Potential of Medical Tourism in India

Abstract

Medical tourism is booming in the market combining the three of the fastest growing industries in the world; healthcare, wellness and tourism. Medical tourism is merely not a new concept as people travel to seek the best healthcare which was present in ancient times. The only difference is that the wealthy patients from less developed countries used to travel to developed countries in order to avail the technologically most advanced medical facilities. Over the time the scenario has changed and now the wealthy persons from developed nations is increasingly seeking expert healthcare services at most affordable rates and quick response in the developing countries.

India is considered to be one of the best destinations for medical tourism due to the availability of specialized team of doctors and world-class medical treatments along with world famous exotic tourist attractions.

The scenario of medical tourism in India depends on well informed potential clients about the procedures, and various treatment facilities. Focused marketing materials such as flyers, booklets, and websites.

The main purpose of this research paper is to analyse the potential of medical tourism in India. This research paper also aims to give an overview of medical tourism in India. The study will also emphasize the role of government in promoting medical tourism in India.

Introduction

Medical tourism is not a new phenomenon. It has been noticed from the history that shows in Roman Empire, the Ancient Romans constructed resorts with thermal health spas and the Ancient Greeks used to travel and visit sanctuary of the healing God, Asklepios, and they found comprehensive health tourism system (Bookman & Bookman, 2007).

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This practice continued in 18th and 19th centuries when the wealthy individuals travelled to medical schools for medical assistance (Swarbrooke & Horner, 2007). Travelling for the spa and sun seeking persisted into the 20th century, different health and spa resorts can be found globally. Today, medical tourist travels the world in search of cosmetic and dental surgery to organ transplants (Horowitz, Rosenweig, & Jeffrey, 2007).

Medical tourism can be defined as people traveling from one place to another in order to get their medical treatment done. In broader term it can be said that medical tourism is cost effect private medical care in collaboration with the tourism industry for overseas patients needing specialised treatment. Markets for medical travel have grown immensely in the past few years in India. Medical tourism (also called medical travel, health tourism or global healthcare) is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of travelling across international borders to obtain health care. Because of globalization, large number of people are traveling to other countries to get quality treatment at affordable prices.

In developed countries, the cost of treatment is very high, further the patients have to wait for a very long time to get treatment or surgery. This has prompted people to look at other effective options. Among these options is looking for treatment in other countries having good treatment facilities at a very reasonable cost. Today we are experiencing both qualitative and quantitative shifts in patient mobility, as people travel from developed to less-developed countries in order to access health services. The reason for such shift is because of low cost treatment in developing countries, the availability of inexpensive flights, less waiting period.

Among the medical tourism providers, Asian countries such as India, Singapore, Thailand, Hong Kong, Malaysia, the Philippines are viewed being probably the most likely places for producing medical tourism due to their natural recourses and excellent quality service together with reduced price.

Medical Tourism in India

Medical tourism is a developing concept in India and it is growing at a very fast rate. The reason why India is becoming an important medical destination is because of its world-class treatment at affordable cost which is much lower when compared to other developed nations, highly skilled and qualified doctors and other staff, rapidly improving technology, Advantage of short waiting list combined with having favourable accommodation facilities with warm hospitality Thus, people from other countries are preferring India for their medical treatment like heart surgery, knee transplant, cosmetic surgery, hip replacement and dental surgery.

Besides that, India’s rich cultural heritage, diversity of tourism destinations, presence of world class hospitals, large number of skilled health professionals of international reputation and patronage of age old therapies have made India as a preferred destination for medical tourism (Kumar Gupta et al., 2015). Recognizing their advantages in this arena and its potential in boosting their economic development, their current government gave special exemptions to attract foreign direct investment (FDI) to invest in this country. By minimizing the bureaucratic hurdles and granting exception to certain rules, all the players in the healthcare industries were able to become competitive in this industry (Bhaidkar & Goswami, 2017).

VISA Procedure in India

All tourists traveling to India must have a valid passport and visa, and ´visas on arrival´ is not an option. India offers a variety of visas that are pertinent for medical tourism and must be obtained before traveling to India.

• A tourist visa is valid for six months from the date of issue.
• Medical (M) visa, which is valid for up to one year or the length of treatment (whichever is less). In order to apply for an M visa a person must provide letters/documents explaining the details of treatment that are signed and stamped by the concerned hospital or doctor.
• Medical escort visa is provided to those who are accompanying a patient traveling to India for medical care on a medical visa. A close relative or a friend of the patient can apply for this visa and included in the application packet along with documents signed and stamped by the doctor or hospital should be a letter of declaration from the patient or immediate family member confirming the name of the escort traveling with the patient.

