MEDICAL TOURISM THE NEW FACE OF TOURISM

HEALTHCARE INDUSTRY The health care industry is considered an industry or profession which includes peoples exercise of skill or judgment or the providing of a service related to the preservation or improvement of the health of individuals or the treatment or care of individuals who are injured, sick, disabled, or infirm. The delivery of modern health care depends on an expanding group of trained professionals coming together as an interdisciplinary team. HEALTHCARE IN INDIA Healthcare in India is the responsibility of the individual Indian states. The Indian constitution charges those states with "the raising of the level of nutrition and the standard of living of its people and the improvement of public health". There is also a National Health Policy, endorsed by Parliament in 1983. TOURISM IN INDIA Welcome to Incredible India, where culture echoes, tradition speaks, beauty enthralls and diversity delights. Indian tourism is one of the most diverse products on the global scene. India has 26 world heritage sites. It is divided into 25 bio-geographic zones and has wide ranging eco tourism products. Apart from this, India has a 6,000 km coastline and dozens of beaches. It also has one of the world's biggest railway systems opening possibilities for those interested in rail tourism. India also has excellent hospitals offering affordable Medicare and traditional healthcare systems like Ayurveda. MEDICAL TOURISM Medical Tourism refers to movement of consumers to the country providing the service for diagnosis and treatment. During the past few years, the number of people going out of their home country to consume health services has significantly increased. The size of this market is estimated to be $40 billion based on a Saudi Report in 2000. During the past four years, the market grew at a whopping rate of 20-30% and is expected to grow further. Considering this growth the current market size is estimated to be $100 billion. Medical Tourism industry offers tremendous potential for the developing countries because of their low-cost advantage. The advantages of medical tourism include improvement in export earnings and healthcare infrastructure. Medical tourism can be broadly defined as provision of cost effective private medical care in collaboration with the tourism industry for patients needing surgical and other forms of specialized treatment. This process is being facilitated by the corporate sector involved in medical care as well as the tourism industry - both private and public.

MEDICAL TOURISM - TRENDS Medical tourism is one of the newest trends in tourism industry. Rising costs in the field of health and increase in waiting time has forced many people from the West to fly to countries mainly in Asia and South America to get medical facilities. Medical tourism generally started with tourists who needed medical centers in visiting countries for small procedures like some plastic surgery of minor nature. From there the trend started to grow and ultimately reached its peak in terms of transparency, systems, services, processes, quality assurance, bench marks and continuity of care. Medical tourism has helped different sectors to grow. It has become a ray of hope for healthcare organizations treating the tourists and increasing the standard of care for its patients. Most of the medical costs in the US, UK and Canada is quite higher. For example, the cost of total hip replacement which is an orthopedic procedure costs about 50,000.00 US Dollars, while same procedure is done at 10 to 15 thousand US Dollars in other places like India and Malaysia. Plus, the waiting time for this treatment involves six months to 18 months in USA, but medical tourists can undergo this treatment over night with a highly competent doctor at a medical tourism destination like India, Malaysia and Panama. Plus, when tourists travel to other places, they mostly land in good hospitals with experienced doctors. The increasing price is perhaps the main factor that is forcing patients to fly to other countries. Even insurance providers are opting for overseas destinations than local hospitals. Insurance companies are not standing behind in offering some really innovated facilities to medical tourism industry and increasing customized and tailor made packages are coming up. A popular American Insurance provider has introduced a plan for medical tourists from US that give them some cover against complications of procedures after they are hack from their treatment done at overseas destinations. The insurance companies too are providing variety of emergency plans for medical tourists at foreign destinations. WHY INDIA? The countries where medical tourism is being actively promoted include Greece, South Africa, Jordan, India, Malaysia, Philippines and Singapore. India is a recent entrant into medical tourism. According to a study by McKinsey and the Confederation of Indian Industry, medical tourism in India could become a $1 billion business by 2012. The report predicts that: "By 2012, if medical tourism were to reach 25 per cent of revenues of private up-market players, up to 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. The Comparative rates of surgeries Surgeries Open Heart Surgery (CABG) Total Knee Replacement Hip Resurfacing LA Hysterectomy Lap Cholcystectomy Spinal Decompression Fusion Obesity Surgery (Gastric Bypass) India ($) 7,500 6,300 7,000 4,000 3,000 5,500 9,500 USA ($) 100,000 48,000 55,000 22,000 18,000 60,000 65,000 UK (GBP) 21,400 25,700 24,100 11,800 9,600 32,100 34,800

