Virtual Global Knowledge

Project on Medical Tourism Industry

Introduction

Medical tourism in India
After the silicon rush India is now considered as the golden spot for treating patients mostly from the developed countries and far east for ailments and procedures of relatively high cost and complexity. India is also aggressively promoting medical tourism in the current years -and slowly now it is moving into a new area of "medical outsourcing," where subcontractors provide services to the overburdened medical care systems in western countries.

India's National Health Policy declares that treatment of foreign patients is legally an "export" and deemed "eligible for all fiscal incentives extended to export earnings." Government and private sector studies in India estimate that medical tourism could bring between $1 billion and $2 billion US into the country by 2012.

Going by the Statistics and various studies it can be easily said that indiawould be the leader in medical tourism within the next decade if only it could improve the infrastructure and tour attractions. The question or rather the doubt that is often asked by critics is how can India provide top line medical care to outsiders while more than 40% of its people languished below poverty line and less than 20% of its people can actually afford medical services. Ethically and morally this problem has to be solved if India has to move into the category of developed country and also as a place which provides medical care to both its own people and patients from other country

The aim of this project is to put a finger on the highly profitable service of medical care combined with tourism in which india is currently considered as a market leader. It has been a known fact for past many decades that Indian doctors are highly skillful in their given field since all around the globe mot hospitals have doctors of Indian origin. Therefore it became almost natural that this trend extended to India.

This project also aims to show why India is attracting medical tourists, is it really a secure destination and how Indiacan promote and develop this particular activity in the coming years so as face competition given by other Asian and African options.

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Medical tourism: A Global perspective

Medical tourism happens when patients go to a different country for either urgent or elective medical procedures. This phenomenon is fast becoming a worldwide, multibillion-dollar industry.

The reasons patients travel for treatment vary. Many medical tourists from the United States are seeking treatment at a quarter or sometimes even a 10th of the cost at home. From Canada, it is often people who are frustrated by long waiting times. From Great Britain, the patient can't wait for treatment by the National Health Service but also can't afford to see a physician in private practice. For others, becoming a medical tourist is a chance to combine a tropical vacation with elective or plastic surgery.

And moreover patients are coming from poorer countries such as Bangladesh where treatment may not be available and going for surgery in European or western developed countries is expensive.

The interesting thing of Medical tourism is that it is a concept which is actually thousands of years old. In ancient Greece, pilgrims and patients came from all over the Mediterranean to the sanctuary of the healing god, Asculapius, at Epidaurus. In Roman Britain, patients took a dip in the waters at a shrine at Bath, a practice that continued for 2,000 years as it was believed that the waters had a healing property . From the 18th century wealthy Europeans travelled to spas from Germany to the Nile. In the 21st century, relatively low-cost jet travel has taken the industry beyond the wealthy and desperate.

Countries that actively promote medical tourism include Cuba, Costa Rica, Hungary, India, Israel, Jordan, Lithuania, Malaysia and Thailand. Belgium, Poland and Singapore are now entering the field. South Africa specializes in medical safaris-visit the country for a safari, with a stopover for plastic surgery, a nose job and a chance to see lions and elephants.

Thailand

While, so far, India has attracted patients from Europe, the Middle East and Canada, Thailand has been the goal for Americans.

India initially attracted people who had left that country for the West; Thailand treated western expatriates across Southeast Asia. Many of them worked for western companies and had the advantage of flexible, worldwide medical insurance plans geared specifically at the expatriate and overseas corporate markets.

With the growth of medical-related travel and aggressive marketing, Bangkok became a centre for medical tourism. Bangkok's International Medical Centre offers services in 26 languages, recognizes cultural and religious dietary restrictions and has a special wing for Japanese patients

The medical tour companies that serve Thailand often put emphasis on the vacation aspects, offering post-recovery resort stays.

South Africa

South Africa also draws many cosmetic surgery patients, especially from Europe, and many South African clinics offer packages that include personal assistants, visits with trained therapists, trips to top beauty salons, post-operative care in luxury hotels and safaris or other vacation incentives. Because the South African rand has such a longstanding low rate on the foreign-exchange market, medical tourism packages there tend to be perpetual bargains as well.

Argentina

Argentina ranks high for plastic surgery, and Hungary draws large numbers of patients from Western Europe and the U.S. for high-quality cosmetic and dental procedures that cost half of what they would in Germany and America.

Dubai

Lastly, Dubai--a destination already known as a luxury vacation paradise--is scheduled to open the Dubai Healthcare City by 2010. Situated on the Red Sea, this clinic will be the largest international medical center between Europe and Southeast Asia. Slated to include a new branch of the Harvard Medical School, it also may be the most prestigious foreign clinic on the horizon.

Other countries

Other countries interested in medical tourism tended to start offering care to specific markets but have expanded their services as the demand grows around the world. Cuba, for example, first aimed its services at well-off patients from Central and South America and now attracts patients from Canada, Germany and Italy. Malaysia attracts patients from surrounding Southeast Asian countries; Jordan serves patients from the Middle East. Israel caters to both Jewish patients and people from some nearby countries. One Israeli hospital advertises worldwide services, specializing in both male and female infertility, in-vitro fertilization and high-risk pregnancies. South Africa offers package medical holiday deals with stays at either luxury hotels or safaris.

Indian tourism: An overview
Tourism will expand greatly in future mainly due to the revolution that is taking place on both the demand and supply side. The changing population structure, improvement in living standard, more disposable income, fewer working hours and long leisure time, better educated people, ageing population and more curious youth in the developed as well as developing countries, all will fuel the tourism industry growth.

The arrival of a large number of customers, better educated and more sophisticated, will compel the tourist industry to launch new products and brands and re-invents traditional markets. The established traditional destinations founded on sun-sea-sand products will have to re-engineer their products. They must diversify and improve the criteria for destinations and qualities of their traditional offers. Alongside beach tourism, the tourism sector will register a steady development of new products based on natural rural business, leisure and art and culture. Thus the study of new markets and emerging markets and necessity of diversified products are the basis of our strategy, which can enhance and sustain, existing and capture new markets.

It is India’s vastness that challenges the imagination: the sub-continent, 3200km (2000 miles) from the mountainous vastness of the Himalayas in the north to the tropical lushness of Kerala in the south, is home to one sixth of the world’s population, a diverse culture and an intoxicatingly rich history. Desert inRajasthan, tropical forests in the north eastern states, arid mountains in the delta region of Maharashtraand Karnataka and vast fertile planes in northern states of Uttar Pradesh, Haryana etc are just some of the geographical diversity that can be observed. We have a wealth of archeological sites and historical monuments. Manpower costs in the Indian hotel industry are one of

the lowest in the world. This provides better margins for any industry which relies on man power.

