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The Introduction To Medical Tourism Tourism Essay

A patient going to a different country for either urgent or elective medical procedures is called medical tourism. Medical tourism is a term that has risen from the rapid growth of an industry, where people from all around the world are traveling to other countries to obtain medical, dental, and surgical care, while at the same time touring, vacationing, and fully experiencing the attractions of the countries that they are visiting. Medical tourism is next booming sector in India as information technology. Patients going to a different country for either urgent or elective medical procedures are fast becoming a worldwide, multibillion-dollar industry. The reasons patients travel for treatment vary. Many medical tourists from the United States are seeking treatment at a quarter or sometimes even a 10th of the cost at home. From Canada, it is often people who are frustrated by long waiting times. From Great Britain, the patient can't wait for treatment by the National Health Service but also can't afford to see a physician in private practice. For others, becoming a medical tourist is a chance to combine a tropical vacation with elective or plastic surgery. And more patients are coming from poorer countries such as Bangladesh where treatment may not be available. Medical 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. In the 21st century, relatively low-cost jet travel has taken the industry beyond the wealthy and desperate. Countries that actively promote medical tourism include Cuba, Costa Rica, Hungary, India, Israel, Jordan, Lithuania, Malaysia and Thailand. Belgium, Poland and Singapore are now entering the field. South Africa specializes in medical safaris-visit the country for a safari, with a stopover for plastic surgery, a nose job and a chance to see lions and elephants. Health tourism is another name or synonym for medical tourism. However it is sometimes used in the context of wellness, where people are looking to make healthy lifestyle choices such as eating better, practicing yoga or undergoing spa treatments. Medical Travel is another name or synonym for medical tourism.

Medical Wellness and Spas

Medical Spas and Wellness is sometimes called Health Tourism. Medical Wellness and Medical Spas have become an accepted industry within healthcare. People's wellness in general has been seen as a way to heal the body naturally. Many hospitals around the world have started to integrate medical wellness. Sometimes these medical wellness and spa treatments are called "complementary" or alternative treatments. The mayo clinic recommends for certain people the following forms of medical wellness for cancer patients, Acupuncture, Aromatherapy, Biofeedback, Exercise, Hypnosis, Massage Therapy, Music Therapy, Relaxation, Tai Chi, and Yoga.

Medical Packages

The health care sector in India has witnessed an enormous growth in infrastructure in the private and voluntary sector. The private sector which was very modest in the early stages has now become a flourishing industry equipped with the most modern state-of-the-art technology at its disposal. It is estimated that 75-80% of health care services and investments in India are now provided by the private sector. An added plus had been that India has one of the largest pharmaceutical industries in the world. It is self sufficient in drug production and exports drugs to more than 180 countries.

Bone Marrow Transplant

Brain Surgery

Cancer Procedures (Oncology)

Cardiac Care

Cosmetic Surgery

Dialysis and Kidney Transplant

Drug Rehabilitation

Gynecology & Obstetrics

Health Checkups

Internal/Digestive Procedures

Joint Replacement Surgery

Nuclear Medicine

Neurosurgery & Trauma Surgery

Preventive Health Care

Refractive Surgery

Osteoporosis

Spine Related

Urology

Vascular surgery

1.2 Medical Tourism in Karnataka

Situated in the southern part of India, the state of Karnataka spreads over the Deccan Plateau. At 300 BC., it had formed the southern tip of the Mauryan Empire. Its boundaries enlarged or receded swaying to the drum beats of history & today it accounts for a sixteenth area of India & has a population of about 45 million. Its language is Kannada & its people are known as kannadigas. The three distinct regions are a narrow coastal area along Arabian Sea; high hills, the Western Ghats; & sprawling plains towards the east. Karnataka popularly known for Carnatic Music through out the World has given much more to the World than Carnatic Music, a unique form of Classical Music patronized by many across the continents. Karnataka with all its richness in culture and traditional grandeur is also one of the fastest growing states in terms of industries and facilities. Karnataka is also known as the Capital of Agarbathi (Incense Sticks), Arecanut, Silk, Coffee and Sandal Wood. All this is apart from the fact that it has been the culture center for hundreds of years and its testimony stands spread across the state pulling millions of tourists from all parts of the world to Karnataka. Karnataka was known as Karunadu (elevated land) in ancient times. It is also believed that the name Karnataka has come from "Kari-nadu" meaning the land of black soil say the scholars & some others hold that Karunadu also means beautiful country; either way the land is celebrated as beautiful throughout its ancient literature. The western strip across the Arabian sea is humid & warm in summer, water-soaked in monsoon, profuse with coconut grooves & paddy fields criss-crossed by strips of silvery streams & sparkling stretches of sand. The hilly uplands of Malanad, One of the wettest regions of the world, where the bamboo flourishes wild & areca, teak, rosewood & matti are grown. It is also the home of the stately gaur & langur. In its southern reaches frequent kheddas are held to capture roaming groups of elephants. Also the swift deer & the deadly tiger, roam animatedly in the forests. The east of the ghats is strikingly bare. This elevated stretch is supposed to be the oldest land on the earth where ancient rocks of earth are seen jutting in & out odd shapes. Rivers like Cauvrey, Sharavathi & Ghataprabha pass through upgraded valleys & resulting in water-falls & occasional rapids.

1.2.1 The Capital par excellence

The capital par excellence Bangalore today has become an Industrial Metropolis. It is also called India's science city. Sophisticated industries in the public sector employ thousands and thousands of workers. It is also called the Electronics city because most of the country's basic electronic industries are based here. It is the fastest growing city in Asia. Aircraft building, telecommunication, aeronautics, machine manufacture, etc., have taken giant strides here. Bangalore was known for its salubrious climate, which however is now being debated because of the accelerated progress of modern industry. It is also called an air-conditioned city and a pensioner's paradise. Karnataka is beautiful not only in the eyes of her sons and daughters. She captivates any one who sets eyes on her. It was the great Mauryan Emperor Chandragupta who traversed all the way from Magadha to distant Sravanabelagola to lay his remains in this land before entering the Kingdom of God. The course of Karnataka's history and culture takes us back to pre-historic times. The earliest find of the Stone Age period in India was a hand axe at Lingasugur in Raichur district. The Ashoka's rock edicts found in the state indicates that major parts of Northern Karnataka were under the Mauryas. Chandragupta Maurya, the great Indian emperor abdicated the throne and embraced Jainism at Sravanabelagola. Adding new dimensions to the cultural and spiritual ethos of the land, many great dynasties left their imprint upon the aesthetic development of Karnataka's art forms. Prominent among them were the Chalukyas, the Hoysalas and the mighty Vijayanagara Empire. The Chalukyans built some of the very early Hindu temples in India. Aihole turned up as an experimental base for the dynamic creations of architects. The Hoysalas who ruled from the 11th to the 13th century chiseled their way into the pages of glory by building more than 150 temples each one is a masterpiece in its own way. The amazing dexterity and fluidity of expressions at Somnathpur, Halebid and Belur open themselves to the wide-eyed wonder in one's eyes. Vijayanagara, the greatest of all medieval Hindu empires and one of the greatest the world over, fostered the development of intellectual pursuits and fine arts. "The eye of the pupil has never seen a place like it and the ear of intelligence has never been informed that there existed anything to equal it in the world" is what Abdur Razaaq the Persian ambassador had to say about Krishnadevaraya's time.

