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Medical Tourism: Opportunities and Challenges in Tamil Nadu Dr. Annamalai Murugan* Introduction 1.1. Where does India Healthcare Industry Stand? India has a wide network of public and private hospitals; most of the healthcare services are provided by the private sector. Public sector institutions are run by the Central or State government bodies, whereas private hospitals are managed by trusts as a profit or not-for-profit organisation. In the recent past, there have been major changes in healthcare delivery. India is gradually moving from conventional standalone set-ups to hospitals chains with well integrated networks. There is increasing penetration of Information Technology (IT) applications in healthcare institution. An It Application further enhances the quality of care and helps to provide one-stop-solution to the patient’s need. India is also at the forefront to adopt innovative solutions such as usage of telemedicine services. There is a continuous increase in the number of healthcare institutions offering telemedicine services. Telemedicine infancy, but it is making intrados at a fast and peace India is expected to emerge as a country with a high penetration rate for telemedicine. 1.2. Healthcare delivery in India-a snapshot India needs to expand its healthcare facilities to cater to its one billion plus population. India has around 180,000 hospitals out of which 1,60,000 are primary healthcare centres. India has a three tier system. Tier 1 hospitals provide super speciality healthcare services, for example, Cardiac surgery, Surgery Tumour Removal, Organ Transplantation etc. They are located in metros and state capitals, around 70-80 per cent of tier 1 hospitals have around 250-300 beds. Tier II hospitals are general hospitals, which do not conduct super-specialty surgeries. They are mainly present in State Capitals and other important cities in each state where there is negligible presence of tier I hospitals. Tier II hospitals typically have a bed strength ranging anywhere between 50-100 beds. Tier III is generally 5-25 bed hospitals which are more popularly termed as nursing homes in India. They may have a small ICU with very basic instruments and a minor OT attached for very basic procedures. In big cities, they play a primary role in treating patients with minor ailments, which do not need surgical intervention or advanced care. Conversely, in small towns they perform the same roles , which tier II hospitals perform in the bigger towns and cities, namely, to stabilise patients with serious conditions and then transfer them to tier I hospitals for advanced treatment. Health services will also have to cope with an increase in the chronic and lifestyle-related conditions associated with rising incomes and greater longevity. In India, 80-85 per cent of the health care expenditure is borne by the patient; 12-15 per cent by the government and a mere 2-3 per cent by the insurance sector. Due to inadequate support from the government, the Indian market is completely controlled by the private sector marking it very price sensitive. This year, the government’s budgetary allocations to healthcare have also been increased to 21.9 per cent over the previous year. The per capita expenditure on healthcare is also on the rise due to the increase in related diseases. To cater to this demand, both public and private healthcare facilities are working towards efficient, affordable and quality healthcare delivery. The private sector is focussing more on tertiary level healthcare services whereas the government is concentrating on the root causes through services towards prevention and eradication Physical Infrastructure (Investments) The Indian healthcare delivery market is also making its presence felt in the global market by providing high class quality services and focussing on medical tourism. An estimated 50 per cent of tertiary level hospitals focus on providing services to the medical tourism sector. Some big industry players like Apollo, wockhardt; Max, Fortis, Manipal, etc. have changed the face of the industry by providing world-class healthcare facilities. They already have hospital chains covering all geographic regions of India. Nevertheless, the current healthcare infrastructure in India is inadequate to meet the future needs. An estimated 7.5-9 lakh hospital beds are required by 2012 to meet the current rate of demand. This infrastructure would need an investment of approximately US$30-40 million.
*Lecturer in Tourism Management, Tagore Government Arts College, Pondicherry. firstname.lastname@example.org
IIMK Part IX – Medical Tourism IIML
Source : Emst & Young Report: Cumulative investments
To meet this demand, a new paradigm in healthcare is the concept of Health City- Township with integrated healthcare facilities. By 2010, about 10-12 health city projects will start operations across India. Health insurance medical tourism and corporate hospitals have resulted in higher demand of quality services. This has resulted in the formation of regulatory and accreditation bodies to define standards and regulations for various healthcare facilities. This initiative will definitely improve the quality of services provided by the Indian healthcare industry. Medical Equipment Market
Source : Ernst & Young Report
Many major hospitals like Apollo and Wockhardt have already achieved the highest level of quality certification from JCI (Joint Commission International) for their healthcare services. 1.3. Leading diseases The leading diseases of the country are Asthma, cardiovascular disease, Tuberculosis, Cancer, Diabetes and AIDS. Urbanisation air pollution and environmental tobacco are the prime reasons for the increase in the prevalence of asthma. Around 20 million people in India are suffering from asthma; majority being children. Early exposure to chemicals, pesticides and smoke are the prime reasons for increased incidence of asthma in children. India is trying to control the prevalence of asthma by strictly prohibiting child labour, as this is also one of the major reasons owing to which, children are exposed to chemicals and pesticides. Health Service Outsourcing Cardiovascular disease is the killer disease in the whole world. India with around 35 million has the highest number of people suffering from cardiovascular diseases in the world. There is a dramatic increase in the incidence of chronic illness would be in the cardiovascular area.
Conference on Tourism in India – Challenges Ahead, 15-17 May 2008, IIMK
APOLLO HOSPITALS: Has 41 hospitals offering 7. housing.Top IIMK Part IX – Medical Tourism IIML Tuberculosis kills almost 1. Healthcare in South Region Since the last few years the south region of India has shown improved health indicators and has become tech-savvy.000 beds and plans to add 5.000 beds.2 crore) in 2006.000 people everyday. coconuts and coffee south India a linguistic cultural region of India comprising the four states of Andhra Pradesh.228 beds. is today the home of hi-end technology in healthcare.400 3. Every year about 1. Tuberculosis morbidity varies between 0.700 2006 2012 Source : Emst & Young Report: Cumulative investments The number of Indians suffering from diabetes currently is around 35 million. highly qualified and experienced doctors best teaching institutes and excellent services and facilities which have further led to high focus on technology up gradation and rationalisation of cost. MAX HEALTHCARE: Has seven hospitals with 800 beds and by 2010.500 beds. The land of elephants. By 2010.4. Making Room The major healthcare chains are on an expansion spree. Conference on Tourism in India – Challenges Ahead. 1. The major factors that influence the prevalence of tuberculosis are nutrition. India’s leading corporate diagnostics chain. IIMK 382 . IDFC Private equity put in $20 million into Manipal Health Systems in 2006 IDFC Private Equity also invested $10 million in Bangalore based Healthcare global Enterprises in 2006.7 per cent in different areas. 15-17 May 2008.000 each year or six to seven hospitals each year).7-3. in 2006.000 beds in the next five years (1. It is expected that by 2020. 7. taking the total number of hospitals to close to 40 in five years. PRIVATE EQUITY AND HEALTHCARE Global investors are betting on the Indian healthcare market.900 beds and has plans of going up to 40 hospitals and 8.000 beds by 2010 WOCKHARDT HOSPITALS: It plans to double the number of hospitals to 14 by 2008 and take the cumulative bed capacity to 3. George Soros’ Quantum and Blue Ridge funds bough around 7 per cent stake in Fortis Healthcare for $33 million (Rs 145. Kerala and Tamil Nadu and the union territory of Pondicherry. every 5th Indian would be a diabetic. The region boasts large number of multi and super speciality hospitals. will have 11 hospitals and 1.000 from 1. but there are loopholes that still need to be mending.1 million new diabetic cases are added to the 35 million. FORTIS HEALTHCARE : has 12 hospitals with 1. Karnataka.500 at the moment CARE HOSPITAL: Has eight hospitals with 1. it expects to have 12. ICICI Venture’s India Advantage Fund-I paid $8 million to acquire around 18 per cent stake in Metropolis Health Services. industrialisation and urbanisation.