One of the fascinations of India is the juxtaposition of old and new; centuries of history – from the pre-historic Indus civilization to the British Raj – rub shoulders with the computer age; and Bangalore's ‘Silicon Valley’ is as much a part of the world's largest democracy as the remotest village is.

Weaknesses

Lack of adequate infrastructure is the biggest problem that India faces. The aviation industry in India, for example, is inefficient and does not provide even the basic facilities at airports. The visitors are appalled by the poor sanitation in the public restrooms at the international airports. The road condition in India is very worse. The population has grown exponentially since 1947 but we still use the same rail system constructed by the British.

Even now the government spends next to nothing on proper marketing of India’s tourism abroad. As a result foreigners still think of India as a country ridden by poverty, superstition, and diseases with snake charmers and sadhus at every nook and cranny. Case in point Thailand; where in spite of the huge problem of bird flu disease the tourists arrival only dropped by less then 15% where as in India when cases of plague started occurring in Surat in 1994 the arrival of foreign tourists in India decreased by almost 36%.

Opportunities

More proactive role from the government of India in terms of framing policies. Allowing entry of more multinational companies into the country giving us a global perspective.

Growth of domestic tourism. The advantage here is that domestic tourism and international tourism can be segregated easily owing to the different in the period of holidays.

Threats

Political turbulence within India in Kashmir and Gujarat has also reduced tourist traffic. Not only that fear of epidemics such as for malaria, cholera, dengue, plague etc are foremost in the mind of European and America patients .Aggressive strategies adopted by other countries like Australia, Singapore in promoting tourism are also not helping.

What is India Offering:
AYURVEDA

India has a rich heritage in the areas of traditional and natural medicines. The earliest mention of Indian medical practices can be found in the Vedas and Samhitas of Charaka, Bhela and Shusruta. A systematic and scientific approach was adopted by the sages of the time leading to the development of a system that is relevant even today. India is the land of Ayurveda. It believes in removing the cause of illness and not just curing the disease itself. It is based on herbals and herbal components without having side effects.

Ayurveda considers that the base of life lies in the five primary elements; ether (space), air, fire, water and earth. And the individual is made up of a unique proportion of the five elements in unique combinations to form three doshas (vata, pita and kapha). When any of these doshas become accute, a person falls ill. Ayurveda recommends a special life style and nutritional guidelines supplemented with herbal medicines. If toxins are abundant, then a cleaning process known as Panchkarma is recommended to eliminate those unwanted toxins and revitalize both mind and body. Ayurveda offers

treatments for ailments such as arthritis, paralysis, obesity, sinusitis, migraine, premature aging and general health care. Kerala is a world tourist destination and part of the reasons lies with the well- known stress-releasing therapies of famed Ayurvedic research centers. The climate along with the blessing of nature has turned Kerala into the ideal place for ayurvedic, curative and rejuvenating treatments.

YOGA If Ayurveda is the science of body, yoga is the science of the mind. Practiced together they can go a long way in making an individual fit. The word yoga means to join together. The ultimate aim of yoga is to unite the human soul with the universal spirit. Yoga was developed 5000 years ago and the base of yoga is described in the Yoga Sutra of Patanjali. This describes eight stages of yoga. These are Yam (universal moral commands), Niyam (self purification), Asana (posture), Pranayama (breathing control), Prathyahara (withdrawal of mind from external objects), Dharana (concentration), Dhyana (meditation), and Samadhi (state of superconsciousness). To get the benefits of yoga, one has to practice Asana, Pranayama and Yoganidra. With the regular practice of asanas one can 327 control cholesterol level, reduce weight, normalize blood pressure and improve cardiac performance. Pranayama helps to release tensions, develop relaxed state of mind and Yoganidra is a form of meditation that relaxes both physiological and psychological systems. Today, yoga has become popular in India and abroad and in a number of places including urban and rural areas yoga is taught and practiced.

SPA TREATMENT

Most of the other parts of the world have their own therapies and treatment that are no doubt effective in restoring wellness and beauty. New kinds of health tours that are gaining popularity in India are spa tours. Spas offer the unique advantages of taking the best from the west and the east combining them with the indigenous system and offering best of the two worlds. In hydropathy, Swedish massages work with the

Javanese Mandy, lulur, aromatherapy, reflexology and traditional ayurveda procedures to help keep the tourist healthy and enhance beauty. Combining these therapies with meditation, yoga and pranayama make the spa experience in India a new destination for medical tourism. The spas are very useful for controlling blood pressure, insomnia, cure tension, depression, paralysis and number of other deadly diseases. Ananda

Resort in Rishikesh, Angsana Resort, Golden Palm Spa and Ayurgram in Bangalore offer ayurveda, naturopathy, yoga and meditation packages. (Gaur Kanchilal) Allopathy

India has made rapid strides in advanced health care systems, which provides worldclass allopathic treatment. This has become possible because of the emergence of the private sector in a big way in this field. More and more foreign tourists are realizing that India is an ideal place for stopover treatment. Indian Multi-specialty hospitals are providing worldclass treatment at an amazingly economical cost as compared to the west. Quality services and low price factor primarily go in favour of India. The cardio care, bone marrow transplantation, dialysis, kidney transplant, neuron–surgery, joint replacement surgery, urology, osteoporosis and numerous diseases are treated at Indian hospitals with full professional expertise. Apollo hospital group, Escorts in Delhi, Jason Hospital, Global Hospital, and Max Health Care are catering to medical care for international patients in the areas of diagnostic, disease management, preventive health care and incisive surgeries.

The tourism department has devised websites in order to provide information. Many Ayurveda health resorts that are owned and rum by traditional Ayurveda Institutes have come up. Ayurgram is a novel concept that not only offers heritage accommodation but also offers a whole range of Ayurvedic treatments and rejuvenating packages. Similarly hotels have also included these types of packages in their holidays. Some of the tour operators have worked out all-inclusive medical treatment package that include treatment, accommodation, food, airport transfers, post operation recuperative holidays, along with a host of other facilities. 328 This in fact shows our product offers true value

for money for service. Many world-class state-of-the-art furnishing and equipment are being added to our Ayurveda Resorts to welcome international guests. Along with these hospitals there are many centers which offer not just physical but emotional and spiritual healing to patients. With all these India is going to be one of the leading medical health care destinations in the near future.

