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INTRODUCTION
The most recent trend in privatisation of health services is medical tourism, which is gaining prominence in developing countries. Globalisation has promoted a consumerist culture, thereby promoting goods and services that can feed the aspirations arising from this culture. This has had its effect in the health sector too, with the emergence of a private sector that thrives by servicing a small percentage of the population that has the ability to buy medical care at the rates at which the high end of the private medical sector provides such care. This has changed the character of the medical care sector, with the entry of the corporate sector. Corporate run institutions are seized with the necessity to maximise profits and expand their coverage. These objectives face a constraint in the form of the relatively small size of the population in developing countries that can afford services offered by such institutions. In this background, corporate interests in the Medical Care sector are looking for opportunities that go beyond the limited domestic market for high cost medical care. This is the genesis of the medical tourism industry. Health tourism is tipped to be next big-bucks business for India. Health care is a $3 trillion industry worldwide, and India is in a position to tap the top-end segment by highlighting its state-of-art facilities and services, and exploiting the brand equity of leading Indian healthcare professionals across the globe. The recent heart surgery of Pakistani baby Noor Fathima in Bangalore has once again turned the spotlight on Karnatakas unique position as a centre for world class healthcare facilities, together with its equally fascinating tourist attractions, and spurred the state into a proactive mode to claim its share of the action. As a part of this initiative, the Karnataka tourism department is leading a team of hospital officials to the Bahrain Global Health Summit to pitch for some attention from potential buyers of health tourism services. Four leading institutions Wockhardt, Narayana Hruduyalaya, Sagar Apollo and Soukya have already participated, said Vandita Sharma, commissioner tourism for Karnataka. According to state tourism and IT minister, DB Inamdar, world-class medical institutes in Karnataka carry out surgeries for half in many cases for a third or fifth of the cost in the west. More importantly appointments are available much quicker than in Note: Not to be printed without permission 1
Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ the US or the UK, where patients often face long waiting lists. There are also a clutch of good health and wellness clinics along with spa resorts, and great locations of tourist interest in the state, which can help position Karnataka as a leading health tourism destination. The US, Canada, the UK, the Mid-East, and even Asian states like Sri Lanka are viewed as great markets for selling health tourism packages in Karnataka. Assistant director for Sri Lankan tourism, Madhubani periera, told ET that Lankan tour operates are already exploring the opportunity with medical centres in Bangalore. The success of the recently set us Apollo Hospital in the island is said to have egged travel companies to scout for fresh possibilities in Karnataka, since there are four direct weekly flights to Bangalore from Colombo. Narayana Hruduyalayas Devi Shetty says tourism related to healthcare generates higher revenues than pure vacationers. Patients who visit Bangalore for treatment along with their families tend to stay longer than most tourists. Post-operation, family members often relax by visiting places of tourist interest. For instance, a person staying in the city for a heart surgery spends around Rs.2 lakh during a week-long halt, which is miles ahead of the expenditure incurred by a typical tourist. Hospitality industry experts say there is another aspect of health tourism, pampering and wellness which is gathering momentum in the west and has been successfully packaged by Kerala. Leele palace Bangalores Eric Swanson explains that pampering involves offering people an experience massages, herbal wraps and exfoliating scrubs that makes them feel relaxed. Wellness involves helping healthy people stays well, both physically and mentally. Sometimes, this means offering diagnostic testing to identify potential problems. The Wests fascination with fitness and alternative therapies for health maintenance and healing is another factor. Spas for healthy people currently represent the lions share of the health tourism market in the west. New trendsetters have started arising on the horizon of the widespread global trade. One of these trendsetters, who is fast emerging and has an added value of making huge economical profits, is Medical Tourism. According to a research professor Rupa Chanda, IIM; Medical Tourism will single handedly fetch a very impressive amount of
Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ $4 trillion on a world-wide scale. The World Trade Organization studied the scope of this new found field. The study was conducted in Thailand, Malaysia, Jordan, Singapore & India, which resulted in the findings, that in these 5 countries the number of medical travelers in the year 2003 was almost 1.3 million and thus collectively earned almost $1 billion (in treatment cost alone). In case of these nations the medical travel spends are growing at the rate of 20% plus on a year-to-year basis. Now, let us know who could be the potential clients for Medical Tourism purposes. These medical travelers could be broadly classified into 4 distinct geographical groups. The first group of medical travelers is made up of Americans. The U.S. boasts of the best medical facilities in the world & that to instantly. But the value of these services offered is very high. Also the American healthcare system is pre-dominantly insurance driven which includes only critical care and not cosmetic care for and not cosmetic care for which a vast no. of American people are opting now including facelifts, liposuction, dental treatments, etc. Going by an estimate a full facelift in the U.S. costs $8000-20000, which costs only $1252 in South Africa. Thus Americans go in for he cosmetic surgeries that are available outside America in other countries like South Africa, Thailand, etc. that mean a vacation well. Given these increasing costs of medical treatments in the U.S. it makes sound economical sense to seek treatments abroad. The second major group are the people in UK. Unlike in the US the British healthcare system ensures free treatments to all its citizens. Yet the people are being forced to seek medical treatments in other countries by the sheer waiting lists caused by the National Health Service which we have seen in the introductory case of Mr. Cyril Parry. This is probably because of the shortage of doctors and hospital beds. Also private medical facilities here are prohibitively expensive and relatively fewer in number. These are the two major reasons why British patients take the initiative to seek their own treatments abroad. The third chunk of medical travelers comes from the Middle-East, where the people of these oil-rich nations fly abroad to seek medical facilities that are either unavailable or in short supply in their own countries. According to an estimate more than 5lakh people
Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ from the Middle-East travel abroad every year for Medical Treatments. They travel mainly to Jordan, Saudi Arabia, Bahrain, US, India, Thailand & Malaysia. By some estimate India itself attracted around 70,000 plus travelers from the Middle-East last year. The final lot includes people from the least developed nations traveling to their well developed neighbours. Last year it was estimated that nearly 50,000 people from Nepal and Bangladesh came for medical treatments to India. India is considered the leading country promoting medical tourism-and now it is moving into a new area of "medical outsourcing," where subcontractors provide services to the overburdened medical care systems in western countries. India's National Health Policy declares that treatment of foreign patients is legally an "export" and deemed "eligible for all fiscal incentives extended to export earnings." Government and private sector studies in India estimate that medical tourism could bring between $1 billion and $2 billion US into the country by 2012. The reports estimate that medical tourism to India is growing by 30 per cent a year. India's top-rated education system is not only churning out computer programmers and engineers, but an estimated 20,000 to 30,000 doctors and nurses each year. The largest of the estimated half-dozen medical corporations in India serving medical tourists is Apollo Hospital Enterprises, which treated an estimated 60,000 patients between 2001 and spring 2004. It is Apollo that is aggressively moving into medical outsourcing. Apollo already provides overnight computer services for U.S. insurance companies and hospitals as well as working with big pharmaceutical corporations with drug trials. Dr. Prathap C. Reddy, the chairman of the company, began negotiations in the spring of 2004 with Britain's National Health Service to work as a subcontractor, to do operations and medical tests for patients at a fraction of the cost in Britain for either government or private care. Apollo's business began to grow in the 1990s, with the deregulation of the Indian economy, which drastically cut the bureaucratic barriers to expansion and made it easier to import the most modern medical equipment. The first patients were Indian expatriates who returned home for treatment; major investment houses followed with money and then patients from Europe, the Middle East and Canada began to arrive. Apollo now has
Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ 37 hospitals, with about 7,000 beds. The company is in partnership in hospitals in Kuwait, SriLanka and Nigeria. Western patients usually get a package deal that includes flights, transfers, hotels, treatment and often a post-operative vacation. Apollo has also reacted to criticism by Indian politicians by expanding its services to India's millions of poor. It has set aside free beds for those who can't afford care, has set up a trust fund and is pioneering remote, satellite-linked telemedicine across India.