The Vijayanagara Empire with its capital at Hampi fell a victim to the marauding army of the Deccan Sultan in 1565 A.D. As a consequence of this, Bijapur became the most important city of the region. This city is a land of monuments and perhaps no other city except Delhi has as many monuments as Bijapur. The Bahmani Shahis and the Adilshahis of Bijapur have played a notable part in the history of Karnataka by their contribution to the field of art and architecture and also by their propagation of Islam in the state. Hyder Ali and his valiant son Tipu Sultan are notable figures in the history of the land. They expanded the Mysore kingdom on an unprecedented scale and by their resistance against the British, became personages of world fame. Tipu was a great scholar and lover of literature. His artistic pursuits were also many and he made rich gifts to the Hindu temples. Tipu Sultan "Tiger of Karnataka" was killed in 1799 A.D., and the Mysore throne was handed over to the Wodeyar's. The whole of Karnataka came under the control of the British in the beginning of the 19th century. The new state was named as new Mysore and the Maharaja of Mysore was appointed Governor by Independent India. This unified state was renamed as Karnataka on November 1, 1973.

1.2.2 Karnataka on global medical map

Karnataka and especially Bangalore is now an acknowledged global medical destination. This is because of referral quality health services supported by qualified and experienced medical professionals, reputed medical research institutions, well connected for travel, conducive climate and cost of treatment being just one tenth that of global hospitals. Between 2005 end and 2006 August, the state has also witnessed a funding of 445 crore from leading corporate hospitals as a part of the brownfield and green field projects. These include a Rs. 200 crore from the Manipal Health Systems, Rs. 140 crore from Wockhardt Group of Hospitals, Rs. 100 crore from One World Hospital and Healing Centre promoted by Maureen Berlin and Rs. 5 crore by HealthCare Global Enterprises Limited (HCG), a leader in oncology care in the private sector in India. "Bangalore has been acknowledged as the city with the highest number of multi speciality medical centres which have successfully treated a large number of international patients. These hospitals have proved the clinical competence and clinical delivery systems,’’ In the last 18 months, there has been a major growth in the healthcare sector in the state. From new hospitals to expansions and partnerships, the healthcare sector is on an upward swing both at the government and private levels, stated the health minister.

Under the state government's medical tourism project, six ISO 9000 certified district hospitals strategically located at tourist spots in Mandya, Hubli, Chitradurga, Kolar, Belgaum and the Vani Vilas Hospital in Bangalore are now ready to administer treatment during tourist emergencies. One of the main reasons why patients from the west come here is the long waiting period for a surgery in their country. Hence healthcare in Karnataka is on an expansion mode, stated Vishal Bali, vice president, Wockhardt and president, Confederation of Indian Industry (Healthcare). The state attracts foreign tourists in large numbers right through the year and many of the medical facilities can provide treatment on par with international standards. The team of qualified doctors, paramedics and extremely low treatment costs open up a huge business potential arising out of the difference in the cost of treatment. "The ISO processes has helped in putting in place standardized protocols for functioning in all the departments of the hospitals in terms of processes and work instructions which are drawn from handling patients from reception to discharge. This has allowed the state to offer medical tourism services,'' stated Bali. Foreign tourists can cash in on the treatment cost factor which is one tenth lesser than in other countries stated Premachand Sagar, vice chairman and CEO, Sagar Hospital.

Bangalore is also known for its leading medical facilities in all disease segments which include cardiac, nephrology, oncology, mental health, neuro care, orthopedics, ophthalmology, general medicine. Hospitals here get patients from Bangladesh, Pakistan, Sri Lanka, the Middle East and several African countries. Patients come here even from the UK and the US, informed Dr. Nagendra Swamy, Manipal Hospital. The hospitals identified for the medical tourism project are A.J Hospital and Research Centre, Bhagwan Mahaveer Jain Hospital, Hosmat Hospital , Mallige Medical Centre, Mallya Hospital, Manipal, Sagar Apollo, St.. John's Medical College Hospital, Bangalore Institute of Oncology, Bangalore Kidney Foundation, National Institute of Mental Health and Neuro Sciences, Rajan Speech and Healing Centre and Shekar Nethrayalaya. Besides, the International Holistic Health Centre (IIHC), headed by Dr. Issac Mathai. IIHC where its health and medical centre referred to as 'Soukya' a recognised exclusive world class therapeutic facility which adopts the concept of holistic healing combining all systems of medicine and therapies is also a recognised centre by the Union government. Soukya-India is a full-fledged health and medical facility at Whitefield near Bangalore which is thronged by patients from 42 countries. "More hospitals, better services and corporate management have all created more jobs in the healthcare sector in Karnataka not just for doctors, nurses and technicians, but managers, administrators and IT-enabled services as well,'' stated government sources. For 2006-07, MHS will invest around Rs. 200 crore for setting up new hospitals and acquisitions. In Bangalore, a 300-bed facility will come up in 2009 neat the new international airport at Devanahalli in Yelahanka. This will be a one-of-a-kind Quardinary Care Centre focussing on multiple organ transplant among other specialities. "We need to deploy a combination of concepts in healthcare management like mergers, acquisitions and new investments which is an approach to survive in a high-risk business besides chalk strategies to keep ahead. In terms of bed strength, MHS is the highest in the country with a capacity of 5,000,'' informed R Basil CEO, Manipal Hospital.

Wockhardt Hospitals Group has commissioned its state-of-the-art second hospital in Bangalore which is on the Bannerghatta Road. The multi specialty 400-bed facility with cardiac care, brain & spine, bone & joint and women's health is expected to touch Rs. 140 crore investment once it is completed. The facility will have the highest intensive care unit of 75 beds. For paediatric cardiology it will become the National Referral Centre with a neonatal ICU of 15-bed. Between the two hospitals in Bangalore, the Group will have 520-bed offering. It will have the latest equipment from medical technology majors like Medtronic, GE Healthcare, Philips and Siemens and with the best medical professionals. A 200 bed One World Hospital and Healing Centre promoted by Maureen Berlin at an investment of over Rs. 100 crore on a 10 acre area within the premises of the leading 1,200 bed missionary medical centre, St. John's National Academy of Sciences campus. Is expected to be commissioned in late 2007. This is a multi super specialty hospital with eight operation theatres, 44 intensive care unit beds. The treatment and therapy is based on the 'blended medicine' concept proven and tried by Dr. Earl Bakken co-founded Medtronic, Inc. and inventor of the first transistorized cardiac pacemaker and founder, the North Hawaiian Hospital in the Big Islands, Hawaii. Hence the hospital will integrate modern medical practices along with yoga, Pranic healing and Reiki besides aqua-therapy proved by the western healthcare specialists HealthCare Global Enterprises Limited (HCG), a leader in oncology care in the private sector in India, has raised Rs. 5 crore in equity from IDFC Private Equity Fund II, a fund managed by IDFC Private Equity. The funds are to develop a nationwide network dedicated to oncology. Under the first phase of the project which entails an investment of Rs. 1.5 crore , 13 new cancer treatment centres at various locations and expansions to Bangalore Institute of Oncology will be made. Besides, PET-CT centre and GMP radiopharmaceutical unit and Central reference laboratory and clinical trials management centre will be set-up, stated Dr. Ajai Kumar, Chairman and Promoter of HCG Enterprises.

