1.SUBMITTED BY: ANKUR PURI THIRD YEAR ROLL NO:-061582 RESEARCH CENTER:INSTITUTE OF HOTEL MANAGEMENT,GWALIOR

2. This project report is based on bits of information, ideas and concept collected over a long period of time through studies and interaction with a large number of people. The list is large. My memory fails in recalling them all and then their constraint of space in mentioning their names herein. I owe a debt of gratitude to them all. I express my deep appreciation and indebtedness to my faculty members for helping me in completing this project. I am deeply indebted to my friends, colleagues and family members for providing me deep insight into the subject and for giving me patronage and support. Ankur Puri 3. CHAPTER NUMBER TOPICCONTENTS PAGE NO. SIGNATURE Chapter 1. Chapter 2. Chapter 3. Chapter 4. Chapter 5. Chapter 6. Chapter 7. Chapter 8. Chapter 9. Chapter 10. Introduction Research methodology Objectives Surgeries associated with medical tourism. Scope of medical tourism in India Favorable places for medical tourism. Government contribution in medical tourism. Conclusion Findings & suggestions Bibliography Questionnaires 1 6 7 8-34 35-49 50-53 54-68 69-70 71-78 79 4. What's called Medical tourism or Medical travel or Healthy tourism? It is a term initially coined by travel agencies and the mass media to describe the rapidly- growing practice of traveling across international borders to obtain health care. Patients going to a different country for either urgent or elective medical procedures? And is fast becoming a worldwide, multibillion-dollar industry. Such services typically include elective procedures as well as complex specialized surgeries such as joint replacement (knee/hip), cardiac surgery, dental surgery, and cosmetic surgeries. However, virtually every type of health care, including psychiatry, alternative treatments, convalescent care and even burial services are available. As a practical matter, providers and customers commonly use informal channels of communication-connection-contract, and in such cases this tends to mean less regulatory or legal oversight to assure quality and less formal recourse to reimbursement or redress, if needed. 5. HISTORY OF MEDICAL TOURISM 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. Spa towns and sanitariums may be considered an early form of medical tourism. In eighteenth century England, for example, med trotters visited spas because they were places with supposedly health-giving mineral waters, treating diseases from gout to liver disorders and bronchitis. 6. REASON FOR MEDICAL TOURISM 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. PROCEDURE USA INDIA (USD) THAILAND SINGAPORE Heart Bypass USD 1,00,000 USD 7,200 USD 11,000 USD 16,500 Angioplasty USD 1,60,000 USD 7,000 USD 10,000 USD 15,000 Hip Replacement USD 43,000 USD 7,100 USD 12,000 USD 9,200 Knee Replacement USD 40,000 USD 8,500 USD 10,000 USD 11,000 Spine Fusion USD 62,000 USD 7,500 USD 8,500 USD 10,000 Lap. Gastric Bypass USD 35,000 USD 9,200 USD 10,200 USD 11,500 Tummy Tuck USD 10,000 USD 4,500 USD 5,500 USD 6,550 Dental Implant USD 10,000 USD 1,500 USD 2,000 USD 2,400 7. 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. 8. PROCESS FOR MEDICAL TOURISM The typical process is as follows: The person seeking medical treatment abroad contacts a medical tourism provider. The provider usually requires the patient to provide a medical report, including the nature of ailment, local doctors opinion, medical history, and diagnosis, and may request additional information. Certified medical doctors or consultants then advise on the medical treatment. The approximate expenditure, choice of hospitals and tourist destinations, and duration of stay, etc., is discussed. After signing consent bonds and agreements, the patient is given recommendation letters for a medical visa, to be procured from the concerned embassy. The patient travels to the destination country, where the medical tourism provider assigns a case executive, who takes care of the patient's accommodation, treatment and any other form of care. Once the treatment is done, the patient can remain in the tourist destination or return home. 9. RESEARCH METHODOLOGY I have selected the following method to collect information for the project Experimental Questionnaire Interviews Survey Exploratory Internet Magazines Newspaper Brochures 10. TO KNOW ABOUT SURGERIES ASSICIATED WITH MEDICAL TOURISM TO KNOW SCOPE OF MEDICAL TOURISM IN INDIA TO KNOW FAVAORABLE PLACES FOR MEDICAL TOURISM TO KNOW GOVERNMENT CONTRIBUTION IN MEDICAL TOURISM 11. TOTAL KNEE REPLACEMENT TOTAL HIP REPLACEMENT SURGERY CORONARY ANGIOGRAPHY PHAROPLASTY ("EYELID SURGERY") FACE LIFT (RHYTIDECTOMY) RHINOPLASTY (NOSE JOB): RESHAPING OF THE NOSE ABDOMINOPLASTY (TUMMY TUCK) RESHAPING AND FIRMING OF THE ABDOMEN BREAST LIFTS (MASTOPEXY): LASIK LASER EYE SURGERY OR KERATOMILEUSIS. 12. HAIR REPLACEMENT 13. TOTAL KNEE REPLACEMENT Knee Replacement Surgery also known Total Knee Arthroplasty is a cure of painful knees, knee arthritis and other knee related issues. Knee Replacement is a surgical procedure during which the bones of the knee are resurfaced with metal and plastic implants. The weight passing through the knee should be well distributed for which the bones of the knee are well aligned. In total knee replacement surgery, the parts of the bones that rub together are resurfaced with metal and plastic implants. Using special, precision instruments, your surgeon will typically remove the damaged surfaces of all three bones. The replacement surfaces will then be fixed into place. Sometimes also called "resurfacing", this operation involves the removal of the damaged, worn ends of the thigh (femur), and leg (tibia) bones that make up the knee joint, as well as the back of the kneecap (patella). The bone ends are precisely reshaped and recapped with metal surfaces, with special plastic liners added as a bearing surface that promotes low friction gliding between metal and plastic. 14. TOTAL HIP REPLACEMENT SURGERY Hip arthroplasty is a surgical procedure in which the hip joint is replaced by a prosthetic implant. Such joint replacement orthopedic surgery generally it is conducted to relieve arthritis pain or fix severe physical joint damage as part of the hip fracture treatment. Hip replacements under go lots of cyclical stress. SYMPTOMS Pain that keeps you awake at night Little or no relief from pain medications Difficulty in walking up or down stairs Trouble standing from a seated position Having to stop activities you enjoy,such as walking, because you're in too much pain. COMPLICATION In the short term post-operatively, infection is a major concern. Reported rates are about 1%. Deep infection will often require one or two stage revision surgery with an extended hospital stay and antibiotics. Recurrent dislocation is another indication for revision. The rate is also about 1%. WOUND CARE You will have stitches or staples running along your wound or a suture beneath your skin. The stitches or staples will be removed approximately 2 weeks after surgery. DIET Some loss of appetite is common for several weeks after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength. Be sure to drink plenty of fluids. ACTIVITY Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal light activities of daily living within 3 to 6 weeks following surgery. Your activity program should include: 15. CORONARY ANGIOGRAPHY Coronary angiography is an X-ray examination of the blood vessels or chambers of the heart. A very small tube (catheter) is inserted into a blood vessel in your upper thigh (groin area) or arm. The tip of the tube is positioned either in the heart or at the beginning of the arteries supplying the heart, and a special fluid (called a contrast medium or dye) is injected. This fluid is visible by X-ray, and the pictures that are obtained are called angiograms BENEFITS: No radiation remains in a patient's body after an x-ray examination. X-rays usually have no side effects Angiography may eliminate the need for surgery. If surgery remains necessary, it can be performed more accurately. 16. ANGIOGRAPHY USUALLY TAKES ABOUT HALF AN HOUR TO COMPLETE. RISKS: Because angiography involves puncturing an artery, internal bleeding or haemorrhage are possible complications of the test. X-rays carry risks of ionizing radiation exposure to the fetus; pregnant women are also advised to avoid this procedure. There is always a slight chance of cancer from radiation. However, the benefit of an accurate diagnosis far outweighs the risk. Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. If you have diabetes or kidney disease, the kidneys may be injured when contrast material is eliminated through the urine. The catheter may damage a coronary artery. If this occurs, the artery may be repaired by emergency heart surgery. A stroke. 17. WHAT TO EXPECT AFTER CORONARY ANGIOGRAPHY After coronary angiography, you will be moved to a special care area, where you will rest and be monitored for several hours or overnight. During this time, your movement will be limited to avoid bleeding from the site where the catheter was inserted. While you recover in this area, nurses will check your heart rate and blood pressure regularly and see if there is any bleeding from the tube insertion site. A small bruise may develop on your arm, groin (upper thigh), or neck at the site where the catheter was inserted. That area may feel sore or tender for about a week. Be sure to let your doctor know if you develop problems such as: A constant or large amount of blood at the site that can't be stopped with a small bandage Unusual pain, swelling, redness, or other signs of infection at or near the insertion site BLEPHAROPLASTY ("EYELID SURGERY") 18. Reshaping of the eyelids or the application of permanent eyeliner, including Asian Blepharoplasty The commonest eyelid procedure is known as Blepharoplasty. Blepharoplasty reduces fat and removes excess skin and muscle from the upper and lower eyelids Blepharoplasty or Eyelid Surgery is mainly done to patients who want to remove their excess fat in the upper eye lids and in the eye bags. These accumulations of fat will make you look tired and older than you are actually. So reduction of the fat is possible by the cosmetic POST EFFECTS OF BLEPHAROPLASTY All surgery carries some uncertainty and risk. Blepharoplasties are normally safe, as long as patients are carefully selected, the operating facility is properly equipped and the physician is a certified Plastic Surgeon. All the surgeries are not positive it can have bleeding and swelling at the corners. You can have double or blurred vision. You can have problem in pulling down the lower lids. Difficulty closing the eyes. - This is generally temporary as the scars heal, but can be permanent in some cases, leading to difficulty sleeping. Ectropion - A very rare complication which results in a downward pulling on the lower lids. Additional surgery may be required to correct ectropion FACE LIFT (RHYTIDECTOMY) 19. . Removal of wrinkles and signs of aging from the face. The Feather-Lift is a non-surgical approach to facial lifting utilizing the patented Aptos threads. POST TREATMENT EFFECT(S) There may be discoloration of the skin (black and blue) for several weeks. Surgery necessary to perform the procedure, as in all surgery, involves certain risks, including but not limited to the following Bleeding Infection Tissue Damage Nerve Injury 20. Technically known as Rhytidectomy, a facelift is a surgical procedure to improve visible signs of aging in the face and neck, such as Sagging in the mid-face Deep creases below the lower eyelids Deep creases between the nose and mouth Fat that has fallen or is displaced Loss of muscle tone in the lower face that may create jowls Loose skin and excess fatty deposits under the chin and jaw A facelift is designed to correct all of these aging features, restoring a more youthful, rested appearance with uplifted contours and improved tone in facial skin and underlying muscle. 21. Rhinoplasty (Nose Job): Reshaping Of The Nose Rhinoplasty is cosmetic surgery of the nose. It is also known as nasal refinement of the bones of the nose and re-setting them in the desired shape, often narrow and straight. PLEASE NOTE: About two weeks after the operation, some swelling will have subsided, usually enough to return to work or visit friends. The majority of swelling should subside in 6 - 8 weeks. The healing process can take up to 12 months, and during this time you will see progressive improvement in the fine details of your nose. Normal breathing at times may take up to three months to recover completely. 22. ABDOMINOPLASTY (TUMMY TUCK) RESHAPING AND FIRMING OF THE ABDOMEN POST TREATMENT EFFECT(S): Reaction to anesthesia Abdominoplasty, the medical term for what is commonly known as "tummy tuck," involves surgically removing excess skin and fat from the middle and lower part of the abdomen and sometimes tightening the abdominal muscles Sahara Medical offers Abdominoplasty which is a major surgical procedure to remove excess skin and fat from the middle and lower abdomen and to tighten the muscles of the abdominal wall. The procedure can dramatically reduce the appearance of a protruding abdomen. FACTS ABOUT ABDOMINOPLASTY Tummy tucks are among the five most popular cosmetic surgery procedures. The results of a tummy tuck depends on the patient's age at the time of the operation, physical condition, type of skin and any changes in weight. The two most common types of tummy tuck are the full tummy tuck (requiring general anesthesia and a short hospital stay) and the mini tummy tuck, which may require only local anesthesia and can be done on an outpatient basis. Abdominoplasty is generally safe. Any surgery, however, has the potential for complications and the patient should clearly understand any and all risks involved. 23. Unplanned hospital admission A collection of blood under the skin (hematoma, or "blood blister") Slow healing and excess scarring A degree of permanent numbness of the abdomen Occasional bleeding Infection Blood clots, particularly in women taking birth control pills BREAST LIFTS (MASTOPEXY): Lifting or reshaping of breasts to make them less saggy, such as weight loss after a pregnancy. It involves removal of breast skin as opposed to glandular tissue. 24. The breast lift raises and tightens the sagging breast. Candidates for breast lift surgery are those with loose skin or women who have lost volume and tone after children. Under some circumstances, breast lift patients may have implants and breast lifts performed simultaneously. Breast lift surgery scars are permanent, but over time fade to some extent. In addition to the benefits of breast lift surgery, make sure you understand its limitations. dont expect perfection. have realistic expectations. Breast lift can reshape your body, but not youre life KERATOMILEUSIS. OR LASIK LASER EYE SURGERY What is popularly referred to as Lasik laser eye surgery is technically termed as Laser-Assisted in Situ Keratomileusis. It is a type of refractive surgery carried out by ophthalmologists for correcting myopia, hyperopia, and astigmatism. The surgery is a relatively simple process and is carried out while the patient is awake but a mild sedative and anesthetic eye drops 25. are administered to block out the pain. Lasik eye surgery is performed in the following broad steps First an anesthetic drop is administered to the eye and then an instrument called lid speculum is used to keep the eyelids open. Following this a ring is placed on the eye and very high pressure is applied to create suction in the cornea. At this stage the doctor uses a microkeratome to cut a flap in the eye. Once the eye is fixed in the correct position the laser is started. The laser will help to vaporize a particular amount of tissue, which is pre- fixed by the surgeon based on initial analysis. In the third and final stage the flap is replaced and a shield to guard the eye is put on the patient. The flap is not stitched back so its important to protect the eye with the shield. One of the most important steps to the Lasik eye surgery occurs much before the patient is taken to the operation table. The pre-surgical evaluation of the patients ophthalmic and medical history is that stage. If you have been traditionally using contact lenses you will need to stay away from them for 2 to 4 weeks prior to this evaluation for it to be accurate. For patients using soft contact lenses the period is of 2 weeks, semi soft its 3 and for users of hard lenses it is 4 weeks. Lasik eye surgery as we are aware, changes the shape of the cornea of the eye, so do lenses except in this case they are temporary. It is this temporary distortion of the normal shape of the cornea that needs to be avoided by avoiding the contact lenses. The cornea is what is vaporized during Lasik surgery therefore knowing its original shape and size is of utmost importance to the surgeons. It