Emerging segments like health tourism are poised to give
Indian tourism a much-welcome boost. Jyoti Koul analyses the impact of this
new phenomenon
State-of-the-art hospitals: (L-R) Escorts Heart Institute
& Research Centre and Rockland Hospital, New Delhi
John Doe is not feeling so good. The 54-year old, former London
taxi driver is overweight from years of eating on the road and is paying the
price literally. His check-up regime is eating into his savings, though his
government's National Health Service (NHS) has footed most of the bills. An
open heart surgery done in the near future will allow John Doe to enjoy his
retirement. The only problem - he is way down on the waiting list, which can
be as long as two years. It is double jeopardy, if he waits, he will not make
it to retirement. If he does make it, the high procedure cost will eliminate
most of his savings. In a global world, Doe looks elsewhere; where the same
procedure is done at a fraction of the cost, where a holiday with wife in tow
to recuperate is part of the package.
Moderately conservative figures indicate half a million people travel across
the globe for health purposes. India, with its 5,000 years of medicine, has
just begun to formally, claim its share. The true size of the iceberg is always
out of sight. Two external agencies, McKinsey and Messe Berlin have painted
very bright pictures of medical tourism in India in a short eight years into
the future. According to a McKinsey report, "If medical tourism were to
reach 25 per cent of revenues of the private up-market (business), Rs 5-10,000
crore will be added to the revenues of these players. The medical tourism market
would then represent three-five per cent of the total delivery market."
Karl Wolfgang Menck, the industry analyst commissioned by Messe Berlin feels
India can expect to earn US$ one billion in foreign exchange from medical tourism
by 2012, when the various industry growth programmes take effect.
This growing industry however has an image problem. It is uncomfortable with
the 'non-positive' image the term medical tourism involves. Preferred terminology
ranges from health, wellness and even rejuvenation tourism. "Health is
wealth here as it encompasses all aspects and services we want to provide,"
says Gour Kanjilal, regional director, Indiatourism, Western India. He is one
of the most vocal proponents of the 'rejuvenation' lobby. However, the major
question that arises is do we actually have the right product and marketability?
Myth And Reality
Across many forums, well-versed tourism and travel practitioners including senior
journalists have questioned about the untapped potential of health tourism.
But what exactly makes one mean by `health tourism'? Is 'health tourism' actually
a tourism product? The answer can be a straight no. As a tourism expert puts
it, "I wonder if an ill person or a patient can ever become a tourist.
Tourism is not always about money but it definitely is about joy, peace and
leisure. Imagine a person whose sole focus is on treatment or better health
- would he hop from one place to another exploring and discovering a destination?
Those who actually come to the country with health problems concentrate on that
aspect alone. So, it might be a gainful proposition for the health care industry
but certainly not for the tourism industry."
We are therefore confusing the inflow of patients with that of tourists. Simply
put, patients are being classified as tourists. No doubt they are travellers
but they do not contribute to the tourism industry. What we need to understand
is that tourists bring foreign exchange into the country, while patients or
medical tourists only bring it by way of airline tickets alone and hotels in
rare cases. Usually, they do not go for sightseeing and therefore, do not indulge
in 'typical tourist' activities (like shopping etc) that can boost foreign exchange
earnings. Such traffic also looks for discounts on airline tariffs and even
on Medicare. The people accompanying these patients prefer to stay in hospitals
(no dual tariff), small time guesthouses, or with relatives where again foreign
exchange doesn't change hand. So, is the percentage of foreign exchange that
India earns through medical tourism is anybody's guess.
In fact, a huge population from the Middle-East comes to India for gynecological
treatments and abortions (as abortions are considered illegal there). These
kind of tourists always come under the guise of VFR (visiting friends and relatives)
and pilgrim tourists. And leave the country after being treated.
Grey Areas
India with its rich cultural heritage, world-class health care professionals
with proven track records and treatment costs at almost a sixth of that in the
US and Europe is an attractive place for healthcare seekers. The country has
tremendous potential in terms of well-qualified doctors, cheaper medical facilities
and a few good hospitals. But these elements are not enough to generate volumes.
In reality, India has hardly any procedure in place, or for that matter made
a conscious attempt to sell healthcare tourism. We are often confusing medical
tourism with other aspects of holistic healing like ayurveda, spa, yoga, meditation
and others. But these components really do not comprise the bracket of health
and medical tourism. These are mainly alternatives to wellness concepts.
The major roadblock in marketing the product is the absence of a visa-on-arrival,
which is a must for medical tourists keeping in mind that illness is something
one can never 'plan'. But in India, there is no such special medical tourist
visa facility available.
