CHAPTER I INTRODUCTION

Medical tourism (also called medical travel, health tourism or global healthcare) is a term initially coined by travel agencies and the mass media to describe the rapidly growing practice of travelling across international borders to obtain health care. Such services typically include elective procedures as well as complex specialized providers surgeries such as joint replacement (knee/hip), cardiac and customers commonly use informal channels of surgery, dental surgery, and cosmetic surgeries. As a practical matter, communication-connection-contract, and in such cases this tends to mean less regulatory or legal oversight to assure quality and less formal recourse to reimbursement or redress, if needed. Leisure aspects typically associated with travel and tourism may be included on such medical travel trips. Prospective medical tourism patients need to keep in mind the extra cost of travel and accommodations when deciding on treatment locations. Medical or Health tourism has become a common form of vacationing, and covers a broad spectrum of medical services. It mixes leisure, fun and relaxation together with wellness and healthcare. Many people from the developed world come to India for the rejuvenation promised by yoga and Ayurvedic massage, but few consider it a destination for hip replacement or brain surgery. However, a nice blend of top-class medical expertise at attractive prices is helping a growing number of Indian corporate hospitals lure foreign patients, including from developed nations such as the UK and the US.

The most recent trend in privatization of health services is medical tourism, which is gaining prominence in developing countries. Globalization has promoted a consumerist culture, thereby promoting goods and services that can feed the aspirations arising from this culture. This has had its effect in the health sector too, with the emergence of a private sector that thrives by servicing a small percentage of the population that has the ability to "buy" medical care at the rates at which the "high end" of the private medical sector provides such care. This has changed the character of the medical care sector, with the entry of the corporate sector. Corporate run institutions are seized with the necessity to maximize profits and expand their coverage. These objectives face a constraint in the form of the relatively small size of the population in developing countries that can afford services offered by such institutions. In this background, corporate interests in the Medical Care sector are looking for opportunities that go beyond the limited domestic "market" for high cost medical care. This is the genesis of the "medical tourism" industry.

Medical Tourism as an Industry

Medical tourism can be broadly defined as provision of 'cost effective' private medical care in collaboration with the tourism industry for patients needing surgical and other forms of specialized treatment. This process is being facilitated by the corporate sector involved in medical care as well as the tourism industry - both private and public.

In many developing countries it is being actively promoted by the government's official policy. India's National Health policy 2002, for example, says: "To capitalize on the comparative cost advantage enjoyed

by domestic health facilities in the secondary and tertiary sector, the policy will encourage the supply of services to patients of foreign origin on payment. The rendering of such services on payment in foreign exchange will be treated as 'deemed exports' and will be made eligible for all fiscal incentives extended to export earnings". The formulation draws from recommendations that the corporate sector has been making in India and specifically from the "Policy Framework for Reforms in Health Care", drafted by the prime minister's Advisory Council on Trade and Industry, headed by Mukesh Ambani and Kumaramangalam Birla.

Description
Generally there are three types of medical tourist: 1) Foreigners coming specially for treatment 2) Foreigners seeking treatment & leisure 3) Expatriates. Factors that have led to the increasing popularity of medical travel include the high cost of health care, long wait times for certain procedures, the ease and affordability of international travel, and improvements in both technology and standards of care in many countries. Medical tourists can come from anywhere in the world, including Europe, the UK, Middle East, Japan, the United States, and Canada. This is because of their large populations, comparatively high wealth, the high

expense of health care or lack of health care options locally, and increasingly high expectations of their populations with respect to health care. An authority at the Harvard Business School recently stated that "medical tourism is promoted much more heavily in the United Kingdom than in the United States". The time spent waiting for a procedure such as a hip replacement can be a year or more in Britain and Canada; however, in Costa Rica, Singapore, Hong Kong, Thailand, Cuba, Colombia, Philippines or India, a patient could feasibly have an operation the day after their arrival. Perceptions of medical tourism are not always positive. In places like the US, which has high standards of quality, medical tourism is viewed as risky. Nonetheless, the number of Americans who are going abroad for health care is increasing. In some parts of the world, wider political issues can influence where medical tourists will choose to seek out health care.

CHAPTER II

Top Destinations for Medical Tourism

The countries which are generally preferred over all other countries in the world for medical tourism destinations generally provides a wide array of medical facilities in a low cost packages. As the experts believe that the medical tourism destinations will have a positive impact on the economy of these distinctive countries and benefits the traders and patients alike. The medical tourism destination phenomenon may also encourage the foreign investors who hold an interest in those countries. One gets the best of medical services and attendance in these countries with reasonable prices. Some of the hospitals in these countries tie ups with various recreational facilities to provide the patient the best of all the time. According to ones budget, one can pay to hospitals which arrange the best available treatment package for you. If one wants any other luxurious treatment the hospital of these medical tourism destinations will also provide with the same. Such as five star services with a round a clock nurse what is more do you need in your medical tourism destination it is the best you can get in these destinations. The best of the medical tourism destination is Belgium . This country has doctors specializing in various medical fields such as surgery of heart, health services, cosmetic surgery, and surgery of knees, orthopedic surgery, and transplant of kidney and in care of teeth also called dental care. One will get to have the best of treatment in Belgium according to ones budget with pleasure and amusement.

The top 5 of the medical tourism destination which provides the most attractive opportunities for patients and investors for there a medical tour is as follows. These medical tourism countries are being selected on there quality and affordability of care as well as openness to foreign investment.
1. 2. 3. 4.

Panama. Brazil. Malaysia. Costa Rica. India.

5.

While some people took the options of only those medical destinations which offer low cost treatment, but these are the countries where you will get your medical treatment with relax and peace of mind. These are the top medical treatment destinations where one will find the best doctors and surgeons for your treatment. A patient will get to have a great time in the superb beauty of these countries which is considered to help the patient to recover and hell quickly. It should also be noted that the medical staff in these countries are largely and highly English speaking so the conflict of the language do not pose a major obstacle for the foreign patients in visiting these countries for there medical treatment. There are some goals of each of these countries on which these countries are working. For example ; Panama represents a wide range of opportunities for real estate investments and as well as investment in the medical tourism industries. And goal of Brazil is to become one of the most dominating economies in the world in terms of medical tourism and is favorable for the foreign investments. Malaysia is doing progress in medical tourism by leaps and bounds. Malaysian medical tourism has grown from 75,210 patients to 296,687 patients from 2001 to 2006 which bring about total revenue of $59 in the country through this act. Malaysia attracts foreign medical tourists and investors alike for its favorable exchange rate, political and economic stability and due to high rate of literacy. Costa Rica like Panama has become a popular medical destination for the foreign peoples due to its High-Quality medical facilities. The countries political stability, high educations levels and its policies for free trade among medical tour have also attracted the foreign investors. While India, arguably has the lowest and the highest

quality of medical facilities available for medical tourism. According to the report of the world travel and tourism council India was ranked as one of the top ten emerging destinations due to its highly skilled and equipped doctors and hospitals. As more and more patients from Europe, the US and other affluent nations with high Medicare costs look for effective options; India is pitted against Thailand, Singapore and some other Asian countries, which have good hospitals, salubrious climate and tourist destinations. While Thailand and Singapore with their advanced medical facilities and built-in medical tourism options have been drawing foreign patients of the order of a couple of lakh per annum. But, things are going to change drastically in favour of India, especially in view of the high quality expertise of medical professionals, backed by the fast improving equipment and nursing facilities, and above all, the cost-effectiveness of the package.

Medical Tourism in India - At a glance.

India is considered the leading country promoting medical tourism-and now it is moving into a new area of "medical outsourcing," where subcontractors provide services to the overburdened medical care systems in western countries. Government and private sector studies in India estimate that medical tourism could bring between $1 billion and $2 billion US into the country by 2012 and that medical tourism to India is growing by 30 % a year.

India's top-rated education system is not only churning out computer programmers and engineers, but an estimated 20,000 to 30,000 doctors and nurses each year. The largest of the estimated half-dozen medical corporations in India serving medical tourists is Apollo Hospital Enterprises, which treated an estimated 60,000 patients between 2001 and spring 2004. It is Apollo that is aggressively moving into medical outsourcing. Apollo already provides overnight computer services for U.S. insurance companies and hospitals as well as working with big pharmaceutical corporations with drug trials. Apollo has also reacted to criticism by Indian politicians by expanding its services to India's millions of poor..India is known in particular for heart surgery, hip resurfacing and other areas of advanced medicine. The government and private hospital groups are committed to the goal of making India a leader in the industry. The industry's main appeal is lowcost treatment. Most estimates claim treatment costs in India start at around a tenth of the price of comparable treatment in America or Britain. India is becoming the destination of choice for US citizens seeking complicated, high-end medical procedures.

The Indian government is taking steps to address infrastructure issues that hinder the country's growth in medical tourism. The South Indian city of Chennai has been declared India's Health Capital, as it nets in 45% of health tourists from abroad and 30-40% of domestic health tourists. Many countries have developed links for speedy treatments in India for their nationals on account of the fact that in these countries one has to wait for extended periods of time to undergo operations.

In India, medical treatment is not only fast but also costs a fraction of what it costs in USA or Europe. The growing need is for high level specialized treatments like transplantation of vital organs, cancer treatment, neuro-surgery, cardiac surgery and many more.

