Medical tourism india handbook 2018 by Itp India

APRIL 2018 | `400

EXPLORING VIRGIN MARKETS INDIAN HOSPITALS ARE USING MULTIFARIOUS STRATEGIES TO TAP NEWER MARKETS LIKE GCC, WEST INDIES, THE CARIBBEAN ISLANDS AND A FEW AFRICAN COUNTRIES

Published by ITP Media (India)

ADVISORY BOARD

DR HARISH PILLAI CEO, Aster DM Healthcare, India

PRAVEEN KUMAR MITTAL Additional Director, FICCI

DR GIRDHAR J GYANI Director General, Association of Healthcare Providers

DR. SIVAKUMARAN J Chief Operating Officer, Kovai Medical Center and Hospital

DALIP KUMAR CHOPRA Director, Gurdasmal Hospitality and Consultancy Services Pvt Ltd

DR VENKATESH MOVVA Managing Director, Regenexx India

DR TARANG GIANCHANDANI CEO, Jaslok Hospital & Research Centre

MS GURU PRASAD Group Head - International Sales & Marketing, Narayana Health

MEDICAL TOURISM HANDBOOK - INDIA

CONTENTS

22 MAIN STORY Indian hospitals are using multifarious strategies to tap patients from newer markets like GCC, West Indies, Caribbean Islands and a few African countries.

GAMECHANGERS IN MVT We profile groups that is setting new benchmarks in medical tourism.

TOP TRENDS IN MVT

Teams from reputed hospitals in India have been travelling to countries like Tanzania, Iraq, Oman and Nigeria to offer specialised services locally.

REGIONAL ANALYSIS

Around 50% of patients receiving treatment in Chennai arrive from outside of the state of Tamil Nadu.

WELLNESS TOURISM - LEISURE & REJUVENATION Wellness travel is being promoted by even federals and funded by the Ministry of Tourism in many countries.

NEED FOR ACCREDITATION

There is a need for strategic intervention from the Government to mandate quality not only in treatment process but also in outcomes.

4 MEDICAL TOURISM HANDBOOK - INDIA

CONTENTS

30 42

GOVERNMENT'S ROLE IN MVT From challenges with visa and improving flight connectivity, there are many aspects that we need to improve on,

SWISS MEDICAL TOURISM GETS A BOOST Swiss medical tourism from the Middle East feeling benefit from US policies affecting Muslims.

KERALA AS MEDICAL TOURISM HUB There are more than 100 government certified Green and Olive leaf Ayurveda centres in Kerala.

CONTINUUM OF CARE

Compassionate, efficient and responsive handling of patient or his dependents is of utmost importance.

TAPPING AFRICAN MARKET

The key strategic focus should be on service differentiation, quality and outlook enhancement, value adds and service customisation.

CHANGING LANDSCAPE IN MVT

Asian countries will observe robust growth in medical tourism due to increase in quality services and technological advancement in the healthcare and medical sector.

MEDICAL TOURISM HANDBOOK - INDIA

EDIT

MVT Market: An Insight

ndia has emerged as among the top six medical value travel destinations of the world which also includes Thailand, Singapore, Malaysia, Taiwan and Mexico. According to data provided by the Ministry of Home Affairs, the number of medical visas issued by India in 2016 rose by 45% over 2015. India issued more than 1.78 lakh medical visas in 2016, including follow up treatment, as against 1.22 lakh in 2015. The Indian medical tourism sector, pegged at $4 billion, is constantly evolving and in this edition of Medical Tourism Handbook, we have captured the sweeping changes that are giving a new direction and thrust to the industry. Leading hospitals are exploring virgin markets as patient catchments areas for medical tourism. While traditionally most of the patients came from the Middle East, Africa, Bangladesh, Afghanistan, Maldives, Pakistan, Bhutan and Sri Lanka, now many are travelling from the GCC Region, West Indies, the Caribbean Islands, and a few African countries. Read our cover story to find out about these emerging markets as well as strategies devised to tap these markets. The handbook also gives an insight into the recent initiatives taken by the Government to give a boost to medical tourism, ways to ensure continuum of care, strategies to tap African market and myriad other topics. Improving on flight connectivity and further easing the visa process to seek medical treatment would aid the segment achieve its true potential of becoming a whopping $9 billion industry by 2020.

Rita Dutta Editor rita.dutta@itp.com

APRIL 2018

ITP MEDIA (INDIA) PVT. LTD Notan Plaza, 3rd Floor, 898 Turner Road Bandra (West), Mumbai – 400050. India T +91 22 6154 6000 Deputy managing director: S Saikumar Group publishing director: Bibhor Srivastava Editorial Editor: Rita Dutta T +91 9980 588199 rita.dutta@itp.com Special Project Consultant: Dalip Kumar Chopra, Gurdasmal Hospitality and Consultancy Services Pvt Ltd, T + 98735 48997 dalipchopra65@gmail.com ADVERTISING Director: Sanjay Bhan T +91 9845 722377 sanjay.bhan@itp.com Business head: Tushar Kanchan T + 91 9821 459592 tushar.kanchan@itp.com Business Associate: Dr Shadaab Shaikh, Identity Space T + 91 9821511115 info@identityspace.in STUDIO Head of design: Milind Patil Senior designer: Vinod Shinde Contributor: Saili Bandre PRODUCTION Deputy production manager: Ramesh Kumar CIRCULATION Distribution manager: James D’Souza T +91 22 6154 6006 james.dsouza@itp.com The publishers regret that they cannot accept liability for error or omissions contained in this publication, however caused. The opinions and views contained in this publication are not necessarily those of the publishers. Readers are advised to seek specialist advice before acting on information contained in this publication, which is provided for general use and may not be appropriate for the readers’ particular circumstances. The ownership of trademarks is acknowledged. No part of this publication or any part of the contents thereof may be reproduced, stored in a retrieval system or transmitted in any form without the permission of the publishers in writing. An exemption is hereby granted for extracts used for the purpose of fair review. Printed and Published by Sai Kumar Shanmugam, Flat no 903, Building 47, NRI Colony, Phase – 2, Part -1, Sector 54, 56, 58, Nerul, Navi Mumbai 400706, on behalf of ITP Media (India) Pvt. Ltd, printed at Indigo Press India Pvt. Ltd., Plot No. 1C / 716, Off Dadoji Konddeo Cross Road, Between Sussex and Retiwala Ind. Estate, Byculla (East), Mumbai-400 027, India and published at ITP Media (India) Pvt. Ltd, Notan Plaza, 3rd floor, 898 Turner Road, Bandra (West), Mumbai – 400050. India Editor: Rita Dutta

6 MEDICAL TOURISM INDIA HANDBOOK

MARKETING FEATURE

Gamechangers in MVT We profile a few leading medical tourism centres across the country INFRASTRUCTURE

The hospitals’ infrastructure has been thoughtfully planned after detailed analysis of patients’ needs and comfort and has some features which are not available in many hospitals. Infrastructure highlights are not limited to the softer aspects alone. It also includes modular OTs equipped with state-of-the-art technology, well-equipped labour room, out-patient department, dedicated health checkup area, daycare surgery unit, endoscopy suite, waiting 1

lounge for patient relatives and cafeteria.

Sahyadri Hospitals

INTERNATIONAL PATIENT TREATED

The Hospital is a hub of quaternary care and a leading referral centre for multiple specialities

The clinical expertise and the affordable surgery packages attract patients from across globe to Sahyadri Hospitals, but comparatively the inflow is higher from the Middle East and North Africa, SAARC. The bariatic programme at Sahyadri has witnessed patients travelling from North America and the UK.

Sahyadri Hospitals is not just known for being the largest chain of hospitals in Maharashtra, but also for its approach where it brings in the best of experts in multiple

HOSPITALITY SERVICES

specialities and the most advanced technologies.

With the understanding that every overseas patient has different needs, the group has a dedicated team to en-

LOCATION AND EASE OF CONNECTIVITY

sure personalised guidance throughout their treatment

Sahyadri Hospitals has eight centres in Pune, easily ac-

and stay in India. Its International Patient Services team

cessible in span of 20 minutes anywhere from Pune and

assists patients in connecting patients with the best doc-

from Mumbai, it is merely two hours away.

tors for medical opinion, providing cost estimates for the treatment and coordinating appointments and admis-

Regular flights from MENA to Pune are also attracting a

sions as per patient’s travel dates.

lot of patients to the city. And with the proposed international airport, direct connectivity to Pune will become easier and make it convenient for patients travelling from across

INFORMATION CENTRES AND OPD CAMPS

the world to access its healthcare expertise and services.

With its motto to make healthcare accessible, affordable and available to everyone, Sahyadri has been working

ADVANCED TREATMENTS OFFERED

on this front overseas as well. Instead of having patient

Sahyadri Hospitals is a hub of quaternary care and a

to travel all the way before proper diagnosis, the team

leading referral centre for multiple specialities like neu-

at Sahyadri has streamlined the entire pre-travel check

rosurgeries, haematology, cardiac sciences and organ

process. There are telemedicines clinics set up in differ-

transplants, which makes it easier for patients to find all

ent countries and the complete medical diagnosis and

the care under one roof.

treatment plan is defined in the patient’s country itself.

STATE-OF-ART-TECHNOLOGY USED

its team of surgeons, nurses and technicians travel and

The group just does not just upgrade to the latest tech-

performs the surgeries with proper permissions on the

nologies but has experts who understand how to make

foreign land itself for the benefit of patients.

the best of it to diagnose and to treat patients, so that the

For more information, contact: Sahyadri Hospitals Ltd, Pune,

It has gone a step further in a few countries, where

patients don’t go through difficulties to find solutions when their health is already giving them a tough time.

