? ABSTRACT Medical tourism has become a popular option for tourists across the world. It takes into account primarily the biomedical procedures, combined with travel and tourism. Medical tourism has been coined by different travel agencies and the mass media to describe the rapidly growing practice of travelling across international borders to obtain cutting edge medical care. Countries like India, Malaysia, and Thailand are promoting medical tourism aggressively. The key competitive advantages of India in medical tourism stem from the following: ?
Low cost advantage. ?Strong reputation in the Advanced Healthcare Segment (Cardiovascular Surgery, Organ Transplants, Eye Surgery etc. ) ? The diversity of tourist destinations available in the country. The key concerns facing the industry include: ?Less Government Initiatives. ?Lack of a coordinated effort to promote the industry. ?No accreditation mechanism for hospitals and the lack of uniform pricing policies and standards across hospitals. Medical tourism or health care tourism is fast growing multibillion-dollar industry around the world.
It is an economic activity that entails trade in services and represents the mixing of two of the largest world industries: Medicine and Tourism. The paper identifies the strengths of India’s medical tourism service providers and points at a number of problems that may reduce the growth opportunity of this industry. This paper focuses on the key issues and opportunities possessed by Indian medical tourism sector that enables it to overcome domestic and international barriers on upgrading its medical services.
Finally, this paper analyses and concludes the main reasons why the developing country like India attracts foreign tourists for the medical treatment. Keywords: Medicine, Tourism, Yoga, Unani, Siddha, Ayurvedic, Naturopathy. INTRODUCTION India has a bountiful of diverse tourism hotspots which enchant the recuperating visitors, their scenic beauty, historicity and socio-cultural significance would be great harbingers of health to the ailing foreign visitors. In the recent years, government support, low cost treatment, improved healthcare infrastructure, and rich cultural heritage, have taken the Indian medical tourism to new heights.
India has emerged as one of the world’s most cost-efficient medical tourism destinations, and hence, attained a position among the global leaders. According to “Booming Medical Tourism in India”, the heart surgery centers in the country offer treatment at a significantly lesser prices compared to North America and Europe. Superior quality of dental care and Ayurvedic Spa treatments are also attracting patients from across the globe. Each market segment describes the cost effectiveness compared to other countries.
Though India’s reputation is not good on hygiene front, its state-of-the-art medical facilities and value for money offered attracts thousands of patients each year. In this way, the country holds enormous potential for growth in medical tourism in future. Extensive research and analysis has also revealed that quality-driven wellness centers, cord blood banking, and medical tourism facilitates medical tourism market. It has been observed that wellness tourism, alternate meditation, and the advantage of being the least competitive pricing have been the Unique Selling Point (USP) of the Indian medical tourism.
Cardiac and Orthopedic procedures constitute the majority share of the market. This study reflects an in-depth knowledge of various government initiatives that provides a positive impact on the medical tourism market in India. The adoption of the Public Private Partnership (PPP) Model by the Indian Government at both central and state levels to improve healthcare infrastructure in the country through expertise of private sector and better support of public sector provided the extra thrust to medical tourism.
We also observed that the regulatory structure in connection to the medical tourism industry has been quite liberal and supportive in the country so far. Considering all the positive insights of the analysis, it’s a hope that the analysis of current market performance and future outlook of the Indian medical tourism industry with the forecasts provided in the report will help in devising the rightful strategies and make sound investment decisions. Comparative Cost of Medical Treatment in Euros (1€ = 70. 24 Rs) Type of ProcedureUnited StatesIndiaThailand
Bone Marrow Transplant300,000 € = 21,072,000 Rs24,000 € = 16,85,760 Rs50,000 € = 35,12,000 Rs Open Heart Procedure40,000 € = 2,809,600 Rs11,000 € = 7,72,640 Rs 35,000 € = 24,58,400 Rs Knee Surgery13,000 € = 9,13,120 Rs3,500 € = 2,45,840 Rs5,500 € = 3,86,320 Rs Eye Surgery2,400 € = 1,68,576 Rs600 € = 42,144 Rs 5,500 € = 3,86,320 Rs Facelift6,500 – 16,000 € = 4,56,560 – 11,23,840 Rs2000 € = 1,40,480 Rs 8,000 – 16,000 € = 5,61,920 – 11,23,840 Rs Source: Business World India and Indian Brand Equity Foundation Comparative Picture of the Price of the Treatment in USD and Percentage ProcedureUSD in USA)USD (in India)Difference in Price Bone Marrow Transplant2500006920028% Liver Transplant3000006935023% Heart Surgery30000870029% Orthopedic Surgery20000630032% Cataract Surgery2000135068% Dental Procedure Metal Free Bridge550060011% Dental Implants350090026% Porcelain Metal Bridge300060020% Porcelain Metal Crown100010010% Source: IIMK Part IX – Medical Tourism CHALLENGES One of the major challenges for Medical Tourism Industry in India is the phenomenon of Crowding-Out where healthcare could become less accessible to the local population.
