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  • 1. Medical Tourism in IndiaIntroductionThe medical faculty of India in collaboration with the tourism industry has worked together toprovide cost-effective treatment to people across the globe. With the privatization of medicalcare in India evolved the recent and popular trend of treatment along with the fun of a vacation,better known as medical tourism in India.India best known as a tourists paradise offers a choice of beaches, majestic palaces, refreshinghill stations and more. With the new trend of medical tourism in India, now vacationers canenjoy a rejuvenating holiday and also avail of world-class medical treatment of different sorts.Attractions in IndiaIndia is a land is assorted beauties. The golden sands and palm fringed beaches of Goa, themagnificent monuments and architectural beauties like the Taj Mahal, Red Fort, misty hillstations like Manali, Kulu, Shimla, are significant tourist attractions and numerous tourists visitIndia from different parts of the world.HospitalsAmong some of the leading Hospitals that offer medical tourism in India is the group ofhospitals. The hospital promises exceptional medical facilities along with special care andconcern.Facilities/Treatments available in IndiaAlong with a choice of tourist places, India offers a range of outstanding medical facilities likeCardiology and Cardiothoracic Surgery, Joint Replacement, Oorthopedic Surgery,Gastroenterology, Ophthalmology, Transplants and Urology. The Hospitals also provide serviceslike Neurology, Neurosurgery, Oncology, Ophthalmology, Rheumatology, Endocrinology, ENT,Pediatrics, Pediatric Surgery, Pediatric Neurology, Urology, Nephrology, Dermatology,Dentistry, Plastic Surgery, Gynecology, Psychiatry, General Medicine and General Surgery.Other services like General Radiography, Ultra Sonography, Mammography and Angiographyare also providedHistoryThe first recorded instance of medical tourism dates back thousands of years towhen Greek pilgrims traveled from all over the Mediterranean to the small territory inthe Saronic Gulf called Epidauria. This territory was the sanctuary of the healing god Asklepios.Epidauria became the original travel destination for medical tourism.Spatowns and sanitariums may be considered an early form of medical tourism. In eighteenthcentury England, for example, patients visited spas because they were places with supposedlyhealth-giving mineral waters, treating diseases from gout to liver disorders and bronchitis.
  • 2. DescriptionFactors that have led to the increasing popularity of medical travel include the high cost of healthcare, long wait times for certain procedures, the ease and affordability of international travel, andimprovements in both technology and standards of care in many countries. The avoidance ofwaiting times is the leading factor for medical tourism from the UK, whereas in the US, the mainreason is cheaper prices abroad. In 2009, there were 60,000 patients going for treatment abroadin the UK.Many surgery procedures performed in medical tourism destinations cost a fraction of the pricethey do in the First World. For example a liver transplant that costs $300,000 USD in Americacosts about $91,000 USD in Taiwan. A large draw to medical travel is convenience and speed.Countries that operate public health-care systems are often so taxed that it can take considerabletime to get non-urgent medical care. Using Canada as an example, an estimated 782,936Canadians spent time on medical waiting lists in 2005, waiting an average of 9.4 weeks. Canadahas set waiting-time benchmarks, e. g. 26 weeks for a hip replacement and 16 weeks for cataractsurgery, for non-urgent medical procedures.Medical tourists come from a variety of locations including Europe, the Middle East, Japan, theUnited States, and Canada. Factors that drive demand for medical services abroad in First Worldcountries include: large populations, comparatively high wealth, the high expense of health careor lack of health care options locally, and increasingly high expectations of their populationswith respect to health care.In First World countries like the United States medical tourism has large growth prospects andpotentially destabilizing implications. A forecast by Deloitte Consulting published in August2008 projected that medical tourism originating in the US could jump by a factor of ten over thenext decade. An estimated 750,000 Americans went abroad for health care in 2007, and thereport estimated that 1.5 million would seek health care outside the US in 2008. The growth inmedical tourism has the potential to cost US health care providers billions of dollars in lostrevenue.An authority at the Harvard Business School recently stated that "medical tourism is promotedmuch more heavily in the United Kingdom than in the United States".Additionally, some patientsin some First World countries are finding that insurance either does not cover orthopedic surgery(such as knee/hip replacement) or limits the choice of the facility, surgeon, or prosthetics to beused. Medical tourism for knee/hip replacements has emerged as one of the more widelyaccepted procedures because of the lower cost and minimal difficulties associated with thetraveling to/from the surgery.Popular medical travel worldwide destinationsinclude: Argentina, Brunei, Cuba, Colombia, Costa Rica, HongKong, Hungary, India, Jordan, Lithuania, Malaysia, The Philippines, Singapore, SouthAfrica, Thailand, and recently, Saudi Arabia, UAE, South Korea, Tunisia, Ukraine, and NewZealand.Popular cosmetic surgery travel destinations
  • 3. include: Argentina, Bolivia, Brazil, Colombia, CostaRica, Cuba,Mexico, Turkey, Thailand and Ukraine. In South America, countries such asArgentina, Bolivia, Brazil and Colombia lead on plastic surgery medical skills relying on theirexperienced plastic surgeons. In Bolivia and Colombia, plastic surgery has also become quitecommon. According to the "Sociedad Boliviana de Cirugia Plastica y Reconstructiva", more than70% of middle and upper class women in the country have had some form of plastic surgery.Colombia also provides advanced care in cardiovascular and transplant surgery.In Europe Belgium, Poland, Slovakia, and Ukraine are also breaking into the business. SouthAfrica is taking the term "medical tourism" very literally by promoting their "medical safaris".A specialized subset of medical tourism is reproductive tourism and reproductive outsourcing,which is the practice of traveling abroad to undergo in-vitro fertilization, surrogatepregnancy and other assisted reproductive technology treatments including freezing embryos forretro-production.However, perceptions of medical tourism are not always positive. In places like the US, whichhas high standards of quality, medical tourism is viewed as risky. In some parts of the world,wider political issues can influence where medical tourists will choose to seek out health care.Health tourism providers have developed as intermediaries to unite potential medical touristswith provider hospitals