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Medical tourism- the concept of traveling far and wide for better medical treatment is not a novel idea, only the term. The globalization of the health care sector and the massive demand for low cost-high quality treatment in recent times has caught the attention of many developing countries that have the adequate resources and potential to meet these demands. The profitability and the lucrative nature of the medical tourism business has now put this trade, high on the agenda of both the Indian government and the private health care providers.
Today, medical tourism has become a commonplace practice with a large number of people around the world since usual constraints like language, finance, difficulties in global travel and fear of the unknown are no longer acting as barriers to the tourists who seek medical treatment in foreign countries. Countries like India, Singapore, Malaysia etc have developed strategies specifically with the aim of tackling such issues and rendering themselves as the ideal medical tourism destinations.
Although India is emerging as the 'hot-spot' medical tourism destinations within the Asia-Pacific and other regions of the world, it seems to be facing tough competition from other big players of this industry who have projected an equally good reputation for themselves and are reaping the benefits of this business. Therefore, it is imperative for India to continuously rethink and reform its marketing strategies to gain competitive advantage and increase its market share in the health care sector.
It is an undisputed fact that medical tourism is a rapidly growing industry and creating inroads into the Indian economy. There are a large number of stake holders in this industry in South East Asia including countries like Singapore and Malaysia. There are various marketing strategies being used for propagating this industry. My endeavor would be to seek the gaps that exist and suggest remedial action.
Being from the medical fraternity and having had the opportunity to treat a number of overseas patients, the concept of medical tourism has generated a great deal of interest in me. I believe that there are some deficiencies in the marketing strategies for health tourism in India that need to be looked into and improvised. The aim of my research would be to propose marketing strategies that would boost the Indian Medical Tourism for the future.
3. Preliminary review of literature
There are three sections of the literature review:-
i) Historical aspects- inception and evolution
ii) Medical tourism in India- the present scenario
iii) Probable concerns and pitfalls of the Indian medical tourism industry.
i) Historical aspects- inception and evolution
The concept of constructing health complexes around hot springs goes back to as old as the Sumerian civilization (circa 4000BC) where health care facilities comprised of grand elevated buildings with flowing pools. The hill tribes of Switzerland of the area presently know as St. Moritz, during the Bronze Age (circa 2000 BC) recognized the benefits of bathing and drinking in iron-rich mineral springs. The discovery of bronze drinking cups used by them in thermal springs in Germany and France possibly signifies health pilgrimages within these cultures.
As per written historical accounts, bathing and healing complexes were erected around therapeutic springs in Mesopotamia, India, Greece and China. The concept of medical tourism emanated as trips to sacred baths and hot springs. However, it is the Greeks who have to be given the credit for laying the foundations for medical tourism networks.
Greek medical tourism.
Asclepius was considered to be the god of medicine according to Greek mythology. In his honor, Asclepian healing temples had been constructed throughout Greece by the 4th Century BC. These temples were established near the mineral springs which were considered to be the prime "Healthful" Locations. The system of medical tourism during this period was as follows:-
Patients and their attendants came to Asclepia temples seeking treatment for various ailments. At Epidaurus, the port temple, treatment included gymnasia, palaestra (exercise area), bathing springs and a 'dream' temple. There was a retinue of priests, caretakers and stretcher carriers who attended to the patients before they were granted final appointment with the mighty priest. Patients made sacrificial offerings according to their status- the poor left shoes; Alexander the Great left his breastplate.
Roman Medical Tourism.
The hallmark of ancient Roman medical tourism centered around hot water baths called Thermae. These centers of medical treatment were posh establishments. Some of these centers comprised of art galleries conference halls, theatres and sometimes sport stadia. Because of the active trade with Asia, the Roman baths augmented medical tourism activities like Chinese medicine, Ayurvedic massage and various aspects of Buddhist spiritual healing at some Roman Thermae.
Japanese Medical Tourism-Onsen.
ONSEN means hot mineral springs in Japanese. Medical tourism in Japan centered around these hot mineral springs which were enriched by surrounding volcanic soil. It attracted a variety of people including hunters, fishermen, farmers and warriors. It was believed that these mineral springs were effective in alleviating pain, healing wounds and recuperation. A thousand years later, this form of medical tourism in Japan is still an ongoing phenomenon.
Indian Medical Tourism.
India has been the home ground of alternative system of medicine for the past 5000 years. Aspects of medical tourism include yoga, eastern cultural, spiritual and medicinal compilation with meditation thrown in. India has been a Mecca for alternative medicine practitioners. A new boost was given to health tourism in the 1960's with the "New Age" movement in the US. This New Age movement seeks "Universal Truth" and the attainment of the highest individual human potential and is characterized by an individual approach to spiritual practices and philosophies and the rejection of religious doctrine and dogma. With this movement, India had once again become the most sought after destination for thousands of western pilgrims. India's deep commitment to health care infrastructure and technology furthered the mass influx of medical tourists. India is now one of the world's oldest medical tourism destinations and has gained popularity over the years over other destinations.
