Medical Tourism in India

IntroductionThe medical faculty of India in collaboration with the tourism industry has worked together to provide cost-effective treatment to people across the globe. With the privatization of medical care in India evolved the recent and popular trend of treatment along with the fun of a vacation, better known as medical tourism in India.

India best known as a tourist's paradise offers a choice of beaches, majestic palaces, refreshing hill stations and more. With the new trend of medical tourism in India, now vacationers can enjoy a rejuvenating holiday and also avail of world-class medical treatment of different sorts.

Attractions in IndiaIndia is a land is assorted beauties. The golden sands and palm fringed beaches of Goa, the magnificent monuments and architectural beauties like the Taj Mahal, Red Fort, misty hill stations like Manali, Kulu, Shimla, are significant tourist attractions and numerous tourists visit India from different parts of the world.

HospitalsAmong some of the leading Hospitals that offer medical tourism in India is the group of hospitals. The hospital promises exceptional medical facilities along with special care and concern. 

Facilities/Treatments available in IndiaAlong with a choice of tourist places, India offers a range of outstanding medical facilities like Cardiology and Cardiothoracic Surgery, Joint Replacement, Oorthopedic Surgery, Gastroenterology, Ophthalmology, Transplants and Urology. The Hospitals also provide services like Neurology, Neurosurgery, Oncology, Ophthalmology, Rheumatology, Endocrinology, ENT, Pediatrics, Pediatric Surgery, Pediatric Neurology, Urology, Nephrology, Dermatology, Dentistry, Plastic Surgery, Gynecology, Psychiatry, General Medicine and General Surgery. Other services like General Radiography, Ultra Sonography, Mammography and Angiography are also provided

History

The first recorded instance of medical tourism dates back thousands of years to when Greek pilgrims traveled from all over the Mediterranean to the small territory in the Saronic Gulf called Epidauria. This territory was the sanctuary of the healing god Asklepios. Epidauria became the original travel destination for medical tourism.Spa towns and sanitariums may be considered an early form of medical tourism. In eighteenth century England, for example, patients visited spas because they were places with supposedly health-giving mineral waters, treating diseases from gout to liver disorders and bronchitis.

Description

Factors that have led to the increasing popularity of medical travel include the high cost of health care, long wait times for certain procedures, the ease and affordability of international travel, and improvements in both technology and standards of care in many countries. The avoidance of waiting times is the leading factor for medical tourism from the UK, whereas in the US, the main reason is cheaper prices abroad. In 2009, there were 60,000 patients going for treatment abroad in the UK.

Many surgery procedures performed in medical tourism destinations cost a fraction of the price they do in the First World. For example a liver transplant that costs $300,000 USD in America costs about $91,000 USD in Taiwan. A large draw to medical travel is convenience and speed. Countries that operate public health-care systems are often so taxed that it can take considerable time to get non-urgent medical care. Using Canada as an example, an estimated 782,936 Canadians spent time on medical waiting lists in 2005, waiting an average of 9.4 weeks. Canada has set waiting-time benchmarks, e. g. 26 weeks for a hip replacement and 16 weeks for cataract surgery, for non-urgent medical procedures.

Medical tourists come from a variety of locations including Europe, the Middle East, Japan, the United States, and Canada. Factors that drive demand for medical services abroad in First World countries include: large populations, comparatively high wealth, the high expense of health care or lack of health care options locally, and increasingly high expectations of their populations with respect to health care.

In First World countries like the United States medical tourism has large growth prospects and potentially destabilizing implications. A forecast by Deloitte Consulting published in August 2008 projected that medical tourism originating in the US could jump by a factor of ten over the next decade. An estimated 750,000 Americans went abroad for health care in 2007, and the report estimated that 1.5 million would seek health care outside the US in 2008. The growth in medical tourism has the potential to cost US health care providers billions of dollars in lost revenue.

An authority at the Harvard Business School recently stated that "medical tourism is promoted much more heavily in the United Kingdom than in the United States".Additionally, some patients in some First World countries are finding that insurance either does not cover orthopedic surgery (such as knee/hip replacement) or limits the choice of the facility, surgeon, or prosthetics to be used. Medical tourism for knee/hip replacements has emerged as one of the more widely accepted procedures because of the lower cost and minimal difficulties associated with the traveling to/from the surgery.

Popular medical travel worldwide destinations include: Argentina, Brunei, Cuba, Colombia, Costa Rica, Hong Kong, Hungary, India, Jordan, Lithuania, Malaysia, The Philippines, Singapore, South Africa, Thailand, and recently, Saudi Arabia, UAE, South Korea, Tunisia, Ukraine, and New Zealand.

Popular cosmetic surgery travel destinations

include: Argentina, Bolivia, Brazil, Colombia, Costa Rica, Cuba,Mexico, Turkey, Thailand and Ukraine. In South America, countries such as Argentina, Bolivia, Brazil and Colombia lead on plastic surgery medical skills relying on their experienced plastic surgeons. In Bolivia and Colombia, plastic surgery has also become quite common. According to the "Sociedad Boliviana de Cirugia Plastica y Reconstructiva", more than 70% of middle and upper class women in the country have had some form of plastic surgery. Colombia also provides advanced care in cardiovascular and transplant surgery.

In Europe Belgium, Poland, Slovakia, and Ukraine are also breaking into the business. South Africa is taking the term "medical tourism" very literally by promoting their "medical safaris".

A specialized subset of medical tourism is reproductive tourism and reproductive outsourcing, which is the practice of traveling abroad to undergo in-vitro fertilization, surrogate pregnancy and other assisted reproductive technology treatments including freezing embryos for retro-production.