India's top-rated education system is not only churning out computer programmers and engineers, but an estimated 20,000 to 30,000 doctors and nurses each year. India is considered the leading country promoting medical tourism-and now it is moving into a new area of "medical outsourcing," where subcontractors provide services to the overburdened medical care systems in western countries. India's healthcare industry is growing at 30 per cent annually and could earn more than $1-2 billion annually, creating 40 million new jobs in the process, by 2012. Today while we look up at the tourism sector the foremost thing that come to our mind are leisure tourism activities, adventure activities etc. but the sector of medical tourism remains unexplored and untapped. The sector has great potentialities in lending the tourism activities. The estimated Indian market alone at present amounts to almost $40 million approximately which suggest that there is even more value than the mentioned one and is yet to be tapped.
Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ The main reason for which I selected Medical Tourism as my final topic for project are as follows: The Medical Tourism sector also known as the Healthcare sector still remains a toddler compared to the other sectors like leisure, adventure, pilgrims, etc. Medical Tourism will act as a boom for boosting the overall tourism sector in India. A well planned and promoted Indian healthcare sector as well as the coordinated efforts of the medical fraternity and the government of India will increase the standards of the healthcare in India. This in turn will be helpful to local population as well. The traditional Indian ways of healing if promoted and publicized well could do wonders to the Indian economy. Along with the medical sector comes a very vital sector for free known as the insurance sector which can also support the Indian economy. Another issue was Indian becoming an important destination for various medical conferences which could improve the influx of the foreign tourists and in turn generate good amount of Forex.
GLOBAL SCENARIO
Nobody has collected the complete worldwide statistics about how many people travel abroad for health related reasons every year or how much they spend. But a Saudi Arabian report pointed out that in 2000, medical travelers from the gulf region alone spent over $27 billion seeking treatments in various countries around the world. If the medical travelers from around the world spent even half as much that year, the total business in 2000 alone would have been in excess of $40 billion and even that would be an underestimate. The estimate is that the healthcare market in the organization of economic cooperation and development countries alone is worth about $3 trillion and is expected to rise up to $4 trillion in 2005. More importantly, it is growing leaps and bounds and turning out to be an immense business opportunity for nations that are positioning themselves correctly. Last
Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ year just 5 countries in Asia (Thailand, Malaysia, Jordan, Singapore & India) pulled in over 1.3 million medical travelers and earned over $1 billion (in treatments alone). In each of these nations the medical travel spending are growing at a rate of 20% plus every year. Elsewhere around the world HongKong, Lithuania and South Africa are emerging as big healthcare destinations and a dozen other nations like Croatia, Greece, etc. are planning to make it big in this sector. By itself, traveling abroad for medical reasons is not a new phenomenon. Even in the ancient times people were used to travel abroad for the same. But in the past 5 years or so the movement has accelerated sharply. It has developed a massive momentum for two critical reasons. The first being the demographics of the developed countries and also the problems associated with their healthcare sector. In the US, UK, Japan and many European countries majority of the population has either hit the retirement age or are heading towards it. Meanwhile the life expectancy rate has also grown steadily over the years. These two reasons add up to give a big surge in the demand of the healthcare. Also there is a pull factor being created by a handful of developing countries like Thailand & Malaysia that have good doctors and excellent facilities and which are positioning themselves as medical destinations of the future in order to boost their economies. India is also joining this bandwagon. Though the movement can still be considered to be in its infancy; medical travel has come under the radar of both the World Health Organization (WHO) and the World Trade Organization (WTO). Both these organizations understand that medical travel could ameliorate much of the demand-supply imbalance in global healthcare. Developed nations could benefit in terms of costs or waiting time or both coming down significantly for a major chunk of the population. Developing countries benefit as it brings revenues, upgrades infrastructure for the locals and reduces brain drain in their medical fraternities. Least developed countries too benefit as they improve upon the facilities lacking for cutting edge treatment.
A WORLDWIDE MARKET
What's called medical tourism patients going to a different country for either urgent or elective medical procedures is fast becoming a worldwide, multibillion-dollar industry. The reasons patients travel for treatment vary. Many medical tourists from the United States are seeking treatment at a quarter or sometimes even a 10th of the cost at home. From Canada, it is often people who are frustrated by long waiting times. From Great Britain, the patient can't wait for treatment by the National Health Service but also can't afford to see a physician in private practice. For others, becoming a medical tourist is a chance to combine a tropical vacation with elective or plastic surgery. And more patients are coming from poorer countries such as Bangladesh where treatment and may not be available. Medical tourism is actually thousands of years old. In ancient Greece, pilgrims and patients came from all over the Mediterranean to the sanctuary of the healing god, Asklepios, at Epidaurus. In Roman Britain, patients took the waters at a shrine at Bath, a practice that continued for 2,000 years. From the 18th century wealthy Europeans travelled to spas from Germany to the Nile. In the 21st century, relatively low-cost jet travel has taken the industry beyond the wealthy and desperate.
Countries that actively promote medical tourism include Cuba, Costa Rica, Hungary, India, Israel, Jordan, Lithuania, Malaysia and Thailand. Belgium, Poland and Singapore are now entering the field. South Africa specializes in medical safaris-visit the country for a safari, with a stopover for plastic surgery, a nose job and a chance to see lions and elephants.
CBC News Online | June 18, 2004
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ For those who plan to get a regular medical check up done, India is the ideal the place to be. With its numerous attraction one can come here with the family and combine the health check up with a pleasure trip for the family. All this is because of the enormous growth witnessed by the private sector. It was very modest in the early stages and has now become a flourishing industry with the most modern state-of-art technology at its disposal. It is estimated that 75-80% of the healthcare services and investments in India are now provided by the private sector. An added advantage that India has is that it has one of the largest congregations of pharmaceutical companies in the whole world. It is self-sufficient in drug production and exports drugs to more than 180 countries. The privatization of this sector has brought with it facilities of the star categories & world class treatments. The country now boasts a number of corporate hospitals. India is a market for professionals in the medical field for most of the renowned hospitals in the whole world. Hi-tech medical facilities have become a necessity following the consumer demand among the worlds fastest growing middle-class masses. India offers at its own doorsteps a range of world quality hospitals and treatments at a fraction of world costs with comparable success rate and service levels directly in proportion to the high value system and natural caring that comes along with its traditional heritage. Indian hospitals are now being acclaimed the world over for the standards of healthcare delivery. The country boasts of superior technology with skilled super specialists along with sound infrastructure & professional outlook. Major hospitals in Chennai, Mumbai, Hyderabad & New Delhi have recorded a 125 patient flow from the neighboring & South-East Asian countries. This is because people have realized that they can now have access to international quality medi-care at 10% of international costs in India. Technologies of the new millennium including ECG through conferencing will soon be introduced in India, making it feasible for doctors to benefit from the advice of other experts. Indian doctors recently performed the countrys first robotic heart surgery which reduces the risk and trauma associated with critical conditions.
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ Apart from that India has also become an important destination for medical conferences. Major international medical conferences on ophthalmology, oral cancer, etc. were held in India with many more on the anvil.
Country
THAILAND
Money Earned
Strength
$470m
JORDAN
126,000
Middle East
$600m
INDIA
100,000
MALAYSIA
85,000
50,000 N.A
Middle East, Bangladesh, UK, Developing countries US, Japan, developing countries US, UK Latin America
N.A
Cosmetic surgery, organ transplantations, dental treatment, joint replacement. Organ transplantation, fertility treatment, cardiac care. Cardiac care, joint replacement, Lasik
$40m
Cosmetic surgery
N.A $25m50m
Cosmetic surgery, Lasik, dental treatment Specialist niche treatment: Vitiligo, night blindness; cosmetic surgery N.A: Not available
International Conference
An international health and medical tourism conference is slated to be held towards the end of this year at Bangalore, which will see delegates from various SouthEast Asian countries, the Middle-East and even Africa participating. This will serve as an ideal platform for Incredible India to market its health and medical tourism products and services.