SPIRITUAL TOURISM

Globally people are increasingly mentally disturbed and looking for solace in spiritual reading, meditation and moments of divine ecstasy. Our country has been known as the seat of spiritualism and India’s cosmopolitan nature is best reflected in its pilgrim centres. Religion is the life-blood for followers of major religion and sects. Hinduism, Islam, Buddhism, Jainism, Zoroastrianism and Christianity have lived here for centuries. The visible outpouring of religious fervor is witnessed in the architecturally lavish temples, mosques, monasteries and Churches spreads across the length and breadth of the country. India is not only known as a place rich in its culture with varied attractions but also for many places of worship, present itself as embodiments of compassion where one get peace of mind. Thus India has been respected as a destination for spiritual tourism for domestic and international tourists. Spiritual tourism is also termed as religious heritage tourism. It includes all the religions mentioned above; religious places associated with, emotional attachment to these centers and infrastructure facilities for the tourists. This can also be referred to as pilgrimage tourism, as clients are not looking for luxury but arduous journeys to meet the divine goal or simple life. The essence of spiritual tourism is inner feeling through love. Love should not be rationed on the basis of caste, creed and economic status or intellectual attainment of the recipient. Religions come into existence for the purpose of regulating human life; what are common to all of them are the principles of love. Thus through religious

tourism there is a sincere effort to bring better understanding among various communities, nations and thus foster global unity.

Hinduism is one of the oldest religions of India. Over 5000 years of religious history created wonderful temples and survived through ages all over India. The most popular spiritual tours are those that are centered on holy Ganges River. Badrinath, Kedarnath, Haridwar, Gangotri, Yamunotri, Allahabad, Varanasi. Jaganath temple at Puri, Bhubaneshwar, Konark in Orissa, Mata Vaishnodevi of Jammu and Kashmir, are some of the important pilgrim centers in north India. There are many spiritual sites in South India as well which dates back beyond the 10th centaury. Rameshwaram, Mahabalipuram, Madurai Meenakshi temple in Tamilnadu and Tirupati in Andhra Pradesh are some pilgrim centers. Every year millions of tourists, both domestic and international, visit these places. India is special to Buddhists all over the world and India is the destination for pilgrimage because Buddhism emerged in India. The country is dotted with places that are associated with the life and times of Gutham Buddha; Lumbini-the birthplace of Buddha, Saranath where Buddha delivered his first sermon, Buddha Gaya where lord Buddha attained enlightenment and Vaishali where he delivered his last sermon and announced his nirvana. Sikhism also emerged in India. The Golden Temple in Amritsar, the Hemkund Sahib, and Gurunanak Devji Gurudwara at Manikaran, which is also known for its hot water springs with healing properties, the holy city of Patna Sahib and Anandpur Sahib are important for Sikhs.

The Jain temples of Dilwara and Mount Abu in Rajasthan, the Gomateswara temple at Karnataka, draw thousands of Jain followers. Even small communities like the Bahais have their own Lotus Temple at Delhi. The Sultanate and Moghul empires built many historical monuments and mosques during their reign, all over the country. Red Fort, Fatehapur Sikri, Jama Masjid, TajMahal, Charminar etc., bear testimony to the blend of the Indian and Islam traditions of architecture. The followers of Islam have many mosques and shrines of Sufi Saints, like Moin-Uddin Chisti and Nizamuddin Aulia. For Christians, spiritual tours to Goa among other place like Mumbai and Kolkata are must. Among the most popular sites in Goa is the church of Our Lady of Rosary, the Rachel

Seminary, and Church of Bom Jesus. In addition to pilgrim centers there are personalities like the Satya Sai Baba, Osho, Shirdhi and others. This shows that spirituality and religion in India is a serious pursuit. The State Governments concerned, charitable trusts, temple trusts have made elaborate arrangements for accommodation, transport and ritual ceremonies. These organizations are also running hospitals, educational institutes, ashrams, meditation centers which benefit local community. More than 500 religious places have been identified and efforts are being made to develop these centers by Central and State Governments with private participation. ADVENTURE TOURISM

Youth tourism has been identified as one of the largest segments of global and domestic tourism. The young travellers are primarily experience seekers, collecting, enquiring unique experiences. Adventure and risk have a special role to play in the behaviour and attitudes of young travellers. The growing number of young travellers is being fuelled by a number of factors such as increased participation in higher education, falling level of youth unemployment, increased travel budget through parental contribution, search for an even more exciting and unique experience and cheaper long distance travel.

Youth and adventure tourism appears to have considerable growth potential. The rising income in some major potential source markets such as the Central and Eastern Europe, Asia and Latin America, combined with the lower travel cost, growing student populations around the world particularly in developing countries, has fuelled the demand. India: a heaven for adventure tourism India has been an attraction for travellers from all over the world. Though in the field of international tourism, the segment of adventure tourism in India is getting only a fraction of such traffic. The trend has been showing an increased movement year after year with the development of facilities and greater awareness about adventure tourism options.

Indian tourism offers both international and domestic adventurers a wide choice of adventures. Water sports, elephant safari, skiing, yachting, hail-skiing, gliding, sailing, tribal tours, orchid tours, scaling the high peaks of Himalayas, trekking to the valley of

flowers, riding the waves in rapids, and camel safari in the deserts are breath taking opportunities for nature enthusias. Ladakh, the Garwal hills, the Himachal hills, Darjeeling, Goa, Lakshadweep, Andaman and Nicobar, Jaisalmer and wildlife sanctuaries and reserves are some of the places that offer adventure tourism.

RURAL TOURISM

Rural tourism has been identified as one of the priority areas for development of Indian tourism. Rural tourism experience should be attractive to the tourists and sustainable for the host community. The Ninth Plan identified basic objectives of rural tourism as: -

• Improve the quality of life of rural people • Provide good experience to the tourist • Maintain the quality of environment. Indian villages have the potential for tourism development. With attractive and unique traditional way of life, rich culture, nature, crafts, folk-lore and livelihood of Indian villages are a promising destination for the tourist. It also provides tourism facilities in terms of accessibility, accommodation, sanitation and security. Rural tourism can be used as a means to:-

• Improve the well being of the rural poor • Empower the rural people • Empower the women • Enhance the rural infrastructure • Participate in decision-making and implementing tourism policies • Interaction with the outside world • Improve the social condition of lower sections of the society.