The discrimination of care has been happening with the opening up of the healthcare market and has brought about for the residents of the destination countries. The revenue generated by developing countries providing medical services to foreign patients can be used to improve the access and quality of care available to the residents. However, concerns have been expressed over Medical Tourism Industry in India that it may seriously undermine the care of local residents by adversely affecting the healthcare workforce distribution.
Critics addresses globalization as commoditization of worldwide healthcare where in the redirection of economic resources to support the foreign care industry makes an ill-effect on local health care as the lower income groups that have reduced access and longer waits for health services. So, instead of contributing to broader social and economic development the provision of care to patients from other countries might make worse, the existing in-equalities and further polarize the richest and poorest members of society.
Healthcare spending in India accounts for over 5% of the country’s Gross Domestic Product (GDP) of which only 20% is provided by the government. This reflects that the public healthcare is not only weak but also under-utilized and inefficient. Similarly contends that rising in-equalities in healthcare access across private and public systems encourages a domestic Brain-Drain (migration of healthcare professionals’ takes place from public to private sector) and increases dualism in healthcare in India.
It is a fear that the remunerative Medical Tourism Industry in India might flourish at the expense of the treatment of endemic diseases (AIDS, tuberculosis and malaria) thus disregarding half of the disease burden in India which is primarily infectious diseases. Hence it is to be emphasized on the governments of destination countries to implement and enforce appropriate macroeconomic redistributive policies to ensure that the local residents of these nations actually realize the potential benefits of the Medical Tourism Industry in India.
In addition, there is a rapidly increasing element of competition for India for medical tourism income from other host countries such as Thailand and Singapore. Hence, one of the key factors for the host hospitals is the concept of efficient marketing to the developed countries offering innovative ideas like a holistic medical service and tourism package. It’s also a concern on the dependency of the developed nations on developing nations for healthcare provision.
In addition, it is wondered if an established model of Medical Tourism Industry in India with the niche market which draws specific patients for designated procedures and can be followed by all developing countries. If multiple developing countries entered this market, the oversaturation of healthcare services would lead to severe price-cutting to the detriment of quality of healthcare. Another area of concern is the effect on the reputation of the destination country of the practice of soliciting patients for money.
For example, Dr Kohli, an Indian pediatric cardiologist admitted to soliciting medical tourists for money on the 60 Minutes. In addition, it’s warned that the quality of some of the services offered to medical tourists can cause significant risks due to the use of:- ? Older surgical equipment and inferior quality medications; ? Poorly trained health care providers; ?Inadequate emergency rooms and implanting older-generation medical devices.
In a recent research conducted by Walsh, an antibiotic found amongst the UK medical tourists returning from India and Pakistan after undergoing cosmetic surgeries. The management of post-operative complications that occur after a patient returns to his home country and the consequent costs of this care are difficult issues that remain unresolved. Besides, hospitals catering to Medical Tourism Industry in India lack accreditation labels whereas there is an demand for oversight by neutral administrator such as (JCI and Patients beyond Borders) to attract foreign to the host country.
Moreover, foreign patients have to bear the treatment cost out of their own pockets since the procedures performed under Medical Tourism Industry in India are usually not reimbursed by the insurance agencies with the exception of a few companies such as Blue Cross and Blue Shield in USA. Also, Medical Tourism Industry in India lacks stringent governance and regulatory policies. Consequently, faced with the choice of many medical institutions in diverse countries, medical tourists may find it very difficult to identify well-trained physicians and modern hospitals that consistently provide high-quality care.
