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TABLE OF CONTENTS
1.     Medical Tourism in Asia
     1.1.   Overview
            Types of Medical Travelers Profile
     1.2.   Medical Tourism Value Chain in Asia
     1.3. Number of Foreign Patients Treated and Foreign Patients Revenue in Asia by
     Countries, 2010
     1.4.   JCI Accredited Hospitals and Centres in Asian Countries, 2010
     1.5.   Medical Tourism Treatment Cost Comparison, 2010
     1.6. Comparison of Major Medical Tourism Destinations (Thailand, India, Singapore,
     Malaysia and South Korea), 2010
     1.7.   Major Market Drivers and Growth Barriers
            Market Drivers
            Major Growth Barriers and Challenges
     1.8.   Recent Trends and Developments
     1.9.   Asia Medical Tourism Future Outlook and Projections, 2015
       1.9.1. Cause and Effect Relationship between Industry Factors and Medical Tourism
       Prospects
2.     Medical Tourism in Thailand
     2.1.   Overview
            Types of Medical Travelers Profile
     2.2. Total Foreign Patients Treated and Foreign Patients Revenue in Thailand, 2005-
     2010
     2.3.   Foreign Patients by Nationality, 2010
     2.4. Competitive Landscape of Major Hospitals (Piyavate, Bumrungrad Hospital,
     Bangkok Dusit Medical Services), 2010
       2.4.1. Market Share of Major Thailand Hospitals by Number of Foreign Patients
       Treated, 2010


                                                                                      2
2.5.   Major Drivers and Growth Barriers
            Major Drivers
            Growth Barriers
     2.6.   Thailand Medical Tourism Future Outlook and Projections
       2.6.1.   Expected Foreign Patients and Foreign Patients Revenue, 2011-2015
     2.7.   Medical Tourism Industry Factors: Historical and Projections
       2.7.1.   Total Foreign Tourist Arrivals and Tourism Receipts in Thailand, 2005-2015
       2.7.2.   Healthcare Expenditure in Thailand, 2005-2015
3.     Medical Tourism in India
     3.1.   Overview
     3.2.   Total Foreign Patients Treated and Foreign Patients Revenue in India, 2005-2010
     3.3. Number of Medical Tourists Arrivals and Medical Tourist Receipts in India, 2005-
     2010
     3.4.   Medical Tourists Arrivals by Nationality, 2009
     3.5. Market Share of Major Indian Hospitals by Number of Foreign Patients Treated,
     2010
     3.6.   Company Profiles
       3.6.1.   Apollo Hospitals Enterprise Limited (AHEL)
            Company Overview
            Corporate Timeline
            Business Strategies
            Financial and Operational Performance
       3.6.2.   Fortis Healthcare
            Company Overview
            Corporate Timeline
            Business Strategies
            Financial and Operational Performance
       Max Healthcare (MHC)


                                                                                              3
Company Overview
            Business Strategies
            Financial and Operational Performance
     3.7.   Major Drivers and Growth Barriers
            Major Drivers
            Growth Barriers
     3.8.   India Medical Tourism Future Outlook and Projections
       3.8.1.   Expected Foreign Patients and Foreign Patients Revenue, 2011-2015
       3.8.2.   Expected Medical Tourist Arrivals and Medical Tourist Receipts, 2011-2015
     3.9.   Medical Tourism Industry Factors: Historical and Projections
       3.9.1.   Total Foreign Tourist Arrivals and Tourism Receipts in India, 2005-2015
       3.9.2.   Healthcare Expenditure in India, 2005-2015
4.     Medical Tourism in Singapore
     4.1.   Overview
     4.2. Total Foreign Patients Treated and Foreign Patients Revenue in Singapore, 2005-
     2010
     4.3. Number of Medical Tourists Arrivals and Medical Tourist Receipts in Singapore,
     2005-2010
     4.4.   Medical Tourists Treatment Expenditure by Nationality, 2009
     4.5. Competitive Landscape of Major Hospitals (SingHealth, Parkway Health, Raffles
     Medical Group, National Healthcare Group), 2010
     4.6.   Major Drivers and Growth Barriers
            Major Drivers
            Growth Barriers
     4.7.   Singapore Medical Tourism Future Outlook and Projections
       4.7.1.   Expected Foreign Patients and Foreign Patients Revenue, 2011-2015
       4.7.2.   Expected Medical Tourist Arrivals and Medical Tourist Receipts, 2011-2015
     4.8.   Medical Tourism Industry Factors: Historical and Projections


                                                                                            4
4.8.1.   Total Foreign Tourist Arrivals and Tourism Receipts in Singapore, 2005-2015
       4.8.2.   Number of Hospitals, Medical Centres and Hospitals Beds, 2005-2015
       4.8.3.   Inpatients and Outpatients Admissions, 2005-2015
       4.8.4.   Registered Health Personnel in Singapore, 2005-2015
       4.8.5.   Healthcare Expenditure in Singapore, 2005-2015
5.     Medical Tourism in Malaysia
     5.1.   Overview
     5.2. Total Foreign Patients Treated and Foreign Patients Revenue in Malaysia, 2005-
     2010
     5.3.   Foreign Patients by Nationality, 2010
     5.4. Competitive Landscape of 35 Private Hospitals Endorsed for International Medical
     Tourism by Ministry of Health, 2009
     5.5.   Major Drivers and Growth Barriers
            Major Drivers
            Growth Barriers
     5.6.   Malaysia Medical Tourism Future Outlook and Projections
       5.6.1.   Expected Foreign Patients and Foreign Patients Revenue, 2011-2015
     5.7.   Medical Tourism Industry Factors: Historical and Projections
       5.7.1.   Total Foreign Tourist Arrivals and Tourism Receipts in Malaysia, 2005-2015
       5.7.2.   Total Number of Hospitals and Hospital Beds in Malaysia, 2005-2015
       5.7.3.   Number of Hospital Admissions in Malaysia, 2008-2015
       5.7.4.   Number of Hospital Doctors in Malaysia, 2005-2015
       5.7.5.   Healthcare Expenditure in Malaysia, 2005-2015
6.     Medical Tourism in South Korea
     6.1.   Overview
     6.2. Total Foreign Patients Treated and Foreign Patients Revenue in South Korea, 2005-
     2010
     6.3.   Foreign Patients by Nationality, 2010

                                                                                              5
6.4.    Foreign Patients by Destination in Korea, 2010
     6.5.    Foreign Patients Selection for Type of Hospitals, 2010
     6.6. Type of Foreign Patients by Inpatients, Outpatients and Medical Checkup Patients,
     2010
     6.7. Competitive Landscape of Major Hospitals (Yonsei Severance, Samsung Medical,
     CheongShim International, Asan Medical and Seoul National), 2010
     6.8.    Major Drivers and Growth Barriers
             Major Drivers
             Growth Barriers
     6.9.    South Korea Medical Tourism Future Outlook and Projections
       6.9.1.      Expected Foreign Patients and Foreign Patients Revenue, 2011-2015
     6.10.       Medical Tourism Industry Factors: Historical and Projections
       6.10.1.       Total Foreign Tourist Arrivals and Tourism Receipts in South Korea, 2005-
       2015
       6.10.2.       Number of Hospitals, Clinics and Medical Centres and Hospital Beds, 2005-
       2015
       6.10.3.       Healthcare Expenditure in South Korea, 2005-2015
7.     Appendix
     7.1.    Market Definition
     7.2.    Abbreviations
     7.3.    Research Methodology
             Data Collection Methods
             Approach
     Disclaimer