• Protection of culture, heritage, and nature.

To tap the immense opportunities, coordinated actives of all agencies involved in the development are required. A carefully planned and properly implemented development will definitely benefit the community economically and improve the quality of life in the villages. The success of such development depends upon the people’s participation at grass root level for the development of tourist facilities and for creating a tourist friendly atmosphere. Development of rural tourism is fast and trade in hotels and restaurants is growing rapidly. Increase in the share of earnings through rural tourism will no doubt; provide an attractive means of livelihood to the poor rural community. It increases the purchasing power at all levels of community and strengthens the rural economy. Development of infrastructure facilities such as rail, electricity, water, health and sanitation will definitely improve the quality of life.

India as a global destination for Medical Tourism
Tourism and healthcare, being an integral part of many economies services industry are both important sources of foreign exchange. Globalisation has promoted a consumerist culture leading to the mushrooming of corporate healthcare settings seized with the necessity to maximise profits and expand their coverage. However, the constraint lies in the fact that these services can be afforded by a relatively small size of population in developing countries.

Low insurance penetration, lack of standardisation of services, poor information base, ineffective monitoring leading to low quality, high levels of fraud and corruption, misallocation of investments and low efficiency of existing hospitals have impeded effective performance leading to a stagnation of the healthcare sector. In this scenario, corporate interests in the medical care sector are looking for opportunities beyond the national boundaries.

This is the genesis of “Medical Tourism” industry. The term medical tourism refers to the increasing tendency among people from the UK, the US and many other third world countries, where medical services are either very expensive or not available, to leave their countries in search for more affordable health options, often packaged with tourist attractions.

Long waiting lists, decline in public spending and rise in life expectancy and noncommunicable diseases that require specialist services are some of the factors directing a wave of medical tourists to more affordable healthcare destinations. Most countries are tapping the health tourism market due to aggressive international marketing in conjunction with their tourism industry. In this rat race, Thailand, Malaysia, Jordan, Singapore, Hong Kong, Lithuania and South Africa have emerged as big healthcare destinations.

India is unique as it offers holistic healthcare addressing the mind, body and spirit. With yoga, meditation, ayurveda, allopathy and other Indian systems of medicine, India offers a vast array of services combined with the cultural warmth that is difficult to match by other countries. Also, clinical outcomes in India are on par with the world’s best centres, besides having internationally qualified and experienced specialists. CII believes that India should capitalise on its inherent strengths to become a world player in medical tourism. According to a CII-Mc Kinsey study, medical tourism in India could become a USD 1 billion business by 2012. Instead of adopting a segmental approach of targeting a few states such as Maharashtra, Kerala, Andhra Pradesh, Chennai, efforts are now being made to project “Destination India” as a complete brand ideal for medical tourists. Countries from where people head for India are the UK, Bangladesh, Oman, Sri Lanka, Indonesia, Mauritius, Nigeria, Kenya, Pakistan, etc.

Visitors, especially from the West and Middle East find Indian hospitals a very affordable and viable option to grappling with insurance and national medical systems in their native lands. There are thousands of expatriates without any social security and health insurance cover who usually compare the costs before going for treatment and India has a cost advantage for this segment. Although, the existing market for medical tourism in India is small, it can grow rapidly if the industry reorients itself to lure foreign patients from all potential regions such as SAARC, Central Asia, Middle East, Africa, Europe, OECD besides the UK and the US. The annual health bill of people from Afro-Asian countries seeking treatment outside their countries is USD 10 billion. If India can even tap a fraction of that market, the potential is enormous. The price advantage is however offset today for patients from the developed countries by concerns regarding standards, insurance coverage and other infrastructure.

The question being asked by many is that how can India become an international destination in healthcare, when the clientele at home is bristling with dissatisfaction. Hence, arises the need to define minimum standards at national level, compulsory registration and adoption of these standards by all providers and regular monitoring and enforcing of such standards at the local level. Quality assessment should combine evaluation of infrastructure as well as outcomes.

An obvious answer to all this is accreditation. This will ensure transparency in the way a hospital performs, and everything from the operating to the cleaning procedures will be monitored, audited and recorded. With an aim to boost the much talked about medical tourism, many corporate hospitals in India are looking to international agencies such as JCAHO/JCI for accreditation. Accreditation will even make tie ups with overseas health insurance agencies such as BUPA and CHUBS easier to route patients to India.

As the medical tourism industry is growing exponentially, government and the private players need to join hands in order to act as a catalyst to build infrastructure for hospitals, create specialty tourist packages to include medical treatment, promote accreditation and standardisation, enable access and tie-ups with insurance companies, provide state of art facilities and improve quality of in-patient care and service to meet the requirements of foreign patients and to attain sustainable competitive advantage.

Many fear about the serious consequences of equity and cost of services and raise a fundamental question on the very existence of medical tourism- why should developing countries be subsidising the healthcare of developed nations? For them, medical tourism is likely to further devalue and divert personnel from the already impoverished public health system. However, with good planning and implementation, medical tourism besides being an economy booster can surely help India maintain good cross border and trade relations, exchange of manpower and technology among countries.

Strategies are thus needed not just to project India as a major healthcare destination, but also to create a system to conduct proper market research and feasibility studies in order to quantify the “How many”, “From where”, “To where”, and most importantly the “How” of medical tourism. Only then can we leverage and channelise all efforts in the right direction. In the absence of proper planning, formulation, implementation and evaluation of coherent strategies, the much created hype and all the talk may just go in vain.

Why the world is moving towards medical tourism
Medical tourists have good cause to seek out care beyond the United States for many reasons. In some regions of the world, state-of-the-art medical facilities are hard to come by, if they exist at all; in other countries, the public health-care system is so overburdened that it can take years to get needed care. In Britain and Canada, for instance, the waiting period for a hip replacement can be a year or more, while in Bangkok or Bangalore, a patient can be in the operating room the morning after getting off a plane.

For many medical tourists, though, the real attraction is price. The cost of surgery in India, Thailand or South Africa can be one-tenth of what it is in the United States or Western Europe, and sometimes even less. A heart-valve replacement that would cost $200,000 or more in the U.S., for example, goes for $10,000 in India--and that includes round-trip airfare and a brief vacation package. Similarly, a metal-free dental bridge worth $5,500 in the U.S. costs $500 in India, a knee replacement in Thailand with six days of physical therapy costs about one-fifth of what it would in the States, and Lasik eye surgery worth $3,700 in the U.S. is available in many other countries for only $730. Cosmetic surgery savings are even greater: A full facelift that would cost $20,000 in the U.S. runs about $1,250 in South Africa.

