What is the USP that a country needs, to offer itself as a destination for medical tourism or health tourism? Medical tourism has to offer a business and a value proposition. Many developing countries are in a position to offer medical services at one-tenth the cost compared to that in many countries in the West, matching the quality at par with developed countries. Thus creating an opportunity in cost-effective treatment and medical tourism. Certain countries like India or China the opportunity is unique as it offers holistic medicinal service. With yoga, meditation, ayurveda, allopathy, and other medical facilities, they offer a unique blend of services to an individual that will be difficult to match in other countries. They have the best medical talent, many of whom have practiced abroad.

Where the cost saved on one MRI could pay for a return ticket, medical tourism is bound to boom.

In certain countries like India or China the medical tourism opportunity is unique as it offers holistic medicinal service. With yoga, meditation, ayurveda, allopathy, and other medical facilities, the medical tourist is offered a unique blend of services that will be difficult to match in other countries. They have the best medical talent, many of whom have practiced abroad.

The latest equipment in India will be identical to the latest equipment in the U.S. or U.K. and Indian Hospitals like IMCL are receiving accredition from Joint Commission International (JCI) of the US

What is the USP that a country needs, to offer itself as a destination for medical tourism or health tourism?

Medical tourism has to offer a business and a value proposition. Many developing countries are in a position to offer medical services at one-tenth the cost compared to that in many countries in the West, matching the quality at par with developed countries. Thus creating an opportunity in cost-effective treatment and medical tourism.

Certain countries like India or China the opportunity is unique as it offers holistic medicinal service. With yoga, meditation, ayurveda, allopathy, and other medical facilities, they offer a unique blend of services to an individual that will be difficult to match in other countries. They have the best medical talent, many of whom have practiced abroad.

How big is the market for medical tourism?

In United Kingdom, the National Health Service has a backlog of about 2,50,000 cases, which can be a ready market for other countries. If we take the annual medical spends in countries in Middle East, and other countries such United States and United Kingdom, medical tourism could be worth about $20 billion as of now.

Can a big inflow of foreign tourists for medical benefits have an adverse impact on local medical services?

In medical tourism, we find there are five-star hotels that cater to high-end customers while there are those that are targeted at budget medical tourists who are looking for affordable cost-effective treatment. Similarly, under health tourism or medical tourism there would be hospitals that will target tourists and patients from abroad. Medical tourism can help to subsidise local medical services as they offer large volumes at better margins.

So, health tourism or medical tourism is a good business proposition by providing affordable cost-effective treatment.

What are the challenges before the countries to develop as health tourism or medical tourism destination?

The biggest challenge is to position themselves as a favourable health care destination by setting high standards and work in association with the government and the medical council to see to it that all hospitals keep up to those standards. There is a huge market for health tourism in Africa. But it would not be possible to reach out to those markets without direct flights.

How is the healthcare industry in respective countries promoting their country as health tourism or medical tourism destination?

Thailand, for instance, has just one world-class hospital, and they are already hot on medical tourism destination. Singapore too has seen this opportunity early and their public health system is being accessed by medical tourists from many countries.
Australia has also set up a huge health care infrastructure for health tourism or medical tourism. The Indian Health Care Federation is now working along with different industry chambers to promote medical tourism in the country.

The Comparative Costs between India and other developed countries like US, UK, and Singapore Approximate Figures In US Dollars.
	US	UK	SINGAPORE	INDIA
Bone Marrow Transplant	upto 200,000	upto 200,000		20,000
Bypass Surgery	15,000-40,000			2,000-6,000
Breast Lump Removal		2,500-3,500	1,000	700
Haemorrhoidectomy		3,500-4,000	1,500	1000
Knee Joint Replacement		15,000	6,000	5,000
No Stitch Cataract Surgery	4,500			500
In-vitro fertilisation (IVF) cycle	15,000			2,000

Country Reports	A Glance of Nuclear Medicine Service Costs in India*	C.T. Scan Costs in India*
India	Rest-Redist. Thall/Rest Gated SPECT/Infarct lmaging: $100	Head - Plain & Contrast: $ 50
Singapore	Thallium Stress Myocardial Perfusion Scintigraphy: $175	Thorax - Plain & Contrast: $ 50
Malaysia	Brain SPECT/First-Pass C.B.F. with Brain Scan: $175	Neck - with Contrast: $ 50
Thailand	Gallium Scanning: $175	Abdomen - with Contrast: $ 50
Hong Kong	Whole Body Bone Scan:$ 75	Pelvis - Contrast: $ 50
Saudi Arabia	99m Tc-Sesta MIBI tumor imaging: $100	Orbits - Plain & Contrast: $ 50
Philippines	Dynamic Hepatobiliary study: $75
Russia	Lung perfusion lmagine: $75	*Approx. Average In US Dollars.

India offers world class medical facilities in world class hospitals and the doctors are comparable with any of the doctors in western countries. India also offers the most competitive prices.

Medical tourism is the buzzword now. The government as well as private players are keenly assessing the potential and means to tap the same. The boom in state-of-the-art hospitals and well-qualified doctors, have attracted the patient population from neighbouring countries, the Middle East and the West who are looking for quality affordable cost-effective treatment.

The equation is ‘First World treatment’ at “Third World prices”. A CII-McKinsey report last year, postulating the opportunities in medical tourism, states that the medical tourism market in the country pegged a 30 per cent growth in 2000 and it has been growing at the rate of 15 per cent for the past five years.

