1

MEDICAL TOURISM IN INDIA

(WITH SPECIAL REFERENCE TO MANGALORE)

A THESIS

Submitted By
VINAYARAJ MOTHIRAVALLY
In partial fulfillment for the award of the degree of

DOCTOR OF PHILOSOPHY

DEPARTMENT OF HOTEL MANAGEMENT AND

CATERING TECHNOLOGY
DR. M.G.R.
EDUCATIONAL AND RESEARCH INSTITURE
UNIVERSITY
(Declared u/s 3 of the UGC Act, 1956)
CHENNAI – 6000 095

SEPTEMBER 2012
 2

CERTIFICATE

I certify that the thesis entitled “Medical Tourism in India (With Special

Reference to Mangalore)” submitted for the Doctor of Philosophy by

Mr. Vinayaraj Mothiravally is the record of research work carried out by him

during the year 2006 to 2012 under my guidance and supervision, and that this

work has not formed the basis for the award of any degree, diploma, associate-

ship, fellowship or other titles in this University or any other University or

Institution of Higher Learning.

 3

DECLARATION

I hereby declare that the thesis entitled “Medical Tourism in India (With

Special Reference to Mangalore)”, submitted by me for the degree of Doctor of

Philosophy is the record of work carried out by me during the year 2006 to 2012

under the guidance of Dr. Prabhu Kumari Vanama and has not formed the basis

for the award of any degree, diploma, associate-ship, fellowship titles or any other

similar titles in this University or any other University or Institution of Higher

Learning.
 4

ABSTRACT

1 MEDICAL TOURISM IN INDIA

2 WITH SPECIAL REFERENCE TO MANGALORE

2.1
Presently, global healthcare industry stands at $20 billion and it is estimated that
by the end of 2012, it will go beyond $60 billion. Growth factors that induced this new
trend are better and cheaper medical treatments in the developing countries, new
technologies in the medical field, affordable air travel, availability of information about
medical destinations and development of information technology. India witnessed a
tremendous growth in the Health Care Sector in the last few years. In monetary terms,
experts estimate that medical tourism could bring India as much as US$2.2 billion per
year from 2012. The project value of medical tourism in 2015 is 18,505.7 million. The
arrival of medical tourists has increased in India by 25 per cent year-on-year since 2002
Since medical tourism is the fastest growing sector in the 21st century and also
because many countries are interested in taking advantage for its economic potential,
countries are capitalizing their popularity as tourist destinations by combining high
quality medical services at competitive prices with tourist packages. Here comes India,
which is considered as one of the popular medical tourism destinations of the world
providing First World Health Care at Third World Price. It offers a world-class
healthcare that costs substantially less than those in most of the other developed
countries, using the same and at times even advanced technology by competent
specialists resulting in similar success rates. When considering affordability and
convenience, India has a very huge potential to make maximum use and advantage of this
medical tourism industry. At present, many hospitals in India are getting ready to attract
 5

the international patients and are trying their best to propagate their names by providing
world standard medical services.
The Government of India is also encouraging to promote medical tourism through
various ways like the introduction of a National Health Policy in 2002, framing of the
Statutory Regulations and Standards to Healthcare Providers (National Accreditation
Board for Hospitals and Healthcare Providers), Creating a Department of AYUSH for the
Complementary and Alternative Medicines and Treatments, initiating the Marketing
Development Assistance Scheme for Travel Agents to promote medical tourism and
encouraging the Public-Private Partnership initiatives through the 11th Five Year Plan and
Medical Visa (M Visa) up to one year, which can be extended for a further period up to
one year.
Inspite of all these initiatives, the foremost predicament with the medical tourism
in India is that it is concentrated mainly to major cities such as New Delhi, Mumbai,
Kolkotta, Chennai, and Bangalore. Since the growth potential of medical tourism seems
sound and promising, more and more destinations are needed to be developed to foster
the growth of Indian medical tourism. Hence, the Indian Government is also
aggressively resorting to promote and to develop India as the Number One Medial
Tourism Destination by developing small and medically potential cities like Mangalore.
This doctoral study starts with tracing the origins of medical tourism from the
time immemorial. So, the period of the study dates back to the ancient period. As far as
the closing period of the study is concerned, it successfully delves into the current trends
in medical tourism i.e., the occurrences that are taking place in the current year. Hence, it
can be safely surmised that the concluding period of the study ends with 2012.
The current study aims to project the Medical Tourism Scenario in India with
Special Reference to Mangalore. To portray the same, this research work focuses on the
following objectives
1. To Discuss the Concepts of Medical Tourism.
2. To Identify the Major Advantages of India as a Medical Tourism Destination.
3. To Describe the Indian Government’s Initiatives for promoting Medical Tourism.
4. To Elaborate the Treatment Options available under the Concept of Medical
Tourism at prominent Hospitals of India.
 6

5. To Explore the existing Major Hospitals along with their Treatment Options to the
Medical Tourists in Mangalore.
6. To Project Mangalore’s Accessibility, Attractions and Amenities as a Tourism
Destination.
7. To Place on Record the Perceptions of Hospitals, Travel Agents and Medical
Tourists about Mangalore as a Medical Tourism Destination
8. To Compare the Medical Facilities of Mangalore with the other major South
Indian Medical Tourism Destinations – Bangalore, Chennai and Kerala.
9. To Suggest probable Recommendations that may develop Mangalore as the
leading Medical Tourism Destination of India.
The present thesis is divided into five chapters like
Introduction – narrates the general scenario of medical tourism, the Geographical
Area of Study, the Period of the Study, the Objectives of the study, the Chapterization,
the Sources of the Study, the Review of Literature, the Scope of the Study, the
Limitations of the Study.
The Medical Tourism in the Global Scenario – examines the theories and
terminology related to medical tourism such as definition of medical tourism, reasons
why medical tourists travel to a destination, major destinations of medical tourism in the
world, historical perceptive, current trends, and future of medical tourism.
India – The Incredible Medical Tourism Destination – describes the existing
medical tourism set up in India, the Government of India’s initiatives to promote medical
tourism, the contributions of the popular Indian hospitals, their treatments and services to
the medical tourists and so on.
Mangalore – The Myriad Marvel of Medi-Tourism explores into the Mangalore’s
tourism potentiality as a destination in general and as a medical tourism destination in
particular. It explores into the capacity of the destination, its’ hospitals, doctors, hotels,
travel agents and patients.
Conclusion – concludes the study with a discussion on the issues recorded in the
study, contrasts the perceptions and suggestion of the medical tourism key players and
attempts to forecast the measures that can transform Mangalore in toto as a leading
medical tourism destination of this Universe in general and India in particular.
 7

