Medical Tourism

Introduction

Medical Tourism is where people who live in one country travel to another country to
receive medical, dental and surgical care while at the same time receiving equal to or greater
care than they would have in their own country, and are travelling for medical care because of
affordability, better access to care or a higher level of quality of care. “Domestic Medical
Tourism” is where people who live in one country travel to another city, region or state to
receive medical, dental and surgical care while at the same time receiving equal to or greater
care than they would have in their own home city, and are traveling for medical care because
of affordability, better access to care or a higher level of quality of care.

Patients are travelling because of the high quality of healthcare, affordability, access of
care or better availability.

A medical tourism facilitator A Medical Tourism Facilitator is an independent company

that helps coordinate a patient's trip to another country for medical care.

History of India’s Health Tourism Industry

India has historically been a regional healthcare hub for neighbouring countries such as
Afghanistan, Bangladesh, Bhutan, Maldives, Nepal, Pakistan and the Middle-East.

Evidence of ancient hospitals offering healthcare facilities funded by local kings and
monarchs can be found in foreign traveller’s accounts as well as medieval scripts.

Most ancient and medieval healthcare centres provided treatment to local and foreign
patients almost free of cost.
 Traditional treatment methods developed from Ayurveda, yoga, Unani, Siddha and
Homeopathy (AYUSH) styles of medicines and practises.

During the early mid-Mughal period Delhi was a well-known regional destination for
conclaves of physicians and Surgeons.

Global healthcare in Medical Tourism

1. Trade in health services

The General Agreement on Trade in Services (GATS) characterizes services as being
traded via four modes of supply: consumption abroad, movement of persons, commercial
presence, and cross-border supply. Thesefour modes also apply to the case of international
trade in health services.
Trade through consumption abroad—that is, movement of patients to receive treatment in
overseas markets—is driven by differences in cost,quality, and availability of treatment across
countries as well as factorssuch as natural endowments; the availability of alternative or
traditionalmedicines and treatment procedures; and cultural, linguistic, and
geographicproximity between countries. For instance, patients from developedcountries such
as the United States and the United Kingdom get heartbypass surgeries or transplants in high-
quality corporate and super-specialtyhospitals in developing countries such as India at one-
fourth or onefifthof what it would cost them in their own countries
2. Trade in health insurance services
Investment opportunities and new technologies have expanded opportunitiesfor trade in
health insurance services, although there has been nosubstantial opening up under any agreed
multilateral rules of GATS.
It is important to recognize that the privatization of health insuranceis a part of the process
of liberalization in developing countries in theirquest for faster growth and integration into an
increasingly interdependentglobal economy.
The degree of private insurance depends on the state of thenational health care system,
market opportunities, the extent of marketaccess permitted for private health insurance
companies, and the regulatoryenvironment.
3. Trade in emerging areas for health and related services
More recently, trade and foreign direct investment have grown in healthrelatededucational
services, where trade is taking the form of commercialpresence, electronic delivery,
consumption abroad, and movement of professionals.
Joint ventures and alliances are being formed between medicalschools, universities, and
training institutions across countries. Several primarily developed countries, such as Australia
and New Zealand, are under taking major initiatives to attract medical students from
developingcountries.
Another important emerging area is that of home-based health careservices, including
assisted living care for disabled and elderly individualsand services for persons with chronic
health conditions or those recoveringfrom surgical procedures. Given the percentage of ageing
populationin the developed world, this is one of the fastest growing areas of trade.

Medical Tourism Association

The Medical Tourism Association also referred to as Medical Travel Association, is the
first membership based international non-profit trade association for the medical tourism and
global healthcare industry made up of the top international hospitals, healthcare providers,
medical travel facilitators, insurance companies, and other affiliated companies and members
with the common goal of promoting the highest level of quality of healthcare to patients in a
global environment. Our Association promotes the interests of its healthcare provider and
medical tourism facilitator members. The Medical Tourism Association has three tenets:
Transparency in Quality and Pricing, Communication and Education.

