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Swot Analysis On: Medical Tourism

Kalyan Chakravarthy K*, C H. Ravi Kumar* and Deepthi K* Health is wealth! Without sound health we cannot achieve anything in our life, nor enjoy what ever we have. In service sector the concept of Medical Tourism, which is catching up at lightning speed across the world. The ultimate concept of medical tourism is a tour to surrounding destination, medical treatment and savings. People from advanced countries, including the United States and Europe, see a benefit in travelling to developing third world countries, like India, Thailand, Philippines, South Africa, etc.while combining medical treatments with inexpensive vacation. The emergence of the medical tourism as a booming industry and the key management aspects that will help India establish as Health Care Destination. The total expenditure on health by the Centre and States together is only 1 percent of GDP. We should raise it to 2-3 percent in2012, and 25 percent in 2020. Table 1: Tourism in India
Year 1994 1995 1996 1997 1998 1999 2000 source: Tourists Arrivals Tourists Arrivals Percentage share to India At Global of India 18,86,433 550.3 0.34 21,23,683 564.4 0.38 22,87,860 597.4 0.38 23,74,094 618.2 0.38 23,58,629 626.7 0.38 24,81,928 650.0 0.38 26,41,157 698.3 0.38 Market Research Division, Dept. of Tourism, Govt of India

The main demand for medical tourism is generated from millions of Indians who live abroad, though a growing number of foreigners are also keen on speedy and in expensive treatment. They are influenced by two important facts: India now has many world-class private hospitals and Indian doctors have experience in abundance. Owing to Indias prodigious population, the strengths in health care sector is doctors treat twice the number of patients in comparison to doctors in the west, domestic aviation has been opened to the private sector, foreign investments are encouraged and a number of incentives are in place. India is considered as a safe destination compared to other countries Foreigners are visiting India for serious medical help as well as rejuvenation therapies and other specific purposes. Definition of Medical Tourism Medical Tourism may be defined as the provision of cost-effective medical care with due consideration to quality in collaboration with tourism industry for foreign patients who need specialized treatment and surgery. Historical Back Ground Medical tourism is thousands of years old service sector. In ancient Greece, pilgrims and patients came from all over the Mediterranean to the sanctuary of the healing God, Asklepios, at Epidaurus. In Romed Britain, patients took the waters at a shrine at bath a practice that continued for 2000 years . From the eighteenth century, wealthy Europeans travelled to Spas from Germany to the Nile. More than 5000 years ago, it was believed that souls return to the earth in a different form to right the wrongs of their past life in Hinduism. A three dimensional purification of the soul is necessary to discharge the sins of each birth in physical, mental and spiritual planes. Yoga, meditation, pleasant demeanour and physical cleansing all part of Ayurveda serve as a tools for purifying the soul, so future reincarnation will be necessary. In the 21st century, relatively low-cost jet travel has taken the industry beyond the wealthy and desperate. Later, mostly wealthy people began travelling to tourist destinations like the Swiss lakes, the Alps and special tuberculosis sanatoriums, where professional and often specialized medical care was offered. In this century, however, medical tourism expanded to much larger scale. Thailand, followed by India, PuertoRico, Argentina, Cuba and others quickly became the most popular destinations for medical tourists. Complicated surgeries and dental works, kidney dialysis, organ transplantation and sex changes, topped the list of the most popular procedures. It was estimated that in 2002, six hundred medical tourists came to

*Research Scholars, Acharya Nagarjuna University, Andhra Pradesh & Don Bosco PG College, Kornepadu (Mdl), Guntur (Dt) )

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Bangkok and Phulket medical centers in Thailand, while approximately one hundred and fifty thousand foreign patients visited India during that time. .From Neolithic and Bronze age wherein people used to visit neighbouring countries for Minerals and Hot Springs, today we have reached the era where Hospitals are more like Spas and Spas more like hospitals. In this digital era, half a million people travel across the globe for health purposes. People from developed and affluent countries are moving out of their own countries to other destinations, seeking solitude, natural and holistic remedies and eco friendly experiences. Medical Tourism is one such new area that is ripe with potential. Why Medical Tourism in India Medical Tourism is poised to be the next Indian success story after Information Technology. According to recent study the industrys earning potential estimated at Rs.5000-10000 crores by2012. The main reason for India emerging as a referred destination is the inherent advantage of its health care industry. India offers a variety of services for overseas patients. Generation of foreign exchange, creation of income, generation of employment, contribution to state revenue and its associated regional development can be cited as the major economic benefits of tourism. The demand for Indian health care services primarily comes from three types of consumers i) Non-Residential Indians ii) Patients from countries with underdeveloped facilities iii) Patients from developed countries. Though tourism is not the primary need of these consumers, it offers additional attraction particularly for people travelling for cosmetic surgery and less complicated procedures. Table 2: Foreign Exchange Earnings through Tourism
Years 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Earnings ( US $ million) 1,861 2,126 2,124 2,272 2,583 2,832 2,889 2,948 3,009 3,168 3,042 2,923 3,533 Percent change ----14.20 -0.10 7.00 13.70 9.60 2.00 2.00 2.10 5.30 -4.00 -3.90 20.90