and other organisations. Companies are beginning to offer global healthcare options that will enable North American and European patients to access world health careat a fraction of the cost of domestic care. Companies that focus on medical value travel typicallyprovide nurse case managers to assist patients with pre- and post-travel medical issues. They alsohelp provide resources for follow-up care upon the patients return.ProcessThe typical process is as follows: the person seeking medical treatment abroad contactsa medical tourism provider. The provider usually requires the patient to provide a medical report,including the nature of ailment, local doctor’s opinion, medical history, and diagnosis, and mayrequest additional information. Certified physicians or consultants then advise on the medicaltreatment. The approximate expenditure, choice of hospitals and tourist destinations, andduration of stay, etc., is discussed. After signing consent bonds and agreements, the patient isgiven 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 caseexecutive, who takes care of the patients accommodation, treatment and any other form of care.Once the treatment is done, the patient can remain in the tourist destination or return home.Risks
  • 4. Some countries, such as India, Malaysia, or Thailand have very different infectious disease-related epidemiology to Europe and North America. Exposure to diseases without having builtup natural immunity can be a hazard for weakened individuals, specifically with respect togastrointestinal diseases (e.g. Hepatitis A, amoebic dysentery,paratyphoid) which could weakenprogress and expose the patient to mosquito-transmitted diseases, influenza, and tuberculosis.However, because in poor tropical nations diseases run the gamut, doctors seem to be more opento the possibility of considering any infectious disease, including HIV, TB, and typhoid, whilethere are cases in the West where patients were consistently misdiagnosed for years because suchdiseases are perceived to be "rare" in the West.The quality of post-operative care can also vary dramatically, depending on the hospital andcountry, and may be different from US or European standards. Also, traveling long distancessoon after surgery can increase the risk of complications. Long flights and decreased mobilityassociated with window seats can predispose one towards developing deep vein thrombosis andpotentially a pulmonary embolism.[24] Other vacation activities can be problematic as well — forexample, scars may become darker and more noticeable if they sunburn while healing. Also, health facilities treating medical tourists may lack an adequate complaints policy to dealappropriately and fairly with complaints made by dissatisfied patients. Differences in healthcare provider standards around the world have been recognized bythe World Health Organization, and in 2004 it launched the World Alliance for Patient Safety.This body assists hospitals and government around the world in setting patient safety policy andpractices that can become particularly relevant when providing medical tourism services. If there are complications, the patient may need to stay in the foreign country for longer thanplanned or if they have returned home, will not have easy access for follow up care.Legal issuesReceiving medical care abroad may subject medical tourists to unfamiliar legal issues.[29] Thelimited nature oflitigation in various countries is one reason for the lower cost of care overseas.While some countries currently presenting themselves as attractive medical tourism destinationsprovide some form of legal remedies for medical malpractice, these legal avenues may beunappealing to the medical tourist. Should problems arise, patients might not be covered byadequate personal insurance or might be unable to seek compensation via malpracticelawsuits.Hospitals and/or doctors in some countries may be unable to pay the financial damages awardedby a court to a patient who has sued them, owing to the hospital and/or the doctor not possessingappropriate insurance cover and/or medical indemnity.[30]Ethical issue
  • 5. There can be major ethical issues around medical tourism.[29] For example, the illegal purchaseof organs and tissues for transplantation had been alleged in countries such as India[31][32] andChina[33] prior to 2007. TheDeclaration of Istanbul distinguishes between ethically problematic"transplant tourism" and "travel for transplantation".Medical tourism may raise broader ethicalissues for the countries in which it is promoted. For example in India, some argue that a "policyof medical tourism for the classes and health missions for the masses will lead to a deepening ofthe inequities" already embedded in the health care system.[35] In Thailand, in 2008 it was statedthat, "Doctors in Thailand have become so busy with foreigners that Thai patients are havingtrouble getting care"..Medical tourism centred on new technologies, such as stem cell treatments,is often criticized on grounds of fraud, blatant lack of scientific rationale and patient safety.However, when pioneering advanced technologies, such as providing unproven therapies topatients outside of regular clinical trials, it is often challenging to differentiate betweenacceptable medical innovation and unacceptable patient exploitation. Some US employers havebegun exploring medical travel programs as a way to cut employee health care costs. Suchproposals have raised stormy debates between employers and trade unions representing workers,with one union stating that it deplored the "shocking new approach" of offering employeesoverseas treatment in return for a share of the companys savings. The unions also raise the issuesof legal liability should something go wrong, and potential job losses in the US health careindustry if treatment is outsourced.Employers may offer incentives such as paying for air travel and waiving out-of-pocket expensesfor care outside of the US. For example, in January 2008, Hannaford Bros., a supermarket chainbased in Maine, began paying the entire medical bill for employees to travel to Singapore for hipand knee replacements, including travel for the patient and companion. Medical travel packagescan integrate with all types of health insurance, including limited benefit plans, preferredprovider organizations and high deductible health plans.In 2000 Blue Shield of California began the United States first cross border health plan. Patientsin California could travel to one of the three certified hospitals in Mexico for treatment underCalifornia Blue Shield.[42] In 2007, a subsidiary of BlueCross BlueShield of South Carolina,Companion Global Healthcare, teamed up with hospitals in Thailand, Singapore, Turkey,Ireland, Costa Rica and India.[43] A 2008 article in Fast Company discusses the globalization ofhealthcare and describes how various players in the US healthcare market have begun to exploreit.Traveling for medical management in another country for better technology, services andstandard, saving cost, availability and other reasons is medical tourism. Millions of patients
