PROSPECTS OF MEDICAL TOURISM FOR EYE CARE IN

BIRATNAGAR

By
Asim Pokhrel (16537/15)

A Summer Project Report Submitted to

B.B.A Program
In partial fulfillment of the requirement for the award of the degree of
Bachelor of Business Administration
Seventh Semester

at
Mahendra Morang Adarsh Multiple Campus
Tribhuvan University

Biratnagar-16
Baishak/2076
 STUDENT DECLARATION

This is to certify that I have completed the Summer Project entitled “PROSPECTS OF
MEDICAL TOURISM FOR EYE CARE IN BIRATNAGAR” under the guidance “Mr.
Mohan Subedi” in partial fulfillment of the requirements for the degree of Bachelor of
Business Administration at Faculty of Management, Tribhuvan University. This is my
original work and I have not submitted it earlier elsewhere

Date: Signature:
Name: Asim Pokhrel

ii
 CERTIFICATE FROM THE SUPERVISOR

This is to certify that the summer project entitled “PROSPECTS OF MEDICAL TOURISM
FOR EYE CARE IN BIRATNAGAR” is an academic work done by “Asim Pokhrel”
submitted in the partial fulfillment of the requirements for the degree of Bachelor of
Business Administration at Faculty of Management, Tribhuvan University under my
guidance and supervision. To the best of my knowledge, the information presented by him
her in the summer project report has not been submitted earlier,

Mohan Subedi
Designation: Supervisor
10th of Baishak, 2076

iv
 ACKNOWLEDGEMENT

The age of learning where a day starts with a new information and innovation has provided
us challenges and opportunities to be enhanced but also has led a path of struggle of tough
competition. Hence, learning by doing is must. Hence, I would express my deep sense of
gratitude to TU, FOM for providing us opportunity of summer project report writing in the
curriculum.
I would like to acknowledge and would like to express our deepest sense of gratitude and
sincerely thanks to Supervisor, Mr. Mohan Subedi for his guidance, encouragement, sincere
support and valuable suggestion.
I would like to express our sincere thanks to Udgam Mishra, Program Coordinator (BBA)
for whole hearted support. I am very much indebted to the whole Team of Biratnagar Eye
Hospital for their kind co-operation and heartily support. I would love to praise friendlier
and helping hand, Kishor Basnet, Senior IT assistant of BEH for extracting the data even in
rush hour.
My thanks and appreciation also go to the IT Faculty, Mr Anil Yadav for his valuable
guidelines and suggestion for formatting this report and special thanks to our classmates
especially, Susmita Timalsena, for her valuable suggestions in preparing this report.

Thank You
Asim Pokhrel

v
 TABLE OF CONTENTS

STUDENT DECLARATION ............................................................................................ ii

CERTIFICATE FROM THE SUPERVISOR ................................................................... iv

ACKNOWLEDGEMENT ................................................................................................. v

LIST OF TABLES ......................................................................................................... viii

LIST OF FIGURES .......................................................................................................... ix

ABBREVIATIONS ........................................................................................................... x

EXECUTIVE SUMMARY .............................................................................................. xi

CHAPTER I: INTRODUCTION ....................................................................................... 1

1.1 Context Information ................................................................................................. 1

1.2 Statement of the Problem ......................................................................................... 2

1.3 Purpose of the study ................................................................................................. 2

1.4 Significance of the study .......................................................................................... 3

1.5 Limitations of the study............................................................................................ 3

1.6 Literature Review..................................................................................................... 3

1.6.1 Pull and Push Factors of Medical Tourism ......................................................... 4

1.4.2 Medical Tourism in Africa and Middle East ...................................................... 6

1.4.3 Medical Tourism in America ............................................................................. 7

1.4.4 Medical tourism in Asia and Pacific Islands ....................................................... 7

1.4.5 Medical Tourism in Europe ............................................................................... 8

1.4.6 Medical Tourism in Nepal ................................................................................. 8

1.4.7 Medical Tourism for eyecare in Biratnagar ........................................................ 9

1.5 Research Methodology........................................................................................... 10

1.5.1 Research Design .............................................................................................. 10

1.5.2 Population and Sample .................................................................................... 10

1.5.3 Data collection Techniques .............................................................................. 10

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 1.5.4 Data Presentation and analysis ......................................................................... 11

CHAPTER 2: DATA PRESENTATION AND ANALYSIS ............................................ 12

2.1 Organization Profile ............................................................................................... 12

2.2 Data Presentation and analysis ............................................................................... 14

2.2.1 Surgeries of BEH on different years................................................................. 14

2.2.2 OPD of BEH of different year.......................................................................... 16

2.2.3 Number of Surgeries and OPD of BEH in 2018 ............................................... 18

2.2.4 Population distribution of Sample .................................................................... 20

2.2.5 Population Distribution by Age........................................................................ 22

2.2.6 Number of -persons accompanied by patients .................................................. 23

2.2.7 Reasons of Medical Tourism for eyecare in Biratnagar .................................... 24

2.3 Findings and Discussion......................................................................................... 26

CHAPTER 3: CONCLUSION AND IMPLICATIONS ................................................... 28

3.1 Conclusion ............................................................................................................. 28

3.2 Action Implication ................................................................................................. 29

REFRENCES .................................................................................................................. 30

APPENDICES ................................................................................................................ 32

Appendix A: Questionnaire for examining the prospects of medical tourism for eye care
in Biratnagar ................................................................................................................ 32

Appendix B: Questionaire For BEH ............................................................................. 34

vii
 LIST OF TABLES

TABLE 2. 1 SURERIES OF BEH ON DIFFERENT YEARS ......................................... 14

TABLE 2. 2 NUMBER OF OPD PATIENTS OVER DIFFERENT YEAR ..................... 16

TABLE 2. 3 NUMBER OF DIFF. SURGERY AND OPD PATIENTS OF 2018............. 18

TABLE 2. 4 POPULATION DISTRIBUTION OF SAMPLE.......................................... 20

TABLE 2. 5 REASONS FOR MEDICAL TOURSIM ..................................................... 24

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 LIST OF FIGURES

FIGURE 1. 1 PUSH AND PULL FACTOR OF MEDICAL TOURSIM IN NEPAL ......... 4

FIGURE 2. 1 NO OF SURGERIES IN BEH OF DIFFERENT YEAR ............................ 15

FIGURE 2. 2 NUMBER OF OPD PATIENTS OVER DIFFERENT YEAR ................... 17

FIGURE 2. 3 NUMBER OF DIFF. SURGERY AND OPD PATIENTS OF 2018 ........... 19

FIGURE 2. 4 PERCENTAGE OF POPULATION DISTRIBUTION OF SAMPLE ....... 21

FIGURE 2. 5 PERCENTAGE OF POPULATION DISTRIBUTION BY AGE .............. 22

FIGURE 2. 6 NUMBER OF PERSON ACCOMPANIED BY PATIENTS ..................... 23

FIGURE 2. 7 REASONS FOR MEDICAL TOURISM ................................................... 24

ix
 ABBREVIATIONS

BEH Biratnagar Eye Hospital

OPD Out Patient Department
EREC-P Eastern Regional Eye Care Programme
NNJS Nepal Netra Jyoti Sangh
IMTJ International Medical Travel Journal
JCI Joint Commission International
PECC Primary Eye Care Center

x
 EXECUTIVE SUMMARY

Medical tourism refers to people traveling to a country other than their own to obtain medical
treatment. Despite the huge prospect of medical tourism for eye care in Biratnagar, various
factors restricted the city to achieve its true potential. The author intends to investigate the
trend of medical tourism and the perception of medical tourist and draft out the prospects of
medical tourism for eye care in Biratnagar. The minimal cost of treatment, service quality,
promptness in services has helped in fostering the prospects while the strikes, instability,
lack of proper long-term vision of the governing authority has backed it. Despite the
weakness, the industry is in the prosperity.

