A PROJECT REPORT ON

MEDICAL TOURISM IN INDIA

SUBMITTED TO
UNIVERSITY OF MUMBAI

BY
GAURAV VIJAY CHHABRIA
T. Y. B.M.S.

YEAR 2005-2006

THROUGH
TOLANI COLLEGE OF COMMERCE
ANDHERI (EAST), MUMBAI – 400 093
 CERTIFICATE

I, Dr. A. A. Rashid, hereby certify that Mr. Gaurav Chhabria of Tolani

College of Commerce, T.Y. B.M.S. (Semester V) has completed his

project titled Medical Tourism in India in the academic year 2005-2006.

The information submitted herein is true and original to the best of my

knowledge.

Dr. A. A. Rashid Dr. Sheela Purohit

(Project Guide) (Principal)
 DECLARATION

I, Gaurav Chhabria, of Tolani College of Commerce, T.Y. B.M.S.

(Semester V) hereby declare that I have completed my project titled

Medical Tourism in India in the academic year 2005-2006. The

information submitted herein is true and original to the best of my

knowledge.

Place: MUMBAI Gaurav Chhabria

Date:
 ACKNOWLEDGEMENT

I would like to acknowledge the following as being instrumental in the

completion of this project:

First and foremost I would like to thank my guide, Dr. A. A. Rashid,

whose invaluable support helped me compile this project.

I also availed of the Internet which is a source of vast, spontaneous and

accurate information on the subject being researched.

Lastly I would like to acknowledge the support of my family and friends

without whom the project wouldn’t have been a success.

I sincerely hope that the project lives up to your expectations.

 INDEX

Sr. Topic Page

no. no.
1. Introduction 1–8
- Why Medical Tourism?
- Global Scenario
- A Worldwide Market
2. Medical Tourism as an Industry 9
3. Growth of Medical Tourism 10
4. The Indian healthcare situation 11 – 13
5. Indian healthcare specialities 14 – 16
6. Ancient Indian Therapy 17 – 23
7. Health check-up 24 – 25
8. Promotion of medical tourism 26 – 28
9. Kerala-the pioneer state 29 – 33
10. Karnataka’s foray into the health care sector 34
11. Medical Tourism and public health services 35
12. Different views on should public hospitals participate in medical 36 – 38
tourism
13. Medical Tourism in Metros & Suburban city (New Delhi, 39 – 47
Mumbai, Pune)
- Maharashtra’s unlimited potential
14. Public survey & analysis 48 – 49
15. Potential of India in area of medical tourism and steps taken 50 – 51
16. Medical tourism may generate Rs.100 billion – Study 52 – 54
17. Medical tourism is growing in smaller city 55 – 56
18. Medical tourism to cure ailing inbound sector 57 – 58
- FICCI’S focus on Medical Tourism
- Medical Tourism - winning hearts overseas
19. Case study 59
20. New Emerging Destination of Medical Tourism other than India 60 – 64
- Jordan the friendly neighbouring doctor
- Thailand a makeover for the makeover expert
- India far cheaper than Thailand
21. Government launches medical tourism council 65
22. Question straight Answer 66 – 67
23. Conclusion 68
- Counter plan (to tap medical tourism)
24. Bibliography 71
 INTRODUCTION
The most recent trend in privatization of health services is medical tourism, which is
gaining prominence in developing countries. Globalization has promoted a
consumerist culture, thereby promoting goods and services that can feed the
aspirations arising from this culture. This has had its effect in the health sector too,
with the emergence of a private sector that thrives by servicing a small percentage of
the population that has the ability to “buy” medical care at the rates at which the “high
end” of the private medical sector provides such care. This has changed the character
of the medical care sector, with the entry of the corporate sector. Corporate run
institutions are seized with the necessity to maximize profits and expand their
coverage. These objectives face a constraint in the form of the relatively small size of
the population in developing countries that can afford services offered by such
institutions. In this background, corporate interests in the Medical Care sector are
looking for opportunities that go beyond the limited domestic “market” for high cost
medical care. This is the genesis of the “medical tourism” industry.

Health tourism is tipped to be next big-bucks business for India. Health care is a $3
trillion industry worldwide and India is in a position to tap the top-end segment by
highlighting its state-of-art facilities and services, and exploiting the brand equity of
leading Indian healthcare professionals across the globe.

The heart surgery of Pakistani baby Noor Fathima in Bangalore has once again turned
the spotlight on Karnataka’s unique position as a centre for world class healthcare
facilities, together with its equally fascinating tourist attractions, and spurred the state
into a proactive mode to claim its share of the action.

As a part of this initiative, the Karnataka tourism department is leading a team of

hospital officials to the Bahrain Global Health Summit to pitch for some attention
from potential buyers of health tourism services. Four leading institutions –
Wockhardt, Narayana Hruduyalaya, Sagar Apollo and Soukya have already
participated, said VanditaSharma, commissioner tourism for Karnataka.

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According to state tourism and IT minister, DB Inamdar, world-class medical
institutes in Karnataka carry out surgeries for half – in many cases for a third or fifth –
of the cost in the west. More importantly appointments are available much quicker
than in the US or the UK, where patients often face long waiting lists. There are also a
clutch of good health and wellness clinics along with spa resorts, and great locations
of tourist interest in the state, which can help position Karnataka as a leading health
tourism destination.

The US, Canada, the UK, the Mid-East, and even Asian states like Sri Lanka are
viewed as great markets for selling health tourism packages in Karnataka. Assistant
director for Sri Lankan tourism, Madhubani periera, told ET that Lankan tour operates
are already exploring the opportunity with medical centres in Bangalore. The success
of the recently set us Apollo Hospital in the island is said to have egged travel
companies to scout for fresh possibilities in Karnataka, since there are four direct
weekly flights to Bangalore from Colombo.

Narayana Hruduyalaya’s Devi Shetty says tourism related to healthcare generates

higher revenues than pure vacationers. Patients who visit Bangalore for treatment
along with their families tend to stay longer than most tourists. Post-operation, family
members often relax by visiting places of tourist interest. For instance, a person
staying in the city for a heart surgery spends around Rs.2 lakh during a week-long
halt, which is miles ahead of the expenditure incurred by a typical tourist.

Hospitality industry experts say there is another aspect of health tourism, pampering
and wellness which is gathering momentum in the west and has been successfully
packaged by Kerala. Leele palace Bangalore’s Eric Swanson explains that pampering
involves offering people an experience – massages, herbal wraps and exfoliating
scrubs – that makes them feel relaxed. Wellness involves helping healthy people stays
well, both physically and mentally. Sometimes, this means offering diagnostic testing
to identify potential problems.

The West’s fascination with fitness and alternative therapies for health maintenance
and healing is another factor. Spas for healthy people currently represent the lion’s
share of the health tourism market in the west.

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New trendsetters have started arising on the horizon of the widespread global trade.
One of these trendsetters, who is fast emerging and has an added value of making
huge economical profits, is ‘Medical Tourism’. According to a research professor
Rupa Chanda, IIM; Medical Tourism will single handedly fetch a very impressive
amount of $4 trillion on a world-wide scale. The World Trade Organization studied
the scope of this new found field. The study was conducted in Thailand, Malaysia,
Jordan, Singapore & India, which resulted in the findings, that in these 5 countries the
number of medical travelers in the year 2003 was almost 1.3 million and thus
collectively earned almost $1 billion (in treatment cost alone). In case of these nations
the medical travel spends are growing at the rate of 20% plus on a year-to-year basis.

Now, let us know who could be the potential clients for Medical Tourism purposes.
These medical travelers could be broadly classified into 4 distinct geographical
groups.

The first group of medical travelers is made up of Americans. The U.S. boasts of the
best medical facilities in the world & that to instantly. But the value of these services
offered is very high. Also the American healthcare system is pre-dominantly
insurance driven which includes only critical care and not cosmetic care for and not
cosmetic care for which a vast no. of American people are opting now including
facelifts, liposuction, dental treatments, etc. Going by an estimate a full facelift in the
U.S. costs $8000-20000, which costs only $1252 in South Africa. Thus Americans go
in for he cosmetic surgeries that are available outside America in other countries like
South Africa, Thailand, etc. that mean a vacation well. Given these increasing costs of
medical treatments in the U.S. it makes sound economical sense to seek treatments
abroad.

The second major group is the people in UK. Unlike in the US the British healthcare
system ensures free treatments to all its citizens. Yet the people are being forced to
seek medical treatments in other countries by the sheer waiting lists caused by the
National Health Service which we have seen in the introductory case of Mr. Cyril
Parry. This is probably because of the shortage of doctors and hospital beds. Also
private medical facilities here are prohibitively expensive and relatively fewer in

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number. These are the two major reasons why British patients take the initiative to
seek their own treatments abroad.

The third chunk of medical travelers comes from the Middle-East, where the people
of these oil-rich nations fly abroad to seek medical facilities that are either unavailable
or in short supply in their own countries. According to an estimate more than 5lakh
people from the Middle-East travel abroad every year for Medical Treatments. They
travel mainly to Jordan, Saudi Arabia, Bahrain, US, India, Thailand & Malaysia. By
some estimate India itself attracted around 70,000 plus travelers from the Middle-East
last year. The final lot includes people from the least developed nations traveling to
their well developed neighbours. Last year it was estimated that nearly 50,000 people
from Nepal and Bangladesh came for medical treatments to 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.

..4..
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
expatriate 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, SriLanka 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.

Why Medical Tourism?

Medical tourism - patients going to a different country for either urgent or elective
medical procedures - is fast becoming a worldwide phenomenon. The reasons patients
travel for treatment vary. Many medical tourists from the United States are looking
for treatment at a fraction of the cost at home. Canadian and UK medical tourists are
frustrated by long waiting times. Becoming a medical tourist also provides a chance to
combine a tropical vacation with elective or plastic surgery, for others.

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. 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 healthcare
industry is growing at 30 per cent annually and could earn more than $1-2 billion
annually, creating 40 million new jobs in the process, by 2012.

Today while we look up at the tourism sector the foremost thing that come to our
mind are leisure tourism activities, adventure activities etc. but the sector of medical

..5..
tourism remains unexplored and untapped. The sector has great potentialities in
lending the tourism activities. The estimated Indian market alone at present amounts
to almost $40 million approximately which suggest that there is even more value than
the mentioned one and is yet to be tapped.

The reasons for which I selected Medical Tourism as my final topic for project are:-
• The Medical Tourism sector also known as the Healthcare sector still remains a
toddler compared to the other sectors like leisure, adventure, pilgrims, etc.
• Medical Tourism will act as a boom for boosting the overall tourism sector in
India.
• A well planned and promoted Indian healthcare sector as well as the coordinated
efforts of the medical fraternity and the government of India will increase the
standards of the healthcare in India. This in turn will be helpful to local population
as well.
• The traditional Indian ways of healing if promoted and publicized well could do
wonders to the Indian economy.
• Along with the medical sector comes a very vital sector for free known as the
insurance sector which can also support the Indian economy.
• Another issue was Indian becoming an important destination for various medical
conferences which could improve the influx of the foreign tourists and in turn
generate good amount of Forex.

Global Scenario
Nobody has collected the complete worldwide statistics about how many people
travel abroad for health related reasons every year or how much they spend. But a
Saudi Arabian report pointed out that in 2000, medical travelers from the gulf region
alone spent over $27 billion seeking treatments in various countries around the world.
If the medical travelers from around the world spent even half as much that year, the
total business in 2000 alone would have been in excess of $40 billion and even that
would be an underestimate.

The estimate is that the healthcare market in the organization of economic

..6..
a cooperation and development country alone is worth about $3 trillion and is
expected to rise up to $4 trillion in 2005.

