medical tourism in India

1. Dr Avinash Borkar
Associate Professor, Community Medicine
HEALTH
TOURISM

2. Scope of Presentation
 Introduction to tourism
- Tourism in general
- Types of Tourism
- Health Tourism
- History of Health Tourism
- Definition of Health Tourism
- Drivers of Health Tourism
 Probable Process of Health Tourism
 Links in Health Tourism
 Destinations of Health Tourism
- Singapore
- Thailand

3.  Health Tourism in India
- Facts
- Why India
- Systems in India
- Treatments
- Health Tourism Zones
- Companies
 SWOT Analysis
 Govt. Policy
- New National Tourism Policy (2002)
-11th Five Year Plan
- Medical Visa
- State Govt.
 Indian Healthcare Federation (IHCF)
 Insurance
 Criticism
 References

4. Introduction to Tourism
What is TOURISM
Urry 2002 – It is a leisure related activity separated from everyday
whereby the tourist gazes upon ‘others’ in the foreign locality
Types of tourism
1.Adventure tourism 7. Disaster tourism
2.Agritourism 8.Drug tourism
3. Ancestry tourism 9.Educational tourism
4.Bookstore Tourism 10.Heritage tourism
5.Cultural tourism 11.Sport tourism
6.Ecotourosm 12. Medical tourism

5. Health Tourism
• The term initially used by travel agencies and mass media
- to describe rapidly growing practice of travelling across
international border to obtain health care
• travelling to far off places for treatment and health
improvement is not new but is known since ancient time.

6. History
• In Ancient Greek – Asclepius temples –World’s
1st Health centre
• In Rome – Hot water baths
• In 13th century,Mansuri hospial in Cairo –
8000 people – healthcare destination
• In 18th century wealthy European travelled
Spas from Germany to Nile
• Later wealthy people began travel travelling
to tourist destination like Swiss lakes, Alps and
special tuberculosis sanatoriums

7. • The ultimate aim of health travel is tour to trustable destination
for sake of medical treatment at the measurable cost
• It mixes leisure, fun and relaxation together with wellness and
healthcare.

8. Definition
“ A practice of travelling from one country to another for the
purpose of obtaining medical care or treatment”
• Provision of cost effective medical care with due consideration
to quality in collaboration with tourism industry for foreign
patients who need specialized treatment and surgery
Health
tourism
Travel
tourism
Pleasure,
physical &
mental
relaxation Value
addition of
medical t/t
at low cost

9.  Alternate terms
Health tourism
Medical tourism
Medical journeys
Global healthcare / Cross border healthcare
Medical value travel
 Worlds largest after retailing
 Global healthcare revenue US$ 2.8 trillion
 Presently health tourism is a rapidly growing and multibillion
dollar industry

10. Drivers for medical tourism
• Long waiting lists in the hospitals in one's own country
• Availability of affordable & quality health care organizations
• Opportunity to combine vacation with wellness with inexpensive
and affordable travel
• Availing services that are illegal in one's own country, e.g.
abortion, euthanasia. For instance, euthanasia for non-citizens is
provided by Dignitas in Switzerland

11. Probable Medical Tourism Process
How MT Works
i. Advertising of available treatments in a particular hospital /medical
packages offered
ii. Enquiries
iii. Registration at the hospitals
iv. Arrival of patient to the host country
v. Transport
vi. Medical Assistance
vii. Medical treatment
viii. Patient recovery
ix. Alternative treatments
x. Sight seeing

12. Links in Medical/Health Tourism
• The traveller
• Foreign tour operator
• Hospitals
• Insurance companies
• Travel Agents
• Tourist destination/place
• Local tour operator
• Local guide
• Local hotels
• Local market
• Independent medical referral companies
• Government & Policy Makers
These actors interact with each other, directly or
indirectly, to form a network

13. Possible Service Sector Network

14. Destinations
The leading
countries
Thailand
Singapore
India
Malaysia

15. Thailand
– Top of the global medical tourism market
– Attracts maximum Americans & western
expatriates across South East Asia
– 14 accredited hospitals by the JCI.
– Bangkok, a center for medical tourism
Year Number of
international
patients
Number of
medical
tourists
(estimate)
2008 1,500,000 300,000
2007 1,400,000 280,000
2006 1,000,000 200,000