8 MEDICAL TOURISM HANDBOOK - INDIA

1. Sahyadri Hospitals has eight centres in Pune.

Mobile No: 7768003770, Email ID: ips@sahyadrihospitals. com, Website: www.sahyadrihospital.com

PROFILE

Gamechangers in MVT

Continental Hospitals The Hospital carries out rare and successful ABO incompatible kidney transplant Weyrah Dahir, a 64 year old gentleman from Somalia,

cal agents, immunosuppressants and double filtration

had been suffering from end stage renal disease and was

plasmapheresis to remove antibodies from his blood.

on dialysis for over four years. Being a hypertensive pa-

After five sessions, the patient’s titers were brought to

tient, his kidneys were seriously deteriorating and this

the desirable range and it was now possible to perform

compelled Dahir to seek for alternate treatment options,

the kidney transplant.

such as a renal transplant. However, the challenge in Da-

A team led by Dr Vishwambar Nath, Chief or Urology

hir’s case that having an O+ blood group, there was no

& Transplant Surgeon consisting of Dr Dhananjaya K L,

family member with a compatible blood group to carry

Consultant Nephrologist, Dr Shyam Varma, Consultant

out the transplant. His nephew with a blood group of AB

Urologist, Dr Jyothirmayi K, Consultant Psychiatrist

was the closest match, and since this was the only option,

and Dr Vishwanath Gella, Consultant Pulmonologist,

the team of experts at Continental Hospitals, Hyderabad

took charge of the case. The transplant was a successful

decided to initiate the pre transplant workup.

procedure without any complications, and the patient

Since this was an ABO incompatible match, the family

was discharged by the 10th day with 1.2 creatinin levels,

was thoroughly counseled about the possible risks and

which is the best outcome in any scenario. The donor

infections associated with a kidney transplant carried

kidney was retrieved through a laparoscopic nephrec-

out between incompatible blood groups. After establish-

tomy which greatly reduced recovery time of the donor

ing familial relationship between the donor and recipi-

to only 4 days.

ent through DNA matching, the clinical team at Conti-

Dr Dhananjaya KL, Consultant Nephrologist, Conti-

nental Hospitals, Hyderabad began the HLA matching

nental Hospitals, says, “The patient had been on dialy-

process. There was no HLA match between the recipient

sis for four years, and he faced a very low life expectan-

and donor, and the patient’s significant titers added to

cy had he continued with dialysis. With the successful

the difficulty of the transplant. Being the least preferred

transplant, he can now lead a healthy life for another

blood group for ABO Incompatible transplant, this was a

12-15 years. Using new methods like double filtration

very challenging task for Dahir’s medical team. The risks

plasmapheresis and other process, we were able to

of organ rejection were very high and the family was

minimise rejection and infection risks, while optimis-

thoroughly counseled about the same.

ing the patient’s post operative recovery. It is very difficult to achieve such positive outcomes given the worst

To overcome the challenge of incompatible match,

HLA and blood group match between the donor and

the team developed an in-house antibody assessment process using gel card method. The results obtained here were measured against those from other labs to affirm their accuracy. The patient was started on biologi-

10 MEDICAL TOURISM HANDBOOK - INDIA

1. For Weyrah Dahir, the kidney transplant was carried out between incompatible blood groups.

recipient. " The Green OT certified facilities available at Continental Hospitals ensure minimal risk of infection, which enhances the patient’s recovery process.

PROFILE

Gamechangers in MVT Mofizul was very reluctant for any surgical option. During this period of deciding what to do, Mofizul suffered another episode of heart failure making his condition further critical. Therefore, after in depth discussions with the family, The Heart Team of Continental Hospitals (consisting of senior cardiologist, cardiac surgeon, cardiac anesthetist and radiologist) advised him for a nonsurgical approach called Transcatheter Aortic Valve Replacement (TAVR) procedure. TAVR or Transcatheter Aortic Valve Replacement, is a non surgical procedure that replaces the damaged aortic valve of heart by implanting an artificial valve, without open heart 1

surgery and through groin only. It is

TAVR: Boon for High-Risk Patients Mofizul underwent TAVR procedure by a team led by Dr Bharat V Purohit.

an ideal procedure for select patients with severe symptomatic aortic stenosis (narrowing of the aortic valve opening), who are high or Intermediate risk or not suitable for traditional open heart surgery.

Mofizul underwent TAVR procedure by a team led by Mofizul Haque is a 57 year old male from Bangladesh

Dr Bharat V Purohit, Senior Interventional Cardiologist

who approached Continental Hospitals, Hyderabad

and ably supported by the CTVS team, Cardiac Anes-

with complaints of severe breathing difficulty since

thetist, Intesivist etc. Post procedure, he recovered well

a couple of months. He is a diabetic with a history of

within 24 hours and was subsequently sent home in ex-

Coronary Artery Disease, for which he underwent by-

cellent condition.

pass surgery also. On evaluation, he was detected to

Speaking about the technology, Dr Bharat V Puro-

have severe aortic stenosis and LV dysfunction with an

hit- Chief of Intervention Cardiology, and Dr Sameer

ejection fraction of 50%. His cardiac health continued

Diwale Chief of CTVS explained how TAVR is a boon

to deteriorate over time. An LVEF of 50% means that

for patients like Mofizul., â&#x20AC;&#x153;Successful completion of the

his heart was pumping at a capacity lower than normal.

TAVR procedure gives a new ray of hope to many such

Untreated, these patients have a survival span of 2-3

high and intermediate risk patients with critical aortic

years only.

valve disease who are suffering and unable to undergo traditional open heart surgery due to advanced age or

Mofizul was first given an option to go for surgical

other associated diseases.â&#x20AC;? Mofizul is now well past his

aortic valve replacement. However, given his previous history of bypass surgery and weakness of heart muscle pumping, it put him in intermediate to high risk category for surgery. Owing to his past experience with previous bypass and knowing the risk of redo open heart surgery,

12 MEDICAL TOURISM HANDBOOK - INDIA

1. TAVR procedure gives a new ray of hope to many such high and intermediate risk patients with critical aortic valve disease.

recovery period, thanks to the timely intervention of the Heart Team at Continental Hospitals, Hyderabad. He is back to his daily routine in Bangladesh and is living a healthy life.

MARKETING FEATURE

Gamechangers in MVT

Jaslok Hospital and Research Centre The Hospital is one of the major bone marrow transplant centres in the country Mumbaiâ&#x20AC;&#x2122;s Jaslok Hospital and Research Centre offers a

Jaslok Hospital has been one of the first private hos-

range of treatments for kidney-related diseases and for

pitals to perform a renal transplantation in India in

kidney failure. Jaslok Hospital has been pioneer in ini-

the year 1974 with the biggest dialysis unit. Since then,

tiating the ABO incompatible programme in early nine-

the hospital has conducted close to 2,600 renal trans-

ties. To meet this requirement and provide timely treatments, Jaslok Hospital with its latest drug regimen has almost removed the line between ABO compatible and ABO incompatible donor transplant.

14 MEDICAL TOURISM HANDBOOK - INDIA

1. Jaslok Hospital has been one of the first private hospitals to perform a renal transplantation in India

plantations. The strength of this transplant programme lies in the team of doctors. The doctors at the hospital have around 43 years of experience in this field of renal transplants.

MARKETING INITIATIVE

Dr MM Bahadur, Director –Administration – Nephrology, Jaslok Hospital, said, “End stage kidney disease is not the end but just the beginning of a new life in the form of a successful transplant. Our first transplant in 1974, 44 years ago, was a young 35-year-old individual and, now is a healthy grandfather at 79 years today." He is not alone; the hospital has several patients transplanted 30 years age doing well. A good transplant programme is what makes the difference.

Adding another feather to its cap, experts at Jaslok Hospital have outshined in Bone Mar-

for undertaking all required tests in-house, without dis-

row Transplant, along with its dedicated approach and

turbing the patient. Special attention is given in train-

striving towards kidney transplant. Bone Marrow, also

ing and preparing a dedicated team of liver nurses and

known as Stem Cell Transplant, is a life-saving proce-

doctors to perform complex operations with the help of

dure which helps in a varied range of malignant and non

state-of the art, fully equipped operation theatres.

malignant life-endangering ailments. Jaslok Hospital

Through this Jaslok Hospital hopes to not just create

has been doing the complex procedure of bone mar-

awareness about the clinic’s success rate but, more im-

row transplant since 2000 and has saved countless lives.

portantly, educate people of India about the importance

Depending on age of the patient, facilities available, and

of transplant. Liver Transplant Surgeon, Dr AS Soin, Director- Liver

experience of the centre the technique of the said pro-

Transplant from Jaslok Hospital & Research Centre,

cedure alters. The hospital has now developed into a large depart-

said, “We at Jaslok Hospital have a facility that is of in-

ment and also probably is one of the major bone marrow

ternational standard, offering both living donor and ca-

transplant centres in the country as of now. The depart-

daver donor liver transplantation in adults and children

ment undertakes a lot of transplants for a number of dis-

with India’s most experienced liver team." “Organ transplantation is one of the most miraculous

eases which are both malignant and non-malignant. Jaslok Hospital has now become a trusted name in

medical breakthroughs of the 20th century. Unfortu-

giving patients the right treatment at the right price

nately, there are not many organs that are available to

along with the best facilities. So far, around 400 stem cell

help everyone in need. Hence, there is a need for aware-

transplants have been conducted at Jaslok.

ness as there are patients waiting for their chance to a

Dr SH Advani, Director-Department of Oncology, Ja-

better life and this bridge can be only gapped once peo-

slok Hospital, said, “Bone Marrow Transplant is upcom-

ple willingly come and donate their organs. Keeping this

ing lifesaving procedure which can convert incurable

in mind, Jaslok Hospital has paved its way to become a

disease to achieve the cure”

leading super specialty hospital in Western India where

With a goal to match up to the world’s best, Jaslok Hospital has recently re-equipped its liver clinic. This clinic will help to cater exceptional support in early detection of liver ailments which will allow timely medical treatment to prevent life-threatening complications in liver disease. Aiming at providing round-the-clock service to liver transplant patients, this special clinic will also provide a modern 24x7 laboratory and diagnostic imaging services

2. Dr AS Soin, DirectorLiver Transplant, Jaslok Hospital. 3. Dr Tarang Gianchandani, CEO, Jaslok Hospital. 4. Dr. MM Bahadur, Administration – Nephrology, Jaslok Hospital.

the most complex diseases are treated and advanced surgeries are performed. As a hospital, we have ensured a state-of-the-art ICU, operating rooms, infrastructure and different equipment to match the requirements; Jaslok is now at the forefront in providing treatments for specialties and bringing back meaning and hope to the lives of many,” said Dr Tarang Gianchandani, CEO, Jaslok Hospital.

MEDICAL TOURISM HANDBOOK - INDIA 15

MARKETING FEATURE

Gamechangers in MVT and wellness in the industry of medical tourism. RANGE OF SERVICES Visa assistance, air ticketing and transportation: Complete support will be provided by GMT. Hotel accommodation: Best of the hotel accommodations with most competitive tariff will be provided by GMT. Health check up: It has empanelled with best of the medical diagnosis centres, wherein it provides all kind of genuine test for the patients, and reports are acknowledge to you on the same day of the test day. Hospitalisation: It has empanelled with all big network hospitals like Wockhardt, Fortis, Apollo, Saifee, Jaslok, Harkishandas, Kokilaben all these aforesaid hospitals and surgeons are well renowned name in the medical sector. 1

Nursing: Nursing department of GMT is dedicatedly

Global Medical Tourism The company aims to define new standards of comfort and wellness in medical tourism

providing complete care and proper services to the patients. Keen attention and selfless care is the cornerstone of its team in Mumbai, ensuring the services round the clock. Further special care would be taken for the patients by trained team of doctors/nurses. Treatment: Cardiac treatment, orthopaedic and joint treatment, spine surgery treatment, cancer treatment, general & minimal access surgery, IVF and infertil-

The General Medical LLP (Shareef Group) has recent-

ity treatment, neurology & neuro surgery, bone marrow

ly forayed into the vertical of medical tourism. In the

transplant, liver transplantation, plastic & reconstruc-

healthcare industry, it is important to provide aid even

tive surgery, urology treatment, ophthalmology treat-

beyond boundaries and share expertise with the world.

ment, paediatric cardiac surgery, kidney transplantation,

According to reports, researches and results, the world

weight loss surgery, cosmetic and dental surgery. Online consultation with doctor: GMT panel of doc-

is turning to India for medical needs, facilities and cost-

tors will provide you with an online solution to your

effectiveness.

problem. Your identity or reports and queries will be

Global Medical Tourism (GMT) endeavours to be the

kept completely confidential.

most organised catalyst between hospital and patients. The venture will add value to people's lives. GMT is predicated on the understanding of the medical con-

The queries will be attended within 24 to 36 working

strains, key skills of the patient, by refining the operat-

hours. Mail us your requirement on info@gmt.in.net or

ing procedures to ensure reduced overall treatment time

call us on 0091 9152008777 any time 24 x 7.

line. The growth of the medical industry especially in In-

Wasim Ansari, Director

dia has taken off and soaring. With India witnessing top

0091 9769567968, wasim@gmt.in.net

ranking in the healthcare sector, GMT offers a network

Ashraf, Director

of high profile hospitals in Mumbai, with exceptional quality treatment at the hands of reputed healthcare professionals all at affordable charges. Our venture aims to define new standards of comfort

16 MEDICAL TOURISM HANDBOOK - INDIA

1. The company endeavours to be the most organised catalyst between hospital and patients.

Fast track

Visa & Air Ticket

Instant

Health Checkup

Best of Effective

Prominent

“Committed to Quality

Healthcare!”

