Medical Tourism

Ravi RohillaCommunity MedicinePGIMS Rohtak

CONTENTS

TourismMedical TourismScope of Medical TourismComponentsAccreditationMedical Tourism Provider

Indian ScenarioSWOT analysisRole of Government and PrivateInnovations

Tourism

“Tourism” comprises of the activities of persons traveling to and staying in place outside their usual environment for leisure, business and other purposes. Tourists are the people who "travel to and stay in places outside their usual environment for not more than one consecutive year for leisure, business and other purposes not related to the exercise of an activity remunerated from within the place visited“.

-World Tourism Organisation

Types of Tourism

United Nations classified three forms of tourism in its Recommendations on Tourism Statistics (1994). Domestic tourism, involving residents of

the given country travelling only within the country.

Inbound tourism, involving non-residents travelling in the given country.

Outbound tourism, involving residents travelling in another country

Medical Tourism

Medical tourism is a term involving people who travel to a different place to receive treatment for a disease, ailment, or condition, and who are seeking lower cost of care, higher quality of care, better access to care, or different care than they could receive at home.

-Global Spa Summit 2011

Why Medical Tourism?

Healthcare and Tourism industries are the fastest growing industries in the world. Medical Tourism is being promoted as a Fusion product of these industries. Various countries like Thailand, Malaysia, India, etc are promoting Medical Tourism aggressively.Medical tourism has tremendously generated services and revenues across the globe and numerous possibilities still remain unexplored.

Reasons for Medical Tourism

Cost Effectiveness Availability of services Expertise Absence of waiting lists

Healthcare industry World's largest industry Total revenue of approximately US$2.8

Trillion.

In India Healthcare industry has emerged as one of

the largest service sectors Estimated revenue of around US$30 billion

constituting 5% of GDP and offering employment to around 4 million people

Scope of Medical Tourism

Medical tourism market is valued to be worth over $310 million with foreign patients coming by 100,000 every year, and the market is predicted to grow to $2 billion by 2012.An estimated 180,000 medical tourists were treated at Indian facilities in 2004 (up from 10,000 in year 2000), and the number has been growing at 25-30% annually.

-

CII-McKinsey report 2008

Scope of Medical Tourism in India

There are various kinds of services that are provided under medical tourism Service Delivery – Medical services Travel Services (Airlines & Hotels) Shopping & Entertainment for tourists and

their family members Insurance Coverage towards the risks

involved during the treatment Websites providing information, booking

facilities and promotions

Scope of Medical Tourism

Countries currently offering International Medical Tourism healthcare services.

ArgentinaAustraliaBahrainBangladeshBarbadosBelgiumBrazilIndiaLebanonLithuaniaMalaysia

CanadaCayman IslandsChileCosta RicaCubaCyprusSwitzerlandTaiwanThailandTurkey

Healthcare & Medical Tourism

Components

Treatment of Illnesses

Joint replacements Heart surgery Cancer treatment, Neurosurgery, Transplants(Liver and Bone marrow) Dental treatment.

Enhancement

‘Enhancement’ procedures are carried out mainly for aesthetic purposes(much of this work is non-disease related unless disfigurement is caused by disease). These are: All cosmetic surgeries Breast surgeries Facelifts, liposuction and cosmetic dental work.

Wellness(Spa/Alternate therapies)

The ‘wellness’ segment of medical and healthcare tourism promotes healthier lifestyles. These products can include: Treatment in spas Thermal and water treatment Acupuncture and Aromatherapy Beauty care, facials, exercise and diet Herbal healing, homeopathy, massage Yoga and naturopathy.

Reproduction(Fertility)

Under this component, there are patients who seek fertility-related treatments such as in vitro and in vivo fertilization and other similar procedures. At times, potential parents travel for the purposes of adopting children because the legislation and supply of babies for adoption is easier in host countries.

Hospital Accreditation

Accreditation has been defined as "A self-assessment and external peer assessment process used by health care organisations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve“.Fundamentally healthcare and hospital accreditation is about improving how care is delivered to patients and the quality of the care they receive.

Accreditation Schemes

Trent Accreditation Scheme (based in UK-Europe)QHA Trent Accreditation, based in the UK Joint Commission International, or JCI (based in USA)Australian Council for Healthcare Standards International, or ACHSI (based in Australia)

Accreditation Canada (formerly the Canadian Council on Health Services Accreditation or CCHSA -based in Canada) Accreditation of France (La Haute Autorité de Santé) based in Paris, France.NABH(National Accreditation Board for Hospitals and Health Centres- based in India)

The Ministry of Health and Family Welfare has set up a National Accreditation Board for Hospitals(NABH), under the Quality Council of India for accreditation of hospitalsEstablished in year 2006.There are 16 JCI accredited and 63 NABH accredited healthcare providers in India.

Outline of NABH Standards

Access, Assessment and Continuity of Care Patient Rights and Education Care of Patient Management of Medication Hospital Infection Control Continuous Quality Improvement Responsibility of Management Facility Management and Safety Human Resources Management Information Management System

Medical Tourism Provider

A Medical Tourism Provider is an organisation or a company which seeks to bring together a prospective patient with a service provider, usually a hospital or a clinic.Some such organisations and companies specialize in certain areas of healthcare, such as cosmetic surgery, dentistry or transplant surgery, while others are more generalised in their approach.

Medical quality standards vary around the world, and international accreditation is relatively new. For these reasons, Medical tourists look to health tourism providers to provide information about Quality, Safety and Legal issues.