  • 6. worldwide visit hospitals and clinics each year in countries other than their own. India alonereceived 4,50,000 patients in 2007 and they paid just 20% of what hey would have paid in USA.Destination countries can be any one but India, Thailand, Singapore, Malaysia, Philippines,Turkey Belgium, Hungary, South Korea Brazil, Costa Rica, Panama, Mexico, USA are leadingone.You might go for medical tourism if -1. You want to save up to 90% on world class medical treatment.2. Insurance cover for you does not exist or is unknot sufficient.3. Procedure advised to you is not offered in your country.4.Insurance company does no cover procedure you plan to undergo.Benefits1. Cost savings. The single biggest reason people travel to other countries for medical treatment is theopportunity to save money. Depending upon the country and type of treatment, uninsured andunderinsured patients, as well as those seeking elective care, can realize 15 to 85 percent savingsover the cost of treatment in the United States. Or, as one successful health traveler put it, "I tookout my credit card instead of a second mortgage on my home." As baby boomers become seniorboomers, costs of healthcare and prescriptions are devouring nearly 30 percent of retirement andpre-retirement incomes. With the word getting out about top-quality treatments at deep discountsoverseas, informed patients are finding creative alternatives abroad. Airfare and lodging costs aregoverned by individual preferences. To compute a ballpark estimate of total costs, add $5,000 tothe amounts shown in the table for you and a companion, figuring coach airfare and hotel roomsaveraging $150 per night. For example, a hip replacement in Delhi, India, would cost about$10,000, for an estimated savings of at least $20,000 compared with the U.S. price. Theestimates above are for treatments alone. Airfare, hospital stay (if any), and lodging varyconsiderably. Savings on dentistry become more dramatic when "big mouth-work" is required,
  • 7. involving several teeth or full restorations. Savings of $15,000 or more are common.2. Better-quality care. Governments of countries such as India and Thailand have poured billions of dollarsinto improving their healthcare systems, which are now aggressively catering to the internationalhealth traveler. VIP waiting lounges, deluxe hospital suites, and staffed recuperation resorts arecommon amenities, along with free transportation to and from airports, low-cost meal plans forcompanions, and discounted hotels affiliated with the hospital. Moreover, physicians and staff intreatment centers abroad are often far more accessible than their U.S. counterparts3. Excluded treatments. Although health insurance policies vary according to the underwriter and individual,your plan probably excludes a variety of treatments, such as cosmetic surgeries, dental care,vision treatments, reproductive/infertility procedures, certain no emergency cardiovascular andorthopedic surgeries, weight loss programs, substance abuse rehabilitation, and prosthetics—toname only a few. Even the most robust health insurance plans exclude a variety of conditionsand treatments. You, the policyholder, must pay these expenses out of pocket. In addition, manypolicies place restrictions on prescriptions (some quite expensive), postoperative care, congenitaldisorders, and pre-existing conditions. Rich or cash-challenged, young or not-so-young, heavilyor only lightly insured, folks who get sick or desire a treatment (even one recommended by theirphysician) often find their insurance wont cover it. Confronting increasingly expensive choicesat home, nearly 40 percent of American health travelers hit the road for elective treatments. Incountries such as India, Singapore, Dubai, and Thailand, this trend has spawned entire industries,offering excellent treatment and ancillary facilities at costs far lower than U.S. prices.4. Unique Procedures. Some procedures like orthopedic procedure known as hip resurfacing, a less expensivealternative to the traditional hip replacement still no practiced in the United States. While thisprocedure has been performed for more than a decade throughout Europe and Asia, it was onlyrecently approved in the United States, and its availability here remains spotty. Some proceduresand prescriptions are simply not allowed in your country. Either Government or the Food andDrug Administration has specifically disallowed a certain treatment, or perhaps its still in thetesting and clinical trials stage or was only recently approved. Such treatments are often offeredabroad. Hundreds of forward-thinking Americans, many having suffered years of chronic pain,have found relief in India, where hip resurfacing techniques, materials, and instrumentation havebeen perfected, and the procedure is routine.
  • 8. 5. No waiting. For decades, thousands of Canadian and British subscribers to universal, "free"healthcare plans have endured waits as long as two years for established procedures. "Some of usdie before we get to the operating table," commented one exasperated patient, who journeyed toIndia for an open-heart procedure. In the United States, long waits are a growing problem,particularly among war veterans covered under the Veterans Administration Act, for whom longqueues are becoming far too common. Some patients figure its better to pay out of pocket to getout of pain or to halt a deteriorating condition than to suffer the anxiety and frustration of waitingfor a far-future appointment and other medical uncertainties.6. Sufficient stay: Medical travelers will welcome the flexibility at the best hospitals abroad, where theyare often aggressively encouraged to spend extra time in the hospital post-procedure. Patient-to-staff ratios are usually lower abroad, as are hospital-borne infection rates. There is no push outpolicy in overseas hospital, patient remains in hospital as longs as necessary and for doctors andhospital.7. Attraction of the new and different. Although traveling abroad for medical care can be challenging, many patients welcomethe chance to blaze a trail, and they find the creature comforts often offered abroad a welcomerelief from the sterile, impersonal hospital environments so often encountered in U.S. treatmentcenters. For others, simply being in a new and interesting culture lends distraction to anotherwise worrisome, tedious process. And getting away from the myriad obligations of homeand professional life can yield healthful effects at a stressful time. Whats more, travel—andparticularly international travel—can be a life-changing experience. You might be humbled bythe limousine ride from Indira Gandhi International Airport to a hotel in central New Delhi orstruck by the simple, elegant graciousness of professionals and ordinary people in Thailand, orwowed by the sheer beauty of the mountain range outside a dental office window in Mexico. Asone veteran medical traveler put it, "I brought back far more from this trip than a new set ofteeth."
