ECUTIVE SUMMARY

The concept of Medical Tourism is not a new one. The first recorded instance of medical tourism dates back thousands of years to when Greek pilgrims traveled from all over the Mediterranean to the small territory in the Sardonic Gulf called Epidauria. This territory was the sanctuary of the healing god Asklepios. Epidauria became the original travel destination for medical tourism.

A combination of many factors has led to the recent increase in popularity of medical travel: the high cost of healthcare in industrialized nations, the ease and affordability of international travel, and the improvement of technology and standards of care in many countries of the world. Medical tourists can come from anywhere in the world, but generally the bulk will come from Europe and the United Kingdom, the Middle East and Japan. This is because of their large populations, comparatively high wealth, the high expense of healthcare, lack of healthcare options locally, and increasingly high expectations of their populations with respect to healthcare. Of the above, Europe and the UK is probably the most promising source of medical tourists for the future, as it is large (with more than twice the population of the USA), while Europeans are much more likely to travel overseas than Americans (it is said colloquially that only 10% of Americans posses passports, and even the US state department only claims that 25% of US citizens have a passport as of 2007.

CHAPTER1
INTRODUCTION 1.1 Introduction of the project

Medical tourism is where the healthcare services are sought and delivered outside of the home country of the customer, wherein the provider and the customer use nonformal channels of communication-connection-contract, with no or minimal regulatory or legal oversight to assure quality and with limited formal recourse to reimbursement or redress, if needed. In other words, 'Medical tourism' or medical travel is the act of traveling to other countries to obtain medical, dental, and surgical care. The term was initially coined by travel agencies and the media as a catchall phrase to describe a rapidly growing industry where people travel to other countries to obtain medical care. Leisure aspect of traveling may be included on such a medical travel trip. It includes medical services (inclusive of elective procedure and complex specialized surgeries) like knee/hip replacement, heart surgery, dental procedures and different cosmetic surgeries.

1.2 OBJECTIVE OF STUDY

To know the medical facility provided to the tourism. To know the opportunity provided by countries

CHAPTER 2
LITRETURE REVIEW

Some countries that operate from a public health-care system are so taxed that it can take a considerable amount of time, to get needed medical care. The time spent waiting for a procedure, such as a hip replacement, can be a year or more in Britain and Canada; however, in Singapore, Hong Kong, Thailand, Colombia, Philippines or India, a patient could feasibly have an operation the day after their arrival. Additionally, more and more patients are finding that insurance coverage either does not cover orthopedic surgery (such as knee/hip replacement surgery) or imposes unreasonable restrictions on the choice of the facility, surgeon or prosthetics to be used within the US. Medical tourism for knee/hip replacements has emerged as one of the more widely accepted procedures because of the lower cost and minimal difficulties associated with the traveling to/from the surgery. Colombia provides a knee replacement for about $5000 USD including all associated fees such as FDA approved prosthetics and hospital stay over expenses. Oftentimes many clinics will quote prices that are not all inclusive and include only the surgeon fees associated with the procedure. Reasons pushing medical travel include lower healthcare costs as well as the search for medical expertise , quality of care, safety, and wait times. In Canada, the number of procedures in 2005 for which people were waiting was 782,936. Further, in that same year, Canada recorded the highest level of health spending in its history.[2] According to research found in an article by the University of Delaware publication, UDaily: The cost of surgery in Bolivia, Argentina, India, Thailand, Colombia, Philippines 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 US$200,000 or more in the U.S., for example, goes for $10,000 in the Philippines and Indiaand 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 or Bolivia and only $200 in the

Philippines, 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 $2,700 in the Philippines or $2,500 in South Africa or $ 2,300 in Bolivia."

To understand the phenomenon of Medical travel, we can compare the average costs of cosmetic surgeries between the industrialized nations and the most popular countries in Latin America which are specialized in medical tourism and cosmetic surgery tourism (Argentina, Bolivia, Brazil, Costa Rica, Colombia, Philippines, and Mexico). All the prices have been provided us by the offices affiliated with the ministries of health in USA, Europe (France, Spain, and Switzerland), Argentina, Bolivia, Brazil, Costa Rica, India, and Mexico.
Europ Argentin Bolivi Brazi Colombi e a a l a $ 1,200 $ 2,600 $ 2,500 $ 2,400 $ 2,700 $ 3,000 $ $ 2,000 2,100 $ $ 4,200 4,500 $ $ 3,400 3,800 $ $ 3,200 3,600 $ $ 3,800 4,700 $ $ 3,800 4,200 Cost Indi Mexic Philippine a a o s Rica $ $ 1,70 $ 1,500 1,500 0 $ $ 4,50 $ 3,000 2,900 0 $ $ 3,90 $ 3,400 2,900 0 $ $ 3,70 $ 2,600 3,000 0 $ $ 4,80 3,200 0 $ $ 4,50 3,200 0

USA

Rhinoplasty

$ $ 5,500 $ 2,300 6,000 $ $ 15,00 $ 4,300 12,500 0

Face Lift

Breast $ Augmentatio $ 7,500 $ 3,700 8,000 n Breast Reduction Complete Liposuction $ $ 8,000 $ 3,900 9,000 $ $ 13,50 $ 4,500 11,000 0

Gluteal $ Augmentatio $ 9,000 $ 4,000 9,000 n

Medical tourists can come from anywhere in the world and may seek essential healthcare services such as cancer treatment and brain and transplant surgery as well as complementary or 'elective' services such as aesthetic treatments (cosmetic surgery). Popular Medical travel worldwide destinations are : Brunei, Cuba, Colombia, Hong, Hungary, India, Israel, Jordan, Lithuania, Malaysia, The Philippines, Singapore, Thailand, and recently, UAE.

Popular Cosmetic Surgery travel destination are: Argentina, Bolivia, Brazil, Colombia, Costa Rica, Mexico and Turkey. In Europe Belgium, Poland and Slovakia are also breaking into the business. South Africa is taking the term "medical tourism" very literally by promoting their "medical safaris": Come to see African wildlife and get a facelift in the same trip.[3] However, feelings towards medical tourism are not always positive. In places like the US, where most have insurance and access to quality health care, medical tourism is viewed as risky. In some parts of the world, wider political issues can influence where medical tourists will choose to seek out healthcare; for example, in late 2006 some patients from the Middle East were choosing to travel to Singapore or Hong Kong for health care rather than to the USA. While the tourism component might be a big draw for some Southeast Asia countries that focus on simple procedures, India is positioning itself the primary medical destination for the most complex medical procedures in the world. India's commitment to this is demonstrated with an ever growing number of hospitals that are attaining the US Joint Commission International accreditation. Singapore positions itself as a medical hub where healthcare services, medicine, biomedical research and pharmaceutical manufacturing converge. Singapore has made international news for many complex surgeries in specialties such as neurology, oncology and organ transplants procedures. Currently Singapore boasts the largest number of US Joint Commission accredited hospitals in the region. On the other hand, in South America, countries such as Argentina, Bolivia, Brazil and Colombia lead on plastic surgery medical skills relying on the vast experience their surgeons have in treating the style-obsessed. It is estimated that 1 in 30 Argentineans had taken plastic surgery procedures, making this population the most operated in the world after the US and Mexico. Colombia, though, has provided advanced care in cardiovascular and transplant surgery thereby breaking ranks with the traditional stereotypes that all Latin America clinics provide "cosmetic surgery" at affordable rates to persons including beauty pageant contestants. In Bolivia the situation is impressive. According to the "Sociedad Bolivian de Cirugia Plastica y Reconstructive", more that 70% women who belong to the middle and upper class had taken plastic surgery procedure. Likewise Colombia has provided cosmetic

surgery to persons of notoriety including beauty pageant contestants from other Latin American and Asian countries. There are companies emerging to offer global healthcare options that will allow North American patients to take full advantage of dramatic reductions in air travel and access world class healthcare at a fraction of the cost. Companies that focus on 'Medical Value Travel' typically will have experienced nurse case managers to assist patients with preand post-travel medical issues. They will also help provide resources for follow-up care upon the patient's return. While these services will initially be of interest to the selfinsured patient, several studies indicate that the rapid growth of Health Savings Accounts will also drive interest to healthcare in other countries. Because standards are everything when it comes to healthcare, there is a parallel issue around hospital accreditation. Potential medical tourists may be assisted in making their choices by whether or not hospitals have been assessed and accredited by reputable external accreditation bodies. In the USA, JCI (Joint Commission International) fulfills such a role, while in the United Kingdom and Hong Kong, the Trent International Accreditation Scheme is a key player. Increasingly, some hospitals are looking towards "dual international accreditation", perhaps having both JCI to cover the US clientele and Trent for the British and European clientele.

MEDICAL TOURISM IN INDIA THE CURRENT SCENARIO

Medical Tourism is poised to be the next Indian success story after Information Technology. Five years ago, hardly 10000 foreign patients visited India for medical treatment. Today India is a key player in medical tourism with 100,000 foreign patients coming in every year and revenue of Rs.1500 Crores. The current market growth-rate is around 30% per year and the country is inching closer to major players like Singapore and Thailand. The following sections discuss in detail the current state of the Medical Tourism in India:

COST COMPETITIVENESS THE KEY DRIVER

The main reason for Indias emergence as a preferred destination is the inherent advantage of its healthcare industry. Today Indian healthcare is perceived to be on par with global standards. Some of the top Indian hospitals and doctors have strong international reputation. But the most important factor that drives medical

Tourism to India is its low cost advantage. Majority of foreign patients visit India primarily to avail of First World Service at Third World Cost.

The Service Spectrum;India offers a variety of services for overseas patients. The table below presents a classification of the service spectrum

Wellness tourism

Alternative

Cosmetic Advanced and life saving Surgery

Systems Of Medicine
Services Offered Spas, StressRelief, Ayurvedic, Siddha, treatment for diseases e.g.

healt h are
Dental Care, Plastic Surgery, Breast Enhancement, Tummy Organ Transplants, Cardio-Vascular Surgery, Eye Treatment, Hip

Rejuvenation Centers

Arthritis, Rheumatism

Reduction, Skin Treatment

Profit Margins

Replacement, In-Vitriol Fertilization

Low
Thailand,

Low

Medium
South Africa,

High
Singapore, Jordan, Thailand, Malaysia

Key competitors

South Africa -------------

Cuba, Thailand

Indias strength

Low Thailand has captured a significant share of the market

High Kerala is

Low South Africa and Thailand lead in plastic surgeries. Cuba specializes in skin treatments

High India has Strong brand equity. Jordan has a strong presence in middleeastern market

popular for this service

COUNTRIES PROMOTING MEDICAL TOURISM:COLOMBIA

Colombia has been treating savvy patients for years from all over the world especially for cosmetic and eye surgery. Colombia has been a recognized provider of high quality care in advanced cardiovascular and transplant surgery for years. One of the more

obvious advantages of Colombia is the ease of travel and closer proximity to the USA and Canada where many of the medical tourists are forced to find surgery abroad.

INDIA
India is one of the most touted destinations in the world for medical tourists. It is known in particular for heart surgery, hip resurfacing and other areas of advanced medicine. The government and private hospital groups are committed to the goal of making India a world leader in the industry. The industry's main appeal is low-cost treatment. Most estimates claim treatment costs in India start at around a tenth of the price of comparable treatment in America or Britain.[4] For example, "Howard Stab, a self-employed, uninsured, middle-aged carpenter from urban North Carolina," needed surgery for acute mitral-valve prolapsed, which would have cost him a fifth of a million dollars in his home state. Stab was treated in New Delhi, India, for less than seven thousand dollars by an Indian doctor trained at New York University.[5]. Take the rising popularity of "preventive health screening". At one private clinic in London a thorough men's health check-up that includes blood tests, electro-cardiogram tests, chest x-rays, lung tests and abdominal ultrasound costs 345 ($574, 500). By comparison, a comparable check-up at a clinic operated by Delhibased healthcare company Max Healthcare costs $84. Escorts Heart Institute and Research Center in Delhi and Faridabad, India performs nearly 15,000 heart operations every year, and the post-surgery mortality rate is only 0.8 percent, which is less than half of most major hospitals in the United States.[1] Estimates of the value of medical tourism to India go as high as $2 billion a year by 2012.[6] In 2003, Indian finance minister Jaswant Singh called for India to become a global health destination".[7]. The biggest stumbling block preventing the rapid growth of India as a healthcare destination is its poor infrastructure and lack of quality hotels. However, the Indian government is taking steps to address these issues. According to statistics at the website, www.Indian-medical-tourism.com,[8] By January this year, 3.3 million travelers had already visited India, spending close to $ 5 billion. The domestic travel is also witnessing rapid growth. Some 368 million Indians are venturing out of their homes, based on rising incomes, lower aviation costs, and more leisure time. The World Travel and Tourism Council has forecast that tourism will

grow at a rapid rate of 8.8% per year for the next ten years, the highest in the world. The industry is projected to attract a capital investment of $21 billion by 2014, up from about $10.2 billion estimated in 2004, according to a WTTC survey. The south Indian city of Chennai has been declared India's Health Capital as it nets in 45% of the health tourists from abroad and 30-40% of domestic health tourists who are also large contributors to Indian Top tier hospitals.