16. Singapore
– an ideal destination
– modern infrastructure
– a clean and structured environment
– an English-speaking populace
– Singapore Tourism Board
Year Medical Tourists
2002 2,10000
2003 2,30000
2004 3,20000
2005 3,74000
2006 4,10000

17. Medical tourism - India
Deep tradition – 5000 yrs ago
Along with strong existence of modern
health facilties ,Indian traditional
healthcare system also devasting
Diverse destinations

18. Tourism in India- facts
• An important component in India’s service sector
• Tourism – 6.11% of GDP , compared to 10% GDP in
world
• Share of India - 0.39% - 1995
- 0.52% - 2006
• 4.40 million international tourists in 2006
• Nearly 2/3 - UK and USA
• Per tourist - > 2000 $ compared to world average of
$ 873 , 2006
• a foreigner spend in the range of 7 to 18 d ( 16 d ).
• Foreign exchange - over Rs. 30,000 crores.

19. Table 1

20. Graph 1

21. Graph 2

22. Table 2 - Foreign Exchange Earnings through Tourism
Source: Market Research Division, Department of Tourism, GOI.

23. Figure 1

24. • 97000/4.4mill foreigner ,2006,- for healthcare
purpose
• The International Passenger Survey ,(2003 ),
2.2% - healthcare purpose
• Out of 2 million NRIs - 10% healthcare objective
• about 200,000 NRI + foreigner, 300,000 patients.
• 5% of foreign travelers undertake wellness
systems
• Thus, it may be quantified that the healthcare
visitors - range of around 500,000.

25. • Average spending - US $ 2000 per person.
• The healthcare tourism industry in India
generated revenue of over US $ 600 million
(or about Rs 2400 crores) in 2006.
• According to study conducted by the
Confederation of Indian Industry and Mc
Kinsey consultants, reported that 1.5
lakh,with 15% rise every yr. & health tourism
alone can bring additional revenue of Rs.
5000-10000 cr. By 2012
• The growth rate of Medical Tourism Industry
@ 12% in 2002 will go to @ 30% annually by
2012

26. Why India ?
“ First World Treatment at Third World Costs ”
1. Low cost
2. World class treatment
3. Qualified medical staff
4. Good hospital standard
5. Less waiting time
6. Low travel cost
7. No language barrier
8. Convenient, inexpensive flights to India
9. Diverse tourist destination
10. Top class luxury resorts .
11. Hub for various alternative medicines ( Indian special )

27. Systems of Health Tourism in India
• Medical tourism, especially in India has :
 Modern Treatment
 Indian System of Medicine
- AYUSH

28. Modern t/t
Dental surgery Cosmetic Heart surgery Eye surgeries
Organ
transplantation
Orthopaedic
surgery
Neurosurgery
Hip
replacement

29. Table 3 : Cost Comparison between India, USA & UK.

30. Table 4 : Procedure charges in India, USA & UK (Rs.)
Procedure India USA
Bone 69000 250000
Liver 69000 300000
Heart 8000 30000
Ortho 6000 20000
Cataract 1250 2000

31. Accreditation of Hospitals
• To accredit health services according to set standard
• Indicator of professional achievement and quality of care
• National Accreditation Board for Hospitals
and Healthcare (NABH)
• Joint Commission International ( JCI )

32. NABH
• Quality Council of India (QCI) in 1997
• Stakeholders - government, consumers, and healthcare industry
• a framework for quality assurance and quality improvement in
hospitals, focussing on patient safety and quality of care.
• The standards equally applicable to hospitals and nursing homes
in the government and the private sector.
• separate standards for Ayurvedic Centres in the country, in
addition - formulate standards for ambulance services, blood
banks, dental centres and stand-alone clinics.