Typically. poor or no services in the government sector. This has been largely due to low infant and child mortality. nursing colleges and nursing schools come under the jurisdiction of the Director of Medical Education. rising aspirations. The poor and underprivileged cannot afford the costs of the private hospitals so the issue of class.5. Kerala and Pondicherry has shown an overall better crude death rate (CDR) in the region. cardiovascular diseases. 1. community health centres (CHCs).1 years in a span of 40 years.6 years and that for females 63. Despite a successful immunisation programme in Tamil Nadu compared to 15 major Indian states the nutritional status of children is still a matter of serious concern. By and large the health indicators have improved in the region attributing the credit to progressive socio-cultural movements. In fact in Andhra Pradesh the intensity of healthcare has proliferated in rural areas whereas missionary institutions are high in Kerala. sustained information programmes education.000 populations in 2003. increasing anaemia cases and enormous burden of hardwork has added to the high rate of maternal deaths.Top IIMK Part IX – Medical Tourism IIML In the social sectors of health. pneumonia. better health as well as improved literacy levels. whereas LEB of Kerala males has increased to 70. major causes being inadequate antenatal care and maternal malnutrition. Besides the improvement in health indicators healthcare in south India has developed due to the procurement of hi-end equipments and also due to the multi-disciplinary approach towards treatment. Also all states of south India have shown a rapid decline in the total fertility rates (TFR). Among the chronic illness. According to the HDR 1999. inadequate services have given a way to the rise in private sector. poor nutrition. Tamil Nadu has seen improved life expectancy at birth (LEB) rate. sub-centres and trained dais are prominent in the rural areas. According to the HDR 2003. In the rural region.4 years in the year 1995. The expansion of the private sector. The medical college run by the state and government hospitals attached to teaching institutions. particularly for males (HDR 2005). PHCs cater to a larger section of the rural population in Tamil Nadu and almost 35 million out patients are treated in PHCs annually. however the state of Karnataka claims highest birth rate in the region 21. Tamil Nadu also has estimated around 300. The Directorate of Health and Family Welfare Services is mainly responsible for the provision to health services. The highest number of PHCs functioning as of September 2005 in the south region is in the state of Karnataka1. The morbidity analysis of the state of Kerala reveals acute diarrhoeal diseases. diabetes. including private medical college. Also with rainy seasons. cancer. cardiovascular diseases. 0000-3500. Leading diseases Infant mortality is a serious issue in south India.8 in 2003. LEB in Karnataka for males has also improved to 60.3 per 1. dengue. Besides nutrition. Among the chronic illness. This has been witnessed in non-government organisations. better economic conditions and greater awareness among people. Inadequate nutrition levels have also affected the health of mothers and children leading to disease and infection. Every States in south has an expanse of health services spread across the region.6.9 years. the number of district hospitals is high. an increase of 26. aiming to integrate promotive. has led to an increased inequality in access to health services. Though there is large number of government hospitals. proper health facilities. Lack of essential and emergency obstetric care. etc. pulmonary tuberculosis. Pollution has become one of the leading reasons for increasing respiratory infectious diseases. preventive and curative aspects. caste and gender needs to be talked in a multi dimensional approach. are emerging a the severe health problems of the region owing to sedentary lifestyle. hypertension. the region has taken some impressive strides. AIDS cases are escalating in south region. The state of Andhra Pradesh shown appalling figures of infant mortality rate (IMR) around 59 per 1. however. 15-17 May 2008. whereas primary health centres (PHCs). Healthcare structure The healthcare delivery system in South India is structured mainly on the basis of national norms. lack of physical activities and obesity Ageing is another area of concern accounting for the overall hike in morbidity of the region. small private hospitals and non-profit hospitals. IIMK 383 . population growth. communicable Conference on Tourism in India – Challenges Ahead. measles. etc to be the dominating ones.681 and the least are in Kerala-911.000 populations for the year 2003. there are hospitals at district and sub-district level. The major factors that have prompted this stark improvement is the demand. where there has been a significant proliferation of corporate. 000 HIV positive cases.
Equipped with latest medical devices to offer internationally proven trends in medical procedures and healthcare. Narayana Hrudalaya and many others has given a revamped look to the healthcare delivery system of the state of Karnataka. Sri Sathya Sai Institute of Medical Sciences. Establishment of Primary Health Centres during Five Years Plans 1800 1600 1400 1200 1000 800 600 400 200 0 Po nd ich er ry Pr ad es h Ka rn at ak a Ke ra la il N ad u Sixth Plan (1981-1985) Seventh Plan (1985-1990) Eighth Plan (1992-1995) Ninth Plan (1997-2002) Tenth Plan Target (1997-2002) Functioning as on Sept 2005 An dh r Source: Modern Medicare March 2007.000 corneal transplants/year. have set a benchmark with advanced treatment modes.1.” It is also amongst the first three hospitals in the world to introduce techniques like ROLL (Radio Occult Lesion Localisation-for breast cancers) and RGNS (Radio Guided Neuro Surgery for bran tumours). 2. like KG Hospital. This model has proven successful in Malaysia. Manipal Hospital was the first in the country to receive ISO certification and Golden Peacock Award. Usha Mullapudi Cardiac Centre. To cite a few examples. It is also the first in the country to provide heli-ambulance service with a DGCA approved helipad within premises. Technology and achievements Pacing with the changed times. Dr. L V Prasad Eye Institute. is the first to enter the healthcare industry in India through the FDI route. Apollo Hospital.750 and resulted in the death of 75 persons in Kerala. IIMK 384 Ta m a . Cancer Institute Adayar. “Manipal’s laboratory is the first one to be accredited by NABL and has the first JCMR approved and DBT authorised trials on Stem Cell therapy in the country. Wockhardt Heart Centre. It had done the highest number of stem cell transplants in the world and is also the first in the world to have an integrated secondary and primary eye care network in rural areas. south India has always been on the forefront to provide hi-end treatment by the means of sophisticated medical technology. Institutions like Manipal Health Systems. MS Ramaiah Hospital. Sankara Nethrayala. Sri Ramachandra Medical College. Incorporated largely by private hospitals. the state of Karnataka was the first to introduce micro-insurance facilities for its population and was also the first to introduce telemedicine facility with ISRO. Apollo Hospitals. this new generation technology has become the integral part of the region.Top IIMK Part IX – Medical Tourism IIML diseases began to dominate. Individual achievements have been equally fabulous in the state. In the state of Andhra Pradesh hospitals like Global Hospital. Agarwal’s Eye Hospital. Asian Institute of Gastroenterology. 15-17 May 2008.” The state of Tamil Nadu also boasts of multi and super speciality that are run on professional lines with all equipments conforming to international standards. LV Prasad Eye Institute is one of the comprehensive eye care centre in India and the first institute in the world to reach an annual figure of 1. MIOT Hospital. Our model hospital delivers a more tightly defined set of products and services as compared to traditional hospitals. Hospitals like Columbia Asia based in Bangalore. for instance the attack and death de to chikungunya that affected around 42. Columbia Asia uses unique proprietary operating software to maintain all patient records electronically and the OTs conform to ASHRa (American Society for Heating and Refrigeration) standards. Conference on Tourism in India – Challenges Ahead.
2. Dr. aberropia. Similarly. Kerala Institute of Medical Sciences.4.2. As a result private hospitals have taken the charge along with voluntary organisations in handling mass causalities during epidemics and natural disasters. the department of health in Karnataka has been in touch with the private healthcare providers to introduce new and innovative centres of excellence. myopia in children and many others. Rural healthcare status The rural healthcare needs tremendous support from the government. KG Hospital based in Coimbatore has performed India’s first Awake Open Heart Surgery and has also dialysed a tow-day-old baby. cancers and neurology. The institute has also received ADCRS video award for the 0. Conference on Tourism in India – Challenges Ahead. health economics and operations research. Thus products of such a system are mismatched with the existing expectations. The government also lacks in monitoring maternal mortality and morbidity rates. In the last five years ground-breaking research has been witnessed in south India. the government has been very proactive in managing epidemic outbreaks. Similarly. diversity of places to visit and lastly state-of-the-art healthcare delivery. 15-17 May 2008. fair distribution of financial costs for access and training providers for competence. Government’s focus has always been to ensure. Also. anatomy. diabetes. Currently the lack of basic infrastructure in the interiors is responsible for the hike in illness prevalence rate. presbyopic LASIK. Aberration frees IOL. The other recent endeavours like purchase of CT and MRI machines for all district hospitals and connecting them to nearest super speciality hospitals has been a positive move by the Karnataka government. stem cell. For instance the Tamil Nadu Government is involved in blindness control and Vision 20/20. Manipal hospital has worked in the forefront of tropical diseases. Kelman Award and Barraquer Award. With the blend of auyrveda. A record of its kind was correction of five heart defects in a 5-year old girl. IIMK 385 . The state of Karnataka has 33 medical colleges-the largest in the nation. phakic IOL. Thiruvananthapuram Medical College. Medical education and research Medical education in India is based largely on the western model and unfortunately the curricula fail to match local health needs. the state gets patients from across the world. Agarwal’s Eye Hospital is known for introducing revolutionary techniques in eye care like 0. In some states. are few hospitals catering to the population. conductive keratoplasty and many others. empathy and accountability and special attention to vulnerable groups such as children women disabled and the aged. 2. the health budget of the government of Kerala is very fragile in terms of allocation for medicine and supplies. while the other states follow in research especially.8 per cent of GDP allotted where do you expect to pour more resources? The government support isn’t much impressive in the region. Besides policy and regulatory issues. Christian Medical College. ruling out few generous initiatives. the Karnataka government has been proactive in supporting the healthcare infrastructure in the state and was amongst the first in the country to encourage the private sector participating in healthcare delivery.7 mm phakonit cataract surgery. especially in Kerala. the south region has become the hub for the same in the entire nation. spas. stem cell biology. adequate training facilities should be made available for medical and paramedical workers. has planned to establish a Stem Cell Research Centre in collaboration with Reliance Life Sciences.7 mm sub 1mm cataract. JIPMER. Dr Agarwal’s Hospital has been involved in the research in diabetic retinopathy. However in other states despite the attempts government is not in a position to combat epidemics that create panic from time to time. L V Prasad eye Hospital has explored the areas of molecular genetics of the eye.3. anaesthesiology.Top IIMK Part IX – Medical Tourism IIML etc. With highest number of medical colleges and research institutes. Meenakshi Mission Hospital and Research Centre. infections clinical trials epidemiology. eyes and kidneys to different people from a brain dead victim-first in the region. For effective and efficient healthcare delivery in rural and urban areas. ECRs Dr.with0. 2. especially in cases like dengue fever. Our stem cell unit has now moved from basic science research to trials and will offer therapy ff the shelf in the near future” KG hospital on the other hand. Government aid The most common question raised is. It had performed multi organ transplants by harvesting the liver. multifocal IOL. Most of the medical institute in Kerala are renowned to cater the foreign tourists.