SINGAPORE MEDICINE
Singapores healthcare services built on a heritage of excellent quality, safety and trustworthiness, coupled with advanced research and international accreditation, and is Asia's leading medical hub. Nine hospitals and two medical centers in Singapore have obtained Joint Commission International (JCI) accreditation. JCI is the main hospital accreditation agency in the United States. SingaporeMedicine is a multi-agency government initiative that aims to develop Singapore into a leading destination for healthcare services in Asia. According to statistics at the official website, www.singaporemedicine.com, 374, 000 visitors came to Singapore purely to seek healthcare in 2005. Many of these patients come from neighboring countries such as Indonesia and Malaysia. However, patient numbers from Indo-China, South-Asia, the Middle East and Greater China to Singapore are seeing fast growth. On top of that, patients from developed countries such as United States also choose Singapore as their medical travel destination for relatively affordable quality healthcare services in a clean cosmopolitan city for a peace of mind. Singapore made news for many complex and innovative procedures such as the separation of conjoined twins and tooth-in-eye surgery. The successful separation of the 10-month-old Nepalese conjoined twins in 2001 puts Singapore's medical expertise onto the World's headlines. Singapore has since accomplished many more milestones both in Asia and in the world arena. Recently, Singapore also hosted the first International Medical Travel Conference (IMTC) from 12th - 15th December 2006. The four-day event attracted participants and media from 21 countries, setting pace and platform for the development of the budding medical travel industry. The conference aims to bring together thought leaders to

10

examine some of the fundamentals, issues and challenges involved in the burgeoning international medical travel industry. As of late 2006, Singapore Hospitals have mainly chosen to accredit themselves through Joint Commission International (JCI), a US-based group. This could be part of the reason why JCI has chosen to set up its Asia Pacific office in Singapore in 2006. In time, Singapore Hospitals may look towards other European or Asian-based systems of hospital accreditation in an attempt to broaden their credibility and appeal, as JCI's principal appeal is to the USA market, which is only one portion of the potential clientele.

THAILAND
Medical tourism is a growing segment of Thailand's tourism and health-care sectors. Lower labor costs translate into significant cost savings on procedures, compared to hospitals in the United States, and a higher, more personalized level of nursing care than Westerners are accustomed to receiving in hospitals back home. In 2005, one Bangkok hospital took in 150,000 treatment seekers from abroad. In 2006, medical tourism was projected to earn the country 36.4 billion baht. One patient who received a coronary artery bypass surgery at Bumrungrad International hospital in Bangkok said the operation cost him US$12,000, as opposed to the $100,000 he estimated the operation would have cost him at home in the US. Hospitals in Thailand are a popular destination for other Asians. Another hospital that caters to medical tourists, Bangkok General Hospital, has a Japanese wing and Phyathai Hospitals Group has interpreters for over 22 languages, besides the English speaking medical staff. When Nepal Prime Minister Girija Prasad Koirala needed medical care in 2006, he went to Bangkok. English is widely spoken in Thailand, which is one reason why it is such a popular tourism destination. Bumrungrad International Hospital makes much of the fact that many of its staff is accredited in the UK, Europe and the USA. The origins of the US medical system are British, with the American Medical Association acknowledging that Manchester Physician Dr Thomas Percival is responsible for modern medical ethics, and even the founder of Harvard University, John Harvard, was born in Southward, London ! The modern Thai medical system shares in this Anglo-US inheritance, as Prince Mahidol of Songla, the King's father, earned his MD degree from Harvard

11

Medical School in the early 20th century. Prince Mahidol and another member of the Thai Royal Family paid for an American medical education for a group of Thai men and women. Prince Mahidol also convinced the Rockefeller Foundation to provide scholarships for Thai citizens to study medicine and nursing. Funds from the Rockefeller Foundation were also used to help build modern medical training facilities in Thailand. The men and women who studied medicine and nursing as a result of Prince Mahidol's efforts became the first educators for the modern Thai medical system. Today many Thai physicians hold US or UK professional certification. A number of Thai hospitals have relationships with educational facilities in the US and the UK (for example, Sheffield Hallam University has links with Bangkok}. The US Consular information sheet gives the Thai healthcare system high marks for quality, particularly facilities in Bangkok and the UK's Foreign and Commonwealth Office web site states "There are excellent international hospitals in Bangkok but they can be expensive". There is indisputably a major HIV/AIDS problem in Thailand, as acknowledged by the World Health Organization and dengue is becoming increasingly common. Ranged against this, Thailand has a modern infrastructure, with clean, safe streets. According to the US Consular information sheets, the crime rate in Bangkok is lower than that of many US cities. Personal safety is another factor to consider when traveling abroad both for vacation as well as healthcare. Thailand offers everything from cardiac surgery to organ transplants at a price much lower than the US or Europe, in a safe, clean environment. Thailand has long been a destination for medical tourists, and has a growing number of hospitals with JCAHO accreditation. Over one million people per year travel there for everything from cosmetic surgery to cutting edge cardiac treatment. Don Ho, the famous Hawaiian entertainer, recently received cutting-edge adult stem cell cardiac treatment at a Bangkok hospital. Six weeks later he had recovered sufficiently from his nonacademic cardiomyopathy and was able to return to the stage. Again, international hospital accreditation may be one way for hospitals to demonstrate their worth, and increasingly Thai hospitals competing for business in this sector may need to look at dual international accreditation or more to enhance their brand equity.

HONG KONG

12

Hong Kong is among the most beautiful cities in the world to visit, and it possesses a superb medical infrastructure. A former British colony, and now a Special Administrative Region (SAR) within China, it is a great place to spend time in as it has some of the best shopping in the world. There are 12 private hospitals and more than 50 public hospitals in Hong Kong. Among the widest range of healthcare services throughout the globe are on offer, and some of the SAR's private hospitals are rightly considered to be among the very best of their type in the world, while all of them are certainly of an extremely high standard. All 12 of the Hong Kong private hospitals in Hong Kong have looked towards a partnership with the United Kingdom rather than the USA or Autsralia when it comes to international hospital accreditation. All 12 are "Trent Hospitals", having been surveyed and accredited by the United Kingdom's Trent scheme since the mid-1990s. This has been a major factor in the general ascent of standards of Hong Kong private hospitals over recent years. As the Trent scheme (see

www.trentaccreditationscheme.org) works closely with the hospitals it assesses to generate standards appropriate to the locality (with respect to culture, geography, public health, primary care interfaces etc.), and always uses combinations of UK-sourced and Hong Kong-sourced surveyors in every survey it does, this has lead to a uniquely cooperative style of approach being generated towards the improvement of hospital standards. Some Trent Hospitals have now gone on to obtain dual international accreditation, with both Trent and JCI (and have therefore attained a standard which surpasses even that of some of the best hospitals in Thailand and Singapore), and others are looking towards dual international accreditation with Trent and the Australian group to "brand enhance". Unlike Singapore, the Hong Kong public hospitals are yet to commit to external accreditation. All Hong Kong private hospitals have English language web sites, and there are a range of options for accessing medical and surgical services at these hospitals.

MEDICAL TRAVEL RISKS AND REWARDS:Medical tourism does carry risks that local medical procedures do not. Should complications arise, patients might not be covered by insurance or be able to seek adequate compensation via malpractice lawsuits, though it should be noted that the

13

malpractice insurance is a considerable portion of the cost in the West. Further, it should be noted that the most outspoken critics of medical tourism are US malpractice lawyers who see this emerging trend as a threat to their livelihood. Some of the counties that are currently sought after as medical tourism destinations provide some form of legal remedies for medical malpractice. However, this legal avenue is unappealing to the medical tourist. Advocates of medical tourism have always advised prospective tourists to balance the unlikely legal challenges with the more practical choice of a superior care facility and surgeon before undergoing any surgery abroad. Some countries such as India, Malaysia, Costa Rica or Thailand have different infectious diseases to Europe and North America, and different prevalences of the same diseases compared to nations such as the USA, Canada and the UK. Exposure to foreign diseases without having built up natural immunity can be a hazard for weakened individuals, specifically for gastrointestinal diseases (e.g. Hepatitis A, amoebic dysentery, paratyphoid) which could weaken progress, mosquito transmitted diseases, and influenza, TB, etc.(e.g. 75% of South Africans have latent TB). International hospital accreditation with Trent or JCI, mentioned earlier, may be of value here when people are trying to settle on a destination to go to for their procedure. Also, travel soon after surgery can increase the risk of complications, as can vacation activities. For example, scars will be darker and more noticeable if they sunburn while healing. Long flights can be bad for those with heart (thrombosis) or breathing related problems (low oxygen environment), not to mention uncomfortable. However, because in poor tropical nations diseases run the gamut, doctors seem to be more open to the possibility of any infectious disease, including HIV, TB, and typhoid, there are cases in the West where patients were consistently misdiagnosed for years because it is perceived to be "rare" in the West, a famous case of the misdiagnosis and death of a CDC researcher from TB, something that few would rule out in India or Thailand.

STRATEGIC POSTURE:OBJECTIVES:To promote India as a quality destination for medical treatment, surgeries, yoga and rejuvenation.

14

To provide comprehensive guidance to patients from across the globe seeking medical help in India. To provide the best possible avenue for patients already coming to India for treatments. To provide ancillary services to patients and their attendants for a comfortable, relaxed and safe stay while treatment process is in progress. To provide medical tourism in India i.e., to amalgamate medical care by stress-free touring of this mystical country of Cultural Heritage, Kaleidoscopic diversity and Natural Splendors.

STRATEGIES:MEDICAL EDUCATION
It is high time that the government really looked hard at the demand supply situation of human resources in the healthcare sector and recalibrated the supply of specialists and paramedicals in the country. This would mean changes to policies on post- graduate medical education, nursing education etc.

INFRASTRUCTURE
Quality of healthcare service can be limited by traffic and hartals. The last thing the fledgling medical tourism industry in India wants is bad press on a couple of foreign patients in ambulances that were stuck in traffic for several hours due to a political partys rally. From airports, and high ways, and hassle free environments for patients relatives, there is quite a bit where improvements can be made on the infrastructure side.

LAW AND ORDER

Law and order and general sense of security are definitely areas for improvement. For all the gold in the world, I might want to get my hip replaced in nearby countries, which are infested with and mines and missiles waiting to take off.

LEGAL INFRASTRUCTURE & ETHICS

What is the mechanism for international patients who seek legal redressal for service gone bad? How long would it take for resolving the same in India? Is our legal infrastructure geared up to handle healthcare specific issues in a speedy manner?

PRIVACY OF PATIENT INFORMATION

15

One area that is understated in discussions around healthcare services in India is confidentiality of patient data and regulations related to privacy and security of patient data in India. A good start would be to adopt HIPAA standards in India.

STRATEGIES, OBJECTIVES AND POLICIES OF ESCORTS:MISSION

To become the leading professional healthcare company in super-specialty tertiary care in the Region, leading in cardiac care with a range of products, services and quality consistent with the highest customer expectations. Move from the ranks of excellence to the ranks of pre-eminence among healthcare providers, and maintain the lead role of continuing pioneering leadership.

VISION
Reaching beyond excellence in high end tertiary healthcare, while doing business with a soul. This will be achieved by:

Providing state-of-the-art world standard health care that exceeds expectations of patients and families.

Pursuing independent as well as collaborative research in all aspects of cardiothoracic medicine and surgery to develop affordable solutions for heart problems of this region.

Establishing a network of joint ventures and satellite centers to extend the availability of quality health care in India and other developing countries.

Providing expert training for medical, para-medical, nursing and other professionals in the field of heart care.

Networking with other organizations to promote health and wellness in society through education, preventive checkups and community outreach programs.

VALUES:HONESTY
Conduct everything we do with highest standards of professional and ethical integrity.

EXCELLENCE

16

Pursue excellence and continuous improvement in technology, skill, services and quality of interaction.

ATTENTIVENESS
Be responsive to the physical and emotional needs of patients and their families, and expectations of the society.