The concept of medical tourism was introduced very earlier in other countries. Various
Foreign governments allocates their budgets regarding development of medical tourism
whereas Nepal has yet been exploring the possibility in Nepal.

The number of surgeries has been increasing over the years . The surgeries are growing by
3.99% and so does the OPD patients is growing by 19.07%. The total surgery of 2018 is
headed by the cataract surgery which almost accounts for 75%. The OPD for general
consultation accounts the most portion of the OPD. The OPD is growing very rapidly.
Around 94% of the total foreign tourist are from the India. The research shows that the age
group of 40-60 are very affected by eye diseases but these age group accounts most for the
OPD care. The surgery is accounted mostly by the age group of 0-20 and 60+ patients.

Maximum number of consumers accompanied two to three number of persons. The prospect
is not only concerned with the surgeries but also majorly with the person accompanied by
the patients. The research reveals that the reason for ongoing increasing prospect of medical
tourism is due to the cost effectiveness, qualitative services etc. The various facilities
provided, and the behavior of staff has led in improvement of effectiveness of the hospital.
Hence, The Biratnagar has huge prospect of medical tourism for eye care.

xi
 CHAPTER I: INTRODUCTION

1.1 Context Information

Context is the background, environment, setting, framework, or surroundings of events or

occurrences. Simply, context means circumstances forming a background of an event, idea
or statement, in such a way as to enable readers to understand the narrative or a literary piece.

Medical tourism refers to people traveling to a country other than their own to obtain medical
treatment. In the past this usually referred to those who traveled from less-developed
countries to major medical centers in highly developed countries for treatment unavailable
at home. However, in recent years it may equally refer to those from developed countries
who travel to developing countries for lower priced medical treatments. The motivation may
be also for medical services unavailable or illegal in the home country.

The profitability and the lucrative idea of the medicinal tourism business have now put this
exchange. High on the motivation of both the Nepal government and the private human
services suppliers. Today, medical tourism has turned into an ordinary practice countless
around the globe thanks to its effectiveness and good results.

Normal limitations like language, finance, challenges in worldwide travel are no longer
going about as boundaries to the voyagers who seek medical treatment in outside nations.
Reasonable amazing restorative offices can make Nepal, extraordinary compared to other
conceivable center points for Medical

Apart from Nepal being as a tourism destination for trekking, adventure, culture, traditions
etc., Nepal is now being hub for affordable high-quality medical facilities. This study only
tries to cover the medical tourism for eye care. The medical tourism for eye care in Nepal
was quite a different some decades ago. Verdys Corporation Limited (2019) study shows
that more than two hundred thousand Indian patients visit Nepal for eye surgery and around
one and half million for eye treatment.

Medical Tourism in context of Nepal and in context of Biratnagar. Biratnagar is attracting

hordes of eye patients from various neighboring states of India for eye examination and eye
surgery. The factors that have led to the increasing popularity of eye care for Indian patients
are affordability, less waiting time for treatment, ease of travel to Nepal and good standards

1
of treatment. In Biratnagar, there are three well equipped Eye hospitals; Biratnagar Eye
hospital, Ram Lal Golchha Eye hospital and Taparia eye hospital. The fame of Biratnagar
Eye Hospital has spread far and wide, attracting patients from various neighboring
countries. The growth in foreign patients is due to its reputation for curing eye problems.
Earlier, there was only one eye hospital in the region, Ram Lal Golchha Eye Hospital. Now
there are three, Birat Eye Hospital and Tapadia Eye Care.

Biratnagar Eye Hospital is an Eastern Regional Eye care Programme hospital located in
Biratnagar Nepal. The hospital is a development of Sagarmatha Choudhary Eye hospital,
Lahan. Biratnagar Eye Hospital since its inception in September 2006 has progressed into
an eye hospital widely recognized for delivering affordable high-quality eye care services to
the economically poor and under-privileged people of the community.

1.2 Statement of the Problem

The medical tourism for eye care in Biratnagar has a huge prospect. However due to lack of
proper tourism policy, proper infrastructure and Technical manpower, the medical tourism
for eyecare in Biratnagar cannot achieve its true potential. In response to the problem, the
study proposes to investigate that the prospects can further be increased by applying various
measures. The following research questions can be raised from the above statement of
problem.

1. What is the current situation of medical tourism for eye care in Biratnagar?
2. What are the current prospects for medical tourism for eye care in Biratnagar?

1.3 Purpose of the study

The research purpose is a statement of "why" the study is being conducted, or the goal of the
study. The purpose of the study are :

1. To Examine the situation of medical tourism for eye care in Biratnagar.

2. To Analyze the prospects of medical tourism for eye care in Biratnagar.

2
1.4 Significance of the study

The significance of the study is the part of the introduction of the research work which
determine who will benefits from the study and how that specific audience will benefit from
the findings. The significance of the study are as follows;

 To the government
o It facilitates for formulation of policy for medical tourism.
 To the society
o It reviews the present conditions of the medical care of the domestic
organization
 To the health care business consultants
o It provides opportunity to access their prospects.

1.5 Limitations of the study

1. The study is conducted in limited time frame. So, long term analysis cannot be
done within short span of time.
2. The sample is small in size, so some sampling error exist in the research
3. The research is carried only on some past data of some years
4. The research is carried only in the BEH.

1.6 Literature Review

A literature review is a comprehensive summary of previous research on a topic. The

literature review surveys scholarly articles, books, and other sources relevant to a particular
area of research.

The word tourist was used in 1772 and tourism in 1811. It is formed from the word tour,
which is derived from Old English ‘Turian’, from Old French ‘torner’, from Latin ‘tornare'
to turn on a lathe, which is itself from Ancient Greek. (Wikimedia foundation, 2019)

(Global Health Care Resources, 2019) define Medical Tourism is where people who live in
one country travel to another country to receive medical, dental and surgical care while at
the same time receiving equal to or greater care than they would have in their own country,
and are traveling for medical care because of affordability, better access to care or a higher
level of quality of care.