33. Outline of NABH Standards
• Access, Assessment and Continuity of Care
• Patient Rights and Education
• Care of Patient
• Management of Medication
• Hospital Infection Control
• Continuous Quality Improvement
• Responsibility of Management
• Facility Management and Safety
• Human Resources Management
• Information Management System

34. Joint Commission International (JCI)
• A U.S. based international agency , the international arm of
Joint Commission for Accreditation of Health Care Organization
(JCAHO)
• accreditation by this agency guarantees - the quality of care
comparable a domestic hospital in US
• By 2007 , 8 hospitals in India but now 16
• India – 9th

35. JCI Accredited Hospitals in India
1. Indraprasta Apollo Hospital, New Delhi
2.Wockhardt Hospital, Mumbai
3. Apollo Hospitals, Chennai
4. Shroff Eye Hospital, Mumbai
5. Apollo Hospitals, Hyderabad
6. Asian Heart Institute, Mumbai 3,
7. Satguru Pratap Singh Apollo Hospital, Mohali
8.Fortis Hospital ,Mohali

36. Graph 3 : Country-wise JCI Accredited Hospitals in
the World

37. Hospitals Accrediated After 2007
1.Ahaliya Foundation Eye , Hospital ,Pallakkad, Kerala
2.Apollo Hospital Bangalore ,Karnataka
3.Apollo Glenagles Hospital ,Kolkata,West Bengal
4.Fortis Escort Heart Institute, New Delhi
5.Grewal Eye Institute,Chandigarh
6.Moolchand Hospital, New Delhi
7.Sri Ramchandra Medical Centre,Chennai,Tamilnadu
8.Fortis Hospital Bangalore, Karnataka

38. Apollo Hospital, Hyderabad Fortis Hospital, Delhi
Wokhardt Hospital,
Mumbai
Wokhardt Hospital
Bangalore
Growth of International Standard Hospitals
Health care facilities at
same std. of united states
Special wards for
foreigner and special
desk
Speciality field
Showcasing Indian skills
to world – conferences
Shroff Eye Hospital,
Mumbai

39. Traditional Healthcare System- Indian System of
Medicine (ISM)
Ayurveda –
• A unique health care system -
• Established- 600 BC.
• A complete naturalistic system
• Depends on the diagnosis of the body's
ailments to achieve the right balance
• Therapies –
1.Rejuvenation Therapy (Rasayana Chikitsa)
2.Body sudation (Sweda Karma)
3.Panchakarma

40. Yoga
• A fitness system of Indian origin
• a secular and scientific methodology to experience the
integration of the mind-body-spirit
• Become need of fast paced lifestyle
• Large number of professional yoga institutes
• Eg.The Yoga Institute, Santacruz (East), Mumbai
• Worldwide institutions – governing bodies in India

41. • Along with Unani,Siddha ,homeopathy;
Aromopathy – a emerging new technique
of treatment
• It is a massage therapy with some oil
extracted from herbal products

42. Spiritual /Faith healing in INDIA
• Controversial – attract foreigner
• India – many religious monuments like
Dwarka ,Vaisnodevi,Ajmer
• Specially for mental healing –
Gunaseelam and Chotanikkara
• Motivating speakers and proponent of
spirutuality – attract tourists
• Eg. - Swami Baba Ramdev, Sri Sri
Ravishankar

43. Medical tourism zones in India
Kerala – The Pioneer state
• Strongly focuss on Ayurveda – wide
array of t/t
• Capitalizing on its Rich Cultural
Heritage and alternate medical
therapies
• Some institute and resort -
1. Amba Ayurvedic Hospital, at
Kottayam
2. Oasis Ayurvedic Hospital –
Panchkarma and research centre,
Pathanpuram
3. Kairali Ayurvedic Health Resort

44. Karnataka’s Foray
• Karnataka has diverse flora and fauna
which makes it a nature tourist’s paradise
• Highest number of approved health system
and alternative therapies
• Hospitals in Karnataka - 8000 health tourist
every year
• Apollo Hospital ,Bangalore

45. Tamilnadu
• Several multi-speciality hospitals
• Also provide other alternative forms of medicine

46. Maharashtra
• A gateway to India -offers
tremendous potential to develop
medical tourism.
• Asian Heart Institute , Mumbai -
offers facilities for all types of heart
complications and preventive
cardiological treatment
• This institute in collaborating with the
Cleveland Institute, U.S.A offers ‘Five
Star’ services at reasonable prices
• Pune,Aurangabad,Nagpur – emerging
medical tourism destinations