The current study comprises of innumerable primary and secondary sources.

Primary Data – Policies of the Government of India and the Government of
Karnataka, Publications of the Government of India, State Governments and
Hopitals are the printed primary sources of this dissertation. A few interesting
publications are Eleventh Five Year Plan 2007-2012, volume 1, Planning
Commission, Government of India (2008), Karnataka Tourism Policy 2009-14,
Advantage Karnataka, Brochure of Global Investors Meet 3-4th June 2010 and so on.
Interviewing technique was mainly based on open ended questionnaires. Major
leading hospitals authorities, travel agents and medical tourist were approached to gather
the primary data.
The first step of the current study is to search the previously published materials
on medical tourism. Printed Books by both the national and the international publishers,
conference papers, newspapers, reports published by the Non-Governmental
Organizations and a variety of search engines available on the internet added innumerable
information to the list of the secondary sources. Innumerable websites related to medial
tourism and hospitals are also consulted. Various Journals, Proceedings and Periodicals
also were consulted exhaustively while preparing the thesis.
The present study adopts a narrative style as far as tracing the evolution and
emergence of medical tourism is concerned. It is also exploratory in nature, for, it apart
from tracing the current state of medical tourism in Mangalore will be projecting how it
can be transformed as one of the best sought after medical tourism hub of India on par
with other well established medical tourism destinations of India like the Bangalore,
Chennai, Delhi and so on.
This research work throws open the gates for Studies on similar smaller
destinations of India, for, this will project India to the world as the treasure land for
medical tourists, who prefer to visit either the developed or the developing city of India.
This study is also a stepping stone for the researchers who would like to carry out
Studies on the Alternative Medical Tourism Facilities available in India. In fact, it acts as
an advancement of knowledge
 8

The present research can be considered as a foundation for further studies in

Comparing and Contrasting the Medical Tourism in the Northern and Southern parts of
India.
 9

ACKNOWLEDGEMENT

First of all, I express my thanks to The Chancellor, of the Dr. M.G.R.

Educational and Research Institute University for his consent to do my doctoral study in
this esteemed University. Thanks to The Vice-Chancellorand Mr. S. Ganeshan–
Director of Dr. M.G.R. Educational and Research and Educational Institute University
for providing me with necessary academic support.

I am grateful to Dr. S .Dinakaran – The Joint Registrar (Staff);Dr.P.Kalidoss–

The Joint Registrar (Students);Dr. Aravindan – Former Vice-Chancellor&the
Present Director (R&D);Dr. Thirunavukkarasu – Dean of Research;Prof. T.
Jeyachandran –Department of Chemistry Dr. Senthilvelan - Former Dean of
Research Dr. M.G.R. Educational and Research and Educational Institute University.

My heartfelt thanks to Dr. Mrs. T. Chandralekha – Former Dean H & S for

showering her blessings on me.

I humbly acknowledge the timely acceptance for admission by Mr. M. Prabu –

Head, Department of Hotel Management and Catering Technology, of Dr. M.G.R.
Educational and Research and Educational Institute University and permitting me to
conduct the department seminars successfully.

Words fail to express my gratitude to the Guide and Supervisor Dr. Prabhu
Kumari Vanama – Assistant Professor, Department of Historical Studies, Bharathi
Women’s College, Chennai, whose constant inspiration and support helped me to reach
the goal.

Special thanks to Prof. G. Venkateshwara Rao –Member, Nellore Dist. Tourism

Development Council; Former UGC Emeritus Professor; Dr. Ajith Kumar -Executive
Director, Hi Tours Ex-Member–ITDC & Prof.. Velu – SRM University, Chennai.

(VINAYARAJ. M.)
 10

TABLE OF CONTENTS

Chapter No. Title Page No.

Certificate ii

Declaration iii

Abstract iv

Acknowledgement viii

Table of Contents ix

List of Tables x

Abbreviations xii

1 INTRODUCTION 1

2 MEDICAL TOURISM IN GLOBAL SCENARIO 24

3 INDIA: THE INCREDIBLE MEDICAL TOURISM 73

DESTINATION

4 MANGALORE: THE MYRIAD MARVEL OF MEDI- 141

TOURISM

5 CONCLUSION 191

BIBLIOGRAPHY I

APPENDICES i
 11

LIST OF TABLES

Table No. Table Name Page No.

2.1 31
Cost Comparison of Medical Procedures of Major Medical
Tourism Destinations Around the World

2.2 Patient waiting time in England 34

2.3 42
Medical Tourism Destinations in Various Continents

2.4 45
Hospitals Engaged in Medical Tourism in Malaysia

2.5 49
Major Hospitals in Singapore

2.6 Major Medical Tourism Hospitals in Thailand 51

2.7 52
Specialized Health Care Centers in Philippines

2.8 Hospitals in UAE 55

3.1 75
Foreign Tourist Arrivals in India from 2001 - 2011

3.2 77
Top 10 Source Countries for Foreign Tourist Arrivals
(FTAs) in India in 2010

3.3 91
A Few Websites promoting Medical Tourism in India

3.4 92
Prominent Medical Treatments in India under Medical
Tourism

3.5 95
Major Hospitals Promoting Medical Tourism in India

3.6 96
Treatment Options at Apollo Hospital
 12

Table No. Table Name Page No.