MARKETING INITIATIVE

Gamechangers in MVT A vision of developing superior talent led Milann to the setting up of our education vertical and initiating post doctoral fellowship and training programs for clinicians and embryologists. This has resulted in a pool of talent who are culturally and clinically connected with the philosophy of Milann. Milann’s outstanding achievements include An established track record of Good Clinical Practice



for over 27 years. Treatment for over 1,00,000 infertile couples.



A high clinical pregnancy success rate of 40 to 50%.

 

World class specialists for infertility and high-risk pregnancy.

Strong team of 20 infertility specialists and over 10 em-



bryologists. 1

India’s first successful SIFT baby.



Milann – The Fertility Center The group has helped over one lakh couples successfully overcome infertility problems

South India’s first ICSI and Laser Assisted Hatching



babies. Milann has initiated cost effective, innovative and patient friendly programmes like: 1. Low Cost IVF. 2. Minimal Stimulation protocols. 3. Vitrification technique leading to an increase in Embryo Freezing and Frozen Embryo Transfers translat-

Milann is a leading infertility chain in India and a brand

ing to a reduction in repeat cycle IVFs.

synonymous with high standards of clinical quality, medical expertise and compassionate patient care. It is headed

4. Freeze all vs fresh embryo transfer

by its Medical Director Dr Kamini Rao, a recipient of the

5. Individualising IVF treatment resulting in better

Padma Shri, who is ably assisted by a competent team of 25

yield and quality of oocytes resulting in higher pregnancy rates.

doctors, 10 embryologists and a 260-strong support staff of nurses, laboratory and administrative personnel who man-

These protocols are associated with fewer side effects,

age the operations at Milann. With its unique approach to

incurs a low risk of ovarian hyper stimulation syndrome,

treatment, Milann has helped over one lakh couples suc-

has a lower cost and good success rates. Milann offers

cessfully overcome infertility problems. With four centres

these protocols as a cost effective, safer alternative to the

in Bengaluru and Centres in Delhi, Mumbai, Chandigarh,

standard IVF programme.

and Ahmedabad, Milann is on the road to a pan India pres-

Milann is committed to providing excellence in qual-

ence and is also the centre of choice for patients from all

ity service, care and treatment using the world’s best

over South Asia, the Middle East and Africa.

standards and applying them to our quality systems. Im-

Since its inception in 1990, Milann’s approach has been

plementation of ISO for over a decade, and application

a careful blend of personalised care, cutting edge technol-

for NABH and NABL has initiated organisational and

ogy, ethical practices and uncompromising quality resulting

structural changes such as introduction of quality con-

in success rates that compare with the best in the world. Among Dr Kamini Rao’s early contributions to the field are the establishment of South India‘s first semen bank, India’s first SIFT Baby and South India’s first babies born through ICSI as well as through Laser Assisted Hatching.

18 MEDICAL TOURISM HANDBOOK - INDIA

1. Milann’s approach has been a careful blend of personalised care, cutting edge technology, ethical practices and uncompromising quality.

trol systems, and quality related committees, which have facilitated a systematic problem-identification and problem-solving process, resulting in streamlining of treatment protocols and practices, which in turn has resulted in improved outcomes.

PROFILE

Gamechangers in MVT

Kovai Medical Center and Hospital The KMCH Heart Institute has performed many complex procedures for the first time in Western Tamil Nadu KMCH Hospital, a multi-specialty tertiary care centre,

plex procedures for the first time in Western Tamil

is one of the pioneer institutions in India to perform

Nadu. The hospital’s location in a tier II city attracts

the most advanced procedures including transplants,

patients residing at various locations in India and in-

robotic surgery, radiation therapy and deep brain stim-

ternational patients for affordable and high-quality

ulation. The Heart Institute has performed many com-

medical care. The experienced team has accomplished many

1 PATIENT TESTAMENT Sandip Kadam, a software professional, thought he wouldn’t live long to see his children grow. The 33-year-old had been suffering from Deep Vein Thrombosis (DVT). His heart’s pumping capacity reduced to 30%, where we expect more than 70% efficiency for an adult of his age. As the baseline issue was severe, most of the major hospitals in northern India had turned down on him and gave only a few days to months as potential life expectancy. That is when he reached KMCH and surgeons in the institute operated on him and put him on Extra Corporeal Membrane Oxygenation (ECHO) machine to support his lungs during its recovery phase for a couple of days. The machine provides support to both heart and lung by providing adequate gas exchange. The patient was discharged on a healthy state over a week’s time. The happiness of the patient and their family is given utmost importance at KMCH. The staff/ clinicians working at KMCH constantly strive to make a seamless journey for its patients and their family. The cost of treatment at KMCH is lower than any other hospitals in metro cities in India where as the quality and clinical outcomes are at par with international hospitals. Additionally, the location is cost effective for patients who need long-term treatment, especially for cancer therapy and neuro rehabilitation. The international patient service team provides concierge service to overseas patient helping them to get the right clinical opinion before they start from the country till they get back and beyond. The patients can connect with the doctors after they reach back to their country through the IT services.

successes but to name a few, the Institute has done the first Heterotopic Cardiac Transplant in Asia (the recipient of the heart is surviving with two heart in his chest cavity), most critical Bilateral Pulmonary Thrombo Endartectomy for lung’s blood vessels which were blocked due to clots in more than 250 locations, advanced hybrid procedure to deploy stent grafts over the major vessels of the heart, most complex electrophysiological procedures to help patients with arrhythmias. For any cardiac problem, immediate and effectual treatment is mandatory. KMCH Heart Institute has a highly efficient team of professionals from cardiology, cardio thoracic surgery, cardiac anesthesiology, critical care team and other support departments to deliver quality cardiac care that is on par with the best heart centres in the world. KMCH has three state of the art interventional cath labs with the latest devices, which offer protection from unwanted radiations. There are separate cardiac medical and surgical intensive care units and post-operative special suites to attend to the needs of the patients.

20 MEDICAL TOURISM HANDBOOK - INDIA

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COVER STORY

22 MEDICAL TOURISM HANDBOOK - INDIA

COVER STORY

Exploring Virgin Markets Indian hospitals are using multifarious strategies to tap patients from newer markets like GCC, West Indies, Caribbean Islands and a few African countries

ndia is the fastest growing medical tourism destination in Asia. It is among the top six medical value travel destinations of the world which also includes Thailand, Singapore, Malaysia, Taiwan and Mexico.. Medical tourism in India

is likely to reach a whopping $9 billion by 2020 as compared to the $3 billon in 2015. India issued more than 1.78 lakh medical visas in 2016, including for follow up treatment, as against 1.22 lakh in 2015, according to the data. In 2014, there were 184,298 Foreign Tourist Arrivals (FTA), in 2015 the number was 233,918 which jumped to 361,060 in 2016 Most of the patients come from the Middle East, Africa, Bangladesh, Afghanistan, Maldives, Pakistan, Bhutan

BY TEAM HR

and Sri Lanka. To grab a pie of the burgeoning market, Indian hospitals are tapping several virgin markets. The emerging markets for tapping medical tourism include Saudi Arabia, Bahrain and the UAE from GCC Region, West Indies and the Caribbean Islands, Africa (Congo, Mozambique and Malawi), Mongolia, Sri Lanka and Indonesia. Patients from the GCC have been travelling to US, Germany, Singapore, Thailand, Turkey and Jordan. Singapore and Thailand is an old time favourite for patients from the East and South East Asia. Patients from CIS have been going to various parts of Europe and Russians also travel to Japan, point out experts. Says Renu Malik Vij, Associate Vice President- International Business and Corporate Sales , Gleneagles Global Hospitals, “We see traction from East and South East Asia as well. Indonesia, Mongolia and Myanmar have really emerged as new markets. CIS is another region to have started looking at India as a treatment option. Patients from Turkmenistan, Tajikistan, Ukraine and Russia are travelling to India. Chinese are also travelling for selected treatment options. From East Africa, Ethiopia has opened up. Ethiopians travelled only to Thailand earlier.” Adds Anas A Wajid, Director- Sales and Marketing, Max Healthcare, “We see opportunities in CIS and Eastern European countries, South East Asian countries as well as the far Pacific. We are also seeing

1. India is preferred for clinical excellence and surgical outcomes as well as low cost.

more patients from war-torn countries in the Middle East. We are also exploring possible opportunities in Northern African markets. Some opportunities are also

MEDICAL TOURISM HANDBOOK - INDIA 23

COVER STORY

STRATEGIES TO TAP

emerging in the Scandinavian countries.” Citizens of these countries prefer India for clinical

The strategies to tap these emerging markets vary as

excellence and surgical outcomes. Cost also plays a role

each country is different, some are state covered, others

but definitely it’s the medical outcomes. Since these are

not. In some countries, insurance sector is strong and in

emerging markets, they are coming for niche treatments and procedures. These patients prefer India due to quality of care, expertise, infrastructure, technology, affordable cost and treatment from accredited facilities that are at par with developed countries.

2. Many patients flock to India from the GCC countries. 3. The strategies to tap these emerging markets vary as each country is different.

some it’s all self-paying patients. So, the strategies depend on the market’s policies and dynamics. Says MS Guru Prasad, General Manager – International Marketing, Narayana Health, “West Indies and Caribbean Islands are markets where the expectation of service levels are very high and are to be managed accordingly. Cost is never a factor for these patients but their priority is only luxury and satisfaction.” The strategies are charted out as the per the group’s expertise. Take, for instance, Gleneagles Global Hospitals, whose strength lies in all the very complicated surgical work like transplants and high-end neuro and onco treatment. For Gleneagles Global, markets such as Saudi Arabia, Bahrain and UAE from the Middle East, Myanmar from South East and Ukraine from CIS have emerged as potential markets. “The patients from these countries mainly travel for all high-end procedures like heart, lung and liver transplants. BMT, oncology and neurosurgical intervention to Global,” says Vij. The group has devised several strategies to get a foothold in these emerging markets. In GCC, it is aiming at the ministry tie ups, as the state covers all the patients. “Since all the high-end procedures are very expensive and patients don’t want to pay from their pockets, our

24 MEDICAL TOURISM HANDBOOK - INDIA

focus is on collaborating with ministries by offering

COVER STORY

them not only treatment in India but helping them in

brand better and they get first-hand information without

their own capacity building by establishing similar pro-

any delays, point out experts. Operations and manage-

grammes in their countries,” says Vij,

ment contracts with local hospitals are also being forged.