1.2.3 Dual Purpose Tourism

According to an official from the Karnataka Tourism Department, healthcare in Bangalore came into the limelight when Noor Fatima from Pakistan came to Narayana Hrudayalaya in July 2003, and was operated on by Dr Devi Shetty. After that, there was no looking back for the city. Her surgery was a landmark because not only did it help in thawing the hostility between the two neighbouring countries, but also drastically reversed the table in the medical scenario of the city for the better. Hospitals and corporate establishments in the city have realised the potential of this niche market and have accordingly channelised their needs and facilities. Travel agents and hotels are structuring their packages and holiday schemes in accordance with the inflow of foreign patients coming into the city. Corporate bigwigs like Apollo have collaborated with travel agents to come up with SitaCare in a bid to attract more tourists to the city. It's not just the Indians and the NRIs from the neighbouring countries who are streaming into India for medical treatment. Apart from NRIs, foreign patients mainly come in from the Gulf, Europe (mainly UK) surprisingly from South East Asia and the US. They come to Bangalore with a dual strategy in mind to get their medical treatment at one-third the cost and to explore Bangalore. A spokesperson from Thomas Cook India informs, "International patients mainly go to Coorg, Mysore, Hampi, Ketur, Belgaum and Bagalkot." In the long run, they add to the foreign exchange of the country. The idea is to kill two birds with one stone.

1.2.4 Bangalore as a destination

From being a global outsourcing centre, Bangalore has now become a health giver to the world. Medical tourism as a phenomenon is only eight to ten years old in the city. Compared to metros like Mumbai and Chennai, Bangalore was a late starter in the race. However, considering the entrepreneurial spirit of the city, it has caught up. Today, the city aims to become the numero uno in attracting foreign patients from all across the world. So the question is, why Bangalore? How has it managed to emerge as the hot seat for healthcare both for domestic and for offshore patients? Experts point out myriad reasons. Dr Kishore Murthy, CEO, Hosmat Hospital explains, "Bangalore is a well-known brand in the world. It is a knowledge city, has the top hospitals and also offers pleasant weather for patients coming here for treatment." Vishal Bali, CEO, Wockhardt Hospitals echoes, "Bangalore has a tremendous impact in the world. Today, people abroad associate India with Bangalore. There is a lot of new health infrastructure. Courtesy the IT industry it is known as the knowledge hub and the hospitals here are internationally acclaimed." According to a spokesperson from Manipal Hospital, "The weather of Bangalore is perhaps the biggest factor for foreign patients coming into the city. It suits almost all patients. Patients say that unlike other cities, they are extremely comfortable with the weather here." Vittal Murthy, Secretary, Kannada Culture Information and Tourism throws light on another aspect. "Bangalore has always been the hub for healthcare since the British era. Now, it has become the centre of attraction primarily because of the large number of top hospitals in the city and the innumerable medical institutes and colleges. Hence, the number of medical experts and professionals are also increasing by the day." Another source from Karnataka Government Tourism points out, "Most of the hospitals in Bangalore have capitalised on the growth of the floating population and the growth of the income bracket." Additionally, holistic health centres in the city also offer alternate systems of therapy like yoga, Art of Living courses and Ayurvedic therapies. Moreover, most experts from the industry acknowledge the fact that the cost of surgeries like cardiac surgeries, cancer treatment or an orthopaedic surgery is one-third the cost charged in developed countries like the US or the UK. There is also a close nexus between technology and the healthcare sector in Bangalore. "There have been cases in our hospital where a patient had not been diagnosed of a particular disease abroad but when they came here their disease was detected," adds the same spokesperson from Manipal. "Online appointments with doctors and specialists have made treatment easier and the waiting period for patients has considerably reduced. This in turn has led to an inflow of foreign patients into the city," informs HOSMAT’s Dr Murthy. The concept of telemedicine is being used on a large scale by hospitals such as Manipal and Narayana Hrudayalaya. Resumes of doctors are displayed online so that international patients can choose their doctors.

1.2.5 International Collaboration

Internationally-acclaimed doctors and specialists choose to venture out in this city-this is yet another feather in the cap for the city, which till date was only associated with IT. This is not all. Hospitals are having tie ups with internationally acclaimed medical brands. Bali adds, "Perhaps the plus point for Wockhardt is its association with Harvard Medical International (HMI), which has a reputation across the world for the quality services rendered to its patients. This in turn has led to more foreign patients coming into our hospital. International patients are very discerning. Before venturing out for treatment to another country, they see to it that they are well informed and not kept in the dark." At the end of the day, patients are always on the look out for quality services, and that is exactly what hospitals in Bangalore are aiming to achieve-to strike the perfect equilibrium between quality and quantity.

1.2.6 Different Strokes for Different Folks

Different hospitals adopt different strategies to attract overseas patients. Sagar Apollo Hospital, for instance, has systematically planned its strategies. "We have standardized almost all protocols in terms of smoother licensing with international system of integrated health-oriented value additions, holistic health solutions as well as conceptual health-oriented options. For instance, we have started with a system of cashless payment with providers and working on a new concept healthcare focusing not only on the highest international standard healthcare but also on integrated health and hospitality snergy where the services are not just promoted as a package. It is rather positioned as an effort to highlight Bangalore as just not a medical hub but as a place which in technology travellers in taking their healthcare beyond boundaries at their personal standards." Hospitals in Bangalore are now providing the services usually provided by a five-star hotel. Accommodation in hotels, which is usually a herculean task for foreign patients, is provided both for the relatives as well as the patients. HOSMAT Hospital even has a building within its campus to accommodate relatives of patients. Airport drops and pick-ups for patients and relatives are all rendered by the hospitality division of the hospital. Most of the hospitals have come up with a travel desk to cater to foreign patients and their relatives. Manipal Hospital, for instance, has an International Patient Care Centre. Additionally, a lot of emphasis is laid on the infrastructure of their hospital. Manipal, for example, has specially designed delux rooms, with posh décor and offers myriad facilities like pantry service and a wireless Internet connection. HOSMAT Hospital is coming up with two floors in its premises dedicated to international patients. These two floors alone have around 80-100 beds. This is indicative of the growing realisation about promoting medical tourism in the city.

1.2.7 Government Does Its Bit

Apparently the Karnataka Government is taking a slew of initiatives in promoting medical tourism in the state. An expert says, "Not just the Karnataka Government, but State Governments all across the country are realising the potential and the benefits that can come about through medical tourism." Most experts from the industry have acknowledged the fact that the State Government is supportive and enthusiastic in promoting medical tourism in the city in particular and the State as a whole Commissioner, Department of Tourism, Karnataka, states, "We have regular annual meets wherein we talk with the medical industry on a one-to-one basis. We do have plans to form a council of the medical community, but it is in a nascent stage as of now." The Karnataka government right now is working in a meticulous manner. They first conduct research to study key players in the field, which include not just the top hospitals but travel agents and consulates in the city. Their performance over the year is reviewed and simultaneously suggestions are taken. "Consulates and travel agents have their networks abroad. So, it is easier for us to have international conferences and contacts," adds Tourism commissioner. Vittal Murthy also gives an interesting bit of information. "After the advent of the IT industry in Bangalore, the IT park was opened up. On similar lines, with the advent of the healthcare industry here, we are contemplating opening up a health park." However, the endeavour is still in its ideation stage and will take some time before it takes shape. The Government also holds health tourism expos. A recent one was held at Bahrain. Such meets are a platform for the Government to meet international experts from the medical fraternity and brief them about the competence of Indian healthcare industry. It's not just the State Government which is putting in a lot of interest. The Central Government, realising the potential of this sector, has come up with a national agenda and is holding tourism trade fairs at regular intervals around the year. This has given new impetus to medical tourism. Naik diplomatically adds, "We are open to anything that will promote medical tourism. Ultimately, it is the doctors and experts from the medical fraternity who are responsible for the boom of medical tourism in the city." This remark is indeed a testimony to the positive nexus of private healthcare with the government.