The savings sound very attractive, but a good new hip and a nice new face don’t seem like the sort of things anyone would want to bargain with. How does the balance of savings versus risk pay off in terms of success rates

Inferior medical care would not be worth having at any price, and some skeptics warn that Third World surgery cannot possibly be as good as that available in the United States. In fact, there have been cases of botched plastic surgery, particularly from Mexican clinics in the days before anyone figured out what a gold mine cheap, highquality care could be for the developing countries.

Yet, the hospitals and clinics that cater to the tourist market often are among the best in the world, and many are staffed by physicians trained at major medical centers in the United States and Europe.

Bangkok’s Bumrundgrad hospital has more than 200 surgeons who are board-certified in the United States, and one of Singapore’s major hospitals is a branch of the prestigious Johns Hopkins University in Baltimore. In a field where experience is as important as technology, Escorts Heart Institute and Research Center in Delhi and Faridabad, India, performs nearly 15,000 heart operations every year, and the death

rate among patients during surgery is only 0.8 percent--less than half that of most major hospitals in the United States.

In some countries, clinics are backed by sophisticated research infrastructures as well. India is among the world’s leading countries for biotechnology research, while both India and South Korea are pushing ahead with stem cell research at a level approached only in Britain. In many foreign clinics, too, the doctors are supported by more registered nurses per patient than in any Western facility, and some clinics provide single-patient rooms that resemble guestrooms in four-star hotels, with a nurse dedicated to each patient 24 hours a day.

Add to this the fact that some clinics assign patients a personal assistant for the posthospital recovery period and throw in a vacation incentive as well, and the deal gets even more attractive. Additionally, many Asian airlines offer frequent-flyer miles to ease the cost of returning for follow-up visits.

Medical tourism trend andwhat statistics shows: Ten years ago, medical tourism was hardly large enough to be noticed. Today, more than 250,000 patients per year visit Singapore alone--nearly half of them from the Middle East. This year, approximately half a million foreign patients will travel to India for medical care, whereas in 2002, the number was only 150,000.

In monetary terms, experts estimate that medical tourism could bring India as much as $2.2 billion per year by 2012. Argentina, Costa Rica, Cuba, Jamaica, South Africa, Jordan, Malaysia, Hungary, Latvia and Estonia all have broken into this lucrative market as well, or are trying to do so, and more countries join the list every year.

Trends in medical tourism in the near future

Some important trends guarantee that the market for medical tourism will continue to expand in the years ahead. By 2015, the health of the vast Baby Boom generation will have begun its slow, final decline, and, with more than 220 million Boomers in the United States, Canada, Europe, Australia and New Zealand, this represents a significant market for inexpensive, high-quality medical care.

Medical tourism will be particularly attractive in the United States, where an estimated 43 million people are without health insurance and 120 million without dental coverage-numbers that are both likely to grow. Patients in Britain, Canada and other countries with long waiting lists for major surgery will be just as eager to take advantage of foreign health-care options.

Advantage India
Indian corporate hospitals excel in cardiology and cardiothoracic surgery, joint replacement, orthopedic surgery, gastroenterology, ophthalmology, transplants and

urology to name a few. The various specialties covered are Neurology, Neurosurgery, Oncology, Ophthalmology, Rheumatology, Endocrinology, ENT, Pediatrics, Pediatric Surgery, Pediatric Neurology, Urology, Nephrology, Dermatology, Dentistry, Plastic Surgery, Gynecology, Pulmonology, Psychiatry, General Medicine & General Surgery

The various facilities in India include full body pathology, comprehensive physical and gynecological examinations, dental checkup, eye checkup, diet consultation, audiometry, spirometry, stress & lifestyle management, pap smear, digital Chest X-ray, 12 lead ECG, 2D echo colour doppler, gold standard DXA bone densitometry, body fat analysis, coronary risk markers, cancer risk markers, carotid colour doppler, spiral CT scan and high strength MRI. Each test is carried out by professional M.D. physicians, and is comprehensive yet pain-free.

There is also a gamut of services ranging from General Radiography, Ultra Sonography, Mammography to high end services like Magnetic Resonance Imaging, Digital Subtraction Angiography along with intervention procedures, Nuclear Imaging. The diagnostic facilities offered in India are comprehensive to include Laboratory services, Imaging, Cardiology, Neurology and Pulmonology. The Laboratory services include biochemistry, hematology, microbiology, serology, histopathology, transfusion medicine and RIA.

All medical investigations are conducted on the latest, technologically advanced diagnostic equipment. Stringent quality assurance exercises ensure reliable and high quality test results.

As Indian corporate hospitals are on par, if not better than the best hospitals in Thailand, Singapore, etc there is scope for improvement, and the country may become a

preferred medical destination. In addition to the increasingly top class medical care, a big draw for foreign patients is also the very minimal or hardly any waitlist as is common in European or American hospitals. In fact, priority treatment is provided today in Indian hospitals.

The Apollo Group, Escorts Hospitals in New Delhi and Jaslok Hospitals in Mumbai are to name a few which are established names even abroad. A list of corporate hospitals such as Global Hospitals, CARE and Dr L.V. Prasad Eye Hospitals in Hyderabad, The Hindujas and NM Excellence in Mumbai, also have built capabilities and are handling a steadily increasing flow of foreign patients. India has much more expertise than say Thailand or Malaysia. The infrastructure in some of India's hospitals is also very good. What is more significant is that the costs are much less, almost one-third of those in other Asian countries.

India will soon become THE global health destination. It is replicating the Thai model, which has been the first Asian destination for International Patients. India benefits from a large staff of world class experts and the ultra-competitive cost advantage it offers.

With prices at a fraction (less than 10% for example in the treatment of gall stone $600 US ) of those in the US or EU, the concept has broad consumer appeal. Indian private facilities offer advanced technology and high-quality treatment at par with hospitals in western countries.

India is promoting "medical outsourcing" where subcontractors aim to provide services to the overburdened medical care systems in western countries. Medical tourism to India is growing by 20% a year. Most non-urgent Western patients usually get a package deal that includes flights, transfers, hotels, treatment and often a postoperative vacation. There are many brokers specialized on the Indian market.