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, orthopaedic surgery, gastroenterology, ophthalmology, transplants and urology to name a few. The various specialties covered are Neurology, Neurosurgery, Oncology, Ophthalmology, Rheumatology, Endocrinology, ENT, Paediatrics, Paediatric Surgery, Paediatric Neurology, Urology, Nephrology, Dermatology, Dentistry, Plastic Surgery, Gynaecology, Pulmonology, Psychiatry, General Medicine. 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 for medical patients/ service seekers. MEDICAL TOURISM AS AN INDUSTRY Medical tourism can be broadly defined as provision of cost effective private medical care in collaboration with the tourism industry for patients needing surgical and other forms of specialized treatment. This process is being facilitated by the corporate sector involved in medical care as well as the tourism industry - both private and public. 3

In many developing countries it is being actively promoted by the governments official policy. Indias National Health policy 2002, for example, says: To capitalise on the comparative cost advantage enjoyed by domestic health facilities in the secondary and tertiary sector, the policy will encourage the supply of services to patients of foreign origin on payment. The rendering of such services on payment in foreign exchange will be treated as deemed exports and will be made eligible for all fiscal incentives extended to export earnings. GROWTH OF THE MEDICAL TOURISM INDUSTRY In India, the Apollo group alone has so far treated 150,000 international patients, many of whom are of Indian origin. Apollo has been a forerunner in medical tourism in India and attracts patients from Southeast Asia, Africa, and the Middle East. The group has tied up with hospitals in Mauritius, Tanzania, Bangladesh and Yemen besides running a hospital in Sri Lanka, and managing a hospital in Dubai. Another corporate group running a chain of hospitals, Escorts, claims it has doubled its number of overseas patients - from 1785 in 2000 to nearly 3,200 this year. Recently, the Ruby Hospital in Kolkata signed a contract with the British insurance company, BUPA. The management hopes to get British patients from the queue in the National Health Services soon. Some estimates say that foreigners account for 10 to 12 per cent of all patients in top Mumbai hospitals despite roadblocks like poor aviation connectivity, poor road infrastructure and absence of uniform quality standards. Analysts say that as many as 250,000 medical tourists came to India last year. However, the current market for medical tourism in India is mainly limited to patients from the Middle East and South Asian economies. Some claim that the industry would flourish even without Western medical tourists. Afro-Asian people spend as much as $20 billion a year on health care outside their countries Nigerians alone spend an estimated $1 billion a year. Most of this money would be spent in Europe and America, but it is hoped that this would now be increasingly directed to developing countries with advanced facilities. CONTRIBUTION TO GNP According to the World Travel and Tourism Council, India' s travel and tourism (T&T) industry contributed 2.1 percent to Gross Domestic Product in 2006 (INR 713.8 billion or US$16.3 billion). In the first half of the Annual Plan period of 2005-2006, the Ministry of Tourism had taken several initiatives in the field of infrastructure development and positioning Indian tourism as a major engine for economic growth. These include: Emphasis for developing the existing and new destinations to world-class standards. Improvement of connectivity to important destinations.

 Identification of 10-15 new destinations / circuits by each state / UT for development to world class standard with all the required infrastructure components. BENEFITS OF MEDICAL TOURISM Tangible Foreign exchange earrings which enable economic wealth of nation Cost Advantage in Tariff over the Developed countries Improve information sharing Increase in efficiency of patient care process, cutting edge treatment. Improvement in hospital supply chain efficiency Strategic alliances with business partners within and outside the country Technology and Knowledge Transfer Better logistics performance both in internal and external Creation of employment opportunities in the industry Better utilization of Infrastructure and skilled manpower Opportunity for development in Infrastructure in Health, Tourism and Travel. Economies of scale. Connectivity with air, road, rail and information and communication industries Clustering of medical Travelers Health opportunities for foreign patients may lead to better standards at home. Scope for Research and Development to offer comprehensive medical solutions. Intangible International acceptance of country as a global healthcare provider Social and cross cultural experience International customer relations Global Marketing and Medical Trade relations Brand image of nation as world-class healthcare destination. Competitive advantage Better coordination among the partners i.e. hospital and hospitality industry. Public and Private Partnerships Patient satisfaction