                                                                                            6
LIST OF FIGURES
Figure 1: Number of Foreign Patients Treated in Asia by Countries, in Percentage, 2010
Figure 2: Revenue from Foreign Patients in Asia by Countries, in Percentage, 2010
Figure 3: Number of JCI Accredited Hospitals and Centres in Asian Countries, 2010
Figure 4: Number of Foreign Patients Treated in Asia by Countries, in Percentage, 2015
Figure 5: Revenue from Foreign Patients in Asia by Countries, in Percentage, 2015
Figure 6: Number of Total Foreign Patients in Thousands and Foreign Patients Revenue in
Thailand in USD Million, 2005-2010
Figure 7: Foreign Patients by Nationality in Percentage, 2010
Figure 8: Market Share of Major Hospitals on the Basis of Number of Foreign Patients
Treated, in Percentage, 2010
Figure 9: Expected Foreign Patients in Thousands and Foreign Patients Revenue in USD
Million, 2011-2015
Figure 10: Total Foreign Tourist Arrivals in Million and Tourism Receipts in USD Billion,
2005-2015
Figure 11: Healthcare Expenditure in Thailand, in USD Billion, 2005-2015
Figure 12: Number of Total Foreign Patients in Thousands and Foreign Patients Revenue in
India in USD Million, 2005-2010
Figure 13: Number of Total Medical Tourists in Thousands and Medical Tourists Receipts in
USD Million, 2005-2010
Figure 14: Medical Tourists by Nationality in Percentage, 2009
Figure 15: Market Share of Major Hospitals on the Basis of Number of Medical Tourists
Treated, in Percentage, 2010
Figure 16: Apollo Hospitals Corporate Timeline, 1983 -2014
Figure 17: Fortis Healthcare Corporate Timeline, 2001-2010
Figure 18: Fortis Healthcare Location Wise Hospital Performance, in INR Million, FY’2010-
FY’2011
Figure 19: Fortis Healthcare Revenue Mix by Specialty in Percentage, FY’2011



                                                                                         7
Figure 20: Number of Procedure Performed by Specialty in Fortis Healthcare, FY’2010 -
FY’2011
Figure 21: Max Healthcare Average Operational Beds and Average Revenue per Bed Day in
INR, FY’2009 – FY’2011
Figure 22: Expected Foreign Patients in Thousands and Foreign Patients Revenue in India in
USD Million, 2011-2015
Figure 23: Expected Medical Tourists in Thousands and Medical Tourists Receipts in India in
USD Million, 2011-2015
Figure 24: Total Foreign Tourist Arrivals in Million and Tourism Receipts in India in USD
Billion, 2005-2015
Figure 25: Healthcare Expenditure in India, in USD Billion, 2005-2015
Figure 26: Number of Total Foreign Patients in Thousands and Foreign Patients Revenue in
Singapore in USD Million, 2005-2010
Figure 27: Number of Total Medical Tourists in Thousands and Medical Tourists Receipts in
Singapore, in USD Million, 2005-2010
Figure 28: Medical Tourists’ Treatment Expenditure by Nationality in Percentage, 2009
Figure 29: Expected Foreign Patients in Thousands and Foreign Patients Revenue in
Singapore in USD Million, 2011-2015
Figure 30: Expected Medical Tourists in Thousands and Medical Tourists Receipts in
Singapore in USD Million, 2011-2015
Figure 31: Total Foreign Tourist Arrivals in Million and Tourism Receipts in Singapore in
USD Billion, 2005-2015
Figure 32: Number of Hospitals, Medical Centres and Clinics and Hospital Beds in
Singapore, 2005-2015
Figure 33: Total Patient Admissions in Singapore, 2005-2015
Figure 34: Total Registered Health Personnel in Singapore, 2005-2015
Figure 35: Healthcare Expenditure in Singapore, in USD Million, 2005-2015
Figure 36: Number of Total Foreign Patients in Thousands and Foreign Patients Revenue in
Malaysia in USD Million, 2005-2010
Figure 37: Foreign Patients by Nationality in Percentage, 2010



                                                                                         8
Figure 38: Expected Foreign Patients in Thousands and Foreign Patients Revenue in
Malaysia in USD Million, 2011-2015
Figure 39: Total Foreign Tourist Arrivals in Million and Tourism Receipts in Malaysia in
USD Billion, 2005-2015
Figure 40: Number of Hospitals and Hospital Beds in Malaysia, 2005-2015
Figure 41: Total Patient Admissions in Malaysia, in Million, 2008-2015
Figure 42: Number of Hospital Doctors in Malaysia, 2005-2015
Figure 43: Healthcare Expenditure in Malaysia, in USD Billion, 2005-2015
Figure 44: Number of Total Foreign Patients in Thousands and Foreign Patients Revenue in
South Korea in USD Million, 2005-2010
Figure 45: Foreign Patients by Nationality in Percentage, 2010
Figure 46: Foreign Patients by Destinations (Seoul, Gyeonggi-do, Daegu, Busan, and
Incheon) in Korea in Percentage, 2010
Figure 47: Foreign Patients Selection for Type of Hospitals in Percentage, 2010
Figure 48: Type of Foreign Patients by Inpatients, Outpatients and Medical Checkup Patients
in Percentage, 2010
Figure 49: Expected Foreign Patients in Thousands and Foreign Patients Revenue in South
Korea in USD Million, 2011-2015
Figure 50: Total Foreign Tourist Arrivals in Million and Tourism Receipts in South Korea in
USD Billion, 2005-2015
Figure 51: Number of Hospitals, Clinics and Medical Centres and Hospital Beds in South
Korea, 2005-2015
Figure 52: Healthcare Expenditure in South Korea, in USD Billion, 2005-2015




                                                                                         9
LIST OF TABLES
Table 1: Number of Foreign Patients Treated in Asia by Countries, in Thousands, 2010
Table 2: Revenue from Foreign Patients in Asia by Countries, in USD Million, 2010
Table 3: Medical Treatment Cost Comparison among the US, India, Thailand, Singapore,
Malaysia, Mexico and the UK, in USD, 2010
Table 4: Key, Emerging and Other Medical Tourism Destinations across the World, 2010
Table 5: Comparison of Major Medical Tourism Destinations (Thailand, India, Singapore,
Malaysia and South Korea) on the basis of Foreign Patients, JCI Accredited Hospitals, Range
of Costs (% of US cost) and Popular Treatment Options, 2010
Table 6: Number of Foreign Patients Treated in Asia by Countries, in Thousands, 2015
Table 7: Revenue from Foreign Patients in Asia by Countries, in USD Million, 2015
Table 8: Cause and Effect Relationship Analysis between Industry Factors and Expected
Medical Tourism Industry Market Prospects
Table 9: Foreign Patients by Nationality in Thousands, 2010
Table 10: Competitive Landscape of Major Hospital Chain/Group in Thailand (Piyavate,
Bumrungrad Hospital, Bangkok Dusit Medical Services), 2010
Table 11: Key Performance Indicators of Major Indian Hospitals in Terms of Foreign
Patients Treated, No. of Hospitals and Beds, 2010
Table 12: Total Foreign Tourist Arrivals in Million and Tourism Receipts in USD Billion,
2005-2015
Table 13: Medical Tourists by Nationality, 2009
Table 14: Key Performance Indicators of Major Indian Hospitals in Terms of Medical
Tourists Treated, No. of Hospitals and Beds, 2010
Table 15: Hospital Expansion Plan of Apollo Hospitals Enterprise Limited (AHEL), 2011
Table 16: Apollo Hospitals Financial Performance, in INR Million, FY’2009 – FY’2011
Table 17: Apollo Hospitals Revenue Mix by Business Segment, in INR Million, FY’2011
Table 18: Apollo Hospitals Operational Performance, FY’2011
Table 19: Apollo Hospitals Geographic Presence, FY’2011
Table 20: Hospital Expansion Plan of Fortis Healthcare, FY’2011

