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Medical Tourism in India

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CHAPTER- 1

INTRODUCTION

³Globalization´ refers to various interrelated processes of global

interconnectedness. It is two core components are economic globalization and the

associated ascendancy of deregulated markets in international trade and

investment. Two other important domains are technological globalization,especially of information and communication technologies, and cultural

globalization.

While globalization has been a boom in most aspects, from a public-health

perspective it appears to be a mixed blessing. On the one hand accelerated

economic growth and technological advances have enhanced health and life

expectancy in many populations. At least in the short-to-medium term, these

material advances allied to social modernization and various health-care and public

health programmes have yielded gains in population health. On the other hand,aspects of globalization have also jeopardized population health via the erosion of

social and environmental conditions, the global division of labor, the exacerbation

of the rich-poor gap between and within countries, and the accelerating spread of

consumerism.1

Of these probably, one of the most significant impact of

globalization on health has been through direct trade in health-related goods,

services and people (patients and professionals).

India implemented its economic reform policies in the 1990s. Since then the

country has enjoyed considerable economic growth. The most dynamic sector

within the Indian economy has been the service sector, which itself has accounted

for nearly 60% of India¶s overall economic growth.2

The most visible and well-

known services within this sector have been software and information technology-

enabled services (ITES). However, there are plans to expand this sector and

provide services in other domains as well. Most lucrative amongst these is the




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health service sector, which has been predicted to become a billion dollar industry

in India.3

A major component of this health service sector that has a global appealis medical tourism. The prospects and potential of medical tourism has attracted

huge investments from the central government as well from private investors.

However, there is inadequate documentation of the scope of these services in the

country and its possible consequences on the public health system.

The present paper examines the opportunities and challenges for medical tourism

in India and attempts to assess its potential impact on the health workforce and

health system. The paper draws upon published literature on medical tourism in

India, however it does not address issues related to cross-border supply of services

(telemedicine and processing of health information).

1.1 Background

Health services are a heterogeneous group of activities, ranging from allopathic

services (modern, facility-based health care services) to alternative health and

wellness services provided in a hotel or spa setting or in a private practice.

Globally, there has been tremendous growth in this sector. This growth has been

assisted by inadequate national public health services, spiraling cost of health

services in the developed world and the availability of cheaper alternative in

developing economies. This has resulted in globalization of health care worldwide

and can be evidenced by growing cross-border delivery of health services that is

estimated to be in excess of $140 billion.

In India, healthcare is one of the largest sectors, in terms of revenue and

employment, and this sector is expanding rapidly. During the 1990s, Indian

healthcare grew at a compound annual rate of 16%. Today the total value of the

sector is more than $34 billion. This translates to $34 per capita, or roughly 6% of

GDP. By 2012, India¶s healthcare sector is projected to grow to nearly $40 billion.5

A major proportion of this growth is predicted to be attributable to the growth in

the business of medical tourism.

Medical tourism in India has gained momentum over the past few years. According

to the Confederation of India Industries (CII), approximately 1,50,000 patients




3

arrived in India in 2005 from across the globe for medical treatment and this is

expected to increase by 15% each year.3

The medical tourism market in India wasestimated at US$ 333 million in 2010 and has grown by about 25 per cent and is

predicted to become a US$ 2 billion-a-year business opportunity by 2012.

Medical tourism in Rajasthan

JAIPUR: Medical practitioners of Indian origin in America advocate public private

partnership (PPP) to promote health tourism in Rajasthan.Talking on the sidelines

of the ongoing Fourth Indo-US health summit in Jaipur organised by the American

Association of Physicians of Indian origin (AAPI), president Dr Ajeet R Singhvi

said public private partnership has done wonders in the tourism sector in the state

and this model should be replicated by the health sector too in the state and the

country at large.

He said "India has excellent medical practitioners matching and even exceeding the

western standards but the infrastructure is not up to the mark. This is an area where

the private sector could step in," he said.