India has top-notch centers for open-heart surgery, pediatric heart surgery, hip and knee replacement, cosmetic surgery, dentistry, bone marrow transplants and cancer therapy, and virtually all of India’s clinics are equipped with the latest electronic and medical diagnostic equipment.

Unlike many of its competitors in medical tourism, India also has the technological sophistication and infrastructure to maintain its market niche, and Indian pharmaceuticals meet the stringent requirements of the U.S. Food and Drug Administration. Additionally, India’s quality of care is up to American standards, and some Indian medical centers even provide services that are uncommon elsewhere. For example, hip surgery patients in India can opt for a hip-resurfacing procedure, in which damaged bone is scraped away and replaced with chrome alloy--an operation that costs less and causes less post-operative trauma than the traditional replacement procedure performed in the U.S.

Healthcare procedures across the world show a wide cost difference. It leads to a question of affordability even to the developed country like the US where significantly huge number of population is not covered under any insurance scheme. In some developed country, long waiting period for elective inpatient and outpatient care has created a situation where people do not hesitate to buy healthcare from other developing countries like India without compromising on quality.

Complimentary tourism packages make the entire offer more attractive to the people who are interested to travel for their healthcare. Globalisation of healthcare industry has started in many level. For instance, Indian software companies like TCS and Mastek has signed IT contract recently worth more than US $ 200 million.

Scope & Opportunities

Though the service sector has considerable contribution in India’s GDP, it is negligible on the export front with only around 25 per cent of total export. Value added services generally exceed 60 per cent of total output in the high income industrialised economy. In the global scenario, India’s share of services export is only 1.3 per cent (2003) i.e USD 20.7 billion which has gone up from 0.57 per cent (1990). Overall service export growth rate in India is 8 per cent (2002) against a global growth rate of 5 per cent.

It had a tremendous impact on India’s Forex reserve. Forex reserve rise to USD 118.628 on May, 2004 in comparison to USD 79.22 for the same period in 2003. Being a service sector member, medical and tourism services export can further rise India’s Forex Reserve along with a major contribution from software exports.

In India, international tourist rose 15.3 per cent between January and December, 2003. Though tourism and travel industry contribution is 2.5 per cent to our countries GDP (international ranking 124) but recent initiative from the government like liberalised open sky policy to increase flight capacity, lower and attractive fares, increase in hotel room capacity by nearly 80 per cent (from 2000) and better connectivity between major tourist destination (Express Highway project) has helped India to rank among the top five international holiday destination when independent traveler conducted a poll in 134 countries.

Healthcare industry has shown considerable growth in last few years. Emergence of top notch corporate hospitals and continuous effort for improvement of quality of care has placed Indian private healthcare in a respectable position on the global map.

High ratio of foreign qualified medical practitioners and well-trained nursing and paramedical staff have developed confidence amongst the people who are seeking

medical care from Indian Hospitals. If everything moves in the right direction, MT alone can contribute an additional revenue of Rs 5000 - Rs 10,000 crore for up market tertiary centre by 2012 (3-5 per cent of total delivery market).

Need For Medical Tourism
Medical tourism can be broadly defined as provision of 'cost effective' private medical care in collaboration with the tourism industry for patients needing surgical and other forms of specialized treatment. This process is being facilitated by the corporate sector involved in medical care as well as the tourism industry - both private and public.

Medical or Health tourism has become a common form of vacationing, and covers a broad spectrum of medical services. It mixes leisure, fun and relaxation together with wellness and healthcare.

The idea of the health holiday is to offer you an opportunity to get away from your daily routine and come into a different relaxing surrounding. Here you can enjoy being close to the beach and the mountains. At the same time you are able to receive an orientation that will help you improve your life in terms of your health and general well being. It is like rejuvenation and clean up process on all levels - physical, mental and emotional.

Many people from the developed world come to India for the rejuvenation promised by yoga and Ayurvedic massage, but few consider it a destination for hip replacement or brain surgery. However, a nice blend of top-class medical expertise at attractive prices is helping a growing number of Indian corporate hospitals lure foreign patients, including from developed nations such as the UK and the US.

As more and more patients from Europe, the US and other affluent nations with high medicare costs look for effective options, India is pitted against Thailand, Singapore and some other Asian countries, which have good hospitals, salubrious climate and tourist destinations. While Thailand and Singapore with their advanced medical facilities and built-in medical tourism options have been drawing foreign patients of the order of a couple of lakhs per annum, the rapidly expanding Indian corporate hospital sector has been able to get a few thousands for treatment.

In India, the Apollo group alone has so far treated 95,000 international patients, many of whom are of Indian origin. Apollo has been a forerunner in medical tourism in India and attracts patients from Southeast Asia, Africa, and the Middle East. The group has tied up with hospitals in Mauritius, Tanzania, Bangladesh and Yemen besides running a hospital in Sri Lanka, and managing a hospital in Dubai.

Another corporate group running a chain of hospitals, Escorts, claims it has doubled its number of overseas patients - from 675 in 2000 to nearly 1,200 this year. Recently, the Ruby Hospital in Kolkata signed a contract with the British insurance company, BUPA. The management hopes to get British patients from the queue in the National Health Services soon. Some estimates say that foreigners account for 10 to 12 per cent of all patients in top Mumbai hospitals despite roadblocks like poor aviation connectivity, poor road infrastructure and absence of uniform quality standards.

Analysts say that as many as 150,000 medical tourists came to India last year. However, the current market for medical tourism in India is mainly limited to patients from the Middle East and South Asian economies. Some claim that the industry would flourish even without Western medical tourists. Afro-Asian people spend as much as $20 billion a year on health care outside their countries - Nigerians alone spend an estimated $1 billion a year. Most of this money would be spent in Europe and America,

but it is hoped that this would now be increasingly directed to developing countries with advanced facilities.

India’s Future Prospect
The global healthcare market is USD 3 trillion and size of the Indian healthcare industry is around 1,10,000 crores accounting for nearly 5.2 per cent of GDP. It is likely to reach 6.2- 8.5 per cent of the GDP by 2012. It is expected that medical tourism will account about 3-5 per cent of the total delivery market.

More than 1,50,000 medical tourists came to India in 2003. Around 70,000 people came from the Middle East for the medical treatment. Traditional system of medicine is able to attract a sizeable number of people from western countries (Kerala, for instance). Most of the medical tourists are Indian in origin. We need to attract more number of people of foreign origin.