                                                                                        10
Table 21: Fortis Healthcare Financial Performance, in INR Million, FY’2009 – FY’2011
Table 22: Fortis Healthcare Operational Performance, FY’2009 – FY’2011
Table 23: Max Healthcare Services in Various Specialties, 2011
Table 24: Max Healthcare Financial Performance, in INR Million, FY’2009 – FY’2011
Table 25: Max Healthcare Inpatient and Outpatient Transactions and Average Revenue per
Inpatient and Outpatient in INR, FY’2009 – FY’2011
Table 26: Total Foreign Tourist Arrivals in Million and Tourism Receipts in India in USD
Billion, 2005-2015
Table 27: Medical Tourists’ Treatment Expenditure by Nationality in USD Million, 2009
Table 28: Competitive Landscape of Major Hospital Chains/Group in Singapore (SingHealth,
Parkway Health, Raffles Medical Group, National Healthcare Group)
Table 29: Total Foreign Tourist Arrivals in Million and Tourism Receipts in Singapore in
USD Billion, 2005-2015
Table 30: Hospitals, Medical Centres and Clinics in Singapore, 2005-2010
Table 31: Inpatient and Outpatient Admissions in Singapore, 2005-2010
Table 32: Registered Health Personnel by Doctors, Dentists, Pharmacists, Nurses and
Midwives in Singapore, 2005-2010
Table 33: Foreign Patients by Nationality, 2010
Table 34: Major 35 Private Hospitals Endorsed for International Medical Tourism by the
Ministry of Health (MOH), 2009
Table 35: Total Foreign Tourist Arrivals in Million and Tourism Receipts in Malaysia in
USD Billion, 2005-2015
Table 36: Total Hospitals and Hospital Beds by Public and Private Sector in Malaysia, 2005-
2010
Table 37: Foreign Patients by Destinations (Seoul, Gyeonggi-do, Daegu, Busan, and Incheon)
in Korea, 2010
Table 38: Foreign Patients Selection for Type of Hospitals, 2010
Table 39: Market Segmentation by Inpatients, Outpatients and Medical Checkup Foreign
Patients, 2010



                                                                                        11
Table 40: Competitive Landscape of Major Hospital Chains/Group in Singapore (Yonsei
Severance, Samsung Medical, CheongShim International, Asan Medical and Seoul National
University Hospital), 2010
Table 41: Total Foreign Tourist Arrivals in Million and Tourism Receipts in South Korea in
USD Million, 2005-2015
Table 42: Number of Hospitals, Clinics and Medical Centres and Hospital Beds in South
Korea, 2005-2015
Table 43: Total Hospitals, Clinics and Medical Centres by Medical, Dental, Oriental
Medicine, Dispensaries, Midwifery Clinics and Specialized Hospitals in South Korea, 2005-
2010




                                                                                       12
MEDICAL TOURISM IN ASIA


NUMBER OF FOREIGN PATIENTS TREATED AND FOREIGN
PATIENTS REVENUE IN ASIA BY COUNTRIES, 2010


…Asia is regarded as the destination for medical tourists across the globe. Thailand is the
leader among the Asian countries which received maximum number of foreign patients (~
thousand) in 2010. India is the second largest player with ~ thousand foreign patients closely
followed by Singapore with ~ thousand. Philippines and Malaysia are other major countries
                                           which received ~ and ~ thousand foreign patients
 The    rising  medical     costs   and    respectively.
overburdened medical structure are
some of the main reasons which have      With regards to the revenue earned from foreign
prompted many individuals to look        patients, India and Singapore are the leaders with
beyond these western countries
                                         a market share of ~% with an earning of nearly
USD ~ million. Thailand with a share of ~% and earnings of USD ~ million was the second
largest country…

Figure: Number of Foreign Patients Treated in Asia by Countries, in Percentage, 2010


                                                                           Thailand

                                                                           India

                                                                           Singapore

                                                                           Phillipines

                                                                           Malaysia

                                                                           Korea

                                                                           Taiwan

Source: AM Mindpower Solutions




                                                                                           13
Table: Revenue from Foreign Patients in Asia by Countries, in USD Million, 2010

Countries                                       Revenue from Foreign Patients (USD Million), 2010

Thailand

India

Singapore

Philippines*

Malaysia

Korea

Taiwan*

Total

Source: AM Mindpower Solutions

Note: * Provincial figures




MEDICAL TOURISM TREATMENT COST COMPARISON, 2010


There is huge difference in the cost of the treatment being offered in the US and in Asian
countries. For instance, Angioplasty treatment will cost USD ~ in the US while it will cost
USD ~ in India and Malaysia, USD ~ in Thailand and USD ~ in Singapore. This huge
difference in the cost is largely due to the lower labour cost in the countries in Asia region.
Even in case of medical diagnostic tests such as MRI scan, there exists a huge gap between
the cost charged in the US and in India.

Table: Medical Treatment Cost Comparison among the US, India, Thailand, Singapore,
Malaysia, Mexico and the UK, in USD, 2010

                                                                                           South
Procedure1,2                 The US   India   Thailand   Singapore   Malaysia   Mexico     Korea

Heart bypass
(CABG)



                                                                                              14
Heart Valve
replacement

Angioplasty

Hip replacement

Knee replacement

Gastric bypass

Hip resurfacing

Spinal fusion

Mastectomy

Rhinoplasty

Tummy Tuck

Breast reduction

Breast implants

Crown

Tooth whitening

Dental implants

Notes:

1. Costs of surgeries around the world. Costs given in USD

2. The price comparisons for surgery take into account hospital and doctor charges, but do not include the costs of flights
and hotel bills for the expected length of stay.




                                                                                                                       15
ASIA MEDICAL TOURISM FUTURE OUTLOOK AND
PROJECTIONS, 2015


CAUSE AND EFFECT RELATIONSHIP BETWEEN INDUSTRY
FACTORS AND MEDICAL TOURISM PROSPECTS


Table: Cause and Effect Relationship Analysis between Industry Factors and Expected
Medical Tourism Industry Prospects

Industry Factors                        Market Impact          Comments

Cost effective treatment in                                      Cause:
the Asia region                                                  Effect:

Limited or no foreign                                            Cause:
insurance cover for medical                                      Effect:
treatment

Long waiting time in                                             Cause:
developed countries leading                                      Effect:
to increased medical costs

Post surgery visits                                              Cause:
                                                                 Effect:

Linguistics issues                                               Cause:
                                                                 Effect:

Healthy lifestyle leading to                                     Cause:
rise in life expectancy                                          Effect.

Source: AM Mindpower Solutions

Note: Shaded region represents the degree of impact on the market




                                                                                16
MEDICAL TOURISM IN THAILAND


COMPETITIVE LANDSCAPE OF MAJOR HOSPITALS (PIYAVATE,
BUMRUNGRAD HOSPITAL, BANGKOK DUSIT MEDICAL
SERVICES), 2010


MARKET SHARE OF MAJOR THAILAND HOSPITALS BY NUMBER
OF FOREIGN PATIENTS TREATED, 2010


Bumrungrad Hospital is the leader in Thailand in terms of the foreign patients treated with
the market share of ~% in 2010. The hospital treated ~ international patients in 2010 from ~
countries and generated USD ~ million revenues from foreign patients. Bangkok Dusit
                                           Medical Services is the second largest foreign
  Bumrungrad Hospital is the leader in
                                           patients treating hospital in Thailand which served
  Thailand in terms of the foreign
  patients treated with the market         over ~ international patients in 2010 and recorded
  share of ~% in 2010. The hospital        international patients’ revenue of USD ~ million.
  treated ~ international patients in      The group operates with ~ inpatient beds and
  2010 from ~ countries                    specializes     in    endocrinology      (diabetes),
                                           gynecology, nephrology (kidneys), orthopedics,
radiology, urology, cosmetic surgery, eye and LASIK, gastrointestinal tract and liver, and ear,
nose and throat (ENT) treatments.