1.2.8 Travel Reaps the Fruits

It is not just the hospitals which are grabbing the limelight. Travel agents and hotels are cashing in on the situation and are coming up with schemes and packages to attract foreign patients to the city. They are gradually realising that immense benefits can be reaped. The Leela Palaces and Resorts, Bangalore, which purely caters to the corporate class, have now decided to spread its wings according to the change in times and trends. The five-star hotel group has decided to tie up with Manipal Hospital. Nitienaa Arif, Head- PR and Communications, Leela Palaces, Bangalore mentions, "We are a business hotel, but understanding the need for medical tourism in the city, we have tied up with Manipal. Everything is in the processing stage." This is not all. The five-star hotel has also joined hands with Globe Health Tours. Air Travel Enterprises (ATE) also offers a whole lot of packages to foreign patients. EM Najeeb, Chairman and Managing Director, ATE, points out, "We offer packages for cardiac surgery, plastic surgery, dental surgery, Ayurveda and orthopaedic surgeries." In addition to this, ATE has a meticulous plan chalked out. "We first identify patients who want medical treatment in this part of the country. We then recommend them to hospitals. Their arrival, departure and accommodation are all handled by us." An important point to remember is that the role of travel agents and hotels is only in its elementary stage. Purnima Castelino-D'abreo, Public Relations Executive, Taj Hotels Resorts and Palaces, Bangalore, states, "Medical tourism is in a nascent stage, but we are looking at cultivating it as a potential segment." The opening of the international airport in the city has attracted the attention of not just the tourists but even players in the hotel industry. Altogether, there are 39 projects coming up in the city. This, in the long run can eradicate problems of accommodation in the city. It will take some time before these agents become one of the major forces in promoting healthcare in Bangalore. Vigilance and patience are the keywords-perhaps the means to achieve that end.

1.2.9 Hurdles to Overcome

The grass always looks greener on the other side of the fence. But the fact remains that for any upcoming trend, the journey is not smooth sailing. There are always two sides to any story. As of now, the major obstacle that might hamper the growth of this promising trend is the unsystematic infrastructure of the city. Due to increase in the floating population, the roads are congested and traffic snarls have become the order of the day. Hene, commuting in the city has become a major problem. Paucity of hotel accommodation within the city for patients and relatives also poses an obstacle for international patients coming to the city. Despite an increase in service flats and a boom in the real estate business, there is no change in the problem. International flights have commenced in Bangalore, but there is connectivity only to a few countries. Bali points out, "The first impression is lasting in the mind of a person visiting Bangalore for the first time. International patients in particular get dismayed at the appalling conditions of Bangalore's infrastructure in contrast to the plush décor of the hospitals." Daniel gives another interesting aspect, "In case of medical evacuationswhere patients have to be airlifted, at least eight seats have to be reserved. Most of the time, this is not possible. Moreover, a lot of money is required to transport the doctor, the attendants the patients and their relatives."

1.2.10 Possible Solutions

Government officials have chalked out a solution to this problem. "In another one to one and a half years, the international airport in Bangalore will have connectivity with almost all the major countries across the globe," predicts Murthy. He further adds, "We are also coming up with a Metro Rail Project and five townships in the city to ease congestion." There are plans to launch air ambulances and helipads to facilitate easy transport of patients from other countries. And as far as the problem of accommodation is concerned, most hospitals are coming up with accommodation within their premises for patients as well as their relatives. Moreover, more than hotels, service flats coming up in every nook and corner of the city are now proving to be the answer to the problem of accommodation. In fact most of the five-star hotels along with their hotel room services also have their own service flats. Subratrin Paul, Director of Sales, The Oberoi Hilton Hotel, Bangalore illustrates, "Bangalore hotels are expensive. Foreign patients coming for treatment will not want to shell out a lot of money just for accommodation. They will be looking at cheaper options to save money. I have not seen too many foreign patients putting up at five-star hotels." As far as medical tourism in the IT city is concerned, the good news is that experts and Government officials are positive that with the flow of time, they will be successful in effacing the hurdles that lie in their path.

1.2.11 Hope Not Hype

The question now that confronts healthcare Bangalore - is it all just hype? Experts assert to the contrary. Murthy emphasizes, "We are confident about the potential of the city and it is certainly not a passing phase or a bubble that might burst anytime." Bangalore is now going through a similar stage that Thailand was going through around five years ago. Through their own expertise and by collaboration with the Government, Thailand became one of the leaders in South East Asia. Medical pundits predict that a few years down the line, Bangalore might rise to that level. Therefore there is an air of confidence among doctors that medical tourism is here for good and to bring about radical changes in the industry. It is definitely not a mirage to fade away in an instant.

1.2.12 Medical tourism 2nd fastest growing sector after IT

Medical tourism is booming in Karnataka and the prospects for growth are second only to the information technology sector. At least that's the word among tourism and medical care specialists who note that Bangalore alone, the Karnataka capital, boasts 25 medical centres, including eight cardiac hospitals of world-class standards. The city also hosts a wide range of complementary or alternative therapies that are unique to Karnataka. One alternative therapy centre, Soukya, has hosted Sarah, Duchess of York; and Bishop Desmond Tutu of South Africa. This week's celebrity guest at the clinic is former Prime Minister Deve Gowda. According to Karnataka tourism commissioner Mahendra Jain, such alternative therapy centres within the state are so successful that they are currently generating foreign exchange of $10 million a year, a figure that is expected to double and even treble within the next two years. "Karnataka's facilities are the best in the country, that's why we have taken the lead in promoting health tourism," says Jain, who was recently in London to participate in the World Tourism Mart. "Because we have these facilities available, we thought it appropriate to promote them. Recently, when baby Noor Fatima from Pakistan came for treatment, she attracted a lot of media attention. Her parents brought her to Bangalore because we have people like Dr Devi Shetty, who is a very renowned figure," he said. "That's what triggered it off, but otherwise we always knew Banaglore had great potential because of its climate and facilities available and in any case people are coming here for business, tourism, etc. So we thought it would be appropriate to promote health tourism," he added. London and Kerala-trained Dr Issac Mathai, medical director of Soukya, is the patron saint or godfather of the clinic where starting rates at $40 per hour for the cheapest treatment are lapped up by both Indians and foreigners who need that extra special touch for their particular ailment. Accommodation with food starts from $90 per night at the clinic, which is spread across a 30-acre site, in which guests or patents are accommodated in individual cottages. A spokeswoman for Dr Mathai, said, "Some people come here for a day package, others for medical treatment. Dr Mathai puts them under the treatment of a particular doctor who designs a programme for them that incorporates different types of treatment. It is all done under one roof and it is very care specific." "We have a wide spectrum ranging from ayurveda, yoga, naturopathy, homeopathy, healing and a whole lot of other things," Jain said, adding: "Whether it is Soukya, Angasana, Ayurgrama, or Golden Star owned by Sanjay Khan, they offer a wide range of complementary medicine."

