What is Medical Tourism?

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. 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. The idea of the health holiday is to offer one an opportunity to get away from their daily routine and come into a different relaxing surrounding. Here one can enjoy being close to the beach and the mountains. At the same time one is able to receive an orientation that will help improve their life in terms of health and general well being. It is like rejuvenation and clean up process on all levels physical, mental and emotional. 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 or knee 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. As more and more patients from Europe, the US and other developed 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 lakhs per annum, the rapidly expanding Indian corporate hospital sector has been able to get a few thousands for treatment. But, things are going to change drastically in favour of India in years to come, 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.

Market Drivers

Why India? India has several advantages that make it a natural choice for Health treatment. Following are some of them:

Large pool of good doctors, nurses and paramedics World-class facilities Cost advantage during treatment as well as medication High brand value of leading Indian Health professionals across the globe Good English speaking population Vibrant Pharmaceutical industry India also has a huge resource for tourism that can convert it in to one of top destinations for tourism following the treatment. Some of them are: Cultural and religious diversity Centuries old vibrant civilisation Number of attractions ranging from wildlife to cultural heritage

Accreditations JCI Accreditation Joint Commission International (JCI) accreditation and certification is the proven process an organization needs to help ensure a safe environment for patients, staff and visitors. This voluntary process shows one organizations commitment to continuously improving patient safety. Benefits of JCI accreditation and certification: Improve public trust as an organization that values quality and patient safety

Involve patients and their families as partners in the care process Build a culture open to learning from adverse events and safety concerns Ensure a safe and efficient work environment that contributes to staff satisfaction Establish collaborative leadership that strives for excellence in quality and patient safety Understand how to continuously improve clinical care processes and outcomes

NABH Accreditation National Accreditation Board for Hospitals & Healthcare Providers (NABH) is a constituent board of Quality Council of India, set up to establish and operate accreditation programme for healthcare organizations.The board is structured to cater to much desired needs of the consumers and to set benchmarks for progress of health industry. NABH is an institutional member of the International Society for Quality in Health Care (ISQua).ISQua is an international body which grants approval to Accreditation Bodies in the area of healthcare as mark of equivalence of accreditation program of member countries. ISQua Accreditation of NABH Standard , India

International Society for Quality in Healthcare (ISQua) has accredited Standards for Hospitals developed by National Accreditation Board for Hospitals & Healthcare Providers (NABH, India). The approval of ISQua authenticates that NABH standards are in consonance with the global benchmarks set by ISQua. The hospitals accredited by NABH will have international recognition This will provide boost to medical tourism.India has many world class hospitals many are accredited by JCI, international agency and NABH reputed Indian accreditation institute. Following are some of the hospitals. JCI Accredited Indian Hospitals Sl No. 1 2 3 4 5 6 7 8 9 10 11 12 Name of Hospital Indraprastha Apollo Hospital Apollo Hospitals Apollo Hospitals Apollo Hospitals Apollo Gleneagles Hospital Wockhardt Hospital Wockhardt Hospital Asian Heart Institute Fortis Hospital Grewal Eye Institute Satguru Partap Singh Apollo Hospital Shroff Eye Hospital Location New Delhi Bangalore Chennai Hyderabad Kolkata Bangalore Mumbai Mumbai Mohali Chandigarh Punjab Mumbai

NABH Accredited Indian Hospitals Sl No. 1 2 3 4 5 6 7 8 9 Name of Hospital Max Super Speciality Hospital Max Devki Devi Heart & Vascular Institute Moolchand Hospital Escorts Heart Institute And Research Centre Sir Ganga Ram Hospital Dharamshila Hospital & Research Centre Chacha Nehru Bal Chikitsalaya Kailash Hospital & Heart Institute Fortis Hospital Location New Delhi New Delhi New Delhi New Delhi New Delhi Delhi New Delhi Noida Noida

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Narayana Hrudayalaya Sagar Hospitals Columbia Asia Medical Centre Hebbal Manipal Hospital Nethradhama Superspeciality Eye Hospital Advanced Medicare And Research Institute B.M. Birla Heart Research Centre Baby Memorial Hospital Mims Hospital (Mims Ltd.) Dr. L. H. Hiranandani Hospital Lakeshore Hospital & Research Centre Ltd. Medwin Hospitals Kerala Institute Of Medical Science Fortis Escorts Hospital Fortis Hospital Sevenhills Hospitals Ltd.