In order to obtain a visa one must have an original passport valid for 6 months, pay the visa fee, have two passport size photographs, supply supporting documents when necessary, and complete the application form. The fees for a visa vary depended on the length of stay. Up to 6 months is about $60, 6 months to 1 year is $85, and more than one year is $150

Discussion

Throughout the years, India has grown to become a prime destination for medical value travel because it scores high over a range of factors that determines the overall quality of care. The factors that makes India a prime medical destination are as follows:

1. Facilities – The high-end healthcare system in India is as good as the best in the world. India maintains not only a robust accreditation system but also a large number of accredited facilities (about 275 such facilities that match any global infrastructure). India has a good number (22) of JCI (Joint Commission International) accredited hospitals and compares well with other countries in Asia. These set of approved hospitals in India can provide care at par or above global standards.
2. Frontier Technologies– Cutting edge technology to support medical diagnostics and medical procedures are employed by specialists in medical facilities. All recognized hospitals have invested a lot in supportive technology and operative techniques. Complicated heart surgeries, cancer care and surgeries, neuro and even general surgeries require high-end technology to continually better outcomes, minimize complications, enable faster recovery and reduce length of hospital stay. The recent advancements in robotic surgeries, radiation surgery or radio therapies with cyber knife stereotactic options, IMRT / IGRT, transplant support systems, advanced neuro and spinal options are all available in India. India’s medical management and acclaimed specialists are quite comfortable in challenging themselves to new frontiers to provide solutions, always building on their expertise.
3. Finest Doctors -India has not only hospitals with world-class facilities but skilled world-class doctors and medical personnel too. The country has the largest pool of doctors and paramedics in South Asia (1.2 million Allopathic doctors. 0.17 million dental surgeons, 2 million nurses). Many of them have established their credentials as leaders around the world. India’s medical history spans thousands of years through Ayurvedic and alternate medicine forms. There are about 0.8 million formally trained Ayurvedic doctors. With a large number of doctors, there is a high level of competency and capability in adoption of newer technologies and innovation and fresh treatment methods. It is a wonderful example of higher quantity leading to higher quality and vice versa.
4. Financial Savings – Quality of care is what attracts people. However, quality services should not be beyond the affordability of the patient who requires it. If quality comes at an affordable cost it is an unbeatable advantage. This confluence of highest quality and cost advantage is unique for India. The benefit is unimaginable when it comes to major treatments such as for leukemia where the difference in cost is 10 to 20 times. For other treatments, it could be anything from a fifth to a tenth when compared to Western countries and 80 to 90 per cent of what is charged in other South Asian medical destinations. The estimated 600,000 people who step into India from other countries do not do so for cheap healthcare but for quality healthcare at an affordable cost. They are not compromised at any level, but regain health at a fraction of the cost.
5. Fast Track – Zero Waiting Time- Patients in developed nations like USA, Britain, Canada have to wait for long period for major surgeries. Quick and immediate attention for surgeries and all interventions are assured in India. Getting an appointment for bypass surgery or a planned angioplasty in certain countries takes almost 3-6 months. And there these treatments are very costly too. It’s zero waiting time in India for any procedure, be it heart surgery, kidney care, cancer treatment, neuro-spinal procedure, knee/hip/joint replacements, dental, cosmetic surgeries, weight loss surgery etc.
6. Language – India has number of different languages; English is widely spoken here. All hospitals have vast number of English speaking doctors, nurses and other hospital staff and even guides. This makes the things easier for foreigners as they can communicate well to the Indian doctors and if English is not patient’s native language the hospitals can also arrange translators for them.

Importance of Accreditation of Hospitals

The demand for best quality healthcare service is the prime need of the medical tourists visiting in a country for medical treatment and also the customers have certain expectations in terms of the treatment from the chosen hospital and this lead to the introduction of national and international accreditation bodies which regulates the quality assurance mechanism in healthcare and medical treatment to the patients.

There are many instances that came into contact about the poor patient care, negligence, inadequate resources with inefficient facilities, lack of information and unwanted medical interventions. On the other hand, there are healthcare organizations and institutions and hospitals providing different level of treatment to both local people as well as the foreigners (medical tourists) who visit India for medical treatment. So in order to avoid such situations and also to provide quality treatment accreditation has been done. It is the single most approach for improving the current standards of the hospitals. Accreditation fills the gaps or removes the areas of deficiency and ultimately establishes optimum standards, professional accountability and clinical excellence.