is always advisable to take someone along to drive to and from the ophthalmic evaluation as well as the Lasik eye surgery. This is because some medicines administered by doctors during the evaluation and both before and after the surgery may cause blurred vision. Another important factor to remember is to stop the use of any make up, perfumes, creams or lotions around the eye or on the lashes one day prior to the surgery as they may cause infection after the procedure. Some surgeons also request 26. patients to scrub the eyelashes to remove the debris of these products that might have been used before for Lasik eye surgery. For a normal Lasik eye surgery a few days of rest period proves sufficient. Pain killers might need to be taken initially and the protective shield has to be kept on for sometime. Itching, watering of the eye, blurred vision are common occurrences following the surgery but they should improve considerably within the first two days. HAIR REPLACEMENT SURGERY Hair transplant is in simple terms the process of taking hair from the location where its not required and planting it in a location where it is, which in majority cases is the most visible part of the head. This location gets first priority as absence of hair at this location makes a person appear bald. From ancient times baldness is associated with advanced years, its an old man who is conventionally visualized as bald and similarly represented in art. Hair transplant is one of the most dynamic areas of scientific research today and latest developments are making it better and better at a fast pace. We must however try to remember that during hair transplant the doctors do not create new hair; they simply rearrange hair thats already there so the effects might not be like the head full we enjoyed to begin with. The safest area from where hair can be uprooted and replanted in the middle of a bald patch with good possibility of 27. re-growth is the horse shoe shape area at the back of the head. The hair from this area has minimum possibility of suffering loss even when put in an area where hair loss is common. Therefore in hair transplant hair from the back of the head is widely preferred. This hair retains its original characteristic no matter where it is re- grafted in the head. Hair transplant is not just a surgery; it is also a form of art as expertise that is required from the doctors side is sometimes of the level of art. We hope you will find the surgeon and the clinic you are looking for in our list and will begin the process of hair transplant with us. Its a regular procedure that is very popular in many countries of the world, please study our list and decide on where you would like to go for it. THE ACTUAL PROCEDURE OF ANY HAIR REPLACEMENT SURGERY FOLLOWS THESE STEPS: A 1 cm wide & 20 cm long strip is taken from the donor site This piece is then cut into many fine strips which are 1 follicular unit in width Following this, the above sections are further dissected into one-haired follicular units (follicular unit graft), two-haired follicular units (micro graft), three-haired follicular units (mini grafts), four-haired follicular units (mini grafts), three-haired follicular groupings, four-haired follicular groupings 28. Finally an incision of the exact size of the graft and in the natural direction of hair growth is made on the donors scalp and the grafting is done. This latest method of hair replacement surgery using natural hair is more successful as it requires less time and leaves less likelihood of injuries to follicular units. Hair replacement surgery, in most cases, can be carried out in the outpatient clinic by a cosmetic surgeon, general anesthesia and sedatives are used o keep the patient comfortable , sometimes several procedures may be required to achieve the desired result and the recovery time usually depends on the complexity of the procedure. Hair replacement is as such an elective procedure if it is undertaken only for cosmetic purposes, however as mentioned earlier for patients who are required to undergo the procedure as a result of suffering hair loss brought about by burning or accidents , it is often covered by insurance. Please do have a clear talk with your insurance agent and your doctor if your hair replacement surgery falls in this category to get an insurance approval for it. Many hospitals in many countries offer this sort of treatment, the surgeons are highly experienced and the results are satisfactory. We have listed down several attractive options of getting a hair replacement surgery done in destinations outside the UK and the USA, study them, and take an informed decision that has the potential to change much more than your physical appearance. 29. INDIA 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. 30. 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. 31. Medical Tourism India - Where the entire world meets for the best in Health Care Medical Tourism in India is one of the best options available to people across the globe. Millions come every year to get treated and then enjoy their recuperative holidays across India. People from different walks of life cut across the entire span of the globe come to India to have their treatments done with peace of mind. India provides world class medical facilities with hospitals and specialized multi specialty health centers providing their expertise in the areas of Cosmetic Surgery, Dental care, Heart Surgeries, Coronary Bypass, Heart Check up, Valve replacements, Knee Replacements, Eye surgeries, Indian traditional treatments like Ayurvedic Therapies and much more, practically covering every aspect of medicine combining modern treatments with traditional experience India is considered the most important country promoting medical tourism. India is one of the most touted medical tourism destinations in the world. 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 2,297,794,117 USD 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. Price advantage is 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) 32. 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. India have a lot of hospitals offering world class treatments in nearly every medical sector such as 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 For long promoted for its cultural and scenic beauty, India is now being put up on international map as a heaven for those seeking quality and affordable healthcare. Analysts say that as many as 150,000 medical tourists came to India in 2004. 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 is becoming 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. Leisure Tourism is already very much in demand in India as the country offers diverse cultural and scenic beauty. India has almost all sort of destinations like high mountains, vast deserts, scenic beaches, historical monuments, religious temples etc. Known for its hospitality for tourists, the county has opened doors to welcome with the same hospitality. 33. FEW FACTS ABOUT MEDICAL TOURISM IN INDIA INDIA FOSTERS GROWING 'MEDICAL TOURISM' SECTOR India is hoping to expand its tourist industry to include visitors with heart conditions and cataracts. Indeed, medical tourism, where foreigners travel abroad in search of low cost, world-class medical treatment, is gaining popularity in countries like India. The field has such lucrative potential that Indian finance minister Jaswant Singh called for India to become a global health destination. And, with prices at a fraction of those in the US or Britain, the concept will likely have broad consumer appeal if people can overcome their prejudices about health care in developing countries. Though the quality of health care for the poor in countries like India is undeniably low, private facilities offer advanced technology and procedures on par with hospitals in developed nations. One Indian hospital director maintains, "In a corporate hospital, once the door is closed you could be in a hospital in America. YaleGlobal ECONOMIST.COM | MEDICAL TOURISM TO INDIA FOR someone about to undergo surgery to remove gallstones, David Potter, a 63- year-old Briton, is remarkably chipper. Pushing a walking-frame he hardly seems to need, he testifies to the success of an earlier operation, to replace a hip. Both are standard surgical procedures PROMOTING HEALTH AND MEDICAL TOURISM IN INDIA - LOOKIN - EXPRESS ... Health and medical tourism is perceived as one of the fastest growing segments in marketing Destination India today. While this area has so far been relatively unexplored, we now find that not only the ministry of tourism, government of India, but also the various state tourism boards and even the private sector consisting of travel agents, tour operators, hotel companies and other accommodation providers are all eying health and medical tourism as a segment with tremendous potential for future growth. INDIA DAILY MEDICAL TOURISM IN INDIA MAY BE WORTH US$2.3 BILLION ... With an increasing number of foreign patients flocking to India for treatment, the country could earn Rs 100 billion (US$2.3 billion) through 'Medical Tourism' by 2012, a study has indicated. 