Why India?
India is benefiting in a big way from globalization. It has become the latest hub for medical outsourcing, with patients from all over the world flocking to myriad hospitals for treatment. They are the new medical tourists and India is flaunted as a medical tourism destination . As per Mc Kinsey study Indias medical tourism industry can be worth a whopping $2.2 billion annually in terms of revenue. It was only a question of time before India harnessed its vast pool of skilled doctors and nurses along with access to the most modern medical technology, at par with the best in the world. Moreover India enjoys the advantage of a skilled medical workforce fluent in English. All medical procedures including hospitalization and recovery costs much be

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less as compared to America and Europe . Indian hospitals adhere to global quality standards for treatment and surgery. Patients in all over the world covered by medical insurance have to wait for years to undergo treatment. Though many may frown at the mention of India, an increasingly large number of patients not having insurance from the US and Europe is undergoing treatment here. They are consulting doctors at the best Indian hospitals to undergo specialized surgery with proper arrangements for recuperation, unlike hospitals in their home

country which discharge patients early due to lack of beds. Indian doctors are qualified in the fields of cardiac surgery, cosmetic surgery, orthopedics, pediatrics, and dentistry. Most importantly if one compares the cost of treatment, lodging and boarding and airfare, it still works out cheaper by a huge margin. For e.g.; A dental implant will cost at least 75% less in India as compared to the US. An MRI will cost about $60 in India and about $700 in the US. An open-heart surgery will cost just $4500 in India as compared to $18000 in the US. Cranofacial surgery or a hip replacement costs about $4300 in an Indian hospital while it may cost upwards of $13000 in America. A kidney transplant can cost just 500 euros while it may cost you about 8500 euros in Britain.

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India has some of the best hospitals and treatment centers in the world with the best facilities. All medical investigations are conducted on the latest, technologically advanced diagnostic equipment. Stringent quality assurance exercises ensure reliable and high quality test results. As Indian corporate hospitals are on par, if not better than the best hospitals in Thailand, Singapore, etc there is scope for improvement, and the country may become a preferred medical destination. In addition to the increasingly top class medical care, a big draw for foreign patients is also the very minimal or hardly any waitlist as is common in European or

American hospitals. In fact, priority treatment is provided today in Indian hospitals. The Apollo Group, Escorts Hospitals in New Delhi and Jaslok Hospitals in Mumbai are to name a few which are established names even abroad. A list of corporate hospitals such as Global Hospitals, CARE and Dr L.V. Prasad Eye Hospitals in Hyderabad, The Hindujas and NM Excellence in Mumbai, also have built capabilities and are handling a steadily increasing flow of foreign patients. India has much more expertise than say Thailand or Malaysia. The infrastructure in some of India's hospitals is also very good. What is more significant is that the costs are much less, almost one-third of those in other Asian countries.

The privatization of the medicare sector has brought with it five-star facilities and world-class treatments. The country can now boast of a number of corporate hospitals. India is a source market for professionals in the medical field for many renowned hospitals around the world. Hitech medical facilities have become a necessity following consumer demand among the world's fastest growing middle class.Indian hospitals are becoming known internationally for standards of health care delivery comparable to the best in the world. India has the technology and the

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skilled

super-specialists

coupled

with

sound

infrastructure

and

professional management, nurses and paramedical staff to take on international competition.

What makes India attractive?

The Indian medical tourism industry, growing at an annual rate of 30 percent, caters to patients chiefly from the US, Europe, West Asia and Africa. Although in its nascent stage, the industry is outsmarting similar

industries of other countries such as Greece, South Africa, Jordan, Malaysia, Philippines and Singapore. As the cost of Health care Industry is increasing day by day, patients in the developed world are looking overseas for medical treatment. India's low cost & availability of highly trained doctors appeal to this medical tourists. Previously, foreign patients were traditionally not covered under medical insurance outside their home countries. However, companies like Blue Cross, Blue Shield of US have begun to tie ups with Indian hospitals for providing "customized medial facilities".

What makes it so attractive?

Foremost is the cost factor. The medical costs in India are one-tenth of the costs in western countries. For instance, a heart surgery costs $6,000 in India as against $30,000 in the US. Similarly, a bone marrow transplant costs $26,000 in India as compared to $2,50,000 in the US. 13

Secondly, foreign patients throng Indian hospitals to pass up the long waiting lists and queues in their native countries. Indian hospitals provide immediate attention to patients rather than asking them to wait for several months like in most western countries. Further, foreign patients need not tackle insurance and national medical systems in India as they have to in their native lands.

India offers the best treatments in modern medicine and in every medical division such as cardiology, orthopedic surgery, eye care, gynaecology, cosmetic surgery and dental surgery. It also provides traditional methods of treatment such as Ayurveda, Homeopathy, Naturopathy and Yoga.

Indias private hospitals have gained international recognition for their state-of-the-art facilities and diagnostic centre besides unsurpassed skills. Their technology and procedures are on par with hospitals in developed nations.

Foreign patients can get package deals including flights, transfers, hotels, treatment and post-operative vacation for their medical visits to India.

Many foreign patients prefer to combine their leisure and relaxation visits to India with healthcare. The Government of India has declared that treating of foreign patients is legal. It is encouraging medical tourism in the country by offering tax breaks and export incentives to participating hospitals. In addition, the Government has cleared medical visas.

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CHAPTER III Top 10 Reasons Why Medical Tourism is Popular ?

Medical tourism dates back to the times when wealthy Europeans and Asians would travel within their continent or to other continents to seek health related treatments. But, of late, the trend has been popularized by Americans, Canadians, British and others who travel to far-off countries in search for low-cost high quality healthcare or for care that's not readily available in their country. Following are the top 10 reasons why people travel to far-flung developing countries for medical care: 1. Incredible Savings: The top on the list is savings. Depending upon your destination country and the cost of the procedure back home, expect to save at least 50%. For example: A cardiac bypass surgery is estimated at well over $100,000 in the US. But in India, at a 5-star type hospital, you can have the same surgery for only about $10,000. That's 90% savings even after you have paid for your travel, accommodation and vacation for yourself and a companion.

2. No Wait-Lists : Access to immediate service is what attracts those from countries that have public health care system towards medical tourism. A case at hand is that of a Canadian who suffered from chronic back pain for 16 years and was given medication to deal with it for all those years. Tired of the system and of the worsening pain, she

15

went to India to get her spinal surgery. She now tells everyone how she got her back by going to India.

3. Excellent Quality : To demonstrate their commitment to quality many international providers choose to be accredited by organizations such as JCI, JCAHO and ISO or by their local accrediting organizations.

4.

World-Class

Facilities:

International

providers

offer

luxurious

accommodation, private spacious rooms, and access to hospitality services 24 x 7. The facilities are immaculate and there are no infections that we so often hear about being present in UK hospitals. 5. Access to Latest Technology : The technology and equipments used by them are the latest and the greatest. It's not uncommon to see surgeons working with billion dollar robotic machines in operating rooms. 6. Surgeon Expertise : Most surgeons catering to international patients have either been educated or have received professional training at top schools in the US, UK or in other countries in Europe. They have colleagues in the US, UK and elsewhere, so it should not come as a surprise if they know your local surgeon at home.

7. Personalized Service : Most medical travelers vouch for the genuine and excellent service that they receive from surgeons, nurses and other medical staff alike. The staff to patient ratio is low making high level of personal care possible.

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8. Longer Hospital Stay : One of the advantages of medical travel is you get to stay in the hospital for long without incurring hefty room charges. You can have a longer hospital stay than possible in your local hospital back home under the supervision of your surgeon and physical therapist.

9. Great Convenience : Given the ease of international travel combined with low airfares, your life-changing surgery is just a flight away. Another convenience that you get is not having to leave the comforts of your home until the surgery is due. You can research all you want on the Internet about hospitals and surgeons, share your medical records online with them, book and plan your itinerary on the web, etc.

10. Travel Opportunities : While the primary motivation for most customers is affordable surgery the opportunity to visit exotic destinations is an additional draw for some. You can choose to have a relaxing recovery in a resort setting or if your surgeon allows you can even enjoy outdoor tourist attractions.