European Medical Tourism.
European medical tourism came into existence with the rediscovery of the Roman baths in the 16th century. With the rediscovery of the Roman baths, Baden Baden , Aachen and most notably Bath, became spa towns. By the 1720's the spa towns came to be frequented by Aristocrats and gentlemen of leisure from other parts of Europe and even royal patronage. Michel Eyquem de Montaigne, French royal inventor of the essay was the most noteworthy medical tourist of this time. He traversed the continent for 9 years for the cure of his gall bladder problem. He is widely believed to be the father of luxury travel and has helped to write one of the earliest documented spa guides for European tourists.
Health Tourism-New world.
English and Dutch colonists in the 1600's, constructed log cabins near mineral springs in the newly discovered Americas. By 19th century the American reformists made it a habit to travel to remote Western springs that were rich in medicinal properties.
Today, there are no physical, economical and cultural barriers that separate nations from one another. Coupled with the flattening global economy, ease of international travel and lenient trade policies has opened the vistas of medical tourism destinations around the globe. This has made affordable health care availability to patients who find it difficult or impossible to access such health care facilities in their own countries. Inflated health care costs are driving the patients to medical tourism destinations like Thailand and India for sophisticated procedures at a fraction of the price. Long waiting periods for medical treatment is another factor that is making patients seek treatment abroad. Also, lack of comprehensive medical insurance has attracted thousands of patients to seek treatment abroad.
Medical tourism today has become a global phenomenon with many countries expanding their offerings, including unique tourism opportunities for example South Africa is promoting medical safari in a big way.
ii.) MEDICAL TOURISM IN INDIA-the present scenario
Medical Tourism India or Health Tourism India is a developing concept that has gained tremendous popularity and is attracting people from all over the world for their medical and relaxation needs. The treatments most commonly include knee transplant, cosmetic treatment, dental treatment and cardiac surgery. India is now a favorable medical tourism destination as its infrastructure and technology are at par with USA, UK and Europe, enabling it to provide treatment centers and hospitals that are best in the world with world class facilities. These factors coupled with visits to some of the most alluring and awe-inspiring places of the world have brought about the merging of tourism with medication giving rise to the concept of Medical Tourism.
India is promoting health tourism through depicting the "high-tech healing" of its private healthcare sector. The Indian government is marketing the concept of traveling to India for cheaper and world-class medical facilities to foreigners, with the intention of encouraging the growing Indian medical tourism industry. The policy of the Indian government to merge medical expertise and tourism was announced during the 2003-04 budgets when the finance minister Jaswant Singh propounded India to become a "Global Health Destination". According to a study conducted by Confederation of Indian Industry (CII), the field is so lucrative that it has the potential to become a $2.3 billion business by 2012. Around 150,000 foreigners visited India for treatment during 2004 and since then, this number has increased by 15% every year.
In recent times, India has emerged as the "Global Health Destination" due to the following advantages:
1. Medical services are provided at almost 30% lower cost than the Western countries and are the cheapest in South-east Asia.
2. India has a large population of doctors and paramedical staff who have good knowledge of spoken English. Therefore language is a major comfort factor that attracts so many foreign tourists to visit for the purpose of medical and health tourism making it easier for overseas patients to relate well to Indian doctors.
3. Indian doctors expertise in various surgical procedures including cardiac surgeries, liver transplants, orthopedic surgeries and other medical treatments.
4. Indian hospitals offer a wide array of high quality treatment procedures comprising of joint replacements, cardiothoracic surgery, dental care, cosmetic treatments and more.
iii) Probable concerns and pitfalls of Indian medical tourism industry
Review of literature suggests the following concerns that need attention if one has to augment and boost the medical tourism sector.
Concerns of the consumers
Some of the consumers feel that India is unhygienic, polluted and bureaucratic. There is no appropriate accreditation system for the hospitals. Concerns about medical insurance which is underdeveloped, inadequate and has few global players. overseas companies refuse reimbursements. There are also concerns about terrorism, communal unrest and bad connectivity between cities and towns. While some of these concerns are genuine, most of them are mere perceptions.
Concerns of the promoters
From the promoters point of view, the concerns that have emerged revolve around lack of regulations concerning ethics and systemic support, lack of infrastructure deficiencies like electricity, power supply and water, inadequate land reforms, taxation anomalies, funding constraints, implementation lacunae and bureaucratic bottlenecks.
4. RESEARCH QUESTIONS AND OBJECTIVES.
India seems to be an emerging medical tourism destination offering great opportunities in terms of creating new jobs and generating sources of revenue for the Indian economy. It is therefore imperative that the impetus gained so far should not be jeopardized and measures should be adopted to improve the present situation by developing and implementing new strategies.