IS INDIA PREPARED FOR GLOBAL MEDICAL TOURISM BOOM? In recent years, India is being seen as an important player in the globally growing "Medical Tourism", which is projected as a new segment in travel and healthcare business. In simple words, medical tourism provides state-of-the-art private medical care in collaboration with tourism industry to patients from other countries at highly competitive price when compared to those prevalent in the western countries. The CII- McKinsey report mentions that the medical tourism market has been growing at the rate of 15 per cent for past five years and by 2012, Rs 10,000 crore will be added to revenues of the private

players. Globally, medical tourism is said to be USD 40 billion industry and analysis available project that people from Afro-Asian countries spend as much as USD 20 billion every year on healthcare services from outside their countries. Foremost, amongst the current private players, in medical tourism are hospitals in the Apollo chain. Main destinations are Delhi, Mumbai, Chennai, Bangalore and Hyderabad. These cities have private hospitals with medical expertise that can offer world class healthcare that costs one fifth to one tenth of the cost in US or Europe depending on the intervention required. In addition to above destinations, the country has many cities with advanced medical facilities making India, a country with tremendous potential to capitalise on to increase its earnings to more than USD 1 billion annually and create hundreds of thousands new jobs in many sectors. This projection excludes earnings from other products included in the wellness tourism meant for rejuvenation of body and mind, eg herbal therapy, naturopathy, yoga, aromatherapy, reiki, music therapy which does not require advanced medical expertise. The apprehensions expressed by some sections that "systematic development of medical tourism will boost up earnings by catering to the wealthy foreigners and Indians working in the foreign countries but it may adversely hit the low income population" need to be addressed for gaining approval of political opinions with varied views on liberalisation. From past ten years, India has entered a phase in medical expertise that is considered on par with international standards. This is because of high quality doctors and medical entrepreneurs who developed hospitals with required infrastructure and management style. Some of these hospitals have marketing departments to increase visibility and acceptance of their products in some countries. MEDICAL TOURISM IN INDIA THE CURRENT SCENARIO Medical Tourism is poised to be the next Indian success story after Information Technology. According to a Mckinsey-CII study the industrys earning potential estimated at Rs.5000-10000 Crores by 2012. Worldwide, healthcare is said to be a $3-trillion industry, and India is in a position to tap the top-end segment by highlighting its facilities and services, and exploiting the brand equity of leading Indian healthcare professionals across the globe. Medical Tourism", the term refers to the increasing tendency among people from the UK, the USA and many other third world countries, where medical services are either very expensive or not available, to leave their countries in search for more affordable health options, often packaged with tourist attractions. Tourism is an integral part of many economies services industry and is an important source of foreign exchange. The labour-intensive nature of the tourism industry also makes it an excellent generator of employment. In 2002, the travel-and-tourism industry generated US$3.3 trillion of GDP and almost 200 million jobs across the world economy.

Approximately one third of this would come directly from the industry itself and the remainder from the strong linkages to other related sectors such as entertainment, retail and construction. Medical Tourism is perceived as one of the fastest growing segments in marketing Destination India today. The equation is World Class Healthcare at 'Economical Price '. Stable economic growth will create an increase in freight flows from, towards, through, and inside the country. All this will stimulate the investments in roads and railroads. As globalization advances, both domestic and international tourism pose new and unprecedented challenges to the health sector and its various partners. The size of the Medical Tourism industry stands between Rs 1200 Crore to Rs 1500 Crore and is growing at rate of 30 percent annually. More importantly, Medical Tourism is growing rapidly and turning out to be an immense business opportunity for nations that are positioning themselves correctly. Last year, just five countries in Asia Thailand, Malaysia, Jordan, Singapore and India- pulled in over 1.3 million medical travelers and earned over $1billion (in treatment costs alone). In each of these nations, medical travel spends are growing at 20% plus year-on-year. Elsewhere around the world, Hong Kong, Lithuania and South Africa are emerging as big medical/healthcare destinations. And a dozen other nations including Croatia and Greece plan to make themselves attractive healthcare destinations. Five years ago, hardly 10000 foreign patients visited India for medical treatment. Today India is a key player in medical tourism with 100,000 foreign patients coming in every year and revenue of Rs.1500 Crores. The current market growth-rate is around 30% per year and the country is inching closer to major players like Singapore and Thailand. HEALTH TOURISM IN INDIA ADVANTAGES AND OPPORTUNITIES The inflow of health tourists from the West, especially the UK, US and some of the European countries has been on the rise for the last couple of years. Price difference or affordability of the treatment, coupled with quality of doctors are the main reasons for the growing western traffic. The quality of Indian hospitals has improved significantly and now matches with the best in any part of the world. India has more than 100 healthcare institutions, which are of international standard. Many hospitals in India today have the infrastructure and equipment that match with the best centers in the world, be it transplantations(liver/kidney/heart or bone marrow), cancer treatment, including radiotherapy, neurosurgery, including sterotactic surgery., angioplasty and cardiac surgery (bypass and paediatric) Public-Private Partnership combines internal hospital expertise with supply chain and logistics expertise.