Bangalore Bangalore Bangalore Bangalore Bangalore Kolkata Kolkata Calicut Calicut Mumbai Kochi Hyderabad Thiruvananthapuram Jaipur Mohali Visakhapatnam

Cost effectiveness of treatment in India All values in USD Procedure Heart Bypass Angioplasty Hip Replacement Knee Replacement Spine Fusion Lap.Gastric Bypass Tummy Tuck Dental Implant Source:Yes Bank Collation USA 1,00,000 1,60,000 43,000 40,000 62,000 35,000 10,000 10,000 INDIA 7,200 7,000 7,100 8,500 7,500 9,200 4,500 1,500 THAILAND 11,000 10,000 12,000 10,000 8,500 10,200 5,500 2,000 SINGAPORE 16,500 15,000 9,200 11,000 10,000 11,500 6,550 2,400

All figures except FTA are in percentage

CLASSIFICATION OF FTAs IN INDIA ACCORDING TO PURPOSE OF VISIT,2010 Country of Nationality Foreign Business & Tourist Professional Arrivals (Numbers) Leisure, Holiday & Recreation Visiting Friends & Relatives Medical Treatment Others

North America Canada USA Total Central & South America Argentina Brazil Mexico Others Total Western Europe Austria Belgium Denmark Finland France Germany Greece Ireland Italy Netherlands Norway Portugal Spain Sweden Switzerland UK Others Total Eastern Europe Czech Rep. Hungary Kazakhstan Poland

242372 931292 1173664

13.0 19.1 18.1

18.0 13.1 13.8

49.8 47.1 47.5

0.4 0.2 0.3

18.8 20.5 20.3

7626 15219 10458 29425 62728

19.3 37.0 31.0 20.2 26.9

41.1 24.4 33.2 31.5 30.9

19.1 18.0 15.1 26.0 20.9

0.1 0.2 0.2 0.4 0.3

20.4 20.4 20.5 21.9 21.0

32620 37709 35541 24089 225232 227720 7441 20329 94100 70756 22229 21038 72591 45028 43134 759494 11291 1750342

26.2 28.6 29.6 27.3 20.9 35.5 22.4 27.5 33.9 34.2 27.9 12.4 25.4 27.3 22.6 16.3 23.3 22.4

30.5 24.8 41.5 47.3 30.1 27.8 34.7 28.6 32.9 27.7 31.1 26.8 33.3 42.1 37.0 26.7 33.4 29.0

21.3 27.5 13.5 8.4 25.7 16.7 13.1 26.2 13.2 20.5 21.1 39.1 21.8 15.0 20.6 37.0 16.4 28.6

0.6 0.1 0.2 0.1 0.2 0.5 0.3 0.1 0.2 0.2 0.5 0.3 0.2 0.3 0.5 0.2 0.3 0.2

21.5 19.0 15.2 17.0 23.1 19.5 29.5 17.6 19.8 17.4 19.3 21.4 19.3 15.3 19.2 19.8 26.6 19.9

9918 6022 8786 25424

39.2 32.2 7.0 23.9

29.9 35.1 66.2 45.6

15.3 15.7 5.0 12.9

0.2 0.3 1.0 0.2

15.4 16.6 20.7 17.5

Russian Fed. Ukraine Others Total Africa Egypt Kenya Mauritius Nigeria South Africa Sudan Tanzania Others Total West Asia Bahrain Iraq Israel Oman Saudi Arabia Turkey UAE Yemen Others Total South Asia Afganistan Iran Maldives Nepal Pakistan Bangladesh Sri Lanka Bhutan Total South East Asia Indonesia Malaysia Myanmar Philippines Singapore Thailand