International experience shows some of the countries like Thailand, Singapore, Jordan and Malaysia have done extremely well. There is technical committee formed by Jordan Government operating for the non-Jordanian Arab patients who visit Jordan for healthcare. This office regulates the healthcare institutions treating those patients and monitor the entire activity.

Making of a Medical Tourism destination

Our healthcare industry has some inherent drawbacks. Lack of standardisation in medical care and cost, lack of regulatory mechanism, infrastructural bottlenecks and poor medical insurance coverage are a few to mention here. On the other hand, tourism and hospitality industries are facing some major challenges to develop the infrastructure and services. Industry and government collaboration in terms of some incentives and creation of soothing environment can further make this endeavor easy for both the service sector. The immediate need is the establishment of health and tourism players

consortium to discuss about all these issues and maintain closer interaction and coordination to develop medical tourism - a growth engine for Forex earnings.

Price Comparison Overview
COST COMPARISON – INDIA VS UNITED STATES OF AMERICA (USA)

Significant cost differences exist between U.K. and India when it comes to medical treatment.

India is not only cheaper but the waiting time is almost nil. This is due to the outburst of the private sector which comprises of hospitals and clinics with the latest technology and best practitioners.

Procedure Charges in India & USA

Procedure

United States (USD) Approx

India (USD) Approx

Bone Marrow transplant Liver Transplant Heart Surgery Orthopedic Surgery Cataract Surgery Smile Designing

USD 2,50,000 USD 3,00,000 USD 30,000 USD 20,000 USD 2,000 USD 8,000

USD 69,200 USD 69,350 USD 8,700 USD 6,300 USD 1,350 USD 1,100

Metal Free Bridge Dental Implants Porcelain Metal Bridge Porcelain Metal Crown Tooth Impactions Root Canal Treatment Tooth Whitening Tooth Colored Composite Fillings / Tooth Cleaning

USD 5,500 USD 3,500 USD 3,000 USD 1,000 USD 2,000 USD 1,000 USD 800 USD 500 USD 300

USD 600 USD 900 USD 600 USD 100 USD 125 USD 110 USD 125 USD 30 USD 90

Procedure Liver Transplant Heart Surgery Orthopedic Surgery Cataract Surgery

India 3,00,000 30,000 20,000 2,000

USA 69,000 69,000 8,000 6,000 1,250

Bone Marrow Transplant 2,50,000

Procedure

United states (USD) India (USD) Approx Approx

Breast : Mastopexy – Reduction Mammoplasty – Mammoplasty Augmentation -Replacement Of Implants Face : USD 7,500 USD 8,000 USD 8,000 USD 6,500 USD 6,000 USD 2,800 USD 3,300 USD 2,750 USD 3,000 USD 2,000 USD 2,800 USD 2,150 USD 2,200 USD 3 Per graft USD 2,300 USD 2,400 USD 1,500 USD 2,900 USD 1,300 USD 3,200 USD 3,150 USD 6,000 USD 1,750

Blepheroplasty (Upper & Lower) -Facelift USD 6,500 -Dermabrasion (Total face) -Canthopexy USD 5,500 w/Orbicularis suspension – USD 6,000 Hair Transplant – USD 50 Per graft Endoscopic Brow lift – USD 5,800 Neck lift – Otoplasty(For prominent Ears) Nose : -Primary Rhinoplasty -Tip Rhynoplasty Body Contouring : -Abdominoplasty -Thigh Lift (Bilateral) -Total Lower Body Lift(Belt Lipectomy) -Liposuction (One Region) Non – Surgical Procedures : Laser Hair Removal – Laser Resurfacing/ Wrinkle Reduction – Laser Acne Treatment – Laser Scar Treatment – Botox USD 550 USD 575 USD 500 USD 70 Per Unit USD 550 USD 6,100 USD 4,700 USD 7,300 USD 6,300 USD 7,700 USD 7,200 USD 9,500 USD 6,100

USD 225

USD 225 USD 230 USD 210 USD 8 Per Unit

COST COMPARISON – INDIA VS UNITED KINGDOM (UK)

Significant cost differences exist between U.K. and India when it comes to medical treatment. Accompanied with the cost are waiting times which exist in U.K. for patients which range from 3 months to over months.

India is not only cheaper but the waiting time is almost nil. This is due to the outburst of the private sector which comprises of hospitals and clinics with the latest technology and best practitioners. Procedure

Procedure

United Kingdom (USD) Approx

India (USD) Approx USD 4,800 USD 4,500

Open Heart Surgery

USD 18,000

Cranio-Facial surgery and skull USD 13,000 base Neuro- surgery with Hypothermia Complex spine surgery with implants Simple Spine Surgery Simple Brain Tumor -Biopsy -Surgery Parkinsons Lesion DBS USD 6,500 USD 4,300 USD 10,000 USD 6,500 USD 26,000 USD 13,000 USD 21,000 USD 13,000

USD 6,800 USD 4,600

USD 2,300 USD1,200 USD 4,600 USD 2,300 USD 17,800 USD 4,500

Hip Replacement

Procedure Heart Bypass Heart Valve Replacement Angioplasty Hip

US Cost $130,000 $160,000 $57,000 $43,000

India $10,000 $9,000 $11,000 $9,000 $3,000 $8,500 $5,500

Thailand $11,000 $10,000 $13,000 $12,000 $4,500 $10,000 $7,000

Singapore $18,500 $12,500 $13,000 $12,000 $6,000 $13,000 $9,000

Replacement Hysterectomy $20,000 Knee $40,000

Replacement Spinal Fusion $62,000

Cost comparison between India, USA, Thailand, Singapore:

*approximate retail costs, US figures based on HCUP data, intl. figures based on hospital quotes in named countries

Here's a brief comparison of the cost of few of the Dental treatment procedures between USA and India

Dental Procedure

Cost in USA ($)

Cost in India ($)

General Smile designing Metal Free Bridge Dental Implants Porcelain Metal Bridge Porcelain Metal Crown Tooth impactions Root canal Treatment Tooth whitening Tooth colored composite fillings Tooth cleaning Dentist 1,800 600 500 600 350 200 100

Top End Dentist 8,000 5,500 3,500 3,000 1,000 2,000 1,000 800 500 300

Top End Dentist 1,000 500 800 300 80 100 100 110 25 75

General cost sheet for a stay in Delhi :

Taxi fare from airport to hospital Registration and consultation with senior consultant at hospital X ray of chest Whole abdomen ultrasound Laparoscopic Cholecystectomy for Gall Bladder Stones Endoscopic Thoracic Hyperhidrosis Stay at nearby hotel Big Mac Meal combo at Mc Donald Tour of Delhi Tour to Agra ( 125 miles from Delhi)