Medical Tourism Destination

Many countries are working to successfully compete in the medical tourism
marketplace by offering awide variety of medical, surgical and dental services in comfortable
modern facilities.
Medical tourists travel to the four corners of the world for executive health evaluations,
ophthalmologiccare, cosmetic dentistry and surgery, bariatric procedures, joint resurfacing or
replacement, cardiac surgery, organ and stem cell transplantation, gender reassignment surgery
and in-vitro fertilization. Several countries in Central and South America have developed
strong reputations for cosmetic and plastic surgery, bariatric procedures, and dental care.
Destinations in Asia are particularly popular for orthopaedics and cardiac surgery.
India, Singapore and Thailand are well-established medical tourism destinations, attracting
large numbers of foreign patients and generating substantial revenue from the services
provided.
These countries have large, modern medical facilities that are staffed by well-trained
physicians who perform complex procedures such as minimally invasive/off-pump heart
surgery, correction of congenital cardiac abnormalities in children, thoracic organ
transplantation,and implantation of mechanical cardiac assist devices.
Challenges and opportunities
Challenges before Indian Medical Tourism Industry
Besides the opportunities, the Indian medical tourism suffer from some major constraint
that is non-availability of adequate infrastructure including adequate air seat capacity,
accessibility to tourist destinations, accommodation and trained manpower in sufficient
number.
The poor visitor experience due poor hygienic conditions and incidents of touting and
harassment of tourists in some places are factors that contribute to poor visitor experience.
Some other reasons are lack of capital, lack of community participation and awareness,
lack of involvement from rural sector, lack of concern for sustainability, complex visa
procedures and lack of good language translators all are serving as the constraints in the way
of medical tourism.
Hospitals in India are lacking behind in providing the hygienic medical facilities and
room services including hygienic food to the patient, as a result Indian hospitals are losing trust
of foreign patients. The major challenges faced by Indian Medical Tourism are:
• Commercialization of the profession in which some doctors are not comfortable since
the personal doctor-patient relationship will be missing in it.
• There is recuperation for patients who avail of treatment abroad.
• Problem of insurance cover.
• Poor power supply even to hospitals.
• Inequalities in the medical services provided by Government and private hospitals.
• Brain drain from government sector to private sector.
The government of India made several plans to improve the status of medical tourism by
removing political instability, terrorism bureaucratic roadblocks and taxation anomalies but
still more improvements are required.
Flow chart of Indian Medical tourism process
SWOT analysis on Indian medical tourism
Strengths Weakness
• Quality Service at Affordable Cost • No strong government support
• Vast supply of qualified doctors /initiative to promote medical tourism
• Strong presence in advanced • Low Coordination between the various
healthcare e.g. cardiovascular, organ • players in the industry– airline
transplants – high success rate in operators, hotels and hospitals
operations • Customer Perception as an unhygienic
• International Reputation of hospitals country
and Doctors • No proper accreditation and regulation
• Diversity of tourism destinations and system for hospitals
experiences • Lack of uniform pricing policies across
hospitals
Opportunities Weaknesses
 • Increased demand for healthcare • Strong competition from countries
services from countries with aging like Thailand, Malaysia, Singapore
population (U.S, U.K) • Lack of international accreditation
• Fast-paced lifestyle increases demand • Overseas medical care not covered by
for wellness tourism and alternative insurance providers
cures • Under-investment in health
• Shortage of supply in National Health infrastructure
Systems in countries like U.K, Canada
• Demand from countries with
underdeveloped healthcare facilities
• Demand for retirement homes for
elderly people especially Japanese

It is inevitable that an increasingnumber of health insurance planswill extend their

provider networksto include selected health care institutionsaround the world and willprovide
incentives to encouragebeneficiaries to use offshore facilitiesfor expensive elective surgical
Procedures.
The loss of even a small numberof profitable insured surgicalpatients could endanger
the viabilityof some programs and institutionsthat provide such services. Thismay be
particularly problematic forsmaller programs and for those witha pre-existingunfavourable
case mix.
In an article in the New England Journal of Medicine, Millstein and Smith point out
that the flight of American patients to foreign destinations for lifesaving operations is
symbolically important and must beaddressed by physician leaders. These authors argue that
Americans going to foreign destinations forsurgical care is a symptom of, andnot a solution to,
an affordability problem.
Their analysis suggests that off shore surgery could decrease total U.S. household
spending forhealth care by only 1 percent to 2percent.12 Mattoo (a World Bank economist)
and Rathindran report that a number of health care servicesare readily tradable and that
potentialgains from trade could benefit allparties, with US health care savings of $1.4 billion
to $2 billion.
Medical institutions in lessdeveloped countries benefit byserving foreign patients. The
skillsand financial resources derived byproviding health care in the globalmarketplace allow
these facilities tobetter care for the local residentswho otherwise would have limitedaccess to
modern medical facilities and services.
Medical tourism enables countriesthat have long waiting lists for certainprocedures to
clear their backlog bysending patients to foreign countriesfor expedient care, at low cost,
withoutexpanding local capacity. Finally, there are opportunitiesfor innovative physician
executivesand other health care leaders toexplore ways to better fund the careof poor patients
by directing certainservices to lower cost hospitals inforeign destinations.