries. Lastly, it gives an approximate comparison of the cost of medical
treatments offered in India, USA, Thailand and Singapore.

MEDICAL TOURISM IN INDIA – THE CURRENT SCENARIO AND ITS DIFFERENT MODES

Medical Tourism is poised to be the next Indian success story after Information Technology. According to a
Mckinsey-CII study the industry’s earning potential estimated at Rs.5000-10000 Crores by 2012 (CII-
Mckinsey, 2002). Medical tourism can contribute Rs 5,000-10,000 crore additional revenue for up-market
tertiary hospitals by 2012 and will account for 3-5% of the total healthcare delivery market, says the
Confederation of Indian Industry (CII)-McKinsey study on healthcare (2002: pp.1-2). Horowitz and
Rosenweig (2007) have identified the following countries as being medical tourism destination: China ,
India, Israel, Singapore, Malaysia, Philippines, United Arab Emirates, Argentina, Bolivia, Brazil, Colombia,
Costa Rica , Cuba , Jamaica, Mexico, United States, Belgium, Germany, Hungary, South Africa and
Australia.

The major service providers in Indian medical tourism are: the Apollo Hospitals, Escorts Hospital, Fortis
Hospitals, Breach Candy, Hinduja, Mumbai’s Asian Heart Institute, Arvind Eye Hospitals, Manipal
Hospitals, Mallya Hospital, Shankara Nethralaya etc. AIIMs, a public -sector hospital is also in the fray. In
terms of locations – Delhi, Chennai, Bangalore and Mumbai cater to the maximum number of health
tourists and are fast emerging as medical tourism hubs. It also visualizes high-end healthcare services
through Indian BPO firms like Hinduja TMT, Apollo Heart Street, Comat Technologies, Datamatics and www.zenithresearch.org.in
Lapiz that work in the areas of claim adjudication, billing and coding, transcriptions and form processing.
One-stop centres in key international markets to facilitate patient flow and stream lining immigration for
healthcare are envisaged. The CII, along with Indian Health Care Federation (IHCF), wants to establish an
Indian healthcare brand synonymous with safety trust and excellence. Therefore, it is clear that the
opportunities and challenges for growth in the health sector are seen primarily within the private/corporate
sector, not in the public sector.

Nowadays medical tourism in India includes advanced and life savings health care services like open
transplants, cardio vascular surgery, eye treatment , knee/hip different cosmetic surgeries and alternate
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systems of medicine. Also leisure aspect medical traveling/wellness tourism may be included on such
medical travel trips. India provides a variety of medical services to overseas patients.

The medical tourism structure in India is depicted in figure 1.

Figure 1: The Medical Tourism structure in India

Medical
Tourism

Advanced and
Wellness Alternative Cosmetic
life savings
tourism systems of surgery
healthcare
medicine

The table 1 gives a classification of the services spectrum of medical tourism in India vis-à-vis its
competitive countries

Table 1: Classification of the services spectrum of medical tourism across globe

Wellness Alternative Cosmetic Advanced and

tourism systems of surgery life savings
medicine healthcare

Services offered Spas, Stress Ayurvedics, Dental Care, Open transplants, www.zenithresearch.org.in
relief, Siddha treatment Plastic Surgery , cardio vascular
rejuvenation for diseases e.g. Breast surgery, Eye
centres Arthritis, enhancement, treatment , Hip
Rheumatism Tummy Replacement , In
reduction , Skin vitrio
Treatment fertilization

Profit Margin Low Low Medium High

Key Thailand , South -- South Africa , Singapore ,

Competitors Africa Cuba , Thailand Jordan, Thailand
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and Malaysia

India’s Strength Low –Thailand High-Kerala is Low –South High-India has

has captured a popular for this Africa and strong image on
significant share service Thailand leads in medical tourism
of the market plastic surgery