34. According to the study conducted by the Confederation of Indian Industry and McKinsey consultants, last year some 150,000 foreigners visited India for treatment, with the number rising by 15 per cent a year. With a large pool of highly trained doctors and low treatment cost, healthcare aims to replicate the Indian software sector's success. Built on acres of land the new sleek medical centres of excellence offer developed world treatment at developing world prices. INDIA CAN EARN $1 BILLION FROM MEDICAL TOURISM India could earn more than $1 billion annually and create 40 million new jobs by sub-contracting work from the British National Health Service, the head of India's largest chain of private hospitals told rediff.com. Houston-trained Dr Prathap C Reddy, chairman, Apollo Hospitals, also said he was waiting for a reply to his proposal to carry out operations at a fraction of what they would cost in the United Kingdom. Details of the multi-million dollar package are also carried in this week's edition of India Abroad. They include surgery for hip and knee replacements and coronary bypass that would slash waiting times dramatically, reducing the queues of British patients waiting to see their doctors. "We have well equipped, state-of-the-art hospitals and we can offer the same level of care as anywhere else in the world," Dr Reddy said. "There is no reason why we should not become the healthcare destination of the world."... CBC NEWS INDEPTH: HEALTH CARE A worldwide market What's called medical tourism patients going to a different country for either urgent or elective medical procedures is 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 35. 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. India 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. WHY IS INDIA MOST SUITABLE? 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 36. 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. 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 37. 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 Number of people having visited India for as medical tourists: India now hosts and treats an estimated of 50,000 medical tourists a year and the catalytic CII-McKinsey report of 2002 projected that medical tourism could contribute up to Rs 10,000 crores in revenue by the year 2012. RE-OPENING OF THE TAJ AND TRIDENT REKINDLES GROWTH OF MEDICAL TOURISM. December 23rd, 2008 Barely a month after the terror attacks in Mumbai, the fire-scarred TAJ and TRIDENT are open for business and stands strong ready to welcome guests to the recuperated sections of the hotel. Guests, including foreign nationals and medical tourists from various countries who need immediate medical care have fearlessly chosen these hotels for stay. Global economic freeze had encouraged several medical tourists to fly down to India to avail quality medical treatment at a low cost. Millions of uninsured and baby boomers in the US were left with no choice but to opt for medical tourism for medical treatments. But the terror attacks in 38. Mumbai On the 26th of November seemed to have weakened the business prospects of health tourism in India. But not for long! The re-opening of the Taj, Trident and the Oberoi within a span of 20 days shows the determination of the hotel owners to show the world the undying spirit and the strength of India. The sight of localities and foreign nationals walking into the gates of these hotels surely is an encouraging sight to the hotel owners. It symbolized their confidence in the spirit of India to fight back terror and show their strength amidst tough times. State wise preparation in progress: Karnataka is now preparing to promote premier government institutions as medical tourism destinations. The department of Tourism with the Health and Family Welfare department has identified centres of excellence in the government health sector such as Jayadeva Institute of Cardiology and the Kidwai Institute of Oncology which will be promoted abroad as places for specialised treatment at affordable costs, said health commissioner Basavaraju. Moreover, what is now being called the Andhra Pradesh model stems from the provision of universal health insurance in three districts, and AP chief minister YS Rajasekhara Reddy has called for bids in six other districts. Thus, as Dr Pratap C Reddy of Apollo Hospitals emphasised, insurance cover and accessibility can drive change. In Aragonda, Andhra 39. Pradesh, with a contribution of a rupee a day a constables son was able to have a bone marrow transplantation done at the best facility. Nobody can afford to pay for major illnesses, and we need a mechanism to make hospital procedures cashless. That is possible only with insurance. After going through the above, what could be the wish list of a common man for making medical tourism a big success for India? Some of these are summarized below: Let there be an identical agency like NAASCOM for medical tourism to periodically come out realistic reports for bettering the services in the days to come. Why only private sector gains - why not public sector too, from the earnings of medical tourism - a thorough study need to be done by involving the experts. The rates charged or services offered could be further subsidized so that people from different parts of the world throng to our hospitals for getting timely, immediate and quality care all at an affordable cost so that at least by word of mouth the message gets well spread across different sections of the societies. ESI hospitals too can join this race by selectively opening up their doors so that their income gets a big boost, which could be optimally utilised for bettering the services from all angles benefiting the registered care seeker. Let our foreign consulate offices act as ambassadors for promoting medical tourism to get this business a big boost. Let there be innovative schemes by targeting medical tourists so that they return back with great feeling of comfort, satisfaction and joy. 40. MEDICAL TOURISM GROWS EXPONENTIALLY Medical tourism is a recognized industry in the west. When Information Technology, manufacturing and technical support jobs went eastward, nobody even bothered to think that healthcare might take the same road somebody. But it did. And thats good news for countries like India, Malaysia, Thailand and Philippines. Medical care in these Asian countries cost just one-tenth of the costs in U.S.A. No wonder 50,000 Americans traveled abroad for medical care in 2006. Surgical care and dental treatment top the list of health care needs of people from America and U.K. Several of the hospitals in these countries boast state-of-the-art facilities, skilled medical professionals and medical care on par with western countries. Insurance companies in the U.S.A. have started to recognize this form of medical care in another country as a viable alternative to high-cost medical care in the U.S. The Economic Times has a report that suggests that 41. western insurance companies are considering covering medical tourism, as well. If one tenth of Americans travel abroad for treatment, the insurance companies could save around $1.4 billion. The report recommends that companies should consider offering SOPs like lowered premiums or added services to boost medical tourism as it improves their bottom-line, eventually. This would again be a great impetus for medical tourism in countries like India. 42. Mediescapes India is India's first medical tourism promotion company fully owned by Indians, run with the cooperation of Indian doctors / medical specialists, and promoting Indian Hospitals / Clinics / Health Care System to patients worldwide. 