3.7 100
Treatments Available at Fortis Hospital

3.8 106
Specialty treatments at Wockhardt Hospital

3.9 Super Specialties at Artemis Health Institute 112

3.10 118
Departments at Columbia Asia

3.11 Treatments Available at Max Healthcare 121

3.12 Treatments at Hiranandini Hospital 124

3.13 Treatments Available at KIMS 126

3.14 128
Treatments Available at Moolchand Healthcare

4.1 Demographics of Mangalore City 146

4.2 151
Major Hotels in Mangalore

4.3 165
Premium Restaurants in Mangalore

4.4 Major Hospitals in Mangalore 168

4.5 Medical Facilities of A. J. Hospital 168

5.1 198
Climate Data of Mangalore, Bangalore, Chennai and Kerala

5.2 199
Comparative Analysis of Accessibility

5.3 200
Comparative Analysis of Tourism Attractions

5.4 200
Comparative Analysis of NABH and JCI Accreditations
 13

CHAPTER - 1
INTRODUCTION

Tourism is one of the prominent industries of the world. It is growing at a steady

pace and now it became one of the major social and economic phenomena of the modern

time.1 Tourism now is a key driver of socio-economic progress due to its creation of jobs,

enterprises, infrastructure development and export revenue earned.2 In fact tourism is an

act of travel. The term tourism is derived from the term tornate, which means staying

outside the usual environment for leisure, business and other purposes. Therefore tourism

is the act of engaging in a trip to a destination from one point and returning to the same point.

Weaver and Opperman defined tourism as the sum of the phenomena and relationship

arising from the interaction among tourists, business suppliers, host governments, origin

governments, universities, community colleges and non-governmental organizations in

the process of attracting, transporting, hosting and managing these tourists and other

visitors.3 Smith defines tourism as the aggregate of all retail businesses that provide

commodities for the travelers, regardless of the motivations or other personal

characteristics.4At the 1991 Conference in Ottawa on Travel and Tourism Statistics, the

demand side concept was accepted as the appropriate approach and tourism was defined as

the activity of persons travelling to and staying in places

outside their usual environment for not more than one
consecutive year for leisure, business and other purposes.5

Tourist is a visitor who travels either internationally, by crossing an international

border, or domestically by travelling within his or her own country. In both cases the
visitor travels to a place other than his or her usual (home) environment, away from home
for at least one night and the purpose of the visit is not paid for by the place visited.
Tourists who stay for a few hours but not overnight are called excursionists.
 14

HISTORICAL PERCEPTIVE
Medical travel started with the history. Greek God of Healing–Asclepius
In the past, many people visited spas and health
centers for getting relief to their health problems2.
Neolithic and Bronze age people travelled to
neighboring countries for health related reasons.
Sumerians, Greeks, Romans, Japanese, Chinese
and Indian cultures also showed evidences of
people who travelled to spas and mineral springs
for medical treatments. In 4000 BC, the Sumerians
built health complexes near health spas along the
mineral springs. Bronze Age tools and votive cups
were the evidences of such medical travels during
the Sumerian age.Temple healings were prevalent
during the Greek ages. Greek pilgrims traveled to
the Asclepian temples from all over the Mediterranean. A temple near the Epidaurus in
Greek was the popular among healing temples. This temple had baths, the springs, the
gymnasiums, an exercise area and the snake farms. The emergence of medical tourism
can be traced with the Greek trend of travelling to healing temples. In the nineteenth,
century wealthy Europeans travelled to various health destinations in Greek. Ancient
Roman Thermae, Indian Yoga, Japanese Onsen, and Chinese Traditional Medicine also
attracted many travelers from around the world. Even though Spa is considered to be
originated in the Belgium town of Spa,3 iron rich hot springs are rampant throughout
Europe. These hot springs had medical benefits for healing diseases such as gout,
rheumatism, intestinal disorders and so on. During the time of the Romans luxury health
complexes were built along these hot springs. Even though the hot springs had medical
benefits, wealthy people visited such health complexes to enjoy social networking.

Onsen near Beppu in Japan

Early Islamic civilization also attracted many medical travelers from around the
world. Mansuri hospital was one such hospital in Cairo that attracted many people.
 15

Mansuri Hospital
in Cairo had an
in-patient capacity
of 8000 patient
beds.4 Japanese
Onsen was
considered to
have healing
properties for
arthritis aches.5
Warriors visited these Onsens to alleviate pain, healing wounds and to regain the energy
lost during the war. History of Indian Yoga dates back to 5000 years. There was a
constant flow of patients and medical students from Middle East and European countries
to India during the ancient period.6

GEOGRAPHICAL AREA OF THE STUDY

The geographical area of the study revolves around the city of Mangalore.
Mangalore is a small coastal city situated on the south-western coasts of India. It is a
narrow strip of territory and from east to west and a broken low plateau spreads from the
Western Ghats to the Arabian Sea. The landscape is
dominated by pristine beaches, coconut palms, picturesque
blue mountain ranges. Mangalore is one of the fastest
growing cities in India. Any medical tourism destination in
the world is popular due to thre factors, viz. attractions,
accessibility and amenities.