47. Companies promoting Health
Tourism in India
• Erco travel, New Delhi
• Med In India
• Sahaj Dental Clinic, Haryana
• Mediscope
• Indicure .New Delhi
• Medi Tours ,Trivendrum

48. SWOT analysis of the Indian Medical
Tourism
Strengths
 Quality and Range of Services
 Affordable costs
 Internationally reputed
hospitals
 Qualified doctor staff
 Diverse destination
Weakness
 No strong government support/
initiative
 Low coordination between the
various players
 Lack of uniform pricing policies
 Cheating
 Political problems

49. Opportunities
 Increased demand from
countries with aging population
(US, UK)
 Increases demand for wellness
tourism and alternative cures.
 Shortage of supply in National
Health Systems in countries like
UK, Canada.
 Demand from countries with
underdeveloped healthcare
facilities.
Threats
 Strong competition
 Lack of international
accreditation
 Lack of Insurance provider
 Under-investment in health
infrastructure
 Exorcism is more in India
 Identifying a real practitioner –
a major problem in India
 Exploitation of tourists by
illegal money changers

50. Govt. Policies
• The tourism industry, 2nd largest
• Contribute – 6.11% GDP
• With 100,000 patients /year and revenue of Rs.15 Billion.
• create 40 million jobs – 9% of total employment
• The Ministry of Health and Family Welfare together with the Ministry of
Tourism of the Government of India - Task Force.
• The Task Force - evaluate the opportunities in the industry and formulate a
policy for accrediation

51. New National Tourism Policy (2002)
• Harness - employment generation, economic development and
providing impetus to rural tourism
• Focus on domestic tourism - a major driver
• Position India as a global brand to take advantage of the global
travel trade
• Acknowledges the critical role of private sector with government
• Create and develop integrated tourism circuit

52. Five key strategic objectives
1. Positioning and maintaining tourism development as a
national priority activity
2. Enhancing and maintaining the competitiveness of India as a tourism
destination
3. Improving India’s existing tourism products and expanding these to
meet new market requirements
4. Creation of world class infrastructure
5. Developing sustained and effective marketing plans and programmes.

53.  The key areas identified to provide the requisite thrust
to the tourism industry include –
• ‘Swagat’ – welcome
• ‘Soochana’ – information
• ‘Suvidha’ – facilitation
• ‘Suraksha’ – safety
• ‘Sahyog’ – coopration
• Samrachana’ – infrastructure development
• ‘Safai’– cleanliness.

54. 11th Five Year Plan
• To focus on creation of adequate tourism infrastructure –
- modernization and expansion airport
- increase in accommodation facilities under star and budget
category
- improved road connectivity to tourist destination
- to preserve historical places
- reduction in various taxes
- provision of hassle free inter-state travel
- conduction of skill development program in hotels

55. Medical (M) Visa
• Tourist visa – non convertible,non extendible,valid
6 mnth
• Medical visa –
- Valid 1 yr / period of t/t ,extendible
- Valid for 3 entries in 1 yr
- For recognised hospital t/t and also for ISM
- For –neurosurgery,opthalmic disorder,heart related
problem,renal disorder,organ transplantation,plastic surgery, joint
replacement
- Attendant / family members also granted (2 persons)

56. At State level
• Kerala – Kerala Tourism Devpt.
Corporation(KTDC) promote tourism and
developing Ayurvedic Health Centre
• Karnataka – Bangalore International Health
City Corporation , on IT skills – Telemedicine
• Maharashtra
- Tourism Devpt. Council (MTDC)
- Medical Tourism Council of Maharashtra
• Gujrat – devpt. Integrated medical tourism
circuit

57. Indian Healthcare Federation (IHCF)
• An independent nonstatutory body,
300 members,
( non-government hospitals + diagnostic centers + medical
equipment manufacturers + pharmaceutical firms.)
• The main objective - to promote and encourage healthcare
industry in the country
- provides a common platform to discuss various issues
- ensure organized action wherever necessary
- endeavours for a disease free India
- ensure to provide accessible quality healthcare at affordable
cost