He said, "India presently accounts for a minuscule percentage in global investment

in medical tourism. But, it has phenomenal potential, provided we upgrade our

infrastructure and lay down proper procedure. We have the essential ingredients in

the form of well-qualified medical practitioners and low cost of services."The

infrastructure could be developed by the private players. Even people from

neighbouring countries like Pakistan and Afghanistan fly to the West for treatment

irrespective of the exorbitant expenses. India could be a hub for medical tourism,

provided it takes appropriate steps, he said.

Co-chairman and president-elect of AAPI, Dr Sunita Kanumury said organ

transplant is another area where the country has a potential to develop into a major

centre. Though the Transplantation of Human Organs Act (THOA) was passed in

1994, the sector has miles to go to meet the rising demand for transplantation.




4

Getting a donor remains one of the main challenges in India. In Amercia about 99

% of the organ

1.2 What is Medical Tourism?

Medical tourism is the direct product of the widespread globalization of healthcare.

The increased integration of global economies and cultures has resulted in the

extensive circulation of products and services between countries. Several

industries, including the healthcare sector, have expanded their horizons to benefit

from the global market. This in turn, has created a niche segment of the healthcare

industry where patients travel across the globe to avail healthcare and medicalservices

µMedical tourism¶ is a term interchangeable with Global healthcare, Medical

travel, Healthcare travel and Health tourism. However, each of these terms can be

used to define specific segments of the global healthcare industry. The definitions

in the next section should help clear out the confusing terminology.

Medical tourism can also be referred to as the growing global industry of

healthcare providers, doctors, clinics and hospitals who are marketing themselvesto overseas patients. Medical tourism provides a range of healthcare benefits and

options to individuals and group.

The medical tourism sector is rapidly developing and is changing the way people,

insurance companies and governments look at healthcare options for its citizens.

The growth of the industry will increasingly have an impact on individuals and

healthcare budgets as governments, health insurance companies and individuals

continue to explore different ways to access high quality, low cost treatment.

Popular elective medical services include knee or hip joint replacements, cardiac

surgery, cosmetic surgery and dental surgery. Patients in need of emergency

procedures are also attracted to this concept as certain countries have long waiting

times for certain medical services, while medical tourism destinations provide

quality healthcare and eliminate availability issues. To read more details on

common medical tourism procedures, we encourage you to read the µMedical




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tourism procedure¶ guidebook which provides all the information a patient would

need.

Medical tourism fills a valuable niche that is desperately needed in countries with

bureaucratically flawed or unaffordable healthcare. This industry looks set to

expand at an escalating pace over the next decade as more and more people begin

to trust the quality and see the advantages of having their surgery performed in

developing countries that provide quality healthcare.

This chapter explains what medical tourism is in all its different manifestations and

the advantages and disadvantages of travelling abroad for medical treatment.

1.2 Medical Tourism Definition and other Terms

In order to completely understand the concept of medical tourism one needs to be

aware of terms associated with it.

If Medical Tourism is ³the set of activities in which a person travels often long

distance or across the border to avail medical services with direct or indirect

engagement in tourism activities´ the person who travels to avail medical service is

called ³medical tourist´ or ³Medical Traveler´. The organization that provideshealthcare services to the traveler or patient is called ³Medical tourism provider´

or a ³Global Healthcare Provider´. The company or agency that provides support

services to facilitate such arrangements is known as a ³Medical Tourism

Facilitator´. All these activities, components and entities are referred as ³Medical

Tourism industry´.




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1.3 History of Medical Tourism

The history of medical travel is inseparable from that of medicine itself. The

written word has many a time illustrated how humans have voyaged to the end of

the world to find remedies for their ailments; to get themselves the best possible

cure, sometimes at the cost of all their possessions, severing ties with their

homeland and even life. This chapter of human history is unparalleled, because had

our ancestors not explored the realms of earth to find cures for themselves, today

we wouldn¶t be where we are in terms of curative knowhow.

Humans have also traversed through several eras of medical treatment. Severalthousand years of history have been researched to discover how ancient

civilizations cured their maladies. These historic journeys of humankind, across the

globe can be chronicled as different epochs that portray how the phenomenon has

progressed over time.