1) Patients are encouraged to FIRST send their medical records to our mailing address (mentioned on the Contact Us web page) and then seek cost estimates / duration of treatment for their respective medical conditions. All medical records are treated as confidential by us and images of patients received (for cosmetic procedures as well as testimonials / feedback) are never shared / disclosed by Mediescapes India. (2) Please note, Mediescapes India will not reply to patients enquiries whose current medical records, including imaging films such as recent MRIs / X-Rays / CT Scans / OPG Images for dental / front or side view for cosmetic / Bariatric surgery etc. are not available to our consultant for evaluation. Neither will we respond to medical enquiries without an accompanying filled-in Medical Questionnaire (we have medical questionnaires for respective medical conditions that have been developed by our medical consultants team and which may require filling-in with the help of the patients family physician). The questionnaires are meant for screening a patients case followed by evaluation of his/her medical records by our panel of eminent medical consultants. (3) Patients are discouraged from window-shopping for their health by sending one-line questions to Mediescapes India such as "How much will this treatment cost?" without transmitting their medical condition records / summary as your medical condition needs to be screened first and then 43. evaluated by our panel of Board-certified eminent medical consultants practicing in JCI-Accredited / ISO-Certified Hospitals of repute. (4) Mediescapes India retains the right to charge adjustable screening fees with medical cost estimates in advance in selected cases from patients enquiries originating in Bangladesh / Pakistan / Afghanistan / Sri Lanka / Bhutan / Maldives and African countries before disseminating treatment plans / medical opinions to these countries patients and or medical enquiries originating from other selected countries. Information provided on this unique Medical Portal Website is for general medical education and to let patients know what to expect during a opt -in medical procedures in India. Such information is subject to change. Mediescapes India. Com does not guarantee that the information is accurate or complete, and is not responsible for any actions resulting from the use of this information. General information provided in this fashion should not be construed as specific medical advice or recommendation, and is not a substitute for consultation of and physical examination by a physician. Only discussion of your individual needs with a qualified physician will determine the best method of treatment for you. All doctors listed on this unique Indian medical portal website are Board- certified and are well-known surgeons / medical consultants attached to super-speciality tertiary health care institutes / hospitals / clinics of repute in India. SUGGESTED HOSPITALS / CLINICS 44. Suggested Hospitals / Clinics Mediescapes India thanks the JCI / ISO accredited medical institutions of repute in India and overseas whose association with us has made this unique medical portal website in India possible. Artificial Limbs Clinic, New Delhi Ayurvedagram Wellness Centre, Bangalore Apollo Hospitals, Chennai Bariatric Surgery Hospital, New Delhi Cosmetic Laser Clinic, New Delhi Dental Implants Clinic, New Delhi EECP and ACT Hospital, Ludhiana Lakeshore Hospitals, Cochin Lifeline Hospitals, Chennai MAX Healthcare Hospitals, New Delhi MIOT Hospitals, Chennai Moolchand IVF & Women Hospital, New Delhi Madras ENT Research Foundation, Chennai Narayana Hrudayalaya, Our Medical Consultants' Panel Mediescapes India thanks our associated Board-certified surgeons / senior medical consultants team that also helped to make this unique medical portal website in India possible. Ayurveda Treatment Physicians in India Bone Marrow Treatment Consultant India Bariatric Surgery Surgeons in India Cardio and Cardio Thoracic Consultant India Cord Blood Storing and Transplant in India Cosmetic Surgery Consultant in India Dermatology / Laser Consultant India Dental Consultant in India ENT Consultant in India ECP Consultant in India General Surgery Consultant in India IVF Consultants in India Nephrology and Urology 45. Bangalore Naturopathy Centre & Spa, Saharanpur Vitiligo & Lipolysis Clinic, Bangalore Physiotherapy & Rehab. Clinic, Mumbai Parkway Group Hospitals, Singapore Shroff Eye Hospital, Mumbai Tushita Meditation Centre, Dharamshala Tiantan Puhua Stem Cell Hospital, China Yoga Centre, Dehradun Consultant in India Neurology Consultant in India Naturopathy Consultant in India Nuclear Medicines Consultant in India Orthopedic Consultant in India Ophthalmology (Eye care) Consultant in India Obstetrics and Gynecology Consultant India Physiotherapy and Rehabilitation Consultant Pediatrics Consultant in India Spinal Surgeon in India Stem Cell Consultants in India Vascular Surgery Consultant in India 46. INDIAN GOVERNMENT ACKNOWLEDGES GROWTH OF MEDICAL TOURISM As more and more people, hospitals and patients the world over are becoming aware of the growth and potential of Medical Tourism; governments too are awakening to take the necessary steps required to facilitate its growth and popularity in their respective countries. The Indian Government is one such body which is taking productive measures towards ensuring that this extremely lucrative opportunity may be available to the deserving, well equipped Indian hospitals and practices. The Government of India estimates that, on average, Indian hospitals offer treatment for 20% of what it would cost in the United States, with even bigger discounts available on cosmetic surgery. The cost of heart surgery in India is $6,000 compared with $30,000 in the United States! India has introduced a medical visa aimed at assisting overseas visitors to travel to the country for cut-price hospital treatment. An initial visa is available for up to a year and can be used for up to three visits during the 12-month period. Speaking at World Travel Market, Leena Nandan, Joint Secretary to the Government of India, Ministry of Tourism, said a task force had now been formed to assess the benefits of actively promoting India as a medical tourism destination. It will be looking at how we can best develop this opportunity whilst ensuring that all hospitals involved offer a uniformly high standard of treatment. 47. India is also keen to promote the more leisure-based health tourism focusing on well-being, spas and traditional therapies. Said Ms Nandan: The Indian systems of medicine including Ayurveda, Panchakarma, yoga and rejuvenation therapy are among the most ancient medical treatments in the world. Health tourism is already being promoted as a key selling point in Kerala where a number of hotels feature Ayurveda centers and its a facility a lot of holiday makers are now looking for. Union Minister Ambika Soni recently announced that a total investment of $6.5 billion is in the pipeline for medical tourism industry in the country and the amount will also be used for setting up affordable hospitals and budget hotels for patients relatives in the country. This announcement highlights the increasing number of Indian private hospitals that are finding themselves mentioned in travel itineries and are sought out by more and more foreigners. If industry estimates are to be believed, the size of the medical tourism industry stands at Rs 1,200-1,500 crore (Rs 12-15 billion). The Indian healthcare market is Rs 15 billion and growing at over 30% every year. The trend is positive and theres a great opportunity to leverage the low- cost, high quality model that India offers. If you see around the world, theres a problem with healthcare infrastructure everywhere. While theres a problem of insurance cover in the US, UK and Canada have a long waiting time. These put a lot of stress on patients and India fits the bill for its value for money expertise. The tie-up with the Incredible India campaign and start of medical visas will go a long way in promoting India as the best healthcare destination, says Dr Anupam Sibal, group medical director, Indraprastha Apollo, New Delhi, which has seen a steady rise in patient volumes from abroad. The rising volume of foreign patients is also expected to provide impetus to the tourism industry. K B Kachru, country head, Carlson Group, highlights that the benefit to tourism industry could be of the order of Rs 1,000 crore (Rs 10 billion). 