3
The first recorded instance of people travelling for medical treatment dates back thousands
of years to when Greek pilgrims traveled from the eastern Mediterranean to a small area in
the Saronic Gulf called Epidauria. This territory was the sanctuary of the healing god
Asklepios. (Wikimedia Foundation, 2019)

Hunzker and Krapf, in 1942, defined tourism as "the sum of the phenomena and relationships
arising from the travel and stay of non-residents, insofar as they do not lead to permanent
residence and are not connected with any earning activity.”

Tourism is one of the mainstays of Nepalese economy. It is also a major source of foreign
exchange and revenue. Possessing 8 of the 10 highest mountains in the world, Nepal is a
hotspot destination for mountaineers, rock climbers and people seeking adventures. The
Hindu, Buddhist and other cultural heritage sites of Nepal, and around the year fair weather
are also strong attractions.

Nepal is the country of the Mount Everest, the highest mountain peak in the world, and the
Birthplace of Gautama Buddha- Lumbini. Mountaineering and other types of adventure
tourism and ecotourism are important attractions for visitors. There are other important
religious pilgrimage sites throughout the country for the followers of various sects and
religions.

1.6.1 Pull and Push Factors of Medical Tourism

Figure 1. 1 Push and Pull factor of medical toursim in Nepal

4
The figure 1.1 show the factors affecting medical tourism in Nepal. The factors are divided
into two types, pull and push factors. Push factor are those factors that forces the individuals
or peer groups to leave the domestic country for seeking the medical facilities in foreign
countries. The major push factors include political instability, strikes, unavailability of
certain treatments etc. In context to these research work, the author only intends to assign
three factors as major push factors for medical tourism. The major pull factors include low
cost, qualitative services

The political instability is the major push factor for medical tourism. Nepal has not any stable
government from B. S. 2007 till now. The ongoing changing political instability, the
changing government results in the changing rules, regulation of the national health sector.
The changing health policy has pushed the medical tourism from Nepal. Many people from
Nepal are going to hospitals of India, Thailand, USA etc.

During January 2008 through August 2013, altogether 4451 events of strikes have been
recorded in Nepal, whose concentration is higher in Terai (55 percent) in economic belts and
Eastern part (32 percent) in development regions. Political parties and rebellion groups have
called for general strikes at higher frequency (36 percent and 17 percent respectively) to
bargain on partisan demands with ruling party. Transport unions come at third position (9
percent) in this line. Local communities (8 percent) falls on fourth position followed by
ethnic and alliance groups (5 percent).

Regarding the economic cost of such general strikes, it is found that one day’s nationwide
strike in Nepal brings a loss of about NRs. 1.8 billion, mostly coming from service and
industry sectors. At this rate, Nepal has incurred a total output loss of NRs. 117 billion in a
period of five years ranging from 2008 to 2013 at an average of NRs. 27 billion per year at
current prices. Out of this, Kathmandu, Morang and Jhapa bear the largest chunks of gross
output loss (6 percent, 4 percent and 3 percent, respectively) at district level. The total output
lost per year due to strikes makes 1.38 percent of the annual gross output. (Shrestha &
Chaudhary, 2019)

Chaulagain (2018) asserts that due to the unavailability of treatment equipment in all parts
of the country, added the unaffordable cost, many patients were dying without proper
treatment.

5
To improve eye care, Nepal has increased the number of eye care professionals trained in
western medicine. Nepal has only one ophthalmologist per 250000 people but has
approximately 300 ophthalmic assistants and other eye care workers such as optometrists
and eye workers. These ophthalmic assistants serve as the heads of primary eye care centers
(PECCs)

The Pull factors includes qualitative services, lower medical cost and promptness in services.

Despite a decade long conflict, the absence of local government for 20 years, instability and
bad governance, Nepal has taken dramatic strides in improving the health of its citizens. And
it is in eye care that the achievement has been most impressive. Thirty years ago, the Nepal
Blindness Survey showed that 0.8% of the population was blind. Nepal’s population then
was 15 million, which means 118,000 people were blind. Cataracts was the cause in 72% of
the cases, and trachoma, a bacterial infection of the eye, was the second leading cause of
blindness. Poor eye-sight and blindness due to Vitamin A were also prevalent. Most of these
were preventable or curable. Women were found to be 1.35 times more likely to get cataracts
because of the detailed nature of their work, and injuries stemming from household work
and farming.

Today, the prevalence of blindness has decreased to 0.3% out of a population of 29 million,
which means only 87,000 are visually impaired. But most of them are blind still because of
cataracts. Last year Nepal became the first country in South Asia to eliminate trachoma.
Cataracts and other preventable cases can now be treated much earlier with modern surgery.
The quality of community cataract surgery here is one of the best among developing
countries and people are coming forward for treatment because they trust us. (Awale, 2019)

The ERECP has undergone one hundred and thirty free camps for the eye care in various
rural areas. The cost of eye care in BEH is very minimal. The promptness in service has also
led in the increasing prospect of medical tourism.

1.4.2 Medical Tourism in Africa and Middle East

Jordan, through their Private Hospitals Association, managed to attract 250,000 international
patients accompanied by more than 500,000 companions in 2012, with a total revenue
exceeding 1B US$. Jordan’s hospitals achieved remarkable success in dealing with the
phenomenon of the “Arab Spring” and in treating patients from Arab countries affected by

6
revolutions. (IMTJ Medical Travel Awards, 2019) Israel, Iran and UAE are said to be the
important places for emerging of medical Tourism in the middle east.

(Medical Tourism South Africa, 2019) asserts that South Africa is said to be the market
maker for the medical tourism in Africa. The South Africa is offering the world class
specialist at the offer able prices. It also Provides the services like IVF, Egg donation and
various other packages.

1.4.3 Medical Tourism in America

Brazil is said to be the first country to have JCI accredited facility outside of the US. Mexico
have seven JCI accredited hospitals. The similar service in Mexico hospitals save around 40
to 60% of the total cost than hospitals of US.

(MacLeod, 1993) asserts that his 12 to 20 of his patients at any one time are ineligible
Americans. This assertion claims that the medical tourism was prevailed that time for saving
the cost

Most of those patients in search of the best care, including 38% from Latin America, 35%
from the Middle East, 16% from Europe and 7% from Canada, are heading to the United
States. Additionally, it's estimated that 32% of all medical travelers simply want better care
than is available in their home countries, mostly those in the developing world, and 15%
want quicker access to medically necessary procedures. That's compared to only 9% of
medical travelers seeking medically necessary procedures at lower prices and 4% seeking
low-cost discretionary procedures. (Forbes Media, 2019)

1.4.4 Medical tourism in Asia and Pacific Islands

Malaysia won six titles out of 15 in IMTJ Medical Travel award 2018 and Health and
Medical Tourism; Destination of the year in 2017. Medical tourism is also growing in India.
Chennai is regarded as the Health City of the India as it is said that it attracts around 45% of
the health tourist of the India. (India Health Visit, 2019).