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Dialysis and kidney transplant Common diseases like Diabetes, Hypertension and Chronic Glomerulo-Nephritis can lead to permanent loss of renal function with Dialysis and renal transplantation being the frequent outcome. The emergence of new therapeutic interventions has created opportunities in India to manage the progression of renal diseases. For those who need replacement therapy, services like Hemodialysis, Chronic Ambulatory peritoneal dialysis (CAPD), and transplantation are also available. Patients can also avail of the Bicarbonate Dialysis facilities. The cost of getting a dialysis is around Rs.1700-1800 per dialysis. Similarly a Kidney transplant package in India is available for around Rs.3 lakh.
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ Neurosurgery & Trauma surgery Other routine procedures performed with excellent results are replacement Arthroplasties, Diagnostics and Operative Arthroscopy, spinal surgery including Harrington rod instrumentation, corrective and reconstructive procedure for poliomyelitis and cerebral palsy. In addition the advanced Luque technique is employed for the correction of complex scoliosis and decompression and stabilization of fractures of dorsal and lumbar spine by neurosurgeon with excellent training and background. Some super speciality hospitals in India like AIIMS, Ram Manohar Lohia hospital, Bombay hospital, Jaslok hospital and Apollo hospitals have advanced facilities dedicated to the treatment of entire range of brain and spinal disorders with highly experienced neurosurgeons, neurologists and neuro-anaesthetists. Joint replacement surgery Shoulder/ hip replacement and bilateral knee replacement surgery using the most advanced keyhole or endoscopic surgery and anthroscopy is done at several hospitals in India including the Apollo hospital, Delhi; Bombay hospital, Mumbai and Madras Institute of Orthopedics and Trauma Sciences. Some hospitals like Apollo in Delhi have operation theatres with laminar air flow system. A knee joint replacement costs about Rs.2 and a half lakhs in India. Refractive surgery This type of surgery is gaining popularity in India both among the public as well as the opthalmogistis. Till a few years ago only a few centers performed high volume radial keratotomy. Today, the highest international quality of eye care for cornea, cataract, squin and glaucoma is available in over 40 centers all over India. When it comes to reliability India has the best ophthalmic surgeons with clinic-academic expertise honed to perfection in the best possible institutions. The no stitch cataract surgery with the most modern way of removing cataracts through the use of phacoemulsification procedure can be performed in India for as little as Rs.20000 for both the eyes. Facilities for PRK, Myopia and astigmatism are now
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ available in almost all parts of the country. Hyperopic and LASIK are available and even supra-hard cataracts are treated using just 1mm instead of 3mm incision size.
Nuclear medicine
This is now common place, as it involves use of radioactive isotopes in very small doses in diagnosing and treatment of diseases, radioactive medicine is injected or administered orally and the distribution in the organ is scanned using a gamma camera. Various non cardiac planar/SPECT studies for bone, thyroid, liver and lung scanning functions are performed at specialized centers in India.
Cosmetic surgery A new dimension of the medical field taking off in India is the cosmetic surgery which utilizes some of the latest techniques in corrective procedures. Some disfigurations corrected include hair restoration, rhinoplasties, stalling of aging process, dermabrasions, otoplasty for protruding ears, chin and cheek enlargement, lip reductions, various types of breast surgeries and reconstructions and liposuction. Non invasive surgical procedures like streotactic radio surgery and radiotherapy for brain tumors are practiced successfully.
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According to the tenets of ayurveda, the human body comprises of five basic elements- earth, fire, water, air and ether (space). Each of these elements is also present in the atmosphere surrounding humans, and their combination affects the human body and mind. These combinations include vatadosha (ether + air, which effects the nervous system, circulation, elimination and respiration); pittadosha (fire + water, which governs digestion and metabolism) and kaphadosha (water + earth, responsible for growth as well as for immunity). Ayurveda bases itself on these three doshas, using the premise that each individual is a unique combination of the doshas, and any imbalance in this combination is the ultimate cause of all diseases. The cure for these diseases, then, lies in a customized cleansing process, tailor-made specifically for the affected individual. The cure is known as `panchkarma' and it aims to treat the disease by eliminating accumulated toxins from the body. Panchkarma can take many different forms, ranging from special diets and oil massages to therapeutic vomiting and purgation.
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ Ayurvedic treatments, if rendered properly, can be very helpful in curing a range of illnesses and physical disorders, including asthma, diabetes, obesity, skin diseases, digestive disorders, joint disorders, allergies and more. Treating diseases of a complex type will obviously take much more than a mere weekend of ayurvedic massages, but a quiet 3 days (or even a week, if you can afford to spare the time) is good enough to get a very rejuvenating taste of what ayurveda is all about.
A huge number of ayurvedic resorts and spas are mushrooming all across India, and all of them offer a tempting range of packages to choose from. Some are specifically geared towards curing certain minor ailments, although most offer a short-term but highly intensive `ayurveda package' which runs the gamut from oil massages and herbal steam baths to special diets and the pouring of medicinal oils on the forehead of the individual. Among the many places that offer excellent ayurvedic packages are: Ananda in the Himalayas Tehri Garhwal (Uttaranchal) Sereno Spa South Goa Aayurgram Ayurvedic Health Resort Bangalore Ayurveda & Yoga Retreat Coonoor (Tamilnadu) Kadavu Ayurvedic Health Centre Malappuram (Kerala) Travancore Heritage Ayurvedic Centre Chowara (Kerala) Kairali Ayurvedic Health Resort Palakkad (Kerala) Angsana Oasis Spa and Resort Bangalore Keraleeyam Ayurvedic Health Resort- Alappuzha (Kerala) Manaltheeram Ayurveda Beach Village- Chowara (Kerala)
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ HYDROTHERAPY Hydrotherapy, or water therapy as it is also known centres around (as you've probably guessed) the use of water as a healing agent. The buoyancy, viscosity and mineral components of water are used through hydrotherapy to heal or relieve ills as varied as fatigue, sore throats, colds, inflammation of the joints, jaundice, rheumatism, arthritis, spondylitis, insomnia, soft tissue injuries and even diabetes. As an alternative system of healing, hydrotherapy is one o f the oldest, safest and cheapest- which is definitely part of the reason why it's swiftly gaining in popularity. Hydrotherapy is no upstart; it's been around for more than 5,000 years, when the first mineral and thermal baths appeared in Greece.The Greeks, however, were not the only people to realize the healing powers of water. They were followed in their appreciation of the therapeutic liquid by the Romans (who are credited with having set up well-planned baths all across their empire); the Egyptians, the Japanese and the native Indian Americans. Most modern techniques borrow from both Eastern and Western forms of water therapy, and span a vast range of treatments. Basically, hydrotherapy is instrumental in stimulating blood circulation, increasing the production of stress hormones, improving the immune system and lessening pain sensitivity. The most common curative methods used in hydrotherapy include:
Cold Baths: Cold baths are used mainly as a means of stimulating blood circulation, and are also used for reducing swelling.
Steam Baths: Hot steam helps encourage sweating, which in turn opens the skin's pores, leaving the individual feeling refreshed and rejuvenated. It's not specifically healing, but it works wonders if you're feeling tired and drained, and can be an effective means of detoxification.
Neutral Baths: A neutral bath-as the name suggests- uses water that is neither hotter nor
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ colder than the temperature of the human body (cold or hot water draws or transmits heat to or from the body, as the case may be). For a neutral bath, the individual is immersed in water that is maintained at a steady temperature of between 33.5C and 35.6, for about half an hour. This has a sedative, and even soporific, effect on the patient and is used to calm the nervous system.
Floatation: As relaxing and refreshing as a neutral bath, floatation involves lying face up in a dark, enclosed tank of warm, heavily salted water. Hot and Cold Sprays: High-pressure spray jets of hot or cold water are used to heal or relieve a number of minor ailments, and mainly to stimulate organ function, the nervous system and the immune system.
Hot and Cold Compresses: Both hot as well as cold compresses actually start off as cold compresses- a cloth dipped in ice-cold water and left on the effected part of the body for a certain period of time. In the case of a cold compress, the pack is replaced by an equally cold pack once it begins to lose its chill. In the case of a hot compress, the pack is left on and allowed to heat up by the warmth of the body. Both types of compresses are used in various ways, especially to treat acute injuries.