The current area of study for this Doctoral Study

i.e., Mangalore is perfect to be the most sought medical
tourism destination in terms of tourist attractions,
accessibility to the place, and medical tourism amenities. Map of Mangalore6
 16

PERIOD OF THE STUDY

This doctoral study starts with tracing the origins of medical tourism from the
time immemorial. So, the period of the study dates back to the ancient period. As far as
the closing period of the study is concerned, it successfully delves into the current trends
in medical tourism i.e., the occurrences that are taking place in the current year. Hence, it
can be safely surmised that the concluding period of the study ends with 2012.

RESEARCH QUESTIONS
1. What are the modern trends of Medical Tourism in the global scenario?
2. Is India gaining momentum as the most sought destination of Medical Tourism?
3. Are there any potentialities in Mangalore to project it as the Medical Tourism
Destination of India?

OBJECTIVES OF THE STUDY

The current study aims to project the Medical Tourism Scenario in India with
Special Reference to Mangalore. To portray the same, this research work focuses on the
following objectives
10. To Discuss the Concepts of Medical Tourism.

11. To Identify the Major Advantages of India as a Medical Tourism Destination.

12. To Describe the Indian Government’s Initiatives for promoting Medical Tourism.

13. To Elaborate the Treatment Options available under the Concept of Medical
Tourism at prominent Hospitals of India.

14. To Explore the existing Major Hospitals along with their Treatment Options to the
people who visit as Medical Tourists to Mangalore.

15. To Project Mangalore’s Accessibility, Attractions and Amenities as a Tourism

Destination.

16. To Place on Record the Perceptions of Hospitals, Travel Agents and Medical
Tourists about Mangalore as a Medical Tourism Destination
 17

17. To Compare the Medical Facilities of Mangalore with the other major South
Indian Medical Tourism Destinations – Bangalore, Chennai and Kerala.

18. To Suggest probable Recommendations that may develop Mangalore as the

leading Medical Tourism Destination of India.

WORKING HYPOTHESIS
An attempt has been made to establish Mangalore as a potential Medical Tourism
Destination. Therefore the hypothesis of the current study is “To Project Mangalore as
a Potential Medical Tourism Destination”.

CONCEPTUAL/THEORETICAL FRAMEWORK
This thesis is a tentative explanation or a theoretical explanation of the

phenomenon or the problem that serves as the basis for the formulation of the above

mentioned research hypotheses. Thus, the conceptual or the theoretical framework of this

thesis consists of Mangalore as the emerging destination which can be projected as the

medical tourism destination of India.

QUALITATIVE RESEARCH

This study is typically an attempt to Explore into the possibilities of showcasing

Mangalore’s adaptability as an upcoming Medical Tourism Destination of India and a

lucid narrative Style has been followed throughout to corroborate the same.

CHAPTERIZATION
The present thesis is divided into five chapters.
1) Introduction
2) The Medical Tourism in the Global Scenario
3) India – The Incredible Medical Tourism Destination
4) Mangalore – The Myriad Marvel of Medi-Tourism
5) Conclusion
 18

Introduction – narrates the general scenario of medical tourism, the Geographical

Area of Study, the Period of the Study, the Objectives of the study, the Chapterization,
the Sources of the Study, the Review of Literature, the Scope of the Study, and the
Limitations of the Study.

The Medical Tourism in the Global Scenario – examines the theories and
terminology related to medical tourism such as definition of medical tourism, reasons
why medical tourists travel to a destination, major destinations of medical tourism in the
world, historical perceptive, current trends, and the future of medical tourism.

India – The Incredible Medical Tourism Destination – describes the existing

medical tourism set up in India, the Government of India’s initiatives to promote medical
tourism, the contributions of the popular Indian hospitals, their treatments and services to
the medical tourists and so on.

Mangalore – The Myriad Marvel of Medi-Tourism explores into the Mangalore’s

tourism potentiality as a destination in general and as a medical tourism destination in
particular. It explores into the capacity of the destination, its’ hospitals, doctors, hotels,
travel agents and patients.

Conclusion – concludes the study with a discussion on the issues recorded in the
study, contrasts the perceptions and suggestion of the medical tourism key players and
attempts to forecast the measures that can transform Mangalore in toto as a leading
medical tourism destination of this Universe in general and India in particular.

THE SOURCES OF THE STUDY

The current study comprises of innumerable primary and secondary sources.

PRIMARY SOURCES
Policies of the Government of India and the Government of Karnataka,
Publications of the Government of India, State Governments and Hospitals are the
 19

printed primary sources of this dissertation. A few interesting publications are Eleventh
Five Year Plan 2007-2012, volume 1, Planning Commission, Government of India,
Karnataka Tourism Policy 2009-14, Advantage Karnataka - Brochure of Global Investors
Meet 3-4th June 2010 and so on. Of course, Interviews form the prime base of the
primary sources. Interviewing technique was mainly based on open ended
questionnaires. These interviews/questionnaires are neutral tools which led to the
negotiated and contextually based results. Ofcourse, before framing the conclusions they
were individually as well as extensively analyzed.

Ten leading hospitals were approached from the existing list of hospitals in
Mangalore and expert doctors were identified, contacted and interviewed. Following is
the list of a few medical personnel interviewed personally during the preparation of the
study. Deputy Medical Superintendent, KMC Hospital, Medical Director, A.J. Hospital
and Research Center, Director, Tejaswini Hospital, Managing Director, City Hospital,
Medical Director, Srinivas Hospital and Research Center, Managing Director, Indira
Hospital, Asst. Manager (Relations), Yenopoya Super Specialty Hospital, Marketing
Consultant, A.J. Hospital and Research Center are to name a few. Travel agents were
also contacted and data has been collected pertaining to tourism aspects of medical
tourism. Purposive sampling method was used to select travel agents. Travel agents
contacted for the interviews are - Branch Manager, Akbar Travels, Tour Administrator,
Nirmala Travels, Proprietor, Lia Travels, Unit Manager, Swastika Holidays, Operations
Manager, Ria Travels, Manager – Leisure Travels. Medical Tourists (both national and
international)werealso selected and contacted at the hospitals in Mangalore where they
were undergoing treatment.