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CHAPTER IV

Major Players In Indian Medical Tourism:

Whos in it?
The hospitals in India, Malaysia and Thailand that participate in medical tourism are all working on getting accredited by the Joint Commission of Accreditation of Healthcare Organizations (JCAHO), an American based commission whose mission is to "... improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations." The JCAHO has a list of accredited hospitals worldwide. By getting accredited hospitals can assure their international patients that their quality of care standards are at an international level. Medical tourism is also growing due to the strength of the dollar and the devaluation of other currencies. This increases the purchasing power of the dollar and means that a foreigner with US dollars can purchase expensive medical procedures for minimal cost. The National Health Policy is also actively promoting medical tourism. The chief cities attracting foreign patients to India are:

Kolkata Chennai Bangalore Mumbai Delhi Jaipur

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The hospitals that attract large number of foreign tourist besides Indians are:

Apollo Hospital, Delhi. All India Institute of Medical Sciences, Delhi. AMRI, Kolkata. Christian Medical College, Vellore. Wockhardt Hospitals. BM Birla Heart Research Centre, Kolkata. Manipal Heart Foundation, Bangalore Escort Heart Institute & Research Centre Limited, New Breach Candy Hospital, Mumbai Escorts Hospital, Jaipur. Asian Heart Institute, Mumbai PD Hinduja National Hospital and Medical Research Centre, Mumbai. Jaslok Hospital, Mumbai. Delhi

Tata Memorial Hospital

The Tata Memorial Centre is the national comprehensive cancer centre for the prevention, treatment, education and research in Cancer and is recognised as one of the leading cancer centres in this part of the world. Nearly 8500 major operations are performed annually and 5000 patients treated with Radiotherapy and Chemotherapy annually in multi-disciplinary programmes delivering established treatments. Apart

19

from the patient care and service, clinical research programmes and randomized trials contribute increasingly to improved delivery of care and highest standards of work ethics. Surgery remains the vital form of treatment along with radiation therapy and chemotherapy. The strategies for early diagnosis, treatment management, rehabilitation, pain relief and terminal care have been established in a comprehensive and multidisciplinary approach for a total cancer care programme.

All India Institute of Medical Sciences

AIIMS' contribution in the fields of medical education, research and specialized treatment is widely acknowledged. The main object of the institute is to demonstrate high-standard of medical education, training of personnel and to conduct experiments and research in various disciplines of medical sciences. Twenty-five clinical departments including four super specialty centers manage practically all types of disease conditions with support from pre- and Para-clinical departments. However, burn cases, dog-bite cases and patients suffering from infectious diseases are not entertained in the AIIMS Hospital. AIIMS also manages a 60-beded hospital in the Comprehensive Rural Health Centre at Ballabgarh in Haryana and provides health cover to about 2.5 lakh population through the Centre for Community Medicine.

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 Apollo Hospital
Apollo Hospitals is committed to treating patients with medical expertise and compassion. Set up on 15 acres of land, the Indraprastha Apollo Hospitals brings together some of the most talented medical professionals from all over the world, with the best of technology and an excellent working environment. It has set aside free beds for those who can't afford care, has set up a trust fund and is pioneering remote, satellite-linked telemedicine across India. This 695-bed hospital provides world-class healthcare facilities, with 50 super-specialties. With a total of 19 operation theatres, and Indraprastha techniques. As part of the Apollo Hospitals Group, committed to delivering healthcare of international standards, the Indraprastha Apollo has a dedicated team to ensure the highest standards of patient care. Apollo offers the latest medical technologies and

Other Locations
Apollo Hospitals are also available in Ahmedabad, Kolkata, Chennai, Colombo and Hyderabad. It is India's first hospital to perform and angioplasty in 1989.

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First

successful

case

in

Asia

for

Directional

coronary

arthectomy. Performed first four cases in the country for rotablators for coronary occlusion. Successful completion of 20,000 open heart surgeries with 98.50 per cent success.

B.M.Birla Heart Research Centre

B M Birla Heart Research Centre is a super specialty hospital dedicated exclusively to the diagnosis, Since treatment its and research in related it to has cardiovascular diseases. commissioning 1989,

established itself as Indias most advanced heart centre comparable to the best in the world. Not only do patients from all over India seek treatment here, but patients from Bangladesh, Bhutan, Nepal, Mauritius, Hong Kong, Kenya and other neighbouring countries also avail of its facilities. The Centre is mananged by highly trained, young, dynamic and accomplished team of medical and para-medical professionals working both collaboratively and interprofessionally. The entire spectrum of cardiac ailments, affecting both adults and children, are dealt with at this Centre. B.M.Birla Heart Research Centre has a special interest in advanced field of cardiac surgery, especially reconstructive operations on babies. B. M. Birla Heart Research Centre is committed to providing World Class Cardiac care to patients. The centre has performed a number of breakthroughs in Cardiac Surgery and Angioplasty. Now the ISO 14001 Certification proves yet again that our persuits for the highest standards are directed towards Quality Heart Care.

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Achievements :
For the first time in the world key-hole surgery was performed to close a hole in the heart. First 'Dynamic Cardiomyoplasty' performed in Asia. For the first time in India Open Heart Surgery was performed on a 9 day old baby weighing 2.5 kg First time in India, Extra Corporeal Membrane Oxygenation was performed on a neonate for respiratory distress. For the first time complete Arterial Graft for ischaemic heart disease. Instruments designed at the Centre (like Special Bull Dog clamp) are being extensively used in Cardiac Surgery. Special kind of technique known as 'Birla Heart Technique' has been developed and is being used extensively in the area of Cardiac Surgery to reconstruct heart valves. First time in India, failing heart of an Adult was supported with Artificial Heart and Mechanical Circulation for 100 hours. One of the few centres performing complicated operations on all age groups ranging from Neonats to elderly patients.

Escorts Heart Institute and Research Center

In Delhi, it performs 15,000 heart operations every year, and its death rate is 0.8 percent, (less than half of all major hospitals in the U.S.). They

23

also offer a pediatric children's healthcare unit. Their impressive results have boosted medical tourism to their facilities.

Wockhardt Hospitals, Mumbai & Bangalore

Wockhardt Ltd., the most renowned healthcare institution in India, has associated with Harvard Medical International, USA. As associate hospitals of Harvard Medical, USA in India, Wockhardt hospitals benefit from the extensive learning and experience of Harvard Medical School and its affiliated institutions world-wide. This association helps Wockhardt Hospitals to stay at the forefront of medical technology and techniques, way ahead of others. Wockhardt Hospitals, Mumbai , has become the first super-specialty hospital in South Asia to achieve accreditation from Joint Commission International (JCI), USA. JCI is the gold standard in global healthcare standards. With this, Wockhardt Hospitals joins an exclusive group of 71 hospitals worldwide, which have passed JCIs stringent clinical quality standards. JCI is the international arm of the Joint Commission on Accreditation of Healthcare Organizations, which evaluates quality standards of US hospitals. Wockhardt Hyderabad, disciplinary infrastructure Hospitals, Kolkata and Bangalore: and Nagpur. state of patient Wockhardt With the care Hospitals Group has

established a chain of super specialty hospitals at Mumbai, Bangalore, latest art technology, world and multiclass capability, facilities, ambience

excellent

processes,

Wockhardt Hospitals is poised to become the most advanced and progressive healthcare institution in this part of the world. There are many others, but these are the facilities that are the most popular for

24

medical tourism. As costs continue to rise, the appeal of medical tourism will continue to grow. It will be interesting to see if these trends make an impact on health policies in the Western world.

CHAPTER V

Facts of Medical Tourism in India :

An estimated 150,000 "medical tourists" visited India last year, representing a 20 per cent jump over the previous year. The CII-McKinsey report suggests that medical tourism could fetch as much as $2 billion by 2012, compared to an estimated $333 million currently.

Ayurveda tourism earned RS.6000 crore last year. Medical Tourism or Medical Travel is the growing phenomenon of Americans traveling abroad for affordable healthcare. The Medical Tourism market is currently valued at $20 billion annually. These numbers are expected to double by 2010. More than 150,000 Americans traveled abroad for healthcare last year and that number is projected to double in 2008. The primary destinations for US patients include India, Thailand, Mexico, Costa Rica and Singapore. Common procedures include dental work, heart surgery, orthopedics, cosmetic surgery, neurosurgery, fertility treatments, LASIK eye repair, and cancer treatments.

Medical travelers come from all over the US, and represent all ages and races. The most common factor is that the patient is either uninsured or underinsured. With 85 million Americans falling into this category, the potential demographic is enormous.

Savings vary worldwide and by procedure. Broadly, patients can expect rates 25%75% less than those in the US. 25

Agencies specializing in international medical travel( known as health travel planners or medical concierge agencies) are a growing part of the medical travel industry and work with hospitals, clinics, physicians, surgeons, airlines, hotels and recovery retreats abroad to offer patients the best quality at the most affordable rates. Some insurance companies allow for coverage based on out of network rates. Although most US insurance companies will not currently cover procedures abroad, regulations are expected to change as American employers and insurance companies evaluate the savings potential. Over the past five years, nearly 100 hospitals and treatment centers abroad have become accredited to US standards of healthcare, through the Joint Commission International (JCI), the nations leading hospital accreditation organization.

For dental care and cosmetic-aesthetic surgery, most Americans prefer to travel to Mexico, Brazil or Argentina, with shorter flights and the allure of potential vacationing prior to treatment. For orthopedic and cardiovascular and Malaysia) procedures, where Americans accreditation

generally prefer to travel to India and Southeast Asia (e.g. Thailand, Singapore standards, healthcare infrastructure and choice of qualified physician is greater.