the hospitals now receive patients from the UK and US.Top IIMK Part IX – Medical Tourism IIML Owing to non-availability of infrastructure and facilities. It has achieved success with 91 per cent infant immunisation cover. Agarwal’s Eye Hospitals. doctors still find it difficult to migrate to rural areas for practice. Besides Anganwadi workers also play a major role in providing thrust to the primary healthcare scenario. The concept is yet to take shape and about 10 per cent of the population has medical insurance.3 8.9 19.1 5. State/UT Andhra Pradesh Karnataka Kerala Tamil Nadu Pondicherry Medical tourism Here.6 5. Agarwal’s Eye hospital receives patients from almost all Asian countries. Agarwal’s Eye hospital to learn techniques invented by the hospital.4 18.2 6. It has distributed over 25.3 18.6 6. 91 per cent female literacy and low death rates/low infant mortality rates.. Thus doctors by and large do not venture out in villages to provide healthcare to the poor in a greater measure.4 5. treated over 50. compared to last five years. etc. Government of Mauritius informal relations with Maldives. Dr.2003 Infant Mortality Rate Rural Urban 67 33 61 24 12 10 48 31 33 17 Total 59 52 11 43 24 . IIMK 386 Infant Mortality Rates . like school. In fact.8 17. However.6 21. Micro-insurance has been introduced in this region and the government is planning to introduce similar scheme through schools and post offices however. Being cost effective with state-of-the-art infrastructure. Better travelling modes.000 green cards in the slums across Bangalore districts that enable free consultation and treatment and provide drugs at discounted price.5 17.000 lives in association with ICICI Lombard. many private and corporate hospitals are currently catering to the needs of foreign patients.8 7. Manipal Group has a tie-up with some foreign governments like the Government of Tanzania. there is a dire need of awareness about the subject among the poor classes of the region. Estimates of Birth Rates and Death Rates -2003 Birth Rate Rural Urban Total Rural 20.8 16.5 18 17. which is a much better figure.. ophthalmologists from around the world have started visiting Dr.7 State/UT Andhra Pradesh Karnataka Kerala Tamil Nadu Pondicherry Death Rate Urban 5.5. etc. Conference on Tourism in India – Challenges Ahead. Columbia Asia wills soon set-up a Customer Guidance Cell to educate people about the benefit of health insurance. Manipal group has adopted 11 villages. Many hospitals along with the Rotary Foundation are undertaking path breaking research projects and national health programmes in the villages.4 8.9 16 16. Bangalore and the state of Kerala score high-the former because of its international nature and connectivity and the latter because of ayurveda and spas. Under the eye research centre.3 7.2 18.4 Total 8 7.1 20.5 7.8 23. a unit of Dr.3 Fortunately the involvement of private and corporate hospitals in improving the rural healthcare scenario has given a ray of hope. The hospitals also organises free eye camps and free OPD on the last Sunday of every month. The Manipal Group’s Manipal Arogya Suraksha Scheme covers over 80. colleges and housing. more than 100 patients from rural areas are operated absolutely free every month. Medical insurance Medical insurance in general is gaining importance and is popular with people from all sections of society. 2. 15-17 May 2008. tie-up with five star hotels travel agencies and international government agencies.000 people and holds 23 weakly clinics. a few of the development in promoting medical tourism.6 6.7 6.
HDR 1999 suggested for the state of Kerala that a judicious combination of incentives and deterrents must be worked out to draw public and private medical personnel into poorly served districts. should reduce the maternal mortality rate to less than one by the end of the next decade. For instance. budget allocation should be augmented. Government needs to start some kind of disease mapping system. Indian Dental Industry . This will enhance connectivity with almost all countries in the world. Theses hospitals will initiate preventive programmes for people through promotions and tie-ups with large institutions. ventures. With the vision of “Health for All’ the days ahead will witness healthy competition between healthcare providers in South India that will lead in the outcome of quality and better healthcare. to improve infrastructure in terms of quick evacuation and pick-up and drops facility from hospital to the airports. Sanitation and nutritional message to the farthest corners of the state. Bali elaborates. medical colleges and pharma companies should work in collaboration along with the need for basic privatisation in some areas of healthcare delivery. The current private and corporate players have chalked out their expansion plans to establish more hospitals across the nation and smaller centres in the interiors. should cut down the IMR to at least 30 by 2010 should raise life expectancy to 75 years by the next decade. as it will help the industry to understand its diagnosis and treatment.1. Karnataka will soon get an international airport in Danhalli.3. which is claimed to be the largest such in south Asia. However. child obesity is increasing but is it region specific? Facts like these are not available. In the coming years The years ahead will sea a rapid growth in the number of world-class facilities offering entire gamut of procedures. etc. To improve the face of rural healthcare in the south region. According to HDR 2003.Top IIMK Part IX – Medical Tourism IIML Eventually the government in this region is supporting the private hospitals by the means of developing infrastructure. Doctors in this region holding great esteem abroad will perform high number of breakthrough surgeries for complex problems. which will create viability participating in paramedics. malocclusion and oral cancer have been increasing in India This is due to changing lifestyles including Conference on Tourism in India – Challenges Ahead..5 by 2010. changes in approach are also required in reaching the health. the struggle is still on. Soon.2. with more technology dependant care.” With the R&D point of view. PHCs & CHCs Functioning Sub-Centre PHCs 12522 1570 8143 1681 5094 911 8682 1380 76 39 CHCs 164 254 106 35 4 A foray in private equity. Health being a state issue one of the biggest platforms to be looked at is the public private partnership (PPP). especially by private players will be a step forward. 3. gum disease (periodontics). A greater number of people utilising health insurance will be seen along with the reduction in the number of smaller level facilities. 3. the Tamil Nadu government should bring down the TFR to 1. Most hospitals are likely to get accredited. For instance. should undertake close study and remedial measures to reduce the incidence of diseases. 3. more five star hotels and beautification of existing tourist places. patients with oral diseases such as dental caries. 15-17 May 2008. Once disease mapping is made available it will be a boon for next generation. more medicines and supplies needs to be provided to the government hospitals and health centres and for this. Things to do The government needs to play a strong role in providing quality healthcare to the masses. IIMK 387 . teaching research. thus benchmarks will be created in healthcare to attract foreign patients to come to India for treatment. should eradicate vector borne diseases like malaria and filarial water borne disease like hepatitis and communicable diseases like TB and should improve overall health by reducing rural and urban poverty and provide sanitation facilities through more effective resource allocation. a large number of Indian doctors will go abroad in a greater measure to train foreign doctors. The future will see more corporate hospitals.an Overview Over the last five decades. State/UT Andhra Pradesh Karnataka Kerala Tamil Nadu Pondicherry Number of Sub-centres.
dental chairs and furniture drill engines and artificial teeth. India has an estimated 100-150 million disposable income population who have capability to spend for private healthcare services and this population is growing at a rapid pace Constituting about 10-15 per cent of India’s total population. Most of the dental expenses are borne directly by the patient and only about one per cent of the Indian population has individual health insurance coverage. increasing consumption of fast food or refined foods. the IDA was instrumental in bringing out National Oral Health Policy and has been the leading authority in the Indian oral health sector. which has opened up opportunities for tremendous growth. Due to the diversity of medical practice in India. as it does not consider it a high priority sector. They are estimated to grow at the rate of 18 per cent annually as shown in the figure. India currently has an estimated 80. The Government has started realising the export potential of the dental services sector and is now planning to provide incentives to boost dental tourism. which attempt to maintain a central register of qualified practioners. digital radiography and CAD/CAM systems has increased the demand. the value placed on oral health has increased. and smile. Cosmetic dentistry procedures like smile designing. Organisations like Dental Council of India (DCI) and Indian Dental Association (IDA) are instrumental in regulating standard in the dental practice and maintain code of ethics in the dental profession. Despite the market a sizable opportunity for growth of the dental sector in India that needs to be explored. Imports by hospitals include dental cements and specialty dental fillings. Though majority of the population still lacks awareness on oral dental hygiene. This is one of the largest recognised bodies of dental professionals in India.Top IIMK Part IX – Medical Tourism IIML diets rich in sugar. Other reasons include lack of knowledge or education about dental problems and presence of high fluoride in drinking water in many areas in India. the growing middle income group are seeking international quality medical services in super-speciality hospitals. The Dentists Act of 1948 “(http://disc.html) controls the practice of dentistry in India. porcelain metal bridge and crown root canal treatment complete dentures.ernet.500 which is critically low when compared to the recommended 1:7. metal free bridge. thereby dividing the growth in the Indian dental sector. They need to give attention on educating patients on importance of dental screening and how the emerging new technologies have potential to make a positive impact on quality of life of people. The adjoining chart depicts the imports and exports of DE and supplies. IIMK 388 .2 per cent of the total population lives in the rural areas and almost all of them are deprived or are unawareness of basic dental care or dental facilities and services. efforts from the Indian Dental Association (IDA) coupled with technical and financial support from private companies like Colgate – Palmolive (India) Limited in launching an intensive awareness and education campaign has tremendously helped increase oral health care education and regular dental check-ups. Advent of cosmetic dentistry focusing on improving the appearance of oral cavity and use of advanced technology like laser. dental instruments and appliances. there are several laws relating to the various system of medicine. New approaches of dental treatments have changed the perfunctory way of looking at dental care. Several major hospitals across India are now offering the latest dental treatment at very competitive prices. incidence of dental diseases has been brought down markedly by oral health education.iisc. In Western countries. the desire for aesthetic dentistry has grown and will probably continue to do so. it has liberalised the trade unions and made the customs duty on the dental imports almost nil. the Government of India does not spend much on the dental sector. From the standpoint of companies who would like to enter this market. mouth. In addition. this industry is solely driven by and dependent upon the medical professionals. and dental veneers among others are done at extremely lower prices (of almost 70 per cent less than the Western counterparts) with an uncompromising Conference on Tourism in India – Challenges Ahead. DCI regulates dental education.000 dentists and the dentist to population ratio is still 1:22. Also the government decision-making bodies in India lack dental health planers with relevant qualification and training Therefore. To add to this. Majority of population is below the poverty line and cannot afford expensive dental check-ups and treatments. consumption of tobacco in many forms like betel nuts quid and pan masala and increased consumption of alcohol. modification of diet and use of fluorides. dental implants. Nearly 72. poor oral hygiene.500 dentists to population ratio by the WHO. As the population has become more affluent and educated.in/vigyan/dent. 15-17 May 2008. Cosmetic dentistry is a new branch of dentistry which focuses on modification of appearance of a patient’s oral cavity and surrounding and thereby improving the appearance of a person’s teeth. There is huge opportunity awaiting them mainly due to high prevalence of dental disease patterns in India. About 40 per cent of the Dental Equipment (DE) and consumables in India are estimated to be imported every year. Though Government of India does not spend much on the dental sector.