India has a very old civilization of more than 5000 years and is known for her cultural and
religious diversities with diverse geographical landmarks. The traditional arts and crafts add to
her appeal to attract tourists. In India, according to the famous words “Atithi Devo Bhava” refers
tourists are treated as God. In India, in addition to existence of modern medicine, indigenous or
traditional medical practitioners continue to practice throughout the country. Popular indigenous
healthcare traditions include Ayurveda, Siddha, Unani, Naturopathy, and Yoga. Ayurveda
provides a complete system of preventive medicine and healthcare, which has been proven as its
effectiveness over a long period in India. The science of Ayurveda is based on the knowledge of
the human constitution. If every individual knows his or her own constitution, they can
understand what constitutes a good diet and lifestyle for themselves. The five great elements,
viz., ether, air, fire, water and earth are manifested into the three Dashas or biological
organizations known as Vata, Pitta and Kapha. These biological organizations are used by an
individual to gain a full understanding of all aspects of bodily functions, in order to establish the
harmonious balance required for a healthy existence. Ayurveda is based on natural herbs, which
gives distinct advantage.

The Siddha system defines disease as the condition in which the normal equilibrium of the five
elements in human beings is lost resulting in different forms of discomfort. The diagnostic
methods in Siddha medical system are based more on the clinical acumen of the physician after
observation of the patient, pulse and diagnosis and clinical history.

Unani system of medicine believes that the body is made up of four basic elements viz., earth,
air, water and fire, which have different temperaments i.e. cold, hot, wet and dry. After mixing
and interaction of four elements a new compound having new temperament comes into existence www.zenithresearch.org.in
i.e. hot-wet, hot-dry, cold-wet and cold-dry. Unani system of medicine believes in promotion of
health, prevention of diseases and cure.

Naturopathy has several references in the Vedas and other ancient texts, which indicate that these
methods were widely practised in ancient India. Naturopathy believes that the human body
possesses inherent self-constructing and self-healing powers. Naturopathy differs slightly with
other systems of medicine, as it does not believe in the specific cause of disease and its specific
treatment but takes into account the totality of factors responsible for diseases such as one’s
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unnatural habits in living, thinking, working, sleeping, or relaxation, and the environmental
factors that disturb the normal functioning of the body.

Yoga is a science as well an art of healthy living physically, mentally, morally and spiritually.
Yoga is believed to be founded by saints and sages of India several thousand years ago. Yoga has
its origin in the Vedas, and its philosophy is an art and science of living in tune with the
universe. Yoga, the art and science of maintaining physical and mental well-being, has its origin
in India. It is an instrument to self evolvement and enlightenment, through physical and mental
well-being. Various Yogic postures gently massage internal vital organs, keeping them in perfect
condition. Cholesterol levels are kept in check and the blood pressure is normalized. This
internal harmony cleanses and detoxifies the body and boosts the immune system.

All these traditional healthcare systems are attracting national and international patients, and
generate tourism flows

GROWTH, OPPORTUNITIES AND PROCESS OF MEDICAL TOURISM IN INDIA

The commitment to provide comprehensive healthcare to all citizens, irrespective of their paying
capacity, was given up by the Indian government after 30 years of Indian independence. After
the globalization and liberalization of Indian economy on 1991, the government of India has
opened up medical service to the voluntary and private sectors for foreign tourists and other
citizens who can pay to get the high-tech medical services. The rapid growth of the private sector
over the 1980s and the emergence of a corporate health sector in the 1990s was a part of the
comprehensive policy that chooses to promote these segments. This was done through shifting
subsidies in terms of cheap land, concessions from equipment and drug import, placing these
institutions on government panels and making them a part of government insurance schemes in
addition to providing trained personnel and expert physicians through state –supported medical
education.

As a part of medical tourism, India is recognized as the cradle for test tube babies and is popular
for surrogacy services (Qaders and John, 2009). Over than these, India offers high-tech cardiac,
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paediatric, dental, cosmetic and orthopaedic surgical services as well as the traditional healing
systems. The medical tourism definitely does not cater to emergency services. The services
provided are largely knee joint replacement, hip replacement (mostly orthopaedic), bone marrow
transplant, bypass surgery and cosmetic surgery etc. Hospitals also advertise for preventive
health check ups for family members accompanying the patients in addition to alternative
medicine services ( Peacock, 2009).
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Table 2: Cost comparison between India, USA, Thailand and Singapore