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1.5 Medical Tourism Terms & Trends

Medical Tourism is often interchanged with the terms ³Medical Travel´, µHealth

Travel´ ³Healthcare Travel´ ³Health Tourism´ and ³Global Healthcare´. Although

each term has a specific meaning, they all fall into the description of individuals

travelling abroad for any type of medical, quasi-medical or health treatment. It also

describes the growing global industry of healthcare professionals, clinics and

hospitals who are marketing themselves to overseas patients.

I have recently conducted a survey based on the terms and trends of medical

tourism and invited leading medical tourism experts to participate in the research.The preferred term for 85% respondents for this particular sector of the healthcare

industry is µMedical Tourism,¶ with 35% selecting this option. µGlobal Healthcare¶

was the next most popular term at 22%, with µHealth Tourism¶ running a close

third at 21%. µMedical Travel¶ was identified by 10% of respondents as their

preferred description, with µHealthcare Travel¶ and µValue Medical Travel¶ both at

6%. (Survey available at www.DrPrem.com)

In Dr Prem's Guidebook - Medical Tourism, we have used the term ³medical

tourism´ as a generalized term that could be interchanged with similar terms suchas ³Medical Travel´ ³Health Tourism´ or ³Healthcare Travel´.

1.6 Developments in Medical Tourism

The medical tourism sector is rapidly developing and is changing the way people,

insurance companies and governments¶ look at healthcare options for its citizens.

The growth of the industry will increasingly impact on individuals and healthcare

budgets as governments, health insurance companies and individuals continue to

explore different ways to access high quality, low cost treatment.

Medical tourism fills a valuable niche that is desperately needed in countries with

bureaucratically flawed or unaffordable healthcare. This industry looks set to

expand at an escalating pace over the next decade as more and more people begin




9

to trust the quality and see the advantages of having their surgery performed in

developing countries that provide high quality healthcare and reasonable prices.

1.7 Benefits & Challenges of Medical Tourism

The realm of medical services has expanded its horizon by offering global

healthcare at much reasonable rates, so patients worldwide can benefit from it. The

escalating growth and popularity of the medical tourism sector demonstrates the

variety of advantages patients can achieve by engaging in medical travel. The most

important and obvious benefit for patients are the low-cost and high quality

healthcare options in medical tourism destination, as the healthcare costs in their

countries are extremely high. But benefits are not limited to cost saving and high

quality of care alone; there are many benefits²if we classify them we can have as

many as seven individual categories for such benefits which encourage patients to

step out of their geographies. Also, the idea of recuperating from a treatment and

relaxing in an exotic location should be enough of a reason to get patients packing

their suitcases and heading towards the airport.

1.8 Seven benefits of medical tourism for consumers

1. Affordability (cost saving)

2. Easy accessibility (immediate treatment)

3. Availability of services at other destinations

4. Better quality of healthcare services

5. Privacy

6. Personalized services aboard

7. Tourism benefits




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1.9 Challenges of medical tourism that all potential travellers should understand

before a decision

to avail medical services abroad is made:

1. Access to correct information

2. Problems with pre- and post-operative care

3. Language and cultural barriers

4. Coping with infections in foreign countries

5. Legal & ethical issues

6. Incorrect estimation of costs7. Authenticating qualifications of doctor/surgeon




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CHAPTER - 2

THE POTENTIAL IMPACT OF MEDICAL TOURISM ON

HEALTH WORKFORCE AND HEALTH SYSTEMS IN INDIA.

2.1 Expansion of Medical Tourism in India

There are several characteristics that make India an appealing destination for

visitors seeking health services. These include its well-trained health practitioners;a large populace of good English speaking doctors, guides and medical staff;

availability of super-specialty centers that excel in cardiology and cardio-thoracic

surgery, joint replacements, transplants, cosmetic treatments, dental care,

orthopedic surgery and more; hospitals that provide the full gamut of health

services which include full body pathology, comprehensive physical and

gynecological examinations, echo Doppler, high strength MRI etc. using latest,

technologically advanced diagnostic equipments; and finally, and more importantly

the availability of these premium services at prices that are extremely reasonablefor the foreign tourist.