1.3 India and Medical Tourism

India is considered the leading country promoting medical tourism-and now it is moving into a new area of "medical outsourcing," where subcontractors provide services to the overburdened medical care systems in western countries. India's National Health Policy declares that treatment of foreign patients is legally an "export" and deemed "eligible for all fiscal incentives extended to export earnings." Government and private sector studies in India estimate that medical tourism could bring between $1 billion and $2 billion US into the country by 2012. The reports estimate that medical tourism to India is growing by 30 per cent a year. India's top-rated education system is not only churning out computer programmers and engineers, but an estimated 20,000 to 30,000 doctors and nurses each year. The largest of the estimated half-dozen medical corporations in India serving medical tourists is Apollo Hospital Enterprises, which treated an estimated 60,000 patients between 2001 and spring 2004. It is Apollo that is aggressively moving into medical outsourcing. Apollo already provides overnight computer services for U.S. insurance companies and hospitals as well as working with big pharmaceutical corporations with drug trials. Dr. Prathap C. Reddy, the chairman of the company, began negotiations in the spring of 2004 with Britain's National Health Service to work as a subcontractor, to do operations and medical tests for patients at a fraction of the cost in Britain for either government or private care. Apollo's business began to grow in the 1990s, with the deregulation of the Indian economy, which drastically cut the bureaucratic barriers to expansion and made it easier to import the most modern medical equipment. The first patients were Indian expatriates who returned home for treatment; major investment houses followed with money and then patients from Europe, the Middle East and Canada began to arrive. Apollo now has 37 hospitals, with about 7,000 beds. The company is in partnership in hospitals in Kuwait, Sri Lanka and Nigeria. Western patients usually get a package deal that includes flights, transfers, hotels, treatment and often a post-operative vacation. Apollo has also reacted to criticism by Indian politicians by expanding its services to India's millions of poor. It has set aside free beds for those who can't afford care, has set up a trust fund and is pioneering remote, satellite-linked telemedicine across India. India is a leading player in the medical tourist/healthcare Facilitation industry. It is increasingly emerging as the destination of choice for a wide range of medical procedures. There are numerous advantages of going to India for treatment. Some of the advantages of going to India for medical treatment are:

Internationally accredited medical facilities using the latest technologies

Highly qualified Physicians/Surgeons and hospital support staff

Significant cost savings compared to domestic private healthcare

Medical treatment costs in India are lower by at least 60-80% when compared to similar procedures in North America and the UK

No Wait Lists

Fluent English speaking staff

Options for private room, translator, private chef, dedicated staff during your stay and many other tailor-made services

Can easily be combined with a holiday / business trip

Within India, we have partnered with world-class private care hospitals, which provide quality medical services at affordable prices for our clients. We have worked with these facilities to ensure that they will deliver a service that will meet our high expectations.

1.3.1 Alternative Therapies in India for Medical Treatment

India is renowned for ancient alternative therapies such as Ayurveda, Yoga and Meditation, and Therapeutic Massage. India is an exotic tourist destination offering everything from beaches, mountains, cosmopolitan cities, quaint villages and pilgrimages to suit every palate. Rich in history and culture, India has proved to be an oasis in the modern world, providing complete health and well being, while providing the latest in technology.

1.3.2 Indian Corporate Hospitals

Indian corporate hospitals have a large pool of doctors, nurses, and support staff ensuring individualized care. The highly skilled personnel, with wide experience and international exposure excel in Cardiology and Cardiothoracic surgery, Orthopedic surgery, Bariatric or Obesity surgery, Gastroenterology, Ophthalmology, Dentistry, and Urology, to name a few. Our hospital partners have exclusive Cosmetic/Plastic surgery departments. Our alliance partners have Centers of Excellence in their specialty areas.All medical investigations are conducted using the latest, technologically advanced and cutting edge diagnostic equipment. Stringent quality assurance exercises consistently ensure reliable and high quality test results in a timely manner. Even though India has many different languages, English is widely spoken. All hospitals have excellent English speaking staff and language or communication is very easy. If English is not your native language, we can arrange translators in most major international languages to be with you during your Indian tour.India has kept pace with the latest in technology and its application has been widely felt in the health industry. Moreover, India's strong pharmaceutical sector has gained international recognition.

1.3.3 Major players in India

The main cities attracting foreign patients to India are Bangalore, Mumbai, Hyderabad, Kolkatta, Delhi, Chennai and Jaipur.

Manipal heart foundation, Bangalore.

Narayan Hrudyalaya hospital, Bangalore.

Escort heart institute and research centreltd, new delhi.

All India institute of medical sciences, delhi.

B M Birla heart research centre, Kolkata.

Breach candy Hospitals, mumbai.

Christian Medical College, vellore

Wockhardt hospitals, Bangalore.

Apollo group of Hospital, Mumbai.

Apollo cancer hospital, Chennai.

Asian heart institute, Mumbai.

PD Hinduja National hospital and Medical research centre, Mumbai.

Jaslok hospital, Mumbai.

Escort hospital, Jaipur.

1.4 Growth of the Medical Tourism Industry

The countries where medical tourism is being actively promoted include Greece, South Africa, Jordan, India, Malaysia, Philippines and Singapore. India is a recent entrant into medical tourism. According to a study by McKinsey and the Confederation of Indian Industry, medical tourism in India could become a $1 billion business by 2012. The report predicts that: "By 2012, if medical tourism were to reach 25 per cent of revenues of private up-market players, up to Rs 10,000 crore will be added to the revenues of these players". The Indian government predicts that India's $17-billion-a-year health-care industry could grow 13 per cent in each of the next six years, boosted by medical tourism, which industry watchers say is growing at 30 per cent annually. In India, the Apollo group alone has so far treated 95,000 international patients, many of whom are of Indian origin. Apollo has been a forerunner in medical tourism in India and attracts patients from Southeast Asia, Africa, and the Middle East. The group has tied up with hospitals in Mauritius, Tanzania, Bangladesh and Yemen besides running a hospital in Sri Lanka, and managing a hospital in Dubai.

Another corporate group running a chain of hospitals, Escorts, claims it has doubled its number of overseas patients - from 675 in 2000 to nearly 1,200 this year. Recently, the Ruby Hospital in Kolkata signed a contract with the British insurance company, BUPA. The management hopes to get British patients from the queue in the National Health Services soon. Some estimates say that foreigners account for 10 to 12 per cent of all patients in top Mumbai hospitals despite roadblocks like poor aviation connectivity, poor road infrastructure and absence of uniform quality standards.

Analysts say that as many as 150,000 medical tourists came to India last year. However, the current market for medical tourism in India is mainly limited to patients from the Middle East and South Asian economies. Some claim that the industry would flourish even without Western medical tourists. Afro-Asian people spend as much as $20 billion a year on health care outside their countries - Nigerians alone spend an estimated $1 billion a year. Most of this money would be spent in Europe and America, but it is hoped that this would now be increasingly directed to developing countries with advanced facilities.