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CHAPTER VI Benefits Of Medical Tourism

An increasing number of people from post-industrialized nations are choosing to travel internationally to receive medical treatments. The reasons for this emerging phenomenon are varied. By choosing medical travel to an emerging country such as Thailand or India, one can find new medical treatments that have not yet been approved in their home country. The wait for treatment may be shorter and hospital accommodations may be friendlier. Cheap surgery and affordable, comfortable accommodations are other benefits of medical tourism. Some people simply find the idea of traveling to an exotic location appealing. There are actually many reasons for medical tourism's increasing popularity: Speed & Convenience : The overburden and heavily taxed health systems in developed countries results in the lack of hospital beds and long waiting times for elective, and even life-saving procedures. For many people, medical tourism is the only viable option for receiving these types of treatments and procedures. Many countries invest heavily in their healthcare system for the purpose of supporting and expanding their medical tourism industry, so there is often an improved level of service and facilities available to overseas patients. Options : Certain procedures are not approved by the public health authorities, as many of them are deemed to be experimental or untested procedures that have not received the adequate amount of testing and approval. In other cases, some procedures are not recognized or endorsed,

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so patients who are seeking alternative treatment or therapy have to travel overseas to undergo these types of procedures. In many cases these

procedures are very well-established overseas, and there is a very low-risk involved, while others may be practiced because of less stringent government regulations or restrictions. Cost : Cost is another of the most popular reasons why people choose medical travel. It can offer substantial savings, providing inexpensive plastic surgery and other procedures for people who cannot afford them in their home countries. Wages for specialty doctors and hospital stay expenses are much lower in places like India and Mexico. Even when one includes the cost of the trip, including airfare, accommodation, transportation and other expenses, not to mention the cost of the procedure, medical tourism can still present a much cheaper option compared to undergoing a procedure locally. These normally apply to procedures that are not subsidized by the government, or do not fall under the insurance policy or coverage of the patient. The degree of union or organized labor control, cheap labor costs and the streamlining of service providers and medical facilities in medical tourism destinations also translate to substantial savings. In many cases, the quality of service is equivalent or better and than local of healthcare healthcare providers, systems such in is the improvement efficiency overseas

destinations. For example, hip replacement becomes a cheap surgery when performed in certain emerging countries. A hip replacement typically costs at least $50,000 in the United States, whereas it is only about $5500 in India. Even when figuring in the additional costs of travel and other expenses, one can expect to save about 75% on a hip replacement surgery by choosing medical travel. Inexpensive plastic surgery, dental care, and

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bariatric surgery, and many other treatments are also common, cheap medical travel procedures.

Therapeutic Benefits : Medical procedures often cause a certain amount of stress on the patient, whether it is a physical and/or mental in its nature. There is always a certain amount of risk post-procedure, so most patients are advised to take a sufficient amount of time to recuperate and recovery from the procedure. Being situated in an idyllic location or somewhere that is out of reach from the stress and pressures of daily life can have a positive effect on the recovery process for the patient. Availability of Cutting Edge Medical Treatments : First world countries such as the United States, Australia, and Britain have the strictest guidelines for approving new medical treatments. When a new surgery or cure is developed, it can take years for the procedure to become available to the masses. Sometimes, people must wait for their government to gather statistics and deem the treatment safe. In other instances, there simply aren't enough doctors skilled in the new treatment to be able to handle everyone who seeks it. Emerging nations do not have as many regulations dictating their medical industry, including the plastic surgery field. This means that one may be able to travel overseas and receive a medical treatment years before it becomes available in their home country. Before doing so, of course, one should research the treatment or plastic surgery that they wish to have in detail. Gain as much information as possible about prospective doctors as well as the medical industry in Mexico, India, Thailand, or whichever country is being considered for medical travel.

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Availability of Doctors and Operating Rooms : Like cutting edge medical treatments, the availability of doctors and operating rooms can cause a long wait for some procedures in one's home country. This is not the case with medical travel. Plastic surgery or medical care is often available months sooner in emerging countries. For some procedures, such as bariatric surgery, patients may be required to go through months of counseling and preparation beforehand in the United States. For those who see this as a hassle, medical travel is a great alternative. One does not have to end up on a long waiting list for a good doctor, hospital space, or operating room when choosing medical travel. While this may not be true at home, there is an abundance of cheap medical resources around the world. Post-industrialized nations with national government healthcare systems have the biggest problems with having to wait months for a medical treatment, whether it is essential (in some cases, bariatric surgery) or elective (such as plastic surgery).

Desire to Travel to an Exotic Location : Some seekers of medical travel find the prospect of being able to travel abroad exciting. Fulfilling a dream to see an exotic location such as Mexico, Thailand, Brazil, or any number of other countries may help tip the scales towards choosing medical tourism. A vacation can be tacked on to the end of the trip, often for an inexpensive price. Relaxing in an exotic location sounds like a great way to recover from one's inexpensive plastic surgery.

Higher Quality Hospital Experience : Medical travel often provides a higher quality hospital experience than one would find at home. Hospital staff may not be as overworked as doctors and nurses are in first world countries, allowing them to be more attentive and friendly. Quality personal care is possible when the professionals have fewer patients to care for. There is more of a customer service mentality towards treatment

30

in medical tourism, which makes them eager for their patients to be happy. The hospital stay can also be longer.

Affordable

Luxury

Accommodations

and

Service

The

accommodations at many facilities where one can find medical tourism are nothing like the hospitals people are used to in countries like the United States and England. The buildings are kept extremely clean. Hospitality services are available around the clock, and with large the private rooms of are offered. travel There is assistance personal additional logistics and medical and getting may be

oriented in a foreign country. A personal nurse, yoga classes, a translator, fee. even like

shopping
the

assistance

available. Some of these medical tourism services do require an However,

inexpensive

surgery,

these

services are generally much cheaper than they would be in one's

home country. Medical travel is an option that should not be

overlooked when one is seeking

cheap surgery. There are a

growing number of quality medical tourism facilities around the world with well-trained staff and state-of-the-art equipment. The immediate into. availability and luxury accommodations of these

inexpensive treatments make medical travel well worth looking

31

Disadvantages of Medical Tourism .

Although there are countless advantages and benefits to medical tourism , there are also a few disadvantages, dangers, and concerns of which you should be aware. Medical tourism is a trade-off, pure and simple. Although one might receive personalized attention, quality health care, convenience, affordable pricing, and a chance to experience a new culture, one occasionally sacrifices familiarity and certain legal guarantees. 1. Medical Malpractice Suits Although most medical tourism facilities (hospitals, dental clinics, etc.) will have medical malpractice insurance to cover any unforeseen events, seeking damages can sometimes be difficult in cases of negligence, misdiagnoses, or incompetence. This is not to say that medical tourists have absolutely no legal recourse, but if the patient is looking for large cash settlements, he should probably stay in his home country. The laws of your country might not be any easier to decipher, but you will probably enjoy greater access to more transparent guidelines and regulations 2. Insurance Laws May Vary

32

Depending on the type of insurance and depending on the type of procedure one needs,he might not be fully covered if you travel abroad. You'll want to check with your insurance carrier and see what portion of the final bill they're willing to cover. In the past, medical tourism was largely relegated to the cosmetic surgery industry, and thus, insurance usually wasn't a major factor since elective procedures aren't normally covered. But increasingly, hospitals in medical tourism destinations like Thailand and India have begun offering life-saving medical procedures that your insurance company would probably cover back home. 3. Postoperative Treatments For many procedures, it's customary to check in with your physician or dentist from time to time as you recuperate. However, by receiving treatment abroad, it becomes prohibitively expensive to consult with whatever doctor or dentist provided you with primary care. This is one reason why many medical tourists decide to recuperate while they are still abroad. Fortunately, many medical tourism destinations have excellent facilities to care for and entertain recovering patients. It's not uncommon to find medical tourists relaxing on the beaches of Phuket or Goa as they recuperate. But for procedures requiring longer recovery periods, you'll need to make postoperative arrangements on your own. This usually requires consulting a local physician or dentist in your hometown, in

addition to whatever foreign health care provider supervised the original treatment. 4. Its Best Not to Travel Alone Anytime you have major surgery done, it's always good to have a friend or family member present both during and after the procedure. When flying

33

abroad to receive medical treatment, it's strongly recommended that you take someone with you. However, this necessarily drives up the total price of your medical vacation since you'll have to book flights and hotel reservations for at least two people.

5. Finding the Best Medical Facility Possible

When

you

shop

around

for

hospitals

and

dental

clinics

in

your

neighborhood, you can easily visit them in person, check out the facilities, and meet with hospital staff. But with medical tourism, this type of in-person reconnaissance becomes a little harder to manage.

CHAPTER VII How Can The Government Facilitate?

The role of the government is critical in various areas if we need to scale the existing model. Some of the areas where government can and should act are: Medical Education. It is high time that the government really looked hard at the demand supply situation of human resources in the healthcare sector and recalibrated the supply of specialists and paramedicals in the country. This would mean changes to policies on post- graduate medical education, nursing education etc. Infrastructure

34

Quality of healthcare service can be limited by traffic and hartals. The last thing the fledgling medical tourism industry in India wants is bad press on a couple of foreign patients in ambulances that were stuck in traffic for several hours due to a political partys rally. From airports, and high ways, and hassle free environments for patients relatives, there is quite a bit where improvements can be made on the infrastructure side. Law And Order Law and order and general sense of security are definitely areas for improvement. For all the gold in the world, I might want to get my hip replaced in nearby countries, which are infested with and mines and missiles waiting to take off.