If industry estimated are to be believed, the size of the medical tourism industry stands at Rs 1,200-1,500 crore (Rs 12-15 billion), growing at the rate of 30 per cent. Health industry is beginning to see scale of opportunity for medical tourism.

A recent CII-McKinsey study on healthcare says medical tourism alone can contribute Rs 5,000-10,000 crore (Rs 50-100 billion) additional revenue for upmarket tertiary hospitals by 2012, and will account for 3-5 per cent of the total healthcare delivery market delivering affordable cost-effective treatment.

India, has many world-class hospitals and medical facilities at its disposal. They definitely have an advantage over others, as apart from the cost factor, most foreign nationals are used to getting treated by Indian nationals abroad. Indian medical professionals settled abroad are associated with high quality care.

Nearly seven per cent of patients at Apollo Hospitals today come from countries in the Middle East. They have now gone on to set up offices in various countries to channelise patients to their hospitals. With telemedicine, it has become easier for patients to keep in touch with them and facilitates their transfer to hospitals in India. Apollo Hospitals currently devotes nearly 10 per cent of its health care infrastructure for medical tourism purpose.

They have already invested around Rs 250 crore in 2003 with the idea to attract medical tourists. They have set up a hospital in Ahmedabad with the intention of attracting non-resident Gujaratis from the world over. They also have put in place medical infrastructure in Sri Lanka to attract tourists who come to that country. They will be soon putting up a combination of a Spa and a hospital in Goa , with focus on non-electric surgeries as well.

"Compared to countries like the UK or the US, minor treatments like those for dental problems or major procedures like bypass surgery or angioplasty come at a fraction of the cost in India, even though the quality of doctors and medical equipment is comparable to the best in the world," says K K Aggarwal, executive vice-chairman of the Heart Care Foundation of India.

A bypass surgery in India costs $2,000-5,000, while in the US it costs between $15,000 and $40,000. That's really affordable cost-effective treatment.

No wonder corporate hospitals like Apollo and Escorts Heart Institute and Research Centre are working towards capturing a larger share of the pie with their cost-effective treatment.

Escorts is in the process of arranging travel and lodging facilities for its overseas patients/medical tourists. In less than two years, Escorts has doubled its number of overseas patients from 675 in 2000 to around 1,200 till date this year.

"Almost 10 per cent of our patients/medical tourists come from Sri Lanka, Bangladesh, Nepal and West Asia," Naresh Trehan, executive director of Escorts, said.

The Mohali-based Fortis Hospital has already entered into a mutual referrals arrangement with Partners Healthcare System, that has hospitals like Brigham Women's Hospital and Massachusetts Hospital, Boston, under its umbrella. "We will soon launch a defined programme for the two-way flow of patients," Harpal Singh, chairman of Fortis, said.

The Apollo Hospitals Group is also holding discussions with the National Health Scheme, UK, to bring patients/medical tourists from the UK to India, highlighting their affordable cost-effective treatment.

"The waiting period for surgeries such as knee replacement is too long in the UK. We are working on a plan for getting those patients/medical tourists to India," Yogi Mehrotra, managing director of Apollo Hospitals, said. The hospital is also working on attracting patients/medical tourists from African countries and is in talks with the authorities concerned.

The Indian Healthcare Federation, an association of the healthcare delivery sector that includes the Apollo Hospitals Group, Mumbai's Hinduja Hospital, Max Healthcare, the Fortis Heart Institute among others, has also decided to project India as a healthcare destination with its affordable cost-effective treatment.

Among private players, Apollo has been a forerunner in health tourism. It has been a choicest destination for patients/medical tourists from Southeast Asia, Africa, and the Middle East. The group has tied up with hospitals in Mauritius, Tanzania, Bangladesh and Yemen besides running a hospital in Sri Lanka, and managing a hospital in Dubai.

In 2002, the number of patients who visited the hospital was 3001 and about 700 were hospitalised. Along with providing treatment, the stay of the foreign medical tourist is taken care 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/medical tourists 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 medical tourists 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 care services. According to him, Indian doctors, medical services, and hospitals are at par with good hospitals in Europe and the US.

AIIMS is a destination for medical tourists from Nepal, Bangladesh, Bhutan, Myanmar, Mauritius, Malaya and Pakistan. Besides regular medical tourists from the Middle-East, an occasional patient/medical tourists from the US drops in for health care. Medical tourists from Pakistan, especially children with heart afflictions, have been regularly coming to AIIMS’ heart centre. According to Dr Gupta, AIIMS was made for the helath care of entire south-east Asia populace and since it is a government institute there are no plans to attract more foreigners.

The attractions for affordable cost-effective treatment 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 medical tourists from Nepal, Bhutan, Sri Lanka, Bangladesh and a few from Maldives and the Gulf region. Their motto is to extend excellent health services to medical tourists 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/medical tourists from abroad, says Anil K Maini, head, marketing, health care and medical tourism business, Escorts Heart Institute and Research Centre. The centre is emerging fast as a favourite destination for patients/medical tourists from neighbouring countries, Africa and CIS. With BUPA recognition, patients/medical tourists from the UK are coming here for treatment. About 1,000 medical tourists from abroad are treated in Escorts on an annual basis.

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 or attitude, put in place an accreditation system and project our capabilities overseas through multiple media.

Hong Kong has a reputation for high standards, but the fees are relatively high.

Though Hong Kong has long been a destination of choice, lower costs are making increasing numbers opt to travel to other countries like India, Thailand and Malaysia.

Where the cost saved on one MRI could pay for a return ticket, medical tourism is bound to boom.

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