National Accreditation Board for Hospitals and Healthcare Providers (NABH)

In India National Accreditation Board for Hospitals and Healthcare Providers (NABH) was set up to establish and operate accreditation programme for healthcare organizations with the objective of enhancing healthcare delivery system and promoting continuous quality improvement and patient safety. Regardless of ownership, legal status, size and degree of independence it provides accreditation to hospitals in a non-discriminatory manner. The standards laid by NABH are accredited by International Society for Quality in Healthcare (ISQua). This shows that the accredited hospital will also get international recognition. NABH accreditation of India is equivalent to some of the world’s leading hospital accreditations like JCI, Japan Council for Quality Healthcare (JCQC), National Safety and Quality Health Service (NSQHS) developed by the Australian Commission on Safety and Quality in Health Care (ACSQHC) etc. So far hospital standards of only 11 countries viz., Australia , Canada , Egypt , Hong Kong , Ireland , Japan , Jordan , Kyrgyz Republic , South Africa , Taiwan , United Kingdom were accredited by ISQua. India becomes the 12th country to join in this group.

Currently in India we have 561 NABH Accredited Hospitals. Vaidam Health has become India’s first and only online platform for medical value travelers (medical tourists) to get accreditation from the National Accreditation Board for Hospitals and Healthcare Providers (NABH).

Cost of treatment in India

Complicated surgeries and treatment are made possible at almost 1/10th the cost of developed countries in developing countries like India. Indian medical tourism is being promoted as First World Treatment at Third World Costs. India is now being put up on international map as a heaven for those seeking quality and affordable healthcare. This lower cost is especially important for a patient who does not have health insurance and for whom a procedure may be financially crippling in the home country.

ROLE OF GOVERNMENT IN PROMOTING MEDICAL TOURISM IN INDIA

Indian Government has undertaken various measures to promote India as a global health destination. The Indian Ministry of Tourism (MoT) has started a new category of visas for medical tourists called the “M” or medical visas. Further, efforts have been made to improve the basic infrastructure including aviation sector to ensure smooth arrival and departure of health tourists. Government is inviting and attracting foreign and private investors to invest in the infrastructure, aviation, and pharmaceuticals sectors to provide best quality of services to their customers. MoT have also prepared brochures, CDs and other publicity materials and widely circulated them in target markets to promote medical and health tourism

The Union Ministry of Commerce and Industry along with ministries of Tourism and Health has launched a website indiahealthcaretourism.com designed to promote India as a premier healthcare destination. The website is a single-source platform providing a comprehensive information to medical travellers on the top healthcare institutions spread across major cities of the nation highlighting its speciality in various medical treatment, wellness and rejuvenation, and Ayurveda & Alternative medicine.

The Ministry of Tourism, Government of India, along with State Governments/Union Territory Administrations and other stakeholders promote Medical Tourism as a niche product in the international markets. The specific promotion of Medical and Wellness Tourism is also done by Ministry of Tourism along with the State Governments including at various international travel events and organizing road shows in potential markets.

Challenges for Medical Tourism in India

The medical tourism sector has lot of potential to grow but is also confronted with many challenges that need to be tackled. The biggest hurdle that medical tourism has had to face, and continues to face, is the challenge of convincing distant potential visitors that medical care in relatively poor countries is comparable with that available at home, in outcome, safety and even in dealing with pain thresholds. This has been especially so when medical care systems, in countries such as India, have been conventionally regarded in the west as inadequate, ‘even’ for India itself. As the German radio station, Deutsche Welle, has pointed out ‘India is not exactly known for health and hygiene’ yet it nonetheless anticipates a major market in Germany (Deutsche Welle, 22 March 2005). Attached to that is the parallel perception that ‘you get what you pay for’, hence cheap medical care may well be inferior. While such situations have now radically changed the perception of inadequacy remains.

The major challenges in the field of medical tourism that countries face across the globe are as follows:

• Competition: Normally, the majority of medical tourists come from the industrialized countries of the world especially Europe, the UK, Middle East, Japan, U.S. and Canada where the cost of medical treatment is very expensive and there are often long waiting times for treatments. On the flip side medical tourism boom is happening not only in India but in other countries like Malaysia, Singapore and Thailand, South Korea, Brazil, Belgium, Cuba, Costa Rica, Hungary, and Jordan is also promoting medical tourism whereas India is likely to lose out foreign patients
• Follow-Up Problems: The follow up care is very difficult in case of patient taking treatment in India. If the patient gets any complications after surgery and is back to his own country, the follow up is not only difficult but expensive also.
• Language and Culture: Language barriers pose major challenge in medical tourism. The country may offer expert doctors and highly sophisticated medical systems but if the doctors, nurses and other medical staff do not understand the language of the patient, the whole process becomes extremely difficult for the patient as well as the staff. Sometimes there is a fearful state of mind for foreign patients about traveling so far away from home to unknown culture place
• Brain Drain: In the countries with a pool of talented doctors and nurses like India, it is a major challenge to retain these professionals. There is shortage of such skilled professionals in most countries across the globe and thus they are offered the best salaries abroad.
• Growing customer expectations: Patient expectations are growing as foreign patients have more options for high quality criteria today. There is growing pressure for more personalized services. There is a demand for high responsiveness. It is the business of managing the total customer experience where price is transparent but value is opaque.
• Infrastructure: Infrastructure is a major concern affecting India as a destination. Some drawbacks include lack of proper flight connectivity to all destinations, bad roads, safe food and water availability etc