Legal Infrastructure & Ethics What is the mechanism for international patients who seek legal redressal for service gone bad? How long would it take for resolving the same in India? Is our legal infrastructure geared up to handle healthcare specific issues in a speedy manner? Privacy Of Patient Information One area that is understated in discussions around healthcare services in India is confidentiality of patient data and regulations related to privacy and security of patient data in India. A good start would be to adopt HIPAA standards in India. Role Of IT Standards : Finally, adopting and adapting of IT systems and standards that are in vogue in the developed world would be required to ease the administrative

35

processes involved in cross-border care and integration with the medical records in the country of origin.

CHAPTER VIII SWOT ANALYSIS

From the above it may be questionable that what makes India attractive? In short, we can portray the SWOT analysis of Indian medical tourism business.

STRENGHTS :

Quality of service. Exquisite Locations. Alternative medical cures like Yoga, Homeopathy and Ayurveda. Niche market. Emerging markets or developing countries have most benefits Differentiation from rivals is through the leisure element of the medical tourism package (e.g. dentistry and Caribbean islands or dentistry and Taj Mahal)

Positive forecast growth. Established travel destinations have a natural marketing platform. 36

Absence of market rules in developed countries banning medical tourism in developing favours market growth.

WEAKNESS :

Local people cant afford the same type of service that is offered to tourists. Absence of laws or policies for international medical care. Therefore consumer not protected against malpractice. The nature of the product, medicine and leisure, requires initial significant investment. Lack of infrastructure. Lack of uniform pricing policy. Poor infrastructure in government aided hospitals. Lack of proper Institute on medical Instrumentation.

The downsides of medical tourism :

Government and basic medical insurance, and sometimes extended medical insurance, often does not pay for the medical procedure, meaning the patient has to pay cash. There is little follow-up care. The patient usually is in hospital for only a few days, and then goes on the vacation portion of the trip or returns home. Complications, side-effects and post-operative care are then the responsibility of the medical care system in the patients' home country. Most of the countries that offer medical tourism have weak malpractice laws, so the patient has little recourse to local courts or medical boards if something goes wrong. There are growing accusations that profitable; private-sector medical tourism is drawing medical resources and personnel away

37

from the local population, although some medical organizations that market to outside tourists are taking steps to improve local service. OUR PROBLEMS : India is still a developing country and has several inherent problems There is a negative perception about the country because of poor hygiene and sanitation No uniformity of quality and accreditation is now becoming a reality Medical insurance is still in its infancy and has a very low penetration Flight connectivity needs attention Infrastructural woes continue to affect the airports, roads and power Save for the initiatives taken by a few organized players, there has been no focused marketing till now.

THEIR PROBLEMS : LACK OF KNOWLEDGE The knowledge about medical tourism is mostly shared by word-of- mouth or by persons who are internet savvy. LACK OF TRUST Patients from developed countries are still sceptical of the quality of medical care abroad, and doubly sceptical of ventures that have no personal or local contacts.

38

LACK OF FOLLOW-UP Continuity in health care is a major cause for concern. There are many stories on the internet about the people who opted for treatment abroad, but returned home without follow-up care and suffering complications. LACK OF MEDICAL LIABILITY Patients from developed countries know that they have legal recourse to medical malpractice for healthcare in their countries. This is often not true of procedures that take place overseas, and are not under their legal jurisdiction.

OPPURTUNITY :

May be adopted by almost any country as it is not geographic It will create new and more jobs for locals in the service sector. Due to the global nature of medical tourism firms

specific but knowledge and infrastructure-specific.

internationalize immediately as the target market is abroad. To differentiate the service can be based on the countrys Impact on Forex reserve. Contribution in GDP. Sharp rise in medical as well as tourism Industry. landscape and tourism attractions.

THREATS :

39

Absence

of

market in

rules

in

developed can

countries delay

banning laws

medical tourism in developing destinations may not last. Corruption developing countries some required to improve the service. The low-price strategy may not be sustainable if input costs Retaliation by healthcare providers medical tourist generating Foreign players may enter into the market. Lack of foreign accreditation. Strong competition from Malaysia, Thailand and Singapore increases. destinations.

CHAPTER IX

MARKETING MIX

PRODUCT:

Medical Packages :
The health care sector in India has witnessed an enormous growth in infrastructure in the private and voluntary sector. The private sector which was very modest in the early stages, has now become a flourishing industry equipped with the most modern state-of-the-art technology at its disposal. It is estimated that 75-80% of health care services and investments in India are now provided by the private sector. An added plus had been that India has one of the largest pharmaceutical industries in the world. It is self sufficient in drug production and exports drugs to

40

more than 180 countries. The different medical treatments available in Inida are as follows:

Bone Marrow Transplant Brain Surgery Cancer Procedures (Oncology) Cardiac Care Cosmetic Surgery Dialysis and Kidney Transplant Drug Rehabilitation Gynaecology & Obstetrics Health Checkups Internal/Digestive Procedures Joint Replacement Surgery Nuclear Medicine Neurosurgery & Trauma Surgery Preventive Health Care Refractive Surgery Osteoporosis Spine Related Urology Vascular Surgery

Common Types of Medical Tourism Treatments Available :

Medical travel, also called medical tourism, can provide a wide variety of treatments and surgeries. The procedures offered do include the wellknown choices of plastic and bariatric surgeries. However, they also go beyond those options that we hear about most often. Lesser-known medical travel services include everything from cancer treatment to brain surgery, dental work, hip replacements, health spas, and sex change

41

operations. Elective procedures as well as cutting edge services are both available to the travel tourist. Medical: Necessary medical treatments are increasingly being performed abroad because they can be done faster and cheaper than in one's home country. Cutting edge procedures are often easier to obtain in emerging countries than in first world nations due to ridiculously long wait periods. Top destinations for medical services include India, Malaysia, Thailand, and Singapore. Weight Loss Surgeries : Bariatric and lap band surgeries are commonly associated with medical tourism. One reason for this is that patients must often pass certain criteria and undergo counseling in order to have bariatric surgery done in the United States. If a patient gets turned down or wants to bypass this process, they can go to Thailand for low-cost bariatric or lap band surgery. These are both forms of weight loss surgery. Bariatric is the more invasive and life-altering version, whereas lap band surgery can be reversed. Ophthalmology: As more people are seeking to have LASIK surgery done on their eyes, low-cost options are becoming more popular. LASIK eye surgery repairs near-sightedness with a laser. It can be found around the world for less than $1000, whereas it is closer to $4000 in the United States. Orthopedics: Hip replacement, hip resurfacing, and knee surgery are commonly performed in the medical travel industry. The vast financial savings of having these surgeries done abroad and long wait periods of up to a year in some countries encourage people to choose medical tourism. Cardiology : Medical tourism options in cardiology can include low-cost open heart surgery, bypass surgery, balloons and stents, and more. By

42

going to India, one can have open heart surgery for approximately $4500 (before travel expenses) and avoid the nine- to eleven-month wait that is typical in Britain and the United States. Fertility and Reproductive : Fertility and reproductive procedures are performed on both men and women in the medical tourism industry. In Vitro fertilization and other fertility treatments, which are rather expensive, can be done for a much cheaper price in emerging countries. Sterilization, mastectomies, and vasectomy reversals are just a few of the offerings.

Neurology: In the United States and the United Kingdom, a typical wait period for brain tumor biopsy or surgery is six to eight months. A spinal surgery may take nine to eleven months to get in. These types of situations make medical travel an option to consider. Oncology : Cancer treatments are extremely cost prohibitive in the United States. The best doctors or those who perform new treatments might have long waiting lists. People often choose medical travel for cancer treatments when they want to explore options not available in their own country. Organ Transplants : Medical tourism procedures involving low-cost organ transplants include bone marrow, liver, and kidney transplants. The bone marrow procedure, for example, has an approximate cost of $250,000 in the United States versus $69,000 in India.

43

Cosmetic surgery: It is not uncommon to see people on TV who have used medical tourism for inexpensive cosmetic surgery. It is one of the most popular forms of treatment for which people decide to choose medical tourism. One reason for this is that insurance plans usually don't cover plastic surgery because the procedures are elective. This makes it important for more people to have them done inexpensively.

Common plastic surgery procedures that are done in medical tourism include minimally-invasive as well as more extensive procedures. Liposuction, facelifts, tummy tucks, breast enhancements and reductions, nose jobs, and sex change operations are all popular. Since the TV reality show Extreme Makeover, some facilities are now offering similar services of multiple plastic surgeries to completely redo one's appearance. When looking for plastic surgery options abroad, there are many choices. Argentina, Costa Rica, Mexico, Brazil, the Philippines, the Dominican Republic, South Africa, Malaysia, Poland, and Thailand are all popular destinations for inexpensive plastic surgery. Thailand is especially known as the popular place to go for low-cost sex change operations.