  • 9. History of Medical TourismMedical tourism is nothing new. The history of medical tourism cites that even in the early times,people have been traveling to other countries for health purposes. There were the ancient Greeksand Egyptians who went to hot springs and baths to improve their health as well as the 18th and19th century Europeans and Americans who flocked to health spas and sanitariums and even inremote places in the hope that they will get treatment for diseases such as tuberculosis, gout,bronchitis or liver diseases.The history of medical tourism dates back to its first recorded case when Greek pilgrims traveledfrom the Mediterranean to Epidauria, a small territory in the Saronic Gulf. It was said that thissmall territory was the sanctuary of Asklepios, known as the healing God. Thus, it was recordedin medical tourism history that Epidauria is the original destination for medical tourism.Medical Tourism StatisticsMore and more countries are becoming medical tourism destinations. Medical tourism statisticsrevealed an anticipated growth of the industry from about $40 billion in 2004 to $100 billion bythe year 2012. The estimate was made by the Confederation of India and the McKinseyCompany.Another report disclosed that an estimated 750,000 Americans seek treatment abroad in 2007. Itwas also estimated that a million and a half Americans sought healthcare outside the US in 2008.Almost a decade after it was originally envisioned as a major phenomenon, medical tourism inIndia is beginning to take off. More and more people across the globe are eschewing expensivetreatments or long waits at hospitals at home for the benefits offered by cheaper countries likeIndia, Thailand, Philippines and Singapore and combining a tummy tuck, say with a visit to theTaj Mahal or the beaches and misty mountains of Kerala.Although India had fallen behind other countries after the initial promise, two studies say healthtourism is projected to be the next big thing after Indias IT outsourcing boom. A 2009 report bythe Confederation of Industries (CII)-McKinsey forecasts that, medical tourism will generateUS$2.4 billion during 2009–2012 for India by attracting 1.1 million health tourists, up from150,000 in 2002.
  • 10. Though the Indian segment is still a sliver of the US$60-billion global medical tourism market,the consultancy firm Deloitte estimates the countrys business will grow at a robust clip of 27 percent each year. The reason for its attraction for Indian industry and tourism is not far to seek.According to the Ministry Of Tourism, as against an ordinary vacationer per-capita spend ofUS$3,000 per visitor, the average medical tourist in India puts out more than $7,000 per visitLeading Indian medical experts ascribe this exponential growth to demand. "With health carecosts going north," says Dr Alok Roy of Fortis Hospital, one of the leading service providers inthe medical tourism sector, "patients are compelled to look at cost-effective destinations formedical treatments. And what could be better if they can combine that with sightseeing at sceniclocations?"Delhi-based physian Narottam Puri believes the current expensive and overburdened health caresystem in the US is not sustainable due to a variety of factors."India, on the contrary," Puri says, "is a value-for-money destination for health care because weproduce over 30,000 new doctors each year combined with a diverse genetic pool for drugtesting."Ironically, despite Indias abysmal spend of 4.9 per cent of its GDP on healthcare -- as comparedto Americas 15.3 percent, Switzerlands 11.3 percent or Frances 11.1 percent – the country iswell poised to become a frontrunner in the global medical tourism market.For starters, Indias pricing of its medical services is lower than in comparable countries. Areport by the Planning Commission points out that while carry Joint Commission InternationalaccreditationSimilarly, heart valve replacement surgery for US$10,000 in Thailand, $12,500 in Singapore andUS$200,000 in the US can be carried out in India for $8,000. According to the AmericanMedical Association data, as against a charge of $5,000 for a spinal fusion in India, a patient willpay $62,000 in the US, $9,000 in Singapore and $7,000 in Thailand.India also offers an impressive scale and repertoire of treatments, qualified, English-speakingdoctors and a varied landscape in which medical tourists can recuperate – from the beaches ofGoa to the deserts of Rajasthan.