Ice Packs: Ice packs- which contain crushed ice or a special gel- are applied to the body to reduce swelling, pain and inflammation.
Wet Sheet Packs: A wet sheet pack (also known as bodies wrap) is, as the name suggests, a procedure in which the entire body is wrapped in a cold, wet sheet that is in turn covered with a woolen blanket. The sheet is left in place until it dries by the warmth of the body (usually about half an hour to relieve a fever; longer to relax and soothe the body; or up to 3 hours to induce sweating, which can be a good detoxification method for those with drinking or smoking problems). Among the spas in India that offer hydrotherapy treatments are: Ananda in the Himalayas Tehri Garhwal (Uttaranchal)
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Spa Aguada Goa Angsana Oasis Spa and Resort Bangalore The Leela Palace Bangalore Golden Palms Spa and Resort Bangalore
YOGA Yoga, now recognized globally as a highly effective form of alternative medicine, originated in India about 5,000 years ago as a discipline that sought to unite the moral, mental and physical aspects of human life to contribute to the overall wellness of the individual. Yoga is believed to have been propounded by the sage Patanjali (2nd century BC). Patanjali, in his treatise (known as the sutras) of yoga, explained the basics of yoga, its benefits and its steps (padas), without going into the details of what postures to adopt, how to breathe and so on.
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HEALTH CHECK-UP
Many common and life threatening conditions can be treated successfully if detected early. Many leading hospitals in India have health check-up programs that screen every part of the body meticulously and professionally. A proper health check-up scans your bio-history, interprets signal and provides the opportunity for the proverbial stitch in time. A heart check-up constituting of echocardiography, consultation by a senior cardiologists, blood tests, general test & haemogram can go long way in ensuring a healthy heart. The test can be done at any of the leading cardiac hospitals or private clinics. A comprehensive health check-up contains the following tests; Doctors consultation and full medical examination Blood tests Complete haemogram Blood group Blood sugar Blood urea serum uric acid Serum creatinine Serum cholesterol Lipid profile Urine and faeces examination X-ray chest PA ECG Exercise stress test (tmt) Stress screening by psychologist Rye examination Gynecologist consultation and PAP smear test Post check-up consultation Optional tests
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ Some additional tests my be advised by your doctor like Pulmonary function test Ultra sound screening for the abdomen ENT examination Screening for liver disease Screening for thyroid disease Hepatitis B screening Test for AIDS Screening for Kidney disease
These tests can be done in leading private and public hospitals. The full health check-up package costs between Rs.2000-2500.
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ the government to provide affordable medical care. It thus attracts only a small fraction that can pay for medical care and leaves out large sections that are denied medical care but cannot afford to pay. The demand for cost effective specialized care is coming from the developed countries where there has been a decline in public spending and rise in life expectancy and non-communicable diseases that requires specialist services.
Knee surgery
$7,500
$60,000
Dental care Tooth extraction Two dental bridges Filling Root canal
(Figures are estimated, are in U.S. dollars or U.K. pounds, figures vary due to prices charged by different medical centres and patient profile and do not include travel and accommodation costs) - Sources CBC News Online | June 18, 2004
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Medical Tourism in Kerala Kerala is already marketed as a health destination mainly for its Ayurveda packages Medical tourism is marketed along with ayurveda and to her health packages. Major hospitals like KIMS, Trivandrum, Lake Shore and AIMS in Kochi, and MIMS, Calicut have pioneered joining hands with the
Government promoting Medical Tourism. Globalization and economic liberalization have given a boost to the specialized Medical Service Sector Health Insurance Companies are playing a major Kerala pioneered health and role in Medical Tourism. medical tourism in India through Ayurveda
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ Medical Tourism Product Medical tourism is like any leisure product where service components like airlines, hotels, travel companies, transportation, food outlets are offered and medical treatment at the best hospitals The medical treatment for various ailments are packaged with recuperative leisure packages at world class tourist resorts.
Kerala a Medical Tourism Destination Well connected by Air from major medical tourism markets in the Middle East European markets and South Asia Moderate weather throughout the year Advanced and sophisticated hospitals of International standards located in Kerala. Renowned doctors specialized in almost all major disciplines. Trained paramedical staff and technicians available in Kerala Easier communication with majority English speaking public The higher hygienic standards of Kerala The developed tourism industry in Kerala with its array of high quality resorts and hotels. Ideal setting for an excellent recuperative holiday Medical tourism packages offered and marketed by tour operators joining hands with excellent hospitals Incredibly competitive cost for packages of medical treatment and surgery compared to other countries Honoring of medical insurance by hospitals in Kerala Marketed efficiently in source markets
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ Distribution - Medical Tourism packages Distributed widely and brought to the doorstep of the customers by the tourism industry. Made available through major tour operators. They sell it as other holiday packages. Made it easy for the patients. The Department of Tourism, Kerala pioneered in promoting Kerala as a medical tourism destination in the International market. The Great India Tour Company (GITC) launched special medical tourism packages under brand name Heavenly Healing in the international tourism marts in association with Kerala Institute of Medical Sciences (KIMS).
The package Medical history emailed and discussed Patient received at the airport, an escort takes over. Transferred to a hotel or resort. Escort takes the patient to the hospital as per appointment with doctor and admits into the hospital. Surgery or treatment conducted. Discharge and recuperative holiday at a resort. Post treatment check up, transfer to airport and departure. Billed as a package all inclusive for the patient and accompanying person.
Demand for treatment in Kerala There is an existing demand for treatment, from countries like Maldives, Bangladesh, Gulf countries and some European countries. European Countries are finding it difficult to offer surgeries in time, due to heavy wait-list. The Non-Resident Keralites are good spokespersons in the originating countries and prefer their home country for treatment. International Corporate houses offer medical treatment facilities to the employees and family / are focusing cost effective options.
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ Some Health indicators of Kerala A well quoted & most discussed phenomenon Population density - 819 per sq km Annual Per capita income Rs 17,756 (national avg - Rs 14,712) Sex ratio - 1036 females to 1000 males Population growth rate 9.4 % Low infant and child mortality - Infant Mortality Rate <12 High life expectancy at birth - Life expectancy 75yrs Virtual elimination of many communicable diseases Replacement level birth rate in many districts Birth rate 18.2 per 1000 Death rate 6.2 per 1000 Maternal mortality rate - <2 per 1000 Per capita expenditure on health care by Kerala population - 11.95 compared to the all India figure of 6 %.
Health-care Infrastructure Bed availability - 377 per 1000 population Kerala spends > 9% of the State GDP on health Kerala Health Sector Private sector dominates with 70% share on health care Health Insurance < 9 % covered
Synergy between Hospitals and an active Tourism Industry Growing tourism industry in Kerala enhances the quality professional services in this sector. Availability of excellent hotels, resorts at beaches, backwaters, hills, plantations managed professionally Patients feel happy having experienced a dream destination like Kerala.
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ Kerala poised for a leap in Medical Tourism Hospitals are joining hands with tourism industry for services. Government has taken it up as a new thrust-area in Tourism, marketing the concept. Private sector is enthusiastic in selling the services. Trained youth entering the industry in big numbers. Better sharing and dissemination of information on health management through internet and satellite channels. State is technology savvy, utilizing video conferencing with experts and other modern communication facilities.