By 2014. 5. 6. The 11.972. 15-17 May 2008.2 per cent (Rs 4.1 billion) to 5. India was adjudged Asia's leading destination at the regional World Travel Awards (WTA).0 per cent of total personal consumption in year 2004.002.7 billion (US$ 90.3 billion. 1. India Business Travel is estimated at Rs 114.4 billion or US$ 5. Bangalore-based Leela Palace Kempinski has been rated as the favourite business hotel in the world in a Readers' Choice Awards by Conde Nast Traveller.On the Upswing International Recognition Along with the growth of this industry. By 2014.8 jobs.6 per cent of the total by 2014.846.456.9 bn. "Conde Nast Traveller".441200 jobs or 2.1 per cent of total) by 2014.8 per cent of total. US$ 19. this should reach Rs 3. The "Incredible India" campaign has been ranked as the Highest Recall Advertisement worldwide by "Travel and Leisure". this should reach Rs 1. US$ 46. By 2014.5 billion.4.9 billion US$ 21. The world's leading travel and tourism journal. ranked India as the numero uno travel destination in the world. rising India's appeal as a leading global tourist destination. 5.000 in India. 7.2 per cent of total investment in year 2004. By 2014.477. 618. High incidence of oral diseases coupled with efforts by WHO and other private organisations to increase awareness of dental hygiene is going to tremendously increase demand for dental care. 5.027.5 billion or 6. facilities and services in future. Gross Domestic Product India’s travel and tourism industry is expected to contribute 2.4 billion in year 2004.8 per cent per annum in real terms between 2004 and 2014. Capital Investment India Travel & Tourism capital investment is estimated at Rs.790. the highest policy making world tourism body represented by 150 countries.3 billion (US$ 38.4 billion or US$ 31. India's Taj Mahal continues to figure in the Seven Wonders of the World.663. Travel and tourism demand is expected to grow by 8. rising in nominal terms to Rs. or one in every 17.4 billion or 7.5 billion or 5.1 per cent of total consumption.5. this should reach Rs 387.9 per cent (Rs 1. 485.000 travel and tourism industry jobs account for 2. Personal and Business Travel Tourism India Personal travel and tourism is estimated at Rs 927. IIMK 389 . 3.7 per cent of total employment or one in every 17. US$ 2.500 at a top end dentist in India as against $8.600 jobs in 2004.Top IIMK Part IX – Medical Tourism IIML level of international quality treatment.0 billion) in this same period.5 jobs. 7.3 billion or US$ 25. Employment The Indian travel and tourism economy employment is estimated at 24. 3. 2. international accolades have been pouring in.404.00 billion). 1. 4.6 per cent of total employment.000 in the US and dental implants that cost $3.4 bn) by 2014.8 billion (2.8 bn) of economic activity (Total Demand) in 2004 growing (nominal terms) to Rs.6 per cent of total employment in 2004 and are forecast at 12. US$ 10.0 billion. Indian Tourism. 2. The travel and tourism economy contribution (percent of total) should rise from 4. Conference on Tourism in India – Challenges Ahead.5 billion or US$ 64. This has made India a favourite hot spot example same designing costs about $1. Key Facts and Figures India’s travel and tourism is expected to generate Rs. India has been elected to head the UN World Tourism Organisation (UNWTO). The Association of British Travel Agents (ABTA) has ranked India as No.1 amongst the top 50 places for 2006. this should total 27. The current government is dedicated to opening India up to the world. 3.612. Incentives given by government like liberalisation of trade unions and almost zero import duties have potential to attract huge investments in Indian dental industry.3 billion.0 per cent to Gross Domestic Product (GDP) in 2004 (Rs.500 in the US are only close to $1.4 billion or US$ 13.2 billion or 7.000 jobs.
8% and 10.7 per cent of total exports (Rs 283.. India has opened up its sky.3 million (133 lakh) in 2000 to 22. The number of seats offered increased from 22 million (220 lakh) in 2003 to 46. The domestic traffic rose from 13.5 million (INR 40. 15-17 May 2008. The low cost carriers are able to successfully woo the upper class railway and road passengers in 2006.Top IIMK Part IX – Medical Tourism IIML Export Visitor Exports play an important development role for the resident travel and tourism economy India travel and tourism is expected to generate 6.3 billion (5. 000 crores) in the airport sector in the next 5-7 years. suggesting urgent up gradation/augmentation of airport infrastructure. Numbers are passenger movement in million Two green field airports namely New International Bangalore airport and New International Hyderabad airport are being developed with the help of private sector (a consortium of Indian and foreign airports/companies). The international passenger and cargo traffic during the same period registered growth of 9.81 43. The approved automatic investment route allows FDI up to 49% in the airport sector. In recent years it has signed liberal Air Services Agreements with many countries resulting in substantial increase of seats offered to and from India. The route followed in awarding these projects has stood the scrutiny by The Supreme Court of India.5% respectively. Therefore awarding any new project following the said route should pose no difficulty to the Government. 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 0 5 10 15 20 25 30 35 40 22. the Ministry of Civil Aviation and Airports Authority of India have decided to liberally involve private sector in the development and management of airports.4 per cent of total) in 2014. the domestic passenger traffic rose by 43%. This sudden spurt in traffic has led to congestion at airports.267.5 35. Domestic air traffic could more than quadruple by 2015.37 33..2 billion or US$ 6.0..5 million (465 lakh) in 2006. 4. civil aviation in India has registered unprecedented growth.8 38.3 million (223 lakh) in 2005 registering annual growth of 18%.3 billion or US$ 16.37 25.21 40.75 27.0 billion) in 2004.5 29. the running airports at New Delhi and Mumbai were given to Joint Venture Companies for management and urgent development of infrastructure. High powered group headed by Prime Minister of India estimates an investment of the order of US$ 102. Civil Aviation and Tourism In recent years.4 31.6 45 50 Source: Business Today September 2007. Experts are of the view that respectable growth in air traffic will be seen in the next 10-15 years. The domestic air freights particularly the express and perishable segments have added new markets. IIMK 390 . They are expected to be opened in 2008. Last year. To meet these challenges. growing (nominal terms) to Rs 1. Conference on Tourism in India – Challenges Ahead.
Goa. constructed by AAI. Greater NOIDA and Kunnar are also in the pipeline. . New airports at Goa. Khajuraho.81 43.5 35. Portblair. Lucknow. Agartala. Pune. Chandigarh. Ranchi. Bhopal. Nagpur.21 40. Based on the decision of the Committee on Infrastructure. Its project cost is estimated around (US$ 1153. Agra. and international traffic double 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 0 5 10 15 20 25 30 35 40 22.75 27. Madurai. Dehradun. • The commercial management of Terminal Buildings. Jammu. These include Ahmedabad. following actions are proposed with regard to development of these 35 non-metro airports of AAI: • Airports Authority of India to undertake air side development of all the 35 non-metro airports including the Terminal Buildings.Top IIMK Part IX – Medical Tourism IIML New Mumbai airport is also on the horizon. In addition Airports Authority of India has announced 35 non-metro airports for up gradation under the public privatization partnership model. • City-side development of all the non-metro airports will be done through Public Private Partnership (PPP) and endeavour should be made to maximize non-aeronautical revenue. The land area of these 35 airports including that of Civil Enclaves vested with the Airports Authority of India (AAI) range from 15 acres to1500 acres. Mangalore.5 29. the Committee of Infrastructure approved development of 35 non-metro airports. Conference on Tourism in India – Challenges Ahead. Rajkot. Numbers are passengers movement in millions Current Development In June 2006.8 million) INR 45000 million. Trichy.37 25. Indore.. Guwahati. Baroda.8 38.37 33. Dimapur. The 35 non-metro airports approved for development are well-spread—from the extreme South (Thiruvananthapuram) to North (Jammu) and extreme East (Imphal) to West (Rajkot) of the country. Imphal. Agatti. IIMK 391 . 15-17 May 2008. Visakhapatnam and Varanasi. Udaipur.4 31. Amritsar.. In this case route taken in awarding New Bangalore and Hyderabad International airports will be followed. Trivandrum. Bhubaneshwar. Pune.6 45 50 Source: Business Today September 2007. Aurangabad. These are other good opportunities. Raipur. Coimbatore. Jaipur. will be so organized as to optimize revenue generation as also user convenience. Patna.