Table 1: Key Performance Indicators of Major Indian Hospitals in Terms of Foreign
Patients Treated, No. of Hospitals and Beds, 2010

                                                                        International Patients
Hospital Chain/Group          Foreign Patients   Number of Beds        Revenue (USD Million)

Bumrungrad Hospital

Bangkok Dusit Medical
Services (BDMS)

Piyavate Hospital

Vejthani Hospital



                                                                                            17
MEDICAL TOURISM IN INDIA


NUMBER OF MEDICAL TOURISTS ARRIVALS AND MEDICAL
TOURIST RECEIPTS IN INDIA, 2005-2010


The medical tourists’ arrivals are increasing in the country at a CAGR of ~% from 2005 to
2010. The country has recorded an influx of ~ thousand medical tourists in 2005 which
inclined to ~ thousand in 2007. The country has various medical centers in different locations
such as Delhi, Mumbai, Chennai, Bangalore and others which offer high class medical
services. The country is famous for low cost medical treatment for heart, dental and cosmetic
surgery. Total medical tourist arrivals were registered at ~ thousand in 2010…

Figure: Number of Total Medical Tourists in Thousands and Medical Tourists Receipts
in USD Million, 2005-2010

              140.0                                                                               400.0

              120.0                                                                               350.0

                                                                                                  300.0
              100.0




                                                                                                          (USD Million)
                                                                                                  250.0
(Thousands)




               80.0
                                                                                                  200.0
               60.0
                                                                                                  150.0
               40.0
                                                                                                  100.0
               20.0                                                                               50.0

                0.0                                                                               0.0
                      2005         2006          2007        2008          2009          2010

                      Medical Tourists (Thousands)      Medical Tourists Receipts (USD Million)




                                                                                                          18
MEDICAL TOURISM IN SINGAPORE


      COMPETITIVE LANDSCAPE OF MAJOR HOSPITALS
      (SINGHEALTH, PARKWAY HEALTH, RAFFLES MEDICAL
      GROUP, NATIONAL HEALTHCARE GROUP), 2010


      Table: Competitive Landscape of Major Hospital Chains/Group in Singapore
      (SingHealth, Parkway Health, Raffles Medical Group, National Healthcare Group)

                                                                                         Financial/
Major                                          Key Medical Treatments and               Operational    International
Players           Group Overview                    Hospital Brands                     Performance   Patients Reach

                                                                                                   




                                                                                                   
Parkway
Health

                                                                                                    
Raffles
Medical
Group

                                                                                                    



      Source: Company Reports, AM Mindpower Solutions

      Notes: Average exchange rate for the period is used to convert SGD into USD

      1) FY’2010 for the year ending March 2011

      2) FY’2010 for the year ending December 2010

      3) JHSIMC: Johns Hopkins Singapore International Medical Centre



                                                                                                          19
SINGAPORE MEDICAL TOURISM FUTURE OUTLOOK AND
PROJECTIONS


EXPECTED MEDICAL TOURIST ARRIVALS AND MEDICAL TOURIST
RECEIPTS, 2011-2015


Out of the total expected foreign patients treated in 2011, nearly ~ thousand will be medical
tourists who will yield USD ~ million. It is expected that medical tourist arrivals will grow
tremendously in the country as the number of JCI accredited medical centers and hospitals
will increase in the future.
By 2015, total medical tourist arrivals will grow by more than ~% from the current level of ~
thousand medical tourists. The total medical tourist arrivals will increase to ~ thousand by
2015, registering an expected CAGR of ~%...

Figure: Expected Medical Tourists in Thousands and Medical Tourists Receipts in
Singapore in USD Million, 2011-2015

              700.0                                                                           900.0
                                                                                              800.0
              600.0
                                                                                              700.0
              500.0
                                                                                              600.0




                                                                                                    (USD Million)
(Thousands)




              400.0                                                                           500.0

              300.0                                                                           400.0
                                                                                              300.0
              200.0
                                                                                              200.0
              100.0
                                                                                              100.0
                0.0                                                                           0.0
                      2011             2012         2013            2014             2015

                      Medical Tourists (Thousand)   Medical Tourists Receipts (USD Million)




                                                                                                    20
MEDICAL TOURISM IN MALAYSIA


MEDICAL TOURISM INDUSTRY FACTORS: HISTORICAL AND
PROJECTIONS


TOTAL NUMBER OF HOSPITALS AND HOSPITAL BEDS IN
MALAYSIA, 2005-2015


Malaysia had around ~ hospitals including ~ public and ~ private hospitals in 2005 with total
~ complement beds. This proportion has increased exceptionally to ~ public hospitals and ~
private hospitals in 2010. The total hospital beds have also grown steadily to ~ beds in 2010.
This underscores the consistent development in the state of art facility and infrastructure for
local and foreign patients. The government is heavily investing in the public healthcare sector
in order to cater to emerging demand for quality medical and diagnostic services and
regulating the private hospitals and medical centers operations. Every private medical center
operating in Malaysia is required to be certified by the Ministry of Health, Malaysia.
Moreover, hospitals which are serving the foreign patients should pass through the
international certification standards…

Figure: Number of Hospitals and Hospital Beds in Malaysia, 2005-2015

       450                                                                                             70,000
       400
                                                                                                       60,000
       350
                                                                                                       50,000
       300
                                                                                                            (Hospital Beds)


       250                                                                                             40,000
(Hospitals)




       200                                                                                             30,000
       150
                                                                                                       20,000
       100
                                                                                                       10,000
              50
              0                                                                                        0
                   2005   2006   2007     2008      2009   2010   2011     2012   2013   2014   2015

                                        Hospitals                        Hospital Beds


                                                                                                            21
Table: Total Hospitals and Hospital Beds by Public and Private Sector in Malaysia,
2005-2010

                           Hospitals                                Hospital Beds

Year                Public Sector       Private Sector      Public Sector       Private Sector

2005

2006

2007

2008

2009

2010




HEALTHCARE EXPENDITURE IN MALAYSIA, 2005-2015


The Malaysia healthcare sector is similar to South Africa which is divided into public and
private health care. The public health care system is used by most of the population living in
Malaysia whereas the private sector health care services are rather afforded by the affluent
class only…
Around USD ~ billion was spent in 2010 on healthcare services. The government allocated a
budget of total RMB ~ billion for the general improvement of the healthcare sector in the
country in 2010. The amount is expected to be spent on purchasing new equipments,
distribute large number of medicines, training of human resources and construction of more
hospitals and medical centers. Increased efforts are being made to provide facilities in Sabah
and Sarawak states in Malaysia….




                                                                                           22
Figure: Healthcare Expenditure in Malaysia, in USD Billion, 2005-2015
          20.0
          18.0
          16.0
          14.0
 USD Billion




          12.0
          10.0
               8.0
               6.0
               4.0
               2.0
               0.0
                     2005   2006   2007   2008   2009   2010   2011   2012   2013   2014   2015




MEDICAL TOURISM IN SOUTH KOREA


FOREIGN PATIENTS BY DESTINATION IN KOREA, 2010
….
Although in 2009, Incheon was one of the leading regions in the country, Daegu has
showcased phenomenal growth in number of medical tourist arrivals in 2010. The medical
                                               tourists increased by ~% in 2010 from ~ in
  Out of the total foreign patients visited in
                                               2009. In 2009, Daegu represented ~% of the
  South Korea, Seoul with ~ received the
  maximum number of foreign patients           medical tourist’s visits in South Korea which
  followed by Gyeonggi with ~ patients and     increased to ~% in 2010.
    Daegu with ~
                                               Some of the prominent medical centers and
institutions in the country are Keimyung University Dongsan Medical Center and Hyosung
Hospital. Dongsan medical center in South Korea is one of the leading medical centers in the
country and is expected to a play a very crucial role in determining the growth of Daegu as
the country’s leading medical region….