  • 11. "The essence of medical tourism is a combination of quality healthcare across a range ofdisciplines coupled with visits to scenic locations to recuperate or rejuvenate oneself," saysPradeep Thukral, Executive Director, Indian Medical Travel Association (IMTA) which workswith Indian hospitals and tourism bodies to promote health tourism.Experts say India also has a reputation for world-class expertise in cardiac care, cosmeticsurgery, joint replacements, neurological and orthopedic treatments and dentistry. "The capacityin super specialty segment Indian hospitals is expanding fast and – unlike the US or the UK --there is no waiting period for local or overseas patients," explains Dr. Roy.Infrastructure spending for health care has also surged. The private sector especially hasflourished, equipped with state-of-the-art technology. Top Indian corporate hospitals like Apollo,Fortis, Wockhardt, Max and Manipal have stepped in to provide quality healthcare andtechnology. A large number of new private specialty hospitals and integrated health citiescoming up in the top metropolitan areas are adding further heft to Indias medical tourismofferings.It is estimated that nearly 75 per cent of health care services and investments in India are nowprovided by the private sector. Coupled with this is the fact that India has perhaps one of thelargest pharmaceutical industries in the world which is not only self-sufficient in drug productionbut also exports them to over 180 countries at a fraction of the price of US pharmaceuticals.According to Vishal Bali, CEO, Wockhardt Group of Hospitals, Indian clinical and paramedicaltalent is globally accepted as high standard. Also, many hospitals now carry Joint CommissionInternational accreditation which puts them at par with the worlds best. "Third-party interventionthrough health insurance," adds Bali, "has also given Indian medical tourism a fillip."To tap the commercial potential, the Indian hospitality industry too is venturing into the market.Spas at star-rated hotels have jumped onto the wellness bandwagon to offer a smorgasbord oftraditional treatments like ayurvedic massages and recuperative therapies."Traditional Indian treatments cover every aspect of medicine at a reasonable cost. This providesthe perfect impetus for overseas patients to come to India," explains Dr Jairam Nair, DirectorSpas, Amatrra Spa, New Delhi. In addition to traditional medicine, adds Nair, India offers many
  • 12. more relaxing and rejuvenating treatment options like yoga, ayurveda, meditation andnaturopathic medicine.The Ministry of Tourisms Market Development Assistance scheme to cover Joint CommissionInternational and National Accreditation Board of Hospitals certified hospitals which have arigorous evaluation process has also helped bolster the wellness sector.The MDA scheme offsets overseas marketing costs for travel companies earning foreignexchange. By opening up the MDA, hospital groups will be made eligible for financialassistance, including publicity through printed material, travel and stay expenses for sales-cum-study tours and participation fees for trade fairs and exhibitions.The government is also lending support, investing about $6.5 billion in medical tourisminfrastructure over the next two years. India has also launched an accreditation program forsecondary and tertiary hospitals by the National Accreditation Board for Hospitals andHealthcare Providers, which works with qualified assessors to grant accreditation to hospitalsthrough a stringent evaluation process.The government has also been working towards providing priority medical visas for. "Howeverthe main bottleneck for medical tourists coming from the UK and US for major surgeries is thatthe insurance companies are not willing to cover treatment in India. Although this scenario ischanging, the process is painfully slow," said a joint secretary at the Ministry of Health.Travel companies are also liaising with hospitals to facilitate travel, arranging phoneconsultations with physicians in India to help the overseas patients save time and money oncethey get to India. Most Indian hospitals also allow the patients personal physicians to consultwith Indian doctors from overseas. Western patients usually get an all-inclusive package thatincludes flights, transfers, hotels, treatment and often a post-operative vacation.The tourism ministry is prompting all players to form a government-industry partnership on thelines of NASSCOM to strengthen the Indian healthcare brand overseas. Efforts will be made tolaunch uniform pricing bands and to combine medical packages with innovative travel products,according to Pradeep Thukral, executive director of the Indian Medical Travel Association.In fact to cater to the burgeoning demand, India is now diversifying into a new area of "medical
  • 13. outsourcing" where subcontractors provide services to the overburdened medical care systems inwestern countries. This initiative has the support of the National Health Policy which declaresthat treatment of foreign patients is legally an "export" and deemed "eligible for all fiscalincentives extended to export earnings.""However, the biggest challenge for India to emerge as a top medical tourism destination is onthe non-medical side," Thukral cautioned. "The marketing, the infrastructure and services tosupport the growth of medical tourism are still at a nascent stage in the country. Till that isshored up, India cant hope to be a frontrunner in the field."The History of Medical TourismLong before Americans stepped onto foreign soil for cardiac surgery, a tummy tuck or a dentaljob, medical travelers from around the world have been searching far and wide to seek the bestmedical services. One can say that the concept of medical travel is as old as medicine itself.Medical tourism history in fact dates back to ancient times.The following is a short excerpt into the colorful history of medical tourism. These time linesindicate that if ever healthcare is in short supply - wherever the location or whatever period intime it may be - sick and injured people will travel for healthcare.Medical Tourism History - Ancient TimesStudies of ancient cultures depict a strong link between religion and healthcare, which dates backthousands of years. Most ancient civilizations recognized the therapeutic effects of mineralthermal springs and sacred temple baths. The following are some of the earliest civilizations.The Sumerians (circa 4000 BC) constructed the earliest known health complexes that were builtaround hot springs. These healthcare facilities included majestic elevated temples with flowingpools.During the Bronze Age (circa 2000 BC), hill tribes in what is now known presently as St. Moritz,Switzerland recognized the health benefits in drinking and bathing in iron-rich mineral springs.The same bronze drinking cups that they used were found in thermal springs in France andGermany, which could signify health pilgrimages within these cultures.