Singapore has dozens of hospital and health centers with JCI accreditation. Thailand has also
become the popular destination for medical tourism, attracting the patients from heat surgery
to fertility treatments. It is said that Thailand is among the ten most popular destination for

7
medical tourism in the world. New Zealand, Pakistan and Singapore are also said to have
less medical cost than the USA for same medical Treatment.

The ministry of Tourism figures that the medical tourism industry of India could grow by
200% by 2020, hitting $9 Billion. Medical tourism is a growing sector in India is becoming
the 2nd medical tourism destination after Thailand. is regarded as "India's Health City" as it
attracts 45% of health tourists visiting India and 40% of domestic health tourists. (Suri, 2019)

1.4.5 Medical Tourism in Europe

Croatia has a claim to be the oldest destination for the Health and medical tourism destination
in Europe. (WHO, 2000) carried out the first ever analysis of the world health report and
claims France to have the world leading health care system. Azerbaijan also attract a lot of
medical tourist from the Iran, Turkey, Russia and Georgia. Bona Dea Hospital was launched
in Baku for bringing the national health system under the universal standard. Around 4.4%
of the total budget is invested in the health care system to achieve this purpose. (Mehdiyev,
2018)

The decision of City of Helsinki, Finland to grant the right to the same health care at the
same price as all the citizen to the minors and pregnant woman who are staying without a
valid visa or residence permit describes the open medical tourism policy for every European
people. The clinic in the Germany, Hallwang Clinic GmbH is said to be the most high-profile
clinic in the European cancer industry, which attracts the patients from UK, US, Australia
and the middle east.

(Medienzentrum Universitätsklinikum Heidelberg, 2018) Claims that, in 2017 there are

more than 250,000 foreign patients in Germany and who brought more than 1.2 Billion Euros
income to the German Hospitals.

1.4.6 Medical Tourism in Nepal

Medical tourism for eye care was quite different three decades ago. People from Nepal had
to go to Sitapur (India) for eye treatment and cataract surgery. However, the good network
of eye hospitals has started to deliver affordable and quality eye care services.
Encouraged by the good facilities and cheap options available at the eye hospitals in Nepal,
and ease of traveling to Nepal, many Indian patients have started to flock to this country for

8
eye treatment. More than 200,000 Indian patients visit Nepal for eye surgery, and more than
1.5 million for eye treatment every year. Although medical tourism in Nepal has not been
developed as a national industry and there is no government policy to promote medical
tourism in Nepal, medical tourism in eye care can be cited as a model for other medical fields
as well.

1.4.7 Medical Tourism for eyecare in Biratnagar

The number of Indian nationals visiting Biratnagar-based eye hospitals for treatment has
increased of late. As many as four eye hospitals are being operated in Biratnagar. Hospital
owners said the number of patients coming from India was more than patients from Nepal.
Patients from bordering states like Bengal, Bihar and Uttar Pradesh come to Biratnagar for
eye treatment. Around 1,200 patients reach Biratnagar Eye Hospital for treatment on daily
basis and most of them are from India, according to hospital sources. Patients from Bhutan
and Bangladesh also reach the hospital for treatment. Director Prakash Dahal at Birat Eye
Hospital said Indian nationals choose Biratnagar-based eye hospitals due to affordable and
quality services provided by hospitals in Nepal. It is said Indian citizens choose Biratnagar-
based eye hospitals due to lack of better hospitals in the bordering areas of India. Besides,
eye patients, patients of other diseases from India also come to Biratnagar seeking treatment.
(The Himalayan Times, 2018)

The fame of Biratnagar Eye Hospital has spread far and wide, attracting patients from
various neighboring countries. Hospital staff overcome the language barrier by using sign
language. Recently, a woman from Bangladesh had come for an eye check-up. The doctors
had to gesture a lot while they gave her a proper examination, but everything went fine. The
Bangladeshi woman is just one example of how eye hospitals in Biratnagar have been
attracting patients from nearby countries. “The patients visiting us are from countries like
Bhutan, Bangladesh and Sri Lanka besides India,” said Dr Sanjay Singh, director of the
Eastern Regional Eye Care Program at the hospital. Besides providing service to local
patients, eye hospitals here have been treating a huge number of patients from Bihar, India
at reduced charges. This has saved Bihari patients from having to travel to Kolkata, Delhi or
Chennai to get their eye diseases treated at huge cost. For a hospital being run by the private
sector, they have maintained good physical infrastructure and human resource management
to be more credible. (Ghimire, 2014/01/27)

9
1.5 Research Methodology

1.5.1 Research Design

A research design is a plan to answer the research questions. Research Design is a strategy
or overall roadmap which describes how the research is going to be conducted.

Descriptive Research Design is used in the research design as it is concerned with describing
the characteristics of an existing/current phenomenon. It attempts to describe systematically
an existing situation or prospects of the medical tourism for eye care in Biratnagar. The use
of descriptive research design helps to systematically collect and present facts and figure to
give a clear picture of the existing scenarios of prospects of the medical tourism

Among the descriptive research design, the author would like to develop the project with the
developmental descriptive research design. As developmental research design aims to
predict the future trend considering the change in human, events, social and cultural
activities. So does the author wants to evaluate the future prospects with the detail
understanding and analyzing of the human and events keeping social and cultural activities
constant.

1.5.2 Population and Sample

Population is total number of people living in a specific area in a certain specified time.
Population in this research work refers to the total number of medical tourists visiting the
Biratnagar Eye care in a year.

 Sampling unit: Patient of Biratnagar Eye Hospital

 Sampling Frame: Patients of Eye Hospitals
 Sampling Techniques
o The simple random probability method will be used as the sampling
techniques
 Sampling size: 70 patients

1.5.3 Data collection Techniques

10
  Types of data: Primary data and secondary data
 Primary data is data that is collected by a researcher from first hand sources, using
methods like surveys, interviews, or experiments. Secondary data is data gathered
from studies, surveys or experiments that has been run by other people for their
research work.
The Author intends to collect to collect the primary data as the sampling unit are
easily available and prior studies on the same sampling frame are not carried out and
the secondary data are collected from the BEH.
 Structured Interview method, questionnaire method is used to collect the data from the
patients and the structured questionnaire is provided to BEH for collection of secondary data

1.5.4 Data Presentation and analysis

The data regarding the number of OPD, surgeries of different years, various number of
surgeries, and OPD, the consumer perception regarding the BEH are shown in bar diagram,
line chart, tables.

The data collected from the research report will be presented by using different table, graphs
and bar diagrams. The different statistical method average, percentage, standard deviation is
calculated, correlation, coefficient of variation is used.