                                                                                                  23
Figure: Foreign Patients by Destinations (Seoul, Gyeonggi-do, Daegu, Busan, and
Incheon) in Korea in Percentage, 2010

                                                                          Seoul

                                                                          Gyeonggi-do

                                                                          Daegu

                                                                          Busan

                                                                          Incheon

                                                                          Others




Table: Foreign Patients by Destinations (Seoul, Gyeonggi-do, Daegu, Busan, and
Incheon) in Korea, 2010

Destination/Province                                                 Foreign Patients, 2010

Seoul

Gyeonggi-do

Daegu

Busan

Incheon

Others




DISCLAIMER


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                                                                                        24

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Asia Medical Tourism Industry Outlook to 2015 - The Destination for Foreign Patients

  • 1.
  • 2. TABLE OF CONTENTS 1. Medical Tourism in Asia 1.1. Overview Types of Medical Travelers Profile 1.2. Medical Tourism Value Chain in Asia 1.3. Number of Foreign Patients Treated and Foreign Patients Revenue in Asia by Countries, 2010 1.4. JCI Accredited Hospitals and Centres in Asian Countries, 2010 1.5. Medical Tourism Treatment Cost Comparison, 2010 1.6. Comparison of Major Medical Tourism Destinations (Thailand, India, Singapore, Malaysia and South Korea), 2010 1.7. Major Market Drivers and Growth Barriers Market Drivers Major Growth Barriers and Challenges 1.8. Recent Trends and Developments 1.9. Asia Medical Tourism Future Outlook and Projections, 2015 1.9.1. Cause and Effect Relationship between Industry Factors and Medical Tourism Prospects 2. Medical Tourism in Thailand 2.1. Overview Types of Medical Travelers Profile 2.2. Total Foreign Patients Treated and Foreign Patients Revenue in Thailand, 2005- 2010 2.3. Foreign Patients by Nationality, 2010 2.4. Competitive Landscape of Major Hospitals (Piyavate, Bumrungrad Hospital, Bangkok Dusit Medical Services), 2010 2.4.1. Market Share of Major Thailand Hospitals by Number of Foreign Patients Treated, 2010 2
  • 3. 2.5. Major Drivers and Growth Barriers Major Drivers Growth Barriers 2.6. Thailand Medical Tourism Future Outlook and Projections 2.6.1. Expected Foreign Patients and Foreign Patients Revenue, 2011-2015 2.7. Medical Tourism Industry Factors: Historical and Projections 2.7.1. Total Foreign Tourist Arrivals and Tourism Receipts in Thailand, 2005-2015 2.7.2. Healthcare Expenditure in Thailand, 2005-2015 3. Medical Tourism in India 3.1. Overview 3.2. Total Foreign Patients Treated and Foreign Patients Revenue in India, 2005-2010 3.3. Number of Medical Tourists Arrivals and Medical Tourist Receipts in India, 2005- 2010 3.4. Medical Tourists Arrivals by Nationality, 2009 3.5. Market Share of Major Indian Hospitals by Number of Foreign Patients Treated, 2010 3.6. Company Profiles 3.6.1. Apollo Hospitals Enterprise Limited (AHEL) Company Overview Corporate Timeline Business Strategies Financial and Operational Performance 3.6.2. Fortis Healthcare Company Overview Corporate Timeline Business Strategies Financial and Operational Performance Max Healthcare (MHC) 3
  • 4. Company Overview Business Strategies Financial and Operational Performance 3.7. Major Drivers and Growth Barriers Major Drivers Growth Barriers 3.8. India Medical Tourism Future Outlook and Projections 3.8.1. Expected Foreign Patients and Foreign Patients Revenue, 2011-2015 3.8.2. Expected Medical Tourist Arrivals and Medical Tourist Receipts, 2011-2015 3.9. Medical Tourism Industry Factors: Historical and Projections 3.9.1. Total Foreign Tourist Arrivals and Tourism Receipts in India, 2005-2015 3.9.2. Healthcare Expenditure in India, 2005-2015 4. Medical Tourism in Singapore 4.1. Overview 4.2. Total Foreign Patients Treated and Foreign Patients Revenue in Singapore, 2005- 2010 4.3. Number of Medical Tourists Arrivals and Medical Tourist Receipts in Singapore, 2005-2010 4.4. Medical Tourists Treatment Expenditure by Nationality, 2009 4.5. Competitive Landscape of Major Hospitals (SingHealth, Parkway Health, Raffles Medical Group, National Healthcare Group), 2010 4.6. Major Drivers and Growth Barriers Major Drivers Growth Barriers 4.7. Singapore Medical Tourism Future Outlook and Projections 4.7.1. Expected Foreign Patients and Foreign Patients Revenue, 2011-2015 4.7.2. Expected Medical Tourist Arrivals and Medical Tourist Receipts, 2011-2015 4.8. Medical Tourism Industry Factors: Historical and Projections 4
  • 5. 4.8.1. Total Foreign Tourist Arrivals and Tourism Receipts in Singapore, 2005-2015 4.8.2. Number of Hospitals, Medical Centres and Hospitals Beds, 2005-2015 4.8.3. Inpatients and Outpatients Admissions, 2005-2015 4.8.4. Registered Health Personnel in Singapore, 2005-2015 4.8.5. Healthcare Expenditure in Singapore, 2005-2015 5. Medical Tourism in Malaysia 5.1. Overview 5.2. Total Foreign Patients Treated and Foreign Patients Revenue in Malaysia, 2005- 2010 5.3. Foreign Patients by Nationality, 2010 5.4. Competitive Landscape of 35 Private Hospitals Endorsed for International Medical Tourism by Ministry of Health, 2009 5.5. Major Drivers and Growth Barriers Major Drivers Growth Barriers 5.6. Malaysia Medical Tourism Future Outlook and Projections 5.6.1. Expected Foreign Patients and Foreign Patients Revenue, 2011-2015 5.7. Medical Tourism Industry Factors: Historical and Projections 5.7.1. Total Foreign Tourist Arrivals and Tourism Receipts in Malaysia, 2005-2015 5.7.2. Total Number of Hospitals and Hospital Beds in Malaysia, 2005-2015 5.7.3. Number of Hospital Admissions in Malaysia, 2008-2015 5.7.4. Number of Hospital Doctors in Malaysia, 2005-2015 5.7.5. Healthcare Expenditure in Malaysia, 2005-2015 6. Medical Tourism in South Korea 6.1. Overview 6.2. Total Foreign Patients Treated and Foreign Patients Revenue in South Korea, 2005- 2010 6.3. Foreign Patients by Nationality, 2010 5
  • 6. 6.4. Foreign Patients by Destination in Korea, 2010 6.5. Foreign Patients Selection for Type of Hospitals, 2010 6.6. Type of Foreign Patients by Inpatients, Outpatients and Medical Checkup Patients, 2010 6.7. Competitive Landscape of Major Hospitals (Yonsei Severance, Samsung Medical, CheongShim International, Asan Medical and Seoul National), 2010 6.8. Major Drivers and Growth Barriers Major Drivers Growth Barriers 6.9. South Korea Medical Tourism Future Outlook and Projections 6.9.1. Expected Foreign Patients and Foreign Patients Revenue, 2011-2015 6.10. Medical Tourism Industry Factors: Historical and Projections 6.10.1. Total Foreign Tourist Arrivals and Tourism Receipts in South Korea, 2005- 2015 6.10.2. Number of Hospitals, Clinics and Medical Centres and Hospital Beds, 2005- 2015 6.10.3. Healthcare Expenditure in South Korea, 2005-2015 7. Appendix 7.1. Market Definition 7.2. Abbreviations 7.3. Research Methodology Data Collection Methods Approach Disclaimer 6
