This document discusses health tourism, including its origins thousands of years ago when people traveled to sites like Epidaurus and Bath for healing. It notes that in the 21st century, low-cost air travel has expanded health tourism globally. India has become a major destination for health tourism due to its high-quality yet affordable medical care and treatments that are often one-tenth the cost of Western countries. The document outlines India's advantages in health tourism and identifies challenges that still need to be addressed to further develop the industry.

1. HEALTH TOURISM

2. HEALTH TOURISM
PRAVEEN TAILOR
LECTURE IN BHAGWANT UNIVERSITY,BIJNOR

3. ORIGIN AND EVOLUTION OF
HEALTH TOURISM
Health tourism is actually thousands of years old.
In ancient Greece, pilgrims and patients came from all over the
Mediterranean to the sanctuary of the healing god, Asklepios, at
Epidaurus. In Roman Britain, patients took the waters at a shrine
at Bath, a practice that continued for 2,000 years..
From the 18th century wealthy Europeans travelled to spas from
Germany to the Nile. Since the early nineteenth century, when
there were no restrictions on travel in Europe, people visited
neighboring countries in order to improve their health.

4. PRESENT SCENARIO ALL OVER THE
WORLD
 In the 21st century, relatively low-cost jet travel has taken the
industry beyond the wealthy and desperate. Later, mostly
wealthy people began traveling to tourist destinations like the
Swiss lakes, the Alps and special tuberculosis sanatoriums,
where professional and often specialized medical care was
offered. In this century, however, medical tourism expanded to
a much larger scale.

5.  It was estimated that in 2002, six hundred thousand medical
tourists came to Bangkok and Phuket medical centers in
Thailand, while approximately one hundred and fifty thousand
foreign patients visited India during that time.
 From Neolithic and Bronze age wherein people used to visit
neighboring countries for Minerals and Hot Springs , Today
we have reached the era where Hospitals are more like Spas
and Spas more like hospitals.

7. Introduction of Health Tourism
 Connell (2006) describes Health tourism as a popular mass
culture where people travel to overseas countries to obtain
healthcare services and facilities such as medical, dental and
surgical care whilst having the opportunity to visit the tourist
spots of that country. Carrera and Bridges (2006) have defined
medical tourism as travel which is systematically planned to
maintain one’s physical and mental health condition

8.  According to GATS (General Agreement on Trade and
Services), Health tourism is the second mode of trade in
health services. In this mode, customers (patients) leave
their home country to obtain health care services with
high quality and affordable prices Blouin et al., (2006).
Monica (2007) has defined that medical tourism occurs
when international patients travel across boundaries for
their healthcare and medical needs. It can be 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.

9. Significance of Health Tourism
 Normally, the majority of medical tourists come from the
industrialized countries of the world especially Europe, the
UK, Middle East, Japan, U.S. and Canada where the cost of
medical treatment is very expensive and there are often long
waiting times for treatments.
 Other than India, countries that are currently promoting
medical tourism are Thailand, Malaysia, Singapore, South
Korea Bolivia, Brazil, Belgium, Cuba, Costa Rica, Hungary,
and Jordan. Private sector development in emerging
economies— such as India, Thailand, Singapore, and certain
Latin American nations—attracts foreign patients for relatively
cheaper care.

10. PROFILE OF MEDICAL TRAVELER
ACROSS THE GLOBE
• Better quality of care -32%
• Quicker access -15%
• Lower cost - 9%
• Most advanced technologies -40%
• Lower cost for discretionary procedures-4%

11. The Great Indian Advantage (U.S.P)

12. Quality and Range of Services
 India has number of hospitals offering world class treatments
in nearly every medical sector such as cardiology and
cardiothoracic surgery, joint replacement, orthopaedic surgery,
gastroenterology, ophthalmology, transplants and urology to
name a few.
 The various specialties covered are Neurology, Neurosurgery,
Oncology, Ophthalmology, Rheumatology, Endocrinology,
ENT, Paediatrics, Paediatric Surgery, Paediatric Neurology,
Urology, Nephrology, Dermatology, Dentistry, Plastic Surgery,
Gynaecology, Pulmonology, Psychiatry, General Medicine &
General Surgery. For its quality of services and the
infrastructure available, India is attracting a vast pool of
tourists from the middle east, Africa etc.

13. Manpower
 India has a large pool of doctors (approx 600000),
nurses & paramedics with required specialization and
expertise and the language advantage (English
speaking skills). The medical education system caters
to the ever increasing demand for the delivery of the
quality health care services all over the country.

