Journeying For Good Health

Visitors from across the world are coming to our shores in pursuit of affordable and quality healthcare services. Yet, it is imperative to mitigate inadequacies like regulatory deficiencies and infrastructure challenges to propel India’s growth as as leading destination for medical value travel. By Lakshmipriya Nair

Medical tourism or medial value travel, which refers to the “practice or trend of patients seeking cross border healthcare”, is nothing new. Sumerian health complexes built around hot springs in circa 4000 BC, the Asclepia Temples in ancient Greece, named after their god of medicine, Asclepius; and the hot water baths of Rome which claimed to enhance and preserve good health; etc attracted people from across the world even during those times to find a cure for their illnesses. Thus, history reveals that mankind has always transcended boundaries and travelled to different places to improve their health and sense of well being.

So, could India, the womb of another ancient civilisation be unaware and ignorant of this concept? Not likely. Yoga and Ayurvedic medicine have been bringing foreign travellers to India’s shores since as early as 5000 years ago. Medical travellers and spiritual students came to this land to seek the benefits of these alternative healing methods. The chronicles of Chinese travellers, Fa Hien (CE 405-411) and Hiuen Tsang (CE 629-645) also mention and describe the hospitals and hospices in India at that time. They are referred to as vaidyasalas or punyasalas. The medieval ages too saw the Arabs playing a significant role in promulgating India’s knowledge in science, medicine, mathematics and other spheres to different parts of the world. Sanskrit texts of Indian medicine like Caraka Samhita and Susruta Samhita have been translated into Arabic. There are several mentions of learned vaidyas or doctors like Dhanvantri, Manaka, Kanka etc in the Arab texts.

These are very concrete evidences that medical value travel has been in practice since a really long time in our country as well.

The present day

With the advent of technology and shrinking borders, alongwith the rising need for healthcare services, the concept has gained more prominence and pertinence over the last couple of decades. A Federation of Indian Chambers of Commerce and Industry (FICCI) report on medical value travel, released in 2014, along with KPMG, pegged the medical value travel industry globally at $10.5 billion and estimates it to grow to $32.5 billion over the next five years at a CAGR of 17.9 per cent.

Today, it comprises two segments i.e. people who travel to other countries for rejuvenation purposes which is a part of the wellness industry, and people who travel for curative care. Another report released this year by the ICAI-CMA & PHD CHAMBER, titled, ‘Destination India – Evolving Medical and Wellness Tourism Hub’, reveals, “Services typically sought by the travellers include elective procedures as well as complex specialised surgeries such as joint replacement (knee/ hip), cardiac surgeries, dental surgeries, cosmetic surgeries diagnostic tests, multi-speciality care, infertility, haematology or diseases related to blood and blood vessels etc. It also encompasses dental implants and orthopaedic care, laser hair removal, hair transplant and lastly spa and beauty treatment. On the other hand, wellness tourism is about to travelling for the primary purpose of achieving, promoting and monitoring maximum healthcare and a sense of wellbeing.”

Explain the growing trend for medical value travel, Nilaya Varma, Partner and Head of Government and Healthcare, KPMG in India states, “On one hand, rising cost of healthcare services has compelled patients from developed nations to seek low cost healthcare services in other countries. On the other hand, lack of healthcare infrastructure and expertise for complex surgeries has compelled patients from developing nations to seek quality healthcare services in other countries. This cross-border movement is also triggered by rising non-communicable diseases such as cardiovascular, oncology, diabetes etc. which require specialised treatments and has high treatment cost.”

Thus, growing global demand for healthcare services, changing demographic factors like increased longevity of life and rise in birth rates, skewed ratio of healthcare facilities in different parts of the world, rise in disposable income, changing disease patterns etc are some of the factors behind the spread of medical tourism. The pursuit for high quality healthcare, specialised treatment options, instant service prospects for travel teamed with affordability have also aided the growth of this sector.

Asian countries like India, Malaysia, Singapore, Thailand, Sri Lanka, and South Korea; Brazil, Costa Rica, Mexico, Cuba from Latin America; and United Arab Emirates have emerged as major hubs for medical value travel. European destinations for medical tourism include France, UK, Hungary and Poland and Turkey.