More importantly, it is growing leaps and bounds and turning out to be an immense
business opportunity for nations that are positioning themselves correctly. Last year
just 5 countries in Asia (Thailand, Malaysia, Jordan, Singapore & India) pulled in
over 1.3 million medical travelers and earned over $1 billion (in treatments alone). In
each of these nations the medical travel spending are growing at a rate of 20% plus
every year.

Elsewhere around the world Hong Kong, Lithuania and South Africa are emerging as
big healthcare destinations and a dozen other nations like Croatia, Greece, etc. are
planning to make it big in this sector.

By itself, traveling abroad for medical reasons is not a new phenomenon. Even in the
ancient times people were used to travel abroad for the same. But in the past 5 years
or so the movement has accelerated sharply. It has developed a massive momentum
for two critical reasons.

The first being the demographics of the developed countries and also the problems
associated with their healthcare sector. In the US, UK, Japan and many European
countries majority of the population has either hit the retirement age or are heading
towards it. Meanwhile the life expectancy rate has also grown steadily over the years.
These two reasons add up to give a big surge in the demand of the healthcare.

Also there is a pull factor being created by a handful of developing countries like
Thailand & Malaysia that have good doctors and excellent facilities and which are
positioning themselves as medical destinations of the future in order to boost their
economies. India is also joining this bandwagon.

Though the movement can still be considered to be in its infancy; medical travel has
come under the radar of both the World Health Organization (WHO) and the World
Trade Organization (WTO). Both these organizations understand that medical travel
could ameliorate much of the demand-supply imbalance in global healthcare.

..7..
Developed nations could benefit in terms of costs or waiting time or both coming
down significantly for a major chunk of the population. Developing countries benefit
as it brings revenues, upgrades infrastructure for the locals and reduces brain drain in
their medical fraternities. Least developed countries too benefit as they improve upon
the facilities lacking for cutting edge treatment.

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 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 and 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.

..8..
 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.

In many developing countries it is being actively promoted by the government’s

official policy. India’s National Health policy 2002, for example, says: “To capitalize
till ion 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”. The formulation draws from
recommendations that the corporate sector has been making in India and specifically
from the “Policy Framework for Reforms in Health Care”, drafted by the prime
minister’s Advisory Council on Trade and Industry, headed by Mukesh Ambani and
Kumaramangalam Birla.

..9..
 GROWTH OF THE MEDICAL TOURISM INDUSTRY
The countries where medical tourism is being actively promoted include Greece,
South Africa, Jordan, India, Malaysia, Philippines and Singapore. India is a recent
entrant into medical tourism. According to a study by McKinsey and the
Confederation of Indian Industry, medical tourism in India could become a $1 billion
business by 2012. The report predicts that: “By 2012, if medical tourism were to reach
25 per cent of revenues of private up-market players, up to Rs 10,000 crore will be
added to the revenues of these players”. The Indian government predicts that India’s
$17-billion-a-year health-care industry could grow 13 per cent in each of the next six
years, boosted by medical tourism, which industry watchers say is growing at 30 per
cent annually.

In India, the Apollo group alone has so far treated 95,000 international patients, many
of whom are of Indian origin. Apollo has been a forerunner in medical tourism in
India and attracts patients from Southeast Asia, Africa, and the Middle East. The
group has tied up with hospitals in Mauritius, Tanzania, Bangladesh and Yemen
besides running a hospital in Sri Lanka, and managing a hospital in Dubai.

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

Analysts say that as many as 150,000 medical tourists came to India last in the year
2004. 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.

..10..
 THE INDIAN HEALTHCARE SITUATION
Besides being the land of Taj, a land of diverse cultures, a land of tradition, a land of
highly developed spiritualism, India can also be called the land of healing for the
ailing.

Contemporary India is a forerunner in providing healthcare facilities for all kinds and
type of patients. This has been possible largely because of the professionalism that has
creped in to the healthcare sector. The credit for this goes wholly to the private sector.
Also as a result of this the medical help in India is now comparable to the best in the
world.

India provides a long list of various facilities like world class hospitals, state-of art
technology, competent doctors, professional management, top quality nurse and
paramedical staff and all this with an icing of comparatively lower prices making it
economical as well. More and more people are realizing that India is the right place
for top quality and economically affordable treatments. It is also reliable and can be
regarded as one of the best in the world.

As far as India is concerned price factor is the major advantage. It has been taken into
account that the cost of getting treated in India is almost 10% and in some cases 80-
90% cheaper than what it costs in the developed countries. This becomes very evident
when you notice the average the Indian cost of a cardiac surgery and Compare it with
the average US cost. This coupled with the fact that cardiac surgery in India has a
success rate of 98.5% which is comparable to the best institutions in the world. This is
certainly a major benefit.

Hospitals in the major metros of India have already recorded a 12% international
patient flow. These patients are mainly from the neighboring South East Asian
countries. And these figures will be growing in the near future.

India can catch up by the medical travelers for specific medical treatments as well as
for regular medical check ups. Most of the hospitals are centrally located in the major
Indian cities, are easily accessible and are capable of looking after the patients with

..11..
best care. This was in regards with urban medi-care but rural India also runs back to
back. It may not have world class infrastructure but the medical attention is prompt
with competent doctors even in the remotest parts of the country.

For those who plan to get a regular medical check up done, India is the ideal the place
to be. With its numerous attractions one can come here with the family and combine
the health check up with a pleasure trip for the family.

All this is because of the enormous growth witnessed by the private sector. It was
very modest in the early stages and has now become a flourishing industry with the
most modern state-of-art technology at its disposal. It is estimated that 75-80% of the
healthcare services and investments in India are now provided by the private sector.

An added advantage that India has is that it has one of the largest congregations of
pharmaceutical companies in the whole world. It is self-sufficient in drug production
and exports drugs to more than 180 countries.

The privatization of this sector has brought with it facilities of the star categories &
world class treatments. The country now boasts a number of corporate hospitals. India
is a market for professionals in the medical field for most of the renowned hospitals in
the whole world. Hi-tech medical facilities have become a necessity following the
consumer demand among the world’s fastest growing middle-class masses. India
offers at its own doorsteps a range of world quality hospitals and treatments at a
fraction of world costs with comparable success rate and service levels directly in
proportion to the high value system and natural caring that comes along with its
traditional heritage.

Indian hospitals are now being acclaimed the world over for the standards of
healthcare delivery. The country boasts of superior technology with skilled super
specialists along with sound infrastructure & professional outlook.
Major hospitals in Chennai, Mumbai, Hyderabad & New Delhi have recorded a 125
patient flow from the neighboring & South-East Asian countries. This is because
people have realized that they can now have access to international quality medi-care
at 10% of international costs in India.

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Technologies of the new millennium including ECG through conferencing will soon
be introduced in India, making it feasible for doctors to benefit from the advice of
other experts. Indian doctors performed the country’s first robotic heart surgery which
reduces the risk and trauma associated with critical conditions.

Apart from that India has also become an important destination for medical
conferences. Major international medical conferences on ophthalmology, oral cancer,
etc. were held in India with many more on the anvil.

International Conference
An international health and medical tourism conference is slated to be held
towards the end of this year at Bangalore, which will see delegates from various
South- East Asian countries, the Middle-East and even Africa participating. This will
serve as an ideal platform for Incredible India to market its health and medical
tourism products and services.

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 INDIAN HEALTHCARE SPECIALTIES

Cardiac Care
Cardiac care has become a speciality in India with names such as the Escorts Heart
Institute, AMIIS and Apollo hospitals becoming names to reckon with. They combine
the latest innovations in medical electronics with unmatched expertise in leading
Cardio logistics and cardio-thoracic surgeons. These centers have the distinction of
providing comprehensive cardiac care spanning from basic facilities in preventive
cardiology to the more sophisticated curative technology. The technology is
contemporary and world class and the volumes handled match global benchmarks.
They also specialize in offering surgery to high risk patients with the introduction of
innovative techniques of minimally invasive and robotic surgeries.

The success rates here at these hospitals in India are at an average of 98.5% which are
at par with the leading cardiac centers around the world.

They are in possession of cardiac care units with sophisticated equipments and
investigate facilities like echocardiography with colored Doppler, Nuclear scanning
and Coronary Angiography.

Dialysis and kidney transplant

Common diseases like Diabetes, Hypertension and Chronic Glomerulo-Nephritis can
lead to permanent loss of renal function with Dialysis and renal transplantation being
the frequent outcome. The emergence of new therapeutic interventions has created
opportunities in India to manage the progression of renal diseases. For those who need
replacement therapy, services like Hemodialysis, Chronic Ambulatory peritoneal
dialysis (CAPD), and transplantation are also available. Patients can also avail of the
Bicarbonate Dialysis facilities. The cost of getting a dialysis is around Rs.1700-1800
per dialysis. Similarly a Kidney transplant package in India is available for around
Rs.3 lakh.

Neurosurgery & Trauma surgery

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Other routine procedures performed with excellent results are replacement
Arthroplasties, Diagnostics and Operative Arthroscopy, spinal surgery including
Harrington rod instrumentation, corrective and reconstructive procedure for
poliomyelitis and cerebral palsy.

In addition the advanced Luque technique is employed for the correction of complex
scoliosis and decompression and stabilization of fractures of dorsal and lumbar spine
by neurosurgeon with excellent training and background.

Some super speciality hospitals in India like AIIMS, Ram Manohar Lohia hospital,
Bombay hospital, Jaslok hospital and Apollo hospitals have advanced facilities
dedicated to the treatment of entire range of brain and spinal disorders with highly
experienced neurosurgeons, neurologists and neuro-anaesthetists.

Joint replacement surgery

Shoulder/ hip replacement and bilateral knee replacement surgery using the most
advanced keyhole or endoscopic surgery and anthroscopy is done at several hospitals
in India including the Apollo hospital, Delhi; Bombay hospital, Mumbai and Madras
Institute of Orthopedics and Trauma Sciences. Some hospitals like Apollo in Delhi
have operation theatres with laminar air flow system. A knee joint replacement costs
about Rs.2 and a half lakhs in India.

Refractive surgery
This type of surgery is gaining popularity in India both among the public as well as
the opthalmogistis. Till a few years ago only a few centers performed high volume
radial keratotomy. Today, the highest international quality of eye care for cornea,
cataract, squin and glaucoma is available in over 40 centers all over India. When it
comes to reliability India has the best ophthalmic surgeons with clinic-academic
expertise honed to perfection in the best possible institutions.
The no stitch cataract surgery with the most modern way of removing cataracts
through the use of phacoemulsification procedure can be performed in India for as
little as Rs.20000 for both the eyes. Facilities for PRK, Myopia and astigmatism are
now available in almost all parts of the country. Hyperopic and LASIK are available

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and even supra-hard cataracts are treated using just 1mm instead of 3mm incision
size.

Nuclear medicine
This is now common place, as it involves use of radioactive isotopes in very small
doses in diagnosing and treatment of diseases, radioactive medicine is injected or
administered orally and the distribution in the organ is scanned using a gamma
camera.

Various non cardiac planar/SPECT studies for bone, thyroid, liver and lung scanning
functions are performed at specialized centers in India.

Cosmetic surgery
A new dimension of the medical field taking off in India is the cosmetic surgery
which utilizes some of the latest techniques in corrective procedures. Some
disfigurations corrected include hair restoration, rhinoplasties, stalling of aging
process, dermabrasions, otoplasty for protruding ears, chin and cheek enlargement, lip
reductions, various types of breast surgeries and reconstructions and liposuction.

Non invasive surgical procedures like streotactic radio surgery and radiotherapy for
brain tumors are practiced successfully.