1.5 Promotion of Medical Tourism

The key "selling points" of the medical tourism industry are its "cost effectiveness" and its combination with the attractions of tourism. The latter also uses the ploy of selling the "exotica" of the countries involved as well as the packaging of health care with traditional therapies and treatment methods. Price advantage is, of course, a major selling point. The slogan, thus is, "First World treatment' at Third World prices". The cost differential across the board is huge: only a tenth and sometimes even a sixteenth of the cost in the West. Open-heart surgery could cost up to $70,000 in Britain and up to $150,000 in the US; in India's best hospitals it could cost between $3,000 and $10,000. Knee surgery (on both knees) costs 350,000 rupees ($7,700) in India; in Britain this costs £10,000 ($16,950), more than twice as much. Dental, eye and cosmetic surgeries in Western countries cost three to four times as much as in India. The price advantage is however offset today for patients from the developed countries by concerns regarding standards, insurance coverage and other infrastructure. This is where the tourism and medical industries are trying to pool resources, and also putting pressure on the government. We shall turn to their implications later. In India the strong tradition of traditional systems of health care in Kerala, for example, is utilised. Kerala Ayurveda centres have been established at multiple locations in various metro cities, thus highlighting the advantages of Ayurveda in health management. The health tourism focus has seen Kerala participate in various trade shows and expos wherein the advantages of this traditional form of medicine are showcased. A generic problem with medical tourism is that it reinforces the medicalised view of health care. By promoting the notion that medical services can be bought off the shelf from the lowest priced provider anywhere in the globe, it also takes away the pressure from the government to provide comprehensive health care to all its citizens. It is a deepening of the whole notion of health care that is being pushed today which emphasizes on technology and private enterprise. The important question here is for whom is 'cost effective' services to be provided. Clearly the services are "cost effective" for those who can pay and in addition come from countries where medical care costs are exorbitant - because of the failure of the government to provide affordable medical care. It thus attracts only a small fraction that can pay for medical care and leaves out large sections that are denied medical care but cannot afford to pay. The demand for cost effective specialized care is coming from the developed countries where there has been a decline in public spending and rise in life expectancy and non-communicable diseases that requires specialist services.

1.6 Medical Facilities in India

Indian corporate hospitals excel in cardiology and cardiothoracic surgery, joint replacement, orthopedic surgery, gastroenterology, ophthalmology, transplants and urology to name a few. The various specialties covered are Neurology, Neurosurgery, Oncology, Ophthalmology, Rheumatology, Endocrinology, ENT, Pediatrics, Pediatric Surgery, Pediatric Neurology, Urology, Nephrology, Dermatology, Dentistry, Plastic Surgery, Gynecology, Pulmonology, Psychiatry, General Medicine & General Surgery. The various facilities in India include full body pathology, comprehensive physical and gynecological examinations, dental checkup, eye checkup, diet consultation, audiometry, spirometry, stress & lifestyle management, pap smear, digital Chest X-ray, 12 lead ECG, 2D echo colour doppler, gold standard DXA bone densitometry, body fat analysis, coronary risk markers, cancer risk markers, carotid colour doppler, spiral CT scan and high strength MRI. Each test is carried out by professional M.D. physicians, and is comprehensive yet pain-free. There is also a gamut of services ranging from General Radiography, Ultra Sonography, Mammography to high end services like Magnetic Resonance Imaging, Digital Subtraction Angiography along with intervention procedures, Nuclear Imaging. The diagnostic facilities offered in India are comprehensive to include Laboratory services, Imaging, Cardiology, Neurology and Pulmonology. The Laboratory services include biochemistry, hematology, microbiology, serology, histopathology, transfusion medicine and RIA. All medical investigations are conducted on the latest, technologically advanced diagnostic equipment. Stringent quality assurance exercises ensure reliable and high quality test results.

1.7 Cost Comparison of treatments

India offers world-class healthcare that costs substantially less than those in developed countries, using the same technology delivered by competent Specialists attaining similar success rates. If a liver transplant costs in the range of 137,867 USD - 160,845 USD in Europe and double that in the US, a few Indian hospitals have the wherewithal to do it in around 34,466 USD - 45,955 USD. Similarly, if a heart surgery in the US costs about 45,955 USD, a leading Indian hospital will do it in roughly 4,595 USD.

1.8 More Americans are coming to India for medical treatment

Health care in the U.S. is expensive. Period. Medical expenditure in U.S. has reached an all-time high of $2 trillion per year. U.S. top the list of nation’s spending on health insurance. But still 46 million Americans continue to live without insurance each year. But health care woes are far from over, even for the insured. Healthcare premium rise nearly three times more than inflation rate. And the insured still have to spend a considerable sum from their pockets, every time they visit a doctor. With the dollar value higher than the money value in most South Asian countries like India, Malaysia, Thailand and Singapore, most Americans feel that it is monetarily more viable to visit these countries for their health care needs. Moreover, these countries boast of cutting-edge medical equipments, reputed medical professionals and quality medical care on par with hospitals and medical centers in the U.S. But the cost of the treatment still remains to be just a fraction of the cost in the U.S. And the cost includes the airfare, stay and a small vacation package. Surprisingly, most patients visit India not for the expected cosmetic enhancements but for dental care, knee surgery, lasik eye surgeries and heart surgeries. But the numbers for tummy tucks and face-lifts are also increasing at a slow and steady rate. Most Indian facilities have a higher patient-nurse ratio compared to America and doctors are as skilled as their counter-parts in USA. Nowadays, several Indian hospitals have started to cater to the special needs of patients from abroad especially from USA with special menu, better facilities and better care. This has made getting treatment in an Indian hospital as good and as comfortable as being treated in their own hometown. The Indian government has also issued a special medical visa promoting medical tourism further. No wonder, more than 500,000 Americans traveled abroad to receive medical care in 2006 and a majority of them made India their medical care destination.

1.9 Destinations

Over 40 countries are marketing medical tourism and trying to attract foreign- international patients.

Africa and Middle East, including Brunei, Saudi Arabia, South Africa, and Tunisia: Africa and the Middle East present a great opportunity for medical tourism.

Israel: Israel is a leading healthcare destination for medical tourism in the middle east. Israel receives over 30,000 medical tourist patients per year from Russia.

Jordan: Jordan has one of the top reputations for healthcare and medical tourism in the Middle East.

UAE: The United Arab Emirates is famous for it's significant investment in healthcare infrastructure. The Americas Countries in the Americas that are treating foreign patients include Argentina, Bolivia, Colombia, Costa Rica, and the Dominican Republic.

Brazil: Brazil is known for cosmetic surgeries but now has a growing reputation for more serious surgeries.

Canada: Many patients travel to and from Canada for healthcare.

Costa Rica: Costa Rica has for many years been a well-known destination for high quality cosmetic and dental procedures. However, in the past few years the country has also begun to attract a significant patient flow from the U.S. and Canada for orthopedic surgery, weight loss surgery, general surgeries and gynecology. Although the Costa Rica is roughly the size of West Virginia, it boasts two Joint Commission International accredited hospitals (with a third one on the way) and has a health care system that was rated as one of the best in the Western Hemisphere, ahead of the U.S. by the World Health Organization.

Cuba: Cuba is a destination for low cost healthcare.

Mexico: Mexico has been a leader in Medical Tourism and attracts millions of patients from the United States every year.

Panama: Panama has been marketing medical tourism for several years.

United States: United States is known for being one of the first countries to promote medical tourism. Thousands of patients travel to the United States from other countries because of the US reputation for having some of the highest quality healthcare, advanced medical technology and expert surgeons.