However, perceptions of medical tourism are not always positive. In places like the US, which has high standards of quality, medical tourism is viewed as risky. In some parts of the world, wider political issues can influence where medical tourists will choose to seek out health care.

Health tourism providers have developed as intermediaries to unite potential medical tourists with provider hospitals and other organisations. Companies are beginning to offer global health care options that will enable North American and European patients to access world health care at a fraction of the cost of domestic care. Companies that focus on medical value travel typically provide nurse case managers to assist patients with pre- and post-travel medical issues. They also help provide resources for follow-up care upon the patient's return.

Process

The typical process is as follows: the person seeking medical treatment abroad contacts a medical tourism provider. The provider usually requires the patient to provide a medical report, including the nature of ailment, local doctor’s opinion, medical history, and diagnosis, and may request additional information. Certified physicians or consultants then advise on the medical treatment. The approximate expenditure, choice of hospitals and tourist destinations, and duration of stay, etc., is discussed. After signing consent bonds and agreements, the patient is given recommendation letters for a medical visa, to be procured from the concerned embassy. The patient travels to the destination country, where the medical tourism provider assigns a case executive, who takes care of the patient's accommodation, treatment and any other form of care. Once the treatment is done, the patient can remain in the tourist destination or return home.

Risks

Some countries, such as India, Malaysia, or Thailand have very different infectious disease-related epidemiology to Europe and North America. Exposure to diseases without having built up natural immunity can be a hazard for weakened individuals, specifically with respect to gastrointestinal diseases (e.g. Hepatitis A, amoebic dysentery,paratyphoid) which could weaken progress and expose the patient to mosquito-transmitted diseases, influenza, and tuberculosis. However, because in poor tropical nations diseases run the gamut, doctors seem to be more open to the possibility of considering any infectious disease, including HIV, TB, and typhoid, while there are cases in the West where patients were consistently misdiagnosed for years because such diseases are perceived to be "rare" in the West.

The quality of post-operative care can also vary dramatically, depending on the hospital and country, and may be different from US or European standards. Also, traveling long distances soon after surgery can increase the risk of complications. Long flights and decreased mobility associated with window seats can predispose one towards developing deep vein thrombosis and potentially a pulmonary embolism.[24] Other vacation activities can be problematic as well — for example, scars may become darker and more noticeable if they sunburn while healing.

Also, health facilities treating medical tourists may lack an adequate complaints policy to deal appropriately and fairly with complaints made by dissatisfied patients.

Differences in healthcare provider standards around the world have been recognized by the World Health Organization, and in 2004 it launched the World Alliance for Patient Safety. This body assists hospitals and government around the world in setting patient safety policy and practices that can become particularly relevant when providing medical tourism services.

If there are complications, the patient may need to stay in the foreign country for longer than planned or if they have returned home, will not have easy access for follow up care.

Legal issues

Receiving medical care abroad may subject medical tourists to unfamiliar legal issues. [29] The limited nature oflitigation in various countries is one reason for the lower cost of care overseas. While some countries currently presenting themselves as attractive medical tourism destinations provide some form of legal remedies for medical malpractice, these legal avenues may be unappealing to the medical tourist. Should problems arise, patients might not be covered by adequate personal insurance or might be unable to seek compensation via malpracticelawsuits. Hospitals and/or doctors in some countries may be unable to pay the financial damages awarded by a court to a patient who has sued them, owing to the hospital and/or the doctor not possessing appropriate insurance cover and/or medical indemnity.[30]

Ethical issue

There can be major ethical issues around medical tourism.[29] For example, the illegal purchase of organs and tissues for transplantation had been alleged in countries such as India[31][32] and China[33] prior to 2007. TheDeclaration of Istanbul distinguishes between ethically problematic "transplant tourism" and "travel for transplantation".Medical tourism may raise broader ethical issues for the countries in which it is promoted. For example in India, some argue that a "policy of 'medical tourism for the classes and health missions for the masses' will lead to a deepening of the inequities" already embedded in the health care system.[35] In Thailand, in 2008 it was stated that, "Doctors in Thailand have become so busy with foreigners that Thai patients are having trouble getting care"..Medical tourism centred on new technologies, such as stem cell treatments, is often criticized on grounds of fraud, blatant lack of scientific rationale and patient safety. However, when pioneering advanced technologies, such as providing 'unproven' therapies to patients outside of regular clinical trials, it is often challenging to differentiate between acceptable medical innovation and unacceptable patient exploitation. Some US employers have begun exploring medical travel programs as a way to cut employee health care costs. Such proposals have raised stormy debates between employers and trade unions representing workers, with one union stating that it deplored the "shocking new approach" of offering employees overseas treatment in return for a share of the company's savings. The unions also raise the issues of legal liability should something go wrong, and potential job losses in the US health care industry if treatment is outsourced.

Employers may offer incentives such as paying for air travel and waiving out-of-pocket expenses for care outside of the US. For example, in January 2008, Hannaford Bros., a supermarket chain based in Maine, began paying the entire medical bill for employees to travel to Singapore for hip and knee replacements, including travel for the patient and companion. Medical travel packages can integrate with all types of health insurance, including limited benefit plans,  preferred provider organizations and high deductible health plans.

In 2000 Blue Shield of California began the United States' first cross border health plan. Patients in California could travel to one of the three certified hospitals in Mexico for treatment under California Blue Shield.[42] In 2007, a subsidiary of BlueCross BlueShield of South Carolina, Companion Global Healthcare, teamed up with hospitals in Thailand, Singapore, Turkey, Ireland, Costa Rica and India.[43] A 2008 article in Fast Company discusses the globalization of healthcare and describes how various players in the US healthcare market have begun to explore it.