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ Social and Cultural Rights. The governments own studies and reports reveal the pathetic state of the public health care system in both rural and urban areas and yet the government chooses to rub shoulders with FICCI to promote private business interests in the health sector. The setting up of this council is driven by two business factors. First the idle capacity of these large elite hospitals and second the long waiting lists for selective surgeries and medical procedures in the developed world. . So I would like to urge the Maharashtra government to stay out of this and take to task these very hospitals enlisted on the MTMC website to honour their commitments as trust hospitals using their idle capacity for treating the poor free of cost as mandated by the Trust Act, and provide free diagnostic services using equipment which was imported with duty concessions. So instead of seeking export revenues, the state should be looking at generating revenues by demanding accountability from these hospitals. These should form the benchmarks and best practices which Sushil Kumar Shinde referred to in his statement during the inauguration of the Council and should be of concern to the state government. The author is co-ordinator with Centre for Enquiry into Health and Allied Themes, Mumbai
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ Yes, it can revolutionise public health care scenario Anupam Verma Public hospitals present a very strong case in being a part of the Maharashtra Medical Tourism Council. These hospitals have professionals who have, perhaps, the maximum exposure to diseases and ailments; a record number of procedures are performed by them and are recognised worldwide for their competence. Once this competency is leveraged, by seed investments in technology and ambience oriented infrastructure, they can be attractive for the foreign tourists. Then arises the question- whether they should participate in the Council? According to me, why not? The critics fail to see the in-built advantages for the Indian society if public hospitals participate in this exercise actively. A parallel revenue stream, apart from the taxpayers money, can bring about a revolution in the Indian public health care scenario. Today, the public health sector and related institutions are suffering because of budgetary constraints. Look at the possibility of the public hospitals being technologically upgraded to world class standards with this possible source of income. Also, with exposure to the paid medical service market, the spirit of competition will germinate in the public hospitals, which will enhance their efficiency, service delivery levels and subsequently their image. Medical tourism is not about primary and secondary health care in our villages and towns, it is also not about critical care and emergencies. So the argument that millions would be deprived of public facilities does not hold water. Hence all these segments will remain unaffected by the surge of medical tourists in public hospitals. In the present form, medical tourism concept in India is based on leveraging the cost differentials of medical treatment by the foreign nationals, or Indian system of medicine, or recuperation and rehabilitation. This is only possible in planned treatments and procedures and to some extent, preventive care and diagnostics. Thus, with the kind of resource inflow envisaged because of tourism, things can only improve in public hospitals. Therefore, an approach to attract medical tourists, in medium and long run, will be beneficial to Indian society at large.
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ of by the hospital itself. The group has tied up with hotels in Delhi for this purpose. According to Dr Chabra, additional medical director, ISIC (Indian Spinal Injury Centre), ISIC is another destination for patients from neighbouring countries, Gulf and a few NRIs from the US. Now, to attract more people, the emphasis is on vacation plus treatment and special packages have been planned for this. On the anvil is another plan to make the patients and their relatives stay in the hospital complex with all the luxuries a hotel provides. Dr Shakti Gupta, AIIMS, stresses on the need to export health services. According to him, Indian doctors, medical services, and hospitals are at par with good hospitals in Europe and the US, so it is the right time to make the most of it. AIIMS is a destination for patients from Nepal, Bangladesh, Bhutan, Myanmar, Mauritius, Malaya and Pakistan. Besides regular patients from the Middle-East, an occasional patient from the US drops in. Patients from Pakistan, especially children with heart afflictions, have been regularly coming to AIIMS heart centre. According to Dr Gupta, AIIMS was made for the entire south-east Asia populace and since it is a government institute there are no plans to attract more foreigners. The attractions at AIIMS include cardiac surgery, neurosurgery, cancer treatment and ophthalmic procedures. The services are charged on actuals and ours being a government institute we are not angling to make money but are here to serve the people, stressed Dr Gupta. The Metro hospitals and Heart Institute, Noida, also manages to attract patients from Nepal, Bhutan, Sri Lanka, Bangladesh and a few from Maldives and the Gulf region. Their motto is to extend excellent health services to people who travel here for health care and also for tourists who need health care while their stay in India. Indian hospitals getting recognition from international insurance companies will bring in more patients from abroad, says Anil K Maini, head, marketing, health care business, Escorts Heart Institute and Research Centre. The centre is emerging fast as a favourite destination for patients from neighbouring countries, Africa and CIS. With BUPA recognition, patients from the UK are coming here for treatment. About 1,000 patients from abroad are treated in Escorts on an annual basis.
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ Although only a few hospitals are making conscious efforts to increase the existing inflow of health tourists, nobody denies the huge potential medical tourism has. And it will not be long before its full potential is realised, provided we cultivate the service mind set, put in place an accreditation system and project our capabilities overseas through multiple media.
PROVIDER NAME Jeevan Anmol hospital G.M.Modi hospital Indraprastha Apollo hospital Tirath Ram Shah hospital Sitaram Bhartia Institute of Science & Research Batra hospital and Medical Research Centre Pushpanjali Medical Centre Rajiv Gandhi Cancer Institute & Research Centre M.G.S hospital (Delhi) Rockland hospital Sonia hospital (Delhi) Veeranwali International hospital
ADDRESS Mayur Vihar Phase-I, Opp.Pratap Nagar Mandir Marg, Saket Sarita Vihar, Mathura Road Sawhnex Marg, Rajpur Road B-16, Mehrauli Industrial Area 1,Tuglauabad Institutional Area A-14/15, Pushpanjali Vikas Marg Extn D-18, Sector V, Rohini 35/37 Rohtak Road, Punjabi Baug Tara Cresent Road Nangloi National Highway No.10 Chandragupta Marg, Chanakyapuri
PIN CODE 110091 110017 110044 110054 110016 110062 110092 110085 110026 110016 110041 110021
BED CAPACITY 125 100 600 183 64 310 60 160 100 130 65 70
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MUMBAI:
STRENGTH
Expertise and skill The city boasts of doctors and nursing staff whose expertise is comparable with
international standards. And, as Dr. Nilima Kshirsagar, dean of KEM Hospital, puts its, Real medicine is provided speedily and efficiently.
Extensive infrastructure Mumbai has one of the largest healthcare facilities run by the Municipal
Corporation, state government, charitable trusts and private owners. Official estimates say the city has 33000 beds, four tertiary care hospitals, several peripheral hospitals. Several speciality and superspeciality hospitals are spread across town, from Mulund in the north to south Mumbai. State-of-the-art equipment is available at most private hospitals as well as a handful of public hospitals.
Several tourist destinations nearby Maharashtra is dotted with tourist destinations. Packages can be developed to lure
patients. As state Health Minister Digvijay Khanvilkar had in an earlier interview said: Even in these places, our rural and primary healthcare facilities are in place.
Last word For it to work, we have to develop products not only related to healthcare but
also tourism. But they should have a USP and be cost advantageous. There is nothing wrong with such a plan for all economies work on cross subsidy and it can be the same here too. Interaction with foreign patients will also improve quality of treatment, says Brigadier Joe Curian, CEO of S L Raheja Hospital.
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ Comparative cost A knee replacement that costs $6000(Rs.2.73 lakh) in India would cost $10000(Rs.4.55 lakh) in the UK. A cardiac bypass costing $15000(Rs.6.82 lakh) in the UK would cost up to Rs.3 lakh here.
WEAKNESS
conditions that public hospitals work under, its unlikely that foreigners would consider them. Most charitable hospitals have over half their beds vacant. And the charity commissioner is doing nothing about it, says Ravi Duggal of centre for Enquiry into health and Allied Themes (CEHAT)
Lack of funds Even though the government aims to bring public hospitals under the purview of
health tourism, there is an urgent need for facilities, If we want to lure people from abroad, we have to create facilities similar to that of nursing homes, says Kshirsagar. The only void is the marketing of public hospitals, says Sushil Jiwarajka, chairman (western zone), FICCI.
Costlier than other cities Where Mumbai is likely to lose out is cost of treatment. A bypass in Mumbai is
nearly comparable with cities like Delhi and Chennai costing up to Rs.3 lakh in public hospitals. In Kolkata it costs between Rs.1.12 lakh and Rs.1.33 lakh at a leading hospital. A caesarean costs over Rs.50000 in a few hospitals, while in Bangalore it costs Rs.23900.
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ Last word In a city where people are dying of dengue and falciparum malaria, it shows how disassociated the government is about ground realities. It is nothing but a political ploy, says Dr. Arun Bal, of Association for consumer Action for safety and health (ACASH).