2 737-800s Jet Lite 10 Boeing 737-800s Kingfisher 30 Airbus A319/320/321s. Source: Business Today September 2007. when it receives the Airbus A340-500 aircraft. Broadly. 15-17 May 2008. Air Deccan 56 A320s. Kingfisher/Air Deccan If granted approvals will start Bangalore – San Francisco flights in April May 2008. INTERNATIONAL PLANS Air India Started non-stop service between Mumbai and New York (JFK) New Delhi. Start services via Shanghai to San Francisco in 2008 depending on Chinese permission Increase capacity on Southeast Asia routes by deploying Airbus A330 instead of Boeing 737 aircraft. maybe Star Alliance headed by Lufthansa Jet Airways Make Brussels a ‘European Scissor Hub’ where flights from India will arrive and then proceed to North American destinations after swapping passengers.. Delhi and Bangalore to North America. Started long-haul services from Mumbai.New York and Bangalore – San Francisco on the cards Plans to increase connectivity from other Indian cities once fleet of 787 ‘Dreamliners’ comes on board from mid-2008 Increase destinations served in Asia and restart services to Australia Join an International airline alliance. 10 Being 787 ‘Dreamliners’. 8 Airbus A330-200s. construction of additional parking stands / remote parking bays. the development on airside involve construction of new terminal building(s) or expansion of existing terminal building(s). Order more Airbus A380 aircraft to offer additional uplift from India. 5 Airbus A330-200s 5 Airbus-500s. taxiway and associated infrastructure. 25 ATR 72s Air India 15 777-300ERs 6 77-200 LRs 27 787-8 ‘Dreamliners’ Air India Express 9 737-800s Go Air 10 A320s Indian Airlines 40 A321/320/319s Indigo 89 A320s Jet Airways 10 Boeing 777-300ERs. IIMK 392 . Get Air Deccan to start low-far services to West and Southeast Asia from various points in India.Top IIMK Part IX – Medical Tourism IIML WHO’S BUYING WHAT? Everyone’s expanding fleet. 5 Airbus A350XWBs. As sated earlier.. Conference on Tourism in India – Challenges Ahead. 17 737-800s Source: Business Today September 2007. the development work on the airside will be undertaken by AAI. 5 Airbus A380s Paramount 10 Embraer E170s (Expected to order 25 more E170/175 aircraft) Spice Jet 5 737-900ERs. extension of runway / taxiway.
5% 393 .447 t of cargo during 03-04 Average Pax.4% 72. How They Stack Up – Jet is by far the biggest private operator as on July 31/07 THE INDIA FILE Fleet size on March 31.5% Domestic International Conference on Tourism in India – Challenges Ahead. 15-17 May 2008.’04 No. IIMK 158 642 98 42. 246 passengers and 1. Development of 35 non-metro airports’ terminal buildings envisages the following: • Modular Design • Air-conditioning system • Aero-bridges with glass walls • Walkways • CUTE (Common User Terminal Equipment) • Escalators • In-line baggage screening for check-in • Improved signage Jet Airways Indian Air Deccan Air India Kingfisher Jetlife Air India Express Alliance Air Indigo Spocejet Paramount Go Air 0 4 10 20 30 40 50 60 5 11 10 14 16 24 30 32 41 60 62 70 Source: Business Today September 2007. 740 Domestic International No.Top IIMK Part IX – Medical Tourism IIML There will be investment opportunity for private sector to participate in the city side development of selected non-metro airports where sufficient land is available and potential exists to provide utility and facility needed for air passengers / travelling public and airport users and employees at airports. Load Factor: 65..951 12.308 58. of scheduled passengers carried per day: 55.259 (03-04) Domestic International Foreign Airlines carried 28. of scheduled aircraft departures per day.
15 lakh 14.6 32.63 lakh 24.Top IIMK Part IX – Medical Tourism IIML Scheduled Cargo carried per day (T) Domestic International Total no.86 lakh 2.238 PARKING SLOTS No. COCHIN Source: DGCA No.81 lakh 9.64 lakh 51.88 lakh 45.2 34.4 31. DELHI 3.605 10.12 lakh 17.38 crore 60. BANGALORE 4.47 lakh 66. 96 lakh 12. of Outbound Aircraft Movements Per Day 137 80 49 35 44 31 15 12 12 11 AIRPORT STATUS REPORT There’s some progress at the major airports.35 lakh 11.4 Conference on Tourism in India – Challenges Ahead. CHENNAI 5.91 lakh 22. 15-17 May 2008.9 25.7 1. of Technical employees Cabin Crew No.29 lakh 4. 541.93 lakh 57. o major closures at the airport this monsoon Chennai Land acquired for expansion of parking bays and construction of parallel runway. of Passenger Embarked 10907 8337 3685 3550 3421 2145 998 970 742 653 1.04 crore 89. India’s 10 Busiest Airports Mumbai Delhi Chennai Bangalore Kolkata Hyderabad Cochin Ahmedabad Goa Trivandrum Total Traffic at India’s airports Domestic 1. New Delhi New Code ‘F’ compliant CAT3B Runway 10R/28L to be operational by mid-2008 New domestic terminal under construction to be operational by mid-to-late 2008 All-new integrated Terminal 3 under construction with 74 aerobridges. Airports No.1 lakh 5.06 crore International 73.86 lakh 18.9 35. unavailability of land Source: Business Today September 2007. of Employees per aircraft: 287 Source: The Economic Ti mes.1 267.03 lakh 11. IIMK 394 . 535 4.35 lakh 20.05 lakh 4. GUWAHATI 10.8 lakh 68.25 lakh 59. of Employees (as on Mar 31st) No.9 32. to be operational by 2010 Mumbai New domestic terminal ready for use Slum rehabilitation work underway. to be operational by end-2008 or early-2009 Hyderabad New airport to be operational by March-April 2008 Bangalore New airport to be operational by April-May 2008 Kolkata Work stalled due to workers’ union.22 crore 2. of Pilots No. AHMEDABAD 8.53 lakh 28. GOA 9.7 36 43.74 lakh 81.57 crore Total 2. MUMBAI 2.4 43.95 lakh 7. delayed due to unavailability of land records Drainage systems improved. HYDERABAD 7.61 lakh 8.5 lakh 25.49 crore 1. Chennai 27th April 2005. KOLKATA 6.05 lakh 12.9 31.63 crore % change from 2005 -06 20.
For example.14 Expected fleet size 358.633 1. A new category of visa.015 330 975 20.940 7% 4 Source: T3 – Travel Trends Today January 2007. Government initiatives To unlock the huge potential in this sector. the Government has taken various initiatives for the development of this sector. Simultaneously. Launch of Incredible India campaign to promote tourism both in domestic and international markets.2. New Room Supply 2006-2011 Markets Delhi/NCR Mumbai Kolkata Chennai Bangalore Hyderabad Pune Goa Cochin Jaipur Total Growth Percent Impact Multiple 2005 7. international hotel asset management companies are also likely to enter India. Marriott International.415 455 220 517 200 400 10.82 33.99 32. has been introduced which can be given for specific purpose to foreign tourists coming into India. With such a huge potential available in this segment. "Medical Visa" ('M'-Visa).102 38% 18 2010 2. It is estimated that the hospitality sector is likely to see US$ 11.78 Cities served 474.043 21% 10 2009 3.38 536.leaving a shortfall of 150. InterContinental Hotels group and Hampshire among others have all announced major investment plans for the country.347 1.298 25.216 1. 4.354 2. Premier Travel Inn (PTI).720 860 210 460 2.252 354 1.402 1. Cost Involved The estimated cost of development and modernization of 35 non-metro airports is Rs. the average increase in room rates has been hovering around 22-25 per cent.82 19.Top IIMK Part IX – Medical Tourism IIML Total top ten Indian airports accounted for 83. US-based HVS International has firmed up plans to enter India. the current availability is just 90. 15-17 May 2008. Already.3 per cent of total air passenger traffic.075 1.827 1. 5500 crores 4.15 -94.88 Source: Business Today September 2007. The Government's move to declare hotel and tourism industry as a high priority sector with a provision for 100 per cent foreign direct investment (FDI) has also provided a further impetus in attracting investments in to this industry.59 Profit/Loss* 397.584 2.16 430. under 'Gold' or 'Silver' category. and industry players believe others like Ashford Hospitality Trust and IFA Hotels & Resorts among others are likely to follow suit. Berggruen Hotels.096 2% 2007 2. While occupancy ratio is around 75-80 per cent.45 -183.93 636.132 2.41 billion in the next two years.380 1. this sector is likely to offer tremendous opportunity for investors. Tourism and Hospitality Hospitality The booming tourism industry has had a cascading effect on the hospitality sector with an increase in the occupancy ratios and average room rates.000.08 -22. Air Deccan IndiGo Spice Jet Go Air Fleet size 437. several global hotel chains like the Hilton.440 12% 6 2008 2.63 457. IIMK 395 . Conference on Tourism in India – Challenges Ahead.89 161.442 510 2.280 3. Recognition of spare rooms available with various house owners by classifying these facilities as "Incredible India Bed and Break fast Establishments"'.. And with the continuing surge in tourist inflow.942 2.3. with around 40 international hotel brands making their presence in the country by 2011.221 550 453 720 11.570 3.030 7. Accor.502 20% 10 2011 335 825 275 645 335 980 165 215 165 3. while the estimated number of required hotel rooms is around 240. Cabana Hotels.207 996 710 778 470 565 275 469 6.906 1.000 rooms to be provided.623 2006 182 0 75 0 270 286 100 60 82 41 1.7 177..6 per cent of all passenger numbers Mumbai and Delhi alone accounted for 44.000 rooms .840 525 650 1.