Traveling for medical management in another country for better technology, services and standard, saving cost, availability and other reasons is medical tourism. Millions of patients

worldwide visit hospitals and clinics each year in countries other than their own.  India alone received 4,50,000 patients in 2007 and they paid just 20% of what hey would have paid in USA. Destination countries can be any one but India, Thailand, Singapore, Malaysia, Philippines, Turkey Belgium, Hungary, South Korea Brazil, Costa Rica, Panama, Mexico, USA are leading one. 

You might go for medical tourism if  -

1. You want to save up to 90% on world class medical treatment.

2. Insurance cover for you does not exist or is unknot sufficient. 

3. Procedure advised to you is not offered in your country.

4.Insurance company does no cover procedure you plan to undergo.

Benefits  

1. Cost savings. 

             The single biggest reason people travel to other countries for medical treatment is the opportunity to save money. Depending upon the country and type of treatment, uninsured and underinsured patients, as well as those seeking elective care, can realize 15 to 85 percent savings over the cost of treatment in the United States. Or, as one successful health traveler put it, "I took out my credit card instead of a second mortgage on my home." As baby boomers become senior boomers, costs of healthcare and prescriptions are devouring nearly 30 percent of retirement and pre-retirement incomes. With the word getting out about top-quality treatments at deep discounts overseas, informed patients are finding creative alternatives abroad. Airfare and lodging costs are governed by individual preferences. To compute a ballpark estimate of total costs, add $5,000 to the amounts shown in the table for you and a companion, figuring coach airfare and hotel rooms averaging $150 per night. For example, a hip replacement in Delhi, India, would cost about $10,000, for an estimated savings of at least $20,000 compared with the U.S. price. The estimates above are for treatments alone. Airfare, hospital stay (if any), and lodging vary considerably. Savings on dentistry become more dramatic when "big mouth-work" is required,

involving several teeth or full restorations. Savings of $15,000 or more are common.

2. Better-quality care.

              Governments of countries such as India and Thailand have poured billions of dollars into improving their healthcare systems, which are now aggressively catering to the international health traveler. VIP waiting lounges, deluxe hospital suites, and staffed recuperation resorts are common amenities, along with free transportation to and from airports, low-cost meal plans for companions, and discounted hotels affiliated with the hospital. Moreover, physicians and staff in treatment centers abroad are often far more accessible than their U.S. counterparts

3. Excluded treatments.

              Although health insurance policies vary according to the underwriter and individual, your plan probably excludes a variety of treatments, such as cosmetic surgeries, dental care, vision treatments, reproductive/infertility procedures, certain no emergency cardiovascular and orthopedic surgeries, weight loss programs, substance abuse rehabilitation, and prosthetics—to name only a few. Even the most robust health insurance plans exclude a variety of conditions and treatments. You, the policyholder, must pay these expenses out of pocket. In addition, many policies place restrictions on prescriptions (some quite expensive), postoperative care, congenital disorders, and pre-existing conditions. Rich or cash-challenged, young or not-so-young, heavily or only lightly insured, folks who get sick or desire a treatment (even one recommended by their physician) often find their insurance won't cover it. Confronting increasingly expensive choices at home, nearly 40 percent of American health travelers hit the road for elective treatments. In countries such as India, Singapore, Dubai, and Thailand, this trend has spawned entire industries, offering excellent treatment and ancillary facilities at costs far lower than U.S. prices.

4. Unique Procedures.

              Some procedures like orthopedic procedure known as hip resurfacing, a less expensive alternative to the traditional hip replacement still no practiced in the United States. While this procedure has been performed for more than a decade throughout Europe and Asia, it was only recently approved in the United States, and its availability here remains spotty. Some procedures and prescriptions are simply not allowed in your country. Either Government or the Food and Drug Administration has specifically disallowed a certain treatment, or perhaps it's still in the testing and clinical trials stage or was only recently approved. Such treatments are often offered abroad. Hundreds of forward-thinking Americans, many having suffered years of chronic pain, have found relief in India, where hip resurfacing techniques, materials, and instrumentation have been perfected, and the procedure is routine.

5. No waiting. 

             For decades, thousands of Canadian and British subscribers to universal, "free" healthcare plans have endured waits as long as two years for established procedures. "Some of us die before we get to the operating table," commented one exasperated patient, who journeyed to India for an open-heart procedure. In the United States, long waits are a growing problem, particularly among war veterans covered under the Veterans Administration Act, for whom long queues are becoming far too common. Some patients figure it's better to pay out of pocket to get out of pain or to halt a deteriorating condition than to suffer the anxiety and frustration of waiting for a far-future appointment and other medical uncertainties.

6. Sufficient stay: 

             Medical travelers will welcome the flexibility at the best hospitals abroad, where they are often aggressively encouraged to spend extra time in the hospital post-procedure. Patient-to-staff ratios are usually lower abroad, as are hospital-borne infection rates. There is no push out policy in overseas hospital, patient remains in hospital as longs as necessary and for doctors and hospital.

7. Attraction of the new and different. 

             Although traveling abroad for medical care can be challenging, many patients welcome the chance to blaze a trail, and they find the creature comforts often offered abroad a welcome relief from the sterile, impersonal hospital environments so often encountered in U.S. treatment centers. For others, simply being in a new and interesting culture lends distraction to an otherwise worrisome, tedious process. And getting away from the myriad obligations of home and professional life can yield healthful effects at a stressful time. What's more, travel—and particularly international travel—can be a life-changing experience. You might be humbled by the limousine ride from Indira Gandhi International Airport to a hotel in central New Delhi or struck by the simple, elegant graciousness of professionals and ordinary people in Thailand, or wowed by the sheer beauty of the mountain range outside a dental office window in Mexico. As one veteran medical traveler put it, "I brought back far more from this trip than a new set of teeth." 