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 ANCIENT INDIAN THERAPY
AYURVEDA
Of the many forms of alternative medicine currently in
vogue in India, yoga and ayurveda almost certainly lead
the pack- and both forms have much in common. Both, for
instance, date back to over 5,000 years ago, and have a
long history of carefully-researched and highly scientific
reasoning to back them up. Both seek to integrate mind,
body and soul for holistic healing, and both are
increasingly gaining popularity as therapeutic sciences that
aim to heal without causing harmful side effects.
Ayurveda' is derived from the two words `ayu' (`age' or `life') and `veda' (a knowledge
of').

As is apparent from the word itself, ayurveda centers round a close understanding of
life; and in the case of ayurveda, this means an intricate relationship between the
many aspects of human life, physical as well as mental and spiritual.

According to the tenets of ayurveda, the human body comprises of five basic
elements- earth, fire, water, air and ether (space). Each of these elements is also
present in the atmosphere surrounding humans, and their combination affects the
human body and mind. These combinations include vatadosha (ether + air, which
affects the nervous system, circulation, elimination and respiration); pittadosha (fire +
water, which governs digestion and metabolism) and kaphadosha (water + earth,
responsible for growth as well as for immunity).

Ayurveda bases itself on these three doshas, using the premise that each individual is
a unique combination of the doshas, and any imbalance in this combination is the
ultimate cause of all diseases. The cure for these diseases, then, lies in a customized
cleansing process, tailor-made specifically for the affected individual. The cure is
known as `panchkarma' and it aims to treat the disease by eliminating accumulated
toxins from the body. Panchkarma can take many different forms, ranging from
special diets and oil massages to therapeutic vomiting and purgation.

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Ayurvedic treatments, if rendered properly, can be very helpful in curing a range of
illnesses and physical disorders, including asthma, diabetes, obesity, skin diseases,
digestive disorders, joint disorders, allergies and more. Treating diseases of a complex
type will obviously take much more than a mere weekend of ayurvedic massages, but
a quiet 3 days (or even a week, if you can afford to spare the time) is good enough to
get a very rejuvenating taste of what ayurveda is all about.

A huge number of ayurvedic resorts and spas are mushrooming all across India, and
all of them offer a tempting range of packages to choose from. Some are specifically
geared towards curing certain minor ailments, although most offer a short-term but
highly intensive `ayurveda package' which runs the gamut from oil massages and
herbal steam baths to special diets and the pouring of medicinal oils on the forehead
of the individual.

..18..
Among the many places that offer excellent ayurvedic packages are:
Ananda in the Himalayas
Tehri Garhwal (Uttaranchal)

Sereno Spa
South Goa

Aayurgram Ayurvedic Health Resort

Bangalore

Ayurveda & Yoga Retreat

Coonoor (Tamilnadu)

Kadavu Ayurvedic Health Centre

Malappuram (Kerala)

Travancore Heritage Ayurvedic Centre

Chowara (Kerala)

Kairali Ayurvedic Health Resort

Palakkad (Kerala)

Angsana Oasis Spa and Resort

Bangalore

Keraleeyam Ayurvedic Health Resort-

Alappuzha (Kerala)

Manaltheeram Ayurveda Beach Village-

Chowara (Kerala)

..19..
HYDROTHERAPY
Hydrotherapy, or water therapy as it is also known centres
around (as you've probably guessed) the use of water as a
healing agent. The buoyancy, viscosity and mineral
components of water are used through hydrotherapy to heal
or relieve ills as varied as fatigue, sore throats, and colds,
inflammation of the joints, jaundice, rheumatism, arthritis,
spondylitis, insomnia, soft tissue injuries and even
diabetes.

As an alternative system of healing, hydrotherapy is one of the oldest, safest and

cheapest- which is definitely part of the reason why it's swiftly gaining in popularity.
Hydrotherapy is no upstart; it's been around for more than 5,000 years, when the first
mineral and thermal baths appeared in Greece. The Greeks, however, were not the
only people to realize the healing powers of water. They were followed in their
appreciation of the therapeutic liquid by the Romans (who are credited with having
set up well-planned baths all across their empire); the Egyptians, the Japanese and the
native Indian Americans. Most modern techniques borrow from both Eastern and
Western forms of water therapy, and span a vast range of treatments. Basically,
hydrotherapy is instrumental in stimulating blood circulation, increasing the
production of stress hormones, improving the immune system and lessening pain
sensitivity. The most common curative methods used in hydrotherapy include:

Cold Baths: Cold baths are used mainly as a means of stimulating blood circulation,
and are also used for reducing swelling.

Steam Baths: Hot steam helps encourage sweating, which in turn opens the skin's
pores, leaving the individual feeling refreshed and rejuvenated. It's not specifically
healing, but it works wonders if you're feeling tired and drained, and can be an
effective means of detoxification.

Neutral Baths: A neutral bath-as the name suggests- uses water that is neither hotter
nor colder than the temperature of the human body (cold or hot water draws or

..20..
transmits heat to or from the body, as the case may be). For a neutral bath, the
individual is immersed in water that is maintained at a steady temperature of between
33.5°C and 35.6, for about half an hour. This has a sedative, and even soporific, effect
on the patient and is used to calm the nervous system.

Floatation: As relaxing and refreshing as a neutral bath, floatation involves lying face
up in a dark, enclosed tank of warm, heavily salted water.

Hot and Cold Sprays: High-pressure spray jets of hot or cold water are used to heal
or relieve a number of minor ailments, and mainly to stimulate organ function, the
nervous system and the immune system.

Hot and Cold Compresses: Both hot as well as cold compresses actually start off as
cold compresses- a cloth dipped in ice-cold water and left on the effected part of the
body for a certain period of time. In the case of a cold compress, the pack is replaced
by an equally cold pack once it begins to lose its chill. In the case of a hot compress,
the pack is left on and allowed to heat up by the warmth of the body. Both types of
compresses are used in various ways, especially to treat acute injuries.

Ice Packs: Ice packs- which contain crushed ice or a special gel- are applied to the
body to reduce swelling, pain and inflammation.

Wet Sheet Packs: A wet sheet pack (also known as bodies wrap) is, as the name
suggests, a procedure in which the entire body is wrapped in a cold, wet sheet that is
in turn covered with a woolen blanket. The sheet is left in place until it dries by the
warmth of the body (usually about half an hour to relieve a fever; longer to relax and
soothe the body; or up to 3 hours to induce sweating, which can be a good
detoxification method for those with drinking or smoking problems).

..21..
Among the spas in India that offer hydrotherapy treatments are:

Ananda in the Himalayas

Tehri Garhwal (Uttaranchal)

Spa Aguada
Goa

Angsana Oasis Spa and Resort

Bangalore

The Leela Palace

Bangalore

Golden Palms Spa and Resort

Bangalore

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YOGA
Yoga, now recognized globally as a highly effective form of
alternative medicine, originated in India about 5,000 years ago as a
discipline that sought to unite the moral, mental and physical
aspects of human life to contribute to the overall wellness of the
individual.

Yoga is believed to have been propounded by the sage Patanjali

(2nd century BC). Patanjali, in his treatise (known as the sutras) of
yoga, explained the basics of yoga, its benefits and its steps
(padas), without going into the details of what postures to adopt, how to breathe and
so on.

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HEALTH CHECK-UP
Many common and life threatening conditions can be treated successfully if detected
early. Many leading hospitals in India have health check-up programs that screen
every part of the body meticulously and professionally. A proper health check-up
scans your bio-history, interprets signal and provides the opportunity for the
proverbial ‘stitch in time’. A heart check-up constituting of echocardiography,
consultation by a senior cardiologists, blood tests, general test & haemogram can go
long way in ensuring a healthy heart. The test can be done at any of the leading
cardiac hospitals or private clinics.
A comprehensive health check-up contains the following tests:
• Doctor’s consultation and full medical examination
• Blood tests
• Blood group
• Blood sugar
• Blood urea
• Serum uric acid
• Serum creatinine
• Serum cholesterol
• Lipid profile
• Urine and faeces examination
• X-ray chest PA
• ECG
• Exercise stress test (tmt)
• Stress screening by psychologist
• Gynecologist consultation and PAP smear test
• Post check-up consultation
• Optional tests

Some additional tests may be advised by your doctor like:

• Pulmonary function test
• Ultra sound screening for the abdomen

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 • ENT examination
• Screening for liver disease
• Screening for thyroid disease
• Hepatitis B screening
• Test for AIDS
• Screening for Kidney disease

These tests can be done in leading private and public hospitals. The full health check-
up package costs between Rs.2000-2500.

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 PROMOTION OF MEDICAL TOURISM
The key “selling points” of the medical tourism industry are its “cost effectiveness”
and its combination with the attractions of tourism. The latter also uses the ploy of
selling the “exotica” of the countries involved as well as the packaging of health care
with traditional therapies and treatment methods.

Price advantage is, of course, a major selling point. The slogan, thus is, “First World
treatment’ at Third World prices”. The cost differential across the board is huge: only
a tenth and sometimes even a sixteenth of the cost in the West. Open-heart surgery
could cost up to $70,000 in Britain and up to $150,000 in the US; in India’s best
hospitals it could cost between $3,000 and $10,000. Knee surgery (on both knees)
costs 350,000 rupees ($7,700) in India; in Britain this costs £10,000 ($16,950), more
than twice as much. Dental, eye and cosmetic surgeries in Western countries cost
three to four times as much as in India.

The price advantage is however offset today for patients from the developed countries
by concerns regarding standards, insurance coverage and other infrastructure. This is
where the tourism and medical industries are trying to pool resources, and also putting
pressure on the government. We shall turn to their implications later.

In India the strong tradition of traditional systems of health care in Kerala, for
example, is utilized. Kerala Ayurveda centres have been established at multiple
locations in various metro cities, thus highlighting the advantages of Ayurveda in
health management. The health tourism focus has seen Kerala participate in various
trade shows and expos wherein the advantages of this traditional form of medicine are
showcased.

A generic problem with medical tourism is that it reinforces the medicalised view of
health care. By promoting the notion that medical services can be bought off the shelf
from the lowest priced provider anywhere in the globe, it also takes away the pressure
from the government to provide comprehensive health care to all its citizens. It is a
deepening of the whole notion of health care that is being pushed today which
emphasizes on technology and private enterprise.

..26..
The important question here is for whom is ‘cost effective’ services to be provided.
Clearly the services are “cost effective” for those who can pay and in addition come
from countries where medical care costs are exorbitant - because of the failure of the
government to provide affordable medical care. It thus attracts only a small fraction
that can pay for medical care and leaves out large sections that are denied medical
care but cannot afford to pay. The demand for cost effective specialized care is
coming from the developed countries where there has been a decline in public
spending and rise in life expectancy and non-communicable diseases that requires
specialist services.

MEDICAL TOURISM: COST COMPARISONS

Type India U.S. U.K.
Partial hip $4,500 $18,000 N.A.
replacement
Full hip $3,000 $39,000 N.A
replacement
Orthopedic $4,500 $18,000 N.A
surgery
Cardiac surgery $4,000- $9,000 or $30,000 - £30,000 (private
£6,000 $50,000 care)
Knee surgery £8,000 N.A £20,000 (private
care)

Gall bladder $7,500 $60,000 N.A

surgery

..27..
Dental care
Type India U.S. Thailand Hungary
Tooth extraction N.A. $350 $30 N.A
Two dental N.A $5,200 N.A $990
bridges
Filling $20 - $40 $300 - $400 N.A N.A
Root canal $200 - $400 $3,500 N.A N.A

N.A: Not available

(Figures are estimated, are in U.S. dollars or U.K. pounds, figures vary due to prices
charged by different medical centres and patient profile and do not include travel and
accommodation costs)

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 KERALA - THE PIONEER STATE
Kerala, or God’s Own Country as its corporate slogan goes, has pioneered health and
medical tourism in India. They have made a concerted effort to promote health
tourism in a big way, which has resulted in a substantial increase of visitor arrivals
into the state. Kerala and Ayurveda have virtually become synonymous with each
other. However, though Kerala has strongly focused on Ayurveda and its wide array
of treatments and medications, good facilities are also available in the other traditional
forms of medicine as well as in modern medical treatment.