RESPECT
Show respect, compassion and truthfulness towards patients, co-workers and all persons we encounter.

TEAM WORK
Recognize that working together can create a power greater than the sum of individual activities and that mutual respect demands collegiality, consensus seeking and cooperation.

17

CHAPTER 3
RESEARCH AND DEVELOPMENT
Apollo Hospitals ties up with IKP for clinical trials
APOLLO Hospitals and ICICI Knowledge Park (IKP) today signed a MoU to promote clinical research activities. IKP has been set up by ICICI Bank Ltd on a 200-acre site in collaboration with the State Government to support business-driven research and development in the country. As part of the agreement, Apollo Hospitals group and its subsidiary Spectra Clinical Research Centre will support the present and potential companies at the park in clinical research and other aspects of healthcare. It would not only provide opportunities to interact with physicians for patient information but also result in diagnostic and therapeutic product development. Mr. N. Vaghul, Chairman of ICICI, who signed the MoU here told media persons that ICICI was exploring the possibility of setting up a sophisticated laboratory at a cost of Rs 15 crore with the assistance of the Department of Science and Technology to offer value-added services. The strengths of the biotech park set up by the State Government and IKP were being fine-tuned to develop a genome valley of international standards. The total investment of ICICI in the park so far was up to Rs 40 crore. Mr. B.P. Acharya, Secretary of the Department of Industries and Commerce, said that an incubator would be set up at a cost of Rs 31 crore with assistance from the Central Government. There was also a proposal to develop agro-biotech as a cluster with ICRISAT (International Crops Research Institute for Semi-Arid Tropics) as the nucleus. He said the Indian Council of Medical Research was planning to establish an animal breeding and research facility in collaboration with the National Institute of Health at a cost of Rs 100 crore. Modalities for the project were being worked out.

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APOLLO TIE UP WITH DRDO

Apollo -DRDO Technology partnership a joint venture of Apollo Group of Hospitals and Defense Research & Development Organization (DRDO) was launched by His Excellency The President of India Dr.A.P.J.Abdul Kalam on 19th January 2004 at Apollo DRDO Hospitals. The other dignitaries present to grace this prestigious occasion were Dr.Vasudeva Aatre - Scientific Advisor to the Defense Minister, Dr.Sivathanu Pillai - Chief Controller R&D DRDO, Mr. Vijay Rama Rao - Minister R&B, Dr. Prathap C.Reddy - Chairman Apollo Group of Hospitals, Ms.Sangita Reddy Director Operations Apollo Group of Hospitals. This joint venture aims in leveraging the core strengths of both partners for the benefit of the common man. The areas identified are:

Use of indigenously developed prosthesis, implants and calipers in orthopedic surgery.

Use of indigenously developed membrane in treatment of burn. Role of stem cells in management of cancer Role of stem cells in neurology and neurosurgery Development of indigenous diagnostic and therapeutic medical devices and instrumentation

19

CHAPTER 4 EXTERNAL ENVIRONMENT

4.1 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 cleans 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.

20

But, things are going to change drastically in favour of India, especially in view of the high quality expertise of medical professionals, backed by the fast improving equipment and nursing facilities, and above all, the cost-effectiveness of the package. 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.

Economic: - facts & figures

India offers world-class healthcare that costs substantially less than those in developed countries, using the same technology delivered by competent Specialists attaining similar success rates If a liver transplant costs in the range of Rs. 60 lakhs-70 lakhs in Europe and double that in the US, a few Indian hospitals, such as Global in Hyderabad, have the wherewithal to do it in around Rs 15 lakh-20 lakhs. Similarly, if a heart surgery in the US costs about Rs. 20 lakhs, the Chennai-headquartered Apollo Hospitals Group does it in roughly Rs 2 lakhs. PROCEDURE CHARGES IN INDIA & US (US $): PROCEDURE Bone Marrow Transplant Liver Transplant Heart Surgery Orthopedic Surgery COST (US$) United States 2,50,000 3,00,000 30,000 20,000

India 69,000 69,000 8,000 6,000

21

Cataract Surgery

2,000

1,250

Here's a brief comparison of the cost of few of the Dental treatment procedures between USA and India DENTAL PROCEDURE COST IN US ($) General Dentist Top End Dentist 8,000 5,500 3,500 1,800 3,000 600 1,000 500 2,000 600 1,000 350 800 200 500 100 300 COST IN INDIA ($) Top End Dentist 1,000 500 800 300 80 100 100 110 25 75

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

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. Economic cost comparison:Euro Argenti Boliv Braz Colomb USA pe na ia il ia Cost Indi Mexi Philippi a a co nes Rica

$ $ $ Rhinoplas $ $ $ $ $ 2,300 2,10 $ 2,000 1,50 1,70 ty 6,000 5,500 1,200 1,500 0 0 0 Face Lift $ $ $ $ $ $ $ 15,00 12,50 $ 4,300 4,50 $ 4,200 2,90 4,50 2,600 3,000 0 0 0 0 0

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Breast $ $ $ $ $ $ $ Augmenta $ 3,700 3,80 $ 3,400 2,90 3,90 8,000 7,500 2,500 3,400 tion 0 0 0 $ $ $ Breast $ $ $ $ $ 3,900 3,60 $ 3,200 3,00 3,70 Reduction 9,000 8,000 2,400 2,600 0 0 0 Complete $ $ $ $ $ $ Liposuctio 13,50 11,00 $ 4,500 4,70 $ 3,800 3,20 4,80 2,700 n 0 0 0 0 0 Gluteal $ $ $ $ $ $ Augmenta $ 4,000 4,20 $ 3,800 3,20 4,50 9,000 9,000 3,000 tion 0 0 0

4.2COST COMPARISON 4.2.1 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. Nature of Treatment Approximate Cost in India ($) * Cost in other Major Healthcare Destination ($) * > 18,000 > 13,000 Approximate Waiting Periods in USA / UK (in months) 9 - 11 6-8

Open heart Surgery Cranio-facial Surgery and skull base Neuro-surgery with Hypothermia Complex spine surgery with implants Simple Spine surgery Simple Brain Tumour -Biopsy -Surgery

Save over 50% Save over 50%

Save over 50% Save over 50%

> 21,000 > 13,000

12 - 14 9 - 11

Save over 50% Save over 50%

> 6,500

9 - 11

> 4,300 > 10,000

6-8

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Parkinsons -Lesion -DBS Hip Replacement

Save over 50% > 6,500 > 26,000 > 13,000 9 - 11 9 - 11

Save over 50%

4.2.2 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 & US (US $): PROCEDURE Bone Marrow Transplant Liver Transplant Heart Surgery Orthopedic Surgery Cataract Surgery COST (US$) United States India 2,50,000 3,00,000 30,000 Save over 50% 20,000 2,000

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

DENTAL PROCEDURE

COST IN US ($)* General Dentist 1,800 600 500 600 350 200 100

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

COST IN INDIA ($)* Top End Top End Dentist Dentist 8,000 5,500 3,500 Save over 50% 3,000 1,000 2,000 1,000 800 500 300

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4.3 WHY CHOOSE INDIA FOR YOUR TREATMENT?

Medical Services in India are available at much lesser costs as compared to other countries. Indian Hospitals are well-equipped to offer world-class medical facilities. Our doctors have rich experience and expertise. Personalized treatment packages using latest techniques combined with Ayurvedic Principles. India has been the most attractive destination for the visitors around the globe. But the recent trend in the tourism sector shows a propelling growth in the travel & tourism industry. This is not only due to the heritage attraction of the country but the medical tourism India which has depicted a steady southward movement, of late. Now the question arises, why should people rush India for treatment? The simple equation

is that the medical treatment package price in India is 35% to 40% lesser than the treatment cost in USA or Thailand. A patient can travel India once in the same cost with the excellence health care treatment in India. So this is the best alternative available particularly for foreigners to travel India with complete medical treatment. Offering surgery in India with the 30% discount India has got the benefit of English speaking populace. So there would not be any problem in making out and addressing the quandary due to the language difference. Not just because of the discount but the superiority concern also. India has got the specialist in around the world and in India as well and also has got the world eminent doctors & hospitals where all the services are provided to the patients. India has got the specialist in around the world and in India as well and also has got the world eminent doctors & hospitals where all the services are provided to the patients. So when you can get the best health care in India then why not opt for India as the destination for medical treatment tourism. A number of specialty hospitals in India are All India Institute of Medical Science Apollo Hospitals B.M.Birla C.M.C Vellore Tata Memorial Hospital Indraprastha Medical Corporation Institute of Cardiovascular Diseases

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 Escorts Heart Institute and Research Centre Kalra Hospitals Dr. U Mohan Rau Memorial Hospital Institute of Child Health and Hospital for Children As health care costs skyrocket, patients in the developed world are looking overseas for medical treatment. India is capitalizing on its low costs and highly trained doctors to appeal to these "medical tourists." Even with airfare, the cost of going to India for surgery can be markedly cheaper, and the quality of services is often better than that found in the United States and UK. Indeed, many patients are pleased at the prospect of combining their tummy tucks with a trip to the Taj Mahal. Many countries have developed links for speedy treatments in India for their nationals on account of the fact that in these countries one has to wait for extended periods of time to undergo operations. In India, medical treatment is not only fast but also costs a fraction of what it costs in USA or Europe. Even tele-consultancy is available for expert opinion and transmission facilities. Some of the states have already established themselves as destinations for health care and medical tourism. The growing need is for high level specialised treatments like transplantation of vital organs, cancer treatment, neuro-surgery, cardiac surgery and many more. India is nearly one quarter of the World's population India has been growing at 6% or better rates for a decade and at an 8% or better level for the last 3 years. Indian growth in its service economy has been historic and manufacturing economy is now ramping up sharply.

The advantages of low cost and skilled made India a globally competitive manufacturing destination India also has offered talent pool of skilled professionals and English speaking population India has increasing disposable incomes and significant domestic demand. Rising per capita income and changing demographic distribution are conducive to growth. India has the highest proportion of population below 35 years-70 percent (potential buyers),

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which means that 130 million people will get added to the working population between 2003 and 2009. The government is also pursuing reforms and liberalization

At present, over 200 of the Fortune 500 companies from the U.S., the UK, Germany, France, Japan, Netherlands, South Korea, Switzerland, Canada, and Sweden are present in India.

A favorable foreign investment environment: freedom of entry and exit, investment, location, choice of technology, import and export, and rule of law.

India has increasingly moved from an agro based economy and has emerged as a service oriented economy. Today India produces more than 50,000 computer professionals and 360,000 engineering and management graduates each year Developed and well regulated banking system of over 63,000 branches supported by a number of international banks, insurance joint ventures, national and state level financial institutions. WTO commitments

TECHNOLOGICAL:Facilities Available in 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 color Doppler, gold standard DXA bone densitometry, body fat analysis, coronary risk markers, cancer risk markers, carotid color Doppler, spiral CT scan and high strength MRI. Each test is carried out by professional M.D. physicians, and is comprehensive yet pain-free.

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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.India is advancing very rapidly in applications of Nano-technologies and anti-gravity techniques with some solid breakthroughs in Healthcare fields. Most of the research is still classified but indications coming out from sources close to the researchers are surprising. Anti-gravity devices are nothing new. Most of the developed world has implemented the same in some form to reduce or eliminate the effect of gravity and hence create a weightless environment. Using the same technology for genetic assembly, curing heart disease especially noninvasive methods of cleaning the artery, alternative to bypass surgery is new. Nano-technology is also advanced in many countries including Germany, America and Japan. The advanced implementation of Nan sensors in bloodstreams to gather medical information and monitor health is unheard before. In addition research is being done to perform molecular-scale surgery with nanorobots. Noano-technology is also being researched to cure type I and II diabetes. These nanobots are used to manipulate other molecules, destroying cholesterol molecules in arties, destroying cancer cells and constructing nerve tissue atom by atom in order to end paralysis. The biggest breakthrough expected in a few years from Indian medical scientists is in the area of noninvasive body scanning to detect cancer-forming cells at a very stage. This may even lead to cancer cure and effective treatment of the same. Indias advanced in anti-gravity and Nano-technologies in healthcare applications are absolutely remarkable. India soon will be ready to tap into $4 Billion emerging market of Healthcare. Medical devices, advanced procedures, drugs and noninvasive advanced medical monitoring systems can replace the current traditional medical systems.