(Approximated figures in US$)
Procedure US India Thailand Singapore

Heart bypass 1,30,000 10,000 11,000 18,500

Heart valve 1,60,000 9,000 10,000 12,500

replacement

Angioplasty 57,000 11,000 13,000 13,000

Hip 43,000 9,000 12,000 12,000

replacement

Hysterectomy 20,000 3,000 4,000 6,000

Knee 40,000 8,500 10,000 13,000

replacement

Spinal fusion 62,000 5,500 7,000 9,000

International figures based on hospital quotes in named countries

Source: http://www.docstoc.com/docs/12163631/MEDICAL-TOURISM/P/36

Quality care, relatively cheaper services compared to the west, package deals and cheap services
from the tourism and hospitality sectors are the biggest attraction of medical tourism in India.
The price differentials of various procedures for Singapore, Thailand and India with the USA
reveal the economic advantage offered to interested patients by India.
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The health care sector in India has witnessed an enormous growth in infrastructure in the private
and voluntary sector. The Indian government predicts that India's health-care industry of $17
billion-a-year, could grow 13 per cent in each of the next six years, can be boosted up to 30 per
cent annually if bundled with tourism sector (International Marketing Conference on Marketing
& Society, 8-10 April, 2007, IIMK)
A detailed flow chart of the Indian medical tourism process is presented in figure 2.
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Figure 2: Flow chart for Indian medical tourism process

Prospective tourist to get medical

service in India

Planned
Medical
Treatment

Obtain invitation Visit India on other visa,

from hospital & get identify suitable
medical visa hospital/treatment
centre

Get medical services from requisite diagnostics and

hospital, receive post treatment instructions and get
discharged

Spend time through sightseeing of holidaying, if desired

and if medically permitted

Apply for and obtain visa extension, if required

Depart from India-Surrender registration certificate before

departure in the case of medical visa and where stay in
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India is for more than 180 days

KEY ISSUES TO THE MEDICAL TOURISM INDUSTRY IN INDIA

As various countries are at loggerheads to get a greater share in the medical tourism industry, India
needs to carve out a distant niche for itself, by leveraging its existing strengths and thereby offering a
unique value proposition. Generally, there are three types of medical tourists.
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Foreigners coming for medical treatment

Foreigners seeking treatment and leisure
Expatriates
The country like India is facing the following issues/challenges to become a tourist destination with
competent medical tourism industry. They are:

1. Lack of infrastructural facilities like lack of connectivity, lack of coordinating system,

poor power supply and poor water supply.
2. Most Indian hospitals are also facing the lack of trust from the foreign patients. The
hospitals have observed poor hygiene awareness in medical attendants, unhygienic food
handling, and lack of proper hospitality services, heterogeneous pricing of services and
no industry standards.
3. The government can play a vital part to upgrade the medical tourism sector. But the
industry is facing the following problems which are caused by the governments. They
are: (a) no regulations, (ii) taxation anomalies, (c ) bureaucratic roadblocks, (d) no works
on land reforms, (e) lack of long-term investor friendly policies and (f) instability with
respect to terrorism and communal tensions.
4. On the part of insurance and allied services, the medical tourism industry in India is also
facing some key bottlenecks. They are: (a) inadequate insurance cover, (b)
underdeveloped insurance market in India, (c) insurance frauds and (d) overseas
companies refusing reimbursement.
5. The following challenges, due to the infrastructural parts in medical tourism sector in
India, are: (a) poor accessibility, (b) lack of capital, (c) lack of Community participation
and awareness, (d) lack of involvement from rural sector, (e) lack of concern for
sustainability, (f) complex visa procedures, (g) lack of good language translators, and (h)
poor airport facilities.
6. Apart from these, there are some specific issues to promote medical tourism in India.
They are: (a) quality accreditations to the Indian hospitals and service providers, (b)
training and Development to the Doctors, Nurses and Para medical staffs, (c) lack of
customer oriented approach
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MEDICAL TOURISM IN INDIA – SWOT ANALYSIS