Uruguay: Uruguay is a major tourism destination for Europeans. Now Uruguay has turned it's eye towards medical tourism and is trying to attract patients to Uruguay from both Europe and the United States.

Asia/Pacific

China: China has had several projects recently start in medical tourism.

Hong Kong: Many Hong Kong hospitals are accredited by the Trent Accreditation Scheme out of the United Kingdom.

India: India is a leader in medical tourism and is known for its high quality healthcare with rock bottom affordable pricing.

Malaysia: Malaysia is emerging as a top destination for medical tourism.

Philippines: The Philippines markets itself as the heart of Asia and prides itself on the warm and loving care provided by their medical providers and nurses.

Singapore: Singapore has a reputation for high quality healthcare and expert surgeons. Singapore does not have its own accreditation system for quality so has adopted the Joint Commission International (JCI) to accredit Singapore's local hospitals.

Taiwan: Taiwan has recently enterd in the medical tourism industry and is focusing it's efforts on chinese patients who are living in other countries.

Thailand: Thailand is one of the top destinations for medical tourism. The reasons for this are quality and pricing. Some of the top hospitals in Thailand are located in Bangkok, including Bumrungrad, Bangkok Medical Center and Samitivej Hospital. Asia, and specifically Thailand is known for having experience in providing high volume medical procedures. Thailand provides numerous surgery options from knee and back surgeries, heart procedures, transplants, and cosmetic surgery.

Europe: Europe has been a center for healthcare and medical tourism for centuries. Europe has been a big destination for medical tourism from the Middle East.

Poland: Please is known for dental tourism, and dental care.

Turkey: Turkey has a reputation for having excellent healthcare and being a leader in medical tourism. Turkey has one of the largest numbers of hospitals accredited by the Joint Commission International (JCI). Turkey has one of the world's top eye hospitals and received many patients from countries surrounding Turkey in Asia, Europe and the Middle East.

1.10 Importance of Medical Tourism

Medical tourism can be broadly defined as provision of 'cost effective' private medical care in collaboration with the tourism industry for patients needing surgical and other forms of specialized treatment. This process is being facilitated by the corporate sector involved in medical care as well as the tourism industry - both private and public. Medical or Health tourism has become a common form of vacationing, and covers a broad spectrum of medical services. It mixes leisure, fun and relaxation together with wellness and healthcare. The idea of the health holiday is to offer you an opportunity to get away from your daily routine and come into a different relaxing surrounding. Here you can enjoy being close to the beach and the mountains. At the same time you are able to receive an orientation that will help you improve your life in terms of your health and general well being. It is like rejuvenation and clean up process on all levels - physical, mental and emotional. Many people from the developed world come to India for the rejuvenation promised by yoga and Ayurvedic massage, but few consider it a destination for hip replacement or brain surgery. However, a nice blend of top-class medical expertise at attractive prices is helping a growing number of Indian corporate hospitals lure foreign patients, including from developed nations such as the UK and the US. As more and more patients from Europe, the US and other affluent nations with high medicare costs look for effective options, India is pitted against Thailand, Singapore and some other Asian countries, which have good hospitals, salubrious climate and tourist destinations. While Thailand and Singapore with their advanced medical facilities and built-in medical tourism options have been drawing foreign patients of the order of a couple of lakhs per annum, the rapidly expanding Indian corporate hospital sector has been able to get a few thousands for treatment. But, things are going to change drastically in favour of India, especially in view of the high quality expertise of medical professionals, backed by the fast improving equipment and nursing facilities, and above all, the cost-effectiveness of the package. As Indian corporate hospitals are on par, if not better than the best hospitals in Thailand, Singapore, etc there is scope for improvement, and the country may become a preferred medical destination. 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. In fact, priority treatment is provided today in Indian hospitals. The Apollo Group, Escorts Hospitals in New Delhi and Jaslok Hospitals in Mumbai are to name a few which are established names even abroad. A list of corporate hospitals such as Global Hospitals, CARE and Dr L.V. Prasad Eye Hospitals in Hyderabad, The Hindujas and NM Excellence in Mumbai, also have built capabilities and are handling a steadily increasing flow of foreign patients. India has much more expertise than say Thailand or Malaysia. The infrastructure in some of India's hospitals is also very good. What is more significant is that the costs are much less, almost one-third of those in other Asian countries.

1.11 Medical Tourism: Opportunities and Challenges for India

India's relatively developing medical tourism segment has been anointed by healthcare and tourism industry pundits as the next 'best' thing for the country. According to a McKinsey report, India is poised to generate business worth USD 2.2 billion by 2010, however there are plenty of challenges that need to be addressed for India to become the world's preferred healthcare destination. Prominent among them being the need for proper accreditation and requisite standardisation systems in place, a tripartite synergy between hospitals, tour operators and respective state governments. These were some of the findings at the seminar titled, 'Medical Tourism: Opportunities and Challenges for India' organised by Express Healthcare Management and Express Travel and Tourism, bringing the two sides of the medical tourism industry together for the first time in the country. NV Ramamurthy, editor, Express Healthcare Management welcomed the delegates and the panelists. He spoke about the various challenges impeding the growth of the medical tourism industry and emphasised the need for a synergy between hospitals, state government and international tour operators. The panelists for the session comprised Dr R V Karanjekar, chief executive officer, Dr D Y Patil Hospital and Research Centre, Mumbai; Anupam Verma, director administration at PD Hinduja National Hospital, Mumbai; Joy Chakraborty, deputy administrator at Sri Ramachandra Medical Centre; Gour Kanjilal, regional director (Western & Central Region), Indiatourism, Mumbai and Mahendra Jain, commissioner of tourism, government of Karnataka. In 2004, India treated and cared for 1.8 lakh patients. This number is poised for substantial growth - 25-30 per cent in 2005. The panel agreed that India's main USP in this regard was the prospect of low-cost treatment by highly professional doctors. According to Dr RV Karanjekar, India will have to project itself as being a holistic medical destination to get an edge over other countries. "India offers not just treatment but spiritual and mental healing as well. We need to club together a couple of 'pathies' because we have a very strong base of alternative healing therapies like yoga, naturopathy, ayurveda, etc," said Dr Karanjekar. The panelists echoed yet another imperative that creating awareness about India's facilities is a must to establish credibility in foreign markets. Joy Chakraborty further suggested that the standardisation of a price band for graded hospitals and a quality assurance model should be taken up immediately to take medical tourism ahead. "CRISIL and ICRA have started something on price bands but are facing few challenges at the moment. What we can do, is try and follow the Thailand model. Thailand first developed its standards as per Joint Commissioner International (JSI) which helped them to get approval from NHS of UK. So convincing medical insurance companies was not a problem." Talking about initiatives that can help in generating the right exposure, Mahendra Jain said, "It is time we create a database on the facilities on offer, the number of patients received and from which market, reason for choosing India, their length of stay, etc. These data can provide pointers to help us in devising country-specific promotional strategies." Gour Kanjilal said, a joint task force on medical tourism has already been set up by ministry of tourism in collaboration with ministry of health which will look into quality assurance, standardisation of price, global networking and improving visibility. According to Kanjilal, talks need to be held with the source-market countries to sort out insurance policy guidelines. At the same time, the government should introduce a medical visa to facilitate long-stay he opined. Anupam Verma very ably moderated the two hour seminar and responded to queries from the doctors and the tour operators. As the hon secretary of Maharashtra Medical Tourism Council formed last year in collaboration with FICCI, he has been actively involved in promoting the state as the preferred medical tourism destination abroad.