HOSPITAL Asian Heart Institute Bhagwati Hospital Bhaktivedanta Hospital Bhatia Hospital Bombay Hospital Breach Candy Hospital and Research Center Cooper Hospital Guru Nanak Hospital Hinduja Hospital J.J Hospital Jaslok Hospital K.E.M Hospital Lilavati Hospital Nair Hospital Nanavati Hospital Tata Memorial Hospital Wockhard Hospital Limited
ADDRESS AREA BED CAPACITY Bandra (East) Borivali Mira Road Grant Road Marine Lines Breach Candy 175 Vile Parle Bandra (East) 150 Mahim 350 Byculla Peddar Road 377 Parel Bandra Recl. 300 Mumbai Central Vile Parle 400 Parel Mulund 222
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PUNE:
It was economical for Robert Dunn to fly from London to Pune for a knee replacement surgery. What would have cost him Rs 15 lakh in Britain was done at a minimal cost of Rs 1.95 lakh in Pune. Whats more, Sancheti Hospitals Medical Tourism Department took care of all his demands and ensured that his 17-day stay was an unforgettable experience. People seeking health solutions for their ailments from various countries have travelled to India and Pune over the last few years. But the inflow of patients has increased not only from countries like the Middle East and Africa but Europe as well, says Manish Sanghvi, Director, Administration at Sancheti Hospital and in charge of the newly set up Medical Tourism Department that will cater exclusively to international patients. The hospital has an average of 7-8 patients per month from overseas, says Sanghvi, adding that in the last four years at least 250 international patients have been treated. The patients mainly seek treatment for joint- related problems at the orthopaedic specialty hospital. According to Sanghvi, the hospital has even prepared a medical tourism package that organises sightseeing tours to tourist spots in the city and elsewhere. Sanghvi even recalls that one family flew down from Kenya for the knee replacement surgery of their father. They wanted to go to Agra to see the Taj Mahal while the kids wanted to hang out at the pubs. While their father was recuperating, family members decided to make the most of their stay in Pune,says Sanghvi. The hospitals medical tourism department arranged everything and their months stay cost them just Rs 6-7 lakh. He pointed out that the hospital was leaving no stone unturned to woo medical tourists. Recent reports have revealed that by 2012, medical tourism in India would be a Rs 10,000 crore opportunity. Our treatment is not just about new technologies and good doctors. It is also about family values and genuine concern for our patients, insists Sanghvi. While international patients are always suspicious regarding the treatment, Sanghvi pointed out that the hospital adheres to a strict protocol regarding such patients.
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ Joint replacement surgeries at Sancheti Hospital cost one tenth of the bill a person pays in Western countries, he pointed out. - Sources Express News Service
PROVIDER NAME Grant Medical Foundation Ruby Hall Clinic Lokmanya hospital Foundation Nigadi Lokmanya hospital Foundation Chinchwad Sanjeevan hospital (Jnana Prabodhini Medical Trust) Sancheti hospital Sane Guruji Arogya Kendra Deenanath Mangeshkar hospital Kotbagi hospital Niramaya hospital
ADDRESS Ruby Hall Clinic, 40, Sassoon Road Regd. Public Charitable Trust No. E-528, Chinchwad Erandwane, off. Karve Road
411033 411004
50 103 125
16 ,Shivajinagar Hadapser 8/13- 2, Erandwane, Near Himalya Society 163, D.P.Road, Aundh Mumbai Pune Road,S.No.4742, Next To Chinchwad (E)Post Office 32, Sassoon Road
411001
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1. Have you heard about the term Medial Tourism? Yes-88% No-12%
Majority of the people have heard about the term Medical Tourism which means that there is awareness amongst the general public about this field.
2. Has any one of your near one been to a foreign country for treatment purposes? Yes-48% No-52%
3. Do you know about celebrities traveling to the US for medical treatments? Yes-92% No-8%
The above questions (1 & 2) were asked to check the awareness of the people expressed in Q1 and the answer supported their views.
The question confirms the faith of the general public in a single medical professional for their treatments.
5. How often do you undergo health check-ups? Once a Year-48% Twice a Year-12% The answer reflects a mixed response of the general public about their own health. Never-40%
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6. Which state in India is famous for Ayurvedic treatments? Maharashtra-0% Rajashthan-0% Goa-24% Kerala-76%
The above answer coveys that people are aware about which state is famous for Ayurvedic treatment.
7. Which of these is a traditional Indian form of healing? Accupuncture-8% Reiki-8% The answer above conveys that the general public has awareness about the traditional methods of healing that are currently in demand amongst the popular states of India. Yoga-84%
8. How would you grade these hospitals of Mumbai from 1 to 4? Hinduja Lilavathi Breach Candy Tata Memorial
In this case 40% f the people have rated Breach Candy hospital as the No.1 hospital which shows that people are aware of the standards of the hospitals in their city.
9. Unfortunately, if anybody in your relation faces a major ailment would you suggest him/her to undergo treatment in a foreign country? Yes-72% No-28%
The above answer expresses that Indians have a fair amount of faith in Indias healthcare system.
10. Do you think India has the potential to become a forerunner in Medical Tourism? Yes-56% No-44%
This answer has evoked a feeling of mixed response among the general public about Indias capacity to become a good healthcare destination.
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ As Indian corporate hospitals are on par, if not better than the best hospitals in Thailand, Singapore, etc there is scope for improvement, and the country may become a preferred medical destination. This can be done through an orchestrated effort by the Centre, airlines, travel houses, insurance companies, tourism sector and healthcare providers, says Ms Anjali Kapoor, Head-International Marketing of Indrasprastha Apollo Hospitals, New Delhi. While accreditation from an international body such as the Joint Commission International (JCI) facilitates better response from Europe and the US, recognition from the National Health Services (NHS) ensures international standards in terms of patient care, quality improvement and patient safety. The Apollo Hospitals Group is in the process of getting accredited with JCI, she said. Indian corporate hospitals excelled in cardiology and cardiothoracic surgery, joint replacement, orthopaedic surgery, gastroenterology, ophthalmology, transplants and urology to name a few, said Dr Ravindranath. The CARE Hospitals, which has specialised in heartcare, has concentrated on drawing patients from the Gulf and at least 50 were treated last year, said a hospital spokesperson. In addition to the increasingly top class medical care, a big draw for foreign patients is also the very minimal or hardly any waitlist as is common in European or American hospitals. In fact, priority treatment is provided today in Indian hospitals.
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ In addition, public spending could double from Rs. 170 billion if the government reaches its target spending of 2 percent of the GDP, up from the current 0.9 percent. Along with the expected increase in the pharmaceutical market, the total healthcare market could rise from Rs. 1.03 trillion currently (5.2 percent of GDP) to between Rs. 2.32 trillion and Rs. 3.2 trillion by 2012. While there is a tremendous stock of intellectual capital in healthcare and with state-of-the-art treatment and world-class surgery available in the country, the system in India faces some lacunae, the CII-McKinsey study added. "There is a pressing need for qualified specialist nurses and paramedics and qualified hospital administrators. Several private hospitals have invested in nursing education, but are concerned about loyalty as trained nurses often leave India, attracted by the higher wages offered in the Gulf countries." It said specialist nurse training would become vital as the number of single-super speciality and multi-super speciality hospitals increased. Standardisation and accreditation of hospitals as also better information management are other aspects, the study highlighted. By efficiently harnessing technology, medical professionals can now consult specialists anywhere across the globe, send images and have video-conferencing to arrive at a decision for complicated cases, it said. On the importance of health insurance, the study pointed out that the number is rising rapidly from less than 10 percent coverage. "Insurance would be the main driver for raising quality consciousness and increased demand for better standards, hospital accreditation and patient-management information systems." Currently, the voluntary health insurance market is estimated at Rs.4 billion but it is growing fast. Industry expects it to touch Rs.130 billion by 2005. Treatment Costs ($)* PROCEDURE US INDIA SOUTH AFRICA THAILAND Facelift 8,000-20,000 10,000-20,000 1,252 2,682 Hip replacement 17,000 2,500 6,671 N.A Open heart surgery 150,000 5,000-10,000 13,333 7,500 Eye (Lasik) 3,100 7,000 2,166 730 * All costs are average estimates - sources Business world Note: Not to be printed without permission 50
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ Dentistry is another branch of medical science that has many takers abroad owing to two reasons. Firstlym owing to the high cost involved in a dental check-up as well as the fact that it is not covered under the health insurance scheme of the governments. According to Dr Vivek Saggar, dentist, who runs a clinic in the city and has been advocating the cause of medical tourism, apart from the specialised treatments, the overseas patients also come to get their regular dental check-ups done. Not only is the cost one tenth but the fact that here we talk about the problem first and insurance later, makes it a more comfortable option as well, he said. According to Dr Sandeep Puri, Medical Superintendent, DMC, though the hospital has been receiving calls from NRIs enquiring about the specialised services pertaining to dialysis and other specialised services, it is yet to execute its plans on medical tourism. Though we have routine NRI patients complaining of medical problems encountered on their visit to the city, we are yet to put together the plans on medical tourism, he said. For Hari Narayan Singh, an NRI based in Canada, who had come to the city to get treated for enlarged prostrate and utheral stricture, a visit here has saved six months of pain and burden of a due operation. If I had not come to CMC, I would have had to wait for six months to get operated upon in Canada, he said. Similar is the experience of S.S. Grewal, also an Indian based in Canada, who is in the city to get treated for a cancerous growth.