The figure 3 depicts the SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis on the
Indian medical tourism Industry in its current state:
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Figure 3: SWOT analysis on Indian medical tourism
Strengths
Quality Service at Affordable Cost
Vast supply of qualified doctors
Strong presence in advanced healthcare
e.g. cardiovascular, organ transplants –
high success rate in operations
International Reputation of hospitals
and Doctors
Diversity of tourism destinations and
experiences
Opportunities
Increased demand for healthcare
services from countries with aging
population (U.S, U.K)
 Fast-paced lifestyle increases demand
for wellness tourism and alternative
cures
Shortage of supply in National Health
Systems in countries like U.K, Canada
 Demand from countries with
underdeveloped healthcare facilities
 Demand for retirement homes for
elderly people especially Japanese
Weakness
No strong government support /
initiative to promote medical tourism
Low Coordination between the various
players in the industry– airline operators,
hotels and hospitals
Customer Perception as an unhygienic
country
No proper accreditation and regulation
system for hospitals
Lack of uniform pricing policies across
hospitals
Weaknesses
Strong competition from countries like
Thailand, Malaysia, Singapore
 Lack of international accreditation
Overseas medical care not covered by
insurance providers
 Under-investment in health
infrastructure
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DEVELOPING STRATEGIES ON INDIAN MEDICAL TOURISM

After the SWOT analysis on Indian medical tourism and also interviewing the healthcare service
providers in India as well as observing the different websites related to medical tourism’s growth and
opportunities, the following marketing strategies may be used by India’s healthcare service providers.
They may be based on the 7 Ps of marketing mix: Product, Price, Place, Promotion, People, Process, and
Physical Evidence (Kotler, 2008; Chartered Marketing Institute, 2005).

1. Product: India has a number of hospitals offering world class treatments in nearly every medical
sector such as cardiology and cardiothoracic surgery, joint replacement, orthopaedic surgery,
gastroenterology, ophthalmology, transplants and urology to name a few. The various specialties
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. Well-
trained medical staff with international board certification (US, UK, Australia, Germany, Japan) are
considered as a valuable asset of the companies and used as an important tool to promote healthcare
services. Moreover, the cutting-edge technology and equipment available made by each hospital is also
used as one of the major products in this industry. Another marketing strategy used by service providers
is to create more value through services. Superior value-added services have been created to
differentiate themselves from their increasing competitors, increasing its efficiency, creating
convenience for the patients, and developing and strengthening the customer relationships. These non-
medical care services are services such as, on-line service for medical arrangement, travel arrangement,
interpreter services in many languages , luxury service apartments for patients’ relatives adjacent to the
hospital, hotel selection and reservation, sightseeing tour services, medical transportation both on land
and air, one-to-one nursing care service, and etc. Major healthcare service providers in India have www.zenithresearch.org.in
started expanding their business to other countries by investing in and/or operating hospitals or medical
center overseas. These hospitals function as a diagnostic center for screening cases and also for follow-
ups in medical treatments.

2. Price: India’s healthcare service providers have a competitive advantage among their competitor due
to its high standard of medical treatments and services offered to the patients at a very competitive
price. In India, complicated medical procedures are being done only at one tenth of the cost in
industrialized countries but in terms of infrastructure facilities such as roads, sanitation, power backups,
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accommodations, and public utility services much more is needed for the country to become a medical
tourism destination (Kaur et al., 2007).

3. Place: Internet is the main means for disseminating information related to medical and non-medical
care services offered by each of healthcare service providers. It is the most effective and inexpensive
way to reach the product to its target customers directly, and at the same time helping patients acquire
correct and valuable information allowing them to make an informed decision. Informative online
marketing of each service provider creates awareness of the medical treatments available and reassures
potential patients. Interactive communication, treatments description, description of services and
facilities, quality assurance other concierge services were also presented on the websites to attract the
patient who are on medical traveling program. All the healthcare service providers generally take the
help of the agents the in promoting their medical tourism. These agents provide information and
recommend the patients regarding their treatments to the hospitals. They work as a center cooperating
between patients and hospitals for screening cases, sending all the necessary medical reports of the
patients to the hospitals. And at the same time agents have the responsibility of advertising and doing
marketing in those countries for healthcare service providers, spreading word of mouth advertising of
service assurance and reliability.