SECONDARY SOURCES
The first step of the current study is to search the previously published materials
on medical tourism. Printed Books by both the national and the international publishers,
conference papers, newspapers, reports published by the Non-Governmental
Organizations and a variety of search engines available on the internet added innumerable
information to the list of the secondary sources. Innumerable websites consulted include
 20

http://www.expresshealthcare.in, http://www.indianhealthcare.in, http://www.medical-

tourism-india.com, http://www.medaccessindia.com, http://www.mediescapes.com,
http://www.health-tourism.com, http://www.medicaltourismco.com, http://www.heal-
wheel-india.com,http://www.unityhospital.in, http://scshospital.org, http://ssiot.org,
http://www.medicaltourismindia.comhttp://www.mangalahospital.comhttp://www.indiah
ealthvisit.com, http://www.yenopayahospital.com, etc. Various Journals, Proceedings
and Periodicals also were consulted exhaustively while preparing the thesis. Some of
them are – Euromonitor International, Express Healthcare, American Medical
Association, Publications, Freesun News, USAtoday.com, Medical Tourism Magazine,
Journal of Legal Medicine, The Physician, Telemedicine and e-Health, Express
Healthcare Management, Tourism Management, Institutional Investor-International
Edition, Business Times (Malaysia),HR Magazine, Express Healthcare Management,
Indian Journal of Medical Ethics, Tourism Management, Acupuncture in Medicine,
Indian Medical/Health Tourism Service Sector Network Report, Journal of Healthcare
Finance, etc. The present study adopts a narrative style as far as tracing the evolution and
emergence of medical tourism is concerned. It is also exploratory in nature, for, it apart
from tracing the current state of medical tourism in Mangalore will be projecting how it
can be transformed as one of the best sought medical tourism hub of India on par with
other well established medical tourism destinations of India like the Bangalore, Chennai,
Delhi and so on.

THE REVIEW OF LITERATURE

For the current study, the focus of the literature review is to find out the research
outcome of the previous studies. The goal here is to identify the central issues. Since
medical tourism is a new and emerging area of study, the pattern of emergence of the
central issues pertaining to medical tourism will became clear when the literature is
presented in a chronological manner. So, in this thesis the organization of the literature is
chronological in nature. Having selected a topic, the next step was to identify appropriate
and related information in a structured way. Since the medical tourism is new emerging
area, the text books are not in large number, only a few text books are available to the
date and all those books are referred to gather the data pertaining to the study. Now-a-
 21

days, literature searches are undertaken most commonly using computers and electronic
databases. The advantage is that it provides access to vast quantities of information,
which can be retrieved more easily and quickly than using a manual search. The main
data bases searched for published materials are Ebsco, Emerald, Science Direct, Proquest,
Jstor, Taylor’s and Francis, PubMed and Google, CHRIE, Oxford Journals,
EUROMONITOR and free online databases such as DOAJ, ERIC, and Open J-gate.
Other than electronic data bases, websites of major periodicals such as Medical tourism
magazine, Express hospitality, Express healthcare, and Forbes.com etc. are also searched
for the published materials. Key word searches are initiated, using “Medical Tourism”.
Boolean operators are also used in the search such as “Medical AND Tourism”, “Health
AND Tourism”, “Medical Tourism NOT Health Tourism”. Type of sources on the
lookout was books, reports, review articles, analytical papers, new papers and periodical
articles.

Even though the medical tourism occupied a prominent place amongst other
forms of tourism, scholarly articles on medical tourism are very scarce. The year 2007
witnessed an increase of interest on medical tourism from the authors. The first article by
Goodrich and Goodrich in 1987 entitled Health-care Tourism: An Exploratory Study
was published in Tourism Management. The trend shows that recently in 2010, there is an
increase in the number of publications on medical tourism and it indicates that the
importance of medical tourism as a research area attracts currently many researchers to
this field. Hence this study places here on record the reviewed literature chronologically.
The advantage of chronological presentation is that it is useful to examine the emergence
of a topic over a period of time.

2005 and Older

The first research article in the said field of study appeared in a research journal
by Goodrich and Goodrich7 in Tourism Management, entitled Health-care Tourism: An
Exploratory Study in 1987. This article explores the health-tourism, but not medical
tourism. In 1987, it was considered as a premier article. Not much research was done, to
distinguish medical tourism with health tourism. In this article the authors surveyed 206
 22

travelers, 22 travel agents, 12 medical doctors and two herbalists. The main purpose of
the article was to explore how destinations can attract people through health related
services. The study discussed the novel concept of health-care tourism from marketing
perspective, by profiling the health-travelers. Though the article adopted a novel, due to
the lack of data, the study could not achieve its objectives in full, but the study sparked
high the concept of medical tourism. A major note that needs to be mentioned here is that
the article is all about European health destinations and the need of health tourism
product modifications that suit the medical tourists.

Following the same line of study Mueller and Kaufmann (2001) addressing some
of the issues pertaining to hotel industry and wellness tourism contributed an article on
the European Tourism and Wellness industry. The purpose of these articles was to define
and delimit the terms such as wellness and wellness tourism, to determine them as the
instruments for quality management and to position them in the wellness market.8It is
interesting to note that they clearly distinguished the wellness with curative travels. This
article marches ahead the previous article by Goodrich and Goodrich (1987) and clearly
demarks the concept of wellness needs and importance of supply side initiatives that
needs to be embedded into the service package. It is an exploratory study because it first
defines and delimits the terms, creates transparency about the terms and later positions
wellness as a niche. Market analysis methods were used as research methods using
cluster analysis. The study used a sample survey with 400 middle class luxury hotels in
Switzerland. One of the interesting things about this article is that it is more rigorous in
methodology and analysis. The article recommended following areas for the host
communities for improvement of destination services such as quality management, target
markets, supply shaping, pricing, communication, distribution and cooperatives. These
areas will boost credibility by making a demarcation between wellness and curative
treatments. This study became notable in the wellness and tourism industry due to its’
recommendations relating to alluring the niche wellness market.