Besides ministry tie-ups, leading groups are focusing on training of doctors, nurses and paramedical staff as a part of capacity building programme. Gleneagles Global, for instance, took its first step by starting liver transplants in Oman and has already performed a few transplants. “The idea is enable them to get self-sufficient in a few years’ time,” explains Vij. Groups are also forging local tie-ups. In Myanmar, Global has tied up with hospitals to extend its support in terms of performing surgeries there. It also has a strong patient support groups in all the countries and these groups are in constant touch with doctors. Hospitals are also opening representative offices in many countries. This helps the patients to know the

4. Renu Malik Vij, AVP, International Business and Corporate Sales Gleneagles Global Hospitals

THE BOTTLENECKS One of the major challenges to these emerging markets is that the citizens don’t recognise India as a preferred

5. Vikas Tyer, Head-Strategic Business and International Marketing Manipal Health Enterprises

destination. Their first preference still remains Singa-

6. MS Guru Prasad, General Manager – International Marketing, Narayana Health

of willingness to pay are some of the other obstacles to

7. Anas A Wajid Director- Sales and Marketing Max Healthcare

pore, Thailand, Turkey and Jordan. Air connectivity, visa restrictions, increase in competition from small non accredited small hospitals, global security issues, lack growth, says Vikas Tyer, Head-Strategic Business and International Marketing, Manipal Health Enterprises. THE ROAD AHEAD To improve the influx of MVT patients from these countries, India needs to actively promote India as a health tourism destination as well as get support from the Gov-

1. EXISTING MARKETS: 1. Africa- Kenya, Tanzania, Uganda, Rwanda, Nigeria, Ghana, Malawi and Mauritius 2. Middle East: Iraq, Yemen, Oman, UAE 3. Francophone countries: Burundi, Djibouti, Congo

ernment for setting up helpline centres. International insurance should support MVT with the help of Indian Government. "India has to go a long way in establishing the service level expectations for these medical tourism patients. The Ministry of Tourism has to set up kiosks at various locations for the comfort of these patients.

2. EMERGING MARKETS: 1. East Africa: Somalia, Ethiopia, Eretria, Sudan, Zanzibar 2. West Africa: Benin, Togo, Chad, Burkina Faso, Gabon, 3. Southern Africa: Zimbabwe, Botswana, Madagascar, Zambia, Mozambique, Namibia 4. Middle East: Qatar, UAE, Kuwait, Bahrain, Saudi Arabia, Iran 5. Francophone: Cameroon, Comoros, Ivory coast

Also, we need to work on making visa processing easier as well as introduce arrival visa for the potential countries and have medical visa to be issued without delays,” says Guru. India needs to improve air connectivity and airport service at the immigration section should be streamlined to help reduce the time spent by patients for clearances.

MEDICAL TOURISM HANDBOOK - INDIA 25

OPNION

Top Trends in MVT Teams from reputed hospitals in India have been travelling to countries like Tanzania, Iraq, Oman and Nigeria to offer specialised services locally BY VINAYAK NAYAK

26 MEDICAL TOURISM HANDBOOK - INDIA

OPNION

he value of the Indian medical tourism

for specialised services in countries like Tanzania, Ethio-

industry is currently $3 billion and is

pia, Sudan, Iraq, Yemen, etc.

going to increase to $7 billion by 2022.

For instance, a patient for oncology has to wait for more

There are on an average about 1.8-2 lakh

than one year to avail either radiation or medical oncol-

medical tourists who visit India annually

ogy service. At the same time, average life span of the

and this has been growing on an average of 30-35% year

patient diagnosed with cancer is lesser than the wait

on year. However as year on year the number of patients

period. Also, disease basically progresses and in the end

have been increasing, there have been some changes in

when the patient eventually starts treatment, he would

the healthcare delivery system in many of the countries.

have been in the terminal stage. In order to meet this gap,

Below are some of the recent changes seen in healthcare

hospitals have started developing local hospitals in the

delivery and medical tourism in recent times:

countries for specialised treatments. In return, the staff of the local hospitals needs to un-

SURGERIES DONE LOCALLY In the recent past, the local Governments in respective countries have been insisting upon procedures and surgeries done locally in the country rather than allowing the person for medical value travel overseas. Five years earlier, people used to travel down to Thailand, India, Turkey for specialised services and the numbers were high. The demand supply gap is huge and hence there is a deluge of medical tourists who still travel down for treatment. The reason for this is a huge waiting period

dergo specialised training. This is being arranged in the

1. In the recent past, the local Governments in respective countries have been insisting upon procedures and surgeries done locally.

hospitals located in India, Thailand, Turkey and others.

2. Once the local hospital staff gets trained, the team from India would then visit overseas hospitals for medical consultations and onsite surgeries.

geria to offer specialised services locally in the country.

Teams from cardiac, oncology, neurosurgery, orthopaedics specialities from reputed hospitals in India have been travelling to countries like Tanzania, Iraq, Oman and Ni-

TRAINING AND CAMPS One of the recent trends that you may have heard of is doctors, nurses, medical practitioners, hospital co-ordi-

MEDICAL TOURISM HANDBOOK - INDIA 27

OPNION

nators and other quality personnel from overseas medi-

would be managing the patients post surgeries and han-

cal colleges, teaching hospitals, private establishments

dle them along with the team travelling from India. In

travelling down to India, Thailand, Turkey for special-

this way, there would be effective exchange of surgical

ised training purposes. The duration of training varies

skill, talent, knowledge, information and hand holding.

from 30 days to 1 year. This can be either observership training programmes or hands on training programmes.

OVERSEAS

Once the local hospital staff gets trained in patient care

POLYCLINICS

and handling in Indian hospitals, the team from India

Medical value travel has been largely due to lack of fa-

then visits overseas hospitals for medical consultations

cilities in developing nations and third world countries.

and onsite surgeries. The duration of visit varies from 7

Earlier the patients would travel overseas to get the

days to 30 days. For instance, to set up a cardiac surgi-

medical treatment. In the recent past, due to the local

cal camp in Iraq- one doctor, one anaesthetist, two ICU

Government of the countries emphasising on local de-

nurses, one perfusionist travel to Iraq every month and

velopments in medical facilities, several Indian hospitals

spend about seven days there.

have been keen to set up diagnostic and primary care

Day one would be to screen the patients and day two and three would be to perform the surgeries and another three to four days would be to follow up and observe the patients post surgery. The local teams in the hospitals

28 MEDICAL TOURISM HANDBOOK - INDIA

DIAGNOSTIC

FACILITIES

AND

centres or polyclinics in countries like Tanzania, Kenya,

3. Whenever one thinks of travelling overseas, the one important currency that has universal acceptance is dollars.

Nigeria, etc. The idea is to set up a small diagnostic facility which can cater to services like blood tests and X-rays and provide basic immediate medical attention. Some of

OPNION

the facilities also have CT Scan and MRI. These diagnos-

Basic information like patient vitals, medical reports,

tic centres and polyclinics also run OPDs for consultants

diagnosis are shared real time and the doctor in India,

and the doctors from India travel once a month to screen

Thailand, Turkey can see the information and a give a

patients and advice appropriately.

real time opinion. Tele ICU is a model where a patient can be monitored remotely by a specialist consultant

ROLE OF TELEMEDICINE AND TELERADIOLOGY

from another country and give advice to the local staff

In recent times, Telemedicine, Teleradiology, Tele ICU,

for any change in management plan of the patient based

Tele- Path have gained importance. A patient in Tanza-

on current information. Tele Path is a model where the

nia, Nigeria or any other country can avail consultation

samples of patients are drawn in the local hospital and

or medical advice from a specialist in India, Thailand or

sent to a strategic partner in India, Thailand, Turkey and

Turkey. Technology has played a major role for this de-

the reporting of the same can be done within stipulated

velopment. Minimum requirement would be tele radi-

times.

ology module with a pusher software and an excellent broadband connection at both the ends. This is the recent trend used by Indian hospitals by appointing strategic partners in overseas locations.

4. In recent times, Telemedicine has gained importance in medical value travel.

MACROECONOMIC

CONDITIONS

EFFECTING

MVT Whenever one thinks of travelling overseas, the one important currency that has universal acceptance is dollars. In certain countries, the availability of dollars is easy and in some it is scarce. In some countries, the value of local currency to USD has considerably increased due to local economic conditions and resources. For instance, $ 1 to Naira â&#x20AC;&#x201C; Local currency in Nigeria was 200 till mid 2016. After mid 2016, the value of Naira has increased to 380 plus which is almost depreciating by 100%. The current trending value of currency Naira is 360 for a USD. This has automatically led to increase in price for a Nigerian travelling overseas. For a patient quoted with $ 5,000 for medical treatment, he has to arrange $ 9,000 - 10000 in return to avail the same treatment in India. On the contrary there are certain countries in the same continent where the currency is strong and availability of dollars or arranging the same from the banks to take overseas is very difficult. For eg: 1 USD to Ethiopian Birr is 27. But the availability of dollars is difficult in Ethiopia and a patient has to wait for minimum three to five months for arranging the amount. This would lead to delay in travel from the medical tourist once he makes up his mind.

Vinayak Nayak is handling international business development 4

With Fortis Healthcare.

MEDICAL TOURISM HANDBOOK - INDIA 29

OPNION

30 MEDICAL TOURISM HANDBOOK - INDIA

OPNION

MVT Market: An Analysis Around 50% of patients receiving treatment in Chennai arrive from outside of the state of Tamil Nadu

edical tourism is a growing sector in India. In October 2015, India's medical tourism sector was estimated to be worth US$3 billion. It is projected to grow to $7–8 bil-

lion by 2020. The primary reason that attracts medical value travel to India is cost-effectiveness, and treatment

BY MAHENDER PALA

from accredited facilities at par with developed countries at much lower cost. India with the lowest cost and highest quality of all medical tourism destinations offers wide variety of procedures at about one-tenth the cost of similar procedures in the US. • Bangladeshis and Afghans accounted for 34% of foreign patients, the maximum share, primarily due to their close proximity with India and poor healthcare infrastructure. • Russia and the Commonwealth of Independent States (CIS) accounted for 30% share of foreign medical tourist arrivals. • Other major sources of patients include Africa and the Middle East, particularly the Persian Gulf countries. In 2016, India became the top destination for Russians seeking medical treatment Chennai, Kolkata, Mumbai, Hyderabad, Bengaluru and the National Capital Region received the highest number of foreign patients primarily from South Eastern countries, with Chennai having come to be known as ‘India's health capital'. Traditional sources has been geographies like SAARC (Bangladesh, Afghanistan, Myanmar, Pakistan) countries, Middle East (Oman, Yemen, Saudi Arabia, UAE, Iraq), CIS (Kazakhstan, Kyrgyzstan, Russia, Ukraine) and Africa (Kenya, Tanzania, Ethiopia, Nigeria, Sudan, Zimbabwe, Zambia, Congo). Also these travellers come for specific treatments in India. 1. Bangladeshis and Afghan account for 34% of foreign patients, which constitute the maximum share of MVT patients

• Some of the popular treatments are orthopaedics (knee and hip replacements), cardiac (angioplasty and CABG) spine surgeries, oncology treatment, urology procedures, gastro procedures, transplants and cosmetic surgeries including bariatric and metabolic surgeries.