The medical tourism industry which is estimated to be worth Rs 1500 crores annually has not only the potential to generate substantial foreign exchange earnings but also provide employment opportunities for the large pool of skilled labor available in India, according to Dr. PC Reddy, chairman, Apollo Hospitals Group, India. According to Group President Pratap C.Reddy, the annual health bill of people from AfroAsian countries seeking treatment outside their country is $10 billion. If India can tap even a fraction of that market, the potential is enormous. The SWOT analysis of Indian medical tourism business is: Strength 1) Quality of service 2) Exquisite Locations 3) Alternative medical cures like Yoga, Homeopathy and Ayurveda. Weaknesses 1) Lack of infrastructure 2) Lack of uniform pricing policy 3) Poor infrastructure in Govt. Aided hospitals 4) Lack of proper Institute on medical Instrumentation. Threats

Opportunities 1) Impact on Forex reserve 2) Contributions in GDP 1) Foreign players may enter into the market 3) Sharp rise in medical as well as tourism 2) Lack of foreign accreditation Industry. INDIA - STRATEGIC THRUSTS FOR THE FUTURE

The following section lays down the strategy for India to achieve leadership position in medical tourism. The strategy largely draws from the discussions in previous section. ROLE OF GOVERNMENT The role of Indian Government for success in medical tourism is two-fold: Acting as a Regulator to institute a uniform grading and accreditation system for hospitals to build consumers trust. Acting as a Facilitator for encouraging private investment in medical infrastructure and policy-making for improving medical tourism. For facilitating investment the policy recommendations include: Recognize healthcare as an infrastructure sector, and extend the benefits under sec 80-IA of the IT Act. Benefits include tax holidays for five years and concessional taxation for subsequent five years. The government should actively promote FDI in healthcare sector.

Conducive fiscal policies - providing low interest rate loans, reducing import/excise duty for medical equipment Facilitating clearances and certification like medical registration number, antipollution certificate etc. The above measures will kick-start hospital financing, which is struggling now due to capital intensive and low efficiency nature of healthcare business. For facilitating tourism the government should: Reduce hassles in visa process and institute visa-on-arrival for patients Follow an Open-Sky policy to increase inflow of flights into India Create Medical Attachs to Indian embassies that promote health services to prospective Indian visitors

MAINTAINING HIGH QUALITY SERVICES IN THE MEDICAL TOURISM INDUSTRY One of the primary concerns for health travelers is whether foreign providers can offer the same high-quality medical care they receive in their country of origin. This growing demand for foreign healthcare providers has prompted the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the best known healthcare accreditation group in the USA, to form an international offshoot known as the Joint Commission International (JCI). In 1999, the JCI began surveying and accrediting hospitals and healthcare facilities outside of the USA. There are now over 220 accredited hospitals worldwide and most are providing quality services for the medical tourism industry. Aside from the JCI, there are alternative non-profit groups providing accreditation for healthcare organizations in the USA. These include but are not limited to: Community Health Accreditation Program (CHAP) The first accrediting body in the US that provides assessments for community based healthcare organizations. Accreditation Commission for Health Care, Inc (ACHC) Was created by home care providers as an accreditation organization that caters to small health institutions. The Compliance Team, Inc Is known for their Exemplary Provider Program. They are an accrediting body for Durable Medical Equipment (DME). Healthcare Quality Association on Accreditation (HQAA) Another accreditation body working with durable medical equipment (DME). National Committee for Quality Assurance (NCQA) Drives improvement in the health care system through the Healthcare Effectiveness Data and Information Set (HEDIS) which is used by 90% of health plans in the USA. 9

