Medical tourism

By,
Advitheya N
091202045
 Introduction
 Global competition is emerging in the health care
industry

 Wealthy patients from developing countries have long

traveled to developed countries for high quality
medical care

 Growing numbers of patients from developed

countries are traveling for medical reasons to regions
once characterized as “third world.”
 These “medical tourists” are not wealthy, but are
seeking high quality medical care at affordable prices
 What is Medical tourism
 Medical Tourism (also called as medical travel or
health tourism) is a term initially coined by travel
agencies and the mass media to describe the rapidly
growing practice of travelling to another country to
obtain health care
 The provider viz the hospital and the customer use
informal channels of communication-connection-
contract with less regulatory or legal oversight to
assure quality and less formal recourse to
reimbursement or redress.
 In addition, to the hospital procedures, leisure
activities are also typically associated with this
treatment, thus travel and tourism aspects are also
included in this medical travel trips.
 Definition
 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”.
 More facts
 Worlds largest after retailing
 Global healthcare revenue US$ 2.8 trillion
 500,000 traveled to India for medical care in 2005
 India’s healthcare industry worth US$ 17 billion; to
grow by 13% per annum
 McKinsey & Company estimates that Indian medical
tourism alone will grow to $2.3 billion by 2012
 Reason for travel
 For most medical tourists the reason for travel is
financial but still getting good quality treatment
 Willingness to travel for medical care is shown by a
recent nationwide survey.

 Almost no one would travel a great distance to save

$200 or less.
 Fewer than 10 percent would travel to save $500 to
$1,000.
 About one-quarter of uninsured people, but only 10
percent of those with health insurance, would travel
abroad for care if the savings amounted to $1,000 to
$2,400.

 For savings exceeding $10,000 about 38 percent of

the uninsured and one-quarter of those with insurance
would travel abroad for care.
 American medical tourists are seeking lower prices
for treatments not covered by insurance (such as
cosmetic surgery and weight loss surgery).

 Uninsured patients paying the cost out of their own

pocket travel because American hospitals often charge
cash-paying, uninsured individuals inflated “list”
prices, which can be much higher than government or
private insurers have to pay
 Small but growing number of insurers are creating
health plans that encourage enrollees to shop for
better prices among approved vendors in other
countries and allow them to share in the savings

 For example, if a procedure cost $4,000 less in

another country, a patient required to pay 20 percent
of the cost (through a copayment) would save $800
out of pocket
 Where they seek treatment
 India is rated amongst the world’s “must see top ten
destination” by Conde Naste (international magazine)

Other countries include Thailand, Singapore,

Brazil , Argentina ,Belgium, South Africa etc
 Issues for treatment in other countries
SAARC , AFRICAS, MIDDLE EAST
 No advance care available e.g Afghanistan ,

Nepal and Bangladesh etc

 Limited specialized care

WEST
 Long waiting – UK (as long as 1yr sometimes)
 Insurance unaffordable leading to semi insured

and uninsured population - US

 Private hospitals very expensive
 Reasons to choose India
 It arguably has the lowest cost
 highest quality of all medical tourism destinations
 English is widely spoken
 Several hospitals are accredited by the Joint
Commission International (JCI) and staffed by highly
trained physicians
 many hospitals bundle services into a package deal
that includes the medical procedure and the cost of
treating any complications
 hospitals often have hotel rooms or can offer
discounts for hotels nearby
 Areas of Treatment
 Cardiology
 Joint replacement
 Orthopaedic surgery
 Gastroenterology
 Ophthalmology
 Transplants (liver, Bone marrow)
 Urology.
Sources: Subimo (U.S. rates); PlanetHospital (international rates), cited in Unmesh Kher, “Outsourcing Your
Heart,” Time, May 21, 2006
 Core Competencies in India
Quality
Large pool of doctors, nurses & paramedics
Strength: - Over 650,000 doctors;
- Highly skilled experts, and
- Possess English speaking skills
Comfort Level
NRI doctors recognized as amongst best in adopted countries (First World)
Usage of English
Indian Nurses increasingly getting international exposure
Lower Medication cost:
Strong Pharma Sector and gaining world recognition
Fast emerging as major Drug R&D Center
Strong Generic drugs business
Low cost of drug development in India
No waiting

Tourist Interest:
5000 year old civilization
Renowned for Historical, Cultural and Religious diversity
Diverse geographical landmarks; vast coastline
Traditional arts and crafts
Vibrant democracy: Freedom for citizens; empowered women population
Alternative Medicine Proposition:

Ancient Ayurvedic stream of medicines

Rejuvenation alternatives: Kerala’s health retreats
Naturopathy and Yoga
 Consumer awareness/Marketing
 Increased visibility & ease of access to leading hospitals,
doctors and surgeons who post their skills & specialties,
pricing etc on websites has made available a wide choice of
treatment to the overseas patients

 Media is showcasing India’s ability to treat overseas patients

in a comparable environment
Insurance
 India proactively talking to Foreign Insurance
companies to treat their beneficiaries in India
 Cashless benefits
 Hassle Free
 Issues for choosing India
 Negative perceptions