In fact, the competitive cost of medical treatment in India has been the main

catalyst for the growth of medical tourism in the country. The costs of comparable

treatment in India are on average one eighth to one fifth of those in the West. For

instance, a cardiac procedure costs anywhere between US$ 40,000 - 60,000 in the

United States, US$ 30,000 in Singapore, US$ 12,000 -15,000 in Thailand and only

US$ 3,000 -6,000 in India. Likewise, the associated costs of surgery are also low.

India also has the potential to emerge as a hub for preventive health screening in

view of the availability of low-cost diagnostic tests. At a private clinic in London a

health check-up for men that includes blood tests, electro-cardiogram tests, chest

X-Rays, lung tests and abdominal ultrasound costs around £350. In comparison, a

comparable check-up at a clinic operated by Delhi-based healthcare company Max

Healthcare costs US$ 84. A Magnetic Resonance Imaging (MRI) scan costs US$




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

A study done by the India Brand Equity Foundation (IBEF) in 2004 showed thatIndia is more cost-competitive as compared to other leading medical tourism

destination like 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 indicates.

Thailand India

US$ 62500 US$ 30000

US$ 75000 US$ 40000

US$ 14250 US$ 4400

US$ 6900 US$ 4500

US$ 7000 US$ 4500

US$ 2012 US$ 511

US$ 1755 US$ 555

The health services in India have the additional advantage of providing a good mix

of allopathic and alternative systems of medicine. For instance, while New Delhi

has emerged as a prime destination for cardiac care; Chennai has established a

niche for quality eye care; Kerala and Karnataka have emerged as hubs for state-

of-the-art ayurvedic healing.

The scope for profit in this sector has encouraged several large corporations, such

as pharmaceuticals and industrial companies, and several non-resident Indians

(NRIs) to invest money in setting up super-specialty hospitals such as Apollo,

Medinova, CDR, Mediciti in Hyderabad; Hindujas and Wockhardt in Mumbai;

Max, Escorts, Apollo in Delhi etc.8

These facilities now dominate the upper end of

the private sector and cater predominantly to medical tourists and affluent sections

of the society. These establishments have created a niche job market for health

professionals predominantly trained in public sector institutes.

Even the Government of India has responded promptly to tap the potential of this




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sector. In its effort to capitalize on this opportunity the Government has untaken

measures to promote India as a ³global health destination´.9

The National HealthPolicy 2002 strongly encourages medical facilities to provide services to users

from overseas. It states that ³providers of such services to patients from overseas

will be encouraged by extending to their foreign exchange, all fiscal incentives,

including the status of ³deemed exports which are available to other exporters of

goods and services´.

The Indian Ministry of Tourism has started a new category of visas for the medical

tourists. These visas called the ³M´ or medical-visas are valid for one year but can

be extended up to three years and are issued for a patient along with a companion.

Efforts have also been undertaken to improve the airport infrastructure to ensure

smooth arrival and departure of the health tourists. A brochure of the ministry

predicts a ³phenomenal expansion´ of the Indian health-care industry in the

coming years.9

These factors have favored the recent spurt of growth of medical tourism in India.

Official figures indicate that medical tourists from 55 different countries come to

India for treatment.11

While most of these patients are from developed countries,

India is also seeing a surge of patients from countries in Africa and South and West

Asia that lack adequate healthcare infrastructure. Among others, foreign health

travelers to India comprise of a large number of non-resident Indians (NRIs). If the

present trend continues trade in health and health-services will become one of the

biggest sectors in India. However, there are several challenges that could impede

the growth of medical tourism in India, more importantly the growth of this sector

poses a threat to the already crippled public health system in India.

2.2 Challenges and threats of the Expansion of Medical Tourism in

India

The present growth in medical tourism in India has been encouraging but to sustain

this growth and to achieve it full potential certain challenges have to be addressed.

It is also important to understand the impact of the growth in this sector on the

public healthcare delivery so that necessary corrective measures can be undertaken.




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2.3 Create inequitable health systems

Three decades after the Alma-Ata Declaration, ³health for all´ remains an

unattainable goal in India. In sync with the fundamental principle of primary health

care, the government has developed an extensive network of health facilities but

regrettably the system has failed to deliver.