19.580 42.890 4.42.081 3.No 1.598 1.747 37.206 15.88.476 29.705 7.415 24.64.726 19.827 126.96.36.1990 8.947 2. Conference on Tourism in India – Challenges Ahead. 12.658 12.18.806 3.050 99.349 11.776 5.86. 11. 27. Tourism in Tamil Nadu Key Facts and Figures Tourist Arrivals in Tamil Nadu – 2006 (Centre-Wise) S.26.715 6.44. IIMK 396 . 26.661 Total 78.885 7. 29 Destination Chennai Elagiri Mamallapuram Kancheepuram Tiruttani Chidambaram Pitchavaram Udhagamandalam Coonoor Mudumalai Thanjavoor Velankanni Nagore Poompuhar Madurai Kodaikanal Palani Rameswaram Courtallam Panchalankurichi Kanniyakumari Tiruchirappalli Salem Yercaud Hogenakkal Tiruchendur Coimbatore Kumbakonam Tiruvannamalai Grand Total Domestic 73.85. 15-17 May 2008.84.261 39.316 41.519 2.316 18.589 820 188.8.131.52.00.Top IIMK Part IX – Medical Tourism IIML Guidelines have been formulated by Department of AYUSH prescribing minimum requirements for Ayurveda and Panchkarma Centres.320 59.106 184.108.40.206.39. 17. Domestic tourist arrival to Tamil Nadu 400 Tourist Arrival (In Lakhs) 350 300 250 200 150 100 50 0 2000 2001 2002 2003 Years 2004 2005 2006 230 238 246.850 15. 25.57.97. 23.70.020 220.127.116.115 63.61 300.481 5.85.658 3.80. 9.38.14 Source : Tamil Nadu Tourism News letter.666 3.432 4.374 6.683 6.945 8. 15.540 51. 18.77 270. 4.15.510 6.600 1.828 6.75.341 6.89.382 Source : Tamil Nadu Tourism News letter. 16.639 1.185 1.30.704 30. 18.104.22.1681 Foreign 5. 7.058 11. 5.17.132 3.861 81.711 2.175 17.479 5. 6.970 78.610 16.266 40.524 31.549 15.218 8.587 20.299 45.74. Ministry of tourism has tied up with United Nations Development Programme (UNDP) to promote rural tourism.16.61.596 2.91.145 61 53.903 4.446 30.661 6.36. 8. 28.823 2.78. 21.510 14.539 2.141 9.59.775 6.50.992 2. 4. 10. 22.39 322.214.171.1240 8.08. 2.617 4. 13. 3. 24.01.124 1.690 12.326 11.038 5.849 3.09.00.521 24.4.273 13.356 21.912 13.06.769 10.35.575 126.96.36.199.59 323.52.05.34. 20.136 6.822 13.
00 2000 2001 2002 2003 Years 2004 2005 2006 7.Top IIMK Part IX – Medical Tourism IIML Foreign Tourist Arrival to Tamil Nadu 14.73 8.35 11.500 Tourist Arrival (In Lakhs) 3. for the patients. Instead.00 6. which are currently good contributors to our nation’s GDP. eye surgery and in-vitro fertilisation.020 Source: Tamil Nadu Tourism News letter.400 to Wockhardt Hospitals for the operation.02 10.000. In 2004. as it was for Marshall. joint replacements. Sharing of a wonderful experience by a foreign national: For thousands of medical tourists like George Marshall.000 1.788 1.Opportunities After Information Technology (IT) and Information Technology enabled Services (IteS).000 500 0 2000 2001 2002 2003 Years 2004 2005 2006 1. IIMK 397 . the offers available today for similar patients are specialised services ranging from cardiology and cardiac surgery (angioplasty.00 0. to make great contributions to the nation’s GDP. organ transplants (liver and kidney). and he paid with his own money. valve replacement). if rightly tapped. as insurance couldn’t cover his outsourcing of medical needs.00 2.79 Source : Tamil Nadu Tourism News letter.86 7.00 4.913 2. from countries with relatively poor healthcare infrastructures and. and those Conference on Tourism in India – Challenges Ahead. he paid £4. a heart bypass was recommended for the 73-year-old British citizen. opinions offered.05 9. 4. which has enormous potential. bypass. The cost differential is significant. those seeking necessary procedures and who are provided with incentives to find lower cost options. The following will illustrate a few valid points by way of expert’s questions vs. Existing offers available for medical tourists: Currently. Medical tourists from the US are usually those seeking procedures not covered by their insurers. Medical Tourism in India .” he said.750 1.5.809 2. bone marrow transplants. the next big thing happening (already begun!!!) could be ‘medical tourism’. Airfare and travel insurance cost extra. “I had to wait for over three months to see the cardiologist and potentially a further six months for the operation.000 2. places with exorbitantly expensive health care systems. current statistics available with future projections and a few suggestions for making best use of medical tourism towards the development of the country’s economic prosperity. which would have cost him up to £20. Reason for going in for medical tourism: Medical tourism is attracting people from all over the industrialised world.500 1. 15-17 May 2008. Foreign Exchange Earned in Tamil Nadu 3.500 2.00 8.00 10.556 3.00 Tourist Arrival (In Lakhs) 12.283 1. in case of the US.58 13. this debate is invisible. to oncology and onco-surgery.
000 crores) by 2010.000 crores (at current prices and exchange rates) in 2012. 15-17 May 2008.000 medical tourists a year and the catalytic CII-McKinsey report of 2002 projected that medical tourism could contribute up to Rs 10. Time and money provide the incentives for seeking healthcare outside country. private rooms are readily available and family members are often included in the trip and made comfortable in luxury facilities that resemble five-star hotels. such as Britain. Dr Milica Bookman. Thailand and Singapore. scientific researcher with the Foundation for Medical Research. US. Quality is a concern for potential medical tourists and what are now being called ‘offshore hospitals’ address their concern by seeking and obtaining accreditation from bodies such as Joint Commission International (JCI). Cosmetic procedures are easily found in South America. Some advantage in availing this service: The lower cost structure of these hospitals allows them to be more generous with resources for their wellpaying clients. “The problem starts when a developing country. explained. Centre for Enquiry into Health and Allied Themes. 240. Mumbai. In the case of public health systems with long delays. In the global medical tourism industry.” said Vishal Bali. a researcher with the Mumbai-based policy analysis group. time is the motivation. chief executive of Wockhardt Hospitals. collaborates in promoting medical tourism when it cannot meet the basic healthcare needs of a majority of its citizens. Accredited hospitals are potential winners in wooing medical tourist. Dr Pratap C Reddy. Some findings done through a study report by a global agency: According to a study by global accounting and consulting firm Ernst and Young and the Federation of Indian Chambers of Commerce and Industry (FICCI). Conference on Tourism in India – Challenges Ahead.000 corer in fiscal 2006 and revenues from the sector are expected to rise up to Rs 130.000 crores in revenue by the year 2012. Nurse-to-patient ratios are higher. According to her research on the economic impact of medical tourism. Our Finance Ministry’s projections on GDP: The Finance Ministry’s Investment Commission emphasises that healthcare delivery is already one of the largest service-sector industries in India. professor of economics at St. Joseph’s University in Philadelphia. a subsidiary of the Joint Commission on Accreditation of Healthcare Organisations (JCAHO). from cosmetic surgery to complex oncology. in the view of Dr Nergis Mistry. Israel and Spain.” Medical tourism creates a climate of inequitable services that undermine the goal of health for all.” Number of people having visited India for as medical tourists: India now hosts and treats an estimated of 50.Top IIMK Part IX – Medical Tourism IIML who cannot secure medical insurance where they depend on the procedures and the physicians. IIMK 398 . explained: “We need to invest $60-70 billion over the next five years in hospitals and healthcare education to expand this sector and reach out to masses as soon as possible. Mistry warns against a technology and urban-centred approach to delivering health care: “It raises the cost of healthcare for the local population because it forces the use of expensive technology and drugs. and specialised in-vitro fertilisation can be found in South Africa. which represents an annual revenue growth rate of about 19 per cent a year. bargain prices can be found at a medical centre somewhere in the world.000 Americans are expected to have travelled abroad for treatment in 2007 and over six million will be doing by 2010. who plans to double its hospitals to 30 from 15 in time span of two years. “The drivers for the future are falling in place. while complex heart and orthopedic procedures are found in India. Several other hospitals that are offering medical tourism in India meet or exceed the standards of care of the finest hospitals located in US. which offers accreditation to hospitals in the US. is author of the book Medical Tourism in Developing Countries. private hospitals in India earned Rs 62.” At the same time. chairman of the Apollo Hospitals Group. which has 75 per cent of its population either poor living at subsistence level. 750. and expects the industry to grow and contribute up to five per cent of GDP (at around Rs.” Comments offered by other professionals in this field: Ravi Duggal. Comments offered by lead hospital spokesperson: “The sector is getting focused from an investment perspective.