4. Promotion: Most healthcare service providers in India particularly big private hospitals participate in
travel marts, travel fairs, trade fair, exhibitions, seminars, conferences, and advertise in travel magazines
in countries with the supporting from the government. In addition, other informative materials such as
brochures, booklets, video-cds, paper bags and t-shirt with logos were also used to create awareness of
the available healthcare services as well. Moreover, some healthcare service providers in India build up
cooperation with the local institutes, universities, medical schools in other countries to establish
collaboration in education, exchange of knowledge and training as well as to promote their alternative www.zenithresearch.org.in
healthcare services. Advertising about medical and non-medical services in both local and international
media are used by healthcare service providers. Articles, video, news related to their high quality and
standard of medical treatments and services, health issues, latest medical technology equipment,
quality assurance/awards/accreditation available on their own websites and also to the international
media. These help to create awareness of the available alternative medical treatments as well as to
build up a positive image of the high quality and international standard of medical care in India.
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5. People: Another strategy that Indian healthcare service providers may use to attract the international
patients for their low cost treatments in India as well as to get the medical services by its well-trained
medical specialists who have qualified from well-known overseas institutes. It is well acknowledged that
having specialized and qualified doctors and staffs gives a competitive advantage for the hospitals.
However, shortage of doctors and trained medical staff is treated as the major concern in medical
tourism in India. Moreover, due to the misunderstanding of the patients’ culture are still considered as
problems and challenges for medical tourism business in India.

6. Process: International patients who seek medical treatments are mostly concerned with the quality of
treatments and also want that the service providers preferably be accredited by a recognized
international organization that audits medical quality. India has a large pool of doctors (approx
6,00,000), nurses and paramedics 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 health care services all over the country. The Joint Commission
International (JCI) recognizes and accredits that the standard of the hospital meets or exceeds the
standard of medical facilities as compared to the west. India is a popular destination for medical
tourists. (Iyer, M., 2004)

7. Physical Evidence: In India, big hospitals like Apollo Hospitals, Escorts Hospital, Wockhardt Hospitals,
Breach Candy Hospitals Lilavati Hospital, Manipal Hospitals, Mallya Hospital, AMRI Hospitals etc. have a
good ambience in their infrastructures with spacious, luxury rooms and excellent amenities same as that
of a five star hotel for patients and relatives, and also are equipped with cutting-edge technology. This is
a competitive advantage of India in order to gain the confidence and build up the trust of international
patients, making a decision to choose India as their preferred choice.

SUGGESTIONS FOR DEVELOPING INDIAN MEDICAL TOURISM

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The following suggestions lay down the future path for India to achieve leadership position in medical
tourism. Theses suggestions largely draw from the discussions with various stakeholders as well as
observing the other countries’ medical tourism conditions.

(1) Role of Government

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The government of India must act as a regulator to institute a uniform grading and accreditation system
for hospitals to build consumers’ trust. It also acts as a facilitator to encourage private investment in
medical infrastructure and policy-making for improving medical tourism. The government should
actively promote FDI (Foreign direct investment) in healthcare sector as well as also enacts conducive
fiscal policies - providing low interest rate loans, reducing import/excise duty for medical equipment It
also facilitates clearances and certification like medical registration number, anti-pollution certificate
etc. The government should reduce barriers in getting medical visa and institute visa-on-arrival for
patients and also can create medical attachés to Indian embassies that promote health services to
prospective Indian visitors.

(2) Medical Visas: A simplified systems of getting medical visas should be developed in order to make
travel across borders smoother. Visas can be extended depending on the condition of the patients. The
procedures for obtaining medical visa, the subsequent registration and visa extension procedures are
complicated and time consuming. There is a need to simplify and speed up these procedures to make
India a more attractive medical tourism destination.

(3) Holistic medical and diagnostic centers within the corporate hospitals: Most of the big tertiary
hospitals are opening up holistic centers within the premises, with yoga and meditation programmes
long with naturopathy, herbal medicine, acupuncture and homeopathy departments. The claim is that
these enhance treatment. However, these services are charged for and add to additional revenues. The
hospitals have small spaces for the relatives to pray in, thereby wedding science with religion and
traditional with modern medical practices.