In 2001 Gonzales, Brenzel and Sancho9 came out with a study on issues
pertaining to health related services in Caribbean Islands. It aimed at various problems
 23

associated with the development of health tourism and public health service system. The
study further looks into policy issues and other health tourism products that need to be
developed in the light of the new health policies and programs related to the health
services of the Caribbean Government. This study also focused on issues relating to the
trade in Health Services, especially cross-border trade.

A similar study can be found in the Bulletin published in 2002 by the World
Health Organization. The study was conducted by Chanda, which was titled as Trade in
Health Services.10 This study too was not directly on medical tourism, but it indirectly
reflects the impact of cross border health care issues in the light of General Agreement on
Trade in Services (GATS), pertaining to health services. The study examines the positive
and negative implications of trade in health services, brain drain etc.

Other major contributors to the field of health care tourism were Borman, Hunter-
Jones and Gracia-Altes. Borman in 2004 explored the implications of health tourism on
National Health Services (NHS).11 He prompted the ethical concerns of doctors towards
the local British and the need of the government initiatives to save the NHS. Borman’s
article is not a research study. It is a comment on the issues related to health tourism and
NHS. Hunter-Jones studied on Cancer and Tourism in 2004.12 This is the first article that
mentioned about the concept of medical tourism other than health tourism. This study
focuses on tourism propensity of patients treated for cancer and records the findings. The
concept of Medical Tourist Lifecycle (MTL) was highlighted for the first time in this
article. Since this study was concentrated much on the cancer tourists, it helped to
identify the need of special medical requests as a niche market. The interesting part in
this study was the various motivators for patient-travelers, which will help in creating a
new-tourism product for the patient-travelers.

Gracia-Altes explored the probable challenges and opportunities of health tourism

in 2004.13 She stressed that due to its prominence in the practical and conceptual
domains, medical tourism requires more attention. In this article she invited the attention
of the researchers to initiate studies on this new found opportunity. Pre-2006 studies on
 24

medical tourism were confined to mere conceptual exploration, but later the studies threw
light on the issues pertaining to medical tourism and the opportunities. Government
policy issues, public health protection against medical tourism exploiters, patient-
travelers and medical tourism and entrepreneurial opportunities were some of the major
topics covered during this period. Though some studies were of rigorous analysis, most
of them were an exploration of concepts, without any empirical approach.

2006
When compared to the previous years, in 2006, a spurt of quality was witnessed in
the publications that appeared in the academic journals. The articles appeared were not
empirical studies, rather they were based on secondary sources. For example - Connell,
Newman, Lee, Srivastava and Matoo and Rathindran can be lined in this empirical
studies category. In fact Lee’s study was on exploring and critically analysing the issues
surrounding the concept of medical tourism. He looked into the entrepreneurial
opportunities associated with it.14 The study was shallow in nature, because only the
secondary sources were used for gathering information pertaining to the study.

Similar to Lee’s study, Connell also explored the concept of medical tourism in

the world scenario.15 He described the emergence of a new concept i.e. Asian Medical

Tourism Market and various economic issues relating to medical tourism such as cost

savings. He also described a few world statistics about medical tourism. He was the first

person to distinguish health tourism with medical tourism. His study can be considered as

the base for researchers who are in pursuit of novelty.

Srivastava viewed medical tourism from a different perspective. He explored an

opportunity for apheresis tourism which is a part of medical tourism.16 Since medical
tourism is an upcoming phenomenon in India, he found an opportunity to promote
apheresis tourism along with medical tourism. Matoo and Rathindran analyzed how
health insurance inhibits the health care.17 In their article, they first estimated the gains
from the health care trade, and compared the cost savings on cross border health care and
proposed remedies for the impediment.
 25

2007
Almost all the articles appeared in the journals are of conceptual in nature except
Sayili’s study on Kangal Fish Spring in Turkey. He investigated socio-economic and
visitor characteristics of people visiting Kangal Fish Spring in his case study. The paper
was concluded with a discussion about the future of the destination and health tourism in
Turkey. Other studies are all about the current scenario of medical tourism and its
implications of medical tourism. Horowitz, Burket and Forgoine and Smith attempted to
present medical tourism and its impact on US health infrastructure coherently. Burket
concentrated much on the American legal perspectives18, but all the papers were ended
with a note on the prosperous future of medical tourism with a little concern about the
quality and safety of cross border health care. Another publication by Smith and
Forgoine19 was on the same line of Burket. In their study they described the impact of
medical tourism and its impact on healthcare system. Horowitz and a few others
described the emergence of medical tourism20, various destinations and concerns with the
global health care and eventually ended the paper with a note on the prosperous medical
tourism future. Though Taguri’s21 paper was on medical tourism, but he deviated from
the beaten track and brought limelight the Libyan health infrastructure to the world.

Hunter in his conceptual paper Medical Tourism - A Conceptual Niche

surveyed the history of medical tourism, its economic scope and travelers’ motivation
associated with medical tourism.22 His discursive analysis explored the implications of
the medical tourism on the tourism industry of a destination and concluded that further
studies are required to gain more benefits from this growing industry. Turner also
presented the prospects of medical tourism with the touching story of Howard Staab.23 He
displayed the current scenario of medical tourism and how patients are being allured to
destinations, which provide cheaper medical services. He explained the economic
benefits of medical tourism to developing countries such as India and Thailand. A
different approach from this conceptual dilemma is of Smith and Forgoine and Bies and
Zackaria. Smith and Forgoine proposed a framework that seeks the factors that influence
patients’ decision to select a health service abroad.24 These authors developed a two stage
model for medical tourism. They also described that the policy makers must be aware of
 26

these factors and to consider them in order to transform the US health system to compete
with the rest of the world.