  • 14. The Ancient Greeks were the first to lay a foundation for a comprehensive medical tourismnetwork. In honor of their god of medicine, Asclepius, the Greeks erected the Asclepia Temples,which became some of the worlds first health centers. People from all over, traveled to thesetemples to seek cures for their ailments.By the year 300 BC, other therapeutic temples flourished under the Greek domain. One facilitycalled the Epidaurus was the most famous and included services like a gymnasium, a snake farm,a dream temple, and thermal baths. Other temple spas included the Sanctuary of Zeus in Olympiaand the Temple of Delphi.In India, the history of medical tourism was also slowly unfolding with the popularity of yogaand Ayurvedic medicine. As early as 5000 years ago, constant streams of medical travelers andspiritual students flocked to India to seek the benefits of these alternative-healing methods.When Rome became a global power, several hot-water baths and springs called thermae cameinto existence and gained popularity among the elite. These baths were not only healthcarefacilities, but became commercial and social networking centers for the rich and the elite.Medical Tourism History - The Middle AgesWith the downfall of the Roman Civilization, Asia continued to be the prime medical tourismdestination for healthcare travelers. Temples gave way to hospitals that provide clinical servicesto travelers seeking healthcare. These institutions are chronicled in medical tourism history.In Medieval Japan, hot mineral springs called onsen became popular throughout the nation dueto their healing properties. The warrior clans soon took notice of these springs and began usingthem to alleviate pain, heal wounds, and recuperate from their battles.Many early Islamic cultures established health care systems that also catered for foreigners. In1248 AD, the Mansuri Hospital was built in Cairo and became the largest and most advancedhospital in the world of that time. With the capacity to accommodate 8,000 people, this hospitalbecame a healthcare destination for foreigners regardless of race or religion.History of Medical Tourism - The Renaissance Period
  • 15. The Renaissance Period of the 14th to 17th century, not only highlighted the rebirth of art andculture in Europe and England, but was also a period where medical tourism flourished.A village known as Ville dEaux or Town of Waters, became famous throughout Europe in 1326when iron-rich hot springs were discovered within the region. Prominent visitors like Peter theGreat and Victor Hugo visited these wellness resorts. The word ―spa‖, derived from the Romanterm ―salude per aqua‖ or health through waters, was first used here.During the 16th century, the rich and the elite of Europe rediscovered Roman baths and flockedto tourist towns with spas like St. Mortiz, Ville dEaux, Baden Baden, Aachen and Bath inEngland. Bath or Aquae Sulis enjoyed royal patronage and was famous throughout the knownworld. It became the center of fashionable wellness and became a playground for the rich andfamous.History of Medical Tourism - The Post-Renaissance PeriodTowards the end of the Renaissance period, aristocrats from around Europe continued to swarmto Bath for healing and therapeutic cleansing.In the 1720s, Bath became the first city in England to receive a covered sewage system and wasahead of London for several years. The city also received technological, financial, and socialbenefits. Roads were paved, streets had lights, hotels, and restaurants were beautified – allbecause of Medical Tourism.The most noteworthy traveler in the history of Medical Tourism was Michel Eyquem deMontaigne. He was the French inventor of the essay, and was believed to be the father of luxurytravel. He helped write the earliest documented spa guide in medical tourism history.The discovery of the New World brought new destinations for European medical travelers.During the 1600s, English and Dutch colonists started building log cabins near mineral springsrich with medicinal properties. During this time, it was noted that the Native Americans in theNew World were adept in the healing arts. Knowledge in herbal medicine was exceptional andrivalled those in Europe, Asia or Africa.During the 18th and 19th century, several Europeans and Americans continued to travel toremote areas with spas and health retreats hoping to cure various ailments like tuberculosis.Medical Tourism History from the 1900s to 1997
  • 16. During this time, the USA and Europe were not only the commercial and industrial centers, butthey were also the center of the healthcare world. Medical travel was limited to the affluent richwho traveled to these countries in order to receive high-end medical services.In 1933, the American Board of Medical Specialties (ABMS) was established and became theumbrella organization for the medical specialist boards in the United States. The ABMSestablished educational and professional policies, which became the blueprint of standardsaround the world.In 1958, the European Union of Medical Specialties (UEMS) was formed. The UEMS is madeup of different National Medical Associations from member nations of the European Unions.During the 1960s, India became a destination of choice for pilgrims when the New Agemovement began in the USA. The flower child movement, which drew the elite and socialites ofAmerica and the UK, eventually developed into a fully-fledged medical tourism industry, withyoga and Ayurvedic medicine rediscovered.With the cost of healthcare rising in the 1980s and 1990s, American patients started consideringoffshore options, like dental services in Central America. Whilst US doctors were appalled at theidea of seeking healthcare in foreign hospitals during these periods, Cuba started programs luringforeigners for eye surgeries, heart and cosmetic procedures.History of Medical Tourism from 1997 to 2001The Asian economic crisis in 1997 and the collapse of Asian currencies prompted governmentofficials in these nations to direct tourism efforts in marketing their countries as premieredestinations for international healthcare. Thailand quickly became the hub for plastic surgery,with fees charged at a fraction of what Western countries could offer.It was in 1997 that the Joint Commission International was formed to check and investigateinternational healthcare facilities for conformance to international standards due to theemergence of health providers around the world.Medical Tourism from 2001 to 2006After the events of 9/11 and the construction boom in Asia, medical tourism continued itsmassive growth with as many as 150,000 US Citizens traveling to destinations in Asia and Latin