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CASE STUDY
Cyril parry waited for a very long time for his turn to come. The 59-year-old retiree from Birmingham, UK, was suffering from rheumatoid-arthritis. He needed a hip replacement operation urgently. He waited patiently though his pain was getting worse and his pain was getting worse and his movements increasingly restricted. Unfortunately, parry was stuck at the end of a very long queue. The overburdened National Health Service orthopaedic surgeons in the UK were booked solid for several years. Finally, Parry was told that his turn would come four years and nine months down the line. That was when Parry started surfing the net to see if he could get his hip surgery done elsewhere in the world. After a full year of research, he shortlisted two destinations: a hospital in Thailand and Apollo speciality Hospital, Chennai. In November this year, Parry opted for the latter because, at 4,000 (excluding airfare but inclusive of a 10-day stay, post-operative care and a full health check-up), it was almost 5,000 cheaper than the Thai option. It was ironic that Parry needed to travel abroad for his treatment. He was, after all, undergoing a procedure called the Birmingham Hip Resurfing a new technique considered as a superior alternative to the full-hip replacement surgery, and named after the city it was pioneered in. It was perfected at the royal Orthopedic Hospital in Birmingham as recently as 1998. Cyril Parry needed to travel because of the healthcare system followed in the UK which is creating long waiting lists of patients in that country. More on that later. But long waiting lists are not the only reason that theres been a huge surge in medical travel globally in recent years. Patients from rich countries in the Middle East travel to the US when they need top notch developing nations such as Nigeria or Bangladesh travel to their more developed neighbours for medical treatment because there arent enough good facilities available in their own countries. Thousands of Japanese citizens seeking medical treatment fly abroad because of the prohibitive costs of treatment in their home country. Americans seeking cosmetic surgery often fly to South Africa for face tucks and breast augmentation because their insurance coverage doesnt pay for those and it is cheaper to get them done in South Africa than back home.
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NEW EMERGING DESTINATION OF MEDICAL TOURISM OTHER THAN INDIA JORDAN THE FRIENDLY NEIGHBOURING DOCTOR
Jordan stumbled upon the medical travel opportunity quite by accident. After 9/11, it found that a vast number of patients from its neighbouring countries, who had otherwise been traveling to the US for treatment, started coming to Jordan. That was when this Middle Eastern country launched a massive investment progamme to upgrade and modernize its public hospitals and medical schools. It helped that Jordan already had fairly good healthcare infrastructure, especially when compared with its neighbours. With around 10000 doctors, 33 private hospitals and 2000-odd beds, it is unlikely that Jordan will be a really big healthcare destination of the like of, say, Thailand, or even India. But what matters is that Jordan attracts a lot of Arab Patients from nations like Yemen, Oman and Syria. They come in for everything from infertility treatments to organ transplants. So, even though Jordan treated only 126,000 or so foreign patients last year, it earned almost $500 million roughly the amount that Thailand earned from 800,000 medical travelers. Two years ago, Jordan set up a special counter at its Queen Alia International Airport to meet Arab patients and offer them a string of free services including transportation to hospitals. A Jordanian minister in an interview sometime back pointed out that when Arab patients come to Jordan for treatment, they typically come with their families. That is why everyone from hotels to taxi drivers benefit from medical tourists. Jordan has now set a target of $1billion from medical travel in the next couple of years. It is likely to have competition from its neighbours though. Both Saudi Arabia and Bahrain are also seriously looking at the medical travel opportunity.
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ The Japanese still form the biggest chunk of medical travelers coming to Thailand, though the Americans and the British are now coming in significant numbers. After 9/11, it also got a huge share of the Arab traffic.
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INDIA FAR CHEAPER THAN THAILAND Today, the medical tourism market in India is worth US$ 333 million.
A liver transplant costs US$ 500,000 in the west, in Delhi, it is being done for US$ 40,000. Cost of medical treatment in India across a whole category of surgeries is substantially lower than Thailand. It is the next big success story out of India. Five years ago, less than 10,000 patients visited India for medical treatment. Today, the medical tourism market in India is worth US$ 333 million with about 100,000 foreign patients coming in every year. Apollo Group Chairman Pratap Reddy estimates that one out of every ten patients treated at his hospitals is from overseas and with an annual growth rate of 30 per cent, India is already inching closer to Singapore, an established medicare hub that attracts 150,000 medical tourists a year. Hospitals in India are doing the latest surgeries, at low cost. In the west, a bone marrow transplant costs US$ 400,000. A similar transplant in Chennai costs US$ 30,000. A liver transplant costs US$ 500,000 in the west, in Delhi, it is being done for US$ 40,000. An MRI of the wrist, for instance, costs just US$ 155 in India while the same can set a patient back by US$ 1600 at a private hospital in Hong Kong. An open-heart procedure at a top hospital in the country would cost the patient around US$ 5000 as against US$ 50,000 abroad. Similarly, neurosurgery in the country costs around US$ 8,000 as compared with US$ 29,000 in the US. A root canal procedure by a dentist in Mumbai would cost about US$ 20 as against US$ 100 in the US. Also in the US, a knee joint replacement would costUS$16000 in the US as compared to US$ 4500 in India. India and Thailand are being portrayed as emerging global hubs for low cost medical care. Media prefers to put India and Thailand in the same cost bracket. Yet, a careful scrutiny of expenses in both countries shows that the cost of medical treatment in India across a whole category of surgeries is substantially lower than Thailand. Thailand has a cost advantage over India in only two categories: plastic surgery and breast
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ augmentation. India is cheaper than Thailand across a whole range of other, and more serious, surgery categories as the following chart shows.
INDIA IS FAR CHEAPER THAN THAILAND SURGERY THAILAND INDIA Bone Marrow Transplant 62500 30000 Liver Transplant 75000 40000 Open Heart Surgery (CABG) 14250 4400 Hip Replacement 6900 4500 Knee Surgery 7000 4500 Hysterectomy 2012 511 Gall Bladder Removal 1755 555 *All figures in US$. The Indian costs are based on the average rates offered by top Indian hospitals like Escorts Heart Institute, Apollo Hospitals and Batra Hospital. The Thailand rates are based on rates provided by Bumrungrad Hospital, Bangkok, which is Thailand's largest private hospital. A joint study by the Confederation of Indian Industry and McKinsey & Co. shows that at the current pace of growth, healthcare tourism alone can rake in over US$ 2 billion as additional revenue by 2012. The Government of India seems to be going along with this projection. In March last year, Finance Minister Jaswant Singh spoke about making India a global health destination, and listed a slew of economic incentives for private hospital groups to create and upgrade infrastructure, as well as reduce their operational costs. He provided tax sops to financial institutions lending to private groups setting up hospitals with 100 or more beds. He also increased the rate of depreciation from 25 per cent to 40 per cent for life-saving medical equipment. Now, state governments, private hospital groups, and even travel agencies have all cottoned on to the trend.