Lack of transparent pricing policies across hospitals, customer perception of some host countries as unhygienic and prone to terrorism with low coordination between the various Medical Tourism Industry in India operators such as airlines, hospitals, hotels and insurance companies are some of the other reported shortcomings. Since, Medical Tourism Industry in India is a relatively new phenomenon, some under-researched areas are observed in the available published literature such as: ?
Limited statistical information; ?Impact of globalization on healthcare policies of Medical Tourism Industry in India; ? Challenges posed by Medical Tourism Industry in India like ethical and litigation issues; ? Public sector health inequity and post operative care of the medical tourists. Hence, a qualitative research is much needed to bridge this gap with a combination of primary (semi-structured interviews) and secondary (literature review) research. OPPORTUNITIES
The emergence of Medical Tourism Industry in India encouraged a reverse Brain-Drain where highly skilled medical professionals prefer to practice in their own countries rather than in the lucrative industrialized nations. One of the compensations for their move is the freedom to carry out rare medical procedures, such as hip resurfacing which have not yet been authorized in industrialized nations. There is an accompanying flow of patients as some citizens of developed nations choose to bypass the care offered in their countries and travel to less developed areas of the world to receive a variety of reasonably priced medical services.
As a result, regional and national governments in India, Thailand, Singapore, Malaysia, Philippines and Indonesia regard Medical Tourism Industry in India as an important resource for economic and social development. The difference in treatment costs can be considerable; for example, the cost of an elective coronary artery bypass graft surgery is about $60,400 in California, $25,000 in Mexico, $15,500 in Bumrungrad, $10,000 in Thailand, and in India only $6,500 in Apollo.
Hence, cost-conscious patients choose to accept the inconvenience and uncertainties of off-shore healthcare to obtain service at prices they can more comfortably afford. Medical Tourism Industry in India can be regarded as a tool for lessen the overburdened healthcare systems of industrialized nations. For example, in the US, there are 46. 6 million people with no medical insurance, inadequate coverage and those who are not eligible for Medicare. Moreover, overwhelming health-related expenses contribute to bankruptcies in the United States.
Also, patients choose Medical Tourism Industry in India to circumvent the delays associated with the long waiting list in their native countries and to attain cosmetic surgeries such as dental reconstruction, fertility treatment not offered in their National Health Services such as in United Kingdom and Canada. Patients also travel overseas to access stem cell therapies which are restricted on ethical grounds in most industrialized countries but are available in the Medical Tourism Industry in India.
The shortage of human organ supply available for transplant in the United States drives some patients to other countries to obtain organ transplants, a practice that has been referred to as transplant tourism. There is another category of patients who prefer Medical Tourism Industry in India for confidentiality of the treatment rendered such as plastic surgery, drug rehabilitation and reproductive tourism. Patients also prefer Medical Tourism Industry in India for more personalized nursing care offered owing to the lower labor costs in developing nations supplemented by travel to exotic locations.
Recently, several Fortune 500 corporations such as Blue Ridge Paper Products Inc. have been evaluating the feasibility of outsourcing expensive medical procedures to offshore healthcare destinations to reduce the financial burden of employee healthcare. In addition with these trends, the health insurance sector has potential commercial opportunity for foreign insurance firms. Insurance provider networks are being expanded to include physicians across the globe, and it is anticipated that within a decade a majority of large employer’s health plans will include off-shore medical centers.
It is believed that if Medical Tourism Industry in India continues its meteoric growth, medical insurance plans could take advantage of its cost savings and begin offering lower-priced premiums if policyholders could be assigned to lower-priced countries for treatment. Hence, healthcare financing could become better calibrated to patients’ financial status. Consequently, medical tourism is a component of export-led economic growth, with the foreign currency earnings from international patients translating into output, jobs and income for developing countries with the added bonus of improving their public health systems.