48. NRIs, Asians and tourists from around the world are beginning to realize the potential of modern and traditional Indian medicine. Health and medical tourism is perceived to be one of the fastest growing segments in marketing Destination Incredible India today. While this area has so far been relatively unexplored, we now find that not only the ministry of tourism but also various state tourism boards are promoting health and medical tourism as a segment with tremendous potential for future growth, he says. The Government does not deny that there are still some legal and infrastructural problems that need to be ironed out like accreditation, quality care, transparency in pricing, easy visa rules etc but they are not against doing the needful. The Government of India is working towards creating a system in which investing in India and all it has to offer becomes an easier and simpler process. 49. MEDICAL TOURISM AND ITS IMPACT ON OUR GDP 50. Looking up for a better and prosperous contribution to the society through medical tourism. It is time to realise the potential of making a mark for ourselves and the country in the field of medical science by collaborating with international medical soci. Sharing of a wonderful experience by a foreign national: For thousands of medical tourists like George Marshall, this debate is invisible. In 2004, a heart bypass was recommended for the 73-year-old British citizen, which would have cost him up to 20,000. I had to wait for over three months to see the cardiologist and potentially a further six months for the operation, he said. Instead, he paid 4,400 to Wockhardt Hospitals for the operation. Airfare and travel insurance cost extra, and he paid with his own money, as insurance couldnt cover his outsourcing of medical needs. 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. Reason for going in for medical tourism: Medical tourism is attracting people from all over the industrialised 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 51. 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. 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 Organisations (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. 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. Josephs University in Philadelphia, US, is author of the book Medical Tourism in Developing Countries. According to her research on the economic impact of medical 52. tourism, 750,000 Americans are expected to have travelled abroad for treatment in 2007 and over six million will be doing by 2010. 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. Our Finance Ministrys projections on GDP: The Finance Ministrys Investment Commission emphasises 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) by 2010. Comments offered by lead hospital spokesperson: The sector is getting focused from an investment perspective, said Vishal Bali, chief executive of Wockhardt Hospitals, who plans to double its hospitals to 30 from 15 in time span of two years. The drivers for the future are falling in place. At the same time, Dr Pratap C Reddy, chairman of the Apollo Hospitals Group, explained: We need to invest $60-70 billion over the next five years in hospitals and healthcare education to expand this sector and reach out to masses as soon as possible. Comments offered by other professionals in this field: Ravi Duggal, a researcher with the Mumbai-based policy analysis group, Centre for Enquiry into Health and Allied Themes, explained, The problem starts when a developing country, which has 75 per cent of its 53. population either poor living at subsistence level, collaborates in promoting medical tourism when it cannot meet the basic healthcare needs of a majority of its citizens. Medical tourism creates a climate of inequitable services that undermine the goal of health for all, in the view of Dr Nergis Mistry, scientific researcher with the Foundation for Medical Research, Mumbai. Mistry warns against a technology and urban-centred approach to delivering health care: It raises the cost of healthcare for the local population because it forces the use of expensive technology and drugs. Number of people having visited India for as medical tourists: India now hosts and treats an estimated of 50,000 medical tourists a year and the catalytic CII-McKinsey report of 2002 projected that medical tourism could contribute up to Rs 10,000 crores in revenue by the year 2012. Existing guidelines seem to be inadequate: In the major states, health departments issue guidelines to private hospitals specifying their obligation to provide beds, treatment and services to the public patient, and to return a portion of revenues from medical tourism into serving the public health overburden, but neither are these hospital held to account on these points by their respective state governments, nor does a standard country-wide regulatory system exist to ensure such compliance. Benefits are accruing only to private sectors: A signal of state-directed change however comes from Tamil Nadu, Karnataka and Andhra Pradesh. As of now, it is only the private sector that is reaping the benefits of medical tourism in Tamil Nadu, said health secretary VK Subburaj, while the government sector remains out of this loop so far: We have been focusing on public health. However, with the 54. concept of pay wards coming up in government hospitals for certain field segments; we can expect this trend to change. STEPS TAKEN BY GOVERNMENT TO ENHANCE MEDICAL TOURISM The medical tourism market in India is worth US$ 333 million,2 growing at 30 percent per annum. Due to the emergence of this industry in India, massive tasks lie ahead to synergise the resources of the two sectors. However there are issues and challenges that need to be addressed to overcome the roadblocks to facilitate the growth of this industry in India. The issues that need attention are: 1. Upgradation of basic amenities and hospital infrastructure 2. Co-ordination between the healthcare and tourism sectors 3. Creating a resource pool of highly skilled and cordial manpower 4. Standardization of services and accreditation of hospitals 5. Increasing visibility of India on the world map 6. The impact on domestic healthcare services 55. UPGRADATION OF BASIC AMENITIES AND HOSPITAL INFRASTRUCTURE Basic amenities in India are not up to international standards, especially air connectivity, road links, conveyance services and Internet connectivity. This gives a poor image of the country to health travelers, and also raises doubts about the quality of healthcare facilities. The state of basic amenities in a country has a considerable impact on the choice of destination for health travelers. Basic amenities need to be upgraded and made hassle free. Travel visa is another critical issue which the Indian government plans to address by introducing special medical visas for foreign tourists coming to India for specialized treatment. This visa will allow the patient to bring along two attendants and will also enable him to access the finest medical care in the most recognized hospitals in the country, that specialize in the treatment he is seeking. The move is caught in red tape at the moment. The existing infrastructure facilities in private hospitals in India are considered to be on par with those in the UK and the US. However, with an annual growth rate of 30 percent,4 there exists a huge opportunity to expand the hospital infrastructure. Recognizing this, the government of India through various measures is encouraging private sector investment in the sector. It has conferred infrastructure status for the healthcare industry, and allowed foreign collaboration. In addition, concessions in tax to raise cheaper long-term funds, reduction in import and custom duties on medical equipment, increase in depreciation limit and income tax exemption for the first five years if the hospital has a capacity of hundred beds or more, have been granted. The concern here is whether corporates will use these incentives as intended by the state, and whether they will repay society in equal measure. Co-ordination between the Healthcare and Tourism Sectors Co-ordinating the resources and services of two unrelated sectorshealthcare and tourismis challenging. Strategic co-ordination essential between these two sectors can be done through facilitation by the government. The Indian Healthcare Federation, Medical Tourism Council of Maharashtra, FICCI, government of India and respective state governments are coordinating to promote this industry. 