This is the era of re-mix music and mixing has been going on in other fields too. Earlier it was mixing of business and pleasure among business travelers. Now it is the mixing of health and tourism creating a new breed of travelers–health tourists.

Medical tourism or health tourism can be broadly defined as provision of ‘cost effective’ private medical care in collaboration with the tourism industry for patients needing surgical and other forms of specialized treatment.

India is a relatively new entrant into this field and has to prepare to face the already existing competitors from other Asian countries including Thailand, Malaysia and Singapore.

Growth of the Medical Tourism Industry in India

According to a study by McKinsey and the Confederation of Indian Industry, medical tourism in India could become a $1 billion business by 2012. The Indian government predicts that India’s $17-billion-a-year health-care industry could grow 13 percent in the next six years, boosted by medical tourism.

“The biggest way in attracting international patients is through word of mouth. We have medical facilitators who market Apollo in source markets like the Middle East, Bangladesh or Britain,” says Ashok Ananthram, President–Business Development, Apollo Hospitals, Chennai.

In India, the Apollo group alone has so far treated 95,000 international patients, many of whom are of Indian origin. Apollo attracts patients from Southeast Asia, Africa, and the Middle East. Another corporate group with a chain of hospitals—Escorts, claims it has doubled its number of overseas patients—from 675 in 2000 to nearly 1,200 in 2004.

Analysts say there was as many as 150,000 medical tourists visiting India in 2003 and the number is increasing at the rate of about 15 percent a year. In the past five years medical tourism in India has got a boost due to the improved medical infrastructure; the entry of multinational corporations and private institutions; and private funding.

This has resulted in international standards of treatment being offered to both International and domestic patients. The now financially sound Indian middle-class is a major ‘buyer’ of the medical services available at premier hospitals, which has resulted in revenues flowing into these healthcare institutions.

With the inflow of cash, these centers are targeting foreigners and Indians settled abroad with medi-goodies at prices five to ten times below of what is charged in the developed world. Thus client base of hospitals in India are increasing and yet is still devoid of the waiting lists so familiar with hospitals abroad.

India’s Health Care System
Taken as a whole, India’s health care system is hardly a model, with barely four doctors for every 10,000 people, compared with 27 in the U.S., according to the World Bank. Health care accounts for just 5.1 percent of India’s gross domestic product, against 14 percent in the U.S.

On the other hand, India offers a growing number of private ‘centers of excellence’ where the quality of care is as good or better than big-city hospitals in the U.S. or Europe.
“Most importantly India should emerge as health care leaders on the domestic front.

India does only 60,000 heart surgeries a year, which is too low vis-à-vis, the burgeoning Indian populace. We need to be really doing 2.5 million heart surgeries,” says Dr.Devi Shetty, Founder, Narayana Hrudayalaya–a heart specialty center near Bangalore. At present India is playing on its cost advantage but that is not sustainable. It needs to build up more expertise to maintain a top position.

This is the long-term initiative to be taken to attract people from the U.S. or U.K.

Advantage India: How Did This Happen?
In U.K. and Canada due to government health care there are long waiting lists for a patient to be attended by a doctor, which deter a growing number to seek treatment within their borders. Hence many are hopping on the next plane to seek treatments in Asia.

There are many patients from the Gulf who come to India because of the lack of medical infrastructure within their countries. With improved domestic and international IT connectivity many myths about ‘dirty’ Asia are being dispelled leading to greater acceptance of its medical services by Americans and Europeans. The aviation boom only has strengthened this cause.

15.2 percent of the entire U.S. population consists of people who have either resigned or have been fired from their jobs resulting in insurance policy lapses as the company in which they worked had covered their Medicare insurance. This has been the case because they cannot afford the premium that private insurance agents charge. Hence these 43.6 million people look towards developing countries to save their lives at cheaper rates without compromising on quality.

Another 45 million people in the U.S. consist of carpenters, gardeners, plumbers and self-employed people who cannot afford the insurance premium and hence look forward to fly east. Indians in the U.S. make up the third largest immigrant population and they come to India to get treated as they have no biases towards the home country and then it works out cheaper too even after Indian hospitals reaching world-class standards.
Dr.Sanjay Sharma, General Manager– Marketing, Escorts Heart Institute and Research Center, New Delhi points out, “Medical tourism started off from Bangkok which catered to sex change operations and later graduated to full-fledged ‘serious’ medical treatments.” Though the McKinsey report claims that by 2012 the Indian medical tourism industry will be worth $1 billion, Sharma is optimistic of it being worth $5 billion.

Blockades in the Growth of Medical Tourism
The biggest drawback that Indian medical tourism faces is the connectivity within India wherein patients have to change three or four flights after embarking from their homeland to reach their choice destination. This takes a toll on their already fragile health.

“There should be direct connectivity between other countries especially Asia and Africa; and the metros of South India so that medical tourism in India can really take off,” asserts Dr.Shetty.

The blockades for growth to medical tourism in India would be poor roads, inconsistent telecommunication services and power services.

The obstacles facing India to be the destination for medical tourism are in getting uniform accreditation among all hospitals so that foreign patients can go to their choice of hospitals. Accreditation like the Joint Commission International rating–the gold standard for healthcare means a lot as it indicates that you are no lesser than other JCI rated hospitals anywhere in the world.

Insurance Issues
200,000 plus overseas patients are expected by end 2005, which is a positive sign of things to come if India maintains the momentum of growth. . “Foreign insurance companies must take a pro-active role and cover international patients in the event of any contingencies,” implores Sharma. Since the treatments are priced low here, the payouts from the foreign insurance companies will also be lower. Thus it is a win-win situation for insurance majors as it increases their top-line— increase of revenues as client base increases and bottom-line —net profit as payouts are low too.

Sought After Treatments of Health Tourists
Cardio-thoracic surgery takes the leading position on what foreign patients seek for treatment followed by orthopedics – knee replacements, hip replacements; thirdly it would be urology and nephrology—liver transplant and kidney transplant. The fourth in line is gastroenterology followed by oncology—cancer treatment. Cosmetic surgery is big as it is not covered by insurance in many western countries and the craze to look good entices people to world-class doctors in India who are mostly trained abroad. Preventive health checkups are big among Indians settled abroad who do it when they come to India on a holiday.

What does it take to be
Numero Uno in Medical Tourism?
“The contribution from the Ministry of Tourism and the Ministry of Health on macro level should go up several notches along with faster visa and ticketing procedures if India has to become the destination for medical tourism,” says Sharma. Escorts on their end has created special international brochures, standardized the medical services for patients from abroad and had set into action a single window redressal procedure which has clicked in a big way.

The tour companies should be pro-active and provide seamless travel facilities to foreigners including nitty-gritty’s like provision of foreign language interpreters. “Hotels in India not just the five-stars should have rooms meeting the standards set by the American Disability Act wherein there is provision for lets say, wheel-chair ramps etc,” advices Sharma.

Widespread expansion of specialty hospitals is needed to distribute the expertise and best practices to cater to the growing international demand. It is here that Dr.Shetty agrees that the reach of Narayana Hrudayalaya is limited because it has restricted itself only to cardiac care.

Hence Hrudayalaya is building a health city with 5000 beds spread among 10 hospitals in Bangalore and Kolkata. This would be a shot in their arm to emerge as one of the premier health destinations for health tourists.
“More has to be done especially to not project India, as a cheap destination as then there will not be value add per tourist. It is better to always have one medical tourist paying $10 than ten tourists paying $1.

One should not look at the numbers but should focus on the quality of patients attracted so that this fledgling industry in India can expand exponentially,” advises Ananthram.