The bias towards health tourism in Kerala is so strong that Kerala Ayurveda Centres
have been established at multiple locations in various metro cities, thus highlighting
the advantages of Ayurveda in health management. The health tourism focus has seen
Kerala participate in various trade shows and expos wherein the advantages of this
traditional form of medicine are showcased.

Medical Tourism in Kerala

• Kerala is already marketed as a health destination mainly for its Ayurveda
packages
• Medical tourism is marketed along with ayurveda and to her health packages.
• Major hospitals like KIMS, Trivandrum, Lake Shore and AIMS in Kochi, and
MIMS, Calicut have pioneered joining hands with the Government promoting
Medical Tourism.
• Globalization and economic liberalization have given a boost to the specialized
Medical Service Sector
• Health Insurance Companies are playing a major role in Medical Tourism.

..29..
 Kerala pioneered health and medical tourism in India through Ayurveda

Medical Tourism Product

• Medical tourism is like any leisure product where service components like
airlines, hotels, travel companies, transportation, food outlets are offered and
medical treatment at the best hospitals
• The medical treatments for various ailments are packaged with recuperative
leisure packages at world class tourist resorts.

Kerala a Medical Tourism Destination

• Well connected by Air from major medical tourism markets in the Middle East
European markets and South Asia
• Moderate weather throughout the year
• Advanced and sophisticated hospitals of International standards located in
Kerala.
• Renowned doctors specialized in almost all major disciplines.
• Trained paramedical staff and technicians available in Kerala
• Easier communication with majority English speaking public
• The higher hygienic standards of Kerala

..30..
• The developed tourism industry in Kerala with its array of high quality resorts and
hotels.
• Ideal setting for an excellent recuperative holiday
• Medical tourism packages offered and marketed by tour operators joining
hands with excellent hospitals
• Incredibly competitive cost for packages of medical treatment and surgery
compared to other countries
• Honoring of medical insurance by hospitals in Kerala
• Marketed efficiently in source markets

Distribution - Medical Tourism packages

• Distributed widely and brought to the doorstep of the customers by the tourism
industry.
• Made available through major tour operators. They sell it as other holiday
packages. Made it easy for the patients.
• The Department of Tourism, Kerala pioneered in promoting Kerala as a medical
tourism destination in the International market.
• The Great India Tour Company (GITC) launched special medical tourism
packages under brand name “Heavenly Healing” in the international tourism
marts in association with Kerala Institute of Medical Sciences (KIMS).

The package …
• Medical history emailed and discussed
• Patient received at the airport, an escort takes over.
• Transferred to a hotel or resort.
• Escort takes the patient to the hospital as per appointment with doctor and admits
into the hospital.
• Surgery or treatment conducted.
• Discharge and recuperative holiday at a resort.
• Post treatment check up, transfer to airport and departure.
• Billed as a package all inclusive for the patient and accompanying person.

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Demand for treatment in Kerala
• There is an existing demand for treatment, from countries like Maldives,
Bangladesh, Gulf countries and some European countries.
• European Countries are finding it difficult to offer surgeries in time, due to heavy
wait-list.
• The Non-Resident Keralites are good spokespersons in the originating countries
and prefer their home country for treatment.
• International Corporate houses offer medical treatment facilities to the employees
and family / are focusing cost effective options.

Some Health indicators of Kerala

A well quoted & most discussed phenomenon
• Population density - 819 per sq km
• Annual Per capita income – Rs 17,756 (national avg - Rs 14,712)
• Sex ratio - 1036 females to 1000 males
• Population growth rate – 9.4 %
• Low infant and child mortality - Infant Mortality Rate – <12
• High life expectancy at birth - Life expectancy –75yrs
• Virtual elimination of many communicable diseases
• Replacement level birth rate in many districts
• Birth rate – 18.2 per 1000
• Death rate –6.2 per 1000
• Maternal mortality rate - <2 per 1000
• Per capita expenditure on health care by Kerala population - 11.95 compared to
the all India figure of 6 %.

Health-care Infrastructure
• Bed availability - 377 per 1000 population
• Kerala spends > 9% of the State GDP on health
• Kerala Health Sector – Private sector dominates with 70% share on health care
• Health Insurance < 9 % covered

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Synergy between Hospitals and an active Tourism Industry
• Growing tourism industry in Kerala enhances the quality professional services in
this sector.
• Availability of excellent hotels, resorts at beaches, backwaters, hills, plantations…
managed professionally
• Patients feel happy having experienced a dream destination like Kerala.

Kerala poised for a leap in Medical Tourism

• Hospitals are joining hands with tourism industry for services.
• Government has taken it up as a new thrust-area in Tourism, marketing the
concept.
• Private sector is enthusiastic in selling the services.
• Trained youth entering the industry in big numbers
• Better sharing and dissemination of information on health management through
internet and satellite channels.
• State is technology savvy, utilizing video conferencing with experts and other
modern communication facilities.

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 KARNATAKA’S FORAY INTO THE HEALTHCARE
SECTOR
The department of tourism, government of Karnataka, has ambitious plans for the
state. According to D B Inamdar, minister for tourism, "The idea is to make
Karnataka a top health tourism destination, not only in India but internationally. We
want to lure foreigners to Karnataka to avail of our sophisticated facilities and
subsequently induce them to enjoy our multiple tourism offerings. This endeavour
will have a positive impact on the entire economy of the state." In fact, the
government is setting up a Bangalore International Health City Corporation which
will cater to patients for a wide variety of health care products and treatments.

The recent operations of children from Pakistan, who have sought medical treatment
in Bangalore, have not only helped to boost the state economy but more importantly,
helped in fostering goodwill, peace and harmony between India and Pakistan. Without
doubt, Indian doctors are among the best in the world and given the right atmosphere
and environment, they can enhance the image of Incredible India as a health and
tourism destination.

The state also boasts of having the unique property, Golden Palms Spa & Resort,
which is the one and only resort in the country where a guest can have a complete
range of pathological tests, dental treatment, electro-cardiograms, stress tests, X-rays,
and even sonography tests. To crown it all, there is even a mini-operation theatre for
cosmetic surgery performed by world renowned surgeons in the field.

..34..
 MEDICAL TOURISM AND PUBLIC HEALTH SERVICES
Medical tourism is going to only deal with large specialist hospitals run by corporate
entities. It is a myth that the revenues earned by these corporates will partly revert
back to finance the public sector. There is ample evidence to show that these hospitals
have not honoured the conditionalities for receiving government subsidies – in terms
of treatment of a certain proportion of in patients and out patients free of cost. If
anything, increased demand on private hospitals due to medical tourism may result in
their expansion. If they expand then they will need more professionals, which means
that they will try to woo doctors from the public sector. Even today the top specialists
in corporate hospitals are senior doctors drawn the public sector. Medical tourism is
likely to further devalue and divert personnel from the public sector rather than
strengthen them.

Urban concentration of health care providers is a well-known fact – 59 per cent of

India’s practitioners (73 per cent allopathic) are located in cities, and especially
metropolitan ones. Medical tourism promotes an “internal brain drain” with more
health professionals being drawn to large urban centres, and within them, to large
corporate run specialty institutions.

Medical tourism is going to result in a number of demands and changes in the areas of
financing and regulations. There will be a greater push for encouraging private
insurance tied to systems of accreditation of private hospitals. There is a huge concern
in the developed countries about the quality of care and clinical expertise in
developing countries and this will push for both insurance and regulatory regimes.
The potential for earning revenues through medical tourism will become an important
argument for private hospitals demanding more subsidies from the government in the
long run. In countries like India, the corporate private sector has already received
considerable subsidies in the form of land, reduced import duties for medical
equipment etc. Medical tourism will only further legitimize their demands and put
pressure on the government to subsidies them even more. This is worrying because
the scarce resources available for health will go into subsidizing the corporate sector.
It thus has serious consequences for equity and cost of services and raises a very
fundamental question: why should developing countries be subsidizing the health care
of developed countries?

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DIFFERENT VIEWS ON - SHOULD PUBLIC HOSPITALS
PARTICIPATE IN MEDICAL TOURISM?

No, why promote private business interests with government’s money?’

-Ravi Duggal

The setting up of the Medical Tourism Council of Maharashtra (MTCM)

collaboratively by the state government and Federation of Indian Chambers of
Commerce and Industry’s (FICCI) western regional centre is a contradiction of sorts.
Tourism is associated with pleasure, fun and relaxation and I fail to understand how
medical care can become a tourist attraction. Those seeking medical care are ill, under
tremendous stress, and are in a vulnerable position. Hence promoting medical care
through a tourism council in itself is a sick concept!

If FICCI wants to promote private health care business worldwide it has a right to do
so. But why involve the state government in promoting private health care business.
All these years the central and state governments have given loads of subsidies to the
private health sector, whether it was land to construct hospitals or medical education
to produce doctors for the private sector, or subsidised bulk drugs to private
formulation units, or tax and duty waivers to import expensive medical equipment etc.

But the private health sector, which is being promoted through this council (mainly
the five star hospitals), and which has benefited most from these subsidies, has been
socially irresponsible. What is worse is that almost all these hospitals are registered as
trust hospitals, which means that for their not-for-profit status they have obligations
under the Public Trust Act to provide health care free to the extent of 20 per cent of
their resources.

Where is the accountability of this provision? The charity commissioner is turning a

blind eye and the hospitals are having a joy ride, and it is well known that the free
patients on their list are relatives of hospital staff, bureaucrats and ministers. The state
becoming party to such a venture is a grossly unethical act. Given the declining public
health situation of the state, the latter seeking to promote medical care for the rich and

..36..
wealthy, instead of focusing its energies and resources on strengthening the public
health system for the benefit of the poor is just not acceptable. The state is violating
the principle of non-discrimination of the International Covenant on Economic, Social
and Cultural Rights. The government’s own studies and reports reveal the pathetic
state of the public health care system in both rural and urban areas and yet the
government chooses to rub shoulders with FICCI to promote private business interests
in the health sector.

The setting up of this council is driven by two business factors. First the idle capacity
of these large elite hospitals and second the long waiting lists for selective surgeries
and medical procedures in the developed world. .

So I would like to urge the Maharashtra government to stay out of this and take to
task these very hospitals enlisted on the MTMC website to honour their commitments
as trust hospitals using their idle capacity for treating the poor free of cost as
mandated by the Trust Act, and provide free diagnostic services using equipment
which was imported with duty concessions. So instead of seeking export revenues, the
state should be looking at generating revenues by demanding accountability from
these hospitals. These should form the “benchmarks” and “best practices” which
Sushil Kumar Shinde referred to in his statement during the inauguration of the
Council and should be of concern to the state government.

‘Yes, it can revolutionise public health care scenario’

Public hospitals present a very strong case in being a part of the Maharashtra Medical
Tourism Council. These hospitals have professionals who have, perhaps, the
maximum exposure to diseases and ailments; a record number of procedures are
performed by them and are recognized worldwide for their competence.

Once this competency is leveraged, by seed investments in technology and ambience

oriented infrastructure, they can be attractive for the foreign tourists.

Then arises the question- whether they should participate in the Council?

..37..
According to me, why not? The critics fail to see the in-built advantages for the Indian
society if public hospitals participate in this exercise actively. A parallel revenue
stream, apart from the taxpayer’s money, can bring about a revolution in the Indian
public health care scenario.

