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Medical Tourism

Historical Background of Medical Tourism in India
Historically India has been a regional healthcare hub for neighboring countries such as Afghanistan, Pakistan, Nepal, Bangladesh, Bhutan, Maldives and the Middle-East. India has a strong background for developing a unique medical treatment which had been patronized by the kings and merchants and others during the historical periods. Ancient Indian literatures like Upanishads, Bahamians and others strongly advocated the supremacy of medical treatment and medicines used were prepared mostly using herbs and shrubs collected from nature. This wonderful country is a treasure trove of health, as it had been for thousands of years. India‟s history in medicine dates back to the Atharva Veda the first Indian text dealing with medicine.India‟s medical history is truly awe-inspiring with its traditional treatment therapies such as the Ayurveda and Yunani, which have been passed down through hundreds of generations. Historical accounts as narrated by different foreign travelers disclosed that free medical treatment was offered to the foreign patient. Such facility was also provided to the courtiers, Brahmins, and needy people at free of cost. During early midMughal period Delhi was emerged as an well-known centre for conclaves of physicians and surgeons. Traditionally some unique treatment methods was developed starting from Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH) in our country. Such system has been evolved through an evolutionary phases.
India was one of the first Asian countries to recognize the export potential from medical tourism. Since 2002, after the Confederation of Indian Industry (CII) produced a study on medical tourism in collaboration with Mc Kinsey management consultants, the Indian Government has strongly supported the development of the
sector. This support included the improvement of important airport infrastructure and the marketing of Indian medical treatment abroad. Between 2009 and 2011, the number of medical tourists seeking treatment in India increased by 30%. Based on past growth, the number of medical tourists going to India is estimated to grow to
nearly half a million annually by 2015.

Medical tourists travel to address what they deem to be unmet personal medical needs, prompted by issues of cost, timely access to services, higher quality of care or perceived superior services, or to access services that are not available in their country of residence. In many instances, patients travel on their own initiative, with or without consulting their physician, and with or without utilizing the services of commercial medical tourism companies. The care medical tourists seek may be elective procedures, medically necessary standard care, or care that is unapproved or legally or ethically prohibited in their home system.

Many medical tourists receive excellent care, but issues of safety and quality can loom large. Substandard surgical care, poor infection control, inadequate screening of blood products, and falsified or outdated medications in lower income settings of care can pose greater risks than patients would face at home. Medical tourists also face heightened travel-related risks. Patients who develop complications may need extensive follow-up care when they return home. They may pose public health risks to their home communities as well.

Medical tourism can leave home country physicians in problematic positions: Faced with the reality that medical tourists often need follow-up when they return, even if only to monitor the course of an uneventful recovery; confronted with the fact that returning medical tourists often do not have records of the procedures they underwent and the medications they received, or contact information for the foreign health care professionals who provided services, asked to make right what went wrong when patients experience complications as a result of medical travel, often having not been informed about, let alone part of the patient’s decision to seek health care abroad.

Physicians need to be aware of the implications of medical tourism for individual patients and the community.

Collectively, through their specialty societies and other professional organizations, physicians should:

(a) Support collection of and access to outcomes data from medical tourists to enhance informed decision making.

(b) Advocate for education for health care professionals about medical tourism.

(c) Advocate for appropriate oversight of medical tourism and companies that facilitate it to protect patient safety and promote high quality care.

(d) Advocate against policies that would require patients to accept care abroad as a condition of access to needed services.

Individually, physicians should:

(e) Be alert to indications that a patient may be contemplating seeking care abroad and explore with the patient the individual’s concerns and wishes about care.

(f) Seek to familiarize themselves with issues in medical tourism to enable them to support informed decision making when patients approach them about getting care abroad.

(g) Help patients understand the special nature of risk and limited likelihood of benefit when they desire an unapproved therapy. Physicians should help patients frame realistic goals for care and encourage a plan of care based on scientifically recognized interventions.

(h) Advise patients who inform them in advance of a decision to seek care abroad whether the physician is or is not willing to provide follow-up care for the procedure(s), and refer the patient to other options for care.

(i) Offer their best professional guidance about a patient’s decision to become a medical tourist, just as they would any other decision about care. This includes being candid when they deem a decision to obtain specific care abroad not to be in the patient’s best interests. Physicians should encourage patients who seek unapproved therapy to enroll in an appropriate clinical trial.

(j) Physicians should respond compassionately when a patient who has undergone treatment abroad without the physician’s prior knowledge seeks nonemergent follow-up care. Those who are reluctant to provide such care should carefully consider:

  1. the nature and duration of the patient-physician relationship;
  2. the likely impact on the individual patient’s well-being;
  3. the burden declining to provide follow-up care may impose on fellow professionals;
  4. the likely impact on the health and resources of the community.


Importance of Medical Tourism
Medical tourists in India tend to go for surgical treatments, especially cardiac procedures, orthopedic procedures, neurological and spinal surgery, as well as cosmetic surgery. Dental treatment is another popular service availed of by medical tourists in India. For wellness tourism, key attraction is the alternative medication
such as ayurvedic spa. India is also focusing on the advancements of cord blood bank facilities as cord blood promises to become a critical input for many surgical treatments. Cord blood is the blood that remains in the umbilical cord after a baby is born and is a rich source of stem cells. The development of cord blood banks is
expected to be a major boost for India‟s medical tourism.