MEDICAL TOURISM HANDBOOK - INDIA 31

OPNION

Medical tourism is so pervasive in the city that approxi-

CONTINENT WISE SHARE OF MEDICAL TRAVEL

mately half of all patients receiving treatment in Chen-

Destinations Continents of Origin

Asia

Europe

nai will arrive from outside of the state of Tamil Nadu.

Latin Middle East North America America

The country of origin of Chennaiâ&#x20AC;&#x2122;s medical visitors has been reported by some as predominantly coming from

Africa

95%

Nigeria, Kenya, Burundi, Congo, Bangladesh, Oman, and

Asia

93%

Iraq and others. Chennai has been able to draw more

Europe

39%

10%

13%

33%

medical tourists than Bengaluru, due to its increased

Latin America

12%

87%

Middle East

32%

58%

North America

45%

26%

27%

Australia & New Zealand

99%

flight connectivity with the US, the Middle East and other countries. Several hospitals in the city has also signed several Memorandums of Understanding (MoUs) with countries such as Tanzania, Uganda, and Kenya, meaning that their citizens will automatically be sent to Chennai for Government-sponsored medical tourism.

POLICY SUPPORT

Key Operators in Healthcare Industry

The Ministries of Health, External Affairs, Tourism and Culture are working to increase the number of medical tourists. The Government provides online visas, multi-

Patient in Home Country

ple entries, extensions of stay, and accreditation to more hospitals. The number of medical visas issued by India rose 45% in 2016 from the year before, an indication that In-

Consultation with home country physician

dia is rapidly becoming a hub of medical treatment for

Hospital

foreigners. Patients from Bangladesh, Afghanistan, the Middle East and African countries like Kenya, Nigeria, Somalia, constitute a major chunk of the medical tour-

Help with paper work

Health Tourism Agent

Airline Ticketing

ists in India. India issued more than 1.78 lakh medical visas in 2016, including for follow up treatment, as against 1.22 lakh in 2015, according to the data.

Help with Insurance Co

Earlier this year, e-Visa has further been sub-divided into three categories i.e. e-tourist visa, e-Business visa and e-Medical visa.

Hospital accommodation

M Visa for patient & attendant

Sight Seeing Tourism, Transfer & Hotel booking

Co-ordinating with Hospital & Insurance co

The scope of e-tourist visa has been expanded to include short-term medical treatment. Separate immigration counters and facilitation desks have also been planned at major Indian airports to boost the medical

Surgery, Treatment & Consultation

Airport Pick up & drop

Airport or hotel transfer

Tour operator & Hotel booking

travel industry. Separate immigration counters and facilitation desks to assist medical tourist have been provided at Indian airports namely, Delhi, Mumbai, Kolkata, Chennai, Bengaluru and Hyderabad. MEDICAL TOURISM MARKET IN CHENNAI

Chennai attracts 40% of all medical tourists in India, with a minimum of 200 international patients each day.

32 MEDICAL TOURISM HANDBOOK - INDIA

OPNION

Key hospitals in Chennai promoting medical tourism: Sr No

Hospital Name

Fortis Malar Hospitals

Global Hospitals & Health City

MIOT Hospitals

Billroth Hospitals

Frontier Life line Hospitals

Sri Rama Chandra Medical College

Shankara Nethralaya

*Around flow of 300 patients/ day in different hospitals in the city *More than 180 patients from Maldives coming to Chennai / day

MEDICAL TOURISM MARKET IN MUMBAI

Mumbai receives patients mainly from West Asia, Afghanistan and Bangladesh, as it offers affordable health care. Maharashtra receives at least 2 lakh medical tourists in a year, a number expected to rise to 5 lakh over the

next two years. Mainly West Asia, mainly Iraq, Oman and Yemen, visit Mumbai for cancer and pediatric congenital

hip surgery, bone marrow transplant, ENT, hernia, gas-

heart diseases.

troenterology, diabetes and hypertension. Most of them have come to India on the advice of their family and friends or doctors and hospital doctor and hospital re-

Medical tourism market in Mumbai Sr No

Hospital Name

Seven Hills Hospitals

Kokilaben Dhirubhai Ambani Hospital

Saifee Hospital

Fortis Hospitals

Tata Memorial Hospital

Hinduja

Breach Candy

Global Hospitals

Jaslok Hospitals

ferrals. Mainly the patients are found to be coming from Middle East, African and South Asian countries that selffinance their treatments. Max, Fortis, Medanta, Apollo, Nova and Moolchand are renowned for their well-known doctors, customised services, highly advanced equipments technologies and procedures and other world class facilities which have made them popular brand names across the globe.

Medical tourism market in Delhi Sr No Hospital Name 1

Apollo Indraprastha Hospitals

MEDICAL TOURISM MARKET IN DELHI

Max Hospitals

Delhi multi-specialty hospitals provide medical treat-

Fortis Hospitals

ment for a wide range of simple and complex medical

BLK Super Specialty

problems. Cardiac, Orthopedics, Neurology, Oncology,

Medanta Medicity

Sir Ganga Ram Hospital

Artemis

Dharamshila (Narayana)

Organ Transplant, Eye Surgery and Tumour treatment are some of the popular medical treatments undertaken by the patients visiting Delhi-NCR hospitals. Patients are also found to be coming Delhi for spine treatment,

2. Chennai attracts 40% of all medical tourists in India, with a minimum of 200 international patients each day.

MEDICAL TOURISM HANDBOOK - INDIA 33

OPNION

MEDICAL TOURISM MARKET IN KOLKATA

The vast potential in the field of medical tourism is still

Kolkata has emerged as a favourite destination for medi-

to be tapped.

cal tourism, owing to the world class facilities provided to the foreign patients at an extremely affordable price.

IMPORTANT STATISTICS- FOREIGN TOURIST

Major folk of patients are coming to Kolkata from the

ARRIVALS (FTA’S)

neighboring countries like Bangladesh, Nepal , Bhutan

• 18.1% growth in Foreign Tourist Arrivals (FTA) in

and Myanmar. Lack of quality healthcare in Bangladesh,

October, 2017 over October, 2016, 67.3% growth in

geographical proximity to West Bengal and a common

Foreign Tourist Arrivals on E-tourist Visa in October,

culture have made Kolkata a hub for medical tourists.

2017 over October, 2016 • The number of FTAs in October, 2017 was 8.76 lakh

Medical tourism market in Kolkata Sr No

Hospital Name

Apollo Gleneagles

CMRI

AMRI

Columbia Asia

Rabindranath Tagore

Tata Medical Centre

BM Birla

MEDICAL TOURISM MARKET IN HYDERABAD

Competitive pricing, air connectivity and quality healthcare are turning Hyderabad into a major hub for medical tourism in the country. On an average, every month about 1,000 foreign nationals visit the city on medical tourism. Hyderabad is fast emerging as one of the preferred medical travel destinations in India for people travelling from the Middle East, Africa and SAARC. People from African countries such as Tanzania, Somalia, Nigeria, Middle East, CIS and South East Asia come to Hyderabad for complex heart surgeries, joint replacements, brain and spine surgery using robots, bone marrow transplants, cancer treatment, bariatric surgery, dental procedures, heart and lung transplant, gynaecology surgeries, colorectal surgeries, gastroenterology procedures, IVF, cochlear implant surgery and preventive health checks. Medical tourism in India is booming. Various kinds of medical facilities are available to inbound patients easily and economically. However, a few challenges faced by the patients need to be addressed. Keeping in mind the importance of medical tourism, the Government has taken various initiatives, though; a lot is still to be done.

34 MEDICAL TOURISM HANDBOOK - INDIA

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Connectivity metrics Place

Direct

1 stop

Connectivity Status

Delhi

100 Plus

High

Mumbai

100

High

Chennai

Little above medium

Kolkata

Medium

Hyderabad

Low

SWOT on Medical Tourism Strength • Economy in cost • Qualified doctors with brand name. • International recognized Brand name hospitals. • Good services during procedural stage. • Online Consistency • Availability of all kinds of medical treatments. Less waiting time for treatment • Good infrastructure with technologies and facilities. • Hygiene and cleanliness in the hospitals.

Weakness • Arrangements of interpreters. • Problems in obtaining visa sometimes. • Non-availability of financial support.

Opportunities • Increasing demand due to high cost of medical treatments in other nations. • Increased demand due to no or less waiting time for the treatments. • Increased demand due to non-availability of very good medical facilities in the neighboring countries. • India is rated among the top three nations in Asia.

Threats • Lack of international accreditation. • Visa hurdles. • Lack of financial support. • Competition from South East Asian nations like Thailand and Singapore. • Security threats.

as compared to FTAs of 7.42 lakh in October, 2016 and 6.83 lakh in October, 2015. • The growth rate in FTAs in October, 2017 over October, 2016 has increased to 18.1%, compared to 8.6% in October, 2016 over October, 2015. • FTAs during the period January- October 2017 were 79.96 lakh with a growth of 15.8% over same period of the previous year, compared to FTAs of 69.05 lakh with a growth of 9.6% in January- October, 2016 over January- October, 2015. • The percentage share of FTA in India during October, 2017 among the top 15 source countries was highest from Bangladesh (21.66%) followed by USA (11.57%),UK (10.23%), Sri Lanka (3.79%), Canada (3.36%), Germany (3.17%), Australia (3.07%), France (2.81%), Russian Fed. (2.81%), Malaysia (2.76%), Japan (2.44%), Thailand (2.10%), China (1.93%), Nepal (1.66%) and Rep of Korea (1.48%).

3. Mumbai receives patients mainly from West Asia, Afghanistan and Bangladesh.

Mahender Pala is Group HeadMarketing& Business Development, CARE Hospitals Group.

MEDICAL TOURISM HANDBOOK - INDIA 35

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Wellness Tourism Leisure & Rejuvenation Wellness travel is being promoted by even federals and funded by the Ministry of Tourism in many countries BY DR BK SANTOSH KUMAR

36 MEDICAL TOURISM HANDBOOK - INDIA

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and accepted by science and medical councils are added to it. Though wellness tourism has nothing to do with medicine or surgery, it requires one to get a health check done prior to travelling for wellness- which is again a part of leisure travel. Wellness Travel has recently gained importance though it was thought to be available only for people from higher socio-economic status and elite. Now it is being promoted by even federals and funded by the Ministry of Tourism in many countries. It is more affordable now with private players coming in and making it popular among youngsters as well as elderly. We need not seek all and every wellness services during one single trip to a destination since various destinations offer different therapies and each is renowned and good at a few. DESTINATIONS WORLDWIDE & ACCREDITA1. Westerns are preferring India over other countries for ‘Wellness Tourism’.