The nemesis of the public healthcare in India has been compounded by low

government expenditure on health as well as by factors such as poor management

of resources, acute shortage of skilled workforce, large-scaled absenteeism,corruption and conflicting job roles.

8These factors along with several policies of

the government (such as release of prime building land at low rates, exemptions

from taxes and duties for importing drugs and high tech medical equipment and

concessions to doctors setting up private practices and nursing homes)12

have

helped in the unabated growth of the private sector.

The private sector has gained a dominant presence and today it accounts for 82%

of outpatient visits, 58% of inpatient expenditure, and 40% of births in

institutions.13

A study conducted by global accounting and consulting firm Ernst

and Young and the Federation of Indian Chamber of Commerce (FICCI), shows

that the private hospitals in India earned Rs. 62,000 crore in fiscal year 2006 and

revenues from the sector are expected to rise up to Rs. 130,000 crore in 2012,

which represents an annual revenue growth rate of about 19% a year.

In

comparison to this public health care system in India has been seriously

underperforming.

As per NSSO estimates between 1995±96 and 2004, the utilization of government

sources of treatment (including public hospitals, PHC/CHC, public dispensaries,

ESI doctors, etc.) increased from 19% to 22% in rural India and declined from

20% to 19% in urban India. For hospitalized treatment, the decline in utilization of

government sources was from 43.8% to 41.7% in rural areas and from 43% to

38.2% in urban areas.15

The inadequacies in the public health sector has also

stunted its growth and tarnished its potential of being a product that could be

offered on an international market.




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The underutilization of the public health system coupled with the growth in the

private sector will increase the disparities and poses as a major threat of medicaltourism in the Indian context. The real challenge to expanding medical tourism as a

strategy for economic growth and development will be to identify and implement

mechanisms that prevent the development of a dual and inequitable health system

with enclaves of high quality health facilities catering to foreign visitors; and foster

mutually beneficial linkages between the private and public health sectors, and

between state-of the art health services and community health.

2.4Intensify shortages of skilled health professionals

An important reason for poor service delivery in the public sector is the shortage of

trained and skilled health personnel. According to the recently released Planning

Commission report, India is short of a phenomenal 600,000 doctors, 1 million

nurses and 200,000 dental surgeons. With positions of 300,000 dental surgeons,

only 73,000 are currently full. Meanwhile 1.1 million nurses are filling up

vacancies for 2.1 million, a shortfall of nearly 50%. To aggravate matters, there is

also a huge paucity of paramedical staff including radiographers, X-Ray

technicians, physiotherapists, laboratory technicians, orthopedists and opticians.

The report also highlights the highly skewed distribution of the available

manpower towards the urban areas.

The availability of medical specialist in local Community Health Centers,

compared to the sanctioned posts, is also disquieting. The existing CHCs have a

high shortfall of specialist manpower, such as obstetricians and gynecologists

(56%), pediatricians (67%), surgeons (56%) and medical specialists (59%), with no

provision of anesthetists. Such acute shortages of medical professionals in India is

ironic as the country has approximately 229 medical colleges with an annual

admission capacity of over 25 600 students.

There are several factors that could explain the shortage of doctors in the public

system. These include bottlenecks in the recruitment process, poor financial

incentives, absence of a conducive work environment and the prevalence of

corruption in the public health sector.




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While the public sector is encumbered with staff and resource shortages, it has

been estimated that over 75% of the human resources and advanced medicaltechnology, 68% of the estimated 15,097 hospitals and 37% of 623,819 total beds

in the country are in the private sector.8

These figures suggest that the private

sector is the prime employer of health personnel predominantly trained in public

health institutes. This also sounds an alarm that further growth of the private sector

could aggravate the manpower crunch in the public sector.

An important expectation of increased trade in health services is that through the

increased opportunities locally and regionally, it would encourage and facilitate a

greater retention of skills in the region. However, considering that at present the

growth is restricted to the private, it may not be a viable solution to the manpower

crunch in the public sector.

2.5 Raise quality of care and accreditation issues

Variation in the quality of care provided and the asymmetry of information

between providers and consumers service sector. A major reason for the

underutilization of the public health services in India is the lack of prescribed

standards of quality. Still it remains a neglected area within the realms of

government policies.