  • 17. America in 2006. During this time, the dentistry and cosmetic surgery industries reached newheights in these countries.Thailand, Singapore and India became legitimate medical destinations due to JCI accreditation.Other Southeast Asian and Latin American countries are emerging as healthcare destinations aswell with JCI accreditation and partnerships with prominent US-based health providers.Medical Tourism in 2007 and BeyondThe number of American medical tourists increased to 300,000 in 2007, the largest ever inmedical tourism history. This figure is estimated to reach over a million by 2010, as patientscontinue to pack suitcases and board airplanes for offshore procedures such as: face-lifts, bypasssurgery or fertility treatments.In 2008, several healthcare and insurance companies in the United States considered medicaloutsourcing. These offered their members the possibility to get non-emergency procedures andsurgeries in other countries. Many are also considering foreign medical procedures as part of ahealth plan coverage.Medical Centers, Hospitals, Clinics, Doctors, Surgeons, Medical Tourism, AffordableHealthcare, Medical Spas, Alternaagent@tive Medicine, Cosmetic Surgery,Dental Treatment, Health Tourism, Global Health Destinations, Surgery Abroad, MedicalTravel, Wellness Vacation, Overseas OperationsSurgery AbroadAlternative Medicine Treatment Abroad Anti-Aging Treatment AbroadAyurveda Treatment Abroad Cancer Treatment AbroadChronic Diseases Treatment Abroad Cosmetic/Plastic Surgery Treatment AbroadDentistry Treatment Abroad Detox Treatment Abroad ENT Treatment AbroadExecutive Healthcheck Treatment Abroad Eye/Lasik Care Treatment AbroadFertility Treatment Abroad Gynecology Treatment AbroadHeart Care/Surgery Treatment Abroad Infertility IVF Treatment AbroadLaparoscopic Surgery Treatment Abroad Medical Spa Treatment AbroadNeurology Treatment Abroad Obesity/Bariatric Surgery Treatment Abroad
  • 18. Orthopedic/Knee Surgery Treatment Abroad Pediatric Treatment AbroadRehabilitation Treatment Abroad Skin Care Treatment Abroad Spine CareSurgery Treatment Abroad Sports Medicine Treatment Abroad Stem Cell Therapy TreatmentAbroadUrology Treatment Abroad Vascular Surgery Treatment Abroad Yoga/Meditation TreatmentAbroadCancer Treatment in Turkey, Fertility Treatment in Turkey, Heart Care/Surgery in Turkey,InfertilityVarious Competitors and participants in this market.Affordable Medical TourismServices: Staffing Services to Hospitals, Content Writing/PR for Hospitals, Hospital WebMarketing, Patient Counseling and Immigration Services, Travel/Tourism Services to Patients,Medical/Health Medical Tourism InsuranceWebsite URL: http://www.affordablemedicalto...Established Year (If Applicable):2009The MeditourServices: Patient Counseling and Immigration Services, Travel/Tourism Services to Patients,Medical/Health Medical Tourism InsuranceWebsite URL: http://www.themeditour.comPrime IndiaServices: Staffing Services to Hospitals, Hospital Web Marketing, Patient Counseling andImmigration Services, Travel/Tourism Services to PatientsPrimes has been successfully emerging in the industry making a remarkable development invarious fields like Jewellery, Tele Communication, BPO & Medical Tourism. Being a young,dynamic Institute we drive positive and remarkable success in every industry we progress. Wedeliver our services with out compromising on time and quality. We are proud to be the leadingInternational Patient Care Facilitator in building the worlds health care infrastructure and inproviding treatments for millions of people around the globe. As a learning organization we
  • 19. grow with our customer needs and love to take new challenges. Backed up with strong qualityprocesses and well trained efficient staffs, we align our strategies to achieve our business goals.A medical tourism facilitator company run by pioneers of Indian healthcare and hospitalityindustry. It provides high quality healthcare services, amiable hospitality, tourism services,rejuvenating wellness services and comfortable travel services to the international medicaltraveler to IndiaIndiSmile Medical NetworkServices: Patient Counseling and Immigration Services, Travel/Tourism Services to Patients,Medical/Health Medical Tourism InsuranceContact Email: abhilashaswarup@indismile.comWebsite URL: http://www.indismile-medical-n...Established Year (If Applicable):2009Indias largest network of hospitals under one roof, IndiSmile Medical Network has in it themaximum number of hospitals and other affiliates.UniHealth Consultancy Private LimitedServices: Staffing Services to Hospitals, Content Writing/PR for Hospitals, Hospital WebMarketing, Patient Counseling and Immigration Services, Travel/Tourism Services to Patients,Medical/Health Medical Tourism InsuranceContact Email: info@unihealthonline.comWebsite URL: http://www.unihealthonline.comEstablished Year (If Applicable):2009Modi Healthcare And Tourism CorporationServices: Staffing Services to Hospitals, Patient Counseling and Immigration Services,Travel/Tourism Services to PatientsContact Email: mhctc@rediffmail.comWebsite URL: http://www.mhctc.com
  • 20. Kanchanjunga HealthcareServices: Patient Counseling and Immigration ServicesContact Email: services4yourhealth@gmail.comEstablished Year (If Applicable):1998Location:2,Prabhat , Mulund -West , Mumbai , Maharashtra , India 400080Akshar Health Care Pvt. LtdServices: Staffing Services to Hospitals, Travel/Tourism Services to Patients, Medical/HealthMedical Tourism InsuranceContact Email: info@aksharmeditour.comWebsite URL: http://aksharmeditour.comLocation:A/2/804, Anmol Tower, , , Ahmedabad , Gujarat , India 380063India in Medical Tourism – SWOT Analysis
  • 21. Medical Tourism may be defined as the ―provision of cost-effective medical care with dueconsideration to quality in collaboration with tourism industry for foreign patients who need
  • 22. specialized treatment and surgery‖. Statistical data vindicate that in the year 2008-09 around 126million domestic trip has been made by Indians in order to get cure at different places of thecountry as a result of the lack of economic opportunity and poor health infrastructure in theirown home town and a sum of 23,000 crore rupees have been spend by them on such trips. Thiswaste of money can be stopped if initiatives in a positive manner are taken by the local and thestate level organizations and the Government itself. It has been seen that where internationaltourist are migrating into India for cheaper treatment and greener pastures , domestic migrationin India is a result of poor health infrastructure. in rural areas and small towns.The main reason for growing importance of medical tourism in India is the cost of medicaltreatment which iscomparatively 40% less, than offered by any other developed countries. Whereas a cardiacpatient has to payUS$ 40,000 - 60,000 in the United States,US$ 30,000 in Singapore,US$ 12,000 - 15,000 in Thailand for histreatment, the same treatment can be availed in India in only US$ 3,000 - 6,000 . At London oneis charged£350 for some tests which include blood tests, electro-cardiogram tests, chest X-Rays, lung testsand other testswhile in India same tests cost only US$ 84.A Magnetic Resonance Imaging (MRI) scan costsUS$ 60 at EscortsHospital in Delhi, compared with roughly US$ 700 in New York.When India is compared with Thailand it is found that India is comparatively very cost effectiveratherthan Thailand in case of medical treatment. It is clear from the following Table:-Table -ITreatment Cost In India (In US$) Cost In Thailand(In US$)Bone Marrow Transplant US$ 30000 US$ 62500Liver Transplant US$ 40000 US$ 75000