History of Medical Tourism

Medical tourism is nothing new. The history of medical tourism cites that even in the early times, people have been traveling to other countries for health purposes. There were the ancient Greeks and Egyptians who went to hot springs and baths to improve their health as well as the 18th and 19th century Europeans and Americans who flocked to health spas and sanitariums and even in remote places in the hope that they will get treatment for diseases such as tuberculosis, gout, bronchitis or liver diseases.

The history of medical tourism dates back to its first recorded case when Greek pilgrims traveled from the Mediterranean to Epidauria, a small territory in the Saronic Gulf. It was said that this small territory was the sanctuary of Asklepios, known as the healing God. Thus, it was recorded in medical tourism history that Epidauria is the original destination for medical tourism.

Medical Tourism Statistics

More and more countries are becoming medical tourism destinations. Medical tourism statistics revealed an anticipated growth of the industry from about $40 billion in 2004 to $100 billion by the year 2012. The estimate was made by the Confederation of India and the McKinsey Company.

Another report disclosed that an estimated 750,000 Americans seek treatment abroad in 2007. It was also estimated that a million and a half Americans sought healthcare outside the US in 2008.

Almost a decade after it was originally envisioned as a major phenomenon, medical tourism in India is beginning to take off. More and more people across the globe are eschewing expensive treatments or long waits at hospitals at home for the benefits offered by cheaper countries like India, Thailand, Philippines and Singapore and combining a tummy tuck, say with a visit to the Taj Mahal or the beaches and misty mountains of Kerala.

Although India had fallen behind other countries after the initial promise, two studies say health tourism is projected to be the next big thing after India's IT outsourcing boom. A 2009 report by the Confederation of Industries (CII)-McKinsey forecasts that, medical tourism will generate US$2.4 billion during 2009–2012 for India by attracting 1.1 million health tourists, up from 150,000 in 2002. 

Though the Indian segment is still a sliver of the US$60-billion global medical tourism market, the consultancy firm Deloitte estimates the country's business will grow at a robust clip of 27 per cent each year. The reason for its attraction for Indian industry and tourism is not far to seek. According to the Ministry Of Tourism, as against an ordinary vacationer per-capita spend of US$3,000 per visitor, the average medical tourist in India puts out more than $7,000 per visit

Leading Indian medical experts ascribe this exponential growth to demand. "With health care costs going north," says Dr Alok Roy of Fortis Hospital, one of the leading service providers in the medical tourism sector, "patients are compelled to look at cost-effective destinations for medical treatments. And what could be better if they can combine that with sightseeing at scenic locations?" 

Delhi-based physian Narottam Puri believes the current expensive and overburdened health care system in the US is not sustainable due to a variety of factors. 

"India, on the contrary," Puri says, "is a value-for-money destination for health care because we produce over 30,000 new doctors each year combined with a diverse genetic pool for drug testing."

 Ironically, despite India's abysmal spend of 4.9 per cent of its GDP on healthcare -- as compared to America's 15.3 percent, Switzerland's 11.3 percent or France's 11.1 percent – the country is well poised to become a frontrunner in the global medical tourism market. 

For starters, India's pricing of its medical services is lower than in comparable countries. A report by the Planning Commission points out that while carry Joint Commission International accreditationSimilarly, heart valve replacement surgery for US$10,000 in Thailand, $12,500 in Singapore and US$200,000 in the US can be carried out in India for $8,000. According to the American Medical Association data, as against a charge of $5,000 for a spinal fusion in India, a patient will pay $62,000 in the US, $9,000 in Singapore and $7,000 in Thailand. 

India also offers an impressive scale and repertoire of treatments, qualified, English-speaking doctors and a varied landscape in which medical tourists can recuperate – from the beaches of Goa to the deserts of Rajasthan.

"The essence of medical tourism is a combination of quality healthcare across a range of disciplines coupled with visits to scenic locations to recuperate or rejuvenate oneself," says Pradeep Thukral, Executive Director, Indian Medical Travel Association (IMTA) which works with Indian hospitals and tourism bodies to promote health tourism.

Experts say India also has a reputation for world-class expertise in cardiac care, cosmetic surgery, joint replacements, neurological and orthopedic treatments and dentistry. "The capacity in super specialty segment Indian hospitals is expanding fast and – unlike the US or the UK -- there is no waiting period for local or overseas patients," explains Dr. Roy. 

Infrastructure spending for health care has also surged. The private sector especially has flourished, equipped with state-of-the-art technology. Top Indian corporate hospitals like Apollo, Fortis, Wockhardt, Max and Manipal have stepped in to provide quality healthcare and technology. A large number of new private specialty hospitals and integrated health cities coming up in the top metropolitan areas are adding further heft to India's medical tourism offerings. 

It is estimated that nearly 75 per cent of health care services and investments in India are now provided by the private sector. Coupled with this is the fact that India has perhaps one of the largest pharmaceutical industries in the world which is not only self-sufficient in drug production but also exports them to over 180 countries at a fraction of the price of US pharmaceuticals.

According to Vishal Bali, CEO, Wockhardt Group of Hospitals, Indian clinical and paramedical talent is globally accepted as high standard. Also, many hospitals now carry Joint Commission International accreditation which puts them at par with the world's best. "Third-party intervention through health insurance," adds Bali, "has also given Indian medical tourism a fillip."