The quality of services is also one of the main arguments against medical tourism.

In response to this, the Government and CII have taken the lead in the process of

national accreditation and licensing for the private sector. The WHO supported

Joint Commission International (JCI) has accredited 10 institutions in India, all of

them being in the private sector.The process is underway to encourage other

private health care facilities, including laboratories, diagnostic centers, outpatient

clinics, and day surgery centers in the country, to attain JCI to accreditation.

Thus initiatives are being undertaken to standardize the quality of services in the

private sector but they have completely bypassed the public sector facilities. This is

disconcerting and is suggestive of the lack of government initiative to improve

services in the public sector.




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2.6 Promote unregulated growth of the private sector

There are several concerns that arise from the growth of the private sector and the

government is supposed to play an important role in regulating this sector.

However, in India, State interventions have been minimal, leaving the sector to

grow laissez-faire.

In India, there is no policy framework to have a common set of regulations for the

private health care sector.

regarding quality is a concern in the health




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CHAPTER - 3

Medical Tourism in Kerala

3.1 INTRODUCTION

Kerala has established itself as a prominent Destination of world leisuretourism for its natural beauty and cultural assets. The growth of Tourism in Kerala

has been induced by the buyer driven factors. The collective marketing effortthrough the tourism department has been limited. The scenario of Medical Tourismis also not much different from leisure tourism.Medical tourism in Kerala grew without much wilful collective effort. It wasrecognized as an opportunity by some sectors, particularly the Ayurveda sector who took some collective effort to convert Kerala assource for Ayurveda




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treatment. Then came Dentistry and Modern Medicine. A combination of many

factors has led to the increase in popularity of medical tourism in Kerala:� Traditional systems of medicine like Ayurveda and Siddha are widely popular inthe state, and draws increasing numbers of tourists

� High costs of healthcare in industrialised nations� Ease and affordability of international travel� Improving technology and standards of care.

The major specialties of Medical Tourism in Kerala are the following:

3.2 Modern Medicine

Cardiac Care Orthopaedic ENT General Surgery

Cosmetic Treatment Urology Ophthalmology Fertility Treatment Neuro SurgeryDental care

3.3 Alternate Medicines

Ayurveda Homoeopathy Sidha Naturopathy

3.4 Objectives

1. Make a comparative study of the participation of medical tourists from differentcountries2. Find the factors that drive Medical Tourism in Kerala3. Study the marketing efforts and their success for Medical Tourism in Kerala4. Identify the problems faced by Medical Tourism in Kerala5. Make suitable suggestions for improvement of Medical Tourism in Kerala




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3.5 The Country-wise Distribution of Health Tourists

An attempt was made to analyze the country-wise distribution of Health Tourists.

But due to the insufficiency of data it was not possible to arrive at an accuratedistribution pattern. Also there is no secondary data available with the TourismDepartment regarding Medical Tourism. Subject to this caveat, we present here thefindings of our study. In the absence of more reliable data it may be taken asindicative.




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3.6 Relevance of Health Tourism in Kerala

Kerala is an established tourist destination. Ayurveda is already popular and Keralais recognised as the number one source for Wellness solution. The Alternativemedicine sector led by Ayurveda has been showing vibrant growth in recent years.There is also tremendous scope for Modern medicine including. Dentistry in the

state.

3.7 Advantages of Kerala in Medical Tourism

� Nobody can beat IndiaKerala cost-wise (See, Annexure 1) Our doctors and nurses are accepted all over the world. We are known as compassionate people (even Thailand lack this)

Kerala Hospitals give many consultancies under one roof Offer eco friendly environment NRIs all over the world function as ambassadors for Kerala

Some US NRIs function as Entrepreneurs facilitating Medical Tourism to India& Kerala: (18 NRI Travel Agents operate in Medical tourism arranging to and fro

travel, treatments and sight seeing).