56. The services of both the healthcare and the tourism sector are required simultaneously once the patient finalises the hospital from where he/she wishes to avail of the healthcare services. Arrangement for passports, visas, airline tickets and conveyance has to be made. The availability of doctor, date of surgery, days to be spent in the hospital and recuperation services have to be confirmed. All this requires co-operation from both the hospital and the tour operator. Thus there is a need to train the people of these two sectors to meet the requirements of this special segment of tourists. Conferences, interaction between the two sectors, knowledge Upgradation workshops, coaching for personality development and investment in information technology are the ways to strengthen this synergy. CREATING A RESOURCE POOL OF HIGHLY SKILLED AND CORDIAL MANPOWER Indian doctors are well-known abroad for their qualifications and skills. This is a big advantage for hospitals in India in attracting more medical tourists. India has the advantage of having advanced life saving healthcare services like organ transplants, cardio-vascular surgery, eye treatment, hip replacement and in-vitro fertilization. There are 5,00,000 doctors and 7,37,000 nurses serving in the Indian healthcare sector and 18,000 persons get qualified as doctors each year from 170 medical colleges, according to a CII-McKinsey report. This skilled human resource pool can help to meet the increasing demand for healthcare services in India. In addition to hiring and retaining skilled manpower, service expectations of medical tourists have made it imperative for hospitals to create an ambience of well-being and cordiality so that their clients feel comfortable and well-attended while on treatment. Corporate hospitals are investing in furnishing their facilities and in training and development of personnel through seminars and short-term courses to gear them up to meet the requirement. A major concern here is about trained medical professionals who go abroad thus diminishing the service capabilities of 57. hospitals in the country. Another concern is that more that 50 percent of these doctors are located in urban hospitals causing a shortfall in the already stressed public healthcare system affecting the larger public in the long run. Doctors working in these private hospitals currently contribute to the public by participating or conducting medical camps and providing consultancy services through telemedicine to remote villages. But once they get assigned to foreign tourists, their continuance in public services may become doubtful. STANDARDIZATION IN PRICING AND ACCREDITATION OF HOSPITALS Standardization in pricing of various surgeries and healthcare services is required as vast price differences exist across hospitals. The Indian Healthcare Federation (IHF) has brought in the concept of price banding to bring some consistency in the prices of different therapies and procedures, along with the move to accredit hospitals. Currently the price banding concept is in the consensus stage; once all the IHF members approve it, it will be legalized through the government. Accreditation will be used to negotiate with overseas health insurance companies to extend their cover to include treatment in India. Both standardization in pricing and accreditation will help Indian hospitals in attracting more medical tourists. Dr. Naresh Trehan, the director of Escorts Heart Institute and Research Centre, says there are 5 crore uninsured people in the US, where the annual premiumfor health insurance is as high as $10,000 for a family of four. Besides, corporates are finding it increasingly difficult to insure their employees as premium shoots up faster than inflation due to the practice of defensive medicine to avoid litigation. These factors will make the network of hospitals in India giving reliable care sooner and cheaper, the ideal partner for overseas health insurance firms. 58. According to YP Bhatia, CEO of Delhi based Rajiv Gandhi Cancer Institute, who heads the CII task force on hospital accreditation, The effort is to develop a comprehensive package for overseas nationals, which will help healthcare do what IT did to the country. The CII-IHF combine is also drafting a code of ethics on the relationship among healthcare professionals and institutions. The rating agencies CRISIL and ICRA have rated hospitals like the Escorts Heart Institute and Research Centre and the Apollo group. The requirement now is for a standard accreditation system. A quality accreditation institution called The National Accreditation Board for Hospital and Healthcare Service Providers (NABH) is likely to be constituted under the aegis of the Quality Council of India. The NABH will have three committeesAccreditation committee, Technical committee and the Appeals committee. The proposed system will assess hospitals based on organizational and clinical governance, operational management, focus on patients, clinical services and human resources, while primary healthcare centres will be assessed on their management and clinical services by designated agencies under the overall control of NABH. The challenge lies in getting the consensus and legalization of this system done. If it gets delayed in the consensus and legalization stages there will be delay in reaping benefits it can bring for the medical tourism sector as well. Huge investment is required to build and maintain this system. There is thus apprehension about mismanagement of funds and resources as this task will be carried out on a large scale around the country. There may be scope for fake accredited hospitals to flourish along with the well-established ones. INCREASING VISIBILITY OF INDIA ON THE WORLD MAP Indias healthcare services cost far less compared to even Thailand, Singapore and many other healthcare destinations. But it is the poor visibility on the world healthcare tourism map and poor image of the country in terms of poverty and basic amenities that deter people from 59. coming to India. Thailand and Singapore are promoting their healthcare services aggressively which has turned their countries into healthcare hubs. Lately, the government of India, the state governments, the Confederation of Indian Industry and the Indian Healthcare Federation have begun promoting India through road shows in some countries, participating in international trade shows and exhibitions and placing advertisements in various media abroad. Tour operators too are taking advantage of this opportunity. Kuoni has tied-up with the Apollo group, and Cox & Kings with Dr. Batras, Vedic India and Omkar Trust. More such tie-ups are on the anvil. Tourism packages specifically designed for the healthcare tourists are being aggressively promoted by these tour operators. Some hospitals now have their own Marketing and Public Relations department. Websites too have been set up for easy availability of information and for immediate contact. THE IMPACT ON DOMESTIC HEALTHCARE SERVICES India is one of the cheapest healthcare tourism hubs in the world especially for advanced life saving surgeries. The inflow of medical tourists is on the rise in India, and private hospitals are ever ready to serve this special segment. However, concerns are being raised about the far reaching impact of medical tourism on the public healthcare system that serves a larger section of the Indian society. Although healthcare services provided by private hospitals in India to foreign patients are cheap for them, these are still exorbitant for many Indians. The private hospitals are registered under the Public Trust Act which makes them liable to provide healthcare services free upto 20 percent of their resources in return for subsidies received from the government. But, it is a question that remains unanswered as to whether they are actually providing free healthcare services to the public. Another concern is about increasing concentration of doctors in urban hospitals. Currently more than 50 percent of the doctors is concentrated in the urban hospitals, especially in the metros. Private hospitals cater to nearly 65% of the healthcare services market. The number of medical tourists is increasing, which means demand for private healthcare services will increase. Private hospitals will need more medical professionals to meet the increasing demand, and the lucrative offers and the work environment they offer will attract many. The public healthcare 60. sector which is disadvantaged vis--vis the private hospitals on these counts will be put under further strain. If more subsidies are given to private hospitals and changes in regulation made to suit them, their concentration in the sector will increase. The public healthcare system will remain neglected. Thus, there is apprehension about the benefits of medical tourism to the Indian public. CONCLUSION To conclude my project I only want to tell that Medical Tourism in India is one of the best options available to people across the globe. Millions come every year to get treated and then enjoy their recuperative holidays across India. People from different walks of life cut across the entire span of the globe come to India to have their treatments done with peace of mind. India provides world class medical facilities with hospitals and specialized multi specialty health centers providing their expertise in the areas of Cosmetic Surgery, Dental care, Heart Surgeries, Coronary Bypass, Heart Check up, Valve replacements, Knee Replacements, Eye surgeries, Indian traditional treatments like Ayurvedic Therapies and much more, practically covering every aspect of 61. medicine combining modern treatments with traditional experience India is considered the most important country promoting medical tourism. India is one of the most touted medical tourism destinations in the world. 