India’s story

India, as a destination for medical value travel, is among the top three destinations in Asia and welcomes visitors from across the globe. Its traditional forms of medicine like Ayurveda, Siddha, and Yoga have attracted a lot of people looking for rejuvenation while the mainstream areas offer quality healthcare at affordable rates to those looking for curative care options in our country. States like Tamil Nadu, Kerala, Karnataka, Andhra Pradesh, Maharashtra, New Delhi and others have emerged as preferred medical tourist destinations. As per statistics given by the India Tourism Statistics 2013, Ministry of Tourism, 2014, around 230,000 patients from all over the world came to India in 2013, with a majority coming from developing and under-developed economies.

Another healthcare report released by FICCI, in collaboration with consultancy firm KPMG, titled, ‘Healthcare: The Neglected GDP Driver’, reveals that the medical travel market in India is set to triple from $2.8 billion in 2014 to $10.6 billion in 2019, registering an increase of 30 per cent annually.

Let’s take a look at the factors driving this segment’s growth in India.

Dr Nandakumar Jairam, Chair, FICCI Health Services Committee and Chairman & Group Medical Director, Columbia Asia Hospitals, informs, “People from different parts of the world are travelling to the country to capitalise on the comparative cost advantage and quality services offered by medical facilities here. Additionally, rising costs of healthcare in the developed world, along with rising disposable income and healthcare awareness among the global population, is forcing patients to explore cheaper options in other countries.”

Reiterating this view, renowned bariatric surgeon, Dr Ramen Goel from Wockhardt Hospital elaborates, “High-end hospitals in India are offering advanced and life savings health services like open transplants, cardio-vascular surgeries, bariatric surgeries, eye treatment, knee/ hip surgery, cosmetic surgeries – all under one roof. Among the many Asian countries, India is one of the most preferred destinations for medical treatment. Patients from both the US and the UK travel to India for various types of healthcare treatment and surgery. One of the major reasons for choosing India is the cost factor. India provides some of the most affordable treatment options for surgery like heart surgery, weight loss surgeries, knee or hip replacement or various orthopaedic treatments and surgery. The doctors in India are highly qualified; many of them have work experience and training in Western countries. Indian doctors are well-known globally for their research and medical skills. They understand the requirements of international patients well and treat them appropriately.”

Dr Pradeep Gadge, Consultant Diabetologist, Breach Candy & Seven Hills Hospital, also informs, “The main source market of our medical tourism patients is low GDP countries of Africa and Middle East. India is known mostly for its cost-effective medical treatments along with high standards in cardiology, orthopaedics, nephrology, oncology and neurosurgery and we need to bank on this. Also, our country is also known for its alternative treatment options such as Yoga and Ayurveda.”

Varma elucidates further, “On one hand, medical value travel offers huge opportunities for India to provide healthcare services to regions such as SAARC, Africa, Gulf countries, South-East Asian countries due to less developed healthcare infrastructure and low availability of specialists. On the other hand, with its inherent strengths and burgeoning healthcare costs worldwide, India stands a great chance of exporting its healthcare services in the form of medical value travel to the patients in developed countries as well.”

The FICCI-KPMG report also mentions that the SAARC countries have been an important source of medical tourists for India. Physical proximity and similarity in culture, food and language makes India a convenient option for these nations. Regional cooperation treaties between India and other countries to promote each other as preferred medical tourist destinations have also played significant roles in strengthening India’s position as a sought after destination for medical value travel.

Thus, high quality treatment combined affordable care has aided India’s rise a medical tourist destination. As per KPMG in India analysis, 2014, “A person coming to India for his/ her medical treatment can have savings anywhere in the range of 30 to 70 per cent. Even if we consider the ticket expenses and accommodation expenses along with the treatment cost, the overall expenditure would be lower than the treatment cost in the UK or the US or many other countries.”

India has several benefits in terms of geographical diversity as well, thus travelling for medical care can also be combined with seeing new places and gaining new experiences.

Metamorphosing for progress

Thus, it is undeniable that India, with its pool of talent, alternate medical therapies and its ability to offer quality healthcare at comparatively affordable rates, is well positioned to become a leading destination for medical value travel. Looking at the huge oppurtunities available in this sphere, Dr Jairam further predicts, “Indian hospitals are poised to host around 2.4 million medical tourists by 2020 and 4.9 million tourists by 2025.”

Healthcare providers in India have also woken up to the potential of medical tourism to drive growth. The burgeoning opportunities in this sphere have impelled them to transform themselves and become set ups that offer services that are at par with global standards. Many of them are also accredited with the National Accreditation Board for Hospitals & Healthcare Providers (NABH) and Joint Commission International (JCI). The FICCI-KPMG report on medical value travel reveals that currently there are 21 JCI accredited healthcare facilities in India.