For example, leading Indian travel houses like Sita and Kuoni have launched tie-ups with overseas players that focus on medical tourism. The Karnataka Government is setting up Bangalore International Health City Corporation, which will cater to international patients for a wide variety of health care products and treatments.
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ The Asian Heart Institute at Mumbai's Bandra-Kurla Complex, offers state-of-the art facilities for all types of heart complications. It has been set up in collaboration with the Cleveland Institute, USA and offers 'five-star' services at a reasonable cost. While people have long travelled to Thailand for nose jobs, tummy tucks and breast enhancement, India is creating a niche to emerge as a hub for life-saving surgery. And though the bulk of the demand comes from the 20 million strong Non Resident Indian community, India can attract ethnic foreigners in large numbers if it manages to effectively market its strengths abroad. Besides low costs, there are two other unique selling propositions that India has to offer: 1. High success rates 2. Growing credibility. Indian specialists have performed over 500,000 major surgeries and over a million other surgical procedures including cardio-thoracic, neurological and cancer surgeries, with success rates at par with international standards. The success rate in the 43,000 cardiac surgeries till 2002 was 98.5 per cent. India's success in 110 bone marrow transplants is 80 per cent. The success rate in 6,000 renal transplants is 95 per cent. India's independent credit rating agency CRISIL has already assigned grade A rating to super specialty hospitals like Escorts and multi specialty hospitals like Apollo But the fact is that it is international credibility that counts more in the medical tourism sweepstakes. NHS of the UK has indicated that India is a favoured destination for surgeries. The British Standards Institute has now accredited the Delhi based Escorts Hospital. Apollo Group - India's largest private hospital chain and Escorts Hospital are now seeking certification from the US based Joint Commission on Accreditation of Healthcare Organisations. Without doubt, India is not about nip and tuck medical tourism. It's about making a real difference in the global healthcare value chain. The Asian Heart Institute in Mumbai set up in collaboration with the Cleveland Institute, USA offers India is creating a niche to emerge as a hub for life-saving surgery. NHS of the UK has indicated that India is a favorable destination for surgeries.
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The state government has been talking about health tourism for quite a while but nothing has really come of it so far. Will the MTCH yield any results? Well see results soon. Given the involvement of the central and state governments, Federation of Industrial Chambers of commerce and Industry (FICCI), health tourism will definitely take off. This is only the starting point. Mumbai and Maharashtra have some of the best doctors and by upgrading existing facilities it is possible to have an excellent health tourism programme in place. How much revenue is it likely to generate? At this moment, its difficult for me to give an estimate. Will medical tourism promotion be restricted to private hospitals or will public hospitals be brought under its purview? Public hospitals will also come under medical tourism. As a matter of fact, we have excellent facilities in placeslike in Pune, Kolhapur and Mumbai. By upgrading facilities, public hospitals can be very much part of medical tourism. Besides, they have excellent staff. Isnt it a bit far-fetched to have patients who come for treatment go for short holidays nearby? We have our rural and primary healthcare facilities very much in place, which should be able to take care of things. If necessary, we can fly them down to major medical establishments. Dont you think that more than launching websites and road shows abroad to promote health tourism, the need of the hour is aggressive marketing and up gradation of facilities? Marketing is indeed very important and well be doing it. But we are working towards improving our medical facilities. - December 2003 Bombay Times, Times of India
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CONCLUSION COUNTER-PLAN
(To tap medical tourism in India) A $40 billion plus market worldwide growing at over 20% a year throws up huge opportunities for anyone smart enough to tap it. India has the entire base and infrastructure required to build-up a strong brand value for itself amongst the international community as a top class healthcare destination. But now depends wholly on how the coordination takes place to tap-in this sector. Some following conclusions as seen after reviewing the entire healthcare situation in India by me can be considered as important steps to improve the Indian Medical Tourism situation. 1. There should be a central regulatory authority to plan-up the Infrastructure development and other issues regarding medical tourism. 2. The sector of medical tourism should be regarded as a totally separate entity other than the regular tourism activities by the central regulatory authority. 3. There should be no sort of red-tapism involved in this sector In the true sense of the word. 4. A great edge has been provided to India by the private sector which has professional management. This sector should be secured respectfully and should be boosted through attractive incentives by government authorities to achieve high valued profits. 5. A study showed without any concentrated and combined efforts up to 1 lakh plus medical travelers visited India during the last year. This shows that there should be a real concerted effort by each segment of the Indian medical sector-Indian. 6. The biggest reason why people travel to India for treatments are the comparatively low cost which should be maintained throughout. 7. India should be marketed as a Healthcare Destination projecting its conventional as well as traditional methods of healing and treatments. 8. India should also attract hordes of tourists by providing information to the foreign medical tourists about the very low costs offered for various treatments through various mediums.
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ 9. Along with these efforts the places of tourist interests in and around the medical destination should be developed well to increase the tourist influx to such places. 10. Various competent hospitals should work according to the international standards & should try and acquire international certification and accreditation.
Thus all in all for the sector of medical tourism to come out in flying colors India needs to develop products related not only to healthcare but also tourism. But they should have a UPS and be cost advantageous. Interaction with foreign patients will also improve the quality & the costs of treatment.
HEALTHCARE
The size of Indias healthcare industry is worth US$ 20 billion. In India, 12 per cent of the national annual expenditure is on healthcare. Of this, 82 per cent of the total health expenditure comes from the self-paid category, while employers account for 9 per cent and insurance covers 5 per cent of the total healthcare expenses. Indias expenditure on health is relatively high when compared to other developing countries. The chart on left compares Indias expenditure to other countries. The rise in the literacy rate, higher levels of income and an increased awareness through enhanced media campaign has led to health receiving greater attention and a preference for private services.
Individual private practitioners providing medical prescriptions and basic healthcare services; Small nursing homes with bed capacity ranging from 5-100 beds primarily concentrated in urban areas
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Medical Tourism Uploaded by Nihit for http://www.linny.org/forum/ As per the 52nd Round of National Sample survey Organisation, 81% of the outpatient care and 56% of inpatient care is being provided by the private sector in the country. Large hospitals run by trusts or corporates that are located primarily in cities and towns across the country. The 1990s have seen significant entry of Indian companies in medical care. Most of these players have focused on large, single or multi-specialty facilities located in large cities. These include Apollo, Fortis, Max, Wockhardt and Escorts, among others. Leveraging Indias IT strengths, telemedicine is being tried out at a few hospitals. This holds promising potential for providing quality medical care even in remote parts of the country.
Opportunities
Healthcare is expected to be one of Indias largest industries in the near term with present growth rates of around 13 per cent annually. Further, India needs to add 80,000 hospital beds a year for the next 5 years according to a WHO report. The opening up of the insurance sector to private players is expected to further boost the healthcare industry. Health Insurance will make healthcare affordable to a large number of people. There is an increasing preference for private medical care amongst the urban population. The National Health Policy (NHP) 2002 announced by the Government envisages increasing public health investment to 2% of GDP by the year 2010 from the existing level of 0.9% and the total health investment to 6% from the current level of 5.2%. The NHP-2002 welcomes the participation of the private sector in all areas of health services-primary, secondary and tertiary.
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Source: Public Expenditures - Finance Accounts upto 2001 and Budget for 2003; Private CSO estimates on Consumption Expenditure 1985 series; BE = Budget Estimate
- Sources www.cehat.org
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BIBLIOGRAPHY Times of India Business world Economics Times www.ourworld.compuserve.com www.mohfw.nic.in www.cehat.org cities.expressindia.com www.expresstravelandtourism.com www.pd.cpim.org www.cbc.ca www.apollohospitals.com www.ibef.orgs www.cbc.ca www.Tata-AIG Hospitals.com www.Tata-AIG Hospitalsdelhi.com www.Tata-AIG Hospitalspune.com
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