NON-US ACCREDITATION ORGANIZATIONS

Aside from the accreditation bodies based in the USA, there are a number of international accreditation organizations in the medical tourism industry that are based abroad. These organizations perform a similar international role as the JCI, providing accreditation to international or regional health providers. Accreditation Canada -Formerly known as the Canadian Council on Health Services Accreditation (CCHSA) - focuses on improving patient safety. Trent Accreditation Scheme (TAS) A UK-based non-profit accreditation organization that performs surveying and accrediting to healthcare providers in the UK and around the world. The Australian Council on Healthcare Standards (ACHS) The leading health care and accreditation organization in Australia. It features the Evaluation and Quality Improvement Program (EQuIP) and acts as a consultant for several countries. International Society for Quality in Health Care (ISQua) With members from over 70 countries, ISQua has board members from North America, Europe and Asia-Pacific regions. European Society for Quality in Healthcare (ESQH) Is dedicated to improving the quality of healthcare in Europe. It consists of 19 member countries, all of which are National Societies for Quality in Healthcare in their respective countries. The Society for International Healthcare Accreditation (SOFIHA) Is a group formed by providers of international healthcare accreditation. This forum is where they discuss and share ideas geared towards developing high-quality accreditation of medical facilities worldwide.

The International Organization for Standardization (ISO) Is an international body formed by various national standards organizations. In the healthcare industry, ISO provides a framework in the design and improvement of quality management systems for healthcare providers. INTERNATIONAL CERTIFICATION STATUS OF MEDICAL PROVIDERS TOURISM

Destination countries for medical travelers that realize the impact of the medical tourism business in the economies of their respective countries, strive to provide the highest quality at the lowest possible cost. These countries are openly marketing medical tourism, with governments supporting these efforts by providing better facilities and seeking international accreditation. Part of these efforts include hiring or training physicians with international credentials, such as professionals who train and are board certified in the USA, Australia, Canada and Europe. For example:

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India Apollo Hospitals are the largest healthcare provider and the first JCIcertified hospitals in India. The Apollo Group is also connected with Johns Hopkins Medicine International on studies regarding heart diseases. On top of this, the Indian Healthcare Federation provides accreditation standards for its local providers. Another provider, Wockhardt, is affiliated with the Harvard Medical School. Singapore This country provides state-of-the-art hospitals, three of which are accredited by the JCI. The International Medical Centre which is also affiliated with Johns Hopkins International, is the most notable. Panama With several Panamanian physicians trained and certified in the United States, Panama's top hospitals are comparable to the US. Foremost is the Punta Pacifica Hospital which is affiliated with Johns Hopkins International. Thailand There are over 1 million medical tourists going to Thailand each year. The fore-runner for Thailand's medical tourism industry is Bumrungrad International Hospital in Bangkok. Located in a modern hospital building that complies with US standards, they comprise of an American-managed medical staff that includes 200 US board-certified doctors and surgeons. The rest of the staff members are licensed in Australia, Europe and Japan.

There are other foreign hospitals that are owned, managed or affiliated with American hospitals, healthcare providers and prestigious universities. An example is the Cleveland Clinic which owns and manages several facilities in other countries like Canada, Austria and the United Arab Emirates. The International Hospital Group which is based in Dallas builds and operates US-standard hospitals in Mexico. INDIAN MEDICAL TRAVEL: A PRIORITY SECTOR The Indian economys steady growth rate is also being reflected in the Indian healthcare and medical travel industry. Healthcare and medical health travel are priority areas for India, and the government has increased its budgetary outlay for medical travel and foreign investment. Customs duties on the import of medical equipment have been slashed, and special incentives are being offered for future private healthcare facilities. GOVERNMENT PLANS FOR ATTRACTING MEDICAL TOURISM TO INDIA To promote growth in the Indian medical travel industry, the Indian government has plans to improve health infrastructure. The government is currently in the process of increasing the number of hospitals, clinics, and clinical laboratories in urban as well as rural parts of the country. Incentives and tax holidays are being offered to hospitals and dispensaries providing health travel facilities. The Indian medical travel and health care sector offers plenty of opportunities for businessmen, medical equipment manufacturers, healthcare service providers, and tourist agencies, and the government is encouraging them to invest in therapeutic and preventive