Naresh Kapoor, Director, BLK Super Speciality Hospital, points out, “Healthcare facilities in India are quite aware of quality perceptions of medical tourists, especially those coming from the West and is fully geared up to not only meet the global standards but in many cases set its own global benchmark. Basic healthcare infrastructure and services in India are growing fast and with the support from the government in reducing barriers for tourists visiting the country for medical purposes, further private investment in healthcare will be seen in the coming years.”

Apart from quality healthcare, these set-ups also offer a host of other services such as an interpreter or translator, free Internet access, facility for offering prayer, pick up and drop from the international airport, international cuisine, assitance for Visa and documentation etc to name a few. Apollo Hospitals, Fortis Healthcare, Aster Medcity, Asian Heart Institute, Medanta – The Medicity, Manipal Hospitals etc are among some of the leading Indian hospitals where people from across the world throng to seek healthcare services that are cutting-edge yet affordable.

India’s traditional forms of medicine like include yoga, meditation, ayurveda, allopathy, naturopathy, unani, etc also offers a varied range of medical services and rejuvenation facilities to patients. India also has a dedicated department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) in India to focus on the development of this segment. Devaaya-The Ayurveda and Nature Cure Centre, Somatheeram Ayurveda Resort, Ananda in the Himalayas, Kairali Ayurvedic Health Village, The Leela, Udaipur, etc. are some of the leading centres for people seeking alternative forms of treatment. Kerala, Goa, Uttarakhand, Rajasthan etc are some of the leading states in India offering great options in the AYUSH segment.

Initiatives of the government

The government has also taken several pivotal steps to make India attractive to medical tourists. Some of the major intitiatives include:

• Market development assistance scheme: Fiscal support is offered under the Market Development Assistance Scheme (MDA)46 to medical tourism service providers who are approved by the Ministry of Tourism
• Quick clearance and simplified visa procedure: The government has introduced a separate category of medical visa: M-visa for medical tourists. They can be extended for 12 months beyond the one year issue period. A no-hindrance-clearance has also been provided at the airports
• Tourism circuits: The current government has promised to build 50 tourism circuits, including a medical circuit whih would connect centres of allopathy and ayurveda
• Improving connectivity: The government is creating infrastructure for transport services, especially, air transport and road transport to facilitate medical tourism
• Healthcare events: Health expos, medical tourism seminars are being organised regularly in foreign locales to showcase India’s offerings in the field of medical tourism

Hurdles to cross

Thus, medical value travel segment in India has seen a lot of activity in the past few years. Yet, all’s not hunky-dory. India is only at the third position in Asia when it comes to medical tourism, lagging behind Singapore and Thailand. The industry experts also feel that there are lot of areas where urgent attention is needed to leverage the full potential in this arena.

As Dr Jairam highlights, “In spite of an impressive growth in the Indian medical tourism industry, India attracted only one per cent of global medical tourists in 2012, whereas nearby countries like Singapore, Thailand and Malaysia received around eight per cent.”

Elaborating further, he says, “The Indian medical value travel industry is presently at a nascent stage as compared to its counterparts. It is evident that most of the countries, be it the US, Turkey, Japan or smaller ones like Jordan, Croatia, Costa Rica, and Malaysia, are extremely organised in promoting themselves for medical travel and are further organising themselves in regions. However, in contrast, India is fragmented in its approach where individual hospitals have been promoting themselves as hospital destinations. Although Indian government is taking steps to deal with infrastructure problems that obstruct medical tourism in India, they further need to increase efficiencies in terms of visa, airport documentation and coordination among various agencies to boost this sector.”

Dr Mohan Thomas, Senior Cosmetic Surgeon, Cosmetic Surgery Institute opines, “India may be losing out on the opportunity to become a hub for medical care due to poor infrastructure, regulatory mechanisms and a mechanism to address patient complaints or discontentment. A long waiting period for adjudication further negates the desire to experience Indian medicine.”