14. The Price Advantage
 In India, complicated surgical procedures are being done
at 1/10th the cost as compare with the procedures in the
developed countries.
 Not only this, the hospitals are well equipped to handle
the data and information through computerized Hospital
Information Systems. USD.

15.  Approx Open Heart Surgery
• USD 18,000(US) (INDIA) USD 4,800
 Cranio-Facial surgery and skull base
• USD 13,000 (US) (INDIA) USD 4,500
 Neuro-surgery with Hypothermia
• USD 21,000 (US) (INDIA) USD 6,800
 Complex spine surgery with implants
• USD 13,000 (US) (INDIA) USD 4,600
 Simple Spine Surgery
• USD 6,500 (US) (INDIA) USD 2,300
 Simple Brain Tumor -Biopsy -Surgery
• USD 4,300 (US) (INDIA) USD 1,200

16. ATTRACTING TO HEALTH TOURISTS

17. Tourism Attraction
• India has a 5000 year old civilization and is known
for its cultural and religious diversity with diverse
geographical landmarks. The traditional arts and
crafts add to its appeal as a tourist’s favourate. Along
with this Indians enjoy freedom, vibrant democracy
and women empowerment

18. Alternative Therapy
 India offers not just treatment but spiritual and mental
healing as well. India needs to club together a couple
of 'pathies' because it has a very strong base of
alternative healing therapies like yoga, naturopathy,
ayurveda Kerala’s health retreats,etc.

19. THERAPIES IN KERELA

20. No Waiting
• 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.
• Hospitals now are starting to attract foreign patients
from industrialized countries, and especially from
Britain, U.S.A, Canada, where patients are becoming
fed up with long waits for elective surgery under
overstretched government health plans.

21. Industrial Analysis
• The Industry can be broadly classified into:
• The Alternative Therapy Service which is available
exclusively to India namely-:
• Yoga • Naturopathy • Ayurveda • Yunani Medicine •
Kerala Health Retreats • Meditation
• The Corporate Health care Services provided by
competent private hospitals like Apollo and Fortis

22. INTERNATIONAL AFFILIATIONS
 Apollo Hospitals is recognized as a training centre by the
National Board of Examination in India for post-graduate
training in 16 medical departments.
 The Department of Radiology at Apollo is recognized by the
Royal College of Radiologists, United Kingdom for training
for fellowship examinations .
 Apollo Hospitals is recognized by the Royal College of
Physicians and Surgeons in Edinburgh for training
postgraduates in radiology, surgery and trauma care.

23.  Apollo Hospitals is the only International training
organization for the American Heart Association
Technical support from Texas Heart institute and
Minneapolis Heart Institute for Cardiology and
Cardio Thoracic surgery.
 Apollo Hospitals has exchange programs with the
Hospitals in the US and Europe. ) Apollo Hospitals
have an association with Mayo Clinic & Cleveland
Heart Institute, USA. ) Apollo Hospitals is also
associated with Johns Hopkins University.

24. ISSUES AND CHALLENGES FOR HEALTH
TOURISM
The country like India is facing the following
issues/challenges to become a tourist destination with
competent medical tourism industry. They are:
1. Lack of infrastructural facilities like lack of
connectivity, lack of coordinating system, poor power
supply and poor water supply.
2. Most Indian hospitals are also facing the lack of trust
from the foreign patients. The hospitals have observed
poor hygiene awareness in medical attendants, unhygienic
food handling, and lack of proper hospitality services,
heterogeneous pricing of services and no industry
standards.

25. 3. The government can play a vital part to upgrade the medical
tourism sector. But the industry is facing the following
problems which are caused by the governments. They are:
(a) No regulations
(b) Taxation anomalies
(c ) Bureaucratic roadblocks
(d) No works on land reforms
(e) Lack of long-term investor friendly policies
(f) Instability with respect to terrorism and communal tensions.

26. 4. On the part of insurance and allied services, the medical
tourism industry in India is also facing some key bottlenecks.
They are:
(a) Inadequate insurance cover
(b) Underdeveloped insurance market in India
(c) Insurance frauds
(d) Overseas companies refusing reimbursement.

27. 5. The following challenges, due to the infrastructural parts in
medical tourism sector in India, are:
(a) Poor accessibility,
(b) Lack of capital,
(c) Lack of Community participation and awareness,
(d) Lack of involvement from rural sector
(e) Lack of concern for sustainability
(f) Complex visa procedures
(g) Lack of good language translators
(h) Poor airport facilities.