  • 7. LIST OF FIGURES Figure 1: Number of Foreign Patients Treated in Asia by Countries, in Percentage, 2010 Figure 2: Revenue from Foreign Patients in Asia by Countries, in Percentage, 2010 Figure 3: Number of JCI Accredited Hospitals and Centres in Asian Countries, 2010 Figure 4: Number of Foreign Patients Treated in Asia by Countries, in Percentage, 2015 Figure 5: Revenue from Foreign Patients in Asia by Countries, in Percentage, 2015 Figure 6: Number of Total Foreign Patients in Thousands and Foreign Patients Revenue in Thailand in USD Million, 2005-2010 Figure 7: Foreign Patients by Nationality in Percentage, 2010 Figure 8: Market Share of Major Hospitals on the Basis of Number of Foreign Patients Treated, in Percentage, 2010 Figure 9: Expected Foreign Patients in Thousands and Foreign Patients Revenue in USD Million, 2011-2015 Figure 10: Total Foreign Tourist Arrivals in Million and Tourism Receipts in USD Billion, 2005-2015 Figure 11: Healthcare Expenditure in Thailand, in USD Billion, 2005-2015 Figure 12: Number of Total Foreign Patients in Thousands and Foreign Patients Revenue in India in USD Million, 2005-2010 Figure 13: Number of Total Medical Tourists in Thousands and Medical Tourists Receipts in USD Million, 2005-2010 Figure 14: Medical Tourists by Nationality in Percentage, 2009 Figure 15: Market Share of Major Hospitals on the Basis of Number of Medical Tourists Treated, in Percentage, 2010 Figure 16: Apollo Hospitals Corporate Timeline, 1983 -2014 Figure 17: Fortis Healthcare Corporate Timeline, 2001-2010 Figure 18: Fortis Healthcare Location Wise Hospital Performance, in INR Million, FY’2010- FY’2011 Figure 19: Fortis Healthcare Revenue Mix by Specialty in Percentage, FY’2011 7
  • 8. Figure 20: Number of Procedure Performed by Specialty in Fortis Healthcare, FY’2010 - FY’2011 Figure 21: Max Healthcare Average Operational Beds and Average Revenue per Bed Day in INR, FY’2009 – FY’2011 Figure 22: Expected Foreign Patients in Thousands and Foreign Patients Revenue in India in USD Million, 2011-2015 Figure 23: Expected Medical Tourists in Thousands and Medical Tourists Receipts in India in USD Million, 2011-2015 Figure 24: Total Foreign Tourist Arrivals in Million and Tourism Receipts in India in USD Billion, 2005-2015 Figure 25: Healthcare Expenditure in India, in USD Billion, 2005-2015 Figure 26: Number of Total Foreign Patients in Thousands and Foreign Patients Revenue in Singapore in USD Million, 2005-2010 Figure 27: Number of Total Medical Tourists in Thousands and Medical Tourists Receipts in Singapore, in USD Million, 2005-2010 Figure 28: Medical Tourists’ Treatment Expenditure by Nationality in Percentage, 2009 Figure 29: Expected Foreign Patients in Thousands and Foreign Patients Revenue in Singapore in USD Million, 2011-2015 Figure 30: Expected Medical Tourists in Thousands and Medical Tourists Receipts in Singapore in USD Million, 2011-2015 Figure 31: Total Foreign Tourist Arrivals in Million and Tourism Receipts in Singapore in USD Billion, 2005-2015 Figure 32: Number of Hospitals, Medical Centres and Clinics and Hospital Beds in Singapore, 2005-2015 Figure 33: Total Patient Admissions in Singapore, 2005-2015 Figure 34: Total Registered Health Personnel in Singapore, 2005-2015 Figure 35: Healthcare Expenditure in Singapore, in USD Million, 2005-2015 Figure 36: Number of Total Foreign Patients in Thousands and Foreign Patients Revenue in Malaysia in USD Million, 2005-2010 Figure 37: Foreign Patients by Nationality in Percentage, 2010 8
  • 9. Figure 38: Expected Foreign Patients in Thousands and Foreign Patients Revenue in Malaysia in USD Million, 2011-2015 Figure 39: Total Foreign Tourist Arrivals in Million and Tourism Receipts in Malaysia in USD Billion, 2005-2015 Figure 40: Number of Hospitals and Hospital Beds in Malaysia, 2005-2015 Figure 41: Total Patient Admissions in Malaysia, in Million, 2008-2015 Figure 42: Number of Hospital Doctors in Malaysia, 2005-2015 Figure 43: Healthcare Expenditure in Malaysia, in USD Billion, 2005-2015 Figure 44: Number of Total Foreign Patients in Thousands and Foreign Patients Revenue in South Korea in USD Million, 2005-2010 Figure 45: Foreign Patients by Nationality in Percentage, 2010 Figure 46: Foreign Patients by Destinations (Seoul, Gyeonggi-do, Daegu, Busan, and Incheon) in Korea in Percentage, 2010 Figure 47: Foreign Patients Selection for Type of Hospitals in Percentage, 2010 Figure 48: Type of Foreign Patients by Inpatients, Outpatients and Medical Checkup Patients in Percentage, 2010 Figure 49: Expected Foreign Patients in Thousands and Foreign Patients Revenue in South Korea in USD Million, 2011-2015 Figure 50: Total Foreign Tourist Arrivals in Million and Tourism Receipts in South Korea in USD Billion, 2005-2015 Figure 51: Number of Hospitals, Clinics and Medical Centres and Hospital Beds in South Korea, 2005-2015 Figure 52: Healthcare Expenditure in South Korea, in USD Billion, 2005-2015 9
  • 10. LIST OF TABLES Table 1: Number of Foreign Patients Treated in Asia by Countries, in Thousands, 2010 Table 2: Revenue from Foreign Patients in Asia by Countries, in USD Million, 2010 Table 3: Medical Treatment Cost Comparison among the US, India, Thailand, Singapore, Malaysia, Mexico and the UK, in USD, 2010 Table 4: Key, Emerging and Other Medical Tourism Destinations across the World, 2010 Table 5: Comparison of Major Medical Tourism Destinations (Thailand, India, Singapore, Malaysia and South Korea) on the basis of Foreign Patients, JCI Accredited Hospitals, Range of Costs (% of US cost) and Popular Treatment Options, 2010 Table 6: Number of Foreign Patients Treated in Asia by Countries, in Thousands, 2015 Table 7: Revenue from Foreign Patients in Asia by Countries, in USD Million, 2015 Table 8: Cause and Effect Relationship Analysis between Industry Factors and Expected Medical Tourism Industry Market Prospects Table 9: Foreign Patients by Nationality in Thousands, 2010 Table 10: Competitive Landscape of Major Hospital Chain/Group in Thailand (Piyavate, Bumrungrad Hospital, Bangkok Dusit Medical Services), 2010 Table 11: Key Performance Indicators of Major Indian Hospitals in Terms of Foreign Patients Treated, No. of Hospitals and Beds, 2010 Table 12: Total Foreign Tourist Arrivals in Million and Tourism Receipts in USD Billion, 2005-2015 Table 13: Medical Tourists by Nationality, 2009 Table 14: Key Performance Indicators of Major Indian Hospitals in Terms of Medical Tourists Treated, No. of Hospitals and Beds, 2010 Table 15: Hospital Expansion Plan of Apollo Hospitals Enterprise Limited (AHEL), 2011 Table 16: Apollo Hospitals Financial Performance, in INR Million, FY’2009 – FY’2011 Table 17: Apollo Hospitals Revenue Mix by Business Segment, in INR Million, FY’2011 Table 18: Apollo Hospitals Operational Performance, FY’2011 Table 19: Apollo Hospitals Geographic Presence, FY’2011 Table 20: Hospital Expansion Plan of Fortis Healthcare, FY’2011 10