 Hygiene/Unsanitary
 Pollution
 Backward & Bureaucratic

 Medical insurance

 Inadequate Cover
 Underdeveloped
 No Global Players
 Overseas Companies Refuse Reimbursements
 Accreditation

 No Uniformity : NABH,ISO,JCI
 WEST: JCAHO

 Instability
 Terrorism Prone
 Communal Unrest
 Licensing Laws

 Itis illegal for a physician to consult with a patient online

without an initial face-to-face meeting.
 It is illegal in most states for a physician outside the state who
has examined a patient in person to continue treating the
patient via the Internet after the patient returns home.
 It is illegal in most states for a physician outside the state to
consult by phone with patients residing in the state if the
physician is not licensed to practice medicine there.
 These laws make it difficult for American patients to seek care
from doctors abroad via telephone and the Internet
 Lack of Follow-Up Care

 patients who have traveled abroad for medical procedures

have problems finding a local physician willing to provide
postoperative follow-up care
 Liability for another provider’s work is a perceived risk to
doctors providing aftercare
 reluctance to provide follow-up care is that patients treated
abroad often lack insurance
 Physicians may prefer not to treat uninsured patients (unless
payment is made in advance) for fear they will not get paid
 Legal Issue

Employers and insurers could lower their health costs by

sending employees abroad for treatment

an employer that sponsors a health plan offering workers a

financial incentive to travel abroad for treatment could have
greater liability risks. The concern is that financial incentives
might induce enrollees to accept substandard care when they
otherwise would select the local hospital of their choice
For Doctors :
Standardized education in Medical Institutions
Strong regulatory mechanism to curb quacks
No communication and inter-personal skills teaching
For Paramedics
Deficient Language skills
Lack of Standardization
Attrition
 Other services

Hygiene awareness in medical attendants

Unhygienic Food handling
Heterogeneous Pricing of services
 Ensuring Quality
 Measuring Quality
 Apollo Hospital Group and Wockhardt Hospitals (which
is affiliated with Harvard Medical School) in India, and
Bumrungrad International Hospital in Thailand, offer a
better level of care than the average community hospital
in the United States.

 India’s Apollo Hospital Group has devised a clinical

excellence model to ensure its quality meets
international health care standards across all its hospitals
 Electronic Medical Records.

potential medical tourists must first be evaluated

remotely, most large health care providers and medical
intermediaries for patients use electronic medical records
(EMRs) to store and access patient files. Patients can then
discuss the procedures with potential physicians via
conference call. Modern hospitals abroad also use
information technology to identify potential drug
interactions, manage patient caseloads and store radiology
and laboratory test results.
 Hospital Accreditation

Hospital Affiliation
Wockhardt (India) is affiliated with Harvard Medical
School

Physician Credentials
physicians are often U.S. board-certified
others have internationally respected credentials.

.
Online Communities

Potential patients can get some idea of the safety and

quality of medical providers by searching online for
testimonies of patients who have had surgery abroad.
Internet communities facilitate the exchange of
information about providers, including facility
cleanliness, convenience, price, satisfaction with
medical services and the availability of lodging while
recuperating
 Major Players in the industry
 Apollo Group of Hospitals (India)
 Escorts Heart Institute (India)
 the Bumrungrad Hospital (Thailand)
 Sunway Medical Centre (Malaysia)
 Raffles Hospital (Singapore)

Almost all these hospitals have upgraded their interiors to

resemble five star hotels. The hotels have also tied up
with travel agents / tourists so as to facilitate a
comfortable and hassle free travel for the over seas
patients
 SWOT for MT in India
 Strengths:
 Quality and Range of Services.
 Affordable costs
 Internationally reputed hospitals
 Personal touch by the doctors in India.
 Traffic system is well developed and easy to go from one
country to another country.
 Medicines and lab our cost is low as compared to developed
countries.
 Weakness
 No strong government support/ initiative to
promote medical tourism.
 Low coordination between the various players in
the industry- airline operators, hotels, and
hospitals.
 Lack of uniform pricing policies across hospitals.
 Cheating
 Political problems etc.
Opportunities

An opportunity is a favorable condition in the service

industry which enables it to consolidate and strengthen
its position.
 Increased demand for healthcare services from countries
with aging population (US, UK)
 Fast-paced life style increases demand for wellness
tourism and alternative cures.
 Shortage of supply in National Health Systems in
countries like UK, Canada.
 Demand from countries with underdeveloped
healthcare facilities.
 Demand for retirement homes for elderly people
especially Japanese.
Threats
A threat is an unfavourable condition in the industry’s
environment which creates a risk for, or causes damage to, the
industry. They are
• Strong competition from countries like Thailand, Malaysia and
Singapore.
• Lack of international accreditaion – a major inhibitor.
• Overseas medical care not covered by insurance providers.
• Under – investment in health infrastructure.
• Exorcism is more in India
• Identifying a real practitioner is a major problem in India.
• Exploitation of tourists by illegal money changers.
Partners in the Medical Tourism Industry
 Success Mantra/Strategies for Medical
tourism
Players dominating the medical tourism sector :
 Tour Operators,
 Hotels,
 Hospitals and / or integrated hospitals cum hotels

For medical tourism to succeed a consortium of

Tour operators, Hospitals and Hotels (if an integrated
set up is not available) is a must
 Marketing Communication plays a very major role –
Word of Mouth communication. Tie-ups with the
leading medical insurance companies also help in
reducing the cost of the tour operators.