28. 6. Apart from these, there are some specific issues to promote
medical tourism in India. They are:
(a) Quality accreditations to the Indian hospitals and service
providers
(b) Training and Development to the Doctors, Nurses and Para
medical staffs
(c) Lack of customer oriented approach

29. DEVELOPING STRATEGIES ON INDIAN
HEALTH TOURISM
1. Product:
 India has a number of hospitals offering world class
treatments in nearly every medical sector such as
cardiology and cardiothoracic surgery, joint replacement,
orthopaedic surgery, gastroenterology, ophthalmology,
transplants and urology to name a few.
 The various specialties covered are Neurology,
Neurosurgery, Oncology, Ophthalmology,
Rheumatology, Endocrinology, ENT, Paediatrics,
Paediatric Surgery, Paediatric Neurology, Urology,
Nephrology, Dermatology, Dentistry, Plastic Surgery,
Gynaecology, Pulmonology, Psychiatry, General
Medicine & General Surgery etc.

30. 2. Price:
 India’s healthcare service providers have a
competitive advantage among their competitor due to
its high standard of medical treatments and services
offered to the patients at a very competitive price.
 In India, complicated medical procedures are being
done only at one tenth of the cost in industrialized
countries but in terms of infrastructure facilities such
as roads, sanitation, power backups, accommodations,
and public utility services much more is needed for
the country to become a medical tourism destination

31. 3. Place:
 Internet is the main means for disseminating information
related to medical and non-medical care services offered by
each of healthcare service providers.
 It is the most effective and inexpensive way to reach the
product to its target customers directly, and at the same time
helping patients acquire correct and valuable information
allowing them to make an informed decision.
 Informative online marketing of each service provider creates
awareness of the medical treatments available and reassures
potential patients

32.  Interactive communication, treatments description, description
of services and facilities, quality assurance other concierge
services were also presented on the websites to attract the
patient who are on medical traveling program.
 All the healthcare service providers generally take the help of
the agents the in promoting their medical tourism.
 These agents provide information and recommend the patients
regarding their treatments to the hospitals.

33. 4. Promotion:
 Most healthcare service providers in India particularly big
private hospitals participate in travel marts, travel fairs, trade
fair, exhibitions, seminars, conferences, and advertise in
travel magazines in countries with the supporting from the
government.
 In addition, other informative materials such as brochures,
booklets, video-aids, paper bags and t-shirt with logos were
also used to create awareness of the available healthcare
services as well.

34.  Moreover, some healthcare service providers in India build up
cooperation with the local institutes, universities, medical
schools in other countries to establish collaboration in
education, exchange of knowledge and training as well as to
promote their alternative healthcare services.
 Advertising about medical and non-medical services in both
local and international media are used by healthcare service
providers. Articles, video, news related to their high quality
and standard of medical treatments and services, health issues,
latest medical technology equipment, quality
assurance/awards/accreditation available on their own websites
and also to the international media

35. 5. People:
 Another strategy that Indian healthcare service providers may
use to attract the international patients for their low cost
treatments in India as well as to get the medical services by its
well-trained medical specialists who have qualified from well-
known overseas institutes.
 It is well acknowledged that having specialized and qualified
doctors and staffs gives a competitive advantage for the
hospitals.
 However, shortage of doctors and trained medical staff is
treated as the major concern in medical tourism in India.
Moreover, due to the misunderstanding of the patients’ culture
are still considered as problems and challenges for medical
tourism business in India.

36. 6. Process:
 International patients who seek medical treatments are mostly
concerned with the quality of treatments and also want that the
service providers preferably be accredited by a recognized
international organization that audits medical quality.
 India has a large pool of doctors (approx 6,00,000), nurses
and paramedics with required specialization and expertise and
the language advantage (English speaking skills). The medical
education system caters to the ever increasing demand for the
delivery of the quality health care services all over the country.
 The Joint Commission International (JCI) recognizes and
accredits that the standard of the hospital meets or exceeds the
standard of medical facilities as compared to the west. India is
a popular destination for medical tourists. (Iyer, M., 2004)

37. 7. Physical Evidence:
In India, big hospitals like Apollo Hospitals, Escorts Hospital,
Wockhardt Hospitals, Breach Candy Hospitals Lilavati
Hospital, Manipal Hospitals, Mallya Hospital, AMRI
Hospitals etc. have a good ambience in their infrastructures
with spacious, luxury rooms and excellent amenities same as
that of a five star hotel for patients and relatives, and also are
equipped with cutting-edge technology