To tap the commercial potential, the Indian hospitality industry too is venturing into the market. Spas at star-rated hotels have jumped onto the wellness bandwagon to offer a smorgasbord of traditional treatments like ayurvedic massages and recuperative therapies. 

"Traditional Indian treatments cover every aspect of medicine at a reasonable cost. This provides the perfect impetus for overseas patients to come to India," explains Dr Jairam Nair, Director Spas, Amatrra Spa, New Delhi. In addition to traditional medicine, adds Nair, India offers many

more relaxing and rejuvenating treatment options like yoga, ayurveda, meditation and naturopathic medicine.

The Ministry of Tourism's Market Development Assistance scheme to cover Joint Commission International and National Accreditation Board of Hospitals certified hospitals which have a rigorous evaluation process has also helped bolster the wellness sector.

The MDA scheme offsets overseas marketing costs for travel companies earning foreign exchange. By opening up the MDA, hospital groups will be made eligible for financial assistance, including publicity through printed material, travel and stay expenses for sales-cum-study tours and participation fees for trade fairs and exhibitions. 

The government is also lending support, investing about $6.5 billion in medical tourism infrastructure over the next two years. India has also launched an accreditation program for secondary and tertiary hospitals by the National Accreditation Board for Hospitals and Healthcare Providers, which works with qualified assessors to grant accreditation to hospitals through a stringent evaluation process.

The government has also been working towards providing priority medical visas for. "However the main bottleneck for medical tourists coming from the UK and US for major surgeries is that the insurance companies are not willing to cover treatment in India. Although this scenario is changing, the process is painfully slow," said a joint secretary at the Ministry of Health.

 Travel companies are also liaising with hospitals to facilitate travel, arranging phone consultations with physicians in India to help the overseas patients save time and money once they get to India. Most Indian hospitals also allow the patients' personal physicians to consult with Indian doctors from overseas. Western patients usually get an all-inclusive package that includes flights, transfers, hotels, treatment and often a post-operative vacation. 

The tourism ministry is prompting all players to form a government-industry partnership on the lines of NASSCOM to strengthen the Indian healthcare brand overseas. Efforts will be made to launch uniform pricing bands and to combine medical packages with innovative travel products, according to Pradeep Thukral, executive director of the Indian Medical Travel Association. 

In fact to cater to the burgeoning demand, India is now diversifying into a new area of "medical

outsourcing" where subcontractors provide services to the overburdened medical care systems in western countries. This initiative has the support of the National Health Policy which declares that treatment of foreign patients is legally an "export" and deemed "eligible for all fiscal incentives extended to export earnings." 

"However, the biggest challenge for India to emerge as a top medical tourism destination is on the non-medical side," Thukral cautioned. "The marketing, the infrastructure and services to support the growth of medical tourism are still at a nascent stage in the country. Till that is shored up, India can't hope to be a frontrunner in the field."

The History of Medical Tourism

Long before Americans stepped onto foreign soil for cardiac surgery, a tummy tuck or a dental job, medical travelers from around the world have been searching far and wide to seek the best medical services. One can say that the concept of medical travel is as old as medicine itself. Medical tourism history in fact dates back to ancient times.

The following is a short excerpt into the colorful history of medical tourism. These time lines indicate that if ever healthcare is in short supply - wherever the location or whatever period in time it may be - sick and injured people will travel for healthcare.

Medical Tourism History - Ancient Times

Studies of ancient cultures depict a strong link between religion and healthcare, which dates back thousands of years. Most ancient civilizations recognized the therapeutic effects of mineral thermal springs and sacred temple baths. The following are some of the earliest civilizations.

The Sumerians (circa 4000 BC) constructed the earliest known health complexes that were built around hot springs. These healthcare facilities included majestic elevated temples with flowing pools.

During the Bronze Age (circa 2000 BC), hill tribes in what is now known presently as St. Moritz, Switzerland recognized the health benefits in drinking and bathing in iron-rich mineral springs. The same bronze drinking cups that they used were found in thermal springs in France and Germany, which could signify health pilgrimages within these cultures.

The Ancient Greeks were the first to lay a foundation for a comprehensive medical tourism network. In honor of their god of medicine, Asclepius, the Greeks erected the Asclepia Temples, which became some of the world's first health centers. People from all over, traveled to these temples to seek cures for their ailments.

By the year 300 BC, other therapeutic temples flourished under the Greek domain. One facility called the Epidaurus was the most famous and included services like a gymnasium, a snake farm, a dream temple, and thermal baths. Other temple spas included the Sanctuary of Zeus in Olympia and the Temple of Delphi.

In India, the history of medical tourism was also slowly unfolding with the popularity of yoga and Ayurvedic medicine. As early as 5000 years ago, constant streams of medical travelers and spiritual students flocked to India to seek the benefits of these alternative-healing methods.

When Rome became a global power, several hot-water baths and springs called thermae came into existence and gained popularity among the elite. These baths were not only healthcare facilities, but became commercial and social networking centers for the rich and the elite.

Medical Tourism History - The Middle Ages

With the downfall of the Roman Civilization, Asia continued to be the prime medical tourism destination for healthcare travelers. Temples gave way to hospitals that provide clinical services to travelers seeking healthcare. These institutions are chronicled in medical tourism history.

In Medieval Japan, hot mineral springs called onsen became popular throughout the nation due to their healing properties. The warrior clans soon took notice of these springs and began using them to alleviate pain, heal wounds, and recuperate from their battles.

Many early Islamic cultures established health care systems that also catered for foreigners. In 1248 AD, the Mansuri Hospital was built in Cairo and became the largest and most advanced hospital in the world of that time. With the capacity to accommodate 8,000 people, this hospital became a healthcare destination for foreigners regardless of race or religion.