58. Ten point agenda
1.Government spending on Healthcare in India is low, it stands at 0.52%
of the GDP and it should be increased to atleast 6%
2.Government should give more focus on Public Health especially rural
primary care, with greater decentralisation to increase
effectiveness
3.Spur private investments in under-served
4.Create public-private partnerships
5.Increase availability of qualified practitioners in rural area (incentives)
6.Central & State Governments to create incentives to attract
investments in medical colleges and nursing schools in under-served
areas
7.Government should stimulate the growth of private, social and
community health insurance to improve affordability.
8.Give greater autonomy to hospitals.
9.Set up more hospitals in the lines of AIIMS and upgrade existing
Medical Colleges to the level of AIIMS
10. Affordable Medicines

59. Insurance
• Professional Liability Insurance
- Claims against the insured arising from the actions of
consultants, sub-contractors or agents
- Breach of confidential information/ privacy extension
- Worldwide territory/ jurisdiction
- Accidental death as a result of the medical
procedure or accident
- Permanent disablement from the medical procedure
or accident
- Return trip extension
- Medical expenses for further consultation
• Complications Insurance
- Follow-home medical coverage for complications
arising from a covered medical procedure.

60. Criticism
• In India, some argue that a "policy of 'medical tourism
for the classes and health missions for the masses' -
will lead to a deepening of the inequities”
• In Thailand, in 2008 it was stated that, "Doctors in
Thailand have become so busy with foreigners that
Thai patients are having trouble getting care”

61. Health Tourism A Boon or Curse?
 From patient’s view
1. Medical vacations can
be affordable
2. Medical tourism
provides you with
options
3. Medical vacations can
be fun
 From country’s view
1. Government revenues
2. Economic development
3. Capital development of
healthcare infrastructure
4. Publicity of culture
5. Employment
‘ Can be a Boon’

62.  From patient’s view
1.Medical Malpractice sue
2. Insurance Laws vary
3. Postoperative Treatments /
follow up – expensive
4. It's Best Not to Travel Alone -
drives up the total price
5.Ethical issues
 From country’s view
1.Environmental destruction
2.Pressure on local resources like
energy, food and other raw
material
3. Earginal employment
4. Unrealistic expectations
5.Diverted and concentrated
development
6. Unstable market
‘ Can be curse’

63. References
1. Healthcare Tourism In India 1 Report of the National Commission on
Macroeconomics and Health, Ministry of Health and Family Welfare,
Government of India, August 2005
2. Swot Analysis On: Medical Tourism Kalyan Chakravarthy K, C H. Ravi
Kumar and Deepthi K Conference on Tourism in India – Challenges
Ahead, 15-17 May 2008
3. Indian Medical/Health Tourism Service Sector Network Report
Sustainable Industrial Networks and Its applications on Micro Regional
Environmental Planning (SINET),2006
4. HEALTHCARE TOURISM OPPORTUNITIES FOR INDIA, Chapter – III
Healthcare Tourism in IndiaVinayshil Gautam, Avdhut Kumbhavdekar
for Export-Import Bank of India andQuest Publications2008,

64. References
5. National Health Programs of India , J. Kishore , 9th edition, Century
publication
6. International Passenger survey -2003; Incredible India, Ministry of
tourism, February 2006.
7. What is health and medical tourism? by Peta S. Cook Humanities
Research Program Queensland University of Technology
8. Medical tourism: Implications for providers and plans Mark S. Kopson
Medical Tourism: Consumers in Search of Value,” Deloitte Center for
Health Solutions (April 14, 2009)
9. Joint Commission International - reviews both American and
international medical and dental facilities, using United States
standards.

65. References
10. American Medical Association Guidelines on Medical
Tourism (June 2008)
11. Indian Healthcare
Federation;www.indianhealthcarefederation.org
12. htpp:// www.incredibleindia.org
13. htpp://www. wikipedia.com
14. htpp://www.keralatourism.org
15. htpp://www.maharashtratourism.gov.in
16. htpp://www.kstdc.net
17. htpp://www.tamilnadutourism.org
18. htpp://www.gujarattourism.com
19.htpp://www.stb.com
20.htpp://www.thailandmedtourism.com

66. Thank
you