Today, the public health sector and related institutions are suffering because of
budgetary constraints. Look at the possibility of the public hospitals being
technologically upgraded to world class standards with this possible source of income.
Also, with exposure to the paid medical service market, the spirit of competition will
germinate in the public hospitals, which will enhance their efficiency, service delivery
levels and subsequently their image.

Medical tourism is not about primary and secondary health care in our villages and
towns; it is also not about critical care and emergencies. So the argument that millions
would be deprived of public facilities does not hold water. Hence all these segments
will remain unaffected by the surge of medical tourists in public hospitals. In the
present form, medical tourism concept in India is based on leveraging the cost
differentials of medical treatment by the foreign nationals, or Indian system of
medicine, or recuperation and rehabilitation. This is only possible in planned
treatments and procedures and to some extent, preventive care and diagnostics. Thus,
with the kind of resource inflow envisaged because of tourism, things can only
improve in public hospitals.

Therefore, an approach to attract medical tourists, in medium and long run, will be
beneficial to Indian society at large.

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 MEDICAL TOURISM IN METROS& SUBURBAN CITY

DELHI:
Although Delhi has witnessed an unprecedented growth in health care industry, how
far has the capital become successful in attracting the medical tourist to its swanky
and big hospitals? Sapna Dogra finds out

When baby Noor Fatima, a two-and-a-half- year old Pakistani girl, successfully
underwent an open heart surgery in India, she opened news vistas reminding the
potential of medical toursim.The Ministry of External Affairs took this opportunity to
encourage medical diplomacy, by facilitating the visit of cabinet ministers and
provincial leaders to India for treatment.

Medical tourism is the buzzword now. The government as well as private players are
keenly assessing the potential and means to tap the same. The boom in state-of-the-art
hospitals and well-qualified doctors, have attracted the patient population from
neighbouring countries, the Middle East and the West.

The equation is ‘First World treatment’ at “Third World prices”. A CII-McKinsey

report last year, postulating the opportunities in health tourism, states that the medical
tourism market in the country pegged a 30 per cent growth in 2000 and it has been
growing at the rate of 15 per cent for the past five years.

“By 2012, if medical tourism were to reach 25 per cent of revenues of private up
market players, up to Rs 10,000 crore will be added to the revenues of these players,”
adds the report. One of the Indian states, Kerala, setting an example by attracting
health tourists, has emerged successful in generating revenues from medical tourism.
Hospital groups in Delhi have realized the potential of health/ medical tourism but
most of them are playing it by the ear.

Among private players, Apollo has been a forerunner in health tourism. It has been a
choicest destination for patients from Southeast Asia, Africa, and the Middle East.
The group has tied up with hospitals in Mauritius, Tanzania, Bangladesh and Yemen

..39..
besides running a hospital in Sri Lanka, and managing a hospital in Dubai. In 2002,
the number of patients who visited the hospital was 3001 and about 700 were
hospitalized. Along with providing treatment, the stay of the foreign patients is taken
care of by the hospital itself. The group has tied up with hotels in Delhi for this
purpose.
According to Dr Chabra, additional medical director, ISIC (Indian Spinal Injury
Centre), ISIC is another destination for patients from neighbouring countries, Gulf
and a few NRIs from the US.

Now, to attract more people, the emphasis is on vacation plus treatment and special
packages have been planned for this. On the anvil is another plan to make the patients
and their relatives stay in the hospital complex with all the luxuries a hotel provides.
Dr Shakti Gupta, AIIMS, stresses on the need to export health services. According to
him, Indian doctors, medical services, and hospitals are at par with good hospitals in
Europe and the US, so it is the right time to make the most of it. AIIMS is a
destination for patients from Nepal, Bangladesh, Bhutan, Myanmar, Mauritius,
Malaya and Pakistan. Besides regular patients from the Middle-East, an occasional
patient from the US drops in. Patients from Pakistan, especially children with heart
afflictions, have been regularly coming to AIIMS’ heart centre.

According to Dr Gupta, AIIMS was made for the entire south-east Asia populace and
since it is a government institute there are no plans to attract more foreigners. The
attractions at AIIMS include cardiac surgery, neurosurgery, cancer treatment and
ophthalmic procedures. “The services are charged on actuals and ours being a
government institute we are not angling to make money but are here to serve the
people,” stressed Dr Gupta.

The Metro hospitals and Heart Institute, Noida, also manages to attract patients from
Nepal, Bhutan, Sri Lanka, Bangladesh and a few from Maldives and the Gulf region.
Their motto is to extend excellent health services to people who travel here for health
care and also for tourists who need health care while their stay in India. Indian
hospitals getting recognition from international insurance companies will bring in
more patients from abroad, says Anil K Maini, head, marketing, health care business,
Escorts Heart Institute and Research Centre.

..40..
The centre is emerging fast as a favourite destination for patients from neighboring
countries, Africa and CIS. With BUPA recognition, patients from the UK are coming
here for treatment. About 1,000 patients from abroad are treated in Escorts on an
annual basis. Although only a few hospitals are making conscious efforts to increase
the existing inflow of health tourists, nobody denies the huge potential medical
tourism has. And it will not be long before its full potential is realised, provided we
cultivate the service mind set, put in place an accreditation system and project our
capabilities overseas through multiple media.

LIST OF HOSPITALS IN DELHI

Name Address Bed Capacity
Jeevan Anmol hospital Mayur Vihar Phase-I 125
G.M.Modi hospital Mandir Marg, Saket 100
Indraprastha Apollo Sarita Vihar, Mathura Road 600
hospital
Tirath Ram Shah hospital Sawhnex Marg, Rajpur Road 183
Sitaram Bhartia Institute B-16, Mehrauli Industrial Area 64
Batra hospital 1,Tuglauabad Institutional Area 310
Pushpanjali Medical A-14/15, Pushpanjali Vikas Marg 60
Centre Extn
Rajiv Gandhi Cancer D-18, Sector V, Rohini 160
Institute & Research
Centre
M.G.S hospital (Delhi) 35/37 Rohtak Road, Punjabi Baug 100
Rockland hospital Tara Cresent Road 130
Sonia hospital (Delhi) Nangloi National Highway No.10 65
Veeranwali International Chandragupta Marg, Chanakyapuri 70
hospital

..41..
MUMBAI:
STRENGTH
Expertise and skill
The city boasts of doctors and nursing staff whose expertise is comparable with
international standards. And, as Dr. Nilima Kshirsagar, dean of KEM Hospital, puts
its, “Real medicine is provided speedily and efficiently”.

Extensive infrastructure
Mumbai has one of the largest healthcare facilities run by the Municipal Corporation,
state government, charitable trusts and private owners. Official estimates say the city
has 33000 beds, four tertiary care hospitals, several peripheral hospitals. Several
specialty and super specialty hospitals are spread across town, from Mulund in the
north to south Mumbai. State-of-the-art equipment is available at most private
hospitals as well as a handful of public hospitals.

Several tourist destinations nearby

Maharashtra is dotted with tourist destinations. Packages can be developed to lure
patients. As state Health Minister Digvijay Khanvilkar had in an earlier interview
said: “Even in these places, our rural and primary healthcare facilities are in place”.

Last word
“For it to work, we have to develop products not only related to healthcare but also
tourism. But they should have a USP and be cost advantageous. There is nothing
wrong with such a plan for all economies work on cross – subsidy and it can be the
same here too. Interaction with foreign patients will also improve quality of treatment,
“says Brigadier Joe Curian, CEO of S L Raheja Hospital.

Comparative cost
A knee replacement that costs $6000(Rs.2.73 lakh) in India would cost
$10000(Rs.4.55 lakh) in the UK.
A cardiac bypass costing $15000(Rs.6.82 lakh) in the UK would cost up to Rs.3 lakh
here.

..42..
WEAKNESS
Benefits only private hospitals
The main beneficiaries would be private and charitable hospitals. Given the
conditions that public hospitals work under, it’s unlikely that foreigners would
consider them. “Most charitable hospitals have over half their beds vacant. And the
charity commissioner is doing nothing about it, “says Ravi Duggal of centre for
Enquiry into health and Allied Themes (CEHAT)

Lack of funds
Even though the government aims to bring public hospitals under the purview of
health tourism, there is an urgent need for facilities, “If we want to lure people from
abroad, we have to create facilities similar to that of nursing homes,” says Kshirsagar.
“The only void is the marketing of public hospitals,” says Sushil Jiwarajka, chairman
(western zone), FICCI.

Costlier than other cities

Where Mumbai is likely to lose out is cost of treatment. A bypass in Mumbai is nearly
comparable with cities like Delhi and Chennai costing up to Rs.3 lakh in public
hospitals. In Kolkata it costs between Rs.1.12 lakh and Rs.1.33 lakh at a leading
hospital. A caesarean costs over Rs.50000 in a few hospitals, while in Bangalore it
costs Rs.23900.

Last word
“In a city where people are dying of dengue and falciparum malaria, it shows how
disassociated the government is about ground realities. It is nothing but a political
ploy,” says Dr. Arun Bal, of Association for consumer Action for safety and health
(ACASH).

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LIST OF HOSPITALS IN MUMBAI
Hospital Address Bed Capacity
Asian Heart Institute Bandra (East) N.A
Bhagwati Hospital Borivali (West) N.A
Bhaktivedanta Hospital Mira Road N.A
Bhatia Hospital Grant Road N.A
Bombay Hospital Marine Lines N.A
Breach Candy Hospital and Breach Candy 175
Research Center
Cooper Hospital Vile Parle N.A
Guru Nanak Hospital Bandra (East) 150
Hinduja Hospital Mahim 350
J.J Hospital Byculla N.A
Jaslok Hospital Peddar Road 377
K.E.M Hospital Parel N.A
Lilavati Hospital Bandra Recl. 300
Nair Hospital Mumbai Central N.A
Nanavati Hospital Vile Parle 400
Tata Memorial Hospital Parel N.A
Wockhard Hospital Limited Mulund 222

..44..
PUNE:
It was economical for Robert Dunn to fly from London to Pune for a knee
replacement surgery. What would have cost him Rs 15 lakh in Britain was done at a
minimal cost of Rs 1.95 lakh in Pune.

What’s more, Sancheti Hospital’s ‘Medical Tourism Department’ took care of all his
demands and ensured that his 17-day stay was an unforgettable experience.

‘‘People seeking health solutions for their ailments from various countries have
travelled to India and Pune over the last few years. But the inflow of patients has
increased not only from countries like the Middle East and Africa but Europe as
well,’’ says Manish Sanghvi, Director, Administration at Sancheti Hospital and in
charge of the newly set up Medical Tourism Department that will cater exclusively to
international patients. The hospital has an average of 7-8 patients per month from
overseas, says Sanghvi, adding that in the last four years at least 250 international
patients have been treated. The patients mainly seek treatment for joint- related
problems at the orthopaedic specialty hospital. According to Sanghvi, the hospital has
even prepared a medical tourism package that organises sightseeing tours to tourist
spots in the city and elsewhere. Sanghvi even recalls that one family flew down from
Kenya for the knee replacement surgery of their father. ‘‘They wanted to go to Agra
to see the Taj Mahal while the kids wanted to hang out at the pubs. While their father
was recuperating, family members decided to make the most of their stay in
Pune,’’says Sanghvi. The hospital’s medical tourism department arranged everything
and their month’s stay cost them just Rs 6-7 lakh.

He pointed out that the hospital was leaving no stone unturned to woo medical
tourists. “Recent reports have revealed that by 2012, medical tourism in India would
be a Rs 10,000 crore opportunity. Our treatment is not just about new technologies
and good doctors. It is also about family values and genuine concern for our patients,”
insists Sanghvi. While international patients are always suspicious regarding the
treatment.