History of Medical Tourism - The Renaissance Period

The Renaissance Period of the 14th to 17th century, not only highlighted the rebirth of art and culture in Europe and England, but was also a period where medical tourism flourished.

A village known as Ville d'Eaux or Town of Waters, became famous throughout Europe in 1326 when iron-rich hot springs were discovered within the region. Prominent visitors like Peter the Great and Victor Hugo visited these wellness resorts. The word “spa”, derived from the Roman term “salude per aqua” or health through waters, was first used here.

During the 16th century, the rich and the elite of Europe rediscovered Roman baths and flocked to tourist towns with spas like St. Mortiz, Ville d'Eaux, Baden Baden, Aachen and Bath in England. Bath or Aquae Sulis enjoyed royal patronage and was famous throughout the known world. It became the center of fashionable wellness and became a playground for the rich and famous.

History of Medical Tourism - The Post-Renaissance Period

Towards the end of the Renaissance period, aristocrats from around Europe continued to swarm to Bath for healing and therapeutic cleansing.

In the 1720s, Bath became the first city in England to receive a covered sewage system and was ahead of London for several years. The city also received technological, financial, and social benefits. Roads were paved, streets had lights, hotels, and restaurants were beautified – all because of Medical Tourism.

The most noteworthy traveler in the history of Medical Tourism was Michel Eyquem de Montaigne. He was the French inventor of the essay, and was believed to be the father of luxury travel. He helped write the earliest documented spa guide in medical tourism history.

The discovery of the New World brought new destinations for European medical travelers. During the 1600s, English and Dutch colonists started building log cabins near mineral springs rich with medicinal properties. During this time, it was noted that the Native Americans in the New World were adept in the healing arts. Knowledge in herbal medicine was exceptional and rivalled those in Europe, Asia or Africa.

During the 18th and 19th century, several Europeans and Americans continued to travel to remote areas with spas and health retreats hoping to cure various ailments like tuberculosis.

Medical Tourism History from the 1900s to 1997

During this time, the USA and Europe were not only the commercial and industrial centers, but they were also the center of the healthcare world. Medical travel was limited to the affluent rich who traveled to these countries in order to receive high-end medical services.

In 1933, the American Board of Medical Specialties (ABMS) was established and became the umbrella organization for the medical specialist boards in the United States. The ABMS established educational and professional policies, which became the blueprint of standards around the world.

In 1958, the European Union of Medical Specialties (UEMS) was formed. The UEMS is made up of different National Medical Associations from member nations of the European Unions.

During the 1960s, India became a destination of choice for pilgrims when the New Age movement began in the USA. The flower child movement, which drew the elite and socialites of America and the UK, eventually developed into a fully-fledged medical tourism industry, with yoga and Ayurvedic medicine rediscovered.

With the cost of healthcare rising in the 1980s and 1990s, American patients started considering offshore options, like dental services in Central America. Whilst US doctors were appalled at the idea of seeking healthcare in foreign hospitals during these periods, Cuba started programs luring foreigners for eye surgeries, heart and cosmetic procedures.

History of Medical Tourism from 1997 to 2001

The Asian economic crisis in 1997 and the collapse of Asian currencies prompted government officials in these nations to direct tourism efforts in marketing their countries as premiere destinations for international healthcare. Thailand quickly became the hub for plastic surgery, with fees charged at a fraction of what Western countries could offer.

It was in 1997 that the Joint Commission International was formed to check and investigate international healthcare facilities for conformance to international standards due to the emergence of health providers around the world.

Medical Tourism from 2001 to 2006

After the events of 9/11 and the construction boom in Asia, medical tourism continued its massive growth with as many as 150,000 US Citizens traveling to destinations in Asia and Latin

America in 2006. During this time, the dentistry and cosmetic surgery industries reached new heights in these countries.

Thailand, Singapore and India became legitimate medical destinations due to JCI accreditation. Other Southeast Asian and Latin American countries are emerging as healthcare destinations as well with JCI accreditation and partnerships with prominent US-based health providers.

Medical Tourism in 2007 and Beyond

The number of American medical tourists increased to 300,000 in 2007, the largest ever in medical tourism history. This figure is estimated to reach over a million by 2010, as patients continue to pack suitcases and board airplanes for offshore procedures such as: face-lifts, bypass surgery or fertility treatments.

In 2008, several healthcare and insurance companies in the United States considered medical outsourcing. These offered their members the possibility to get non-emergency procedures and surgeries in other countries. Many are also considering foreign medical procedures as part of a health plan coverage.

Medical Centers, Hospitals, Clinics, Doctors, Surgeons, Medical Tourism, Affordable Healthcare, Medical Spas, Alternaagent@tive Medicine, Cosmetic Surgery,

Dental Treatment, Health Tourism, Global Health Destinations, Surgery Abroad, Medical Travel, Wellness Vacation, Overseas Operations

Surgery Abroad

Alternative Medicine Treatment Abroad Anti-Aging Treatment Abroad

Ayurveda Treatment Abroad Cancer Treatment Abroad

Chronic Diseases Treatment Abroad Cosmetic/Plastic Surgery Treatment Abroad

Dentistry Treatment Abroad Detox Treatment Abroad ENT Treatment Abroad

Executive Healthcheck Treatment Abroad Eye/Lasik Care Treatment Abroad

Fertility Treatment Abroad Gynecology Treatment Abroad

Heart Care/Surgery Treatment Abroad Infertility IVF Treatment Abroad

Laparoscopic Surgery Treatment Abroad Medical Spa Treatment Abroad

Neurology Treatment Abroad Obesity/Bariatric Surgery Treatment Abroad

Orthopedic/Knee Surgery Treatment Abroad Pediatric Treatment Abroad

Rehabilitation Treatment Abroad Skin Care Treatment Abroad Spine Care

Surgery Treatment Abroad Sports Medicine Treatment Abroad Stem Cell Therapy Treatment Abroad

Urology Treatment Abroad Vascular Surgery Treatment Abroad Yoga/Meditation Treatment Abroad

Cancer Treatment in Turkey, Fertility Treatment in Turkey, Heart Care/Surgery in Turkey,

Infertility

Various Competitors and participants in this market.