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Some of the drug manufacturing companies are implementing drug development through nanoparticle formulation services. This is provide early stage breakthrough in life saving and other critical drugs. Things are becoming clear now why India agreed to WTO (World Trade Organization) requirements of implementing Product patents. These new products and procedures will push way ahead of other countries in medical technologies. Blue Star whole-body CT cardiovascular and general angiography systems; special purpose X-ray machines; MRI scanners; biochemistry, hematology and other analytical products; EEG monitors. Wipro-GE Systems Hewlett Packard range of analytical instruments and equipment from Beckman, Bio-Rad, Becton Dickinson and Serono Diagnostics. Medical Coordinators Pvt ultrasound scanners; cardiology equipment; endoscopes; CO and Nd: YAG laser equipment. Toshniwal Brothers urology equipment; lithotripters; MRI and CT whole-body scanners; cobalt therapy units; angiography systems. Government imitative in technological advancement:Indian Union Minister for Science and Technology and Earth Sciences, Mr Kapil Sibal has launched a new StanfordIndia Biodesign Program, which is a collaborative venture between the Department of Biotechnology, Ministry of Science and Technology, and Stanford University, USA. The objective of the program is to create medical technology innovation in India in partnership with Stanford University, USA by developing leaders in biomedical technology. The program seeks to provide training to young engineers from Indian Institute of Technology (IIT), leading engineering institutions with partner medical institution to identify major health needs in India and develop solutions that are costeffective and widely deployable across a broad socio-economic spectrum. The goals of the program are:

To introduce the Stanford model of Biodesign into educational system of these institutions

To establish Center of Excellence at each Indian Institute of Technology (IIT) in partnership with a medical institution

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To identify opportunities through observation of patients by a multidisciplinary team comprised of biologist, engineer, chemistry and medical persons, then to select at least one new technology for group to be designed and develop it into a prototype.

The focus of the program will be on the development of implants, medical devices and bioinstrumentation. The initial development phase will include an intensive design and planning process based on the national needs. The faculty and fellows would be trained in the design innovation process by providing hands-on training at Stanford University, USA. Once the training will be over, the team will come back to India and start designing process and identifying clinical needs/challenges in India based on their experience at Stanford University, USA. Stanford's Program in Biodesign is partnering with the government of India to establish a new training program, called Stanford-India Biodesign, to help create the next generation of biomedical technology innovators in India. "India is on the move," said Harry Greenberg, MD, senior associate dean for research at the School of Medicine. He described the partnership as a plan to meet the future needs of India's medical technology industry, which is poised to grow dramatically in coming years. "India represents a huge part of the population of the globe that is likely to benefit from medical innovation and technology over the next 20 years," said Greenberg. The Indian government announced May 31 it will allocate $4.8 million over the next five years to help fund the joint venture between Stanford and India's department of biotechnology. The program will train future medical device innovators and catalyze the expansion of the medical technology industry in India. "By sharing our teaching methods with our Indian partners, we expect similar Biodesign training programs to spring up around India fueling the development of exciting new technologies within the next decade," said Paul Yock, MD, director of Stanford's Program in Biodesign. "We hope this will parallel the extraordinary growth of the medical technology industry in the Silicon Valley over the past 25 years." The plan is to bring the Stanford program's method of "teaching innovation" to Indian engineering, business and medical students through a two-year fellowship pilot project. The fellowship will start with hands-on innovation training at Stanford and progress to

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immersion in health clinics and hospitals in India, where fellows will identify unmet medical needs specifically targeted for the Indian heath-care environment and then create cost-effective solutions to meet those needs. At the end of the program, the fellows will remain in India and lead more development and testing of these solutions at a university, a start-up company or at a new unit of an existing company. The $4.8 million in funding from the Indian government should cover about half the cost of the program, which means Stanford must rise the additional funding. While Stanford's Biodesign program has successfully trained medical innovators with its unique methods of immersion in clinical settings and hands-on innovation for years now, the new partnership will emphasize the cost-effectiveness of the technology more than it has in the past. This is a new emphasis that the Stanford leaders hope to promote for their own Stanford students as well. "The purpose is to eventually help meet the medical needs of the people at the bottom of the economic pyramid in India," said Balram Bhargava, MD, the India-based executive director of Stanford-India Biodesign and a professor of cardiology at the All India Institute of Medical Sciences in New Delhi, one of two educational institutions involved in the first stage of the Stanford-India Biodesign initiative. The Indian Institute of Technology is the other. "With a population over 1 billion, an ever-increasing need for improved health care, and world-class engineering and medical talent, India is poised for explosive growth of its nascent medical technology industry," said Rajiv Doshi, MD, a Stanford graduate in both engineering and medicine who has been named the U.S.-based executive director of Stanford-India Biodesign. "There's a huge opportunity to do a lot of good. The potential in India is limitless. What's needed is a catalyst. We are hoping the combined efforts of the three educational institutions will be this catalyst." While this initial partnership is based on Stanford bringing its training skills to India, Yock emphasized that Stanford is hoping to cultivate long-term benefits from the program. The hope is that the five-year pilot project will develop into an ongoing collaboration between Stanford and key institutions in India. "The global health marketplace for biomedical technology innovation is going to be important in a way that it never was before," Yock said. "Inventors and developers of new medical technologies will need to understand the global applications. The best way

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for our students to train for this new era is to jump in and experience first-hand the process of innovation in a developing-world setting." Other hoped-for benefits to Stanford will be the new emphasis on creating costeffective technology, Yock said. "Ninety percent of Indian citizens lack medical insurance and many live in rural areas without access to decent health care," he said. "We think cost-effective technology has a really important role in bridging the gap to these underserved patients." India has already developed several examples of cost-effective medical devices that reach underserved patients such as the Jaipur limb, a lower leg prosthesis that can be manufactured and fitted in a matter of a few hours and is provided free to those who can't afford it. And at the Aravind Eye Institutes, a custom-designed and manufactured intra-ocular lens is implanted in tens of thousands of patients a year, free for those who can't afford it. In the United States, medical technology is often blamed for much of the runaway costs of health-care expenditures, Yock said. "We think there is a kind of technology innovation that we don't understand at all in the U.S. that is cost-efficient, cost-effective and still high quality. We want to expose our students to its implications in the context of the developing world," he said. The SIB program will be developed in conjunction with Stanford's newly announced International Initiative and the Hasso Plattner Institute of Design at Stanford.

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4.4 POLITICAL AND LEGAL:Government promoting medical tourism-the Government plans to start overseas marketing of India as a medical tourism destination. According to senior Government officials, "The formalities for marketing medical facilities to a global audience have already started. We hope to complete the process of price-banding of hospitals in various cities by the third quarter of this year." By marketing India as a global medical tourism destination, the Government hopes to capitalize on the low-cost, high-quality medical care available in the country. Medical tourism focuses on treatment of acute illness, elective surgeries such as cardiology and cancer, among others. Statistics suggest that the medical tourism industry in India is worth $333 million (Rs 1,450 crore) while a study by CII-McKinsey estimates that the country could earn Rs 5,00010,000 crore by 2012. Probably realizing the potential, major corporate such as the Tatas, Fortis, Max, Wockhardt, Piramal, and the Escorts group have made significant investments in setting up modern hospitals in major cities. Many have also designed special packages for patients, including airport pickups, visa assistance and board and lodging, health care industry officials said. While the trickle of foreigners coming to India for treatment has started, officials are hopeful that this will become a flood once the various initiatives being taken by the Government take off. Apart from receiving patients from those parts of the globe that have poor medical facilities, India has also been getting some medical visitors from the West for a variety of reasons including the long waiting period there for treatment in Government hospitals there. Among the factors that make India an attractive proposition for medical treatment is cost efficiency. It is estimated that while it would cost about $30,000 to get a heart surgery done in the US, while the same could be performed here for about $6,000. Similarly, a bone marrow transplant could cost about $2, 50,000 in the US while it could be done here for about $26,000. The Government has introduced various policy measures to further encourage medical tourism. For instance, the National Health Policy recognizes the treatment of international patients as an export, which allows private hospitals treating such patients to enjoy benefits such as lower import duties, increase in the rate of depreciation (from 25 per cent to 40 per cent) for life-saving medical equipment, and several other tax sops.

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1. NATIONAL POLICY ON MEDICAL TOURISM

The Export Import Bank of India (Exim Bank) discussed the need for an extensive national policy on medical tourism. Since no state had ever come up with such a policy, Dr. Vinayshil Gautam, Professor of Management Studies stated: "Tamil Nadu, specifically Chennai, is an eye care hub, New Delhi is known for heart care and Kerala has marketed itself as an Ayurvedic destination. Yet none of these States has brought out a comprehensive medical tourism policy." According to him, other countries Thailand, China, Singapore and South Africa have long had national medical tourism policies for ages. With increasing awareness of the gigantic leap in the medical tourism sector, the Indian government is extending a helping hand to the growth of the industry. In the Union Budget for 2003-2004, the government has bestowed infrastructure status to Tourism, therefore paving the way for reasonably priced, long term funds to help finance the tourism infrastructure. The aggregate for tourism for the Tenth Five Year Plan is Rs. 2900 Crore. State governments such as Kerala lay plenty of Emphasis on elevating tourism. The state had an outlay of Rs. 74.25 Crore for the financial year 2003 to 2004.

Visa Related Developments

1. COLOURS OF INDIA The year 2007 is turning out to be an excellent month for medical tourism. Thanks to the government along with the Ministry of Tourism AND the Ministry of External Affairs, a Medical Visa, also known as Mvisa or MXvisa has been put together. Aside from this fact, the validity of this Visa has also been extended from a period of six months to three years in order that there may be a rise in inbound medical tourism. This way, healing and good treatment can be continued absolutely hassle-free. 2. MINISTRY GIVES MEDICAL TOURISM A BOOST Speaking at the India Health Conclave 2007 at the Hyatt Regency hotel in Mumbai, Union Minister for Tourism Ambika Soni focused on the efforts made by the Ministry to promote Incredible India through its Mvisas, specially designed for medical tourists. We are offering several packages to promote such visitors. The idea is to encourage medical tourists to return after their first visit, stated Soni. With the tourism industry set to boom with the coming of the 2010 Asian Games and the 2014 AfroAsian games, Soni said that it was just the right time to promote medical tourism.

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Members in the audience agreed that medical tourism could get the much required revenue to run super-specialty centers. According to Dr P V R Mohandas - director of MIOT Hospitals - in Chennai: There needs to be a corridor specifically designed for medical tourism because this industry is going to grow. Also, immigration procedures should be simplified to make it convenient for patients visiting India. CLOSE on the heels of introducing medical visas, the Government are shifting gears. Come October, the Government plans to start overseas marketing of India as a medical tourism destination. According to senior Government officials, "The formalities for marketing medical facilities to a global audience have already started. We hope to complete the process of price-banding of hospitals in various cities by the third quarter of this year." The Government has also introduced various policy measures such as the National Health Policy recognizes the treatment of international patients as an export, which allows private hospitals treating such patients to enjoy benefits such as lower import duties, increase in the rate of depreciation (from 25 per cent to 40 per cent) for lifesaving medical equipment, and several other tax sops in order to encourage medical tourism in India.

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4.5 SOCIO-CULTURAL:Segmentation of the Patient Population Currently, the bulk of the patients come to India from neighboring countries such as Bangladesh, Pakistan, other Asian countries, Africa and the Middle East. In many cases, the driver for cross border care is a question of quality of care than cost itself. The quality of care that we provide in India is simply not available in some of the neighboring countries. The second segment is the segment of patients sponsored by the governments in their respective countries such as Middle East and Africa. For those governments, India is relatively a cost-effective option compared to Europe or the US. Private patients (not sponsored) from these countries look at India as value for money option Vis a vis Europe and US. Moreover, post 9/11 there has been a dramatic drop in patients from Middle East to the US. The market segment that the healthcare industry is targeting is the patient population from Europe and the US. There are several patients of Indian origin residing in UK and US, who are already using the services of hospitals in India, when they are on vacation etc. Apart from this we have the widely-publicized cases of patients from the US and Australia. True, these countries do have an increasing population and the healthcare systems are on the verge of collapse. Even though it is economically viable for some of these governments to officially bless shipping of patients abroad, it is the political viability of such a decision that may need to be worked on. Would a political party in power in Europe/US would want to face the next election as the pioneer of shipping patients to third world countries.