Dental : When people use medical tourism for dental work, it is generally for expensive cosmetic or restorative procedures. Obviously, it is only cost effective to travel to a foreign country for the more extensive dental work. A dental procedure that can easily cost over $5000 in the United States can be found for less than 10% of that amount (before travel costs) in the Philippines or India, for example. Top destinations for dental travel include Costa Rica, the Czech Republic, Hungary, India, Mexico, Panama, South Africa, and Thailand. Wellness : Health spas and Ayurvedic treatments seem to be especially popular in India. The country is geared up to promote medical tourism there to boost its economy. Certain areas of India are actually seeing an 44

increase in tourism during the monsoon months because it's believed that the rainy season is the best time to undergo Ayurveda therapy. These spas offer services such as massages, oil treatments, special vegetarian diets, and cooking classes. Ayurveda: It is a natural science. A unique line of Indian traditional system of Medicine, 'Ayurveda' is the World's oldest complete medical science, originated nearly 5000 years ago. It is a powerful unfailing system of diagnosis and treatment based on medicines prepared from herbal plants found in abundance in India. An amalgamation of Science and Philosophy, Ayurveda balances the physical, mental, emotional and spiritual components necessary for holistic health. It offers a rich, comprehensive outlook to a healthy life. It is often called the "Mother of All Healing". Ayurveda is considered by many scholars to be the oldest healing science. In Sanskrit, Ayurveda stands for "Science of Life". The word 'Ayurveda' comprises of 'Ayur' and 'Veda'. 'Ayur' means 'Life' and 'Veda' means 'Knowledge'. It provides a systematic approach to health that includes a proper diet, exercise and seasonal daily practices that lead to healthy living. Ayurveda is considered divine in origin. It originated from Artharva Veda which is full of references to Health, Disease, Treatments, description of Medicinal plants etc. Ayurveda is an integrated approach towards presenting an individual a healthy lifestyle with perfect balance and harmony within the human existence, from the most abstract transcendental values to the most concrete physiological expressions, which are based on an intelligent synchronization of the Atma (Soul), Mana (Mind), Indriya (Senses) and Sharira (Body).

45

Ayurveda includes herbal medicines, massage, oil treatments and body cleansing. The treatments are all-natural, and have no side effects. Moreover, Ayurveda gives lasting effects rather than temporarily relief as it treats the root cause of the illness rather than the symptoms. The aim of the treatment is to improve the vitality and the symptoms. The aim of
the treatment is to improve the vitality and to strengthen the immune system. All ingredients used (herbs, plants and minerals) are found in their natural habitats, and are prepared in nonpolluting ways. This ensures there are no negative impacts on the environment. Ayurveda is divided into eight branches, which are collectively called as Ashtang Ayurveda. The eight branches of Ayurvedic science are as follows:

Kayachikitsa (Internal Medicine), Shalya chikitsa (Surgery ) Bala chikitsa- (Pediatrics), Graha chikitsa- Bhoot Vidya (Psychiatry) Urdhvanga chikitsa-Treatment of eyes, ears, nose, throat and head, Damstra chikitsa- agad tantra or (Toxicology), Jara chikitsa- Rasayan a (Gerentorology), Vrishya chikitsa (vajikarana) (Aphrodisiacs) Ayurveda says that Swasthya (Health) depends upon the balanced condition of the three constituents of the Sharira (body) i.e. (Tridosha, Sapta Dhatu and Malas). These three founders affect the Swasthya (Health) qualitatively and quantitatively. All the Physiological and Pathological processes involve these

46

constituents and are responsible for health and ill health in a person. Ayurveda strongly emphasizes on Prevention, Promotion, Cure and Rehabilitation. For this, it suggests to follow the principles of health, observation of principles- Dincharya (daily regimen), Rutucharya (Seasonal regimen),Ratricharya (Night routine), Sadvritta and Achar Rasayan (Ethical and Moral activities), Aahar (Food), Nidra (Sleep) and Brahmachary a (Regulated Action).

There are more treatments available in medical tourism than many people realize. The industry provides fast and inexpensive procedures for virtually every healthcare field. Low-cost dental care, bariatric surgery, plastic surgery, sex change operations, and fertility treatments are now readily available around the world. Medical tourism is a growing field that doesn't appear to be slowing down soon.

PRICE :
COST COMPARISONS
Significant cost differences exist between USA, U.K. and India when it comes to medical treatment. India is not only cheaper but the waiting time is almost nil. This is due to the outburst of the private sector which comprises of hospitals and clinics with the latest technology and best practitioners.

COST COMPARISON INDIA VS UNITED STATES OF AMERICA (USA)

Procedure Charges in India & USA

47

Procedure

United States (USD) India(USD) Approx Approx

Bone Marrow Transplant Liver Transplant Heart Surgery Orthopedic Surgery Cataract Surgery Smile Designing Metal Free Bridge Dental Implants Porcelain Metal Bridge

USD 2,50,000 USD 3,00,000 USD 30,000 USD 20,000 USD 2,000 USD 8,000 USD 5,500 USD 3,500 USD 3,000

USD 69,200 USD 69,350 USD 8,700 USD 6,300 USD 1,350 USD 1,100 USD 600 USD 900 USD 600

Porcelain Metal Crown Tooth Impactions Root Canal Treatment Tooth Whitening Tooth Colored Composite Fillings / Tooth Cleaning

USD 1,000 USD 2,000 USD 1,000 USD 800 USD 500 USD 300

USD 100 USD 125 USD 110 USD 125 USD 30 USD 90

Procedure Breast : -Mastopexy -Reduction Of

United

states

India Approx

(USD)

(USD) Approx USD 7,500 USD USD 6,500

Mammoplasty Augmentation Implants

-Mammoplasty -Replacement

USD 2,800 USD USD 3,000

8,000 USD 8,000 3,300 USD 2,750

48

Face face)

-Blepheroplasty -Canthopexy -Hair Brow lift

(Upper

& USD 6,000 USD USD 6,000 USD 50 Per graft USD USD 4,700 USD 7,300 USD 6,300 USD 7,700 USD USD 6,100

USD 2,000 USD USD 2,200 USD 3 Per graft USD

Lower) -Facelift -Dermabrasion (Total w/Orbicularis Transplant -Neck suspension -Endoscopic

6,500 USD 5,500 2,800 USD 2,150

lift 5,800 USD 6,100 2,300 USD 2,400 USD 1,500 USD 2,900 USD 1,300 USD 3,200 USD USD 1,750

-Otoplasty(For prominent Ears) Nose : -Primary Rhinoplasty -Tip Rhynoplasty Body Contouring : -Abdominoplasty -Thigh Lift (Bilateral) -Total Lower Body Lift(Belt Lipectomy) -Liposuction (One Region) Non Surgical Procedures : -Laser Hair Removal -Laser Resurfacing/ -Laser Acne Wrinkle Reduction

7,200 USD 9,500 3,150 USD 6,000

USD 550 USD 550 USD 225 USD 225 USD 575 USD 500 USD 230 USD 210 USD 70 Per Unit USD 8 Per Unit

Treatment -Laser Scar Treatment -Botox

# These costs are an average and may not be the actual cost to be incurred.

49

COST COMPARISON INDIA VS UNITED KINGDOM (UK)

Significant cost differences exist between U.K. and India when it comes to medical treatment. Accompanied with the cost are waiting times which exist in U.K. for patients which range from 3 months to over months. United Kingdom (USD) Approx USD 18,000 USD 13,000 India Approx USD 4,800 USD 4,500 (USD)

Procedure Open Heart Surgery Cranio-Facial surgery and skull base NeuroHypothermia Complex spine surgery with implants Simple Spine Surgery Simple Brain Tumor -Biopsy -Surgery Parkinsons DBS surgery with

USD 21,000

USD 6,800

USD 13,000 USD 6,500 USD 4,300 USD 10,000

USD 4,600 USD 2,300 USD1,200 4,600 USD 17,800 USD 4,500 2,300 USD USD

Lesion USD 6,500 USD 26,000

Hip Replacement

USD 13,000

50

# These costs are an average and may not be the actual cost to be incurred.

PROMOTION Incredible India campaign Ministry of Tourism promotes Medical Tourism in India.
Ministry of Tourism, Government of India participated at the World Travel Mart 2006 in London in November 2006 and at International Tourism Bourse (ITB) at Berlin in March 2007. The objective of participation was to promote India as the new emerging Healthcare destination and disseminate information on Medical Value Travel. The response was good and generated a lot of queries for promoting medical tourism in UK from potential tourists, medical tourism companies, health insurance companies, and travel and tour operators. Ministry of Tourism participated in New York Times Travel show in February 2007. A new category of Medical Visa has been introduced which can be given for a specific purpose to foreign tourist coming to India for medical treatment. This visa which is initially issued to a patient with a companion for a period of one year can be extended up to three years after fulfilling certain conditions and recommendations from the accredited medical authorities and concerned visa authorities.