 Additionally tie ups with foreign universities –

wherein internship is offered in India also helps in
securing medical tourists to India.
 The purpose of these tour operators / agents is to
liaise with the insurance companies and the private
/public medical practitioners in the European and
American markets, so as to ensure a steady stream of
patients.

 In addition, the tour operators also help in explaining

the problems that the patients may face when they
visit India. (For e.g. the unhygienic surrounding, the
non-availability or inadequate transport system etc.)
 An Example of Kerala
Treatments provided

 Ayurveda Abhyangam (14 days treatment)

 Dhanyamla Dhara (14 days treatment)
 Dhara (14 days treatment)
 Kativasthi (14 days treatment)
 Kizhi (14 days treatment)
 Nasyam (14 days treatment) etc
 Tourists Attractions
 Alappuzha Beach
 Kappad Beach
 Kovalan Beach
 Marari Beach
 Periyar Wildlife Sanctuary
 Tekkady
 Wild life Resorts etc
 Success factor: The ancient art of treatments along
with these tourists attractions has made Kerala very
successful in medical tourism.
 Other Hospitals
Apollo Hospitals:
 On an average it attracts around 95000 tourists many
of whom are of the Indian origin.
 The group has tied up with hospitals in Mauritius,
Tanzania, Bangladesh, Yemen and Sri Lanka.

 Ruby hospitals : in Kolkata has signed a contract

with the British Insurance Company(BUPA).
 Bottom-line :Benefits to Hospitals
PROFITS are to be made in two areas:

 In the treatment offered to the medical tourist

 In the areas outside the treatment e.g. the room
offered, the food offered, the laundry services offered
etc.
 How is it achieved?????: Areas of
Revenue Generation
 Medical tourists need to be provided a “More Than
DELUXE Service – an area where customer centricity is
a must. Such “More than Deluxe Service” can be offered
at a premium price with marginal costs to the hospital.
 The cost to the hospital is extremely marginal in
upgrading the economy room to More Than DELUXE
Room, which is offered to the customer. The cost of
converting an economy room to a More than Deluxe
Room is an additional 20%, while the tariff charged is
more than 300% to 400%.
From the hospital’s perspective, food served to the medical tourist is
different from that served to the normal domestic patients—an area where
again profits can be made.

Themedical tourist is normally accompanied by two or three relatives,

who need housing—quite close to the hospital or better still within the
hospital premises itself—another area where again profits can be made.

Thepre and post operative care is another important area where profits
can be made.

Thus from the hospital perspective, along with quality treatment, a host of
areas exists where profits can be generated.
 Initiatives by Government
 “Medi City” : Support the initiative by well known
heart surgeon Dr. Naresh Trehan
 900-bed
 17 super specialties
 A medical college and paramedical college.
 cost an estimated $493 Million
 Integrate allopathic care with alternative treatments ,
including unani, ayurvedic and homeopathic medicine
 telemedicine services as well.
 Other incentives by Govnernment
 Lower import duties
 higher depreciation rates on medical equipment
 expedited visas for overseas patients seeking medical
care in India.
 India - Strategic Thrusts for the Future
Role of Government
The role of Indian Government for success in
medical tourism is two-fold:
 Acting as a Regulator to institute a uniform
grading and accreditation system for hospitals
to build consumers’ trust.
 Acting as a Facilitator for encouraging private
investment in medical infrastructure and
policymaking for improving medical tourism
 Future focus areas
 Uniform Medical Education Standards
 Industry Accreditation Standards
 Mandatory Accreditation of all Colleges & Hospitals
 Target-oriented Infrastructure Investment
 More Medical, Nursing colleges and Hospitals
 Regulatory Bodies with Teeth
 Government soft loan to Private Players
 Tax Holiday & Further Duty Roll Back
 Greater Industry & Govt. Interaction
 Medical Insurance Reforms
 Seamless Single-Window Facility to Tourists
 Govt. sell India as Medical Tourism Destination
 Conclusion
 For Hospitals : The key issues is marketing the
concept of medical tourism to the developed
countries, providing quality services both pre
operative, post operative and the other incidental
services which are provided along with the treatment.

 Innovative ideas like offering a total package which

includes medical services plus tourism packages are
the key areas for success
 References
 The key issues and challenges in medical tourism sector in
India (A Hospital perspective) - Dr. R Gopal
 Medical Tourism: Global Competition in Health Care -
Devon M. Herrick
 Medical Tourism, the Future of Health Services
 Dr Christine Lee
 Tourism Research Unit (TRU), Department of Management,
Monash University, Australia.
 Medical Tourism - Kalyan Chakravarthy K, C H. Ravi
Kumar and Deepthi K
 Medical Tourism in Kerala—Challenges and Scope Joseph
M. Cherukara and Dr. James Manalel
Thank you