122048 16462 38990 227650

5.5 13.6 26.6 11.1

69.1 37.2 34.6 59.5

3.5 9.2 14.8 6.5

0.4 0.9 0.5 0.5

21.5 39.1 23.6 22.5

8017 29223 21672 23893 55688 7418 17645 40969 204525

47.9 15.4 10.0 28.2 16.5 15.4 13.0 21.3 18.6

12.0 15.5 34.2 6.3 33.8 8.0 19.0 13.2 21.6

14.7 38.1 24.6 20.1 32.6 13.4 30.0 25.9 29.1

0.5 4.3 3.3 25.2 0.3 5.4 10.6 4.2 5.4

24.9 26.7 27.8 20.3 16.8 57.8 27.3 35.5 25.3

7766 28221 43456 35485 21599 15483 45482 14931 22894 235317

8.5 8.1 40.4 8.2 12.6 38.9 4.2 9.7 16.7 15.4

20.6 10.9 22.2 22.6 26.7 22.8 25.2 20.9 17.5 22.6

29.0 17.7 18.3 17.1 20.6 13.4 30.9 26.6 18.6 22.3

3.8 24.0 0.2 16.4 3.5 0.1 7.0 3.2 12.5 7.5

38.1 39.3 18.9 35.8 36.8 24.7 32.6 39.6 34.7 32.2

73389 49265 58152 104374 51739 431962 266515 12048 1047444

12.3 12.4 2.8 10.8 8.2 5.4 15.5 19.0 8.9

14.0 17.1 4.9 10.5 30.5 11.4 36.5 12.3 19.9

22.7 32.1 3.5 21.3 43.5 19.4 13.1 1.9 18.2

7.1 0.6 63.1 1.3 0.9 8.3 1.9 6.4 8.9

43.8 37.9 25.8 56.0 16.9 55.4 33.1 60.4 44.1

26171 179077 14719 24534 107487 76617

28.6 12.1 11.2 31.1 25.6 20.3

24.6 39.4 41.4 12.3 20.3 47.0

19.8 26.8 8.3 18.5 36.6 8.6

1.0 0.9 2.8 0.4 0.6 0.1

25.9 20.9 36.2 37.7 17.0 24.1

Vietnam Others Total East Asia China (Main) China (Taiwan) Japan Rep.of Korea Others Total Australasia Australia New Zealand Others Total

7458 2980 439043

31.8 28.5 18.7

28.6 32.6 33.7

11.6 11.3 24.8

0.1 0.1 0.7

27.9 27.5 22.1

119530 23915 168019 95587 4896 411947

60.0 41.1 56.9 43.1 14.2 53.0

10.6 33.0 19.2 19.9 17.6 17.5

11.1 11.2 9.8 12.4 16.1 11.1

0.1 0.0 0.1 0.1 1.3 0.1

18.2 14.7 14.0 24.5 50.9 18.4

169647 37024 3604 210275

20.3 17.4 13.6 19.7

24.4 20.8 18.3 23.7 14.2 16.2 24.0

39.4 43.8 37.1 40.1 4.9 20.8 27.5

0.2 0.2 5.2 0.3 0.1 0.0 2.7

15.7 17.9 25.8 16.3 77.8 41.5 27.2

Others 12087 3.0 Stateless 670 21.5 Grand Total 5775692 18.6 Source: India Tourism Statistics, 2010

The above table clearly reflects that 2.7% of the tourists who visited India in 2010 came for medical treatments and the most important source markets for the medical tourists emerges to be South Asia; where Maldives is the most important source country then followed by Africa where Nigeria is the most important source markets for health tourists followed by Iraq of West Asia. There is an urgent need to draw attention of people from Europe and America towards Health and Wellness Tourism facilities in India.

Medical Tourism Ecosystem

Global Market

Medical Tourism Impact on U.S

A McKinsey & Company report (2008) revealed that the core reasons for medical travel are those seeking:-

Best technology regardless of cost (est. 40%)This may include experimental, traditional or disallowed treatments (possibly IVF)- High quality and lower costs for medically necessary procedures/treatments (est.30%)

An uninsured or underinsured person may seek reasonable cost alternatives to the home country for selected treatments- Quick access to medical care (est. 15%)

Specific treatments are not available in the home country, or there is a significant waiting list for an elective procedure- Lower costs for discretionary medical care (est. 4%)this could include cosmetic surgery and wellness or spa treatments

Growth Barriers

Future Outlook In a Press Release by the Press Information Bureau (PIB) on November 15, 2010, the Union Ministry of Tourism has already included Medical Tourism segment under the Marketing Development Assistance (MDA) Scheme. Following this, the Ministry of Tourism has approved US$ 27,742 as MDA to 10 Medical Tourism Service Providers during current year. As stated in a report by RNCOS, 'Booming Medical Tourism in India', the countrys share in the international medical tourism business will be 3 per cent by the end of 2013 and is expected to generate revenue worth US$ 3 billion growing at a CAGR of around 26 per cent during 2011-2013. The number of medical tourists is anticipated to grow at a CAGR of over 19 per cent during the forecast period to reach 1.3 million by 2013. India has been ranked among the top five destinations for medical tourism," says Rana Kapoor, founder, managing director and CEO of Yes Bank, which has recently done a study on health and wellness tourism in India along with apex chamber of commerce FICCI. Yes Bank forecasts that there will be an increase in domestic tourist movements over the period (2008-2020) by 118% and foreign tourist inflows over the same period will increase by 71.87%. What the potential for medical tourism from within this growth rate of 71.87% will be depends upon government policies, faith of the patients and many other external factors. The domestic segment of the Indian medical tourism has also seen a growth in recent years with a

number of domestic tourists taking trips to states like Kerala, Karnataka, Himachal for 'health and medical' purposes. Further to promote more foreign tourists into the country on medical trips, the Government of India has introduced a new category of visa, "Medical Visa" ('M'-Visa), especially for foreign tourists coming into India for medical tourism. It is to be believed this sector will play a significant role as a contributor towards the overall tourism growth in India