(4) Setting Up National Level Bodies: To market India’s specialized healthcare products in the world and
also address the various issues confronting the corporate healthcare sector, leading private hospitals
across the country are planning to set up a national-level body on the lines of National Association of
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Software and Service Companies (NASSCOM), the apex body of software companies in the country. . It is
therefore essential to form an apex body for health tourism – National Association of Health Tourism
(NHAT). The main agenda for NAHT will be:

(a) Building the India Brand Abroad: Classify the target consumer segments based on their
attractiveness and position the India Brand based on the three main value propositions – high quality
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service, value for money and destination diversity. An integrated marketing Communications campaign
using print, media and road shows should be developed.

(b) Promoting Inter-Sectoral Coordination: The NAHT should take up the responsibility of aligning the
activities of various players – Tourism Department, Transport Operators, Hotel Associations, Escorts
personnel etc.

(c) Information Dissemination using Technology: NAHT should set up a portal on medical tourism in
India targeted at sharing information and enabling online transactions.

(d) Standardization of Services: NAHT should also focus on establishing price parity for similar kinds of
treatments in various hospitals and ensure the hospitals adhere to high hygiene and quality standards. It
is felt that not only the private hospitals but the country too stands to benefit from this by earning
foreign currency (Roy Choudhury and Dutta 2004).

(5) Integrate vertically: Various added services may be offered to the patients. For example, hospitals
may have kiosks at airports, offer airport pickups, bank transactions, or tie-ups with airlines for tickets
and may help facilitate medical visas by the government. With more Arab patients coming in, some
hospitals may have hired Arabic interpreters, stocked up on prayer rugs and opened up a kitchen serving
the food preparations in corporate hospitals in India.

3. Joint Ventures / Alliances: To counter increasing competition in medical tourism sector, Indian
hospitals should tie-up with foreign institutions for assured supply of medical tourists. Specifically they
may tie-ups with capacity constrained hospitals and insurance providers. For example Mohali’s Fortis
Hospital has entered into a mutual referral arrangement with the Partners Healthcare System, which has
hospitals like Brigham Women’s Hospital and Massachusetts Hospital in Boston under its umbrella, to
bring patients from the US (Kohli 2002). The Apollo group has also tied up with hospitals in Mauritius,
www.zenithresearch.org.in

Tanzania, Bangladesh and Yemen. In addition, it runs a hospital in Sri Lanka, and manages a hospital in
Dubai (Dogra 2003).

As a part of this policy of promoting public and private initiatives, the Indian travel industry and tour
operators have also design packages that include air travel, hotel accommodation, and surgery
expenses, claiming savings. They may also operate jointly to facilitate travel for medical services. Other
than the central government’s list of hospitals for medical tourism on the web, the medical tourism may
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also get promoted through popular magazines, tourist guide books, business magazines and journals on
tourism. Textual and video testimonies of cured foreign patients and administrators describing the
excellence of the treatment, the low cost, the professional approach, the technical expertise, the
affectionate and caring doctors and staff, and the cutting edge technology are all displayed on hospital
web sites as evidence of efficiency.

CONCLUSION

India is in an advantageous position to tap the global opportunities in the medical tourism sector. The
government’s role is crucial to the development of medical tourism. The government should take steps
in the role of a regulator and also as a facilitator of private investment in healthcare. Mechanisms need
to be evolved to enable quicker visa grants to foreign tourists for medical purposes where patients can
contact the Immigration Department at any point of entry for quick clearance. Tax incentives to the
service providers, import duty reduction on medical equipment, committees to promote and foster
medical tourism are some of the initiatives that can be undertaken. There is also a need to develop
supporting infrastructure such as transport services to facilitate tourism in India. The tourism, health,
information and communication departments need to work in tandem for efficient patient care. This
paper has recommended some of the medical tourism strategies for further promoting medical tourism
in India. These include building and promoting the image of India as high quality medical tourism
destination, creating and promoting new combination of medical tourism products, keeping up the high
standard of quality treatments at a reasonable price, providing informative online and offline materials
and make them available to the potential customers. Also attaining the accreditation/standard to
reassure the quality of treatments as well as emphasizing on the needs and demands of the existing
target markets must be incorporated.

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