2. TASK ENVIRONMENT:SUBSTITUES:Where to go for medical tourism? Once the decision has been made to go abroad for medical care (see our article, Five Reasons to Go Overseas for Medical Treatment and Three Reasons Not to Travel), the aspiring medical tourist is confronted with many possible destinations. Though many countries boast about their growing medical tourism industries, these are usually either

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not competitive in price or too weak in quality for American or European tourists. There are effectively three major hubs and three minor hubs that should be considered, while the rest can be safely ignored. The three major hubs are Singapore, India and Thailand. In 2006, Singapore claimed 374,000 medical tourists while India brought in over six hundred thousand. Thailand is the undisputed heavyweight of the industry, drawing over 1.2 million medical tourists. Many of these tourists will visit Bangkoks Bumrungrad Hospital, which accounts for a third of Thailands medical tourists. To put this in perspective, this single Thai hospital received more medical tourists than all of Singapores hospitals put together, and two-thirds as many as all of India. India and Singapore together have fewer foreign medical tourists than Thailand, and these are not just for minor procedures but also major heart and joint replacement surgeries, among many others. These hubs are also growing frantically, with 30% annual increases in foreign tourists as an industry standard and expected to be maintained for the foreseeable future. The three minor hubs are Central America (exemplified by Costa Rica), Eastern Europe (led by Hungary) and South Africa. The minor hubs established themselves long before the major hubs by focusing on low cost dental and cosmetic surgery. At half the price of the United States, these hubs cannot compete financially with India or Thailand but rely on other benefits to attract tourists. Central America and Eastern Europe are much more convenient to medical tourists in the US and Western Europe, respectively, than the major hubs which all require 18+ hour flights. South Africa offers a more polished package for medical tourists and less culture shock than the major hubs. What makes these hubs minor is not just the numbers of tourists, however, but also their capabilities for major surgery. They do not have the large volume of the major hubs and thus are not equal to their quality or low prices, making them suitable only for dental, cosmetic or other minor surgery.

SINGAPORE
Singapore has a well-deserved reputation as a high-tech, clean and orderly city-state. With medical costs about half those of the US, Singapore is considerably more expensive than India or Thailand and in line with the minor hubs. While the quality of medical facilities is on par with the main medical centers in Thailand and India, Singapores major attraction is its status as a developed country and the reassurance this provides to new medical tourists. While Singapores hospitals are no more reliable

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than the medical tourist facilities of their competitors, Singapores pristine streets contrast sharply to Indias overcrowded and underdeveloped cities to inspire confidence in the city-states medical abilities. For those very nervous about going to a developing country for health care, Singapores shining towers are a strong alternative. The Singaporean government has recently made a significant effort to expand its biotechnology sector, mostly with large financial grants to lure researchers from other countries. While this controversial policy is having mixed results overall, it has been quite successful in supporting stem-cell research when other regions of the world have stalled on the issue. This focus, along with related personal health technologies, has resulted in a number of cutting edge therapies, especially for cancer, that are not available anywhere else. Singapores tourist attractions tend toward high-end shopping rather than white sand beaches (in fact Singapore has to import sand from Indonesia). Hotels and services are very expensive, but many tourists stay only for their medical care and arrange for the vacation portion of their trip to be spent in nearby Malaysia or Indonesia, where Java is a top destination. Most flights to these destinations will have a stopover in Singapore anyway, so it is best to think of it as a vacation to Java with a medical stop in Singapore, not the other way around. Singapore has the best English speaking population of the medical tourist hubs, however, so if the goal is to minimize culture shock staying in Singapore with its diverse and high-end restaurants and luxury services is an option. Conclusion: Singapore is a good alternative if youre nervous about going abroad and dont trust India or Thailands medical capabilities, but this is just a matter of confidence and realistically almost all tourists should favor the other two hubs.

THAILAND
Thailand is the largest medical tourism hub in total volume and in both high-end and low-end procedures. Long a major tourist destination, Thailand has translated this expertise along with a largely Western-trained medical community into a very convenient package for westerners. Thailands two largest medical tourism targets are the Bumrungrad and Bangkok Hospitals, which annually treat 400,000 and 150,000 foreign patients, respectively. Thailands prices are about 20% higher than Indias, on average, with the main advantages being a better tourist experience overall and more bundling of services. Whereas most medical tourists going to India should focus of specialty hospitals that are often in different cities, each of these Thai mega-centers is

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full service.

Their massive volume overall translates into high volume in each

specialty, which in turn translates into more experienced doctors, better equipment and lower prices. This packaging of services often earns Thailand regular medical tourists, who find that flying to Thailand annually for a comprehensive physical exam, dental work and any minor procedures along with a week on the beach at Phuket is a cheaper and more enjoyable option than staying at home. Thailands tourism options are among the strongest of any medical hub, balancing exotic culture with pristine beaches and supported by a very mature tourism industry. Both Thai and foreign restaurants are plentiful and affordable, while Thai hotels come in all levels of luxury and are much more reasonable than their competition in Singapore or India. For tourists seeking a number of smaller procedures, Thailand is a sure bet. For first time travelers who want to step outside the more Westernized cultures of South Africa and Singapore, Thailand is also a good choice. Those seeking a specific, major surgery should weigh Thailand and India carefully: the Indian option will likely be cheaper, but not by much and the recovery environment and support are generally better in Thailand. Thailand govt.policies:Government starting to accommodate medical tourism in visa policies The government is seeking to accommodate "medical treatment tourism" in Taiwan and attract more foreign national visitors coming for medical purposes, according to the Council for Economic Planning and Development (CEPD).The CEPD noted Thailand, Singapore, and Korea have already started to develop services catering to "medical tourism". The CEPD cited the example of Singapore in particular. Singapore offers anti-aging cosmetic surgery and comparatively cheaper medical exams, which attract many visitors from India and Malaysia. In 2005, Singapore had over 400,000 foreign nationals visit as patients, and this figure is expected to rise to 500,000 this year. Singapore earned nearly USD 1.5 billion from visiting patients in 2005, and this figure is projected to rise to USD 3 billion by 2012. According to the CEPD, Taiwan's strengths in medical care are in liver disease treatment, dentistry, facial reconstruction, Chinese medicine and health checkups -fields which the government has already marked for further development. Representatives of a number of hospitals have responded positively to the proposal, saying that new considerations for granting visas would better enable patients to complete a full course of treatment while in Taiwan, especially for longer-term

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recovery. In addition, the CEPD has been in contact with major international insurance companies to discuss providing medical care insurance to foreign nationals coming to Taiwan for medical treatment. So far, the response from insurance companies has been positive, said CEPD sources. Upon a recommendation by the CEPD, the Ministry of Foreign Affairs (MOFA) is now allowing visitors to Taiwan apply for a visa for 'medical treatment' reasons. Currently, visitors wishing to visit Taiwan for medical purposes can receive a visitor visa granting a six-month stay by providing appropriate medical documentation. As more and more patients from nations with high Medicare costs look for medical tourism options, India has competition namely from Thailand, Singapore and other Asian countries. They have good hospitals, attractive climates and are established tourist destinations. While these countries with their advanced medical facilities and medical tourism options have been drawing overseas healthcare traffic, India is and looks set to, expand at a faster rate. Conclusion: Thailand is the major player in the medical tourism field for a reason and is both the most balanced of the hubs and overall strongest in several categories.

The Minor Hubs SOUTH AFRICA

South Africas strength lies in the packaging of its tours, rather than the outright price of their medical capabilities. While their hospitals are at first world standards, South African facilities have far less experience with heart or joint surgery and specialist hospitals in India or Thailand are better for these patients. The majority of South African medical tourists are after cosmetic surgery, with breast augmentations as the number one procedure. South African prices hover around 40-60% of those in the US, making them one of the more expensive medical tourism hubs. Tourists to South Africa will find a very polished experience, however, with a mature medical tourist industry. A cosmetic surgery package in South Africa will consist of a consultation and surgery, personal physical therapist and personal assistant during your recovery in a spa and a safari tour afterwards. Any of these components can be found in other tourism hubs for far less and some travel agents will even bundle them, but the professionalism and polish of the South African package cannot be matched. Combined with

widespread use of English and familiarity with western culture, South Africa is a good choice for those who want to travel without tremendous culture shock. Recently, however, crime has become a major problem in South African cities and many hotels

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will not allow guests out at night except in a hotel car, which further limits exposure to the local culture. Conclusion: South Africa is a solid candidate for tourists that want to be pampered after their cosmetic surgery and dont mind paying a premium for it.

COSTA RICA
Costa Ricas main selling point is that it doesnt require a trans-Pacific flight for US tourists to get there. As with many smaller hubs, the focus is on cosmetic surgery and dental work. Costa Rica boasts gorgeous beaches and rainforests and is no stranger to American tourists, making this a very convenient and appealing option. Prices are approximately 40-50% of the US, however like the other small hubs having major surgery here is not recommended. Conclusion: Costa Rica is a good choice for those seeking dental work or plastic surgery and dont want to endure a 20 hour plane ride.

HUNGARY
Like Costa Rica, Hungary offers cheap but reliable dental and cosmetic surgery. The major draw is that Hungary is convenient to European tourists by air or train. Prices are 40-50% of the US, though almost all patients that go there are Europeans with heavily state-supported health care systems. Usually the benefit is availability of

procedures rather than cost (no two year waiting lists). One drawback is that this is one of the only medical tourism hubs that do not possess a tropical beach there are options for tourism but they are more cultural rather than natural or decadent. Conclusion: Hungary is convenient for Europeans, though like Costa Rica is not suitable for major surgery and is expensive by medical tourism standards.

4.6 COMPETITIVE BRANDS AND POTENTIAL ENTRANTS/ ENTRY BARRIERS

APOLLO HOSPITALS GROUP Located at Delhi, Chennai, Hyderabad & Madurai

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The Apollo Hospitals Group is today recognized as the "Architect of Healthcare" in India. Its history of accomplishments, with its unique ability of resource management and able deployment of technology and knowledge to the service of mankind, justifies its recognition in India and abroad. Their mission is "to bring healthcare of international standards within the reach of every individual. We are committed to the achievement and maintenance of excellence in education, research and healthcare for the benefit of humanity" Apollo's capabilities have received international acclaim resulting in the replication of its Indian models at international locations. Apollo group is also in talks with private healthcare groups and government authorities in Nigeria, South Africa, Tanzania, Mauritius, Yemen, Muscat, Bahrain, Vietnam, Malaysia, Thailand and other neighboring countries to establish its presence World Class Clinical Efficiencies Among the few providers of quaternary care for complicated medical conditions, Apollo saves millions of lives everyday Touched the lives of over 10 million patients till date. Over 4, 00,000 Preventive Health checks done. Have the largest and the most sophisticated sleep laboratories in the World. Has pioneered orthopedic procedures like Total Hip and knee replacements, the Illizarov procedure, and the Birmingham Hip Resurfacing technique. Has performed over 750,000 major surgeries and over 10, 00,000 minor surgical procedures till date. Has performed over 49,000 cardiac surgeries at a 98.5% success rate. Has performed over 2, 00,000 angiograms, 16,200 angioplasties (PTCA) and 3,500 mitral balloon valvuoplasities. First heart transplant patient is alive, 7 years after the operation. Has performed over 9,400 renal transplants. 130 Bone Marrow Transplants performed at high success rates. Over 30 Liver transplants done (Live and cadaver)

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Has over 4,000 specialists and super specialists, 3,000 medical officers spanning 53 clinical departments in patient care.

International Affiliations Apollo Hospitals is recognized as a training centre by the National Board of Examination in India for post-graduate training in 16 medical departments. The Department of Radiology at Apollo is recognized by the Royal College of Radiologists, United Kingdom for training for fellowship examinations like FRCR. Recognized as a centre for conducting research work leading to Ph.D. of the Anna University, Chennai, in medical physics and digital signal processing. Apollo Hospitals is recognized by the Royal College of Physicians and Surgeons in Edinburgh for training postgraduates in radiology, surgery and trauma care. Apollo Hospitals is the only International training organization for the American Heart Association Technical support from Texas Heart institute and Minneapolis Heart Institute for Cardiology and Cardio Thoracic surgery. Apollo Hospitals has exchange programs with the Hospitals in the US and Europe. Apollo Hospitals have an association with Mayo Clinic & Cleveland Heart Institute, USA. Apollo Hospitals is also associated with Johns Hopkins University.