..45..
LIST OF HOSPITALS IN PUNE
Hospital Address Bed Capacity
Grant Medical Sassoon Road 535
Foundation
Lokmanya Hospital Chinchwad 50
Sanjeevan hospital Karve Road 125
Sancheti hospital Shivajinagar 110
Sane Guruji Arogya Kendra Hadapser 200
Deenanath Mangeshkar hospital Erandwane 450
Kotbagi hospital Aundh 50
Niramaya hospital Mumbai Pune Road 100
Jehangir hospital & Medical Sassoon Road 266
Research

..46..
MAHARASHTRA’S UNLIMITED POTENTIAL
This state, as a gateway to India, offers tremendous potential to develop medical
tourism. The latest addition in Mumbai is the Asian Heart Institute at Bandra-Kurla
Complex, which offers state-of-the art facilities for all types of heart complications
and even offers preventive cardiological treatment to avoid heart ailments and also to
keep under control a host of heart problems. This institute which is in collaboration
with the Cleveland Institute, USA, offers ‘five-star’ services at reasonable prices.
There are even provisions for financial assistance which is offered through various
trusts associated with the institute.

There are a wide range of hospitals which help to promote medical tourism in the
state. Some of these are Lilavati Hospital, Jaslok Hospital, Bombay Hospital, Hinduja
Hospital, Wockhardt Hospital and Apollo NUSI Wellness Retreat. Hotels like Hyatt
Regency, JW Marriott, Renaissance and Resort, also offer extensive spa facilities
aimed at rejuvenating both the domestic and international tourist.

..47..
 PUBLIC SURVEY & ANALYSIS
A survey was conducted by me to study the awareness amongst the general the
general public about Medical Tourism and their general behaviour. For this purpose I
selected 50 individuals randomly of an age, sex and occupation. The results obtained
and their conclusions were as follows:

1. Have you heard about the term ‘Medial Tourism’?

Yes-88% No-12%
Majority of the people have heard about the term Medical Tourism which means that
there is awareness amongst the general public about this field.

2. Has any one of your near one been to a foreign country for treatment purposes?
Yes-48% No-52%

3. Do you know about celebrities traveling to the US for medical treatments?

Yes-92% No-8%
The above questions (1 & 2) were asked to check the awareness of the people
expressed in Q1 and the answer supported their views.

4. Do you believe in the concept of ‘Family Doctors’?

Yes-100% No-0%
The question confirms the faith of the general public in a single medical professional
for their treatments.

5. How often do you undergo health check-ups?

Once a Year-48% Never-40% Twice a Year-12%
The answer reflects a mixed response of the general public about their own health.

6. Which state in India is famous for Ayurvedic treatments?

Maharashtra-0% Goa-24% Rajashthan-0% Kerala-76%
The above answer coveys that people are aware about which state is famous for
Ayurvedic treatment.

..48..
7. Which of these is a traditional Indian form of healing?
Accupuncture-8% Yoga-84% Reiki-8%
The answer above conveys that the general public has awareness about the traditional
methods of healing that are currently in demand amongst the popular states of India.

8. How would you grade these hospitals of Mumbai from 1 to 4?

Hinduja Breach Candy Lilavathi Tata Memorial
In this case 40% f the people have rated Breach Candy hospital as the No.1 hospital
which shows that people are aware of the standards of the hospitals in their city.

9. Unfortunately, if anybody in your relation faces a major ailment would you suggest
him/her to undergo treatment in a foreign country?
Yes-72% No-28%
The above answer expresses that Indians have a fair amount of faith in India’s
healthcare system.

10. Do you think India has the potential to become a forerunner in ‘Medical
Tourism’?
Yes-56% No-44%
This answer has evoked a feeling of mixed response among the general public about
India’s capacity to become a good healthcare destination.

..49..
 POTENTIAL OF INDIA IN AREA OF MEDICAL
TOURISM AND STEPS TAKEN
A nice blend of top-class medical expertise at attractive prices is helping a growing
number of Indian corporate hospitals lure foreign patients, including from developed
nations such as the UK and the US.

If a liver transplant costs in the range of Rs 60 lakh-70 lakh in Europe and double that
in the US, a few Indian hospitals, such as Global in Hyderabad, have the wherewithal
to do it in around Rs 15 lakh-20 lakh. Similarly, if a heart surgery in the US costs
about Rs 20 lakh, the Chennai-headquartered Apollo Hospitals Group does it in
roughly Rs 2 lakh.

As more and more patients from Europe, the US and other affluent nations with high
medicare costs look for effective options, India is pitted against Thailand, Singapore
and some other Asian countries, which have good hospitals, salubrious climate and
tourist destinations.

While Thailand and Singapore with their advanced medical facilities and built-in
medical tourism options have been drawing foreign patients of the order of a couple
of lakhs per annum, the rapidly expanding Indian corporate hospital sector has been
able to get a few thousands for treatment.

But, things are going to change drastically in favour of India, especially in view of the
high quality expertise of medical professionals, backed by the fast improving
equipment and nursing facilities, and above all, the cost-effectiveness of the package,
said some of the hospitals Business Line spoke to.

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 in Mumbai, etc 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

..50..
good. What is more significant is that the costs are much less, almost one-third of
those in other Asian countries," says Dr K. Ravindranath, who returned from abroad
to start Global Hospitals, which has facilities for liver, kidney and heart
transplantations.

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. This can be done through an orchestrated effort by the
Centre, airlines, travel houses, insurance companies, tourism sector and healthcare
providers, says Ms Anjali Kapoor, Head-International Marketing of Indrasprastha
Apollo Hospitals, New Delhi.

While accreditation from an international body such as the Joint Commission

International (JCI) facilitates better response from Europe and the US, recognition
from the National Health Services (NHS) ensures international standards in terms of
patient care, quality improvement and patient safety. The Apollo Hospitals Group is
in the process of getting accredited with JCI, she said.

Indian corporate hospitals excelled in cardiology and cardiothoracic surgery, joint

replacement, orthopaedic surgery, gastroenterology, ophthalmology, transplants and
urology to name a few, said Dr Ravindranath.

The CARE Hospitals, which has specialised in heartcare, has concentrated on drawing
patients from the Gulf and at least 50 were treated last year, said a hospital
spokesperson.

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.

..51..
 MEDICAL TOURISM MAY GENERATE RS.100 BN BY
2012: STUDY
Medical tourism could help upmarket tertiary hospitals gain additional revenues of
Rs. 50-100 billion ($1.1-2.2 billion) by 2012, said a new industry study released on
April 8.

The study by Confederation of Indian Industry (CII) and consultancy firm McKinsey
said India has immense potential to benefit from medical tourism as healthcare costs
skyrocket in the developed world.

"In comparison to most developed countries such as Britain or the U.S., treatments
like those for dental problems or major procedures like bypass surgery or angioplasty
come at a fraction of the cost in India," said Naresh Trehan, chairman of the CII
National Healthcare Committee.

Similarly, cardiac surgery in India costs one-tenth of that in the U.S., he said. "Given
the potential, medical tourism could account for 3 to 5 percent of the total healthcare
delivery market, provided the industry re-orients itself to attract foreign patients," said
the study. Infrastructure for hospitals, speciality tourist packages to include medical
treatment and promotion of hospital accreditation and standardisation are some of the
prerequisites needed to realise the potential.

"The hospitals would have to provide state-of-the-art facilities and improve the
quality of in-patient care and service to make the overall experience attractive to
foreign tourists," the study noted.

According to the report, India, with 1.5 beds for every 1,000 people, is currently far
behind China, Brazil and Thailand with an average of 4.3 beds for every 1,000 people.
The study projects that changing demographic and disease profiles and rising
treatment costs will result in healthcare spending more than doubling over the next 10
years.
Private healthcare will be the largest component of this spending, rising to Rs. 1.56
trillion by 2012, up from the current Rs. 690 billion. This could rise by an additional

..52..
Rs. 390 billion if health insurance cover is available to the rich and the middle class,
the study said.

In addition, public spending could double from Rs. 170 billion if the government
reaches its target spending of 2 percent of the GDP, up from the current 0.9 percent.
Along with the expected increase in the pharmaceutical market, the total healthcare
market could rise from Rs. 1.03 trillion currently (5.2 percent of GDP) to between Rs.
2.32 trillion and Rs. 3.2 trillion by 2012.

While there is a tremendous stock of intellectual capital in healthcare and with state-
of-the-art treatment and world-class surgery available in the country, the system in
India faces some lacunae, the CII-McKinsey study added.

"There is a pressing need for qualified specialist nurses and paramedics and qualified
hospital administrators. Several private hospitals have invested in nursing education,
but are concerned about loyalty as trained nurses often leave India, attracted by the
higher wages offered in the Gulf countries."

It said specialist nurse training would become vital as the number of single-super
speciality and multi-super speciality hospitals increased. Standardisation and
accreditation of hospitals as also better information management are other aspects, the
study highlighted.

By efficiently harnessing technology, medical professionals can now consult

specialists anywhere across the globe, send images and have video-conferencing to
arrive at a decision for complicated cases, it said.

On the importance of health insurance, the study pointed out that the number is rising
rapidly from less than 10 percent coverage.
"Insurance would be the main driver for raising quality consciousness and increased
demand for better standards, hospital accreditation and patient-management
information systems."

..53..
Currently, the voluntary health insurance market is estimated at Rs.4 billion but it is
growing fast. Industry expects it to touch Rs.130 billion by 2005.

Treatment Costs ($)*

* All costs are average estimates - sources Business world

PROCEDURE US INDIA SOUTH THAILAND

AFRICA
Facelift 8,000-20,000 10,000-20,000 1,252 2,682

Hip 17,000 4,500 6,671 6,900

replacement
Open heart 150,000 5,000-10,000 13,333 7,500
surgery
Eye 3,100 7,000 2,166 730

..54..
 MEDICAL TOURISM IS GROWING IN SMALL CITY

LUDHIANA CITY
According to the data, a bypass surgery in England may cost anywhere between Rs 8
to 10 lakh while in India it costs Rs 1.5 to 2 lakh, which, the experts insist, is done
with the same technique and methodology as abroad.

With the increasing globalisation and shrinking borderlines, tourism is not the only
budding industry. Now it is skills, techniques, technology and hope that crosses
borders with individuals.

Aptly described as ‘medical tourism’, the trend of non-resident Indians visiting their
homeland for specialised treatment as well as other benefits is fast catching up in the
country with Ludhiana serving as an epicentre owing to its specialised medical
services.
According to doctors, the reason for a shift in preference to India in terms of medical
benefits can be attributed to the fact that the expenditure incurred here for a specific
treatment is almost one tenth of what it may cost overseas, especially since the
expertise and the treatment meted out in India is of international standards. ‘‘I think
the fact that the doctors have achieved the international level of competence and are
capable of conducting specialised surgeries has attracted the patients here,’’ said Dr
Kim Mammen, Head of Department of Urology, CMC. According to the data, a
bypass surgery in England may cost anywhere between Rs 8 to 10 lakh while in India
it costs Rs 1.5 to 2 lakh. Similarly, an MRI test of brain costs approximately 750
pounds abroad as opposed to a mere Rs 3,000 here, which, the experts insist, is done
with the same technique and methodology as abroad.

According to Dr Mammen, the Urology Department in CMC on an average receives

four to five NRI patients a month, usually for prostrate operation, urological cancer,
management of stone diseases and reconstruction purposes. He also mentioned that
the patients hail mostly from Canada and the UK, as these countries house a major
proportion of NRIs who otherwise belong to Punjab. The other reason cited by him
for choosing Ludhiana over a treatment overseas by the patients being the long-

..55..
waiting period usually given to them at the hospitals abroad. Dr Mammen had
recently operated upon two NRIs based in Canada.