Affordable Medical Tourism

Services: Staffing Services to Hospitals, Content Writing/PR for Hospitals, Hospital Web Marketing, Patient Counseling and Immigration Services, Travel/Tourism Services to Patients, Medical/Health Medical Tourism Insurance

Website URL: http://www.affordablemedicalto...

Established Year (If Applicable):

2009

The Meditour

Services: Patient Counseling and Immigration Services, Travel/Tourism Services to Patients, Medical/Health Medical Tourism Insurance

Website URL: http://www.themeditour.com

Prime India

Services: Staffing Services to Hospitals, Hospital Web Marketing, Patient Counseling and Immigration Services, Travel/Tourism Services to Patients

Primes has been successfully emerging in the industry making a remarkable development in various fields like Jewellery, Tele Communication, BPO & Medical Tourism. Being a young, dynamic Institute we drive positive and remarkable success in every industry we progress. We deliver our services with out compromising on time and quality. We are proud to be the leading International Patient Care Facilitator in building the world's health care infrastructure and in providing treatments for millions of people around the globe. As a learning organization we

grow with our customer needs and love to take new challenges. Backed up with strong quality processes and well trained efficient staffs, we align our strategies to achieve our business goals.

A medical tourism facilitator company run by pioneers of Indian healthcare and hospitality industry. It provides high quality healthcare services, amiable hospitality, tourism services, rejuvenating wellness services and comfortable travel services to the international medical traveler to India

IndiSmile Medical Network

Services: Patient Counseling and Immigration Services, Travel/Tourism Services to Patients, Medical/Health Medical Tourism Insurance

Contact Email: abhilashaswarup@indismile.com

Website URL: http://www.indismile-medical-n...

Established Year (If Applicable):

2009

India's largest network of hospitals under one roof, IndiSmile Medical Network has in it the maximum number of hospitals and other affiliates.

UniHealth Consultancy Private Limited

Services: Staffing Services to Hospitals, Content Writing/PR for Hospitals, Hospital Web Marketing, Patient Counseling and Immigration Services, Travel/Tourism Services to Patients, Medical/Health Medical Tourism Insurance

Contact Email: info@unihealthonline.com

Website URL: http://www.unihealthonline.com

Established Year (If Applicable):

2009

Modi Healthcare And Tourism Corporation

Services: Staffing Services to Hospitals, Patient Counseling and Immigration Services, Travel/Tourism Services to Patients

Contact Email: mhctc@rediffmail.com

Website URL: http://www.mhctc.com

Kanchanjunga Healthcare

Services: Patient Counseling and Immigration Services

Contact Email: services4yourhealth@gmail.com

Established Year (If Applicable):

1998

Location:

2,Prabhat , Mulund -West , Mumbai , Maharashtra , India 400080

Akshar Health Care Pvt. Ltd

Services: Staffing Services to Hospitals, Travel/Tourism Services to Patients, Medical/Health Medical Tourism Insurance

Contact Email: info@aksharmeditour.com

Website URL: http://aksharmeditour.com

Location:

A/2/804, Anmol Tower, , , Ahmedabad , Gujarat , India 380063

India in Medical Tourism – SWOT Analysis

Medical Tourism may be defined as the ―provision of cost-effective medical care with due consideration to quality in collaboration with tourism industry for foreign patients who need

specialized treatment and surgery‖. Statistical data vindicate that in the year 2008-09 around 126 million domestic trip has been made by Indians in order to get cure at different places of the country as a result of the lack of economic opportunity and poor health infrastructure in their own home town and a sum of 23,000 crore rupees have been spend by them on such trips. This waste of money can be stopped if initiatives in a positive manner are taken by the local and the state level organizations and the Government itself. It has been seen that where international tourist are migrating into India for cheaper treatment and greener pastures , domestic migration in India is a result of poor health infrastructure. in rural areas and small towns.

The main reason for growing importance of medical tourism in India is the cost of medical treatment which is

comparatively 40% less, than offered by any other developed countries. Whereas a cardiac patient has to pay

US$ 40,000 - 60,000 in the United States,

US$ 30,000 in Singapore,

US$ 12,000 - 15,000 in Thailand for his

treatment, the same treatment can be availed in India in only US$ 3,000 - 6,000 . At London one is charged

£350 for some tests which include blood tests, electro-cardiogram tests, chest X-Rays, lung tests and other tests

while in India same tests cost only US$ 84.A Magnetic Resonance Imaging (MRI) scan costs US$ 60 at Escorts

Hospital in Delhi, compared with roughly US$ 700 in New York.