Prospects of Growth
India, naturally endowed with a rich cultural heritage, tourism potential and reputation for age-old medicines and therapies such as ayurveda, unani, homeopathy, naturopathy and yoga is a heaven for wellness tourism. However, in terms of market share the country enjoys a meager part of the global wellness market
which evidently points at the under utilization of the potential and wellness quotient that India treasures. Fortunately, with regard to medical tourism, India has been successful to a large extent in positioning itself as a viable destination for cost-effective and qualitative advanced healthcare. However, one must not forget the keenness and speed with which countries such as South Africa, China, Malaysia, Thailand and Indonesia are accentuating their medical facilities and strategizing rapidly to
garner larger market shares and revenues. Therefore, it is pertinent for India to rethink the marketing plans on medical and wellness tourism in terms of the services offered in the country. What is also crucial is how the country is positioned to the world as a unique destination.
India‟s main target markets are the developed countries, especially the United Kingdom and the United States. Patients from neighbouring South Asian countries such as Pakistan, Bangladesh and China also visit India for treatment. Having identified the growing potential of medical and wellness segments, several medical tourism
companies / facilitators promising end-to-end medical tourism services have sprung up across the country. Inarguably, medical tourism is an economic tool for a nation like India to boost its economy through direct benefits such as increase in revenue, employment opportunities, investments in tourism avenues, etc. and indirect benefits that include spillover effects leading to growth in other industries. Though the benefits may apparently be micro-faced, the ripple effect is capable of touching innumerable spheres in the economy, namely, rise in living standards of people associated with tourism, need for education, demand for related educational courses, growth ancillary industries and so on.

Advantages of Visiting India for Medical Treatment
1. Internationally accredited medical facilities using the latest technologies
2. Highly qualified Physicians/Surgeons and hospital support staff
3. Significant cost savings compared to domestic private healthcare
4. Medical treatment costs in India are lower by at least 60-80% when compared to similar procedures in North America and the UK
5. No Wait Lists
6. Fluent English speaking staff
7. Options for private room, translator, private chef, dedicated staff during your stay and many other tailor -made services
8. Can easily be combined with a holiday/business trip

Promotional Measures taken by the Central Government
To promote growth in the Indian medical travel industry, the Central government has plans to improve health infrastructure. The National accreditation Board for Hospitals and Healthcare Providers (NABH) does its own accreditation of hospitals to guarantee service quality and has so far accredited several of the hospital members.
It is currently in the process of increasing the number of hospitals, clinics and clinical laboratories in urban as well as rural parts of the country. Incentives and tax holidays are being offered to hospitals and dispensaries providing health travel facilities. The Indian medical travel and healthcare sector offers plenty of opportunities
for businessmen, medical equipment manufacturers, healthcare service providers, and tourist agencies and the government is encouraging them to invest in therapeutic and preventive health services so as to increase medical travel to India. The overseas offices of India‟s Ministry of Tourism market medical tourism by stocking up and
disseminating informations about Indian hospitals for potential foreign patients. They advertise the sector‟s expertise in cardiac surgery, oncology treatment, orthopedic and joint replacement, holistic healthcare in hospitals that they promote as centers of excellence. The government also provides special M-visas for patients and their companions that have longer durations of stay (usually one year) than ordinary tourist visas. The government improved airport infrastructure to smoothen the arrival and departure of medical tourists. It has championed a public-private sector partnership (PPP) model at both central and state level to improve healthcare infrastructure to provide efficient services and innovative delivery models.

Promotional Initiatives of State Tourism Boards
At the state level, several initiatives are taken by the industry in association with the state governments.

Since 1990s, Kerala Tourism Development Corporation (KTDC) is promoting health tourism to cater to the requirements of the visitors. Tie-up with various Government and Private Ayurveda Centers has also increased the quality of treatment provided to the visitors.

This state is in the process of setting up of a Bangalore International Health City Corporation, offering patients with a wide variety of healthcare products and treatments. The Government of Karnataka is also in the process of leveraging the state‟s IT prowess to tap business in the healthcare outsourcing services. IT skills would help enhance Karnataka‟s position in associated services to the growing healthcare sector such as medical billing, disease coding, forms processing and claims settlement. It is also bidding high on Telemedicine, a concept by which patients can be treated even when the doctor is geographically placed in a different area.

In Maharashtra, the Infrastructure Development and Support of Maharashtra (MIDAS) has granted the tourism activity with an industry status, with the objective of granting all the benefits and incentives that are given to other industries. This Act would also empower the Maharashtra Tourism Development Corporation (MTDC) as a special planning authority, to procure and provide land available at various tourism estates without needing approval from the Maharashtra Industrial Development Corporation (MIDC). The industry in association with the state government has set up a Medical Tourism Council of Maharashtra (MTCM).

This is one of the few states which has announced a separate policy for medical tourism, with the objective of creating integrated medical tourism circuits based on the location of specialty hospitals, heritage and culture. In addition, Gujarat is in the process of setting up a Healthcare Tourism Council in association with the healthcare and tourism industry.

West Bengal
Kolkata is, slowly but surely, regaining its rightful place in the healthcare firmament in not just India but this part of the world. Several latest healthcare facilities have been set up by the private sector even as the State Government has been proactive in encouraging public private partnerships (PPP) in this sector.

There are several issues which are hindering factors for the growth of medical tourism in our country, they are:-
1.  No strong government support/initiative to promote medical tourism.
2.   Lack of proper insurance policies for this sector.
3.  Lack of uniform pricing policies across hospitals.
4.  Customers perception as an unhygienic country.
5.  Lack of international accreditation- a major inhibitor.
6.   Strong competition from countries like Thailand, Malaysia and Singapore.
7.  Under-investment in health infrastructure.
8.  Middlemen with little or no knowledge and training to manage patients are playing havoc.
Low coordination between various players in the industry like airline operators, hotels and hospitals.

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