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health services so as to increase medical travel to India. The government has published analytical reports on the available opportunities in the Indian health care industry so corporate houses can make informed decisions regarding the Indian medical tourism sector. INITIATIVES OF PRIVATE HOSPITALS IN HEALTH TRAVEL PROJECTS OUTSIDE INDIA Recently, a memorandum of understanding (MoU) was signed between the famous Apollo Hospitals and the American International Medical University (AIMU) for developing medical tourism projects worth $200 Million in the Bahamas and St Lucia. According to the MoU, the Apollo group will develop a super specialty teaching hospital, research, and treatment facility for the AIMU group. In addition, Apollo will develop, manage, and monitor the healthcare facilities at the existing AIMU groups medical education facilities at the Bahamas and St Lucia campuses. The AIMU group offers MD and PhD programs and offers $1.5 million in scholarships to Indian students every year. It is estimated that the AIMU group of institutions will attract 500 Indian doctors to the US in the current year. Source: Apollo, AIMU mull medical tourism projects," Times News Network, January 12, 2007 THE MARKETING MIX OF INDIAN MEDICAL TOURISM Some of the exclusive medical packages offered by the Indian medical tourism are in the following treatments: MEDICAL PACKAGES HEART PACKAGES Cardiac surgery and cardiology Angioplasty Angiography Cardiology robotic surgery Open heart surgery Paediatric intervention ORTHOPAEDIC SURGERIES NEURO SURGERY Joint Knee Replacement (Unilateral and Bilateral) Parkinsons Epilepsy 12

Essential tumors Malignant tumors CARDIOLOGY ECG Doppler Test TEE Beating heart surgery Valve surgery Stenting Peripheral vascular surgery Congenitial heart disease NEPHROLOGY Dialysis Haemodialysis Slow continous ultrafication Plasmapherisis DENTAL CARE PACKAGES UROLOGY COSMETIC TREATMENT

PRICE The price range offered by the Indian medical industry is unbelievable because India offers the most reasonable prices. India is not only cheaper but the waiting time is almost nil. This is due to the outburst of the private sector which comprises of hospitals and clinics with the latest technology and best practitioners. PROCEDURE CHARGES IN INDIA & USA Bone Marrow Transplant Liver Transplant Heart Surgery US (USD) Approx USD 2,50,000 USD 3,00,000 USD 30,000 India (USD) Approx USD 69,200 USD 69,350 USD 8,700

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Orthopedic Surgery Cataract Surgery Smile Designing Metal Free Bridge Dental Implants Porcelain Metal Bridge Porcelain Metal Crown Tooth Impactions Root Canal Treatment Tooth Whitening Tooth Colored Composite Fillings / Tooth Cleaning

USD 20,000 USD 2,000 USD 8,000 USD 5,500 USD 3,500 USD 3,000 USD 1,000 USD 2,000 USD 1,000 USD 800 USD 500 USD 300

USD 6,300 USD 1,350 USD 1,100 USD 600 USD 900 USD 600 USD 100 USD 125 USD 110 USD 125 USD 30 USD 90

PROCEDURE CHARGES IN INDIA & UK Significant cost differences exist between UK and India when it comes to medical treatment. Accompanied with the cost are waiting times which exist in UK for patients which range from 3 months to over months. Procedure Open Heart Surgery Cranio-Facial surgery and skull base Neuro- surgery with Hypothermia Complex spine surgery with implants Simple Spine Surgery Simple Brain Tumor - Biopsy - Surgery Parkinsons UK (USD) Approx USD 18,000 USD 13,000 USD 21,000 USD 13,000 USD 6,500 USD 4,300 USD 10,000 India (USD) Approx USD 4,800 USD 4,500 USD 6,800 USD 4,600 USD 2,300 USD1,200 USD 4,600

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- Lesion - DBS Hip Replacement Major players In Indian medical tourism:

USD 6,500 USD 26,000 USD 13,000

USD 2,300 USD 17,800 USD 4,500

The National Health Policy actively promotes medical tourism. The main cities attracting foreign patients to India are: 1) Kolkata 2) Chennai 3) Bengaluru 4) Mumbai 5) Delhi 6) Jaipur The hospitals that attract large number of foreign tourist besides Indians are: 01) Apollo Hospital, Delhi 02) All India Institute Of Medical Sciences, Delhi 03) AMRI, Kolkata 04) Christian Medical college, Vellore 05) Wockhardt Hospitals 06) BM Birla Heart Research Centre, Kolkata 07) Manipal Heart Foundation, Bengaluru 08) Escort Heart Institute & Research Centre Limited, New Delhi 09) Breach Candy Hospital, Mumbai 10) Escorts Hospital, Jaipur 11) Asian Heart Institute, Mumbai PROMOTIONAL ACTIVITIES TO PROMOTE MEDICAL TOURISM CME ( Continuous medical education for doctors) Patient Education Progress Free health Checkup camps. Tie ups with various hospitals and insurance companies abroad. Participation in Health Expos abroad. Tie ups with Embassies. Advertisement campaigns. Nodal centers in other countries. Reduction of Excise duty from 17% to 8% on all goods produced in the pharmaceutical sector as per the Budget 2008-2009.