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3.8 Some Reasons for Travel of Foreign Patients to India/Kerala:

1. UK NHS²National Health Service for poor citizens is heavily burdened and thesystem almost collapsed. Indian costs being only 1/6 of UK attracts the lower andmiddle income groups to India.2. In the U.S. the cost of medical treatment is so high that only 10% can afford thecosts in US, while Indian costs are only 1/10.3. The Middle East: Huge infrastructure facilities are available. But the expertise isinsufficient. After 9/11, they have reduced trips to U.S.

3.9 Role of CII

India and Kerala have only private institutions participating in Medical Tourism.CII has been attempting to bring several medical institutions under one umbrella.They have already succeeded in bringing 40 hospitals under the umbrella of medical tourism. CII started medical tourism promotion in Kerala with 12hospitals. Some of them are Lakeshore, Amrita, Medical Trust, MIMS, BabyMemorial, KIMS, Ananthapuri, Uthradom Thirunal, EMS Coop. Hospital etc. CII

recently completed a study on the Scope of Medical Tourism in India. The studysays that the medical tourists in modern medicine at present is hardly 12,000 to

16,000. (This is exclusive of Ayurveda which is already about 3.5 lakhs.) By 2012it will hit 1 million visitors to India. Out of this Kerala¶s target is 20%, i.e.2 lakhs.It is expected that in 5 to 10 years Medical tourism will overtake other forms of tourism.

3.10 Suggestions for Improvement of Medical Tourism in Kerala

Ayurveda in Medical Tourism

Ayurveda is a synonym for Medical Tourism in Kerala. There has been a

spontaneous growth in Kerala for Ayurveda, which has no competition in thewhole world. By unorganized but collective effort the name Ayurveda got brandedall over the world. The present problem in the market is the overcrowding of unqualified people conducting massage parlours in the name of Ayurveda. If immediate measures are not taken to control such fake set ups, the tourists whocome in search of genuine Ayurveda treatment will get cheated and carry back awrong message about Ayurveda. This is especially so because Ayurveda is not




23

very strong in standardization and scientific data. Another problem facing

Ayurveda is the scarcity of certain essential herbs and medicines, which will affectthe quality of the treatment.

CHAPTER- 4

Findings and Suggestions

Most of the Hospitals who participate in Medical Tourism do not give muchsignificance to Tourism. As seen earlier in Table 2 only 28% felt that the desire of

patients who come to Kerala because of opportunity for tourism is high. 25%thought that it is medium. The remaining 47% thought patients were not concernedabout it at all. Only less than half of the hospitals were found to take someinitiative to help patients to club their medical travel with tourism. It was alsorevealed that only 33% of the hospitals were making some initiatives on their ownto market their services and only 31% of them were participating in any collectiveeffort for marketing medical tourism. This attitude will not help Medical Tourism.At the same time 64% of them claimed that they were taking initiatives for marketing their services in foreign countries even though in actual practice they

were not doing anything more than relying on word of mouth publicity.

4.1 Need for Collective Promotion

Almost all the respondents had pointed out the need and relevance for

Collective Promotion. The need to organise road shows, Medical Tourism Fares,and other efforts to convert Kerala as Destination for Medical/Dental Tourismwere also suggested by some of them.

4.2 Accreditation of Hospitals

The attitude of Hospitals towards quality certification is very cold. For thesuccessful participation in Medical Tourism, this should change because theforeign tourists value quality recognitions.




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4.3 Government involvement for the growth and promotion of

Medical Tourism

The survey among hospitals engaged in Medical Tourism very clearly brought outthe low key played by the Government in promoting Medical Tourism. Only

8.33% felt that the Government was successful. As high as 64% were of theopinion that Government efforts have failed. In our discussions with the officers of the Tourism Department they also admitted that not much was being done in thisdirection. So far the activity of the Tourism Department of the Government of Kerala is limited to accreditation of the Ayurvedic Hospitals as Green Leaf/OliveLeaf Classes. About 50 units have been given Green Leaf Accreditation andaround 40 units given Olive Leaf Accreditation. In the area of Medical Tourism inthe Modern Medicine area, other than identifying the scope for Medical Tourismand constituting an informal committee including personalities of prominenthospitals involved in Medical Tourism, nothing more has been done. Therespondents of our survey strongly felt that the Government should involve moreactively in the promotion of Medical Tourism.