Need for the Study

Medical tourism is growing at Fast pace in India and medical tourism has that potential to attract more and more number of tourists from all over the world. It is required to put efforts towards the development of India in terms of better medical facilities and services offering to the medical tourists for that regard it is required to understand and study the potential of medical tourism. By studying it not only help in knowing about the country’s potential but also the things which need to be improve to increase the number of medical tourists into the country therefore benefiting the nation economically.

Research Objective

The objective of this research paper is to put emphasis or bring into account the potential of India as the medical tourism destination in the world. It also aims to give an overview of medical tourism in India. The study also aims to discuss the role of government in promoting medical tourism in India.

Literature Review

Reddy (2000) written that the healthcare industry has the potential to show the same exponential growth that the software and pharmaceuticals industries have shown in the last decade. Worldwide the market for healthcare is expected to be over $4 trillion and of this over $ 750 million will be the share of the developing world. This would make the healthcare industry the largest service sector industry in the developing world.

Mukherjee and Mookerji (2004) mentioned that after Singapore and Thailand, India may be the next multimillion dollar Asian medical industry. Apollo hospitals group, Wockhardt, Escorts, Fortis, Hinduja and Breach Candy are some of the names in healthcare that have come forward to tie up with tourism industry players like Hyatt, Kuoni, Indian Airlines and Bangladeshi carrier GMC to offer discount-laced customized packages to international medical tourist to India.

Baxi (2004) reported that India is well positioned to tap the top end of the $3-trillion global healthcare industry because of the facilities and services it offers, and by leveraging the brand equity of Indian healthcare professionals across the globe. India’s medical expertise is comparable to the best in the world and the work done by doctors in India is recognized all over. The key reason for India’s emergence as an important destination for healthcare is due to Indian doctors who are renowned world over. There are over 35,000 specialty doctors of Indian origin in the US alone. Also, Indian nurses are the most sought after and their caring approach towards treatment is well recognized.

Rao (2005) described that a substantial number of foreigners are coming to India to avail the quality medical treatment at a cost much lower than that of other countries of the world, particularly in the field of cardiology, cardiac surgery, joint replacement, ophthalmology, pathology and Indian systems of medicine etc. The government of India has constituted a task force to promote India as a health destination for persons across the globe so as to gainfully utilize the healthcare expertise and infrastructure available in the country.

According to Gupta (2004), medical tourism can be defined as the provision of cost-effective medical care to patients in collaboration with the tourism industry. This process is usually facilitated by the private medical sector, whereas both the private and public sectors are involved in the tourism industry. By traveling abroad to have surgery or other medical treatment, medical tourists also take advantage of the opportunity to visit a popular travel destination, thus combining health care with a vacation.

Connell (2006) defined medical tourism as constituting a form of popular mass culture whereby individuals travel long distances to obtain medical, dental, or surgical services while being holidaymakers in the more conventional sense

Conclusion

Medical tourism in India has emerged as the fastest growing segment of tourism industry. In the past the growth potential of the medical travel industry in India has been hindered by capacity and infrastructure constraints but that situation is now changing with strong economic progress in India. India as a medical tourist destination is unique as it offers holistic medicinal services with yoga, meditation, ayurveda, allopathy and other medical facilities. It offers a unique basket of services to an individual that will be difficult to match in other countries. For Indian healthcare institutions, the quality of service is the biggest benefit, followed by the cost advantage.

With more and more hospitals receiving JCI accreditations and foreign patients concern on safety and quality of care are becoming less of an issue for those choosing to travel for medical treatment at an affordable cost. The combined cost of travel and treatment in India is still a fraction of the amount spent on just medical treatment alone in western countries. Indian medical tourism is being promoted as First World Treatment at Third World Costs. Long promoted for its cultural and scenic beauty, India is now being put up on international map as a heaven for those seeking quality and affordable healthcare

It can be concluded that these accreditations of hospitals ensure the quality and safety in medical tourism globally.