51

Supplement on Incredible India: Medical tourism has gained momentum in India over the past few years, a trend underpinned by Indias low-cost advantage and the emergence of new high-quality healthcare service providers. In India, approximately 1,50,000 patients arrived in 2004 from across the globe for medical treatment, from countries like US, UK, Middle East, Africa, SAARC countries. In the last year we have seen an increase of approximately 20% in the medical tourists arriving in India. The medical tourism market in India, estimated at US$ 333 Million in 2004 grew by about 25 per cent and is predicted to become a US$ 2 billion-a-year business opportunity by 2012. Medical tourism focuses on treatment of acute illness, elective surgeries such as cardiology and cancer, among others. From October this year, the Government plans to start overseas marketing of India as a medical tourism destination. Senior Government officials say that the formalities for marketing medical facilities to a global audience have already started and they hope to complete the process of price-banding of hospitals in various cities by the third quarter of this year. The government of India is of the opinion that by marketing India as a global medical tourism destination, it could capitalize on the low-cost, high-quality medical care available in the country. Statistics shows that the medical tourism industry in India is worth $333 million (Rs 1,450 crore) while a study by CII-McKinsey estimates that the country could earn Rs 5,000-10,000 crore by 2012. Probably realizing the potential, major corporate such as the Tatas, Fortis, Max, Wockhardt, Piramal, and the Escorts group have made significant investments in setting up modern hospitals in major cities. Many have also designed special packages for patients, including airport pickups, visa assistance and board and lodging, health care industry officials said. Among the

52

factors that make India an attractive proposition for medical treatment is cost efficiency.

The Government has also introduced various policy measures such as the National Health Policy recognizes the treatment of international patients as an export, which allows private hospitals treating such patients to enjoy benefits such as lower import duties, increase in the rate of depreciation (from 25 per cent to 40 per cent) for life-saving medical equipment, and several other tax sops in order to encourage medical tourism in India

What can the government do to promote medical tourism?

The steps taken by the government to promote medical tourism include promotion in overseas market through brochure, CDs, films and other publicity materials. Visa Indian Missions abroad including those in Western cities grant visas expeditiously in keeping with the relevant norms. Visas are granted on the same day or the next day of the receipt of application except in the case of applications which require prior approval of the government, she said. At present, 24 Indian missions have already started outsourcing of collection of visa application forms. Tourists intending to visist India are

53

provided prompt and courteous services when they visit these missions abroad for seeking Indian Visa. Medical tourism has become a hot area in India today; and the government promises to do everything they can to promote this. After all, not only does it earn the country valuable foreign exchange, the fact that patients come to India from the US and the UK adds to our national prestige.Ideally, the government should promote medical tourism by providing subsidies and infrastructure services to hospitals and doctors so that they can improve the care they provide. This is done routinely for the IT industry, which gets large tracts of real estate from the government at highly subsidized rates, so there's no reason why this cannot be done for hospitals ( which provide employment to thousands and a socially useful service to local citizens as well !) In order to promote exports , the government offers a lot of sops and carrots to industries which earn foreign exchange. For example, companies which earn foreign exchange are eligible for tax exemptions , which means they pay much less tax than others. Why can't the same rules be applied for doctors and hospitals who earn foreign exchange from overseas patients ? Why shouldn't the export of all services which earn foreign exchange ( whether in the IT industry, jewellery industry, the hotel industry or the healthcare industry) be treated on par ?

FICCIs Focus on Medical Tourism It is indeed gratifying to note that well established chambers of commerce are now seriously looking at medical tourism and in fact, the Federation of Indian Chambers of Commerce and Industry, Western Region Council (FICCI-WRC) has taken the lead by setting up a task force for the

54

promotion of health and medical tourism in Maharashtra. This task force has representatives from the Maharashtra government, the medical educational institutions and the drugs department, Maharashtra Tourism Development Corporation, pharmaceutical companies, travel agents and tour companies.

Wing Cdr Anil M Gadkari, director, FICCI-WRC explained, "This is our dream project and we hope to get the support of all service providers of the industry. This project will indeed give a major boost to the tourism and hospitality of Maharashtra. We have received a positive response from MTDC who will work with us on this promotion."

Maharashtras Unlimited Potential This state, as a gateway to India, offers tremendous potential to develop medical tourism. The latest addition in Mumbai is the Asian Heart Institute at Bandra-Kurla Complex, which offers state-of-the art facilities for all types of heart complications and even offers preventive cardiological treatment to avoid heart ailments and also to keep under control a host of heart problems. This institute which is in collaboration with the Cleveland Institute, USA, offers five-star services at reasonable prices. There are even provisions for financial assistance which is offered through various trusts associated with the institute. There are a wide range of hospitals which help to promote medical tourism in the state. Some of these are Lilavati Hospital, Jaslok Hospital, Bombay Hospital, Hinduja Hospital, Wockhardt Hospital and Apollo NUSI Wellness Retreat. Hotels like Hyatt Regency, JW Marriott,

55

Renaissance and Resort, also offer extensive spa facilities aimed at rejuvenating both the domestic and international tourist.

International Conference An international health and medical tourism conference is slated to be held towards the end of this year at Bangalore, which will see delegates from various South-East Asian countries, the Middle-East and even Africa participating. This will serve as an ideal platform for Incredible India to market its health and medical tourism products and services.

56

PROCESS :
The typical process is as follows: The person seeking medical treatment abroad contacts a medical tourism provider. The provider usually requires the patient to provide a medical report, including the nature of ailment, local doctors opinion,

57

medical

history,

and

diagnosis,

and

may

request

additional

information. Certified medical doctors or consultants then advise on the medical treatment. The approximate expenditure, choice of hospitals and tourist destinations, and duration of stay, etc., is discussed. After signing consent bonds and agreements, the patient is given recommendation letters for a medical visa, to be procured from the concerned embassy. The patient travels to the destination country, where the medical tourism provider assigns a case executive, who takes care of the patient's accommodation, treatment and any other form of care. Once the treatment is done, the patient can remain in the tourist destination or return home.

Medical Process Flowchart

58

CHAPTER X Medical Tourism Statistics

59

Medical tourism is said to be the second most popular industry now-a-days. The increase in the number of medical tourists each year denotes that the medical tourism industry will soon be on the boom. The patients who long for quick and effective cure of the diseases visit India on medical tourism. The world class infrastructure and highly qualified team of doctors available in India favors the booming demand for medical tourism services. The foreign traffic was 10% earlier and has trebled in the last three years.

COUNTRIES PROMOTING MEDICAL TOURISM

The greatest impetus for the growth of medical tourism in India is the difference in the cost and the increasing world-class medical facilities available in here. A simple rhinoplasty costs 2.64 Lakh in US, but will only cost around 50,000 Rs in India. Likewise a face lift costs 5.28 Lakh in USA but costs only 1.5 Lakh rupees in India. If such is the difference then who is not tempted to avail the dual benefit of cure for sure and explore for sure.

CHAPTER XI
CASE STUDIES :

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Case1 : Mr.Alton When Russ Alton was told he had the choice of an agonizingly long wait for a heart bypass on the NHS, or a bill of between 17,000 and 24,000 to have it done privately, he turned to the internet in frustration. Within minutes Mr. Alton and his wife Joy had found a company that would get him the surgery within weeks for a fraction of the cost, 5,000 miles away in India. Despite his long-standing loyalty to the NHS he used to work for Sheffield Children's Hospital as a management consultant and Mrs. Alton still works for the service as an occupational therapist Mr. Alton felt he had no choice but to go overseas. He now says it was the best decision of his life. "I was diagnosed 18 months ago with heart disease and chronic atrial fibrillation an irregular heartbeat and my condition soon began to worse," he said. "I couldn't walk up stairs, I couldn't travel for my work, I couldn't lift anything and I was putting on weight. Effectively I was in heart failure. But when I found out I would have to wait several months for an operation, despite my consultant at Aberdeen hospital saying I needed an urgent heart bypass, Joy and I decided we had to go private. When we looked at the cost of the operation in the UK we started considering going abroad." The Taj Medical Group, which Mr. Alton found with Google, quoted him 7,800 for a package of treatment, including all the medical costs of the operation and aftercare at the Wockhardt Hospital in Mumbai, return flights for both him and his wife, 14 nights' hospital accommodation and 13 nights' recuperation at a country club. While the price was attractive, Mr. Alton, a health and safety consultant, was still nervous about the prospect of traveling to what he thought of as a Third World country for major surgery. He began to research the record of the Wockhardt and discovered the hospital carried out 500 bypasses a year, compared with 200 at a typical UK hospital. 61

"That gave me a lot of confidence and we decided to go for it," he said. On checking into the Wockhardt last month, Mr. Alton was subjected to a number of tests, given a treatment plan and only then asked for a deposit payment, the balance being paid once the operation had been carried out. Mr. Alton, 43, said he now felt like a different man. "I've been given a new lease of life and I feel bloody marvelous. I'm back into my work and I've lost two stone. It's only now I realize just how sick I was." Now back home in Carnoustie, near Dundee, Mr. Alton says he was amazed by the high standard of care he received in India. "Nothing was too much trouble for the staff. The care, the cleanliness and the attention to detail were all excellent. There was no comparison to my treatment in Britain, where I felt like a lump of meat on the production line." As health professionals, Mr. Alton and his wife were both struck by the contrast between the standards of hygiene in the Bangalore hospital and those in the UK. "When we flew back from India we arrived to the news that 90 people in this country had been killed by Clostridium difficult. We were stunned. In the Wockhardt they had never had a case of either MRSA or C. diff. "The wards were spotless. They had three separate teams to clean the floors, change the beds and change patients' water. Nobody could approach your bed without cleaning their hands and in the intensive care unit everyone had to go through a three-stage procedure of changing their clothes, putting on gowns and washing their hands with an alcohol rub." Following his experience abroad, Mr. Alton has arrived at a damning assessment of the state of the NHS.