TIONS

2. AYUSH has been funding and promoting wellness through alternative medicine and healing.

countries for ‘Wellness Tourism’, as India has got rich

Europeans, Americans and alternative therapy seekers from other countries are preferring India over other and varied geographical destinations, herbal and natural resources, and Ayurveda is an approved and proven age-

hen we say ‘Wellness Tourism’ the first thing that comes to our mind is a remote and calm resort, island or beach or even a hill station where one can

detox, relax and rejuvenate in the lap of mother nature. Wellness Tourism is not just visiting the above places when it would be so much more meaningful when a few aspects like herbal medicine, nutrition & diet, exercise & yoga, and other alternative therapies that are approved

MEDICAL TOURISM HANDBOOK - INDIA 37

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old therapy along with other therapies like Unani, Sid-

PREPARATION FOR WELLNESS TRAVEL

hha, etc. The Government of India has set up AYUSH to

The seekers of wellness tourism are advised to hire a

promote the same which permits and provides accredi-

professional consultant or guide who can advise you

tation for centres offering these wellness therapies after

and plan your travel based on your choice of destination,

proper audits that follow protocols and prerequisites.

budget, type of therapy, duration, etc. Such wellness tour

There are many centres overseas that offer well-

could be worth for money, relaxing and result oriented if

ness tourism services but most of them offer spa, baths,

it is planned very well in advance, so that we do not land

scrubs, occupations massage therapy, especially Thai-

in a place which doesnâ&#x20AC;&#x2122;t offer services that we are look-

land, Costa Rica, Estonia, Nepal, New Zealand, Bali, Ari-

ing for or could be too expensive, not accredited by local

zona and these days Turkey as well as Vietnam too have

healthcare authority. A quick cross-check and seeking

become sought after destinations especially due to the

reviews would help avoid such blunder.

initiative that their Governments have taken and fund-

Following are the recommended preparedness and

ing the cause as well as generating huge revenues. So, it

due diligence, before we decide to go for a wellness tour:

is in other words, travelling to seek peace and happiness.

1. Save money for your wellness travel at least once in a year since such a tour is not covered by an insurance

INDIA AS A WELLNESS TRAVEL DESTINATION

payor. 2. Keep reading blogs and articles related to wellness

India has been one of the top destinations since ages

tourism and get to know more and more.

for wellness tourism and been a favourite choice for

3. Communicate and discuss with friends and family

frequent travellers as well as for population seeking al-

about their experience, reviews and suggestions.

ternative and drugless therapy. Destinations like Kera-

4. Visit websites of such wellness travel promoters or

la, Shimla, Mahabaleshwar, Goa, Bengaluru, Ooty and

services providers and check if they are accredited.

few other beaches and hill stations in India offer such

5. Go for complete health check before leaving for a

wellness therapies accredited by AYUSH. As men-

wellness tour if the destination is overseas .

tioned above, there are many centres that are approved and accredited by AYUSH that is funding and promot-

We wish the wellness tourism enthusiast all the best

ing wellness through alternative medicine and healing.

for their travel within and outside their country and

Most of these wellness centres in India are residential

hope the article gives you some insight before you plan

and require the visitors to stay within the facility, so that

to go for it.

they can experience the natural surrounding, get detoxified with the help of proven age-old therapies that are written in Ayurveda medicine in addition to complete cleansing of toxins, baths, spa, yoga, exercise and relaxation. This helps us with lifestyle modification, posture correction and increases self confidence.

38 MEDICAL TOURISM HANDBOOK - INDIA

3. Destinations like Kerala, Shimla, Mahabaleshwar, Goa, Bangalore, Ooty and few other beaches and hill stations in India offer such wellness therapies accredited by AYUSH.

Dr BK Santosh Kumar is Business Head - Medical Tourism with Zoylo Digihealth Pvt. Ltd.

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Need for Accreditation There is a need for strategic intervention from the Government to mandate quality not only in treatment process but also in outcomes BY DR ALEXANDER THOMAS

ealthcare

delivery

models

to pursue healthcare across border.

have

evolved considerably in the last

India has emerged as one of the most sought after des-

decade and medical tourism has

tinations for medical tourists across the globe owing to

emerged as a popular model and

its high value proposition in terms of quality healthcare, pool of specialists and availability of alternate treatment

continues to witness steady growth

globally. As people around the world become aware of healthcare options and as quality healthcare rises as a priority in the minds of the majority, patients are bound

1. There are many instances of middlemen exploiting patients, and this reflects poorly on our country.

options such as Ayurveda and yoga. However, there are many instances of middle men exploiting patients, and this reflects poorly on our country.

MEDICAL TOURISM HANDBOOK - INDIA 39

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Today, medical tourism is a growing industry and can

Healthcare Providers (NABH) and Joint Commission

boost tourism receipts and employment in both medical

International (JCI) to attract tourists. However, there is

centres as well as in other sectors. Global medical tour-

a need for strategic intervention from the Government

ism is pegged at $ 59 billion in the year 2016 or about

to mandate quality not only in treatment process but also

2-3 % of global tourism, and growing at the rate of about

in outcomes. NABH has initiated a programme which

20 % per year. In India, medical tourism is about $ 3.9

accredits medical value travel facilitator.

billion (about 0.2% of Indiaâ&#x20AC;&#x2122;s GDP) in 2016 with a mar-

To facilitate good strategies, the Government needs

ket share in global medical tourism of 5%. The growth of

adequate data which is a primary requirement for as-

medical tourism in India is accelerating and expected to

sessing and designing medical tourism strategies. Exist-

reach $8 billion by 2020, with significant employment

ing secondary data on parameters critical for assessing

potential.

status and potential for medical tourism is inadequate or inaccurate for comprehensive analysis. This was ascer-

Reasons for growth of medical travel differ across

tained through the CSIR NISTADS project.

countries. In regions where quality healthcare is unavailable, the need to access healthcare may lead to medi-

This project, attempted to assess the status and poten-

cal travel. For others, cost effectiveness may be the rea-

tial of medical tourism in India, is based on primary and

son. The primary reasons for medical tourism growth in

secondary surveys along with analysis. The goal of the

India are high quality healthcare, specialised treatment

project was to enhance Indiaâ&#x20AC;&#x2122;s current global medical tourism share of 5% to 10% by 2022. The NISTADS sur-

options, immediate service opportunity for travel coupled with affordability. While India is currently a leading medical tourism hub in the world, there is stiff competition from several Asian and other countries. At the same time, there is potential for higher growth both in terms of global share and in terms of actual volume. However, realisation of this potential and staying ahead of the competition require innovative planning with foresight. Multiple stakeholders are involved in the medical tourism industry. The major factor is the skilled workforce- the doctor. Given the availability of highly trained and experienced doctors across multiple medical centres in India, other factors may also become important. These include medical centre accreditation, insurance coverage and facilitation. To realign with the medical tourism opportunity, which is a strategic objective for several Indian private healthcare providers, many of them (private hospitals) are accredited with the National Accreditation Board for Hospitals &

40 MEDICAL TOURISM HANDBOOK - INDIA

2. NABH has initiated a programme which accredits medical value travel facilitators.

vey was carried out over three cities: Delhi-NCR, Chennai and Bengaluru in six different domains. The survey involved interactions with public and private clinic/hos-

OPNION

is required to meet the projected demand. Without ready capacity, the growing market would be lost to others. ⊲ Quality Policy: A quality policy for medical tourist centres should be adopted. This will prevent negative impact due to a few low-quality firms. ⊲ Financial Enabling: Smaller medical centres may be offered tied funding to promote provision of medical tourism related services, especially non-medical services. SMEs catering to medical tourism sector may be extended softer loans. Similarly, skilling agencies that train workers for medical tourism may extended benefits. ⊲ Policy Enabling: As more countries may allow their citizens to seek medical treatment elsewhere, India as a country destination and/or Indian medical centres could consider a form of empanelment with the health insurers of these countries to ease access to their centres by their citizens. ⊲ Ayurvedic Wellness Tourism: Systematic development of Ayurvedic system aimed at medical tourists may gives India an edge. 3

⊲ Medical Tourist Visa: Policy for fast-track issue of visa for medical tourism. The Government through its various departments

pital, patients, experts and policy makers. The NISTADS survey found that the number of medi-

is already looking at all round development of medi-

cal centres hosting foreign medical tourists is more in

cal tourism. The National Medical & Wellness Tourism

the survey compared to those available in the public

Board, under the Ministry of Tourism, was set-up to of-

domain. Also, while comparing average treatment cost

fer an institutional sub structure for the growth of medi-

for different treatments from the survey to those listed

cal tourism in the country. The National Medical & Well-

across the world-wide-web, it was found that the average

ness Tourism Promotion Board has been given the task

treatment cost in survey varies from that found in world-

of writing a draft of medical and wellness tourism policy

wide-web sources.

for India. In this regard, AHPI has been given the mandate to engage in intense dialogue with different stake-

Based on the analysis of the survey, the following recommendations were suggested:

holders and propose strategies to enhance and sustain

⊲ Improved Informatics: The information regarding

medical tourism multi-fold in India.

choices of medical centres and respective treatment

We are confident that the Government will be able to

costs is not available either from the Government or

create suitable policy interventions to enable rapid and

from the medical tourism websites. This information

accelerated growth of quality medical tourism in India.

gap needs to be filled in a credible way to attract more medical tourists to India.

Dr Alexander Thomas is

⊲ Decision Support Facility: Informatics need to go beyond passive information and provide decision support to tourists for customisation of their medical tourism. ⊲ Capacity Building: A pro-active capacity building

President of Association 3. A quality policy for medical tourist centres should be adopted.

of National Board of Accredited Institutions (ANBAI).

MEDICAL TOURISM HANDBOOK - INDIA 41

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Wishlist from Government From challenges with visa and improving flight connectivity, there are many aspects that India needs to improve on BY GOKUL PREM KUMAR

42 MEDICAL TOURISM HANDBOOK - INDIA

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tiatives that the Government has taken to liberalise the visa norms, is obtaining medical visa at a faster pace. We are missing out every year on many patients to other countries, as there is always a sense of emergency when it comes to health issues and patients would want to travel at the earliest possible. Itâ&#x20AC;&#x2122;s very important to have empathy towards patients as every experience counts in 1. We need to get medical visa at a faster pace.

their journey towards recovery. For people who travel

2. Our Indian representatives in respective countries should see whether the hospital in India has accreditation before issuing a medical visa.

if they need any medical attention and want to convert

to India on business or tourist visa and during their stay the status of their visa on medical grounds, our current norms do not allow for visa conversion and this has been a setback for the industry.

ccording to various reports, India would be generating $ 5 to 6 billion business for MVT by 2018 but we could achieve only about $ 4 billion in revenues due to some hurdles- both internal and external.

Though the outlook is positive and vibrant, we could have done better to accelerate the growth rate as compared to competitors in the region. One big challenge which we still face despite few ini-

MEDICAL TOURISM HANDBOOK - INDIA 43

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and overlook if that particular hospital which has sent the invitation letter has got NABH accreditation, JCI accreditation or any other national/ international accreditation of repute, so that we can minimise the adverse events and improve our score on compliance and governance in safeguarding the interest of the patients. The Government should take some initiatives to improve flight connectivity as this plays a vital role in decision making, especially for patients travelling from CIS and SAARC countries. Africa is well connected to many destinations in India through Middle East airlines like Emirates, Etihad and Qatar. Turkey and Thailand score over us in both the above aspects. When it comes to clinical excellence and affordability of treatment, India is ranked high and I believe if it is coupled with excellent service at various levels and improvising connectivity and visa issues, India will emerge as a formidable player 3

in the MVT domain for the years to come and enhance the growth rate at faster pace. Another area where all the stakeholders involved need to pay attention is to ease the facility of money transfer

The authorities should improvise the system for regu-

for patients from their respective countries to India.

lation and monitor the promotion of hospitals and their services offered in overseas market. There were incidences where patients from overseas visited India and ended up in hospitals without any accreditation and had adverse experience which in turn had brought bad repute to the industry. So, our Indian representatives in their respective countries deployed should do some due diligence before they issue a medical visa to any patient

44 MEDICAL TOURISM HANDBOOK - INDIA

3. The authorities should improvise the system for regulation and monitor the promotion of hospitals and their services offered in overseas market.