  • 11. Table 21: Fortis Healthcare Financial Performance, in INR Million, FY’2009 – FY’2011 Table 22: Fortis Healthcare Operational Performance, FY’2009 – FY’2011 Table 23: Max Healthcare Services in Various Specialties, 2011 Table 24: Max Healthcare Financial Performance, in INR Million, FY’2009 – FY’2011 Table 25: Max Healthcare Inpatient and Outpatient Transactions and Average Revenue per Inpatient and Outpatient in INR, FY’2009 – FY’2011 Table 26: Total Foreign Tourist Arrivals in Million and Tourism Receipts in India in USD Billion, 2005-2015 Table 27: Medical Tourists’ Treatment Expenditure by Nationality in USD Million, 2009 Table 28: Competitive Landscape of Major Hospital Chains/Group in Singapore (SingHealth, Parkway Health, Raffles Medical Group, National Healthcare Group) Table 29: Total Foreign Tourist Arrivals in Million and Tourism Receipts in Singapore in USD Billion, 2005-2015 Table 30: Hospitals, Medical Centres and Clinics in Singapore, 2005-2010 Table 31: Inpatient and Outpatient Admissions in Singapore, 2005-2010 Table 32: Registered Health Personnel by Doctors, Dentists, Pharmacists, Nurses and Midwives in Singapore, 2005-2010 Table 33: Foreign Patients by Nationality, 2010 Table 34: Major 35 Private Hospitals Endorsed for International Medical Tourism by the Ministry of Health (MOH), 2009 Table 35: Total Foreign Tourist Arrivals in Million and Tourism Receipts in Malaysia in USD Billion, 2005-2015 Table 36: Total Hospitals and Hospital Beds by Public and Private Sector in Malaysia, 2005- 2010 Table 37: Foreign Patients by Destinations (Seoul, Gyeonggi-do, Daegu, Busan, and Incheon) in Korea, 2010 Table 38: Foreign Patients Selection for Type of Hospitals, 2010 Table 39: Market Segmentation by Inpatients, Outpatients and Medical Checkup Foreign Patients, 2010 11
  • 12. Table 40: Competitive Landscape of Major Hospital Chains/Group in Singapore (Yonsei Severance, Samsung Medical, CheongShim International, Asan Medical and Seoul National University Hospital), 2010 Table 41: Total Foreign Tourist Arrivals in Million and Tourism Receipts in South Korea in USD Million, 2005-2015 Table 42: Number of Hospitals, Clinics and Medical Centres and Hospital Beds in South Korea, 2005-2015 Table 43: Total Hospitals, Clinics and Medical Centres by Medical, Dental, Oriental Medicine, Dispensaries, Midwifery Clinics and Specialized Hospitals in South Korea, 2005- 2010 12
  • 13. MEDICAL TOURISM IN ASIA NUMBER OF FOREIGN PATIENTS TREATED AND FOREIGN PATIENTS REVENUE IN ASIA BY COUNTRIES, 2010 …Asia is regarded as the destination for medical tourists across the globe. Thailand is the leader among the Asian countries which received maximum number of foreign patients (~ thousand) in 2010. India is the second largest player with ~ thousand foreign patients closely followed by Singapore with ~ thousand. Philippines and Malaysia are other major countries which received ~ and ~ thousand foreign patients The rising medical costs and respectively. overburdened medical structure are some of the main reasons which have With regards to the revenue earned from foreign prompted many individuals to look patients, India and Singapore are the leaders with beyond these western countries a market share of ~% with an earning of nearly USD ~ million. Thailand with a share of ~% and earnings of USD ~ million was the second largest country… Figure: Number of Foreign Patients Treated in Asia by Countries, in Percentage, 2010 Thailand India Singapore Phillipines Malaysia Korea Taiwan Source: AM Mindpower Solutions 13
  • 14. Table: Revenue from Foreign Patients in Asia by Countries, in USD Million, 2010 Countries Revenue from Foreign Patients (USD Million), 2010 Thailand India Singapore Philippines* Malaysia Korea Taiwan* Total Source: AM Mindpower Solutions Note: * Provincial figures MEDICAL TOURISM TREATMENT COST COMPARISON, 2010 There is huge difference in the cost of the treatment being offered in the US and in Asian countries. For instance, Angioplasty treatment will cost USD ~ in the US while it will cost USD ~ in India and Malaysia, USD ~ in Thailand and USD ~ in Singapore. This huge difference in the cost is largely due to the lower labour cost in the countries in Asia region. Even in case of medical diagnostic tests such as MRI scan, there exists a huge gap between the cost charged in the US and in India. Table: Medical Treatment Cost Comparison among the US, India, Thailand, Singapore, Malaysia, Mexico and the UK, in USD, 2010 South Procedure1,2 The US India Thailand Singapore Malaysia Mexico Korea Heart bypass (CABG) 14
  • 15. Heart Valve replacement Angioplasty Hip replacement Knee replacement Gastric bypass Hip resurfacing Spinal fusion Mastectomy Rhinoplasty Tummy Tuck Breast reduction Breast implants Crown Tooth whitening Dental implants Notes: 1. Costs of surgeries around the world. Costs given in USD 2. The price comparisons for surgery take into account hospital and doctor charges, but do not include the costs of flights and hotel bills for the expected length of stay. 15
  • 16. ASIA MEDICAL TOURISM FUTURE OUTLOOK AND PROJECTIONS, 2015 CAUSE AND EFFECT RELATIONSHIP BETWEEN INDUSTRY FACTORS AND MEDICAL TOURISM PROSPECTS Table: Cause and Effect Relationship Analysis between Industry Factors and Expected Medical Tourism Industry Prospects Industry Factors Market Impact Comments Cost effective treatment in  Cause: the Asia region  Effect: Limited or no foreign  Cause: insurance cover for medical  Effect: treatment Long waiting time in  Cause: developed countries leading  Effect: to increased medical costs Post surgery visits  Cause:  Effect: Linguistics issues  Cause:  Effect: Healthy lifestyle leading to  Cause: rise in life expectancy  Effect. Source: AM Mindpower Solutions Note: Shaded region represents the degree of impact on the market 16
  • 17. MEDICAL TOURISM IN THAILAND COMPETITIVE LANDSCAPE OF MAJOR HOSPITALS (PIYAVATE, BUMRUNGRAD HOSPITAL, BANGKOK DUSIT MEDICAL SERVICES), 2010 MARKET SHARE OF MAJOR THAILAND HOSPITALS BY NUMBER OF FOREIGN PATIENTS TREATED, 2010 Bumrungrad Hospital is the leader in Thailand in terms of the foreign patients treated with the market share of ~% in 2010. The hospital treated ~ international patients in 2010 from ~ countries and generated USD ~ million revenues from foreign patients. Bangkok Dusit Medical Services is the second largest foreign Bumrungrad Hospital is the leader in patients treating hospital in Thailand which served Thailand in terms of the foreign patients treated with the market over ~ international patients in 2010 and recorded share of ~% in 2010. The hospital international patients’ revenue of USD ~ million. treated ~ international patients in The group operates with ~ inpatient beds and 2010 from ~ countries specializes in endocrinology (diabetes), gynecology, nephrology (kidneys), orthopedics, radiology, urology, cosmetic surgery, eye and LASIK, gastrointestinal tract and liver, and ear, nose and throat (ENT) treatments. Table 1: Key Performance Indicators of Major Indian Hospitals in Terms of Foreign Patients Treated, No. of Hospitals and Beds, 2010 International Patients Hospital Chain/Group Foreign Patients Number of Beds Revenue (USD Million) Bumrungrad Hospital Bangkok Dusit Medical Services (BDMS) Piyavate Hospital Vejthani Hospital 17