11
 CHAPTER 2: DATA PRESENTATION AND ANALYSIS

2.1 Organization Profile

Biratnagar Eye Hospital, since its start in September 2006, has been developed into a hospital
widely recognized for delivering affordable high-quality eye care services to the
economically poor and under-privileged people of the community.

BEH is an Eastern Regional Eye Care Programme of Nepal Netra Jyoti Sangh. BEH is
providing a wide range of services. The services of BEH includes the following;

1. Surgeries
a. Cataract Surgeries
b. Glaucoma Surgeries
c. Cornea- Scleral Surgeries
d. Vitro-Retinal Surgeries
e. Oculoplasty
f. Laser
g. Squint and
h. Others
2. Out Patients
a. General Screening
b. Refraction services
c. Laboratory Facility
d. Other OPD procedures
e. Dispensing of medicines and spectacles
f. Counseling
3. Ear Surgeries

BEH is managed by the 259 member staff and all its Satellite Clinics include 18
ophthalmologist, 2 ENT surgeon, 14 administrative staff and other.

12
BEH is organizing various Services to reach Nepali patients in the community. These
activities are advertised through public local media. They are performed by special teams in
co-operation with local organizations.

1. School Screening camps

Outreach teams visit schools in Koshi Zone on a regular basis and refer children found
with refractive errors or problems requiring treatment to BEH.

2. Paediatric Screening Camps

Outreach teams visit villages in Koshi Zone regularly to examine pre-school children
and children not enrolled in schools. Children found with refractive errors or problems
requiring treatment are referred to BEH.

3. Cataract Screening Camps

Outreach teams visit villages in Koshi Zone on a regular basis to perform cataract
screening. People found with cataract or other operable diseases are taken to BEH for
surgery free of cost. Patients requiring special examination and treatment are referred to
BEH.

4. Surgical Camps
Cataract surgical camps are performed in the hill areas in co-operation with local
organizations and local hospitals to reach those patients who are not able to come to the
eye hospital.

5. Diabetic Retinopathy Screening Camps

BEH apart from daily OPD activity regularly organizes diabetic retinopathy screening
camps in mass as people with diabetic retinopathy have 25 times more chances of
becoming blind. In these screening camps highly trained staff with latest equipment’s
screen general public and gives advice and treatment to needed one and thus helps people
to save their sight.

13
2.2 Data Presentation and analysis

Data presentation is the presentation of the analyzed facts or figures in the form of table,
pictorial diagram and other methods. The data has been presented by differentiating on
different criteria. The criteria are Age group, Gender, surgeries and OPD. The data can be
presented by using various pictorial diagram. The primary and secondary data collected from
the BEH and patients of BEH has been presented below using various tables, Bar diagram,
line chart, Pie chart etc.

Data analysis is the process of systematically analyzing the data presented in a summarized
way and evaluating and interpreting the data thereof. The data can be analyzed by using
various statistical tools like percentage, standard deviation etc.

2.2.1 Surgeries of BEH on different years

Table 2. 1 Sureries of BEH on different years

Year No. of Surgeries Percentage Change

2018 69784 3.87

2017 67181 10.38
2016 60861 8.48
2015 56106 -6.74
2014 60164 -

Coefficient of Variation 8.84%

Standard Deviation 5556.2

(Source: EREC-P Annual report from the year 2014 to 2018)

The table 2.1 shows the total number of surgeries done by BEH in different years from 2014
to 2018. The BEH surgeries has been gradually been increasing. The total surgeries including
Glaucoma, Retina, Cornea, Oculoplasty, cataract and laser surgery in 2018 is 69784 in
number. The number of surgeries in 2018 has been increased from 67181 to 69784. The
number of surgeries in 2017 has been increased from 60861 to 67181. The number of
surgeries in 2016 has been increased from 56106 to 60861. The number of surgeries in 2015
has been decreased from 60164 to 56106. The number of surgeries in 2014 is 60164.

14
 No. of Surgeries in BEH on different Year
80000
67181 69784
70000 60164 60861
56106
Number of surgeries

60000
50000
40000
30000
20000
10000
0
2013.00 2014.00 2015.00 2016.00 2017.00 2018.00 2019.00
Year

Figure 2. 1 No of Surgeries in BEH of different Year

The increasing number of surgeries of BEH denotes the increasing prospects of medical
tourism for eye care in Biratnagar. The increasing trend of surgeries indicates that the flow
of tourist to Biratnagar for surgeries has gradually been increasing. The number of surgeries
in 2018 has increased by 3.87% and the number of surgeries in 2017 is increased by 10.38%
and the number of surgeries in 2016 has been increased by 8.48% but the number of surgeries
has been decreased in 2015 by -6.74 %. The earthquake in Nepal on 25th April,2015 killed
more than 8000 people and around 21000 are injured. Continued aftershocks occurred
afterwards with one major aftershock on 12 May 2015. Due to this natural calamity patient
flow decreased in eye hospitals in Nepal. This was further compounded by political unrest
and general shutdown for more than 5 months in terai part of Nepal since September 2015
decreasing total no of patient in EREC-Despite the effect of major earthquake and political
unrest in Terai part more than 566,869 patients were examined and 100,036 surgeries were
performed at EREC-P hospitals, Eye Care Centers and in Out-reach activities.

The standard deviation of 5556.2 refers that the surgeries deviate by 5556.2 in number from
the average number of surgeries. The deviation is quite low. The low deviation implies that
the increment or decrement is not galloping but is steady.

The coefficient of Variation of 8.84% show that the deviation per 100% of average is 8.84.
The coefficient of variation of 0.0084 implies that the deviation around the data per unit
number of average surgeries is 0.0084 surgery.

15
2.2.2 OPD of BEH of different year

Table 2. 2 Number of OPD patients over different year

Year Number of Out Patients

2018 298653
2017 281222
2016 258213
2015 140459
2014 181531

Average 232015.6

S.D. 60793.79

Coefficient of variation 0.26

(Source: EREC-P Annual report from the year 2014 to 2018)

The out patient refers to those patients who attends a hospital without staying there
overnight. The increasing number of outpatients describes the increasing popularity of BEH
or increasing prospects of medical tourism for eyecare in Biratnagar. The total number of
outpatients in 2018 is 298653 which is increased from 281222 in 2017. The total number of
outpatients in 2016 is 258213 which is increased from 140459 in 2015. The number of
patients has gradually been decreased in 2015 because of the earthquake and strike on terai.

The average OPD patients are 232015.6 over the years and the standard deviation is
60793.79. The standard deviation of 60793.79 represents that around sixty thousand people
or tourist varies from the average in every year.

The coefficient of variation of 0.26 implies that degree of variedness per unit tourist is very
low. It implies that the possibility of one tourist that would be decreased or increased is only
26%.