Medical tourism provider

Medical issues Availability of

techniques Pre-travel health

issues, such as antimalarial therapy and relevant immunisations

Medico-legal issues

Non Medical issues

Prices and how to pay Hotels(checking in) Language issues Ethics

Various issues for Medical Tourists

Various service providers(India)

http://www.medaccessindia.com/http://www.recoverdiscover.com/http://www.medicaltourisminindia.net/http://www.forerunnershealthcare.com/http://www.medicalresortindia.com/http://www.medicaltourism-india.in/http://www.medicaltourismco.com/

NEJM echoes

The New England Journal of Medicine detailed an account of a self-employed carpenter who had an acute mitral-valve prolapse that required surgery. Estimated fees at the nearest hospital approached $200,000, half of which needed to be paid in advance.   After some more digging around, this patient was able to find a hospital in Texas that could perform the procedure for $40,000. 

After some more research, the patient decided to fly to New Delhi, India where he had the procedure performed for less than $7,000. 

Shortly after returning to North Carolina, the patient went back to work with a healthy heart.

To India

Why India?

India has several advantages that make it a natural choice for Medical treatment. Cost advantage during treatment as well as

medication Large pool of good doctors, nurses and

paramedics World-class facilities High brand value of leading Indian medical

professionals across the globe Good English speaking population Vibrant Pharmaceutical industry

Healthcare Pricing(Comparision)

Procedure US UK Burmungrad Bangkok

Raffles

Singapore

Max Healthcare

(India)

Angioplasty 30000 21000-27000

4000 - 5000 5000 4000 - 5000

Angiography 2500 - 3000

2000 1100 800 400

Hip replacement

19000 13000-16000

_ 6600 6000

Knee replacement

27000-32000

16000-18000

_ 6000 6000

CABG 30000 _ 9600 6400

Lasik _ 2250-2900

750 _ 400

Major Players

Following are major players in the Medical Tourism industry. Escorts Apollo Hospital Max Healthcare Indraprastha Apollo Hospital Hinduja Hospital Jaslok Hospital Fortis Wockhardt

Competition

Thailand, Singapore, Malaysia, India and Philippines are the major destinations in the Asian medical tourism market. Thailand is more popular among Western European medical tourists for cosmetic surgery. Singapore and India specialize in complex procedures with India having a cost advantage and Singapore a technology advantage.

Brand India

Medical Treatment in USA=

A tour to India + Medical Treatment + Savings

“First World Services at Third World Cost”.

Medical Tourism : SWOT approach

Business/service firms undertake SWOT analysis to understand their external and internal environments.Through such an analysis, the Strengths and Weaknesses existing within the medical tourism can be matched with the Opportunities and Threats operating in the Indian environment so that an effective strategy can be formulated.

Strengths

A strength is an inherent capacity which an organization can use to gain strategic advantage. Quality and Range of Services Affordable costs Vast supply of qualified doctors: Strong presence in advanced health care International Reputation of hospitals and Doctors. Diversity of tourism destinations and experiences

Weakness

A weakness is an inherent limitation or constraint which creates strategic disadvantages. No strong government support/initiative to

promote medical tourism. Low coordination between the various players in

the industry- airline operators, hotels, and hospitals.

Lack of uniform pricing policies across hospitals. Customer Perception as an unhygienic country Political problems etc

Opportunities

An opportunity is a favorable condition in the service industry which enables it to consolidate and strengthen its position Increased demand for healthcare services from

countries with aging population (US, UK) Fast-paced life style increases demand for

wellness tourism and alternative cures. Shortage of supply in National Health Systems

in countries like UK, Canada.

Demand from countries with underdeveloped healthcare facilities.

Demand for retirement homes for elderly people especially Japanese.

Personal touch by the doctors in India. Traffic system is well developed and easy to

go from one country to another country. Medicines and lab-our cost is low as

compared to developed countries.

Opportunities

Threats

A threat is an unfavourable condition in the industry’s environment which creates a risk for, or causes damage to, the industry. Strong competition from countries like Thailand,

Malaysia and Singapore. Lack of international accreditaion – a major

inhibitor. Overseas medical care not covered by insurance

providers. Under – investment in health infrastructure.

Exploitation of tourists by illegal money changers.

Terrorism Rise of Resistant strains (NDM-1)

Threats

Role of Government

The role of Indian Government for success in medical tourism is two-fold: Acting as a Regulator to institute a

uniform grading and accreditation system for hospitals to build consumers’ trust.

Acting as a Facilitator for encouraging private investment in medical infrastructure and policymaking for improving medical tourism.

Government’s Role

Investment facilitator:Recognize healthcare as an infrastructure

sector, and extend the benefits under sec 80-IA of the IT Act.

Should actively promote FDI in healthcare sector

Providing low interest rate loans, reducing import/excise duty for medical equipment

Facilitating clearances and certification

Tourism facilitator: Reduce hassles in visa process(M-

Visa) Follow an Open-Sky policy to increase

inflow of flights into India Create Medical Attachés to Indian

embassies that promote health services to prospective Indian visitors

Government’s Role

Private Sector Role

1. Increased participation in building infrastructure

2. Integrate Horizontally

3. Joint Ventures / Alliances

Innovation Through MEDICITIES

Software industry-Establishment of Export Oriented Software Technology Parks

Medical tourism industry-Medicities

MEDICITY

MEDICITY-A self-sustained healthcare hub with Super specialty hospitals of international

standards Ancillary facilities Research institutions Health resort Rehabilitation centers and residential

apartments.

References

World Tourism Organisation, unwto.org/Ministry of Tourism, India, tourism.gov.in/Incredible India, www.incredibleindia.org/NABH, www.nabh.co/CII-McKinsey Report

THANKS