Dentistry is another branch of medical science that has many takers abroad owing to
two reasons. Firstlym owing to the high cost involved in a dental check-up as well as
the fact that it is not covered under the health insurance scheme of the governments.
According to Dr Vivek Saggar, dentist, who runs a clinic in the city and has been
advocating the cause of medical tourism, apart from the specialised treatments, the
overseas patients also come to get their regular dental check-ups done. ‘‘Not only is
the cost one tenth but the fact that here we talk about the problem first and insurance
later, makes it a more comfortable option as well,’’ he said.

According to Dr Sandeep Puri, Medical Superintendent, DMC, though the hospital

has been receiving calls from NRIs enquiring about the specialised services pertaining
to dialysis and other specialised services, it is yet to execute its plans on medical
tourism. ‘‘Though we have routine NRI patients complaining of medical problems
encountered on their visit to the city, we are yet to put together the plans on medical
tourism,’’ he said. For Hari Narayan Singh, an NRI based in Canada, who had come
to the city to get treated for enlarged prostrate and utheral stricture, a visit here has
saved six months of pain and burden of a due operation. ‘‘If I had not come to CMC, I
would have had to wait for six months to get operated upon in Canada,’’ he said.
Similar is the experience of S.S. Grewal, also an Indian based in Canada, who is in the
city to get treated for a cancerous growth.

..56..
 MEDICAL TOURISM TO CURE AILING INBOUND
SECTOR

Medical Tourism Tops FICCI Agenda

The Federation of Indian Chambers of Commerce and Industry (FICCI), Western
Region Council (WRC) has set up a task force for the promotion of medical and
health tourism in the state of Maharashtra. Foundations of the project have already
been laid, with the task force consisting of the government of Maharashtra, medical
education and drugs department of Maharashtra, Maharashtra Tourism Development
Corporation (MTDC), travel agents and tour operators and representatives from
hospitals and medical research centres.

The aim of this project is to tap the potential of the cost effective medical treatment
offered by Maharashtra simultaneously show-casing it as an ideal tourism product.
This project will structure special itineraries for both domestic and international
tourists who are interested in availing of any kind of medical treatment in the state of
Maharashtra. A complete tourism package would be offered according to the
destination of the chosen hospital or medical centre where the treatment would take
place. Transport facilities including land and air arrangements, hotel accommodation,
etc will also be looked after. Sight seeing tours of noted tourist attractions of that
destination would be part of the itinerary for those wishing to combine their treatment
with leisure. These customized packages aim to optimize the value gained by the
tourist by delivering dual benefits of medical facilities along with a leisure holiday
plan.

Says wing commander Anil M Gadkary, director, FICCI (WRC), “This is our dream
project and we hope to get the support of all the service providers of the industry. This
project indeed will give a major boost to the tourism and hospitality industry of
Maharashtra. We have received a positive response from MTDC who will jointly
work with us on this promotion.”

..57..
FICCI’s Focus on Medical Tourism
It is indeed gratifying to note that well established chambers of commerce are now
seriously looking at medical tourism and in fact, the Federation of Indian Chambers of
Commerce and Industry, Western Region Council (FICCI-WRC) has taken the lead
by setting up a task force for the promotion of health and medical tourism in
Maharashtra.

This task force has representatives from the Maharashtra government, the medical
educational institutions and the drugs department, Maharashtra Tourism Development
Corporation, pharmaceutical companies, travel agents and tour companies. Wing Cdr
Anil M Gadkari, director, FICCI-WRC explained, "This is our dream project and we
hope to get the support of all service providers of the industry. This project will
indeed give a major boost to the tourism and hospitality of Maharashtra. We have
received a positive response from MTDC who will work with us on this promotion."

Medical Tourism - winning hearts overseas

Through the last few years tourists have been coming for
rejuvenation packages to Kerala or Goa. So far it’s been mainly
the non-resident Indian. The effort now is to institutionalise and
re-route patients from foreign markets to Indian hospitals - it
works out to onefifth the UK rates or one-tenth US prices. A
patient can even enjoy the facilities of a hotel, for instance, during the recuperation
period or post-operative care.

Indraprastha Apollo Hospital's, Managing Director, Dr Yogi Mehrotra, said that the
group has already treated about 60,000 foreigners. Indian surgeons are internationally
reputed and Indian medical institutions are already seeing patients from Turkey,
Egypt, South Africa, Kenya, Tanzania, Sudan, Ethiopia, Mauritius, some European
countries and Seychelles. According to the McKinsey study on healthcare, the
medical tourism industry could generate revenues to the tune of Rs 10,000 crore by
2012.

..58..
 CASE STUDY
Cyril parry waited for a very long time for his turn to come. The 59-year-old retiree
from Birmingham, UK, was suffering from rheumatoid-arthritis. He needed a hip
replacement operation urgently. He waited patiently though his pain was getting
worse and his pain was getting worse and his movements increasingly restricted.
Unfortunately, parry was stuck at the end of a very long queue. The overburdened
National Health Service orthopaedic surgeons in the UK were booked solid – for
several years. Finally, Parry was told that his turn would come four years and nine
months down the line.

That was when Parry started surfing the net to see if he could get his hip surgery done
elsewhere in the world. After a full year of research, he shortlisted two destinations: a
hospital in Thailand and Apollo speciality Hospital, Chennai. In November this year,
Parry opted for the latter because, at £4,000 (excluding airfare but inclusive of a 10-
day stay, post-operative care and a full health check-up), it was almost £5,000 cheaper
than the Thai option.

It was ironic that Parry needed to travel abroad for his treatment. He was, after all,
undergoing a procedure called the ‘Birmingham Hip Resurfing’ – a new technique
considered as a superior alternative to the full-hip replacement surgery, and named
after the city it was pioneered in. It was perfected at the royal Orthopedic Hospital in
Birmingham as recently as 1998.

Cyril Parry needed to travel because of the healthcare system followed in the UK
which is creating long waiting lists of patients in that country. More on that later. But
long waiting lists are not the only reason that there’s been a huge surge in medical
travel globally in recent years. Patients from rich countries in the Middle East travel
to the US when they need top notch developing nations such as Nigeria or Bangladesh
travel to their more developed neighbours for medical treatment because there aren’t
enough good facilities available in their own countries. Thousands of Japanese
citizens seeking medical treatment fly abroad because of the prohibitive costs of
treatment in their home country. Americans seeking cosmetic surgery often fly to
South Africa for face tucks and breast augmentation because their insurance coverage
doesn’t pay for those – and it is cheaper to get them done in South Africa than back
home.

..59..
 NEW EMERGING DESTINATION OF MEDICAL
TOURISM OTHER THAN INDIA

JORDAN THE FRIENDLY NEIGHBOURING DOCTOR

Jordan stumbled upon the medical travel opportunity quite by accident. After 9/11, it
found that a vast number of patients from its neighbouring countries, who had
otherwise been traveling to the US for treatment, started coming to Jordan.

That was when this Middle Eastern country launched a massive investment
progamme to upgrade and modernize its public hospitals and medical schools. It
helped that Jordan already had fairly good healthcare infrastructure, especially when
compared with its neighbours.

With around 10000 doctors, 33 private hospitals and 2000-odd beds, it is unlikely that
Jordan will be a really big healthcare destination of the like of, say, Thailand, or even
India. But what matters is that Jordan attracts a lot of Arab Patients from nations like
Yemen, Oman and Syria. They come in for everything from infertility treatments to
organ transplants. So, even though Jordan treated only 126,000 or so foreign patients
last year, it earned almost $500 million – roughly the amount that Thailand earned
from 800,000 medical travelers.

Two years ago, Jordan set up a special counter at its Queen Alia International Airport
to meet Arab patients and offer them a string of free services including transportation
to hospitals. A Jordanian minister in an interview sometime back pointed out that
when Arab patients come to Jordan for treatment, they typically come with their
families. That is why everyone – from hotels to taxi drivers – benefit from medical
tourists. Jordan has now set a target of $1billion from medical travel in the next
couple of years. It is likely to have competition from its neighbours though. Both
Saudi Arabia and Bahrain are also seriously looking at the medical travel opportunity.

THAILAND A MAKEOVER FOR THE MAKEOVER EXPERT

Even five years ago, Thailand’s claim to fame in the medical travel world was as a
cheap and reliable destination for sex change operations. Over the past few years, the

..60..
Thai government and half a dozen private hospitals have gone into overdrive to
change that image. They are now repositioning Thailand as Asia’s premier healthcare
hub for everything from cosmetic surgery to hip replacements.

The Thai Ministry of Public Health is working closely with the Thai Ministry of
Tourism to promote medical tourism in Thailand. More interestingly, the Thai
minister met his counterpart from Malaysia a few months ago to see if the two
countries could mount some sort of joint-promotion to beat competition from other
countries.

But the government initiatives pale before the kind of action that the private hospitals
are taking to attract medical travelers. Bangkok’s Bumrungrad Hospital is by far the
clear leader in the field. With 554 beds on offer, it treated 300,000 plus expatriates
and foreigners last year. In fact, a full 25% of all the patients that the hospital treats
today are foreigners. To make itself attractive to foreigners, Bumrungrad offers a host
of facilities. It offers assistance in 13 languages and it has got itself accredited from
the JCAHO, an international certification recognized by most of the big insurance
companies. It’s even got a McDonald’s and a starbucks coffee shop in its compound
to cater to the tastes of its foreign patients and their companions. “To facilitate
patients, we have opened offices in Myanmar, Vietnam, Nepal, Sri Lanka, Maldives,
Cambodia, the Netherlands and the Middle East,” says Carl Schroeder, CEO,
Bumrungrad Hospital.

The other private hospitals aren’t sitting still either. The Phyathai hospital is hiring
teachers from the British Council to train its staff, including the maids. It has also
signed contracts with hospitals in the Netherlands and Bangladesh to bring in patients
awaiting heart surgery there. Thailand provides specialized medical clinics, skilled
nursing care, long-term care, nursing homes and rehabilitation clinics at costs that are
a fraction of what it would cost in US or Britain. “The cost of treatment in Thailand is
less then half of what other neighbouring countries charge,” says Surapong
Ambhanwong, chief medical officer of Phyathai 1 hospital.

The Japanese still form the biggest chunk of medical travelers coming to Thailand,
though the Americans and the British are now coming in significant numbers. After
9/11, it also got a huge share of the Arab traffic.

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INDIA FAR CHEAPER THAN THAILAND
Today, the medical tourism market in India is worth US$ 333 million.

A liver transplant costs US$ 500,000 in the west, in Delhi, it is being done for US$
40,000. Cost of medical treatment in India across a whole category of surgeries is
substantially lower than Thailand.

It is the next big success story out of India. Five years ago, less than 10,000 patients
visited India for medical treatment. Today, the medical tourism market in India is
worth US$ 333 million with about 100,000 foreign patients coming in every year.
Apollo Group Chairman Pratap Reddy estimates that one out of every ten patients
treated at his hospitals is from overseas and with an annual growth rate of 30 per cent,
India is already inching closer to Singapore, an established medicare hub that attracts
150,000 medical tourists a year.

Hospitals in India are doing the latest surgeries, at low cost. In the west, a bone
marrow transplant costs US$ 400,000. A similar transplant in Chennai costs US$
30,000. A liver transplant costs US$ 500,000 in the west, in Delhi, it is being done for
US$ 40,000.

An MRI of the wrist, for instance, costs just US$ 155 in India while the same can set a
patient back by US$ 1600 at a private hospital in Hong Kong.

An open-heart procedure at a top hospital in the country would cost the patient around
US$ 5000 as against US$ 50,000 abroad. Similarly, neurosurgery in the country costs
around US$ 8,000 as compared with US$ 29,000 in the US. A root canal procedure by
a dentist in Mumbai would cost about US$ 20 as against US$ 100 in the US. Also in
the US, a knee joint replacement would costUS$16000 in the US as compared to US$
4500 in India.