Dr Harish Pillai, CEO, Aster Medcity also shares his concerns and says, “The lack of public policy, adequate uniform infrastructure and policy will cause long-term harm; we should learn from the enormous damage caused internationally to our national brand equity in the pharma sector due to a few unscrupulous players exporting counterfeit drugs. Similarly, there is a alarming trend of growing dissatisfaction and concerns regarding the trend to over investigate; perform unnecessary procedures; prolong length of stay from a few domestic players. The cost in brand erosion due to short term gain and gold diggers will be catastrophic in a highly competitive market. The best regulatory norm should be self driven by the healthcare stakeholders.”

Varma gives a detailed outline of the areas that need focus and the challenges that need to be tackled to further our progress. He says that to become a leader in medical value travel industry, India needs to overcome the following glitches:

• Poor infrastructure: India needs to invest in infrastructure such as road, airport, etc. especially in medical value travel hubs. This is expected to streamline the logistics related to handling medical tourists.
• Low coordination among stakeholders: Low coordination between various stakeholders such as hospitals, hotels and airlines is hampering the growth of this sector. All the stakeholders need to collaborate and bundle their services to patients for a rich experience of medical tourist.
• Low transparency in pricing: Hospitals need to increase transparency by providing cost of various surgeries online/ on their website. This is expected to help international patients in choosing the right hospital with the right price.
• Low government support: Government needs to support and facilitate medical value travel in India. It can take a cue from Thailand, where the government is promoting medical value travel through online e-marketing campaigns, easy visa policy, support to high technology and it also showcases its medical and wellness treatments to various global news agencies via organising familiarisation tours.
• Low PPP models in healthcare: India has very few PPP models in healthcare and it needs to promote PPP models for upgradation and expansion of medical facilities. This is expected to help India in establishing more quality hospitals that can attract more international patients.
• Low transparency in role of facilitators: India needs to develop guidelines to streamline the role of facilitators and increase transparency.

The way forward

So, what are the steps that these experts recommend to tackle these challenges?

Dr Pillai lists down some measures that would help us boost medical tourism.

• The quality mantra should be mandatory; it’s time that we emulate models seen in nearby countries like Singapore or UAE, especially Dubai, wherein a quality accreditation is mandatory to establish a practice. The oft repeated excuse of us being a poor country will not do us any good. QCI and NABH is God send for India and all states should build roadmaps to get all public and private centres accredited
• Trade bodies and the government incubate a neutral entity to list down minimum criteria and grade hospitals/ providers on a matrix score covering quality systems; clinical outcomes; staffing; infrastructure on a model similar to star hotels and publish them annually
• Design specific courses to sensitise staff on the specific needs of medical value traveler’s; more healthcare-oriented language courses to be certified and available
• Create a GoI and trade body-owned healthcare portal listing all eligible hospitals and access to their websites
• Run national campaigns similar to Incredible India hosted by Bollywood star Amir Khan on the need to treat them well
• A national task force representing all regions need to be constituted by GoI involving ministries of health, commerce, tourism, home and external affairs – call a national workshop that will create a policy document which can eventually become a law
• Declare health sector as a priority area and incentivise stakeholders to attract more investment in infrastructure and human resources
• Develop a 10-year strategic roadmap, looking at year 2025 to be the consistent leader in medical value travel

Dr Goel suggests, “The Indian government needs to promote India as the new emerging medical value travel destination abroad. Private and public hospitals need to synergise their efforts to promote India as the healthcare destination worldwide. The healthcare industry will also have to standardise their processes and make its functioning more transparent and accountable. Indian healthcare sector should ensure that they provide good quality and affordable healthcare to all. For this, there is a need to reduce inequalities, imbalances that exist between regions, cities and villages and different socio-economic groups.”

Promoting medical tourism on digital platforms, encouraging more PPPS, signing MoUs with other countries etc, creation of a Single Consultative Platform (SCP) with a unified agenda of promoting medical travel, etc are some of the other steps recommended to pave the way for further progress. The government is also mulling the introduction of a new tourism policy which would also focus on promulgating medical tourism. This too would be a positive step as in an exclusive interview to Financial Express Online, Suman Billa, Joint Secretary, Ministry of Tourism, Government of India, informed that they will be creating a Medical Tourism Promotion Board to create synergy between tourism and the healthcare sector. The board will work with the industry to action out a clear gameplan to work upon. The board will have representations from the Ministry of Health, the medical industry including hospitals, AYUSH as well as from tour operators who deal with medical tourists.

If these measures are implemented effectively and monitored to ensure constant quality, India would definitely be able to ensure a better travel experience to medical tourists and rise about its competition to become the top player in this segment.

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