16
 No. of OPD Patients of BEH on different year
350000
298653
300000 281222
258213
No. of OPD patients

250000
200000 181531
140459
150000
100000
50000
0
2018 2017 2016 2015 2014
Year

Figure 2. 2 Number of OPD patients over different year

The increasing number of OPD patients of BEH denotes the increasing prospects of medical
tourism for eye care in Biratnagar. The increasing trend of OPD patients indicates that the
flow of tourist to Biratnagar for Basic services has gradually been increasing. The number
of OPD in 2018 has increased by 6.2 % and the number of OPD patients in 2017 is increased
by 8.9 % and the number of OPD patients in 2016 has been increased by 83.8% but the
number of OPD patients has been decreased in 2015 by -22.6 %. The earthquake in Nepal
on 25th April,2015 killed more than 8000 people and around 21000 are injured. Continued
aftershocks occurred afterwards with one major aftershock on 12 May 2015. Due to this
natural calamity patient flow decreased in eye hospitals in Nepal. This was further
compounded by political unrest and general shutdown for more than 5 months in terai part
of Nepal since September 2015 decreasing total no of patient in EREC-Despite the effect of
major earthquake and political unrest in Terai part more than 566,869 patients were
examined and 100,036 surgeries were performed at EREC-P hospitals, Eye Care Centers
and in Out-reach activities.

17
2.2.3 Number of Surgeries and OPD of BEH in 2018

Table 2. 3 Number of diff. surgery and OPD patients of 2018

Name of facility OPD Surgeries

Glaucoma 18,302 1,821

Retina 31,924 7,670

Cornea 26,123 2,950

Oculoplasty 11,699 2,299

Cataract - 51,266

The number of total surgeries of the 2018 A. D is 69784. The total surgery includes the
following Glaucoma of 1821 in number, Retina of 7670 in number, cornea of 2950 of
number and oculoplasty of 2299 in number and 51266 number of cataract surgery and
includes 3778 number of the laser procedure and squint surgeries. These surgeries are the
major reasons for increasing number of prospects. The low-cost leadership and the
qualitative services are major reason for the possibility of increment of medical tourism for
eye care in Biratnagar.

The number of total OPD patients in 2018 A. D is 298653. The total OPD patients includes
the, Glaucoma of 18302 in number, Retina of 31924 in number, cornea of 26123 of number
and oculoplasty of 11699 in number and 210605 number of other OPD patients. These
increasing OPD patients are the major reasons for increasing number of prospects. The low-
cost leadership, qualitative services and promptness in services are major reason for the
possibility of increment of medical tourism for eye care in Biratnagar.

18
 No of OPD and Surgeries of year 2018
60,000
Number of OPD and surgeries

51,266
50,000
40,000
31,924
30,000 26,123
18,302
20,000
11,699
10,000 7,670
1,821 2,950 2,299
0
Glaucoma Retina Cornea Oculoplasty Cataract
OPD and Surgery

OPD Surgeries

Figure 2. 3 Number of diff. surgery and OPD patients of 2018

The figure 2.3 shows the number of OPD patients and surgeries of the year 2018. The
different types of OPD and surgery are shown in x-axis and number of OPD patients and
surgeries are shown in y-axis. The Cataract contributes to around 73.46 % of total surgery.
The cataract surgery is the major surgery of the BEH. The cataract surgery is the major
surgery or appealing surgery of BEH for medical tourism. The second most large number of
surgeries is surgery of Retina, it contributes around 11% of total surgery. Retina surgery is
also the second most appealing surgery for medical tourism for eyecare. The cornea surgery
accounts for 4.22%. The oculoplasty surgery accounts for 3.29%. The Glaucoma surgery
accounts for 2.60% out of total surgery.

The OPD for other accounts for highest. The other includes the basic eye checkup for
spectacles, regular eye checkup and other services. Other than this, the retina contains
10.68% of total Retina OPD. The OPD for cornea accounts for 8.74%. The OPD for
Glaucoma accounts for 6%. The OPD for oculoplasty accounts for 3.92%. The OPD for
regular eye checkup contributes the major appealing aspects of OPD.

19
2.2.4 Population distribution of Sample

Table 2. 4 Population distribution of sample

Country Number of Patient

Bihar 25
West Bengal 12
India
Jharkhand 15
Other 14
Bangladesh 4

(Source: Survey in BEH)

The number of Tourist visiting the BEH are almost Indian and almost only 5.71% are only
from Bangladeshi Tourist. The total Indian constitute 64 in number and almost constitute the
major portion of medical tourist. Among, the Indian tourist, the majority of tourist are from
the Bihar. In survey of 70 people, 25 are from the Bihar. Jharkhand also hold the majority
of number of people. 15 patients are from the Jharkhand. The west Bengal state compromises
of 12 people among the 70 tourist of total sample size. The tourist from other states are 14
in number. The tourist from other people majorly includes those people who are came for
other purpose and are visiting the BEH for medical purposes and those people who came for
medical purposes along with the tourism perspective. India is a major market for the
Biratnagar eye care. The research work show that the prospect is increasing in Biratnagar
due to unavailability of the eye center in various village of India and high medical cost.

Bangladesh is also a second market of medical tourism for eye care in Biratnagar. Among
the survey of 70 people, 4 people are from Bangladesh. Bangladesh is also a prominent and
emerging market for eyecare. Nowadays the Bangladeshi people are also attracted toward
the BEH. The low-cost services, qualitative services, promptness in service are also the
major reasons for increasing prospect of medical tourism for eyecare in Biratnagar.

20
 Percentage of Population From different countries

Bihar
36%
West Bengal
Bangladesh India 17%
6% 94%
Jharkhand
21%
Other
20%

Figure 2. 4 Percentage of Population distribution of sample

The figure 2.4 show the percentage of population of patients or medical tourist for eyecare
in Biratnagar. The Indian tourist consist of around 94% of total number of medical tourist of
BEH and among those 94% of total tourist, 36 % of total tourist are from the Bihar, Bihar
constitute the maximum number of medical tourist for eye care in Biratnagar, also the
Jharkhand constitute around 21% number of total patient or medical tourist among the total
number of medical tourist for eye care in Biratnagar. The people of northern side of the
Jharkhand are the major tourist area for eye care. The west Bengal also constitute the third
most populated state of medical tourist for eye care in Biratnagar. The south west side of the
Bengal are the prominent areas for medical tourism for eye care in Biratnagar. The other
portion also constitute the major portion of the tourist.

Around 6% of the total population of the BEH are from the Bangladesh. The major cities
like atiwari, Baliadangi, toria are the major cities from where the Bangladeshi patients came
for the medical treatment of eye care.

The medical prospect for eye care is increasing not only in India but also in Biratnagar.
)Alam, 2019( asserts that her husband lost his vison totally after treatment in Bangladesh
and so they have come to Nepal for treatment of eyecare due to qualitative services and low
cost and promptness in treatment.