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ESCORTS HEART INSTITUTE & RESEARCH CENTRE

Located at Delhi and Faridabad Escorts are steadily consolidating its presence in healthcare, which is likely to emerge as the largest service sector industry. Currently, Escorts is operating three large hospitals in New Delhi, Faridabad and Amritsar. Together with 11 heart command centres and associate hospitals, Escorts is managing nearly 900 beds. Escorts excellence in providing healthcare services has received due recognition. Escorts Heart Institute and Research Centre (EHIRC), New Delhi, has been ranked as the best cardiac hospital in India by an Outlook-Cfore survey and has been given the highest grade by CRISIL - an acknowledgement of the quality of delivered patient care. EHIRC is a leader in the fields of cardiac surgery, interventional cardiology and cardiac diagnostics. The Institute has introduced innovative techniques of minimally invasive and robotic surgery. The Institute's latest addition of state-of-the-art Cardiac Scan Centre providing a combined power of CV-MRI and Smart Score CT Scanner to diagnose coronary artery disease at its very early stage. This facility is the first of its kind outside America. State-of-the-art infrastructure and equipment has made this setup technically the largest and the best dedicated cardiac hospital in the world. The 332bed Institute has nine operating rooms and carries out nearly 15,000 procedures every year. DR. VIVEK SAGGAR'S DENTAL CARE & CURE CENTRE Located at Ludhiana Dental Care and Cure Centre is, centrally located in Ludhiana, easily approachable from any part of Punjab by rail or road. It takes not more then two hours from any part of Punjab to reach this place. Theirs is a 6 chair operatory with an in house dental lab, the Dental Caps, Crowns and Beyond Dental Lab, which has been designed on the European standards. The office has been designed to provide an environment of comfort that combines exceptional skill levels, a respectful approach to treatment, Clinical and technical excellence with an individualized care approach by providing the most advanced, optimal dental care to the best of our ability.

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Theirs is a full service cosmetic and general dental office specializing in creating beautiful smiles. The in house facility of Dental Caps, Crowns and Beyond ... Dental Lab gives them the unmatched time advantage plus international quality control. For NRI's and foreigners they provide special care in the form of appointments at a short notice and the work is completed within the span of 3-5 days keeping in mind your tight schedule. Standard Procedures: Oral Prophylaxis (gum cleaning & polishing) Sub Gingival Root Planing Invisible Composite Fillings Simple Tooth Extractions Root Canal Therapy Advanced technology: Smile Designing Crown & Bridge Work Tooth Whitening Dental Implants (single tooth or entire set of teeth) Oral & Maxillofacial Surgery (third molar extractions, apicoectomy surgeries, management of mandible fractures) Geriatric Patient (partial & complete dentures, implant supported dentures, complete extractions under local anesthesia) Diagnostic & Preventive (cancer screening, occlusal splints, tooth desensitization) Care of the Child Patient (fluoride treatment, milk teeth as well as permanent teeth restorations, preventive orthodontics, fixed orthodontics, habit breaking appliances, sedation dentistry (licensed anesthesiologist)) The Lab Dental Caps, Crowns and Beyond Dental Lab was established in with the goal of supporting Dental Care and Cure Centre and providing dentists of north India with restorations of superior quality and value. The lab has been set up as per European standards. They specialize in crown & bridge Metal Ceramic and Metal Free Ceramic

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restorations. Their highly skilled technicians with state-of-the-art techniques, materials, and equipment guarantee exceptional quality restorations with correct fit and shading. Quality is the cornerstone of their work. They were the first lab in north India to start metal free ceramic work. NM EXCELLENCE Located at Mumbai NM Excellence was formed from one man's vision to provide a healthier future for the citizens of Mumbai. Established in 2001 by M.D. Radiologist Dr. Nilesh Shah, this modern and sophisticated preventive health checkup centre aims to revolutionize the way healthcare is perceived and practiced in India. Backed by over two decades of diagnostic experience under the banner of NM Medical, NM Excellence employs the latest, top-of-the-line imagining modalities, operated by qualified and professional doctors, with a friendly and efficient staff to make a client's experience as memorable as possible. Having viewed the vast range of diseases that can be prevented if detected early enough through its diagnostic experience, NM Excellence philosophizes that a preventive health checkup in today's day and age is an absolute must NM Excellence is one of Mumbai's foremost preventive healthcare centres boasting of top-of-the-line diagnostic equipment, highly qualified doctors, a well-trained service staff, and a professional yet warm environment that makes one feel at home immediately. Health Packages Their diagnostic experience has guided them in forming their health packages for different age and professional categories of people. They believe their health plans are comprehensive enough in covering the entire spectrum of life-threatening ailments you face in today's fast-paced, constantly stressful world. The health plans range from those for busy executives, to senior citizens, from housewives to working women, from kids to pre-employment clients. The health plans are most affordably priced, mostly discounted to the tune of forty percent

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Health Plan for NRI's & Foreigners The Plan Price starts from US$ 225+ and includes the following: Pathology Tests Complete haemogram, test for diabetes, test for liver disease, test for kidney disease, test for heart disease. Diagnostic Tests Digital Chest X-ray, ECG, Sonography, Stress Test, 2D Echo, Spirometry, Dexa Bone Densitometry, Body Fat Analysis,

Mammography, Transvaginal Sonography Consultations Physical Examination by MD Physician, Dental Checkup, Eye Checkup, Diet Consultation, Gynecological Checkup, Pap-Smear Highlights of the package are: International Quality of Equipments Highly Qualified Doctors Life & Stress Presentation View Reports on Net Reports on CD Health Gift Certificates

PD HINDUJA NATIONAL HOSPITAL & MEDICAL RESERCH CENTRE Located at Mumbai An ultramodern hospital on the busiest artery in Central Mumbai, PD Hindujas National Hospital & Medical Research Centre was established by the Hindujas Foundation in collaboration with Massachusetts General Hospital (MGH), Boston. The fulfillment of Founder Parmanand Deepchand Hindujas dream, the 351-bed hospital offers comprehensive services covering the gamut from diagnosis and investigation to therapy, surgery and post-operative care. As a tertiary care hospital, the services offered are comprehensive covering investigation & diagnosis to therapy, surgery & postoperative care. The inpatient services are complemented with a day centre, out-patient facilities and an exclusive center for health check for executives. Hinduja Hospital was the first multi disciplinary tertiary care hospital to have been awarded the prestigious

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ISO 9002 Certification from KEMA of Netherlands for Quality Management System. The Hinduja Foundation's quest for up gradation of healthcare facilities in India has prompted it to join hands with the 32,000 member American Association of Physicians of Indian origin (AAPI), with the objective of bringing to India well qualified and experienced doctors from USA to upgrade the expertise of HNH doctors, provide quality medical care and continuing medical education; to ensure co-operation in research and pursue joint projects in the fields of: Coronary artery disease, Osteoporosis and Asthma; and to provide consultancy, technology and treatment support to AAPI dispensaries in India on case to case basis Cutting Edge Technology in Diagnostics Hindujas Hospital has a fully automated Laboratory Medicine Department. The Laboratory offers over 500 different types of tests some of, which are exclusive. It also offers an emergency / Stat menu of tests with a very short turn around time. The department participates in International Quality Control programme conducted by the College of American Pathologists, WHO & National Quality Control Programme where it has achieved and maintained a high ranking consistently for a number of years. Imaging forms a key part of the diagnostic facility at the hospital. Technology Upgrades The hospital keeps upgrading its technology by acquiring new state-of-the-art diagnostic & therapeutic equipment. Hindujas Hospital was the first in India to acquire the Gamma Knife-gold standard in Radio surgery, a non-invasive neurosurgical tool. The hospital was also the first to acquire the Holmium Laser in the country thus replacing the surgeon's scalpel. The Oncology Services are wholistic & complete with installation of the Linear Accelerator with Multileaf Collimator (MLC) & Micro MLC. The hospital is the first centre in India to have installed the sophisticated state of the art GE-LCA Digital Subtraction Angiography System. In keeping with the quest for continuos improvement in quality & technological advancement, the hospital has recently commissioned the Bone Mineral Densitometer (DEXA), an addition to the Imaging department.

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LV PRASAD EYE INSTITUTE Located at Hyderabad In October 1987, L V Prasad Eye Institute began the work of realizing its mission to achieve excellence, equity and efficiency in eye care. In addition to treating patients dealing with a wide range of vision problems, LVPEI began to conduct research into eye diseases and vision-threatening conditions, train eye care workers, product development and rehabilitate those with incurable visual disability. The focus, right from the start, has been on providing eye-care services to underprivileged populations in the developing world Set up as a not-for-profit trust, LVPEI has now come a long way in its journey towards realizing these goals. However, our changing world continues to throw up new challenges and new threats to health, and LVPEI too continues to search for ways in which these challenges can be overcome, in the field of eye health. In partnership with international health organizations such as the World Health Organization and the International Agency for the Prevention of Blindness, LVPEI designs and implements innovative eye health programmes that reach people in the most remote rural areas. While the range of our research and training activities is international, our focus is on bringing this quality of care to the poorest segments of India and the developing world. Our successes include the establishment of rural eye health centers that provide highquality eye care at the lowest possible cost, or at no cost to those to whom such care would otherwise be inaccessible. In fact it is this same model that operates successfully in our nodal center in Hyderabad, Andhra Pradesh. At the L V Prasad Eye Hospital, nearly 50 percent of our patients are treated free of cost. The Eye Hospital forms the nucleus of the Institute's activities. Designed along the lines of the finest eye hospitals in the world. Patients with a wide range of eye disorders are treated which is staffed by a world-class team of dedicated doctors representing all ophthalmic sub-specialties and a highly competent support staff. The Hospital's comprehensive facilities also include the in-house expertise of physicians, microbiologists, pathologists and biochemists trained to apply their knowledge and skills to eye care.

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4.7 ENTRY BARRIERS IN MEDICAL TOURISM

1. Risk of political instability, public unrest or war
Hospitals are affected by everything that affects the tourism industry. Of all the major medical tourism destinations probably Singapore is the lowest risk location in this regard. Indias standing in the world has improved over the last couple of years and its competitiveness as a medical tourism hub has increased greatly. Thailand on the other side has become less stable in 2006. While the coup detach in September 2006 was peaceful, it nevertheless brought for a short time tanks onto the streets of Bangkok. More a concern today is the fact that the tensions before the coup between the supporters of ex-prime minister Thaksin Shinawatra and his opponents have still not been resolved and it is not unlikely that tensions will flare up again during the run-up to elections - or when elections are postponed. With the military and the police force as divided as the rest of the population in Thailand, things could turn nasty rather quickly. Elections are scheduled for this year, but there is still plenty of uncertainty in the air in medical tourisms most important country worldwide.

2. Risk of international and local terrorism

International terrorists can hit anywhere in the world and any place hit by a major attack is likely going to suffer a severe short term economic impact. While there are still tourists in Bali for example, the whole island economy has suffered significantly from the terrorist bombings of 2002 and 2005. In 2006, Mumbai was the site of a major terrorist incident in which over two hundred people were killed when several bombs exploded almost simultaneously on a local railway. While the bombs left no lasting economic impact, a repeat attack could make a huge difference. After the first bomb in Bali, Australians continued to visit the place in order to not let the terrorists win. After the second set of bombs went off in 2005 the mood has turned clearly negative and tourism has not recovered since.

Thailand is quite unique in regards to terrorism. The South Thailand insurgency with the associated violence has attracted comparatively little international media attention,

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although more than one thousand people have lost their lives since the escalation of violence started in 2004. Should the violence spill over into places like Phuket or Bangkok this could change from one day to the next though. In Thailand so far none of the violence was targeted at foreigners but nobody knows how long this will last.

3. Risk of health epidemics

South-east Asia is still bird flu central. While the virus has been found in many parts of the world, it is still in Asia, where most of the cases continue to make news. Remember SARS? Although Thailand had no reported cases of the disease, SARS kicked us quite badly, says Ralf Krewer, marketing manager at the International Medical Center of Bangkok Hospital. Nobody wanted to get on a plane. And many foreigners were concerned about the safety of the blood supply in developing nations, although officials say those worries were unfounded. Even established players like Singapore Airlines had to lay off 1000+ local staff to cut cost following the devastating effects of the SARS epidemic on the travel industry in 2003. A little virus had turned a successful company within weeks into one which was losing between $3 million and $4 million a week. Sure, like other risks, the risk for a full outbreak is not specific to the medical tourism industry, but any restrictions to international travel will impact medical tourism operators in the affected areas just like the rest of the tourism industry.

4. Risk of appreciating domestic currency

Currency fluctuations impact medical tourism operator the same way they impact exporters of other goods or services. In 2006 and 2007 the Thai Baht for example has appreciated against the US Dollar, the Yen and the Euro. The more the Thai Bhat strengthens, the less cost incentive foreign patients will have to come to Thailand for treatment.

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5. Risk of staff shortage

Increasing demand for nurses, pharmacists and last not least doctors with overseas training drives up the prices for local talent. Some places make it very difficult or even impossible to recruit foreign medical staff and any quick-fix solution like importing specialists from abroad is not always an option. Thailand is one of these countries which make it impossible for foreign doctors to practice medicine.