Source: Market Research Division, Department of Tourism, GOI.

Medical Tourism In India Indias health care sector is on the road to global fame. India is the seat of spiritualism. It is the confluence of different religions: Hinduism, Sikhism, Christianity, Islam and Jainism etc. Medical tourism in India is promoted as high-tech healing destinations, which provide world-class treatment at low cost, incorporating the Indian Systems of Medicine. India offers world-class treatments and a leisure holiday at excellent locations at almost 50 percent less than the total sum the foreign patients would spent on treatment in their own country. Foreigners are attracted to Indian Systems of Medicine (ISM) and tourism. The Indian Systems of Medicine include Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy together characterized under the department of AYUSH in the union health and family welfare ministry. During the ninth plan, with an expenditure of more than Rs.1,000 crore, a quantum jump in outlays on schemes for development and promotion of AYUSH system of medicine has been achieved during Tenth Plan. Indians are known for their hospitality and warmth.India has an incomparibly rich heritage in ancient systems of medicine that make up a veritable treasure house of knowledge for both preventive and curative health care. Around 1000 BC when Indian Systems of Medicine (ISM) were fully documented in Charaka Samhita and Sushruta Samhita. Thus, ISM is considered to be one of the oldest organized systems of medicine for positive health and cure of human sickness. The most important and massive ancient compilation of the school of medicine is known as Charaka Samhita. It contains several chapters dealing at length with internal medicine. About six hundred drugs of plant, animal and mineral origin are described in
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it. So far so good. But traditional medicine was ignored when western medical knowledge and procedures were introduced into the country. Ayurveda : Ayurveda means the science of life in Sanskrit. It is one of oldest and the best documented among the ancient systems of medicine. From the Charaka Samhita (600 B.C) and the Susruta samhita. Yoga & Naturopathy : Yoga is not really a system of medicine. Its objectives are self- realization and spiritual union with all pervasive divine cosmic power. But certain intermediary practices and yogic attitudes have proved beneficial for reducing stress, preventing many lifestyle-related diseases, and promoting general health and well being. Naturopathy is based on the fundamental principles of ayurveda. The basic tenet of Naturopathy is to live according to the laws of nature: disease occurs due to the accumulation of toxins in the body, and to cure the ailment, the body is purified with the use of natural methods, dietary regulations and exercise. Unani : The Unani system originated in the fourth and fifth century BC in Greece under the patronage of Hippocrates (460BC-377)and Galen. The system is based on the humoural theory that good health depends on the balance of the four humours: blood, phlegm, yellow bile and black bile. Siddha : Siddha means a master thus the name denoted the mastery of such practices. The most famous of the siddha was Nagarjuna, whose rasatantra forms the basis of this system. The distinctive features of siddha are its reliance on minerals and metallic compounds, and its emphasis on rejuvenation therapies. Homeopathy : The term homeopathy comes from the Greek word homios means like and pathos means suffering. Homeopathyworks by looking at the symptoms, will take into account the individuals mental, physical, emotional,and spiritual health before deciding the treatment. Homeopathy is based on the principles that like cures like. Table 3: Summary of Medical care, Medical Manpower facilities available under Indian systems of Medicine
Facilities Hospitals Beds Dispensaries Registered Practitioners Ayurveda 2398 42963 13914 453661 Unani 268 4489 1010 46558 Siddha 231 2401 464 6381 Yoga 8 135 71 0 Naturopathy 18 722 56 888 Homeopathy 230 10851 5836 217850 Total 3203 61561 21351 725338

Source: Department of Ayush, ---- Health & Family welfare, Government of India.