Gokul Prem Kumar is Head - International Business, Continental Hospitals.

OPNION

Swiss Medical Tourism: An Upward Swing Swiss medical tourism from Middle East is reaping the benefits from US policies affecting Muslims BY ANDRES OPPENHEIM

edical tourism traffic into Swit-

tals and clinics there. Now, however, because of the cur-

zerland from the Middle East

rent political situation in the US, they are no longer keen

could receive a big shot in the

to travel there.

arm from the effects of US Presi-

At the same time they know they will always be very

dent Donald Trump’s treatment

well received in Switzerland. Swiss excellence in spe-

of Muslims,. There is a growing flow of Middle East pa-

cialist healthcare and hospitality is well known to Arab

tients opting for Swiss medical checks and treatments

audiences.

after turning their backs on America.

The Swiss Medical Network, and the Nescens Clin-

Trump’s policies are having a very negative effect on

ique de Genolier in particular, are already very well es-

Muslims, as they are on a lot of other people, and medical

tablished in this market and we expect a growing num-

healthcare into Switzerland is one of the beneficiaries.

ber of discerning Middle Eastern travellers who demand

People in the Middle East who need an immedi-

the very best in medical treatment and hospitality.

ate medical solution will always find it because they’re strongly connected to top hospitals and clinics worldwide. In fact they have very good hospitals here so they don’t even need to get on a plane. But a lot of people here who look after their personal health capital are used to travelling to the USA for checks up and treatments at some of the leading hospi-

1. There is a growing flow of Middle East patients opting for Swiss medical checks and treatment.

Andres Oppenheim is General Manager of the renowned Nescens Clinique de Genolier.

MEDICAL TOURISM HANDBOOK - INDIA 45

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Kerala as Medical Tourism Hub There are more than 100 government certified Green and Olive leaf Ayurveda centres in Kerala BY NEELAKANNAN P

edical tourism is a growing sector

medical tourism destinations, and it offers a wide vari-

in India. The Indian medical tour-

ety of procedures at about one – tenth the cost of similar

ism market is expected to grow

procedures in the US.

from its current size of $ 3 billion to $ 7 – 8 billion by 2020. The pri-

mary reason that attracts medical value travel to India is cost – effectiveness and treatment from accredited facilities at par with developed countries at much lower cost. The medical tourism market Report: 2015 found that India was one of the lowest cost and highest quality of all

46 MEDICAL TOURISM HANDBOOK - INDIA

1. Kerala currently it attracts only 4 - 5% of medical tourism patients. 2. The average population per nurse in Kerala / India is 138 / 472.

WHY KERALA? ‘Kerala’, the mesmerising land located in the south of India, enjoys geographical features that are unique in the world tourism map for its natural beauty and cultural heritage. The state is ideally suited for medical tourism because of its moderate weather throughout the year,

OPNION

Kerala Healthcare - Appendix No. of Institution No. of beds

No. of doctors No. of nurses

Public

Public Private

Private

Public

Allopathy

1278

Ayurveda

857

4332

3920

Homeopathy

561

3226

1295

Others Total Total per 10000 population

4825 43616

Private

Public 14257

Private

57071

5273

15281

5502

1054

5986

19125 1598

813

607

3684

463

535

1105

447

138

15614

113235

32322

40713

4.8

34.6

9.9

12.4

Source: Kerala Economic Review 2012, Government of Kerala, Thiruvananthapuram Source: RHS Bulletin, March 2012, M/O Health & F.W., GOI

advanced hospitals with world class facilities, renowned doctors specialised in major disciplines, trained para medical staff and technicians and international connectivity. While on one side Kerala boosts of the traditional medical systems like Ayurveda, Sidha, Naturopathy, Panchakarma, Kalari and others, on the other hand it also gives relevance to modern medicine with many accredited private healthcare institutions with state-of-the-art facilities. Currently, it attracts only 4 - 5% of medical tourism but has the potential to increase its share to 10 â&#x20AC;&#x201C; 12% of the overall market. QUALIFIED MANPOWER SURPLUS The state with the highest literacy rate in the country is

MEDICAL TOURISM HANDBOOK - INDIA 47

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FEW STATS • Foreign tourist visits to Kerala have grown from about 2 lakh tourists in 2001 to over 9 lakh tourists in 2014 (contributing over 4% to the overall foreign tourist visits in India). • Kerala is amongst the states with the lowest infant mortality rate, maternal mortality rate and the highest literacy rate in the country. • Largest producer of nursing and technician pool in the country and has a fairly robust doctor pool in the country. • About 30% of the foreigners visit Kerala for wellness reasons and about 40% of the State’s tourism revenue is generated from Ayurveda. • Kerala has 2 JCI accredited facilities, 23 NABH accredited hospitals out of the 25 and 317 accredited facilities in the country respectively, and 2 ACHSI accredited facilities.

48 MEDICAL TOURISM HANDBOOK - INDIA

$4bn

3. Kerala boasts of three well spread out international airports in Kochi, Trivandrum and Calicut with direct connectivity with all GCC countries and most Asian countries

Overall tourism revenue in Kerala - 2014

OPNION

KEY HOSPITALS: 6 – 8 LARGE HOSPITALS BEDS: 2,400 – 2,700 BEDS IN THESE HOSPITALS KEY STRENGTHS: SUPER/MULTI SPECIALTY, CARDIAC

also considered as the ‘nursing hub; for regions West of Europe. The average population per nurse in Kerala / India is 138 / 472. WELLNESS & AYURVEDA Alternative medicine is increasingly becoming popular

KEY HOSPITALS: 5 – 6 LARGE HOSPITALS BEDS: 1,400 – 1,600 BEDS IN THESE HOSPITALS KEY STRENGTHS: SUPER/MULTI SPECIALTY

especially in German speaking areas of Europe. Ayurveda plays a leading role within a trend of deeply relaxing wellness therapies and Kerala possesses an unbroken tradition of Ayurveda that has surpassed many invasions and intrusions both foreign and native. Unlike the other

KEY HOSPITALS: 6 – 8 LARGE HOSPITALS BEDS: 2,700 – 3,000 BEDS IN THESE HOSPITALS KEY STRENGTHS: SUPER/MULTI SPECIALTY, CARDIAC

Indian states, the status of Ayurveda in Kerala is not that of an alternative but is main stream. There are more than 100 Government certified Green and Olive leaf Ayurveda centres. Hence we can see more and more foreign tourists, especially from developed countries throng the state to avail such services.

KEY HOSPITALS: 4 - 5 LARGE HOSPITALS BEDS: 1,200 – 1,400 BEDS IN THESE HOSPITALS KEY STRENGTHS: SUPER/MULTI SPECIALTY

INFRASTRUCTURE Kerala boasts of three well spread out international airports in Kochi, Trivandrum and Calicut with direct connectivity with all GCC countries and most Asian countries. In terms of medical infrastructure, the health system in the state fares better than the national average,

KEY HOSPITALS: 12 - 15 LARGE HOSPITALS BEDS: 4000 – 4200 BEDS IN THESE HOSPITALS KEY STRENGTHS: SUPER/MULTI SPECIALTY, CARDIOTHORACIC

resulting in the state recording among the lowest IMR and MMR in the country. Also the average population served per Government hospital bed Kerala / India is 918/1833.

* Large hospital : 200 – 300 beds on an average

Few roadblocks that we need to overcome: ⊲ Lack of insurance policy for this sector. ⊲ Low investments in health infrastructure.

Existing Corridors that Kerala can easily tap Key existing corridors

Potential opportunity

To leverage on

GCC to various Indian states

High

Direct connectivity, expat population strength

Africa to South India

Moderate to High

Showcase clinical excellence at par with competition

Existing Corridors that Kerala can easily tap

⊲ Shortage of specialists in this field. ⊲ Strong competition from other countries – Singapore, Malaysia, Thailand and Phillipines. ⊲ Different pricing policy in hospitals. ⊲ Lack of coordination between various players in the industry – airlines, hotels and hospitals. Though there will be some roadblocks on the way, it’s

Key existing corridors

Potential opportunity

To leverage on

time for Kerala to leverage its tourism brand and secure

Western countries to various Indian states

High

Wellness brand image already created among Western tourists

a leading place in medical tourism.

West and South Asian to various Indian states

Moderate to High

Improve promotion, direct connectivity

Neelakannan P is Group COO, KIMS Global.

MEDICAL TOURISM HANDBOOK - INDIA 49

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Continuum of Care Compassionate, efficient and responsive handling of patient or his dependents is of utmost importance BY COL HEMRAJ SINGH PARMAR

ndia is on the way to fast emerging as a for-

mouth and things could go awry pretty quickly, if the pa-

midable destination for Medical Value Travel

tients are not handled appropriately. In the long term,

(MVT), this being a sunrise industry. As na-

only good quality of overall patient experience, afforda-

tional borders become increasingly porous, MVT experts and healthcare providers need

to explore new ways of managing international medical travel. This business is driven, inter alia, by word of

50 MEDICAL TOURISM HANDBOOK - INDIA

bility and exceptional outcomes will drive this business. 1. Continuity of care leads to an improvement of the satisfaction level, reduces costs and improves health.

Lately, however, we have had challenges in delivery and there have been alleged instances of cheating, suboptimal outcomes and cost escalations.

OPNION

MVT VALUE CHAIN

up consultations and clinical reviews for patients coming from Africa, MEA and other regions.

Right from the time a query is raised till a patient reaches a hospital, compassionate, efficient and responsive han-

• Country Visits: Continuity of care by doctors visiting

dling of patient or his/her dependents is of utmost im-

some of these countries for OPD, medical camps and

portance. Continuity of care post treatment is equally im-

other promotional activities can also see the patients

portant too. A typical MVT value chain may involve the

and review their medical condition. This helps build trust and provide continuity of care.

following: • Receipt of investigations and diagnostic reports from

• Self Help Groups: Some hospitals have also created self-

the patient and a feedback by provider to patient on

help groups in social media to help answer their medi-

diagnosis, line of treatment, scope of services and com-

cal queries and mitigate post treatment clinical and lifestyle related concerns.

mercials. • Assistance in pre-travel formalities and procedures

• Physical Presence: Some providers are establish-

(medical visa, travel & staying arrangements and arrival

ing hospitals and other healthcare facilities in some

formalities et al).

of these target countries to ensure care. Many others

• Treatment in the hospital in line with best practices.

have opened facilitation centres or have even started

• Provide post-travel post treatment support and ensur-

‘surgery camps’ with some local players to bring care closer to patients. These initiatives have their definitive

ing continuity of care to the patient. • Extension of language and cultural support.

upside in increasing patient outreach and establishing

• Financial support.

long-term partnership and confidence.

• Optimising the respective roles of the physician/surgeon, International Patient Services Team (IPS) hospi-

MEASURING QUALITY OF CARE

tal, nurse and case manager in risk reduction and pa-

Accreditation of the providers, including those of health-

tient clinical care.

care facilitators, will help drive quality. All hospital staff 2. Caregiving and follow up clinical staff need to be adequately trained for the job..