38. Policy for India’s Services Sector By
Dr. H.A.C. Prasad and R. Sathish
Executive Summary and Conclusion
 Services sector is particularly important for India for various
reasons. The ratcheting up of the trend rate of GDP growth of
the economy reaching 9.4 per cent in 2006-07 was to a great
extent due to the ratcheting up of the trend growth rate in the
services sector of around 10 percent since 2004-05. Even in
2008-09 when GDP growth was relatively lower at 6.7 per
cent due to global recession, services growth was at 9.7 per
cent with its share in GDP at 57.3 per cent

39.  State wise growth rate of GSDP is also closely associated with
higher growth of tertiary sector. The primary importance of
services sector in the growth process of India and most of the
states of India has been strongly established in the last two
decades. India is also moving towards a services dominated
export growth. Even in 2008-09 when the merchandise export
sector was severely affected by the global recession, services
exports grew by a respectable 12.5 percent. The openness of
the Economy reflected by total trade including services as a
percentage of GDP shows a remarkable increase from 27.4
percent in 2000-01 to 52.1 percent in 2008-09.

40.  Some services have been particularly important for India.
Software is one sector in which India has a brand identity.
Tourism and travel related services and transport services are
also major items in India’s Services exports.
 Besides these, the potential services which are particularly
important for India include many professional services,
infrastructure related services and financial services. India also
has great potential to be a major outsourcing destination for
many services, though this prospect has been threatened by the
recent developments in US & EU limiting outsourcing.

41. Major Policy Issues
The major policy issues in the services sector are
1) the Domestic Policy Issues including FDI, Disinvestment,
Tariff &Tax Issues, Credit & Finance related issues and Other
Policy Issues – General & Sector Specific;
2)Domestic Regulations-Sector Specific and General;
3) Market Access Issues due to domestic regulations, subsidies
and other barriers; and
4) Other Issues like bilateral, regional and multilateral
negotiations and policies of multilateral institutions.

42. UTTARAKHAND IN HEALTH TOURISM

43. Major Achievements/Initiatives
 Tourism & Civil Aviation:- •Concept Note on Tehri Lake
Tourism Development Plan has been submitted to Planning
Commission.
 Developmentworkson02MegaCircuits( Nirmal Gangotri Mega
Circuit and Haridwar - Rishikesh- Muniki Reti–Swargasharm
Mega Circuit) are in progress.
 The MoUs with PPP Partners for 03rope ways(Jaankichatti-
Yamunotri, Kaddu Khal- Surkanda Devi&Thuligarh-
Punyagiri) have been signed.
 02Airportsand 06 Helipads are in progress.
 New Flights started for Lucknow, Thiruvananthapuram
&Proposed for Kathmandu.

44. KERALA HEALTH POLICIES

45. Vision
• Tourism becomes a vibrant and significant contributor to the
sustainable development of the state of Kerala.
Mission
• The state delivers a world-class, yet local visitor experience
• Tourism sector attracts investment, which will be sensitive to
the natural environment
• Communities benefit from tourism and value its contribution.
• Kerala is positioned as a visible global brand in tourism.
• Our market share is enhanced, within and outside India
• Kerala becomes a quality human resource provider in tourism
for the state and the country

46. Objectives
• To ensure quality visitor experience
• To focus on benefits for the community from tourism
• To create enabling environment for investment
• To market Kerala as a visible global brand in domestic and
international markets
• To develop quality human resources in tourism and hospitality

47. STATISTICS OF KERALA
• YEAR-2010
• Foreign tourists - 659265
• Foreign tourists arrival to India- 5583746
• % of foreign arrival - 11.81
• Domestic tourist arrival -8595075
• Foreign exchange earnings in tourism(Rs. in
billions)- 37.97
• Total earnings tourism (Rs. in billions)- 173.48

48. SUMMARY

49. ANY QUESTIONS

50. REFERENCES
• Grawhill publishers Services Marketing –Indian perspective
by Ravi shankar, Excel publishers Services Marketing-
Integrating customers across the world by Zeithaml, Bitner,
Tata Mc Services Marketing-People ,Technology,Stratgy by
Lovelock, Wirtz, Pearson Publications Travel & Tourism –
Cahllenges & Opportunities,Suresh,ICFAI press
• www.Zenithresearch.org.in
• Arnold Milstein and Mark Smith, “America’s New
Refugees — Seeking Affordable Surgery Offshore,” New
England Journal of Medicine, Vol. 355, No. 16, October 19,
(2006). Arnold Milstein and Mark Smith, “Will the Surgical
World Become Flat?” Health Affairs, Vol. 26, No. 1,
January/February (2007), pages 137-41.
• www.india brand equity foundation.org.in