When India is compared with Thailand it is found that India is comparatively very cost effective rather

than Thailand in case of medical treatment. It is clear from the following Table:-

Table -I

Treatment Cost In India (In US$) Cost In Thailand

(In US$)

Bone Marrow Transplant US$ 30000 US$ 62500

Liver Transplant US$ 40000 US$ 75000

Open Heart Surgery(CABG) US$ 4400 US$ 14250

Hip Replacement US$ 4500 US$ 6900

Knee Surgery US$ 4500 US$ 7000

Hysterectomy US$ 511 US$ 2012

Gall Bladder removal US$ 555 US$ 1755

This segment of tourism is increasingly gaining importance and attracting several large corporations, such as pharmaceuticals and industrial companies, and several NRIs and foreign investors to invest money in setting up super-specialty hospitals in India such as Apollo, Medinova, CDR, Mediciti in Hyderabad; Hindujas and Wockhardt in Mumbai; Max, Escorts, and Apollo in Delhi etc. These hospitals are well equipped with those new machineries and technologies, which are required by the medical professionals to tackle the serious diseases, and are capable to cater the needs of aristocrats and as well as of the budgetary class.A Tourist who is coming to indulge/ lure himself in a healthy and pure atmoshphere, to learn the art of yoga and meditations, to rejuvenate oneself at the spas, or for maintaining their looks by travelling to Cosmetic

Surgery Clinics ,will be considered as a medical tourist. It is not necessary that they should come for any surgery or treatment to be count as the medical tourist.For example, going to China to get treated of backache with acupuncture and acupressure is the example of former travelling to Kerala for ayurvedic treatment for entire body.Specific Tour Packages For Medical Tourist In IndiaIndian Government is launching various schemes and programmes to promote health tourism and inviting foreign and private investors to invest in hospitals and accommodation sector. According to a study 75-80% of health care services and investments in India are now provided by the private sector. India is granting various incentives and tax rebate to various pharmaceuticals industries to provide medicines, surgicalequipments, and other medical facilities. Various specific tour packages available to medical tourist are as follows:-

1) Bone Marrow Transplant

2) Brain Surgery

3) Cancer Procedures (Oncology) and Cardiac Care

4) Cosmetic Surgery

5) Dialysis and Kidney Transplant

6) Drug Rehabilitation

7) Gynaecology & Obstetrics

8) Health Checkups

9) Internal/Digestive Procedures

10) Joint Replacement Surgery

11) Nuclear Medicine, Neurosurgery & Trauma Surgery

12) Osteoporosis, Urology and Vascular Surgery

13) Gall Bladder stones surgery and Hernia surgery

14)Laparoscopic Appendicectomy,

15) Laparoscopic Banding of stomach for Morbid Obesity and others

16) Hip-Knee replacement surgeries and other orthopedic surgeries.

17) Heart surgery packages like Cardiac Surgery and Cardiology, Open Heart Surgery, Angiographies and

Angioplasties.

18) Treatments of different skin problems including skin grafting

Contribution of Medical Tourism in the Indian Economy

Many hospitals in India are accredited by international institutions and are offering world-class treatment at that cost which is comparatively 40-50% less than that of any European country. Acknowledging the significance of medical tourism in India, Government is trying to persuade the international tourist traffic by offering medical visa. Generally a medical visa is valid for one year, or the period of treatment whichever is less. The period of medical visa can further be extended for one year with the permission of state government or

FRROs, if prescribed by the specialized doctor/specialized hospital.

India not only offers the medical treatment but also other rejuvenative services such as yoga, meditation, herbal therapies and other skin treatments which could upliftthe mood and enhance health of medical tourists. As a result India is receiving a huge number of international tourist who are coming to gain the rejuvenative benefits. In 2009,India has received a total of 180,000 foreign health tourist. It is estimated that it will grow at a Compound Annual Growth Rate of over 19% and will reach upto 1.3 million by 2013.

Medical Tourism in India is playing a vital role in improving the economic and social status of the society. According to a study by McKinsey & Company and the confederation of Indian Industry, India will receive $1 billion business by 2012, from medical tourism. Which is 1% of the total world-wide revenue. generated by medical tourism. The total revenue generated from

medical tourism in the year 2004, worldwide was $40 billion which has increased upto $60 billion in the year 2006. McKinsey& Company estimates that it will raise to $100 billion by the end of the year 2012.

Table-2

Revenue Generated Through Medical Tourism World-Wide

Year Revenue (In Billion US $)

2004 :-40

2006 :-60

2008:- 80

2012 :-100

Source:-www.health-tourism-india.com

India is preferred as a health destination, mostly by those people who are living abroad and by those foreigners who demand for speedy and in expensive treatment. Indian hospitals are now well equipped with skilled, trained and experienced doctors, who have good command on English .Indian doctors treat twice number of patients, in comparison to doctors in the western European countries. India is considered as a safe place for medical treatment in comparison to other countries.Medical Tourism in India is on the peak. Now health tourist can avail every kind of medical facilities easily and conveniently. Various private investors and pharmaceuticals companies are coming forward to provide their services to the health tourist. Statistics vindicate that by the end of the year 2012, India will receive around one million health tourist with a compound annual growth rate(CAGR) of 28.09% over the year 2007. In India a health tourist has to spend less on different surgeries in comparison to other developed countries. It is

Tourism in India is flourishing and gaining a status of industry and contributing a lot towards the revenue generation and removing the problem of unemployment from the society. Today many states of India like Kerala, Arunachal Pradesh, West Bengal, Uttarakhand, Tamil Nadu Uttar Pradesh, Dadar & Nagar Haveli, and UTs of Daman & Diu, has got a status of an industry. State

governments are making provisions to include tourism in Schedule-I, of the Industries Development Act 1951 to grant it the status of an industry and to promote accommodation sector, so that every segment of tourism industry including hotels throughout the country can avail various benefits under the Industrial Policy of the respective state governments like Land banks for budget hotels, Exemption of duty on stamp paper, Exemption in VAT and Sales Tax, and Singlewindow clearance for new hotel projects etc.