Non A/C $10 $25

A/C $30

$4 $15 Economy Ward $600 (Total Cost) Economy Ward $1200 Single Room $900 (Total Cost) Single Room $2000 (Total Cost) 4 star $150,

Sympathectomy for (Total Cost) Economy

class $50/ day 5 star $250 $2

$ 50 by coach $ 150 same day return

$ 150 by personal car $ 250 with overnight stay at 5 star hotel

Major players offering Medical Tourism packages

Indian corporate hospitals excel in cardiology and cardiothoracic surgery, joint replacement, orthopedic surgery, gastroenterology, ophthalmology, transplants and urology to name a few. The various specialties covered are Neurology, Neurosurgery, Oncology, Ophthalmology, Rheumatology, Endocrinology, ENT, Pediatrics, Pediatric Surgery, Pediatric Neurology, Urology, Nephrology, Dermatology, Dentistry, Plastic Surgery, Gynecology, Pulmonology, Psychiatry, General Medicine & General Surgery

The various facilities in India include full body pathology, comprehensive physical and gynecological examinations, dental checkup, eye checkup, diet consultation, audiometry, spirometry, stress & lifestyle management, pap smear, digital Chest X-ray, 12 lead ECG, 2D echo colour doppler, gold standard DXA bone densitometry, body fat analysis, coronary risk markers, cancer risk markers, carotid colour doppler, spiral CT scan and high strength MRI. Each test is carried out by professional M.D. physicians, and is comprehensive yet pain-free.

There is also a gamut of services ranging from General Radiography, Ultra Sonography, Mammography to high end services like Magnetic Resonance Imaging, Digital Subtraction Angiography along with intervention procedures, Nuclear Imaging. The diagnostic facilities offered in India are comprehensive to include Laboratory services, Imaging, Cardiology, Neurology and Pulmonology. The Laboratory services include biochemistry, hematology, microbiology, serology, histopathology, transfusion Medicine and RIA

All medical investigations are conducted on the latest, technologically advanced diagnostic equipment. Stringent quality assurance exercises ensure reliable and high quality test results

The chief cities attracting foreign patients to India are Mumbai, Bangalore, Hyderabad, Kolkata and Chennai. Similarly, the speciality hospitals excelling in the medical tourism industry in the country are:

* Escorts Heart Institute and Research Centre Limited, New Delhi * All India Institute of Medical Sciences, Delhi * Manipal Heart Foundation, Bangalore * B. M. Birla Heart Research Centre, Kolkata * Breach Candy Hospital, Mumbai * Wockhardt Hospitals * Christian Medical College, Vellore * Asian Heart Institute, Mumbai * PD Hinduja National Hospital and Medical Research Centre, Mumbai * Jaslok Hospital, Mumbai * Apollo Hospital, Delhi * Apollo Cancer Hospital, Chennai

Medical Packages
The health care sector in India has witnessed an enormous growth in infrastructure in the private and voluntary sector. The private sector which was very modest in the early stages, has now become a flourishing industry equipped with the most modern state-ofthe-art technology at its disposal. It is estimated that 75-80% of health care services and investments in India are now provided by the private sector. An added plus had been that India has one of the largest pharmaceutical industries in the world. It is self sufficient in drug production and exports drugs to more than 180 countries.

* Bone Marrow Transplant * Brain Surgery * Cancer Procedures (Oncology) * Cardiac Care * Cosmetic Surgery * Dialysis and Kidney Transplant * Drug Rehabilitation * Gynaecology & Obstetrics * Health Checkups * Internal/Digestive Procedures * Joint Replacement Surgery * Nuclear Medicine

* Neurosurgery & Trauma Surgery * Preventive Health Care * Refractive Surgery * Osteoporosis * Spine Related * Urology * Vascular Surgery

* Gall Bladder stones surgery ( Laparoscopic Cholecystectomy ) * Hernia surgery ( Laparoscopic mesh repair ) * Piles ( Stapled Hemorrhoidectomy ) * Varicose Veins surgery * Endoscopic Thoracic Sympathectomy for Hyperhidrosis * Laparoscopic Appendicectomy * Laparoscopic Adrenalectomy * Laparoscopic Fundoplication for Hiatus Hernia * Laparoscopic Banding of stomach for Morbid Obesity * Laparoscopic splenectomy

Other packages include:

•

Hip-Knee replacement surgeries and other orthopedic surgeries.

•

Bone marrow transplantation surgery.

•

Heart surgery packages like Cardiac Surgery And Cardiology, Open Heart Surgery, Angiographies and Angioplasties.

•

Treatments of different skin problems including skin grafting.

The services provided by the host country’s hospital/ organisation are:

•

Put in touch with aworld class Private hospital or Nursing home and the doctor & fix up an appointment with the doctor at the hospital.

•

Receive you at the airport and provide transportation to the hotel and for the rest of the days during your stay here.

•

Provide accommodation in a hotel as per your choice and budget near the Nursing Home or the Private hospital.

•

We can arrange for another place to stay or a rejuvenating sight-seeing tour while your mother recovers after the treatment.

•

In addition to the increasingly top class medical care, a big draw for foreign patients is also the very minimal or hardly any waitlist as is common in European or American hospitals. In fact, priority treatment is provided today in Indian hospitals.

STEPS OF SEEKING TREATMENT WITH MEDICAL TOURISM

1. Is the medical ailment suitable for treatment in a country different from yours the

patients own country. The answer to this question will be based on combined information from your own doctor and the overseas doctor.

2. Ailments that require a one shot treatment like surgery for gall stones, hernia, piles,

varicose veins, hysterectomy, adrenalectomy, nephrectomy, thyroidectomy, joint replacement etc are more suitable for medical tourism.

3. The ailment should be such that a follow up should not be necessary and you should

not need to visit the country again to ‘ tie up loose ends.

4. The patient/ tourist should be otherwise well enough to be able to utilize the tourism

part of it. Other wise you could just go to the hospital directly for treatment.

5. Mostly planned elective surgery for which there may be a long waiting list in your country is best suited for medical tourism.

6. Decide on the country, hospital and doctor who would be treating . This information

would be available through the net or from recommendation by another patient. Visit the website of the hospital and doctor is the next step. Writing and asking about their training and experience in the procedure along with the cost implications is vital.

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