Bies and Zacharia proposed another model for medical tourism.25 Their study
aimed at determining whether medical tourism is worth promoting and, if so, in what
form. To portray the same, they developed an Analytic Network Process (ANP) model.
ANP model is the most comprehensive framework for the analysis of societal,
government and corporate decision that is available today to the decision-makers. They
applied benefits, opportunities, costs and risks associated with the four alternatives, viz.
employer, individual, government and people who do not participate directly in medical
tourism. They found out that self-selected medical tourism is the most preferred
alternative. This study can be applied to develop marketing strategy and medical tourism
products for the individual medical travelers rather than government, or employer
sponsored travelers. Hume and DeMicco studied about the hotel and medical tourism.26
They described the opportunities of hotels in the medical tourism scape. They pointed out
that hotels will be more competent and do better service for medical tourists if they are
equipped with service innovations. Lee and Spisto undertook a conceptual study on
medical tourism. In their study, they applied the Porter’s Diamond model to evaluate,
analyze and discuss the growth of medical tourism.27 They proposed monitoring and
quality increment are necessity to keep pace with the international standard.

In conclusion, the studies published in various journals during 2005 showed that
the researchers started exploring various implications of medical tourism and applied
various models to medical tourism concept. Prior to this, such kind of exploration have
not resorted to, except Hunter-Jones’s article that has come to public in 2005.Of course,
most of the studies were conceptual in nature. Empirical studies were scarce, expect
Sayili’s and a few others publications in 2007. One interesting thing to note here is that
all these implication studies on medical tourism were confined only to the US health
system. The reason may be due to the fact that majority of the medical tourists are from
the US. Similar implication studies that were found in 2006 by Borman, but the
difference is that the concentration was on National Health Service (NHS) of UK only.
 27

One book has been published entitled Medical Tourism in Developing

Countries by Milica Z. Bookman and Karla R. Bookman. It is an attempt to systemically
evaluate the phenomenon of medical tourism from an economic point of view. This book
is one of the first academic works published on medical tourism. The main purpose of the
book is to appraise medical tourism as a strategy for economic growth, focusing on how
revenue from international patients translates into output, job and income. The authors
also providing an interesting discussion of medical tourism as a market for travelers and
countries.28

2008
In 2008, only three serious papers on medical tourism were traced. Almost all
these papers were conceptual in nature. Lautier aimed at filling the gap of the availability
of empirical study on medical tourism and the rapid growth of health service exports.29
This paper projected only one aspect of medical tourism, i.e. medical service export.
Conceptually, this paper provided a different perception on the case of Tunisia, which
considered as a potential medical tourism destination of the Middle East.

The second paper is by Chambers and McIntosh. Their paper identified the
importance of developing unique medical tourism products for the English speaking
Caribbean.30 They admitted that it is very difficult to compete with the world as far as
medical tourism is concerned, especially Asian countries such as India and Thailand. In
such cases they proposed to develop a unique medical tourism product to provide
authentic experience to the medical tourists in order to compete with the world market.
The methodology used in this study is underpinned by a constructivist philosophical
approach. Their study discussed the term authenticity and argued how it can be embedded
into making the tourism product that benefits the English speaking Caribbean.

The third is the book published by Melanie Smith and Laszlo Paczko entitled
Health and Wellness Tourism. The book takes an innovative look at the rapidly
growing health and wellness tourism sector. The book examines the range of motivations
that drives this diverse sector of tourists, the products that are being developed to meet
 28

their needs and the management implications of these developments. A wide range of
international case studies illustrate the multiple aspects of the industry and new and
emerging trends such as spa treatments, wellness tourism, meditation and yoga retreats.
The authors also evaluate marketing and promotional strategies and assess operational
and management issues in the context of health and wellness tourism.31 All the papers of
2008 were resorted to conceptual nature, but the approach was wide when compared to
2007.

2009 and Later

India is considered as one of the prominent medical tourism destinations of the
world and for the first time an empirical study substantiating this has appeared in the
form of a journal. It was undertaken by Rajeev and Latif. It was on the knowledge,
attitude and experiences of the population with special reference to Mangalore.32 It was
the first empirical study on medical tourism in India in general and Mangalore in
particular. Methodology used in that study was primarily based on a questionnaire survey
with the Non-Indian Residents and Foreigners. The second paper was a case study on
medical tourism and Apollo Hospitals in India by Babu George.

This study identified the strength, weakness, opportunities and threats of Apollo
hospitals in India. The article described how Apollo hospital became the forerunner in the
medical tourism in India. The year 2009 saw only two studies and they are on Indian
medical tourism.33

Most of the studies so far consulted were conceptual in nature not many are
empirical researches. A few models were applied to medical tourism to theory building.
In 2006 and 2007 more articles were appeared when compared to 2008 and 2009.

A book entitled Medical Tourism came out in 2009. This book was written by
Parekh R.L. the book starts with a general introduction of the concept of medical tourism.
Various aspects mentioned in this book are medical tourism in the Indian context,
 29

globalization of medical treatments and its impacts on medical tourism industry. The
book also describes positive and negative aspects of emerging medical tourism industry.34

John Connell came out of a book on medical tourism in 2010. This book
examines medical tourism as an emerging component of the tourist industry and a distinct
and controversial element of health provision. The book consists of ten chapters. The
various elements discussed in this book are the reasons why medical tourism has
emerged, vast range of practices and brings together tourism and health, and the
evolution of medical tourism. The book also examines Asia as an emerging medical
tourism destination. Issues such as the influence of internet on medical tourism, the
impact of medical tourism, and ethical issues on medical tourism are also discussed. The
book ends with a discussion on globalization of medical tourism.35

From the literature review it is evident that the medical tourism lacks empirical
studies. Therefore more and more such studies are needed about medical tourism. So, the
current study is important in nature with its purpose of investigating the case of
Mangalore as medical tourism destination.