Medical Tourisim has been a popular concept in countries like Malaysia, Thailand, Singapore, Costa Rica, Hungary, India, Israel, Jordan, Lithuania. South Africa specilises in medical Safaris-visit the country for a safari, with a stock over for plastic surgery. Due to liberlisation of our economy and internalization of health care profession, India has entered the industry in only recent times. Indias corporate hospitals are fully equipped with up market and efficiency. With their toll free lines, interactive websites, online quotes and time bound treatment access, they appear to be a world apart from the over burden, often badly managed and poorly funded public health system. Many opt to under go surgery in India for reasons that range from long waiting times in Canada and U.K, high costs and lack of insurance cover in the U.S.A to plain lack of expertise in many Asian, African and West Asian countries. Most patients are coming from poorer countries like Bangladesh, Iran and Pakistan where treatment may not be available. According to study conducted by the Confederation of Indian Industry and Mc Kinsey consultants, reported that 1,50,000 foreigners visited India for treatment, with the number rising by 15 percent a year. The recent operations of children from Pakistan, who have sought medical treatment in Bangalore, have helped not only in boosting the state economy but more importantly fostering goodwill, peace and harmony with neighbouring countries like Pakistan, China, Bangladesh and Ceylon etc. The Indian Sytems of Medicine were given importance in southern India. The states like Kerala, Karnataka, Tamil Nadu and other states in India plays a key role in medical tourisim.

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Kerala-The Pioneer State Kerala has pioneer health tourisim in India. Kerala has strongly focused on Ayurveda and its wide array of treatments and medications, good facilities are also available in other traditional forms of medicine as well as in modern medical treatment.

Kerala is Capitalizing on its Rich Cultural Heritage and alternate Medical Therapies. Karnatakas Foray The government of Karnataka has ambitious plans to make Karnataka the top health tourism destination not only in India but internationally. In fact, the government is setting up a Bangalore International Health City Corportation for provision of a wide variety health care products and treatments. Tamil Nadu Tamil Nadu has multi speciality hospitals that offer the best medical treatment at surprisingly low rates. In the state various other forms of medicine, viz, Siddha, Ayurveda, Unani, Nature Therapy and Yoga are also practiced, which the foreigners are inclined to patronize. The Tourism Department is taking steps to promote the illness to wellness concept by developing tourism with health care. Maharastras Unlimited Potential This state, as a gateway to India, offers tremendous potential to develop medical tourism. The latest addition in Mumbai is the Asian Heart Institute at Bandra-Kurla complex, which offers state-of-the art facilities for all types of heart complications and even preventive cardiological treatment to avoid heart alignments and keep under control a host of heart problems. This institute in collaborating with the Cleveland Institute, U.S.A offers Five Star services at reasonable prices. Other States of India In other states of India also, a number of private hospitals offer packages designed to attract wealthy patients, with airport-to-hospital bed car service, in-room Internet access and private chefs. Another trend is to combine surgery in India with Yoga are holiday trip to the world famous Taj Mahal, Ellora, etc. The Escorts hospital group in Delhi completed 4200 heart operations for foreign patients during 2004. Medical Infrastructure In India, it is estimated that there are 15,000 hospitals, 8,75,000 hospital beds, 5,00,000 doctors, 7,37,000 nurses, 170 medical colleges,3,50,000 retail chemist outlets. Around 18,000 new doctors are added every year. Almost 80,000 additional beds are still required.
SC/PHC/CHC Dispensaries & Hospitals Beds (Private& Public) Nursing Personnel Doctors (Modern System)
*RHS: Rural health Statistics, 2006 ** Health Information of India, 2004 @ National Health Profile, 2005

Table 4 . Trends Health Care Infrastructure 1951 1991 2005( Period/Source) 725 57353 171608* 9209 23555 27770 117198 185054 61800 569495 143887 268700 914543(all types)** 865135 @ 656111 @

Sub Centres (SC) Primary Health Centres (PHC) Community Health Centres (CHC)