Before. health departments issue guidelines to private hospitals specifying their obligation to provide beds. insurance cover and accessibility can drive change. from the earnings of medical tourism . and to return a portion of revenues from medical tourism into serving the public health overburden. which could be optimally utilised for bettering the services from all angles benefiting the registered care seeker. 15-17 May 2008. Let our foreign consulate offices act as ambassadors for promoting medical tourism to get this business a big boost. More and more top class colleges are set up in the country. treatment and services to the public patient.a thorough study need to be done by involving the experts. it is only the private sector that is reaping the benefits of medical tourism in Tamil Nadu. IIMK 399 . what could be the wish list of a common man for making medical tourism a big success for India? Some of these are summarized below: Let there be an identical agency like NAASCOM for medical tourism to periodically come out realistic reports for bettering the services in the days to come. ESI hospitals too can join this race by selectively opening up their doors so that their income gets a big boost.Top IIMK Part IX – Medical Tourism IIML Existing guidelines seem to be inadequate: In the major states. Conference on Tourism in India – Challenges Ahead. international airports. sight seeing points made more visible and attractive and customer care from start to finish is of the highest order. Karnataka and Andhra Pradesh.” After going through the above. satisfaction and joy. what is now being called the Andhra Pradesh model stems from the provision of universal health insurance in three districts. The rates charged or services offered could be further subsidised so that people from different parts of the world throng to our hospitals for getting timely. immediate and quality care all at an affordable cost so that at least by word of mouth the message gets well spread across different sections of the societies. and AP chief minister YS Rajasekhara Reddy has called for bids in six other districts.” while the government sector remains out of this loop so far: We have been focusing on public health. That is possible only with insurance. The department of Tourism with the Health and Family Welfare department has identified centres of excellence in the government health sector — such as Jayadeva Institute of Cardiology and the Kidwai Institute of Oncology — which will be promoted abroad as places for specialised treatment at affordable costs. with a contribution of a rupee a day a constable’s son was able to have a bone marrow transplantation done at the best facility. Let there be more and more infrastructure avenues opened up so that consultants can join the fray for bringing in world class quality treatment facilities. Nobody can afford to pay for major illnesses. Andhra Pradesh. Apollo Hospitals emphasised. “As of now. best pick up and return conveyance. Why only private sector gains . all under one roof. “In Aragonda. with the concept of ‘pay wards’ coming up in government hospitals for certain field segments. Let our doctors who are serving out of India and willing to come back be encouraged to the fullest for doing their best to give a big push to this trade.why not public sector too. nor does a standard country-wide regulatory system exist to ensure such compliance. best of the five star /three star hotels at affordable rates. Moreover. and we need a mechanism to make hospital procedures cashless. let’s hope our country’s overall infrastructure moves fast on issues like good quality roads. with foreign collaboration. State wise preparation in progress: Karnataka is now preparing to promote premier government institutions as medical tourism destinations. so that aspiring students lovingly join this profession to earn their degree (doctorate) for serving the society and mankind. However. concluding. we can expect this trend to change. Let there be innovative schemes by targeting medical tourists so that they return back with great feeling of comfort. Benefits are accruing only to private sectors: A signal of state-directed change however comes from Tamil Nadu. but neither are these hospital held to account on these points by their respective state governments.
Stanely Medical College – is well known for its gastrointestinal procedures.000 in patients alone. which is how it is able to leverage competitive rates. Tamil Nadu has come a long way in carving a niche for itself in this field.V. Cholayil Sanjeevanam. Prasanth Multispeciality Hospital. M. Some of Tamilnadu’s most reputed Multi specialty Hospitals and Health Care Centre Hospitals 1. The investment in public sector hospitals is substantial. Madras Medical Mission for heart surgery. too. and Chennai. In a bid to promote medical tourism. and battalions of paramedics and the best practices of Government hospitals the states. The request was put forward during the four-day Pacific Asia Travel Association (PATA) Travel Mart held at Bali. medical tourism in India is synonymous with Tamil Nadu.com http://lasikpavilion. is ensured. as private laboratories test every batch of medicines independently. Chennai 2. MIOT Hospitals.spothospital. With almost all government-run and private hospitals introducing newer technologies and better services in the healthcare sector. Kovai Medical Centre and Hospital for arthroscopicm Laparoscopic and thoracoscopic surgeries. The system is totally supportive and foolproof. Chennai 5. IIMK 400 .com www. Chennai 5. Rajan Eye Care Hospital. Hospitals in Tamil Nadu cater to the treatment of various disease.com Some of Tamilnadu’s most reputed Health care facilities: 1. convalesce in enchanting locals. talented medical professionals. liver. In fact. The medical tourism desk would be manned by trained hospital staff to help tap the vast potential of medical tourism. Madurai and Coimbatore have a stellar role to play in the burgeoning medical tourism industry. it has fallen upon the medical sector to benchmark medical standards in the country. The quality. all government hospitals are free from the hassle of procurement of drugs and equipment. Ultra-modern corporate hospitals. Chennai 4. Diabetes Speciality Centre (MVDSC). Chennai 4. Apollo for hip and total-knee replacement. Madras Medical Mission.lifeline-hospital. Indonesia is showing interest in medical tourism initiatives of Tamil Nadu Government and has requested Tamil Nadu Tourism to organise a Medical Tourism Fair with participation from super speciality hospitals of the state at Jakarta. The all. like MIOT for orthopaedics (joint and bones) and traumatology.com www. Apollo Hospital. Toda. Medical Tourism in Tamil Nadu Envisioning the potential of medical tourism in the state. Christian medical college for open-heart surgery. The government medical college. Shankar Netralaya for ophthalmology (eye procedures). 15-17 May 2008. Chennai 3.com www.computerised system of the corporation allows the procurement to be 25-30 per cent less than the market rate. Chennai 3. multi-organ and cord blood transplants. Further. Chennai Conference on Tourism in India – Challenges Ahead. The Government of India is so taken with this high level of competence that it would like the other states to emulate the Tamil Nadu model.cholayilsanjeevanam.Top IIMK Part IX – Medical Tourism IIML Lastly. Lifeline Multi Specialty Hospital. Sri Ramachandra Medical Centre (SRMC). let’s hope our GDP do get a boost of at least 5 per cent and more in the near future so that the economy keeps growing at a fast rate.pfrcivf. the government has identified 25 city hospitals to help showcase medical tourism as well as inaugurated an exclusive Medical Tourism Desk at the Tamil Nadu Tourism Complex. to name a few. Chennai Website www. the Tamil Nadu Medical Services Corporation has an excellent tract record for its streamlined processes for the distribution of drugs.art operation theatres and technology at cost-effective prices. which they are able to offer state-of-the. Tamil Nadu is a pioneer in providing the best healthcare. and recuperate swiftly. Vellore. have attracted people to the state to receive excellent treatment. Also the Government-led General Hospital is well known for providing services for up to 7. Chennai 2. As a result. Healthcare in Tamil Nadu has earned a good reputation in the country because both the private as well as the government hospitals are so professionally run. where Tamil Nadu Tourism had a stall at the Incredible India pavilion. Spot Hospital.
creating institutional infrastructure for upholding standards and quality – the accreditation system. Kovai Medical Centre and Hospital. 5. Chennai 7. Additional FSI for hospitals will bring down healthcare cost in Medical Tourism in Tamil Nadu: "The Government of Tamil Nadu should hike the Floor Space Index (FSI) for hospitals and healthcare institutions from the current 1. and other treats. Fourth. They do not have to invest as much as 40-50% of the project cost in acquiring new lands.2. sea and sand. Chennai 9. Gracious and courteous reception is characteristic of traditional Tamil Nadu hospitality Destination diversity Tamil Nadu offers a myriad of enjoyable ways in which one can achieve a speedy recovery. Coimbatore 15. Tamil Nadu’s winning marketing mix includes A welcoming destination with an appreciation of the needs of different cultures and the availability of support services to serve diverse needs. Dr. 15-17 May 2008. There is no doubt that visitors seeking treatment in Tamil Nadu get more for only a fraction of what it costs back home leaving them with extra to spend on their favourite leisurely pursuits such as sight-seeing. Solace Meditour Private Limited 12. Tamil Nadu. there are several other pluses that add to the attractiveness of the destination as a health tourism centre. State Involvement and Implications It has to be done in Five major ways. And third. Gandhiji Nature Cure Centre. the Tamil Nadu Tourism should directly lead in the marketing of medical tourism overseas through trade missions and other promotional event activities. Attractive prices.3.Par Excellence with International Standard. etc. Take life at a more leisurely pace at any of the hundred of Temples around Tamil Nadu enjoying the fresh mountain air or sun. Frontier Lifeline. Ganga Hospital. First. Chennai 10. tax incentives should be given to support the growth of healthcare corporations. CMC. Coimbatore 14. Elagiri & Chennai Source: Tamil Nadu Tourism News letter. as forming Core Committee of Medical experts with field specialist to study the lacunae in enhancing the commodity of healthcare Internationally. PSG Hospitals. Service Quality. Pilgrimage.ness and Enchanting Tamil Nadu traditions Patients and users of other hospitals and allied services are welcomed as “guests”. 5.Top IIMK Part IX – Medical Tourism IIML 6. standardization guidelines.Sandy beaches and beauty treatments. Coimbatore 16. 5. the range of high quality healthcare and medical care products and services available at highly affordable prices and value for money. Chennai 11. IIMK 401 . increase number of beds and healthcare talent pool of the State. Guests and visitors are of the view that Tamil Nadu Medical Tourism offers value for money.4.1. Hospital. Vellore 18. Coimbatore 17. Aggarwal’s Eye Hospital.Travel agencies and Tour Operators Co-ordination as selling the Brand of TamilNadu as Prime Medical Tourism Destination and Fifth. Hill resorts ." "The relaxation in FSI will allow hospitals and institutions create more infrastructure in the same premises. Dr. Ayush Therapy Centre 13. The Wining mix for Health Tourism Ingredients for success Beyond the professionalism and technical expertise of medical staff or Travel agencies and Tour operators. Vijaya Hospital. Second. 5. Mehtas Hospital. K. Chennai 8. fee packaging guidelines. shopping. Recuperating has never been more pleasurable.5 to 5 to bring down the rising healthcare cost. Value for money. Or simply indulge on a diet of delicious Tamil Nadu cuisines and health-restoring rejuvenating herbal therapies offered by Tamil Nadu resorts combined with mesmerising massage. Sankara Nethralaya.G. Instead they can invest directly in healthcare equipments or human resources and reduce healthcare cost." Conference on Tourism in India – Challenges Ahead.