6. Risk of increased international and local competition

From Turkey to Nicaragua and from India to Taiwan, there seem to be fewer and fewer countries who have not yet declared themselves as medical tourism destinations. That some of the countries have a horrendous health care situation for their own citizens does not hold them back. In contrary, many regions seem to see medical tourism as an opportunity to make money and at the same time improve their own health care options. While not all the new self-declared medical tourism destinations are a threat to established players like Thailand or Singapore, newer entrants like India will eventually want a bigger share of the cake. Slowly growing overcapacity will put pressure on prices and profit margins. An interesting development is also the increasing competition among European countries. It has now become normal for many Europeans to travel to Hungary or Poland for dental treatment, to Turkey for LASIK or to take a canal ferry to Belgium for coronary bypass surgery. Additionally, for some medical services, notably LASIK, discount operators have appeared on the scene in some of the high cost countries and contributed to a narrowing of the price gap to medical tourism destinations. This trend can be expected to continue, but it is most likely going to have limited impact in all but a few niches. Some very high margin procedures like the setting of dental implants and some standard plastic surgery procedures will be first in line. Complex procedures especially in the general surgery area are less likely to attract discounters in high price countries. Local competition has also picked up. In a city like Bangkok medical tourists now can choose among a number of international standard hospitals and the days when the Bumrungrad Internationals Hospital and the Bangkok Hospital were the only games in town are long over.

7. Risk mitigation strategies

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Being in an industry which grows at 20 30% annually is like driving fast on a bumpy road. It is exciting and we hope you enjoy the ride. We believe in the transforming power of medical tourism more than ever, but it never hurts to think about some likely bumps in the road ahead some can be circumnavigated.

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4.7.1 SUPPLIERS:-

Insurance partners:International Insurance Partnerships Being JCI accredited, Apollo Hospitals is recognized by Health Insurance Providers in the US. So, international patients can now overcome the long waits for medical treatment in their country and avail the advantage of world class treatment at Apollo, at prices which are just a fraction of those prevailing abroad - without having to worry about whether the insurance provider will recognize the treating hospital. Our insurance partnerships Insurance suppliers to Apollo:BUPA INTERNATIONAL BLUE CROSS BLUE SHIELD AETNA ALICO (AMERICAN LIFE INSURANCE COMPANY) CIGNA SEVEN CORNERS INC INTERNATIONAL SOS ASIA RESCUE & MEDICAL SERVICES ASIA MEDICAL ASSISTANCE

Device importers and local manufacturers:4.7.2DISTRIBUTORS

Accurate Surgicals Aerobe Medicare Alliance Biomedica Amar Immunodiagnostics Amy Trading Company Appasamy Associates Avm Healthcare Products Biomed Importers Biomedix Optotechnik & Devices

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Blue Star Cardio Products Corporation Care International Carewel Hospital Supplies Chokhani Surgicals Confident Dental Equipments Consolidated Products Corporation Deena Enterprise Dss Imagetech (A Unit Of Darbara Singh & Sons) D Shah & Company Eagle Medical Systems Electrocare Systems & Services Essential Dental Products Hi-Tech Surgical Systems Hospimedica International Hysel India Inor Orthopaedics (A Division Of Inor Medical Products) Inter Cure Drugs Interkardio Jambotkar Medequip Jayant Medical & Surgical Kashmir Surgical Works Leela Exports Libral Traders Medishare Modern Surgical Moditech International Monarch Marketing Enterprises Myovatec Surgical Systems National Industrial Ortholine Plasti Surge Industries Pushpanjali Sales Promotion Rohit Surgical

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Rustagi Surgical Saxsons Biotech Serwell Medi-Equip Spectrum Medical Industries Sun Overseas Marketing Suncare Medicals Suyog Diagnostics Technomed Systems Towa Optics Towa Sales Corporation Trans Health Care Triage Systems Venus Surgicals Vishal Surgical Equipment Company Zabby's 4.7.3DOMESTIC PRODUCTION Domestic Producers Anand Medicaids Pvt Ltd ASCO Atlas Surgical Company 6 Carewell Mediproducts 6 Dent-Eq 86 Emdin India Pvt Ltd Hindustan Latex Ltd 6 Hindustan Syringes and Medical Devices Ltd Kay & Company Kiran Medical Systems Narang Enterprises Pace Devices Ribbel International Ltd Sahajanand Medical Technologies South India Surgical Company (SISCO) SURU International

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Wadia Group (INOR Orthopaedics, Dental Products of India and Medical Microtechnology Ltd ) Multinational Activity Bausch and Lomb Baxter International B Braun Becton Dickinson GE Medical Systems Johnson & Johnson

4.8 SOME OF THE AGENCIES OR LEADING PROVIDERS TO MEDICAL TOURISM

Following are agencies, are the providers for medial treatment and has vast networking area between the patients and hospitals. These agencies help their client in arranging their tours from the day they leave home until the day they return back. 1 ERCO travels Erco Travels is one of India's leading Incoming Tour operator based in New Delhi. Erco Travels Pvt. Ltd. was formed in New Delhi (India) on 1999, as an Incoming Tour operator promoted by Erco Reizen B.V., Erco has team of around 15 operational staff who are working 24 hours (round the clock) in shifts to help the visiting Tourists. Company is headed by Mr Ravi Gusain, a Post Graduate in Tourism Management with experience of over 10 years in Tourism Industry. Competitive prices and personalized services help Erco travels to grow its business in last few years and providing it services to Diplomats, Celebrities, Distinguished Travelers, Big Multinational Corporate houses and medical tourists. Erco Travels Pvt. Ltd arrange Appointment for patients before their arrival in India and ERCO travels send all the informations about the treatment, also arrange hotel, pickup and drop facility from hotel to hospital, give patients personal assistance at the time of admission. Along with treatment ERCO travels arrange tour package for patients according to their requirement. The Taj Medical Group

http://www.globehealthtours.com

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The Taj Medical Group is a Limited Company registered in England and Wales. Their main office is located in Kenilworth, Warwickshire. It was set up in December of 2003 essentially for relieving the pain and suffering of orthopedic patients on long surgery waiting lists in the UK by co- ordinating their immediate private treatment in India. Through recommendations by satisfied patients and their families the company has steadily grown and now also includes in addition to hip and knee replacement surgery, cardiac surgery, prostate surgery, spinal rehabilitation, dental care (specialising in crowns, bridges and implants), cosmetic surgery and preventative healthcare checks. The Taj Medical Group now has an extensive network of privately owned hospitals and specialist clinics throughout India comprising more than 400 Specialist Doctors, Dentists, Surgeons and Anaesthetists as part of The Taj Medical Group Medical Group has formed strong links with highly qualified, skilled and experienced surgeons, doctors and anaesthetists in New Dehli, Mumbai, Ahmedabad, Baroda, Chennai, Goa and Banglore to name a few, where a high quality of care is offered immediately at substantial cost savings. Meditours Meditours is only arranging the services. The only service offering all-inclusive surgery packages, where their mission is to take care of all travelers and make surgery arrangements from the day patient leave home until the day they return back. Meditours has engaged some of the top surgeons and state of the art hospitals available for international patients, and puts together packages for patients, which include patient airfare, surgery, accommodation and meals. For the best and most personalized service which is available in medical tourism, Meditour has open its website to review all the available information on the various procedures and details of the surgeons and hospitals that one is looking. Once the patient reaches or contacts to Meditour, It becomes their job to make arrangements for tour and medical package without any patient or its family members botheration. A high level of medical service is provided to the patient or the customer with accommodations in 5 star hotels for recuperation for about the same price as just the surgery in their own country. For site visits and scenic beauty Meditours offer many locations includes, Mumbai, Goa, Kerala and other destinations depending on Patient requirements and budget. Patient who needs major medical treatment will have a

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companion Meditours can arrange treatment for the companion also such as dentistry, lasik, plastic, full health check-up or any procedure that may reduce cost for the accompanying person since they are already with their all medical procedures and costs connected to the hospitalisation. Health Care Facilitator The Health Care Facilitator (HCF) helps its client to understand and obtain the full benefits and services available from your UC-sponsored health plans under the UC group contract. As a knowledgeable counselor, he or she will provide you with confidential one-on-one assistance in resolving medical plan issues. The There is no charge for this service. The Health Care Facilitator can provide:

Help to understand patient UC health plan coverage and patient rights Help patient to understand how Medicare benefits coordinate with UCsponsored medical plans

Help to define patient health care issues Assist in resolving issues with client or doctor, medical group or medical plan carrier

Help to navigate the health care system

Globe Health Tours Globe Health Tours is a UK based company established by medical professionals to help people with medical needs to schedule medical treatments in distant countries as well as making the necessary travel arrangements. Globe health tour are in a partnership with the Scottish Dental Implant Centre, Scotland's leading dental implants centre and HelpMeGo.To which is a leading travel company in the UK that specialises in creating sophisticated itineraries for travellers. Globe Health Tours is access to affordable healthcare that provide help to uninsured and under-insured consumers. Healthcare programme gives people significant discounts on needed care at the time that it is required. Globe Health Tours links consumers to a range of international healthcare providers who agree to offer all in one health care packages to patients, these packages include theatre and surgery costs, inpatient costs and also expected consumables or diagnostic testing.

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Globe Health Tours exists to help people decide and manage their treatments abroad. They make arrangement for holiday or business visitors who are seeking treatment for very low cost health check up examination to patients requiring major surgery or longterm treatments. MedInIndia MedInIndia provides professional, caring and comprehensive services to Medical Tourists looking for medical treatments in India. There services help its client to make exclusive selection of state-of-the-art hospitals, treatment scheduled at client convenience and that too at an affordable cost. It includes surgery of heart, hips and joints and cosmetic surgery, dental care treatment and likewise many such other treatments. All kind of operation whether they are funded from private means or by a medical insurer MedInIndia take care of all the arrangements down to the last detail including travel insurance and travel arrangements for the patient and near dear ones. Medical Service Providers are the Hospitals, Specialty Clinics etc. providing excellent medical services in their respective medical disciplines. MedInIndia aims at: -. Providing unmatched Quality Services at nominal costs Offers options of Alternative health and healing Avoids months of long delays in getting treated

MedInIndia carries out the process of locating, evaluating, contacting, and soliciting quotes from qualified Medical Service Providers and travel service providers for medical tourists. It offers Medical tourists with all required medical services provided by required Service Providers and their price quotes. The MedInIndia team acts as a facilitator, between Medical Tourists and Medical Service Providers, along with taking care of the aspects of Service Providers selection, and Medical Deal monitoring

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STIC STIC Care, a part of the STIC Travel Group, provides Medical Treatment in India, They understand the critical nature of travel therefore they have collaborated with major and selected hospitals and research centers and prepared a meticulous plan to make the whole process very smooth for their client & is well complemented by it's Air Charter Division. STIC Care is a well-established company Infrastructure with more than 1000 full-time professionals; a nationwide presence, 40 offices across India aims to showcase the high standards of medical care and facilities offered in India for all kind of healthcare domains.

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Customers and their profile:-

GROUP

DESCRIPTION
1.Low-cost treatment 2. Easy issuing of medical visa

COUNTRIES

DEMAND DRIVER

Non-Residential Indians

Numbering 20 million across the world

Low Cost Healthcare combined with trip back home Quality Healthcare at Affordable Prices.

Patients from Countries with Underdeveloped Facilities

Nepal, Burma, Bangladesh, African Countries, Middle East Countries, Latin America U.S, U.K, Canada

Patients from Developed Countries

Low Cost of Healthcare, Capacity Constraints for Services in Home Country.

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1. Available of tour packages 2. Government promoting medical tourism

1. More insurance facility 2. Inter-nationally affiliated hospitals

1. Cultural heritage

L H M L

Issue priority matrix

POSITIVE:-

Probability of occurrence

Probable impact on the new unit NEGATIVE:H 1. Less hotels 2. scarcity of doctors 1. High living cost for patients due to living in metro cities

1. integrated only in metro cities 1. Political instability

L H M L

Probability of Occurrence Probable impact on the new unit

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CHAPTER 5
INTERNAL ENVIRONMENT (RESOURCES NEEDED)
5.1 MARKETING:The key "selling points" of the medical tourism industry are its "cost effectiveness" and its combination with the attractions of tourism. The latter also uses the ploy of selling the "exotica" of the countries involved as well as the packaging of health care with traditional therapies and treatment methods. 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 sometimes even a sixteenth of the cost in the West. Openheart surgery could cost up to $70,000 in Britain and up to $150,000 in the US; in India's best hospitals it could cost between $3,000 and $10,000. Knee surgery (on both knees) costs 350,000 rupees ($7,700) in India; in Britain this costs 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. The price advantage is however offset today for patients from the developed countries by concerns regarding standards, insurance coverage and other infrastructure. This is where the tourism and medical industries are trying to pool resources, and also putting pressure on the government. We shall turn to their implications later. In India the strong tradition of traditional systems of health care in Kerala, for example, is utilized. Kerala Ayurvedic centres have been established at multiple locations in various metro cities, thus highlighting the advantages of Ayurvedic in health management. The health tourism focus has seen Kerala participate in various trade shows and expos wherein the advantages of this traditional form of medicine are showcased.