India and Thailand are being portrayed as emerging global hubs for low cost medical
care. Media prefers to put India and Thailand in the same cost bracket. Yet, a careful
scrutiny of expenses in both countries shows that the cost of medical treatment in

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India across a whole category of surgeries is substantially lower than Thailand.
Thailand has a cost advantage over India in only two categories: plastic surgery and
breast augmentation. India is cheaper than Thailand across a whole range of other,
and more serious, surgery categories as the following chart shows.

INDIA IS FAR CHEAPER THAN THAILAND

SURGERY THAILAND INDIA
Bone Marrow Transplant 62500 30000
Liver Transplant 75000 40000
Open Heart Surgery 14250 4400
(CABG)
Hip Replacement 6900 4500
Knee Surgery 7000 4500
Hysterectomy 2012 511
Gall Bladder Removal 1755 555

*All figures in US$. The Indian costs are based on the average rates offered by top
Indian hospitals like Escorts Heart Institute, Apollo Hospitals and Batra Hospital.
The Thailand rates are based on rates provided by Bumrungrad Hospital, Bangkok,
which is Thailand's largest private hospital.

A joint study by the Confederation of Indian Industry and McKinsey & Co. shows
that at the current pace of growth, healthcare tourism alone can rake in over US$ 2
billion as additional revenue by 2012. The Government of India seems to be going
along with this projection. In March last year, Finance Minister Jaswant Singh spoke
about making India a global health destination, and listed a slew of economic
incentives for private hospital groups to create and upgrade infrastructure, as well as
reduce their operational costs. He provided tax sops to financial institutions lending to
private groups setting up hospitals with 100 or more beds. He also increased the rate
of depreciation from 25 per cent to 40 per cent for life-saving medical equipment.
Now, state governments, private hospital groups, and even travel agencies have all
cottoned on to the trend.
• For example, leading Indian travel houses like Sita and Kuoni have launched tie-ups
with overseas players that focus on medical tourism.

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• The Karnataka Government is setting up Bangalore International Health City
Corporation, which will cater to international patients for a wide variety of health care
products and treatments.

• The Asian Heart Institute at Mumbai's Bandra-Kurla Complex, offers state-of-the art
facilities for all types of heart complications. It has been set up in collaboration with
the Cleveland Institute, USA and offers 'five-star' services at a reasonable cost. While
people have long travelled to Thailand for nose jobs, tummy tucks and breast
enhancement, India is creating a niche to emerge as a hub for life-saving surgery. And
though the bulk of the demand comes from the 20 million strong Non Resident Indian
community, India can attract ethnic foreigners in large numbers if it manages to
effectively market its strengths abroad. Besides low costs, there are two other unique
selling propositions that India has to offer:
1. High success rates
2. Growing credibility.

Indian specialists have performed over 500,000 major surgeries and over a million
other surgical procedures including cardio-thoracic, neurological and cancer surgeries,
with success rates at par with international standards. The success rate in the 43,000
cardiac surgeries till 2002 was 98.5 per cent. India's success in 110 bone marrow
transplants is 80 per cent. The success rate in 6,000 renal transplants is 95 per cent.
India's independent credit rating agency CRISIL has already assigned grade A rating
to super specialty hospitals like Escorts and multi specialty hospitals like Apollo But
the fact is that it is international credibility that counts more in the medical tourism
sweepstakes. NHS of the UK has indicated that India is a favoured destination for
surgeries. The British Standards Institute has now accredited the Delhi based Escorts
Hospital. Apollo Group - India's largest private hospital chain and Escorts Hospital
are now seeking certification from the US based Joint Commission on Accreditation
of Healthcare Organisations.
Without doubt, India is not about nip and tuck medical tourism. It's about making a
real difference in the global healthcare value chain.

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 GOVERNMENT LAUNCHES MEDICAL TOURISM
COUNCIL

What do you get if you combine Ajanta-Ellora, Mahableshwar and the Konkan coast
with 20,000-odd medical specialists and hi-tech tertiary care hospitals? Answer
(according to the Maharashtra government): a medical tourism haven.

Hooked on to the idea of making the state a medical tourism hub, the Maharashtra
government, in collaboration with FICCI (Western Region Council), began working
on idea around eight months ago. On November 19 of 2003, the Medical Tourism
Council of Maharashtra (MTCM) was formally launched at a function at which health
minister Digvijay Khanvilkar, chief secretary Ajit Nimbalkar, Principal Secretary,
medical education & drugs department, G.S.Gill, FICCI-WRC chairman Sushil
Jiwrajka and Union minister of state for commerce and industry S.B.Mookherjee were
present.

Speaker after speaker outlined the fact that Maharashtra had a winning combination of
prime tourist destinations and world-class healthcare facilities, which made it a great
choice for a medical tourist centre. Pointing out that healthcare, from a simple root
canal to open-heart surgery, was available in India at one-fifth the cost of western
countries, Mr. Gill declared that MTCM would work on leveraging this advantage. “A
CII-McKinsey report had stated that the medical tourism industry could be expected
to grow at 30 per cent per year from 2000 onwards,” he said. “My estimate is that if
all goes well, we can earn Rs 10,000 crore annually from medical tourism by 2012.”

Interestingly, it’s not only private hospitals—public hospitals also part of the deal. Mr
Khanvilkar declared that the government was putting a lot of effort into upgrading
these, and hoped that they would attract the middle-class medical tourist. “Eventually,
we hope that the estimated 30 per cent annual growth of medical tourism will go up to
50 or 60 per cent,” said Anupam Verma, honorary secretary, MTCM.

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 QUESTION STRAIGHT ANSWERS
DIGVIJAY KHANVILKAR – STATE MINISTER FOR HEALTH, ON LAUNCH
OF THE MEDICAL TOURISM COUNCIL OF MAHARASHTRA (MTCM)

The state government has been talking about health tourism for quite a while but
nothing has really come of it so far. Will the MTCH yield any results?

We’ll see results soon. Given the involvement of the central and state governments,
Federation of Industrial Chambers of commerce and Industry (FICCI), health tourism
will definitely take off. This is only the starting point. Mumbai and Maharashtra have
some of the best doctors and by upgrading existing facilities it is possible to have an
excellent health tourism programme in place.

How much revenue is it likely to generate?

At this moment, it’s difficult for me to give an estimate.

Will medical tourism promotion be restricted to private hospitals or will public

hospitals be brought under its purview?

Public hospitals will also come under medical tourism. As a matter of fact, we have
excellent facilities in places—like in Pune, Kolhapur and Mumbai. By upgrading
facilities, public hospitals can be very much part of medical tourism. Besides, they
have excellent staff.

Isn’t it a bit far-fetched to have patients who come for treatment go for short
holidays nearby?

We have our rural and primary healthcare facilities very much in place, which should
be able to take care of things. If necessary, we can fly them down to major medical
establishments.

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Don’t you think that more than launching websites and road shows abroad to
promote health tourism, the need of the hour is aggressive marketing and up
gradation of facilities?

Marketing is indeed very important and we’ll be doing it. But we are working towards
improving our medical facilities.

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 CONCLUSION
COUNTER-PLAN
(To tap medical tourism in India)

A $40 billion plus market worldwide growing at over 20% a year throws up huge
opportunities for anyone smart enough to tap it. India has the entire base and
infrastructure required to build-up a strong brand value for itself amongst the
international community as a top class healthcare destination. But now depends
wholly on how the coordination takes place to tap-in this sector. Some following
conclusions as seen after reviewing the entire healthcare situation in India by me can
be considered as important steps to improve the Indian ‘Medical Tourism’ situation.
1. There should be a central regulatory authority to plan-up the Infrastructure
development and other issues regarding medical tourism.
2. The sector of medical tourism should be regarded as a totally separate entity other
than the regular tourism activities by the central regulatory authority.
3. There should be no sort of red-tapism involved in this sector In the true sense of
the word.
4. A great edge has been provided to India by the private sector which has
professional management. This sector should be secured respectfully and should
be boosted through attractive incentives by government authorities to achieve high
valued profits.
5. A study showed without any concentrated and combined efforts up to 1 lakh plus
medical travelers visited India during the last year. This shows that there should
be a real concerted effort by each segment of the Indian medical sector-Indian.
6. The biggest reason why people travel to India for treatments are the comparatively
low cost which should be maintained throughout.
7. India should be marketed as a ‘Healthcare Destination’ projecting its conventional
as well as traditional methods of healing and treatments.
8. India should also attract hordes of tourists by providing information to the foreign
medical tourists about the very low costs offered for various treatments through
various mediums.
9. Along with these efforts the places of tourist interests in and around the medical
destination should be developed well to increase the tourist influx to such places.

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10. Various competent hospitals should work according to the international standards
& should try and acquire international certification and accreditation.

Thus all in all for the sector of medical tourism to come out in flying colors India
needs to develop products related not only to healthcare but also tourism. But they
should have a UPS and be cost advantageous. Interaction with foreign patients
will also improve the quality & the costs of treatment.

HEALTHCARE
The size of India’s healthcare industry is worth US$ 20 billion. In India, 12 per cent
of the national annual expenditure is on healthcare. Of this, 82 per cent of the total
health expenditure comes from the self-paid category, while employers account for 9
per cent and insurance covers 5 per cent of the total healthcare expenses. India’s
expenditure on health is relatively high when compared to other
developing countries. The chart on left compares India’s expenditure to other
countries.
The rise in the literacy rate, higher levels of income and an increased awareness
through enhanced media campaign has led to health receiving greater attention and a
preference for private services.

Private Health Care

Private health care may be classified into various levels, based on the scale of
operations and the range of services provided. Some of these are listed below:
• Individual private practitioners providing medical prescriptions and basic
healthcare services;
• Small nursing homes with bed capacity ranging from 5-100 beds primarily
concentrated in urban areas

• As per the 52nd Round of National Sample survey Organisation, 81% of the
outpatient care and 56% of inpatient care is being provided by the private sector in
the country.

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• Large hospitals run by trusts or corporates that are located primarily in cities and
towns across the country. The 1990s have seen significant entry of Indian
companies in medical care. Most of these players have focused on large, single or
multi-specialty facilities located in large cities. These include Apollo, Fortis, Max,
Wockhardt and Escorts, among others.
• Leveraging India’s IT strengths, telemedicine is being tried out at a few hospitals.
This holds promising potential for providing quality medical care even in remote
parts of the country.

Opportunities
• Healthcare is expected to be one of India’s largest industries in the near term with
present growth rates of around 13 per cent annually. Further, India needs to add
80,000 hospital beds a year for the next 5 years according to a WHO report.
• The opening up of the insurance sector to private players is expected to further
boost the healthcare industry. Health Insurance will make healthcare affordable to
a large number of people.
• There is an increasing preference for private medical care amongst the urban
population.
• The National Health Policy (NHP) – 2002 announced by the Government
envisages increasing public health investment to 2% of GDP by the year 2010
from the existing level of 0.9% and the total health investment to 6% from the
current level of 5.2%. The NHP-2002 welcomes the participation of the private
sector in all areas of health services-primary, secondary and tertiary.

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 BIBLIOGRAPHY
Newspapers
1. Times of India
2. Economics Times

Magazines
1. Business world

Websites
1. www.ourworld.compuserve.com
2. www.mohfw.nic.in
3. www.cehat.org
4. cities.expressindia.com
5. www.expresstravelandtourism.com
6. www.pd.cpim.org
7. www.cbc.ca
8. www.apollohospitals.com
9. www.ibef.org
10. www.cbc.ca
11. www.Tata-AIG Hospitals.com
12. www.Tata-AIG Hospitalsdelhi.com
13. www.Tata-AIG Hospitalspune.com

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