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SWOT analysis Business, service firms undertake Swot analysis to understand their external and internal environments. SWOT, which is the acronym for strengths, weaknesses, opportunities and threats, is also known as WOTS-UP or TOWS analysis. Through such an analysis, the strengths and weaknesses existing within the medical tourism can be matched with the opportunities and threats operating in the Indian environment so that an effective strategy can be formulated. Some of the primary environmental influences operating currently in the context of the Medical Tourism in India. Medical Tourism : SWOT approach. Given below is a SWOT analysis of the Indian Medical Tourism. Strengths A strength is an inherent capacity which an organization can use to gain strategic advantage. An example of a strength is superior research and development for a new service industry development so that the industry can gain a strategic advantage. The strengths in medical tourism are: Quality and Range of Services. India has number of hospitals offering world class treatments in nearly every medical sectorsuch as cardiology and cardiothoracic surgery, joint replacement, orthopaedic surgery, gastroenterology, ophthalmology, transplants and urology to name a few. The various specialities covered are Neurology, Neurosurgery, Oncology, Ophthalmology, Rheumatology, Endocrinology, ENT, Paediatrics, Paediatric Surgery, Paediatric Neurology, Urology, Nephrology, Dermatology, Dentistry, Plastic Surgery, Gynaecology, Pulmonology, Psychiatry, General Medicine & General Surgery. For its quality of services and the infrastructure available, India is attracting a vast pool of tourists from the middle east, Africa etc. Affordable costs : For a long promoted for its cultural and scenic beauty, India is now being put up on international map as a heaven for those seeking quality and affordable healthcare. With 50 million Amercians without health insurance and waiting lists for state- run facilities often endless in the UK,Canada and Europe, foreigners are increasingly flocking to India because it offers quality treatment at a fifth of the cost abroad. In India, complicated surgical procedures are being dine at 1/10th the cost as compare with the procedures in the developed countries. Table 5: Cost Comparison between India, USA & UK.
Nature of Treatment Open heart surgery Cranio- Facial surgery Neuro-Surgery with hypothermia Complex Spine surgery with implants Simple spine surgery Simple brain tumor Biopsy Surgery Parkinsons Lesion DBS Hip replacement Approximate cost in India ($) 4,500 4,300 6,500 4,300 2,100 1,000 4,300 2,100 17,000 4,300 Cost in other major health care destinations ($) > 18,000 > 13,000 > 21,000 > 13,000 > 6,500 > 4,300 >10,000 >6,500 > 26,000 > 13,000 Approximate waiting periods in USA/UK ( in months) 9 11 68 12 - 14 9 11 9 - 11 6- 8 6- 8 9 11 9 - 11 9 - 11

* These costs are an average and may not be actual costs to be incurred. Source: The Guradian News, Feb. 1,2005.

Cost Comparison with the West Price advantage is, of course a major selling point. The slogan, thus is First World Treatment at Third World Prices. The cost differential across the board is huge : only a tenth and some times even a sixteenth of the cost in the west.
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Open-heart surgery could cost up to $70,000 in Britain and upto $150,000 in USA, in Indias best hospitals it would cost only between $3000 and $ 10,000. Knee surgery (on both knees) costs Rs 3,50,000 ($7700) in India ; in Britain this cost----- 10,000 ($16,950)- more than twice as much. Dental, eye and cosmetic surgeries in western countries cost three to four times as much as in India. Table 6. Procedure charges in India, USA & UK
Procedure Bone Liver Heart Ortho Cataract India 69,000 69,000 8,000 6,000 1,250 USA 250,000 300,000 30,000 20,000 2,000

Vast supply of qualified doctors: India has a Large pool of doctors (approx 600000), nurses & para medics with required specialization and expertise and the language advantage ( English speaking skills).The medical education system caters to the ever increasing demand for the delivery of the quality healthcare services all over the country. Strong presence in advanced health care. Eg. Cardiovascular, Organ transplants-high success rate in operations. International Reputation of hospitals and Doctors.

Internationally reputed hospitals are : Apollo hospitals group located at Delhi, Chennai, Hyderabad & Madurai. Escorts heart institute & research centre located at Delhi and Faridabad. Dr, Vivek Sagars Dental care & cure centre located at Ludhiana. PD. Hinduja National Hospital & Medical Research Centre located at Mumbai. LV. Prasad Eye Institute located at Hyderabad. Diversity of tourism destinations and experiences. Top class luxury resorts A destination resort provides a wide variety of experiences and facilities to keep guests occupied in one location for a month or more. Luxury takes convenience to a level of utmost extravagance and soaks the receipent in superior comfort . Mainly hired for enchanting business meets, luxury resorts denote finer hospitality and best comfort that money can buy. The places are like man made heaven on the earth and few hospitality places are :