FACTORS ENHANCING MEDICAL TOURISM IN INDIA a) Cost Competitiveness The Key driver 15

The main reason for Indias emergence as a preferred destination is the inherent advantage of its healthcare industry. Today Indian healthcare is perceived to be on par with global standards. Some of the top Indian hospitals and doctors have strong international reputation. But the most important factor that drives medical tourism to India is its low cost advantage. Majority of foreign patients visit India primarily to avail of First World Service at Third World Cost.

Source: Business World India and Indian Brand Equity Foundation As the table above shows, India has significant cost advantages in several health procedures making it a preferred destination b)The Service Spectrum India offers a variety of services for overseas patients. The table below presents a classification of the service spectrum.

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c) Consumer Profile The demand for Indian healthcare services primarily comes from three types of consumers. The table below presents the profile of these three consumer groups:

Though tourism is not the primary need of these consumers, it offers additional attraction particularly for people traveling for cosmetic surgery and less complicated procedures. KEY CHALLENGES BEFORE INDIAN MEDICAL TOURISM: 1) Lack of Government support to promote medical tourism 17

2) Lack Of medical Infrastructure 3) Lack of international accreditation 4) Perception among the foreign tourist as an unhygienic country 5) Strong competition from Malaysia, Thailand and Singapore CONCLUSION However, Medical tourism is the next best thing for India. According to the CII Mackinsey report, Medical Tourism in India is expected to bring revenue of over $2 billion by 2012.The object is to capitalise the low cost advantage and to attract medical tourist by providing attractive packages. Indian tourism Industry should work more in collaboration with the Government department in order to implement the concept-"Atithi devo Bhavo" (a guest is a form of God) as major marketing mantras. Medical Tourism in India is booming and can be witnessed by the huge number of International tourist visiting this region. India is one of the worlds most preferred region of the world in the case of medical tourism due to the low cost of treatment, no waiting time, approachability, tourists spots in India and other value added services. As the Indian economy of growing so worlds best hospitals are coming to India to encash the opportunity. The healthcare industry has successfully managed to maintain the interest and attention of not only the Indian government, but also the common man. The top Indian hospitals such as Apollo, Escorts, Max, etc, are investing immense time, effort, manpower and money in their R&D. As a matter of fact, several new innovative products have been launched in the Indian market and have been patented. The Indian consumer has ready access to new innovations in the field of health and medicine. The companies are constantly acquiring latest technology either through partnerships or developing them indigenously. The government is fully supporting the cause of state of the art infrastructure by providing support in setting up new hospitals and financing them. BIBLIOGRAPHY Davenport Karen, Health Care Benefits, (2007) Daschle Tom, Achieving Universal Health Coverage, (2007) Seshamani Meena, Opportunity Costs and Opportunities Lost: Businesses Speak Out About Health Care, (2007) CII and Mekinsey, Healthcare In India The Road Ahead, (2006) Alvarez, David P.; Connecting people to the promise of healtchare, No. 15 (2000) Sonam Jagasia, A Report on Medical Tourism in India Issue 2 (2008) Hautea, Dr. Randy A.; Krattiger, Dr. Anatole F. And Van Zanten, Ir. Jasper E; Healthcare costs comparisons, No. 18 (2000) http://en.wikipedia.org/wiki/Healthcare_in_India http://www.nature.com/nm/journal/v9/n4/full/nm0403-377a.html

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http://www.cbc.ca/news/background/healthcare/medicaltourism.html http://timesofindia.indiatimes.com/More_options_for_health_insurance/articleshow/19822 38.cms http://www.who.int/mediacentre/factsheets/fs172/en/index.html http://www.indiatogether.org/2007/jan/hlt-hltcare.htm http://www.deloitte.com/dtt/whitepaper/0,1017,sid%253D34239%2526cid %253D71669,00.html