• Minimise potential risks and clinical care deficiencies in medical/surgical travel practices, hospitals and aftercare facilities.

needs to be trained too. The following KPIs will need to be monitored to ensure exceptional patient delight: • Patient satisfaction at critical touchpoints outside the

CONTINUUM OF CARE • Maximising the Hospital Experience: Most hospitals have a full-fledged IPS team and translators who help the physicians in delivery of care. • Prevention of Malpractices: Canvassing and pestering of patients right from the airport onwards have been reported occasionally, at least in NCR. Such is the competition that there have also been reported cases of patient ‘theft’. Cases of inflated billing, ill-treatment and botched outcomes have also been reported off and on. The menace must stop, as it gives a bad name to the industry and dents overall industry image. • Accreditation of MVT Companies: A notable trend in accreditation of MVT facilitators also augurs well for the industry. This will set benchmarking standards for many others to follow suit and bring in quality and improvements into the MVT protocols. • Telemedicine & Post Treatment Review: Telemedicine is fast catching up in the country and can provide follow

MEDICAL TOURISM HANDBOOK - INDIA 51

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THE ROAD AHEAD

clinical setting such as the hotel or transportation. • Average treatment charges.

The MVT industry is becoming highly competitive. The

• Service delivery times and TATs – many providers

continuing regulatory pressures will further put down-

struggle on this count.

ward pressure on healthcare providers. This may increase

• The average time it takes you to respond to a prospect.

costs of treatment and derail the movement of people

• Patient follow up.

moving to India, seeking world class treatment at cheaper rates. It is very important for any organisation to identify

TECHNOLOGY IS THE DRIVER

problems and opportunities and to increase productivity

To ensure the continuum of care, HIPAA compliant ICT

wherever service levels are lacking. Continuity of care is

technologies are being developed globally to store and

important to caregivers and patients alike, and it leads to

retrieve medical information in hospitals, in a central-

an improvement of the satisfaction level, reduces costs

ised information infrastructure about treatment and care

and improves health. Patient feedback is equally impor-

plans, while preserving personal information confidenti-

tant. Caregiving and following up clinical staff need to be

ality. Telemedicine, AI, EMR/EHR sand Blockchain are

adequately trained for the job. Many clinicians are them-

the future of medicine in the country and going to help

selves not up to the mark and need to be upskilled.

the MVT industry immensely. These will also help ensure

Providers will have to up the game to remain ahead of

continuity of care, long after the patient has left for his/

the curve to provide value to patient throughout the treat-

her own country after getting good treatment.

ment value chain. There are no short cuts to success here. Optimising processes and providing continuity of care

MAINTAINING TRANSPARENCY

will help build trust and long-term relationship and take

Some cases of violence have been reported in the recent

the MVT industry to the next level.

past because of fatalities or lack of transparency in pricing. This has gotten the industry a bad name and affects India’s story as a destination for medical value travel. The presence of large number of touts and many other fly by night operators severity affect the patient interests and dent the quality of healthcare delivery.

52 MEDICAL TOURISM HANDBOOK - INDIA

Col Hemraj Singh 3. Optimising processes and providing continuity of care will help build trust and long term relationship.

Parmar is Chief Executive Officer of BR Life.

OPNION

Tapping African Market The key strategic focus should be on service differentiation, quality and outlook enhancement, value adds and service customisation BY BENNY CHARLES DANIEL

MEDICAL TOURISM HANDBOOK - INDIA 53

OPNION

he key to the success of generating revenue from a market is the ability of a particular hospital, facilitator or a provider to show value to the customer. The value that can be created in a market though

would initially be leveraged on the perceived value that the consumer has about a particular organisation, country, destination and seller. The perceived value needs to be constantly added and delivered, so as the reputation to the customer still helps him with a favourable buying decision. As one looks at adding the perceived value, the key strategic focus should be on service differentiation, quality and outlook enhancement, value adds and service customisation. As the perceived value of a particular seller is created and sustained towards creating a sustainable and strong transactional market, there is also a key importance in deploying strategies that actually helps solutioning the need areas of the market in a most effective and mutually beneficial way. Though the above paragraphs focus on generic focus

areas in relation to creating perceived value and delivering value proposition, I would like to take a few of my

continent, it is imperative that they first see the need

experiences, in what I feel worked for me in creating in-

and demand in the market. The specific demand in that

ternational markets. For this article I would restrict my

particular market and the shortfalls for the next three

experience only to African markets. Africa is taken as an

years that the country might have before they evolve

example because the continent gives us enough instanc-

their healthcare is a good base to strategically position

es with different stage of growth. There are markets that

the seller and most importantly perceive the sustenance

are generating high volumes, markets with high growth

and growth rate. With that as the background, the seller needs to look

trajectory and also markets with extremely specific dis-

at immediate, mid-term and long-term strategies. The

ease conditions. Given the versatility of the African continent, there

immediate strategy though will focus on patients travel-

exist a huge demand and opportunity for every seller in

ling out of the country and to attract them to the seller,

healthcare to add an element of value for the continent.

and the mid-term strategy should focus on how much

In my personal opinion, any successful business associa-

the seller wants to be a part of the growth with the coun-

tion starts with value creation, the commercial and stra-

try. This should focus on strategies that help in effective-

tegic aspects should evolve under the base of value to

ly managing diseases, population based health, quality of

patients. Africa as a fast growing continent is developing

life and care continuum. The long-term strategy should focus on how the seller

a robust and strong healthcare scenario, but given the current stand it gives us immense opportunities to support the system and look at it in a long-term symbolistic association. The continent should be looked as an opportunity that would enable sellers to create healthcare in Africa than just focus on the interim outward referrals When a seller looks at tapping any segment of the

54 MEDICAL TOURISM HANDBOOK - INDIA

1. The African markets generate high volumes.

can associate in helping the country achieve and scale

2. The long-term strategy should focus on how the seller can associate in helping the country achieve and scale the availability of healthcare.

demand healthcare for the citizens. Though the above

the availability of healthcare that would address a high are more strategic, the key is to convert the above strategic steps into executionable action plans, so as the sellers benefit at all the three stages.

OPNION

IMMEDIATE STRATEGIES

and scalability in the market. Many sellers without this

Different sellers deploy different strategies to enter

would see that the volume has picked up but cannot be a

and capitalise this phase of opportunity, the common

consistent revenue platform. Long-term strategies are the

shortfall to look for is below:

foundation on which your immediate strategies are built.

1. Never plan only on the number of patients that you

The long-term strategies will help you build a strong perceived value, thereby creating a powerful brand that pa-

would need to attract immediately.

tients can trust. Few things to look for are as below;

2. Never look at immediate foot falls just because an-

1. What is the current shortfall in the targeted countries

other seller is having the volumes, the sustenance of

health systems? How do you see the next three years?

a market is on how the patient sees your brand. So

2. To what extend does your institution want to partici-

building that is key than immediate response. Instead of planning your immediate strategy based on

pate? And how long are you willing to wait to get this

the above questions, always have the following questions

done? Will you have your investments / technology /

answered before you estimate the market:

talent in place to fulfill this journey? Once you are able to address these key points of dis-

1. How many patients do you feel your institution can

cussion, then executing it with action points becomes

add value to?

easy and in line to fulfill a strong, high growth and domi-

2. What are the values that you can offer? Is it only by

nated market.

bringing them for treatment or any other support functions? 3. What is the immediate value that you can pass to the patient? Price or outcomes or care? MID-TERM AND LONG-TERM STRATEGIES

The key to having this thought through in the beginning is because it lays the foundation on your sustainability

3. The long-term strategies will help you build a strong perceived value.

Benny Charles Daniel is Co Founder and CEO, VB Health.

MEDICAL TOURISM HANDBOOK - INDIA 55

OPNION

Changing Landscape in MVT Asian countries will observe robust growth in medical tourism due to increase in quality services and technological advancement in the medical sector BY SIDDHESH S ASALEKAR

edical tourism takes place when people prefer travelling to another country apart from their own, to get medical treatments. Recently, this term mainly refers to people

who travel from developed countries to less-developed or developing countries due to low price in medical treatments. Most of the times, medical tourism takes place in cases where surgical, dental and medical care are required which is received better than their own country. There is also â&#x20AC;&#x2DC;domestic medical tourismâ&#x20AC;&#x2122; wherein people travel from one state to the other to receive surgical, medical and dental care. Precisely, patients happen to travel due

56 MEDICAL TOURISM HANDBOOK - INDIA

OPNION

MEDICAL TOURISM HANDBOOK - INDIA 57

OPNION

to high quality of healthcare, access of better care and

babwe visited Gleneagles Hospital in Singapore during

mainly affordability.

a trip for a medical check-up. After getting ousted from

According to an ongoing study by Future Market In-

his power, he was seen for the first time in public. It

sights, the analysts found out that there is increase in in-

was learned that the medical check-up was a part of the

ternational patient flow and demonstrable achievements

package that he received to travel overseas as a retired

and ever-evolving innovation in developing countries.

president. Currently, he is experiencing frail health and

A few prominent centres for medical tourism include

has been reportedly fought prostate cancer. Mugabe has

Malaysia, Singapore, India and Thailand, etc. The study

been visiting Singapore several times in the recent years

projects, by the end of 2020, the Asian countries will ob-

for undisclosed medical issues.

serve robust growth in medical tourism due to increase

In addition to Singapore, India is also famous for spe-

in quality services and technological advancement in the

cialist cardiac surgeries. While Singapore is considered

healthcare and medical sector. Further, the study observes

as the most popular destination for medical tourism due

that Asklepios Klinik Barmbek (Germany), KPJ Health-

to its expertise in complex surgical procedures, the de-

care Berhad (Malaysia), Fortis Healthcare (India), Bang-

mand for medical tourism is also surging in other parts

kok Hospital (Thailand), Raffles Medical Group (Sin-

of Asia. Since 2006, Thailand has been one of the most

gapore), Min-Sheng General Hospital (Taiwan), Prince

preferred centres for cosmetic surgery. Malaysia offers

Court Medical Centre (Malaysia), Asian Heart Institute

modern medical treatments and infrastructure along

(India), Anadolu Medical Centre (Turkey), Wooridul

with highly qualified and skilled professionals. The

Spine Hospital (Korea), Bumrungrad International Hos-

centre also offers economically affordable treatment al-

pital (Thailand), Clemenceau Medical Centre (Lebanon),

ternatives as well as favourable Government initiatives.

Samitivej Sukhumvit Hospital (Bangkok), Gleneagles

Due to such eventualities, the expansion of the global

Hospital (Singapore) and Apollo Hospitals (India) are the

medical tourism market will continue to remain concentered in the Asia Pacific region.

key players in the global medical tourism market, with majority of them located in Asian countries. Amongst these, Gleneagles Hospital has recently made news for its development in medical tourism. According to a recent news, Mugabe visited Gleneagles Hospital for the first time since ouster for a medical check-up. Robert Mugabe, the former president of Zim-

58 MEDICAL TOURISM HANDBOOK - INDIA

1. Singapore is considered as the most popular destination for medical tourism due to its expertise in complex surgical procedures. 2. India is also famous for specialist cardiac surgeries.

Siddhesh S Asalekar is Team Lead â&#x20AC;&#x201C; Content Marketing with Future Market Insights.

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