21
2.2.5 Population Distribution by Age

Number of tourist of different age group

60+
20%
0-20
30%

40-60 20-40
37% 13%

Figure 2. 5 Percentage of population distribution by age

The figure 2.2.5 show the number of medical tourists of different age groups. The maximum
patients are from the age group 40-60 accounts for 37% because as the aging starts the eye
of the people start to be blur. They need special medical treatment like medical cares. The
people of this age group are very prone to eye diseases. The common symptoms are dry eyes.
Reduced color vision etc.

The age group of 0-20 accounts for 30% of total medical tourist. They are very prone to eye
diseases from their birth. The common eye diseases are squint or strabismus, Amblyopia,
chalazion, epiphora (blocked tear duct) etc.

The 60+ patients or old people are also very prone to eye diseases and accounts for 20% of
total medical patients. The most common eye diseases are Glaucoma, Age related macular
degeneration, diabetes retinopathy etc.

The age group of 20-40 only accounts for 13% as they are healthier in terms of eye care.
These people of these age groups usually visit the eye hospital for the regular eye checkup,
blur vision and some IT related syndrome caused due to the electronic devices.

22
2.2.6 Number of -persons accompanied by patients

Number of Person Accompanied

40 36
Number of medical tourist

35
30
25
25
20
15
10 8
5 1
0
0-1 2-3 4-5 6+
Size of person accompanied

Figure 2. 6 Number of person accompanied by Patients

The number of persons accompanied means that number of persons they bring with them for
their company in the medical place. Higher the number of persons accompanied by them
higher will be the span of their expenditure. Hence, not only the number of patients
determines the increasing prospect of medical tourism for eyecare in Biratnagar but also the
number of persons accompanied by them.

Twenty-five number of people accompanied one or came by themselves. Among those who
came alone are those people came for OPD and the patients accompanying one person is
their guardian on the major.

Thirty-six people accompanied the two to three people. The person accompanied are their
majorly guardian and the person who have some knowledge about the hospital or the place.

Eight patients accompanied four to five persons. They are those people who have their
relatives nearby the BEH. Among those four to five people, three to four of them are the
tourist from other countries and one to two are their relatives residing here.

One patient only has more than 6 persons accompanied. They were for natural tourism and
on the way, they are having medical treatment for ey

23
2.2.7 Reasons of Medical Tourism for eyecare in Biratnagar

Table 2. 5 Reasons for medical toursim

Reasons for Medical Tourism Number of Patients

Low Cost 28
Qualitative services 25
Easy accessibility 14
Others 3

The table 2.5 shows the number of patients and their reasons for medical tourism. Maximum
number of patients have approach to BEH for the low-cost services and qualitative services.
Some patients are approached due to the location accessibility and other reasons.

Reasons for medical Tourism

30 28
25
25
Number of Patients

20
14
15
10
5 3

0
Low Cost Qualitative Easy accessibility Others
services
Reasons for medical tourism

Figure 2. 7 Reasons for medical tourism

The figure shows the reasons for medical tourism for eye care in BEH and the number os
patients backed by the reasons. Highest number of patients around 40% of patients came for
eye treatment in BEH due to low cost of medical treatment.

24
Higher number of patients have come BEH for the low cost of medical treatments. The
cataract surgery cost more than forty thousand in India while BEH cost only around Twelve
hundred in general ward, four thousand in private ward, and 6000 in private cabin.,
Computerized refractometer, Lensometer, Optometry services. The facilities of BEH
includes the following:

 6 well equipped operation theatres

 8 microscopes 4 with video facilities
 6 Phacoemulsification units
 Vitrectomy unit with wide-angle viewing system (BIOM)
 ECG, pulse oximetry and Boyle’s anesthesia machine for pediatric patients.
 Cryo and laser unit
 2 suction machines
 2 ultra sound cleaner
 2 air compressors
 5 electric autoclaves
 1 ETO sterilization

The free border access is also another reason for medical tourism for eyecare in Nepal. Nepal
has free border with India, no any visa is needed for cross border operation. Hence,
maximum number of Indian patients visited Nepal for medical tourism for eye care.

The other reasons are avoiding waiting times. BEH perform the cataract surgery within or
after the day of the admission, glaucoma surgery for also on the same day or after one day.
BEH provides very prompt services to the patients.

Another reason for medical tourism includes enjoying vacation along with treatment, Nepal
has geographical, climatic, cultural diversity. Hence, people often visit Nepal for
Adventurous, religious tourism.

Hence, due to the low cost of the medical treatment and accommodation facility, qualitative
medical services, promptness in services, easy availability, enjoying vacation, people visit
BEH for medical treatment of eye care.

25
2.3 Findings and Discussion

The research is a descriptive research regarding the prospects of medical tourism for eye
care in Biratnagar. The findings of the report are based on the survey conducted on the
sample and secondary data provided by the hospital. The findings of the report can be
summarized below:

 The majority of the tourist around 94% are from India and Bihar and Jharkhand are
the major states of India from where the tourist visits BEH for eye treatment. Only
around 6% of the total tourist are from the Bangladesh.

 The age group of 40-60 are very prone to eye diseases. These age group people face
the problem of blur vision, they are usually OPD patients, the second highest age
group with prone to eye diseases are the people who are under 20. These people have
common eye problem of glaucoma, cataract. These age group people are for more
surgery than the OPD. The people who are above 60 are seemed to be very prone to
eye diseases but they visit the local eyecare center for the treatment rather than the
hospital.

 The eyecare patients are majorly the male patients. The other research studies
however show that the female is very prone to eye diseases but due to gender
inequality and cross border operation, the male are more in number in terms of
patients in BEH.

 The BEH treat patients main attractions are cataract surgery, glaucoma, retina, cornea
and oculoplasty. The hospital around 60% of its surgery is cataract surgery. The
number of surgery is increasing day by day,

 Many patients who are engaged in agriculture came for the eye treatment in BEH.
This is due to the low-cost services. Generally, in context of Nepal and India, farmers
are the low-income group. Hence, these people seek the value of money and have
low purchasing and paying capacity. The seek for qualitative services in minimal
cost. Hence, BEH offer the low cost affordable qualitative services.

 Many persons visited the BEH because of lack of eye hospitals in their areas. The
Bihar state lack the proper governmental eyecare in every parts of the country.
Hence, the people of the border side districts of the Bihar often visit the BEH for eye
treatment.