Taj Excotica, Goa. Kumarakom Lake Resort in Kerala, is a wonderful blend of traditional architecture, natural beauty and great service and as close to nature as it can get. The Leela, Goa designed to reflect Goas Portuguese and Indian heritage, The Leela, Goa, pampers guests with a choice of luxurious villas, suites or rooms characterized by plush furnishings and serene ocean views.The Leela Palace, Goa, has won the World Travel Awards as Asias leading luxury resort for three years in a row. The Oberoi Rajvilas, Jaipuir is an oasis of elegance and luxury, offering consistently high standards of facilities and services. Taj Exotica, Goa a tranquil corner of the world steeped in sepia-tinted romantic history. With tropical dcor, its grand architecture, a lush sun-drenched atrium, wide shady corridors and flower-lined patios, every corner of the Taj Exotica is a retreat itself. One of the highlights at the Taj Exotica is that each
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room offers a panoramic view of the sea, whetherit is from ones own private balcony or from the generously appointed terraces. Indias most economic assets are its outstanding archaelogical sites and ancient town scapes. In India adventure tourism and nature tourism have been identified as the largest segment of global and domestic tourism. Indian doctors treat twice the number of patients in comparison to doctors in the west.

Weakness A weakness is an inherent limitation or constraint which creates strategic disadvantages. An example of a weakness is overdependence on a single service line, which is potentially risky for a service industry in times of crisis. The weakness are as follows : No strong government support/ initiative to promote medical tourism. Low coordination between the various players in the industry- airline operators, hotels, and hospitals. Lack of uniform pricing policies across hospitals. Cheating Political problems etc. Opportunities An opportunity is a favorable condition in the service industry which enables it to consolidate and strengthen its position. The following are opportunities in medical tourism. Increased demand for healthcare services from countries with aging population (US, UK) Fast-paced life style increases demand for wellness tourism and alternative cures. Shortage of supply in National Health Systems in countries like UK, Canada. Demand from countries with underdeveloped healthcare facilities. Demand for retirement homes for elderly people especially Japanese. Personal touch by the doctors in India. Traffic system is well developed and easy to go from one country to another country. Medicines and lab our cost is low as compared to developed countries. Threats A threat is an unfavourable condition in the industrys environment which creates a risk for, or causes damage to, the industry. They are : Strong competition from countries like Thailand, Malaysia and Singapore. Lack of international accreditaion a major inhibitor. Overseas medical care not covered by insurance providers. Under investment in health infrastructure. Exorcism is more in India, foreigners may attract. Identifying a real practitioner is a major problem in India. Exploitation of tourists by illegal money changers. India - Strategic Thrusts for the Future The following section lays down the strategy for India to achieve leadership position in medical tourism. The strategy largely draws from the discussions in previous section . Role of Government The role of Indian Government for success in medical tourism is two-fold: Acting as a Regulator to institute a uniform grading and accreditation system for hospitals to build consumers trust. Acting as a Facilitator for encouraging private investment in medical infrastructure and policymaking for improving medical tourism. For facilitating investment the policy recommendations include: Recognize healthcare as an infrastructure sector, and extend the benefits
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Under sec 80-IA of the IT Act. Benefits include tax holidays for five years and concessional taxation for subsequent five years. The government should actively promote FDI in healthcare sector. Conducive fiscal policies - providing low interest rate loans, reducing import/excise duty for medical equipment. Facilitating clearances and certification like medical registration number, anti-pollution certificate etc. The above measures will kick-start hospital financing, which is struggling now due to capital intensive and low efficiency nature of healthcare business. For facilitating tourism the government should: Reduce hassles in visa process and institute visa-on-arrival for patients. Follow an Open-Sky policy to increase inflow of flights into India. Create Medical Attachs to Indian embassies that promote health services to prospective Indian visitors. Conclusion The medical tourism industry offers high potential for India primarily because of its inherent advantages in terms of cost and quality. However the competition is getting heated up and the success in future will largely be determined by development and implementation of a joint strategy by various players in the industry. India is emerging as an attractive, affordable for healthcare & BUT there are some challenges that the country has to overcome to become a tourist destination with competent health care industry. The government should step in the role of a regulator and a facilitator of private investment in healthcare. An apex body for the industry needs to be formed to promote the India brand abroad and aid inter-sectoral coordination. Joint ventures with overseas partners and establishment of MEDICITIES will help in India building a significant advantage and leadership position in the industry.

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