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A generic problem with medical tourism is that it reinforces the medicalised view of health care. By promoting the notion that medical services can be bought off the shelf from the lowest priced provider anywhere in the globe, it also takes away the pressure from the government to provide comprehensive health care to all its citizens. It is a deepening of the whole notion of health care that is being pushed today which emphasizes on technology and private enterprise. The important question here is for whom is 'cost effective' services to be provided. Clearly the services are "cost effective" for those who can pay and in addition come from countries where medical care costs are exorbitant - because of the failure of the government to provide affordable medical care. It thus attracts only a small fraction that can pay for medical care and leaves out large sections that are denied medical care but cannot afford to pay. The demand for cost effective specialized care is coming from the developed countries where there has been a decline in public spending and rise in life expectancy and noncommunicable diseases that requires specialist services.

5.2 HR ISSUES:In todays scenario, where it is predicted that medical tourism industry will grow by 15 per cent annually, the real challenge lies in acquiring and developing a depository of people skill in the organization. Hospitals should focus on developing workforce with: 1. Positive attitude: I can do it is the first thought that an employee should get when he encounters a problem. He/she can think positively if he/she is happy, cheerful with good sense of humor. 2. Ingenuity: Employees should possess natural incentive and creative abilities to solve unforeseen problems. They should be capable of coming up with satisfactory solutions instantaneously. 3. Initiative: If a hospital has employees who are self-starters, then it is like a dream come true. If you empower people, then they show exceptional resourcefulness in handling unforeseen events or situations effectively. 4. Loyalty: Organization should value an employee who maintains service interest uppermost in his mind. Employees who display a high degree of sincerity and honesty

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of purpose and are upright in dealings with patients. Superiors, equals and subordinates are asset to any organization. 5. Maturity: Tact and maturity are the keys to handle difficult and demanding patients. Employees who are considerate and understanding in dealing with patients can form the backbone of service excellence culture. 6. Team spirit: Healthcare cannot be delivered by a single person; it is always a team work of people with diversified competencies. Employees who find ready acceptance by others and make good contribution towards functioning of the group are very good team players. They provide wholehearted co-operation to colleagues, superiors and subordinates. 7. Interpersonal skills: Interpersonal skills are of paramount importance. Written and oral communication, listening skills and body language play a very important role in service delivery. It is important to be respectful and courteous with co-workers and patients. 8. Appearance and Bearing: Hospitals should see that the appearance and bearing of employees is synchronized at all levels. It should not happen that support staff like kitchen and cleaning staff does not follow any hygiene standard. It is not only the employee who is properly dressed draws attention but the employee who is not neatly dressed also excites discussion amongst the patient relatives.

To develop the inventory of these competencies in the organization. Hire

employees with competencies to meet the requirement of the organization. HR heads should focus on development of a recruitment tool which helps in identification of the requisite competencies and measurement of available degree of these competencies in the prospective employees. It should be very clearly understood that people with desired competency come at a cost and therefore entire manning plan and the compensation budget should be re-used. If required people should be paid slightly more then the competing organization as hiring is not the only issue, organization has to also retain high performing Individuals. Another solution to the problem is nurturing key competencies in the workforce and align individual competencies to the requirement of the organization.

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1. Identification of individuals with desired competencies: First and foremost, HR department along with the line managers should identify people for selective retention so that they can be used as mentors for coaching and development. An employee with similar job role and working conditions empathies with another employee better than anybody else. The identified mentor should communicate effectively, know the job profile thoroughly, demonstrate trust in improvisation, and help individuals as and when needed. He knows the constraints and the requirements of the job. He can also act as a role model and foster a feeling of constructive competition in other employees. 2. Train the identified individuals: The identified individual has to act as an mentor and train other employees and therefore he has to lead by example. It is the responsibility of the HR department to train him in conducting training sessions. HR department should sensitise him with issues like how to conduct training. 3. Conduct on going training programme: Ongoing training programmes are very beneficial as no hospital is free of attrition rate. Exodus of well trained staff to middle east, the US & the UK cannot be stopped because of massive requirement in these countries, but remember whenever a employee joins an overseas hospital, the identity is always linked with the past employer. Continuous training programme on communication, attitude and personality development should be carried out and mechanism should be set to analyze the impact of these programs. Competencies and strengths vary from people to people and all the employees are never the same. Leverage their strengths and differences because these are the facts that will help distinguish you and your organization from the competition. Leverage each others strengths inside the team to develop a new identity of the hospital.

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CONCLUSION
STRENGTH
A central body- the Indian Nursing Council, governs the nursing education system in the country. This gives standardization and uniformity within the system enabling nurses to move jobs within the country. The uniformity of the education system also allows the Indian Nursing Council to monitor the education and training at all universities and colleges in India. There are several courses available to nurses. Nurses can always upgrade their qualifications and training by opting for higher education. There is an intrinsic need for nursing care. People will always fall ill, and the changes in the disease profile in India and the ageing population is increasing this basic need. Nursing staff in India receives a low salary, thus making them comparatively costeffective in the highly price-sensitive Indian market. The demand for nurses is not dependent of the state of the economy.

WEAKNESSES
Nursing is not a highly regarded profession as other medical professions, and thus does not draw respect and social standing Traditionally nurses have been looked at as middle-age hospital assistants by both patients and doctors. This has not allowed Indian nurses to practice their expertise to their maximum abilities. They are often seen working in the shadow of physicians and doctors. Nursing education, especially post-registration, has not received importance thereby leaving little scope for Indian nurses to excel, improve and climb up the career ladder. The pay scales of nurses in India are considerably low as compared to many countries. Thus it is difficult for the Government to convince de-motivated nurses to upgrade their skills or to enhance their performance.

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Government hospitals are not equipped and managed up to international standards, thus nurses working at these hospitals do not have exposure to state-of-the-art equipment and training.

The ratio of nurses per 1,000 beds in India is way behind the international WHO norms. This is putting additional pressure on nurses.

The increasing costs and demands experienced by the Ministry of Health and Family Welfare are restricting the availability of funds to promote and pay for nursing.

The vast majority of the training and education of nurses is done in a budgetconscious public sector. This is restricting the training and continued nursing education process in the country.

OPPORTUNITIES
The number of nurses qualifying every year in India is among the highest in the world. There exists a vast pool of qualified nursing personnel in the country. The growing need for healthcare is increasing demand for nursing services. There is a tremendous demand for Indian nurses in the international markets. This encouraging nurses to look for opportunities for better pay and work conditions outside India. Major Indian corporates have started investing large sums of money to commence international standard hospitals, nursing homes and nursing colleges. This is giving Indian nurses an opportunity to enhance and upgrade their existing skills. Nursing shortage is resulting in improved pay scales in the private sector, a better career structure and better prospects for nurses. Super specialty courses have been started by some nursing colleges in India to meet the growing demand of specialty nurses. There is an option for nurses to specialize in chosen fields. This has also been recognized by the Indian Nursing Council, which has decided to commence 15 specialty diplomas from 2004.

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THREATS
More and more nurses have been migrating to the Gulf and western countries in search for better salaries and work conditions. This is leading to a shortage of experienced nursing staff in Government hospitals in the country. Fund shortages in the public sector are restricting the availability of employment. Nursing pay remains low compared to other professions, making it more difficult to recruit and retain staff in the private sector. Absence of a nursing management system in the country is making it difficult to monitor and access nursing information, posing a constant threat to the public sector. Along with post-registration education and other up gradation, it has to be seen that the basic education of nurses must be the same in different regions of the country. There are some private colleges providing un-recognized courses to nurses.

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RECOMMENDATIONS
FINANCE:1. Raising funds from public by IPO (initial public offer). 2. Raising capital by taking loan from bank. 3. Getting the project financed from venture capitalist.

HR:Five mindsets matter most to improve business performance. One, maintain the right balance between market-making and disciplined execution. That is, insist on outstanding returns from today's operations while at the same time investing heavily in `what it will take to be a game-changing innovator in the future'. Two, obsessively identify and multiply talent; this demands you to `invest a disproportionate amount of time in recruiting and developing people', rather than simply pushing HR harder. Leaders have to "get personally involved in the search for talent and the development of people." Three, use a selective scorecard to measure business performance. There should be `a simple, memorable way of measuring success', especially in today's organization, where executives are drowned in `an ocean of technology generated data'. Four, Make the company's business model as simple and as transparent as possible, and figure out exactly which measures are needed to illuminate the model's success. Five, the leader has to distil the company's unique value proposition, `the company's value algorithm', into `an elevator speech that everyone in the organization can absorb and act on'. Accountants can perhaps reinvent themselves in their organizations by offering to evolve the right metrics that fit into the performance anatomy. 1. The doctors should be trained according to the need of foreign patients. 2. Lingual problems should not be there. Hospitals should tie up with language teaching institutions for interpreting and they should arrange for interpreters as and when required. 3. Training in every 3 months for every specialization to keep up with upcoming technology and upcoming new methods.

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4. There should be separate departments looking for foreign patients to look for foreign clientele. Like centralized help lines where they can get their queries resolved. 5. Giving incentives to the doctor after completing a particular number of foreign patients.

Marketing:1. The big players should have tie ups with travel planners like make my trip. They should opt. for medical packages to foreign patients which include their treatments, stay, travel, sight seeing. 2. They should also tie-up with insurance companies operating globally which could cover the medical expenses of these patients. 3. The hospitals could have tie-up with hotels such that the stay of the patient and his relative can be subsidized. 4. The foreign patients can be offered discounts on their sight seeing if they go for a treatment beyond a particular treatment. 5. Centralized website should be maintained where the foreign patient can obtain information regarding their reservation in hospitals, hotels and travel tickets, appointments with the doctors. 6. The tourist should be offered online meeting with the doctor. 7. Hospitals should collaborate with embassies to make the foreign patients get visas easily and also make their travel hassle free. 8. World wide advertisements should be done.

Operations:Separate account and background information for every foreign patient should be maintained for further usage. 1. Proper administration department should be maintained. 2. Proper cleaning departments should be maintained. 3. Department should be there check the technical instruments regularly.

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Research and development:1. There should be separate department to look after research and development. 2. Hospitals should have separate doctors team to research about new methods and technology. 3. Hospital should invest good amount of money in research and development 4. Hospital should tie-up with other institutions to get the better facility for research and development 5. Hospital should look for government help in research and development by tieing up with government institutions. The key recommendations which are suggested by the researcher are as follow: The major hospitals should make separate complexes exclusive for the medical tourist according to there tastes and likings of the targeting countries or the region of the world. Depending on the conditions of the patients, doctor can suggest travel etnery that which type of climate and tourist place will be suitable to its patient with in India at the given point of time of the year, for the relaxation and healing of the patient after the treatment.

Extension of visas facility should be provided within hospitals itself so the patients do not have to worry for the extension of the visa at the particular period of the treatment.

There should be Export Promotion Council for the promotion of medical tourism which main function is to earn foreign exchange for the country. These EPC has got MDA that is Market development Assistance which should be extended its contribution of funds to the major hospitals in medical tourism related to exhibition and fair abroad.

The key to success depends on the development and implementation of a joint strategy by key players in the industry. With gleaming new, private hospitals coming up from groups like Apollo and Escorts as centers of Excellence, India might just make it as a world leader in medical tourism.

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BIBLIOGRAPHY
Web-links:
http://www.medicaltourismindia.com http://www.exinearticles.com http://www.globehealthtours.com http://www.healthandmedicaltourisminindia http://www.cii.com http://www.google.com http://www.apollo.com http://www.fortis.com

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MEDICAL TOURISM FEEDBACK

[ DOCTORS POINT OF VIEW]

Q. What do you feel about MEDICAL TOURISM? Is it upcoming in India?

Q.

What opportunities and threats do you see for MEDICAL TOURISM and doctors in India?

Q. Which treatments do you provide to foreign patients in India?

Q. What facilities/benefits are being provided to foreign Patients in India?

Q. Kindly comment on our recommendations? Are they practical?

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