  • 23. Open Heart Surgery(CABG) US$ 4400 US$ 14250Hip Replacement US$ 4500 US$ 6900Knee Surgery US$ 4500 US$ 7000Hysterectomy US$ 511 US$ 2012Gall Bladder removal US$ 555 US$ 1755This segment of tourism is increasingly gaining importance and attracting several largecorporations, such as pharmaceuticals and industrial companies, and several NRIs and foreigninvestors to invest money in setting up super-specialty hospitals in India such as Apollo,Medinova, CDR, Mediciti in Hyderabad; Hindujas and Wockhardt in Mumbai; Max, Escorts,and Apollo in Delhi etc. These hospitals are well equipped with those new machineries andtechnologies, which are required by the medical professionals to tackle the serious diseases, andare capable to cater the needs of aristocrats and as well as of the budgetary class.A Tourist whois coming to indulge/ lure himself in a healthy and pure atmoshphere, to learn the art of yoga andmeditations, to rejuvenate oneself at the spas, or for maintaining their looks by travelling toCosmeticSurgery Clinics ,will be considered as a medical tourist. It is not necessary that they should comefor any surgery or treatment to be count as the medical tourist.For example, going to China to gettreated of backache with acupuncture and acupressure is the example of former travelling toKerala for ayurvedic treatment for entire body.Specific Tour Packages For Medical Tourist InIndiaIndian Government is launching various schemes and programmes to promote healthtourism and inviting foreign and private investors to invest in hospitals and accommodationsector. According to a study 75-80% of health care services and investments in India are nowprovided by the private sector. India is granting various incentives and tax rebate to variouspharmaceuticals industries to provide medicines, surgicalequipments, and other medicalfacilities. Various specific tour packages available to medical tourist are as follows:-1) Bone Marrow Transplant2) Brain Surgery3) Cancer Procedures (Oncology) and Cardiac Care4) Cosmetic Surgery5) Dialysis and Kidney Transplant6) Drug Rehabilitation7) Gynaecology & Obstetrics
  • 24. 8) Health Checkups9) Internal/Digestive Procedures10) Joint Replacement Surgery11) Nuclear Medicine, Neurosurgery & Trauma Surgery12) Osteoporosis, Urology and Vascular Surgery13) Gall Bladder stones surgery and Hernia surgery14)Laparoscopic Appendicectomy,15) Laparoscopic Banding of stomach for Morbid Obesity and others16) Hip-Knee replacement surgeries and other orthopedic surgeries.17) Heart surgery packages like Cardiac Surgery and Cardiology, Open Heart Surgery,Angiographies andAngioplasties.18) Treatments of different skin problems including skin graftingContribution of Medical Tourism in the Indian EconomyMany hospitals in India are accredited by international institutions and are offering world-classtreatment at that cost which is comparatively 40-50% less than that of any European country.Acknowledging the significance of medical tourism in India, Government is trying to persuadethe international tourist traffic by offering medical visa. Generally a medical visa is valid for oneyear, or the period of treatment whichever is less. The period of medical visa can further beextended for one year with the permission of state government orFRROs, if prescribed by the specialized doctor/specialized hospital.India not only offers the medical treatment but also other rejuvenative services such as yoga,meditation, herbal therapies and other skin treatments which could upliftthe mood and enhancehealth of medical tourists. As a result India is receiving a huge number of international touristwho are coming to gain the rejuvenative benefits. In 2009,India has received a total of 180,000foreign health tourist. It is estimated that it will grow at a Compound Annual Growth Rate ofover 19% and will reach upto 1.3 million by 2013.Medical Tourism in India is playing a vital role in improving the economic and social status ofthe society. According to a study by McKinsey & Company and the confederation of IndianIndustry, India will receive $1 billion business by 2012, from medical tourism. Which is 1% ofthe total world-wide revenue. generated by medical tourism. The total revenue generated from
  • 25. medical tourism in the year 2004, worldwide was $40 billion which has increased upto $60billion in the year 2006. McKinsey& Company estimates that it will raise to $100 billion by theend of the year 2012.Table-2Revenue Generated Through Medical Tourism World-WideYear Revenue (In Billion US $)2004 :-402006 :-602008:- 802012 :-100Source:-www.health-tourism-india.comIndia is preferred as a health destination, mostly by those people who are living abroad and bythose foreigners who demand for speedy and in expensive treatment. Indian hospitals are nowwell equipped with skilled, trained and experienced doctors, who have good command onEnglish .Indian doctors treat twice number of patients, in comparison to doctors in the westernEuropean countries. India is considered as a safe place for medical treatment in comparison toother countries.Medical Tourism in India is on the peak. Now health tourist can avail every kindof medical facilities easily and conveniently. Various private investors and pharmaceuticalscompanies are coming forward to provide their services to the health tourist. Statistics vindicatethat by the end of the year 2012, India will receive around one million health tourist with acompound annual growth rate(CAGR) of 28.09% over the year 2007. In India a health tourist hasto spend less on different surgeries in comparison to other developed countries. It isTourism in India is flourishing and gaining a status of industry and contributing a lot towards therevenue generation and removing the problem of unemployment from the society. Today manystates of India like Kerala, Arunachal Pradesh, West Bengal, Uttarakhand, Tamil Nadu UttarPradesh, Dadar & Nagar Haveli, and UTs of Daman & Diu, has got a status of an industry. State
  • 26. governments are making provisions to include tourism in Schedule-I, of the IndustriesDevelopment Act 1951 to grant it the status of an industry and to promote accommodationsector, so that every segment of tourism industry including hotels throughout the country canavail various benefits under the Industrial Policy of the respective state governments like Landbanks for budget hotels, Exemption of duty on stamp paper, Exemption in VAT and Sales Tax,and Singlewindow clearance for new hotel projects etc.