26
 The major reason for the increasing tourist in BEH is the low-cost leadership and
qualitative services. BEH provide the services more than their value of money. The
qualitative affordable prompt services are the major pulling factor of medical tourism
for eye care in Biratnagar.
 The respondents assert that they are visiting the BEH as a recommendation from their
friends and family. The BEH has earned a lot of word-of-mouth by its Qualitative
affordable and prompt services. The hospital is also referred by the various eye care
center located near the border side small eye care center. The website and social
media has not been yet effective tools to attract the various medical tourist for eye
care.
 Maximum people are satisfied with the services provided by the hospital. The
respondents mention the following indicators for the satisfaction.

o The hygienic solid waste management system is praised by around 80% of

the respondents. Biratnagar Eye Hospital (BEH) has started systematic
approach for biomedical waste management. After implementing the system,
all wastes are managed by hospital and with this, hospital is moving towards
Zero Waste Concept. Biratnagar Eye Hospital is now pioneer hospital in
Province No 1 for having proper system of Health Care Waste Management
as per national and international standards.
o The hospitals have various rest areas in its compound. The hygienic green
environment with a lots of rest areas has made the hospital more popular
among others. Managing the rest areas of the hospitals is very often
challenging job because to main proper cleanliness, proper infrastructure is
very costlier but BEH is providing hygienic greenery rest areas.
o The behavior of hospital staff is very friendlier and polite. The energetic
behavior has led the hospital enrich with such dynamic human resources. The
hospitals with its dynamic, capable manpower can manage such huge mass
with such less people.

Hence, the findings show that the patients are very satisfied with the hospitals

27
 CHAPTER 3: CONCLUSION AND IMPLICATIONS

3.1 Conclusion

Medical tourism refers to people traveling to a country other than their own to obtain medical
treatment. Medical tourism for eye care in context of Biratnagar has a huge prospect.
Biratnagar is quite well infrastructure with the cross border road way, airport facilities and
well equipped four eye hospitals. Despite the huge prospect of medical tourism for eye care
in Biratnagar, the lack of proper attention of federal, state and local government in
developing Biratnagar as the medical tourism hub, the lack of awareness among the citizen
of Biratnagar regarding such huge prospect of medical tourism for eye care has restricted the
city to achieve its true potential. The author intends to investigate the trend of medical
tourism and the perception of medical tourist and draft out the prospects of medical tourism
for eye care in Biratnagar.

Various factor in Biratnagar has increased the prospect of medical tourism for eyecare in
Biratnagar and some has restricted to achieve its potential. The minimal cost of treatment,
service quality, promptness in services has helped in fostering the prospects while the strikes,
instability, lack of proper long-term vision of the governing authority has backed it. Despite
the weakness, the industry is in the prosperity.

The concept of medical tourism was introduced very earlier in other countries. Various
Foreign governments allocates their budgets regarding development of medical tourism. A
new concept of EcoMedical Tourism is introduced. It refers to the tourism of economical
medical tourism with involving the visiting of fragile, pristine, and relatively undisturbed
natural areas.

The research work carried forward with the descriptive research design with the population
of total patients of BEH intends to carry out the research work by structured interview
method and questionnaire method.

The number of surgeries has been increasing over the years . The surgeries are growing by
3.99% and so does the OPD patients is growing by 19.07%. The total surgery of 2018 is
headed by the cataract surgery which almost accounts for 75%. The OPD for general
consultation accounts the most portion of the OPD. The OPD is growing very rapidly.

28
Around 94% of the total foreign tourist are from the India, so India is very good market for
eyecare. Bangladesh can also be the emerging market for eyecare in Biratnagar. The border
side state of India with Nepal like Bihar, Utter Pradesh, Jharkhand, West Bengal, Sikkim are
the very market of the medical tourism for eye care.

The research shows that the age group of 40-60 are very affected by eye diseases but these
age group accounts most for the OPD care. The surgery is accounted mostly by the age group
of 0-20 and 60+ patients.

Maximum number of consumers accompanied two to three number of persons. The prospect
is not only concerned with the surgeries but also majorly with the person accompanied by
the patients because the medical tourism not only affected the revenue of the hospital but
also the hotels, lodges, transportation, communication facilities. Hence Maximum number
of persons accompanied will increase the prospect of tourism.

The research reveals that the reason for ongoing increasing prospect of medical tourism is
due to the cost effectiveness, qualitative services etc. The various facilities provided, and the
behavior of staff has led in improvement of effectiveness of the hospital. Hence, The
Biratnagar has huge prospect of medical tourism for eye care.

3.2 Action Implication

Action implication is the effect that an action or decision will have on something else in the
future purpose. Every study is conducting for the purpose of future. So, this study has some
action implication for further study. Action implication of this research can be categorized
into following different ways:

 The research work can be used for the academic purposes. This research work is very
beneficial to the students who are pursuing their academics in medicines and
specially in eye care.
 The research work is beneficial for the BEH and other eye care center and hospitals.
This research work is very beneficial to the student.
 The report can be used by the various consumers or medical tourist of Nepal and
other countries to find out the true result of the organization and prospect.

29
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Conscious Travelers. Retrieved from Caspian News:

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to-lure-health-conscious-travelers-2018-4-13-15/

Shrestha, M. B., & Chaudhary, S. K. (2019, March 1). The economic cost of general
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31
 APPENDICES

Appendix A: Questionnaire for examining the prospects of medical tourism for eye
care in Biratnagar

The purpose of the study is to examine the current situation of medical tourism for eye care
in Biratnagar and analyze the prospects. The questionnaire intends to seek answer regarding
the reasons why the tourist is visiting to Biratnagar either due to the lack of eye care center
at their place or the very quality services of hospitals of Biratnagar. The information
provided are confidential and the participation is entirely voluntarily.
1. Name:
2. Country/ City
3. Age: Below 20 ( ) 20-40 ( ) 40-60 ( ) 60+ ( )
4. Sex: Male ( ) Female ( )
5. Occupation
a. Agriculture ( )
b. Business ( )
c. Service ( )
d. Others, specify………………….
6. Does your place have any Eye care center or not

a. Yes ( ) b. No ( )
7. How many persons accompanied you?
a. 0 ( ) b. 1-3 ( ) c. 4-6 ( ) d. 6+ ( )
8. Why are you visiting BEH ?
a. Lack of eye care in your area ( )
b. Qualitative service of BEH ( )
c. Low cost in BEH ( )
d. Others, Specify

32
9. From where do you get to know about BEH ?
a) Relatives and friends ( )
b) Websites or social media ( )
c) Referral ( )
d) Other, Specify……………………..
10. Are you satisfied with the services provided by the hospital ?
a. Yes ( )
b. No ( )
c. Can’t Say ( )
11. Is the treatment provided by the hospital hygienic ?
a. Yes ( )
b. No ( )
c. Cant’t Say ( )
12. Are you satisfied with the accommodation facilities of the hospital?
a. Highly satisfied ( )
b. Satisfied ( )
c. Neutral ( )
d. Dissatisfied ( )
e. Highly Dissatisfied ( )
13. How do you perceive the behavior of the hospital staff?
a. Very Good ( )
b. Good ( )
c. Neutral ( )
d. Bad ( )
e. Worst ( )
Appendix B: Questionaire For BEH

Date of Establishment:

Number of Employees:

Number of OPD in 2018

 Base:
 Camp:

Number of surgeries in 2018

 Base:
 Camp:

Number of outreach camp:

Name of facility OPD Surgeries

Glaucoma
Retina
Cornea
Oculoplasty
Cataract