SCOPE OF THE STUDY

Travel and Tourism is one of the important industries in the Indian economy in
terms of foreign currency earning and employment generation. In the tourism arena
medical tourism is a newfound opportunity, which is yet to be developed to its’ full
potential. Because of its’ phenomenal potential, it deserves the attention of the policy
framers, researchers as well as the public. Hence, this study opens up those vistas that are
essential for an elaborate scholarly research. It attempts to identify all the allopathic
treatment options available in India in general and Mangalore in particular under medical
tourism.

This research work throws open the gates for Studies on similar smaller
destinations of India, for, this will project India to the world as the treasure land for
medical tourists, who prefer to visit either the developed or the developing city of India.
 30

This study is also a stepping stone for the researchers who would like to carry out
Studies on the Alternative Medical Tourism Facilities available in India. In fact, it
acts as an advancement of knowledge

The present research can be considered as a foundation for further studies in

Comparing and Contrasting the Medical Tourism in the Northern and Southern
parts of India.

LIMITATIONS OF THE STUDY

Though this is an elaborate research study, the page constraint stood as a limitation
and the study could not incorporate information in detail pertaining to the other treatment
facilities that can be utilized by the medical tourists i.e., Ayurveda, Siddha, Homeopathy,
Unani, Yoga, Meditation and so on which are quite popular as effective Indian medicare.

TOURISM TODAY
Today tourism accounts for the single largest peaceful movement of people across
cultural boundaries. At the Manila Declaration on the social impact of tourism the World
Tourism Organization mentioned that tourism can support greater involvement of
communities in the planning, implementation, monitoring and evaluation processes of
tourism policies, programmes and projects within the context of national objectives and
priorities, which improves people’s standard of living through tourism by providing
economic and social opportunities for wider participation and wherever possible and
acceptable, dispersal of tourism activities and destinations to outlying areas to increase
rural income.36 Throughout the world, tourism is considered as a development vehicle
due to its contribution to the local and national economy. It represents an important
source of foreign exchange earnings, especially for developing countries. For many
countries tourism is the major source of employment for local communities. According to
World Travel Tourism Corporation every 10th person in the world is related to tourism
industry by 2012.37 Apart from foreign exchange earnings and job creation, tourism has
many other benefits also. Some of them include
 31

• Tourism re-distributes wealth

• No trade barriers for tourism
• Tourism utilizes natural, free infrastructure
• Backward linkages
• Preservation natural treasures
• National development, through new tourism product development

Due to all this, over the next ten years the industry is expected to grow by an
average of 4% annually, taking into 10% global GDP, or US $ 10 trillion. By 2022, it is
anticipated that it will account for 238 million jobs or 1 in every 10 jobs on the
planet.38This places tourism roughly on the same order of magnitude as agriculture or
mining.

Contribution of Tourism to GDP

Source: World Travel and Tourism Council, 2012

BACKGROUND OF THE STUDY
Economic freedom, more time to enjoy leisure, increased life expectancy,
knowledge about other places, affordability and easy international travel gave rise to
many new trends in the tourism industry. A notable trend amongst those is the increasing
number of patients traveling to places to seek medical treatments. The splicing of medical
treatment and tourism is relatively a new concept.39 It is a type of tourism where people
 32

seek medical services at a destination and engage in tourism activities before or after the
medical treatment and it is

as ancient as prehistory and as up-to-date as tomorrow.40

In the past, when one needed medical treatment, he or she used to search for a
suitable medical practitioner locally. However, in pursuit of the advanced medical
requirements, people from developing nations travelled to developed countries. This is
due to lack of advanced technologies and insufficient medical expertise in the developing
countries. But now, patients travel from developed nations to developing nations seeking
advanced medical treatment. This is in contrast to the traditional model where patients
traveling from developing countries to the developed countries. The emergence of this
reverse model captured the world attention since 2006. Over-burdened medical systems
and long waiting times in the developed nations, cheaper medical treatments in the
developing nations, internet communications, affordable air travels and easy visa
regulations are the base growth factors for this transformation. These factors changed the
way people travelled a few years back and this niche travel pattern is bringing a rapid
change in the tourism industry in future, because freedom of choice in the selection and
convenient time to visit the medical destination are providing flexibility to patients to

consume the (medical) service at the point of sale.41

In fact, Medical tourism is a new concept of an old phenomenon of people

traveling to distant destinations for curative medical care. More and more countries are
entering this newly found potential industry and currently more than fifty countries have
identified medical tourism as a national industry. In many developing countries such as
India medical tourism is being actively promoted with the government support42. At
present, major medical tourism destinations in the world are India, Thailand, Malaysia,
The Philippines, Mexico, Puerto Rica, Turkey, South Africa, Brazil, and Costa Rica. Like
developing nations, developed nations are also promoting medical tourism. For example
The U.S., UK, Dubai, and Singapore. More and more countries are getting themselves
equipped to attract patients around the world. In future Asian countries too will continue
 33

to maintain their place as the medical destinations of the world due to the fact that the
medical facilities in the developing nations are now on par with developed nations and of
course they are economical too.

ENDNOTES

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 35

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26. Lydia F. Hume and Fred J. DeMicco, “Bringing Hotels to Healthcare: A Rx for
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27. Christine Lee and Michael Spisto, “Medical Tourism, the Future of Health
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 36

31. Melanie S. and Laszlo Puzcko, Health and Wellness Tourism (Oxford: Elsivier,
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