  • 18. MEDICAL TOURISM IN INDIA NUMBER OF MEDICAL TOURISTS ARRIVALS AND MEDICAL TOURIST RECEIPTS IN INDIA, 2005-2010 The medical tourists’ arrivals are increasing in the country at a CAGR of ~% from 2005 to 2010. The country has recorded an influx of ~ thousand medical tourists in 2005 which inclined to ~ thousand in 2007. The country has various medical centers in different locations such as Delhi, Mumbai, Chennai, Bangalore and others which offer high class medical services. The country is famous for low cost medical treatment for heart, dental and cosmetic surgery. Total medical tourist arrivals were registered at ~ thousand in 2010… Figure: Number of Total Medical Tourists in Thousands and Medical Tourists Receipts in USD Million, 2005-2010 140.0 400.0 120.0 350.0 300.0 100.0 (USD Million) 250.0 (Thousands) 80.0 200.0 60.0 150.0 40.0 100.0 20.0 50.0 0.0 0.0 2005 2006 2007 2008 2009 2010 Medical Tourists (Thousands) Medical Tourists Receipts (USD Million) 18
  • 19. MEDICAL TOURISM IN SINGAPORE COMPETITIVE LANDSCAPE OF MAJOR HOSPITALS (SINGHEALTH, PARKWAY HEALTH, RAFFLES MEDICAL GROUP, NATIONAL HEALTHCARE GROUP), 2010 Table: Competitive Landscape of Major Hospital Chains/Group in Singapore (SingHealth, Parkway Health, Raffles Medical Group, National Healthcare Group) Financial/ Major Key Medical Treatments and Operational International Players Group Overview Hospital Brands Performance Patients Reach         Parkway Health    Raffles Medical Group    Source: Company Reports, AM Mindpower Solutions Notes: Average exchange rate for the period is used to convert SGD into USD 1) FY’2010 for the year ending March 2011 2) FY’2010 for the year ending December 2010 3) JHSIMC: Johns Hopkins Singapore International Medical Centre 19
  • 20. SINGAPORE MEDICAL TOURISM FUTURE OUTLOOK AND PROJECTIONS EXPECTED MEDICAL TOURIST ARRIVALS AND MEDICAL TOURIST RECEIPTS, 2011-2015 Out of the total expected foreign patients treated in 2011, nearly ~ thousand will be medical tourists who will yield USD ~ million. It is expected that medical tourist arrivals will grow tremendously in the country as the number of JCI accredited medical centers and hospitals will increase in the future. By 2015, total medical tourist arrivals will grow by more than ~% from the current level of ~ thousand medical tourists. The total medical tourist arrivals will increase to ~ thousand by 2015, registering an expected CAGR of ~%... Figure: Expected Medical Tourists in Thousands and Medical Tourists Receipts in Singapore in USD Million, 2011-2015 700.0 900.0 800.0 600.0 700.0 500.0 600.0 (USD Million) (Thousands) 400.0 500.0 300.0 400.0 300.0 200.0 200.0 100.0 100.0 0.0 0.0 2011 2012 2013 2014 2015 Medical Tourists (Thousand) Medical Tourists Receipts (USD Million) 20
  • 21. MEDICAL TOURISM IN MALAYSIA MEDICAL TOURISM INDUSTRY FACTORS: HISTORICAL AND PROJECTIONS TOTAL NUMBER OF HOSPITALS AND HOSPITAL BEDS IN MALAYSIA, 2005-2015 Malaysia had around ~ hospitals including ~ public and ~ private hospitals in 2005 with total ~ complement beds. This proportion has increased exceptionally to ~ public hospitals and ~ private hospitals in 2010. The total hospital beds have also grown steadily to ~ beds in 2010. This underscores the consistent development in the state of art facility and infrastructure for local and foreign patients. The government is heavily investing in the public healthcare sector in order to cater to emerging demand for quality medical and diagnostic services and regulating the private hospitals and medical centers operations. Every private medical center operating in Malaysia is required to be certified by the Ministry of Health, Malaysia. Moreover, hospitals which are serving the foreign patients should pass through the international certification standards… Figure: Number of Hospitals and Hospital Beds in Malaysia, 2005-2015 450 70,000 400 60,000 350 50,000 300 (Hospital Beds) 250 40,000 (Hospitals) 200 30,000 150 20,000 100 10,000 50 0 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Hospitals Hospital Beds 21
  • 22. Table: Total Hospitals and Hospital Beds by Public and Private Sector in Malaysia, 2005-2010 Hospitals Hospital Beds Year Public Sector Private Sector Public Sector Private Sector 2005 2006 2007 2008 2009 2010 HEALTHCARE EXPENDITURE IN MALAYSIA, 2005-2015 The Malaysia healthcare sector is similar to South Africa which is divided into public and private health care. The public health care system is used by most of the population living in Malaysia whereas the private sector health care services are rather afforded by the affluent class only… Around USD ~ billion was spent in 2010 on healthcare services. The government allocated a budget of total RMB ~ billion for the general improvement of the healthcare sector in the country in 2010. The amount is expected to be spent on purchasing new equipments, distribute large number of medicines, training of human resources and construction of more hospitals and medical centers. Increased efforts are being made to provide facilities in Sabah and Sarawak states in Malaysia…. 22
  • 23. Figure: Healthcare Expenditure in Malaysia, in USD Billion, 2005-2015 20.0 18.0 16.0 14.0 USD Billion 12.0 10.0 8.0 6.0 4.0 2.0 0.0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 MEDICAL TOURISM IN SOUTH KOREA FOREIGN PATIENTS BY DESTINATION IN KOREA, 2010 …. Although in 2009, Incheon was one of the leading regions in the country, Daegu has showcased phenomenal growth in number of medical tourist arrivals in 2010. The medical tourists increased by ~% in 2010 from ~ in Out of the total foreign patients visited in 2009. In 2009, Daegu represented ~% of the South Korea, Seoul with ~ received the maximum number of foreign patients medical tourist’s visits in South Korea which followed by Gyeonggi with ~ patients and increased to ~% in 2010. Daegu with ~ Some of the prominent medical centers and institutions in the country are Keimyung University Dongsan Medical Center and Hyosung Hospital. Dongsan medical center in South Korea is one of the leading medical centers in the country and is expected to a play a very crucial role in determining the growth of Daegu as the country’s leading medical region…. 23
  • 24. Figure: Foreign Patients by Destinations (Seoul, Gyeonggi-do, Daegu, Busan, and Incheon) in Korea in Percentage, 2010 Seoul Gyeonggi-do Daegu Busan Incheon Others Table: Foreign Patients by Destinations (Seoul, Gyeonggi-do, Daegu, Busan, and Incheon) in Korea, 2010 Destination/Province Foreign Patients, 2010 Seoul Gyeonggi-do Daegu Busan Incheon Others DISCLAIMER No part of this manual or any material appearing may be reproduced, stored in or transmitted on any other Web site without written permission of AM Mindpower Solutions and any payments of a specified fee. Requests to republish any material may be sent to us. 24