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"I'm sorry to say Third World standards are what we now find in British hospitals. I'm afraid we've regressed. We've became obsessed with targets and it makes me very angry," he said.

Case 2: Mary Auchterlonie 'For us, being able to get the very best treatment was the crucial factor' For Keith Auchterlonie, flying his wife to Madras for hip surgery was a good use of Air Miles clocked up through a busy career. Housewife Mary, aged 59, had consulted both NHS and private doctors in Scotland to seek surgery to ease her excruciating pain. She was offered a total hip replacement available quickly privately, or on the National Health Service, if she was prepared to wait slightly longer. But research on the internet alerted the Fife couple to less invasive techniques that would offer Mrs. Auchterlonie far more mobility and a quicker recovery time. The catch was that no local hospitals offered the procedure, called "hip resurfacing". In fact, the more that the couple looked on the web, the more they found themselves looking further a field. Internet sites on the topic repeatedly led them to the work of Dr Vijay Bose, a surgeon based in Madras who specialized in the operation. Mr. Auchterlonie, a consultant in public relations, said: "We had to think about it seriously, but in the end it wasn't a difficult decision.

"We realized that we could get world-class treatment at a much lower price than in the UK. For us, being able to get the very best treatment was the crucial factor". They contacted Dr Bose, who carried out a consultation via email.

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Three weeks ago they flew to India; a day later Mrs. Auchterlonie entered the overseas patients' ward of the Apollo Hospital to undergo treatment. On arrival, she was screened to see if she carried the super bug MRSA a procedure that will not be introduced into the NHS until next year. Her husband said: "From the moment we got there we were impressed. "The ward was newly built and dedicated to overseas patients. The room was cleaned from top to bottom twice a day, and whenever the doctors and nurses went near Mary they always used the hand scrubs. "The care from doctors and nurses was incredible, added Mrs. Auchterlonie. "They really couldn't do enough. We met the consultant every day, and the nurses would flock around you checking everything was all right." With flights taken care of via Air Miles, collected via years of business travel, the healthcare bill facing the couple was 4,000 a third of the price offered in the UK by those few private hospitals offering the treatment. On top of that, the couple spent 700 on a week's stay recuperating in a luxury resort. Back home in Fife two weeks later, the couple have no regrets. Mrs. Auchterlonie would recommend medical treatment abroad to anyone prepared to do their homework. But she issued one word of warning: "People get misled by the idea of medical tourism. "We stayed in a lovely resort after the operation, but this is major surgery, not a holiday."

Case 3: Barry Peters 'I was in a lot of pain' Barry Peters would have had to endure up to eight months of worsening pain if he had waited for a hip replacement on the NHS. Had he chosen to go private, Mr. Peters, 60, a

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chauffeur from Weybridge in Sudney, would still have faced a month-long wait, as well as a 10,500 bill. But within two weeks of contacting a health tourism agency, he was in a hospital bed being prepared for surgery at the TATA MEMORIAL Hospital, for a fraction of the cost. Mr. Peters said: "I was in a lot of discomfort and pain and I really didn't want to wait that long for the operation. It was astonishing how quickly things moved when I decided to go overseas, compared with how long I would have had to wait in Britain. I arrived in Mumbai and within three hours I had all the tests and results and two days later I had the operation." Mr. Peters contrasted the standard of care he received in India with the cursory examination he got from his NHS consultant. "The staff in Mumbai could not do enough for me, from the doctors to the nurses and cleaners. They are dripping with staff, because wages are cheap I guess, and that's reflected in the level of service. And I had no fears about MRSA which is always at the back of your mind when you set foot inside a British hospital. The Apollo is cleaned twice a day and they just don't seem to have MRSA out there because of that." Mr. Peters paid 3,500 for his return flight to Mumbai , medical care, nine nights at the hospital and five days recuperating at a five-star hotel. The package was arranged by the Taj Medical Group. He said: "I feel absolutely fine now and have no problems walking, apart from having to lose a bit of weight. I'm very pleased I did it."

Case 4: Felipe Lpez Nadal, Spain, When I had the heart attack in India a year ago, little did I know that it would be the best place to have it ! Firstly, from a professional standpoint. It is clear from the way I feel 65

today that you did a first class job, but I have consulted with cardiologists here in Spain and their verdict is unanimous: they could not have done a better job ! Secondly, and even more importantly, from a human perspective. The love and care I received during my hospital stay will never be forgotten. These days, that type of nurturing is difficult to find in European hospitals, and I feel honoured and very lucky to have had the chance to experience it in Jaslok Hospital in Mumbai. For these two crucial reasons I thank you, Dr. Seth, and convey my heartfelt gratitude to all those who made my stay in hospital, odd as it may seem, a most pleasant one.

An article from 'Hindustan Times' dated Feb 16, 2007. Americans flock to India for treatment
Robert Walter Beeney was unable to walk due to a stiff hip when he landed in India January 24. Twenty days later, he not only recovered after a rare hip replacement surgery at Apollo Hospital here but also visited the famous Taj Mahal in Agra after that. The 64-year-old real estate consultant from San Francisco underwent successful surface replacement surgery using the anatomic surface replacement (ASR) hip system January 27, reportedly becoming the first US national to come to India for the treatment. Another patient from Florida will be landing in Chennai for a similar procedure at the Apollo Hospital there later this week.

A team of doctors, led by orthopaedic surgeon Vijay Bose, carried out the procedure for Beeney. Jayaramchander Pingle, a member of the medical team, told a news conference on Tuesday that while in the conventional hip replacement 66

surgery, the total hip was replaced, in the new system, the patient's original head and neck of femur were preserved and only their surface is replaced with metal on metal articulation. With the use of very advanced metallurgy in this device, the wear and tear is reduced to a fraction in the artificial joint as opposed to the conventional total hip replacement. Another advantage of the latest procedure is that in the event of any problem that may occur in the long term, the conventional total hip replacement can be done at a later stage. Beeney, who came to know about the procedure in India through the Internet, said that since this was not yet cleared by the US Food and Drug Administration, he decided to come to India. "This is despite the fact that the device that is fixed in the hip is made in the US," he said. He also had other options like going to Britain or Belgium for treatment. "But I preferred India as the treatment costs there are huge," he said. The treatment in India cost him $6,600 (Rs 300,000) while the same as a part of clinical trial in US would have cost $24,000. Even in Britain, where this procedure was first developed a few years ago, it would have cost 12,000 pounds. ...

CHAPTER XII
RECOMMENDATIONS AND SUGGESTIONS

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Future positive outlook How can the trend be further encouraged?

The medical tourism industry in India is presently earning revenues of $333 million. Encouraged by the incredible pace of growth exhibited by the industry, the Confederation of Indian Industry (CII) and McKinsey have predicted that the industry will grow to earn additional revenue of $2.2 billion by 2012. With a view to facilitating the medical tourism industry to achieve the targets and to give greater momentum for its growth, the Ministry of Health and Family Welfare together with the Ministry of Tourism of the Government of India has set up a Task Force. The Task Force will evaluate the opportunities in the industry and formulate a policy for accrediting healthcare institutions in the country. The accreditation program is aimed at classifying health service providers on the basis of infrastructure and quality of services offered. It is expected to standardize procedures and facilitate foreign patients in selecting the best hospitals. Meanwhile, several hospitals in the country are seeking to take advantage of the booming medical tourism industry. They are investing largely in acquiring equipments, size and skills. To provide for brighter prospects for the industry, the hospitals can also acquire international accreditation, integrate traditional and clinical treatments and offer end-to-end value added services by tying up with tour operators, airline carriers and hotel companies. Hospitals can also

sallow foreign patients to pay through credit and ensure proper support services to foreign patients after they return to their native countries.

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Lastly, the Government of India can also reinforce its support through quick visa processing, improved flight connectivity and infrastructure development. The Indian laws governing to organ transplantation and many other treatments have to be more transparent and should be in place to further encourage medical tourism. More authentic information should be provided through various medias like internet which his one of the main media for promoting medical tourism. Various committees like that of the professionals, specialists doctors, etc should be formed.

CONCLUSION

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Medical tourism is the next best thing for India. According to the CII Mackinsey report, Medical Tourism in India is expected to bring revenue of over $2 billion by 2012.The object is to capitalize the low cost advantage and to attract medical tourist by providing attractive packages. Indian tourism Industry should work more in collaboration with the Government department in order to implement the concept-"Atithi devo Bhavo" (a guest is a form of God) as major marketing mantras. Surely, the future for medical tourism is bright. If travel can provide good health without making holes in the pockets, then nothing is better than medical tourism.

BIBLIOGRAPHY

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 THE HINDUSTAN TIMES TIMES OF INDIA MARKETING MASTERMIND BOOK CASE STUDY FOLIO

WEBLIOGRAPHY
www.tourismindiaonline.com www.neoncarrot.co.uk www.wttc.org www.tourismofindia.com http://www.consultavalon.com http://www.indiafirstfoundation.org http://www.bseindia.com http://www.medicaltourismindia.com/ http://www.medical-tourism-india.com/ http://en.wikipedia.org/wiki/Medical_tourism http://www.medical-tourism-india.com/ http://www.indiaprofile.com/medicaltourism/index.html http://www.health-tourism-india.com/

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