4.4 Problems Faced by Medical Tourism

It is thankful to know that the level of perceived problems in Medical Tourism islow. However as pointed out earlier, when the scale of operation increases more

problems are bound to occur.

4.5 Environment and Infrastructure

The various suggestions from the respondents and the discussions we had with the

resource persons have emphasised the point that we need improvement in physical

and social environment. The physical environment includes the improvement in basic infrastructure, standard of cleanliness etc. Basic amenities should be goodtoilets should be user friendly and well maintained. Good standards at lesser costwill make the state a more attractive, value for money destination. For this we haveto improve the physical infrastructure and connectivity. The social environmentincludes the improvement in human culture and behaviour. People have to befriendly to the visitors and guests. Our old manthra, µAthidhi devo bhava¶ orµguest




25

is equal to god¶ is very relevant in this context. We should have a responsible

political culture. The overcrowded schedules of Harthals and strikes will spoil theimage of Kerala as a tourist friendly state.

4.6 Environment and Infrastructure

With over 3000 dentists and 1200 dental clinics Kerala has a distinct advantage indental tourism. The fact that the treatment requires multiple sittings with liberalgaps in between sittings and hence requiring around 30-40 days stay makes thedental patient an ideal candidate for medical tourism. Hence, more efforts should

be made to market the dental tourism product.

4.7 Government involvement for the growth and promotion of

Medical Tourism

The government should take more active role for the growth of tourism. It shouldfunction as a facilitator and catalyst. There has been a suggestion that Hospitalsshould be given industry status for power, import of machinery, equipments etc. Itwould be advisable to follow a Private-Pubic-Partnership Model (PPP) in

promoting Medical Tourism as suggested in the study conducted by CII (See

diagram below). The Central Government could also help popularise MedicalTourism through Embassies and through Health Ministries in various foreigncountries. More financial and fiscal concessions need also be offered to this sector

which has tremendous employment and foreign exchange earning potential. Onlythen they can be encouraged to make the necessary investments needed for upgradation, standardisation and accreditation of the medical facilities/institutions.Other areas which will require government/statutory support is in the field of insurance facilities, visa on arrival with special facilities for medical visas, qualitycontrol andcertification/accreditation.

We need to organise Medical Tourism Fairs and Road-shows for promotingmedical tourism besides participation in international medical tourism events.Special efforts targeted at SARC countries may also be tried. In this, there must beactive participation from all category of Medical Tourism players, industryassociations like CII and Central and State Governments as shown in the diagram.




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4.8 The Partners of Medical Tourism Industry

Limitations

� The statistics obtained is subject to validation by further studies.

� Due to the limitation of the resources, the study is limited to a sample size of 36only� This study is based on the responses from the medical service providers only.The point of view of consumers has not been studied.

CHAPTER - 5

5.1 References

Department of Tourism (2000), Tourism Policy: Vision 2020, Government of

Kerala.Farrugia, Joseph (2006), Medical Tourism²What Prospects?, The Times, May 31.http://dir.indiamart.comhttp://en.wikipedia.org/wiki.Medical_tourismhttp://indiamedicine.nic.in

http://keralatourism.orghttp://mediescapes.comPruthi, Raj(2006), Medical Tourism in India, Arise Publishers and Distributors,

New Delhi.Puri, Narottam (2003), Health Tourism, Paper presented at FICCI Seminar onMedical Tourism, 11th December,Chennai.Radhika, P.C(2007) Potentialities of Dental Tourism in Kerala--A Case Study on

Dr. Rajkrishnan¶s Dental Clinic,Dissertation submitted to M.G. University, Kottayam.

State Planning Board (2007), Economic Review, Government of Kerala,Trivandrum.www.ayur-vedic.comwww.howtobooks.co.uk www.imtjonline.com/zine/home/india-new-medical-visawww.keralatraveltourism.com




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www.newmedicalhorizons.com

Source: IBEF Researchwww.google.com

www.en.wikipedia.com

www.ask.com

madical tourism r katiriya sunrise udaipur

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