1.12 Joint ventures: pointing the way forward

One way of overcoming such problems would be in the form of joint ventures involving physicians and hospitals in various countries, in order to facilitate the coordination between health insurers, medical needs and the possibilities offered by medical tourism. In this way some of the current objections could be eliminated. This proposal has already been put into practice, and agreement on such joint efforts has been reached by Indian and American hospitals. There has been sharp rise in the number of companies in the United Kingdom that organise travel to Turkey, Costa Rica and India and are working in close consultation with hospitals in those countries. This is not just another form of north-south tourism. As the chairman of Fortis, a company based in England, stated: “We will soon launch a defined programme for the two-way flow of patients.”

Such bilateral collaboration can enable the provision of long-term medical care in accordance with the same performance standards, provided that this is preceded by an accurate exchange of data. Independent monitoring of performance and success eliminates the risk of disputes about the cost of treatment and the settlement of liability issues. Joint ventures between companies provide for an accurate division of labour and reduced costs. This is in the interests of all concerned. Moreover such long-term forms of collaboration enable suppliers in developing countries to unlock commercial possibilities in the industrialised nations which could not be replicated in any other way.

1.13 Medical tourism and its impact on our GDP

 AFTER INFORMATION Technology (IT) and Information Technology enabled Services (IteS), which are currently good contributors to our nation’s GDP, the next big thing happening (already begun!!!) could be ‘medical tourism’, which has enormous potential, if rightly tapped, to make great contributions to the nation’s GDP. The following will illustrate a few valid points by way of expert’s questions vs opinions offered, current statistics available with future projections and a few suggestions for making best use of medical tourism towards the development of the country’s economic prosperity.

1.14 Existing offers available for medical tourists:

Currently, the offers available today for similar patients are specialised services ranging from cardiology and cardiac surgery (angioplasty, bypass, valve replacement), to oncology and onco-surgery, organ transplants (liver and kidney), bone marrow transplants, joint replacements, eye surgery and in-vitro fertilisation. The cost differential is significant, as it was for Marshall, for the patients.

1.15 Reason for going in for medical tourism:

Medical tourism is attracting people from all over the industrialized world, from countries with relatively poor healthcare infrastructures and, in case of the US, places with exorbitantly expensive health care systems. Medical tourists from the US are usually those seeking procedures not covered by their insurers, those seeking necessary procedures and who are provided with incentives to find lower cost options, and those who cannot secure medical insurance where they depend on the procedures and the physicians. Cosmetic procedures are easily found in South America, while complex heart and orthopedic procedures are found in India, Thailand and Singapore, and specialized in-vitro fertilization can be found in South Africa, Israel and Spain. In the global medical tourism industry, from cosmetic surgery to complex oncology, bargain prices can be found at a medical centre somewhere in the world. Time and money provide the incentives for seeking healthcare outside country. In the case of public health systems with long delays, such as Britain, time is the motivation.

1.16 Accredited hospitals are potential winners in wooing medical tourists:

Quality is a concern for potential medical tourists and what are now being called ‘offshore hospitals’ address their concern by seeking and obtaining accreditation from bodies such as Joint Commission International (JCI), a subsidiary of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which offers accreditation to hospitals in the US. Several other hospitals that are offering medical tourism in India meet or exceed the standards of care of the finest hospitals located in US.

1.17 Some advantage in availing this service:

The lower cost structure of these hospitals allows them to be more generous with resources for their well-paying clients. Nurse-to-patient ratios are higher, private rooms are readily available and family members are often included in the trip and made comfortable in luxury facilities that resemble five-star hotels. Dr Milica Bookman, professor of economics at St. Joseph’s University in Philadelphia, US, is author of the book Medical Tourism in Developing Countries. According to her research on the economic impact of medical tourism, 750,000 Americans are expected to have travelled abroad for treatment in 2007 and over six million will be doing by 2010.

1.18 Some findings done through a study report by a global agency:

According to a study by global accounting and consulting firm Ernst and Young and the Federation of Indian Chambers of Commerce and Industry (FICCI), private hospitals in India earned Rs 62,000 corer in fiscal 2006 and revenues from the sector are expected to rise up to Rs 130,000 crores (at current prices and exchange rates) in 2012, which represents an annual revenue growth rate of about 19 per cent a year.

1.19 Our Finance Ministry’s projections on GDP:

The Finance Ministry’s Investment Commission emphasizes that healthcare delivery is already one of the largest service-sector industries in India, and expects the industry to grow and contribute up to five per cent of GDP (at around Rs. 240,000 crores).

1.20 Medical tourism and its side-effects

There is much optimism in the medical field in India. Outsourcing is now turning its attention to medical care. From medical transcription to mediclaim processing and diagnosis it is now moving towards hospital itself. Medical tourism is the new buzzword. There are stories galore of foreign patients coming to India for heart surgery or knee replacement procedure. Yet, this is not an unmixed blessing. There can be unintended side-effects. The Waterfall Model refers to people in the higher reaches having better access to resources than those in the lower reaches. Medicare ranges from primary to super-specialty; the unequal spatial reach from rural to urban care; the quality of care, ranging from palliative to curative; the difference in public to private hospital care, and from nursing-home-type care to super-deluxe hospitals, more like five-star hotels. Depending on one's socio-economic status, one can access these services. If one can afford it, the Indian system is the best as it gives immediate access even to super-specialist care without the need for a referral system. And one can shop around also. Little wonder that hospitals are aggressively gearing themselves to attract foreign patients. `Medi-cities' are coming up and perhaps even an SEZ will be set up. Hospitals are taking steps to get accredited by international agencies, much like software firms. They are also trying to get empanelled by insurance companies abroad. A positive side to these developments is that they may bring discipline to the hospital industry and force it to adopt world-standard systems and standardize processes. In the hospital industry a key element is cost that has a tendency to rise, taking medicare beyond the reach of many. One reason for the high cost of care is the low capacity utilization of hospital infrastructure. Higher volumes in the private hospitals will help bring down the costs. But this is countered with the argument that hospitals need to constantly spruce up their infrastructure and processes, especially those facilities that handle foreign patients. Even more than infrastructure or investment is the availability of doctors. It is much easier to build hospitals than groom doctors. The incubation time for doctors is much longer than for hospitals. There is again a pyramid-like structure in the medical profession, with few specialists at the top, conforming to the waterfall model. Of course, in this case, the base is made up of general physicians who are the key to diagnostics. What the country needs, especially if it wants to sell the medical tourism model, is people at the top. Surely, foreign patients are not going to come for simple procedures; they will come mainly for specialty care. It is here that India faces a problem, for, unlike software professionals, medical specialists are not scalable in a short time. One possible scenario is that Non-Resident Indian medical professionals will start returning as they might find India lucrative enough. Or, hospitals might go the airlines way; the latter are flying their planes with foreign pilots. So, the country's hospitals may fly in both patients and doctors. Only, the local Medicare-seekers may get pushed down the pecking order. The plight of the poor patients can be imagined. Government hospitals would be fighting a losing battle to retain talent. It is only a tiny segment now but, then, the segment that gets specialty care in India is also tiny.

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