whereas the World Health Organisation recommends at least 1:500 ratio. India has about 7 lakh doctors and 1. hospitals are not able to increase beds in the same premises. he said. when they acquire land to increase the number of beds.with its new universal healthcare scheme. while Russia and Western nations have one bed for 110 and 250 people respectively. Challenges to the Industry Tamil Nadu is emerging as an attractive. Tamil Nadu produces 2000 doctors a year and for every doctor.the State alone needs to produce 10. Healthcare is also a major foreign exchange earner with the inevitable growth of medical tourism. These small hospitals constitute 80% of the total healthcare services provided in the State." The Government should provide healthcare sector incentives that are equal to those provided to the IT sector. the increasing land prices in the State means that the land cost constitutes about 40-50% of a hospital project and with low FSI. AP too has a very liberal FSI to increase its healthcare infrastructure. 80. The basic expectations that the industry feels are important to be concerned about are: Hygiene Staff ( trained technically as well as in soft skills) Customization Insurance Cover Stability Connectivity International standard certification Para – Medical Ambulance facilities ( to and fro from Airport). India needs to invest Rs. Hence. would increase the number of hospital beds by approximately 20-30 %. 5. over 10% of Indian medical professionals . In comparison. affordable destination for healthcare But there are some challenges that the country has t overcome to become a tourist destination with competent health Care industry: A. FSI in Delhi and Karnataka is 3. home about 60% of their earnings. as in Mumbai. India needs to double its bed strength of 7 lakhs to meet the WHO recommendation of 1 bed for 500 people. At US$ 3 trillion.Top IIMK Part IX – Medical Tourism IIML In a press release issued by CII . there is a need for 5 Para medical staff . FSI should be same across the State to benefit especially the small 20-bed hospitals . Japan has one bed for 90 people. The additional FSI of 5. "We cannot import healthcare like cement or steel. Conference on Tourism in India – Challenges Ahead. we have to improve our healthcare infrastructure on war footing. who are working abroad.000 crore to create one lakh additional beds every year for the next 20 years. At national level. Manufacturing sector continues to downsize but hospitals world over continue to generate more employment.1 million nurses but the country needs at least 17 lakh doctors and 37 lakh paramedical staffs to meet the local demand.over 80% of its population . They are not able to keep the healthcare cost at affordable level. as healthcare has the potential to create employment opportunities five to ten times more than what the IT industry can do. Arogya Sree. The Foreign Customer Concerns and Expectations: The biggest challenge that the Indian hospitals face is assuring the foreign patients that they will receive quality care with no hidden costs. Infrastructural facilities Roads Sanitation Power Backups Rest/ Guest Houses Public Utility Services B. it is one of the largest sectors of world economy.5.000 nurses per year. The industry experts need to develop the decision making models through a thorough study on the factors that motivate the patients to choose India as a health care solution spot. Other States to follow the healthcare model of Andhra Pradesh. there is only one bed for 1. 15-17 May 2008.including paramedical staff. as compared to just 1." There is acute manpower shortage in the people-intensive healthcare industry.100 people in Tamil Nadu. As the country adds 25 million children every year.5 in Tamil Nadu."the frontline brigades in the battlefield for saving lives of people in need of emergency treatment". IIMK 402 . The healthcare sector has the potential to increase its direct employment from 4 million to 30 million and generate an equal number of indirect employment opportunities. send. At present. "In addition to that. which intends to cover 5 crore people .
Apollo group of hospitals which has become the first hospital in India to get a JCI certification.Apollo group of hospitals which has become the first hospital in India to get a JCI certification. The same has to come to more hospitals of India. In addition. D. Excess Glamourisation of Health Care It has been seen that the doctors and key player hospitals in India emphasis more on glamorization of health care than its actual advantages or research uniqueness. Market accessibility The next challenge for the Indian industry is to make the Indian market accessible by tourist travel agents and websites of Indian health tourism. the gold standard for US and European Hospitals. The same has to come to more hospitals of India. Infrastructure Indian hospitals must create exclusive infrastructure for corporate medical tourism Conference on Tourism in India – Challenges Ahead. Globalisation of marketing activities by Indian Tour & Travel Agents Tying up with foreign Travel Agents for promotion Insurance companies abroad who target customers E. G. have no gradation system and a far from perfect insurance sector. The government can play a vital part as the same can bring in lots of foreign revenue. Even if we were having the best of quality standards as has Indraprastha Apollo Hospital we will still be perceived as inferior in standards . Even if we were having the best of quality standards as has Indraprastha Apollo Hospital we will still be perceived as inferior in standards . The Image of India needs to be enhanced (Standardization) The only one quality that Indian health industry lacks in is Health standards and hygiene. and are unwilling to disclose data regarding these. D. The Image of India needs to be enhanced (Standardization) The only one quality that Indian health industry lacks in is Health standards and hygiene. 15-17 May 2008.Pre/Post treatment. The major ways of promoting our health tourism could be: Tour operators and Travel agencies of India Doctors of India visiting foreign countries International standard certification C. The major ways of promoting our health tourism could be: State Tourism Offices in India and abroad. We need to work more on our research in medical field to be competent enough to beat our international competitor.Top IIMK Part IX – Medical Tourism IIML C. top Indian hospitals have high infection and mortality rates. hospitals and states in promoting health tourism abroad so that we can tap a wider range of customers. Doctors of India visiting foreign countries. suffer from a lack of standards in terms of quality and rates for healthcare procedures. the state should help in the same. International websites on Indian tourism with True Perceptions. IIMK 403 . It should help the companies. Indian hospitals lack accreditation from the Joint Commission on Accreditation of Healthcare Organisations (JCAHO). In addition. State Intervention As this is a product which needs international tie-ups and international marketing. top Indian hospitals have high infection and mortality rates. and are unwilling to disclose data regarding these.This can be avoided by getting Quality standards .This can be avoided by getting Quality standards . Indian hospitals lack accreditation from the Joint Commission on Accreditation of Healthcare Organisations (JCAHO). Market accessibility The next challenge for the Indian industry is to make the Indian market accessible by tourist travel agents and websites of Indian health tourism. The government can play a vital part as the same can bring in lots of foreign revenue. In other words SERVICES should be given more attention and importance than PACKAGING. have no gradation system and a far from perfect insurance sector. F. the gold standard for US and European Hospitals. suffer from a lack of standards in terms of quality and rates for healthcare procedures.
Poland and Singapore are now entering the field. Published by Tamil Nadu Tourism. March 11 (2007).1. Belgium. Business Today. On the Emerging Trends in the Indian Hotel Industry. body and spirit. Public Health. J. I. Global Demand It can be seen in case of hospitals like Apollo and Escorts that the Local demand itself to be catered to is vast. 15-17 May 2008. Travel Trend Today. Thus this would become a way of mutual marketing tacit cs between the Indian health tourism industry and the foreign Insurance agencies. Where does India Stand? Tamil Nadu Tourism News Letter. Competition (Neighbouring countries) Countries that actively promote medical tourism include Cuba. IIMK 404 . References Business Today.This will be one of our major threats in bringing up and developing the health tourism industry. Israel. They can benefit from us by our services. Wind Under their Wings. Jordan. Costa Rica. 27th April (2005). September 9 (2007). Pronto! Indian Aviation Goes Jet-Setting. Lithuania. corporate to reduce expenditure on healthcare H. Malaysia and Thailand. Private Opportunity. Tamil Nadu offers a one-stop shop that leaves you looking good and feeling great from Hospital to Hospitality. with a stopover for plastic surgery.23. Conclusion Tamil Nadu has long been a centre of ancient healing traditions based on herbal medicine and holistic treatments that have evolved from folk knowledge as well as Asian well-being therapies such as Indian Ayurvedic and Allopathic practices. With the growing popularity of holistic healing techniques that restore balance and rejuvenate mind. Conference on Tourism in India – Challenges Ahead. South Africa specializes in medical safaris-visit the country for a safari. Thus it is a challenge for both the Alternate therapy industry and Corporate Health Care Service Providers to cater to this vast market efficiently without compromises in quality on either side. Chennai. a nose job and a chance to see lions and elephants. March (2007). Modern Medicare.Top IIMK Part IX – Medical Tourism IIML Chartered flight services. Local Demand vs. Insurance Backup One good way of tapping the foreign customers is tying up with Insurance companies abroad who could provide a genuine database of target customers. Chennai The Economic Times. in addition to conventional medical treatment. Vol. January (2007). attractive tourism packages could be part of infrastructure There's growing pressure on U. Thus India has enough competition from the international market . India. Hungary. Issue No. We should remember that we should have the facilities enough to manage the foreign customers not neglecting the local markets.S.
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