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 2,297,794,117 USD 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. 62. 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 63. 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. 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 Number of people having visited India for as medical tourists: India now hosts and treats an estimated of 50,000 medical tourists a year and the catalytic CII-McKinsey report of 2002 projected that medical tourism could contribute up to Rs 10,000 crores in revenue by the year 2012. 64. TREATMENT PROVIDED AT HOSPITALS ARE HYGENIC YES NO CAN'T SAY SERVICES PROVIDED BY HOSPITALS ARE SATISFACTORY YES NO CAN'T SAY HOSPITALS ARE SATISFIED WITH GOVERNMENT CONTRIBUTION YES NO CAN'T SAY 65. SHOULD INDIA HAVE TO INCREASE THERE SURGERIES YES NO CAN'T SAY ARE INDIA AWARE OF MEDICAL TOURISM YES NO CAN'T SAY TOTAL TOURIST VISITING AT INDIAN HOSPITALS 10-40% 40-80% 80-90% CAN'T SAY 66. INDIA POSITION AMONG DIFFERENT OTHER COUNTRY IN MEDICAL TOURISM. 1ST 2ND 3 RD ANY OTHER GUEST IS SATISFIED WITH SERVICES IN HOSPITALS OR NOT YES NO CAN'T SAY INDIAN HOSPITALS SERVICES ARE AFFORDABLE BY ALL OR NOT YES NO CAN'T SAY PHYSICIAN IN HOSPITALS ARE WELL TRAINED YES NO CAN'T SAY 67. ACCOMMODATION FACILITIES FOR PATIENTS ARE ADEQUATE YES NO CAN'T SAY 68. India is one of the cheapest healthcare tourism hubs in the world especially for advanced life saving surgeries. The inflow of medical tourists is on the rise in India, and private hospitals are ever ready to serve this special segment. However, concerns are being raised about the far reaching impact of medical tourism on the public healthcare system that serves a larger section of the Indian society. Although healthcare services provided by private hospitals in India to foreign patients are cheap for them, these are still exorbitant for many Indians. The private hospitals are registered under the Public Trust Act which makes them liable to provide healthcare services free upto 20 percent of their resources in return for subsidies received from the government. But, it is a question that remains unanswered as to whether they are actually providing free healthcare services to the public. Another concern is about increasing concentration of doctors in urban hospitals. Currently more than 50 percent of the doctors is concentrated in the urban hospitals, especially in the metros. Private hospitals cater to nearly 65% of the healthcare services market. The number of medical tourists is increasing, which means demand for private healthcare services will increase. Private hospitals will need more medical professionals to meet the increasing demand, and the lucrative offers and the work environment they offer will attract many. The public healthcare sector which is disadvantaged vis--vis the private hospitals on these counts will be put under further strain. If more subsidies are given to private hospitals and changes in regulation made to suit them, their concentration in the sector will increase. The public healthcare system will remain neglected. Thus, there is apprehension about the benefits of medical tourism to the Indian public. 69. The medical tourism market in India is worth US$ 333 million,2 growing at 30 percent per annum. Due to the emergence of this industry in India, massive tasks lie ahead to synergise the resources of the two sectors. However there are issues and challenges that need to be addressed to overcome the roadblocks to facilitate the growth of this industry in India. The issues that need attention are: 1. Upgradation of basic amenities and hospital infrastructure 2. Co-ordination between the healthcare and tourism sectors 3. Creating a resource pool of highly skilled and cordial manpower 4. Standardization of services and accreditation of hospitals 5. Increasing visibility of India on the world map 6. The impact on domestic healthcare services 70. Bibliography Internet web sites www.google.com www.indianhospitalassociation.com www.yahoo.com www.msn.com BOOKS NEWSPAPER PERIODICALS MAGAZINES 71. NAME OF PERSON. AGE.. OCCUPATION.. DESIGNATION. Is services provided by hospitals are satisfactory? o Yes No o Cant say . The treatment provided at hospitals is hygienic? o Yes No o Cant say . Are hospitals are satisfied with government contribution? o Yes No o Cant say Should India have to increase there surgeries? o Yes o No o Cant say Are Indians aware of medical tourism? Yes 72. No Cant say Total tourist visiting at Indian hospitals? 10-40% 40-80% 80-90% India position among different other country in medical tourism? o 1st o 2nd Any other Guest is satisfied of services in hospitals? o Yes No o Cant say Is Indian hospital services are affordable by all or not? Yes No o Cant say The physician in hospitals are well trained? Yes 73. No o Cant say The accommodation facilities are adequate for patients? o Yes o No o Cant say The staff is well trained about hygiene or not? o Yes No o Cant say There is increase or decrease in patients at Indian hospitals? o Increase o Decrease o Cant say Hospitals menus are acceptable by patients? Yes No o Cant say 74. NAME OF PERSON. AGE.. OCCUPATION.. DESIGNATION. Is services provided by hospitals are satisfactory? o Yes No o Cant say . The treatment provided at hospitals is hygienic? o Yes No o Cant say . Are hospitals are satisfied with government contribution? o Yes No o Cant say 75. Should India have to increase there surgeries? o Yes o No o Cant say Are Indians aware of medical tourism? Yes No Cant say Total tourist visiting at Indian hospitals? 10-40% 40-80% 80-90% India position among different other country in medical tourism? o 1st o 2nd Any other Guest is satisfied of services in hospitals? o Yes No o Cant say Is indian hospital services are affordable by all or not? 76. Yes No o Cant say The physician in hospitals are well trained? Yes No o Cant say The accommodation facilities are adequate for patients? o Yes o No o Cant say The staff is well trained about hygiene or not? o Yes No o Cant say There is increase or decrease in patients at Indian hospitals? o Increase o Decrease o Cant say Hospitals menus are acceptable by patients? Yes No Cant say 77. NAME OF PERSON. AGE.. OCCUPATION.. DESIGNATION. Is services provided by hospitals are satisfactory? o Yes No o Cant say . The treatment provided at hospitals is hygienic? o Yes No o Cant say . Are hospitals are satisfied with government contribution? o Yes No o Cant say Should India have to increase there surgeries? o Yes o No o Cant say 78. Are Indians aware of medical tourism? Yes No Cant say Total tourist visiting at Indian hospitals? 10-40% 40-80% 80-90% India position among different other country in medical tourism? o 1st o 2nd Any other Guest is satisfied of services in hospitals? o Yes No o Cant say Is Indian hospital services are affordable by all or not? Yes No o Cant say 79. The physician in hospitals is well trained? Yes No o Cant say The accommodation facilities are adequate for patients? o Yes o No o Cant say The staff is well trained about hygiene or not? o Yes No o Cant say There is increase or decrease in patients at Indian hospitals? o Increase o Decrease o Cant say Hospitals menus are acceptable by patients? Yes No 80. o Cant say