ANNEXURE
INBOUND TOURISM STATISTICS
Foreign Tourists In India (Number)
2001 January February March April May June July August Septembe r October 2002 2003 2004 2005 2006 2007 2008 584765 560658 509926 369677 290785 344526 -

283750 228150 274215 337345 385977 459489 532088 262306 227529 262692 331697 369844 439090 498806 248965 225558 218473 293185 352094 391009 444186 185338 155378 160941 223884 248416 309208 333945 151098 132998 141508 185502 225394 255008 267758 176716 143100 176324 223122 246970 278370 310104 224432 186432 225359 272456 307870 337332 377474 196517 161477 204940 253301 273856 304387 360089 162326 151721 191339 226773 257184 297891 325893 181605 212191 260569 307447 347757 391399 440715

November 209685 243566 290583 385238 423837 442413 510987 December 319271 417527 479411 541571 575148

Total

2282738 2073025 2726214

345747 391861 444716 497719 7 0 7 3

2660337

Percentage Changes in foreign tourists arrival 2002/01 2003/02 2004/03 2005/04 2006/05 2007/06 2008/07 January February March -19.6 -13.3 -9.4 22.0 13.1 1.6 23.0 26.3 34.2 14.5 17.3 25.2 19.0 18.7 11.1 15.8 13.6 13.6 9.9 12.4 14.8

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April May June July August Septembe r October November December

-16.2 -12.0 -19.0 -16.9 -17.8 -6.5 16.8 16.2 -

5.0 0.2 27.5 22.5 26.91 26.11 22.11 19.40 -

39.1 31.1 26.5 20.9 23.6 18.5 18.0 32.6 30.8

16.5 23.8 16.0 7.3 6.9 11.4 7.0 7.8 11.0

24.5 13.1 12.7 9.6 11.1 15.8 12.5 4.4 13.0

8.0 5.0 11.4 11.9 18.3 9.4 12.6 15.5 6.2

10.7 8.6 11.1 -

Total

9.2

13.1

26.8

13.2

13.5

11.9

11.5

International Tourists Arrivals to India 2001 Arrivals from Region/ Country USA 32914 34818 41080 7 405472 2 3 526120 61116 5 696739 2002 2003 2004 2005 2006

UK

38784 43091 55590 65180 6 7 7 3

734240

Canada

88600 93598

10767 13588 15764 1 4 11667 9 13182 4 3

176567

Germany

80011 64891 76868 10243 4

120243 156808

France Australia Italy Japan Malaysia Singapore Nepal

78194 97654

152258 175345

52691 50743 58730 81608 96258 109867 41351 37136 46908 65561 67642 80634 59709 77996 96851 10308 2 79978 119292

57869 63748 70750 84390 96276 107286 42824 44306 48368 60710 68666 41135 37136 42771 51534 77024 82574 91552

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Sri Lanka Netherlands China South Korea

11281 10800 10909 12871 13640 3 8 8 1 0

154813 58611 62330

42368 31669 40565 51211 52755 13901 15422 21152 34100 44897

27150 29374 35584 47835 49895 705407

OUTBOUND TOURISM STATISTICS

Destination Wise Outbound Travel of Indian Nationals 2000 Canada USA 52071 2001 54742 2002 55492 2003 57010 2004 68315 2005 77849

274202 26967 257271 272161 308845 344926 80415 11377 65743 2618 69960 84704 11502 86578 7096 80469 10999 89861 19658 86231 10260 95685 59560

Bangladesh 74268 78090 Maldives Nepal Pakistan Sri Lanka Malaysia Singapore Thailand China Australia 10616 96995 8511 63722

66061 58378 31860 33924

90603 105151 113323

132127 143513 183360 145153 172966 225789 346356 339813 375658 309446 471196 583543 224104 206132 253110 230316 300163 352766 120930 159361 213611 219097 309411 356460 41452 48227 45022 45597 55603 67951

Hong Kong 131368 161752 193705 178130 244364 273487 Japan 38767 40345 45394 47520 53000 58572

Statistics of Indian National Going Abroad Year 2000 2001 2002 2003 No of Outbound Indians 4415513 4564477 4940244 5350896 Percentage Change over the previos year 7.3 3.4 8.2 8.3

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2004 2005 2006

6212809 7184501 8339614

16.1 15.6 16.1

Source- Ministry of Tourism, Govt of India

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