1. What is the present state of Indian medical tourism? - indicating assessment of the present situation.
2. What are the drawbacks or felt impediments of the medical tourism trade sector? - indicating an analytical structuring of the data.
3. What are the ways to improve medical tourism in India through better marketing strategies? - an assessment of the lacunae in the existing marketing strategies.
4. Is the government doing enough to support the medical tourism industry? - an assessment of the governmental leaning towards the industry.
1. To develop pragmatic marketing strategies for health care institutions involved in medical tourism in India.
2. To assess the impact of the government action on the present marketing strategies for foreign patients.
3. To make a marketing plan model for the Health tourism industry in India
5. RESEARCH PLAN
My research approach is based upon the words of the renowned anthropologist Clifford Geertz "man is an animal suspended in webs of significance he himself has spun. I take culture to be these webs, and the analysis of it is not to be an experimental science in search of law but an interpretive one inn search of meaning" (Jewell,S.2010). It therefore forms an interpretivist approach. Since the medical tourism industry is a business and management perspective, any research into this field would fall into the gamut of positivist and interpretivist approaches. My research is essentially a qualitative one since my data collection is mainly secondary in nature. Furthermore, my research is theory forming where in I shall be using the inductive approach to analyze the data. My research also involves the assessment of factors of concern that are related to the health tourism industry of India. It would be my effort to sift out the relevant factors and analyze them from the point of view of developing marketing strategies.
The approach that best answers my research questions fits into the modified cross sectional design. Here, the research design revolves around the collection of data that is occurring naturally over a designated period. My research design also involves mainly quantitative data and some qualitative data too. My research is based upon observation and document analysis. The cross sectional design also gives information on aspects of who, what, how many, where, and the how and why.
Data collection methods
I shall be collecting my data through analysis of secondary data. I also intend to submit questionnaires to the stakeholders and the major players of the medical tourism in India with the aim of seeking relevant data that would help me in answering my research questions and fulfill my research objectives.
Secondary data: the secondary data would be collected through the following;
Written materials- various websites, websites of homepages of key players, magazines and journals, books and publications. I would also be looking for government publications, laws and acts related to this subject.
Non-written materials- media, television etc.
Most of the data from outside the individual organization will yield information about the medical tourism industry. While, data that is collected from the organizational websites would give information on how things are done within the organization and their modus operandi.
ii. Questionnaires: I will be sending the questionnaires to all the major players in the Indian medical tourism industry. The questionnaires will be used to obtain data for quantitative analysis in order to assess the functioning of various medical tourism facilities in India. The idea of using questionnaires is that a large quantity of data can be made available covering a wide range of database for quantitative analysis. A good amount of objectivity can be incorporated and the results would be of valid and reliable nature.
Analysis of data
Having collected all the qualitative and quantitative data, I would subject it to appropriate analysis and apply relevant statistical tests of significance to ensure that the results are valid, reliable and give a reasonable level of generalisabilty. I aim to deduce the relevant marketing strategies being used and to assess their impact on the industry. I shall be presenting the analyzed data in the form pie diagrams, bar charts and other forms of statistical presentations.
Validity and reliability
Since my data is mainly secondary in nature it is presumed that global players in the me dical tourism industry would not putting false data to propagate their business ventures. From this point of view my data would be valid as well as reliable. As my data is being collected from internet, websites of various stake holders, magazines etc. I am confident that stake holders at this level of global competitiveness would not be putting up false data or information for promotional activities that could jeopardize their reputation. However, the limitations of validity and reliability I foresee to come across would be from the questionnaires I would be sending to the stake holders. The disadvantage I feel I would face using the questionnaires is that some people may not respond, may take a long time for returning back and the response rate cannot be predicted. However despite these limitations, I expect to be able to generate valid information and data for quantitative analysis. I shall be sending these questionnaires to the concerned stakeholders through their homepages and their websites and try and elicit as much response as possible from them.
My research design is based upon the study of an industry and does not impinge upon a case study research. All factors being studied can be considered as offshoots of a single industry. For e.g. the legislation aspects would be covering the entire industry and not a single institution or a hospital. Secondly, my aim is to give broad based generalized guide lines on the recommendations for improving medical tourism in India. My attempt therefore would be to collect and analyze data from where generalisabilty can be achieved.
I will abide by the Coventry University BES ethical guidelines. I will conduct my research honestly and present all the data accurately. I will get the low risk approval form signed by my supervisor to get his approval before I begin my research.
I shall take all precaution to ensure and respect the rights and integrity of subjects if any.
I shall treat all the data confidentially and would ensure that it would not be used for any other purpose other than that intended.
Since my data collection is mainly secondary in nature, my research work is considered to be a low risk from the ethical point of view. I shall keep all the raw information on ethics and the data collected for audit purposes.
I will paraphrase; reference and cite the sources used by me, to acknowledge the work of others and avoid any sort of plagiarism.