Supplemented by other factors such as: ? Low cost of administrative and medico-legal expenses; ?Medical visas being issued in lieu of travel visas for patients allowing an extended stay for medical reasons; ? Favorable economy. English being widely spoken due to India’s history as a British colony and enjoying a favorable Government support Medical Tourism Industry in India seems to be a promising sector for India. STRATEGIES ON INDIAN MEDICAL TOURISM ?Product ?Price ?Place ?Promotion ?People ?Process ?Physical Evidence SUGGESTIONS Role of Government: The government of India must act as a regulator to institute a uniform grading and accreditation system for hospitals to build consumers’ trust. ?Medical Visas: A simplified systems of getting medical visas should be developed in order to make travel across borders smoother. Visas can be extended depending on the condition of the patients. ?Holistic medical and diagnostic centers within the corporate hospitals: The hospitals have small spaces for the relatives to pray in, thereby wedding science with religion and traditional with modern medical practices. Setting up National Level Bodies: To market India’s specialized healthcare products in the world and also address the various issues confronting the corporate healthcare sector, leading private hospitals across the country are planning to set up a national-level body on the lines of National Association of Software and Service Companies (NASSCOM), the apex body of software companies in the country. It is therefore essential to form an apex body for health tourism – National Association of Health Tourism (NHAT). The main agenda for NAHT are: 1. Building the India Brand Abroad . Promoting Inter-Sectored Coordination 3. Information Dissemination using Technology 4. Standardization of Services ?Integrate vertically: Various added services may be offered to the patients. For example, hospitals may have kiosks at airports, offer airport pickups, bank transactions, or tie-ups with airlines for tickets and may help facilitate medical visas by the government. ?Joint Ventures / Alliances: In order to counter increasing competition in medical tourism sector, Indian hospitals should tie-up with foreign institutions for assured supply of medical tourists.
CONCLUSION ?The First World’s Treatment at Third World Prices: India offers world-class healthcare that costs substantially less than those in developed countries, using the same technology delivered by competent specialists and attaining comparable success rates. ?India is receptively Less “Scary” Now: The author believes that a lot of entrusting medical care to different locations is about a psychological fear of the unknown. An important strategic challenge for developing-country hospitals is to reduce the psychological fear, which India has and is doing assiduously. Presence of a Collection of Medicine and Medicine Care: In India, the same depth of pool of talent for medicine exists as is the case of engineering and mathematical talent for software outsourcing. In the 1950s and ’60s, the Indian government invested a lot in tertiary education. By now there are at least a small handful of medical institutes that are really first-rate, and the doctors they produce are extremely well trained. ?Strong Reputation in the Advanced Healthcare Segment: India has a plethora of hospitals offering world class treatments in nearly every medical field of specialization. Portfolio of Indian Healthcare Tourism Offerings: This includes non-surgical medication complemented with Yoga therapies; unani and homoeopathic streams of medical care are in vogue. India is at an advantageous position to tap the global opportunities in the medical tourism sector. Its role is crucial to the development of medical tourism. The government should take steps in performing a role of a regulator and also as a facilitator of private investment in healthcare.
Mechanisms need to be evolved to enable quicker visa grants to foreign tourists for medical purposes where patients can contact the Immigration Department at any point of entry for quick clearance. Tax incentives to the service providers, import duty reduction on medical equipment, committees to promote and foster medical tourism are some of the initiatives that can be devised. There is also a need to develop robust infrastructure in terms of transport services to facilitate tourism in India. The tourism, health, information and communication departments need to work in tandem for efficient patient care.
It should aim in building and promoting the image of India as high quality medical tourism destination, creating and promoting new combination of medical tourism products, keeping up the high standard of quality treatments at a reasonable price, providing informative online and offline materials and make them available to the potential customers. It should place a help desk and multi-lingual at different airports for medical tourists seeking information in various aspects. The fountainhead of India’s competitive advantage arises from the skillful use of its core competencies.
These competencies are used to gain competitive advantage against rivals in the global market. Also attaining the accreditation/standard to reassure the quality of treatments as well as emphasizing on the needs and demands of the existing target markets must be incorporated. References ?Dr. Suman Kumar Dawn & Swati Pal, International Journal of Multidisciplinary Research ? Dr. R Gopal, The key issues and challenges in medical tourism sector in India (A Hospital perspective) ? Jyotsana Mal, Globalisation of Healthcare: Case studies of Medical Tourism in Multi-Specialty Hospitals in India ? Journals on HealthCare and Medical tourism