However, industry experts are not sure whether such facilities will be properly
used. Citing an experience of Kerala said a tour operator, "When Kerala
liberalised its skies and permitted charters to come, all the cobblers from
London came and spoiled the place, forcing the state to cease services. So,
in this case I am not very sure that it will be a healthy decision."
Further, capabilities of the doctors are not enough to sell the product. To
actually market medical tourism, it has to be strongly backed by infrastructure
- that is setting up of specialty hospitals, getting state-of-art health and
medical equipment and setting up special wards for overseas patients (oops,
health tourists) in general hospitals. Besides, we will have to cultivate the
'service' mindset and establish credibility.
Most importantly, India must put up a uniform accreditation system in place
for hospitals in line with Joint Commission of Accreditation of Healthcare Organisations
(JCAHO) of UK. After all, such international accreditation will assure patients
of the quality of treatment provided.
Another spoke in the wheel is lack of insurance facilities. Most insurance companies
do not cover medical treatment in a foreign country. Further, disciplines including
ENT, cosmetic surgery, dentistry and infertility are not covered by health insurance
anywhere in the world. "I think the Indian players should join hands with
international insurance companies and tourism agencies to realise the full potential
of health tourism," said Preetha Reddy, managing director, Apollo Hospitals.
Sunny Side Up
The Indraprastha Apollo Hospitals, New Delhi
When baby Noor Fatima, a two-and-a-half- year old Pakistani
girl, successfully underwent an open-heart surgery in India, suddenly the potential
of medical tourism was realised - thanks to the media. It is estimated that
National Health Service, UK alone has over a million patients waiting for treatment,
a potential market for India. Apollo in the last five years has attracted over
60,000 patients from over 55 countries. The Apollo group and other leading healthcare
players have aggressively focussed their attention on foreign markets. The recent
CII delegation and road shows to the UK and Middle-East have also generated
a good response.
Delhi has witnessed an unprecedented growth in healthcare, as it has been successful
in attracting medical tourists to its swanky and big hospitals. The government
as well as private players are keenly assessing the potential and means to tap
the same. The boom in state-of-the-art hospitals and well-qualified doctors
in the national capital has attracted the patient-population from neighbouring
SAARC countries, the Middle-East and Western parts of the world.
The catchphase is 'First World Treatment' at 'Third World Prices'. A CII-Mckinsey
report last year, postulating the opportunities in health tourism, states that
the medical tourism market in the country pegged a 30 per cent growth in 2000
and it has been growing at the rate of 15 per cent for the past five years.
"By 2012, if medical tourism were to reach 25 per cent of revenue of private
up-market players, up to Rs 10,000 crore will be added to the revenues of these
players," adds the report.
Hospital groups in Delhi have realised the potential of health/medical tourism
but most of them are playing it by the ear. Among private players, Apollo has
been a forerunner in health tourism; it has been a choice destination for patients
from Southern 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.
In 2002, the number of patients who visited the hospital was 3001 and about
700 were hospitalised. Along with providing treatment, the stay of the foreign
patients is taken care of by the hospital itself. The Apollo group has tied
up with hotels in Delhi for this purpose. According to Dr Chabra, additional
medical director, ISIC (Indian Spinal Indury Centre), ISIC is another destination
for patients from neighbouring countries, Gulf and a few NRIs from the US.
Now, to attract more people, the emphasis is on vacation plus treatment and
special packages have been planned on these lines. On the anvil is another plan
to make patients and their relatives stay in the hospital complex with all luxuries
of a hotel.
Dr Shakti Gupta of All India Institute of Medical Sciences, (AIIMS), stresses
on the need to export health services. According to him, Indian doctors, medical
services, and hospitals are at par with good hospitals in Europe and the US,
so it is the right time to make the most of it.
AIIMS is a destination for patients from Nepal, Bangladesh, Bhutan, Myanmar,
Mauritius, Malaysia and Pakistan. Besides regular patients from the Middle-east,
an occasional patient from the US drops in. Patients from Pakistan, especially
children with heart afflictions, have been regularly coming to the AIIMS heart
centre.
According to Dr Gupta, AIIMS was made for the entire South East Asia populace
and since it is a government institute, there are no plans to attract more foreigners.
The attractions at AIIMS include cardiac surgery, neurosurgery, cancer treatment
and opthalmic procedures. "The services are charged on actuals and ours
being a government institute, we are not angling to make money but are here
to serve the people," stressed Dr Gupta.
The metro hospitals and Heart Insitute in Noida (NCR) also manages to attract
patients from Nepal, Bhutan, Sri Lanka, Bangladesh and a few from Maldives and
the Gulf region. Their motto is to extend excellent health services to people
who travel here for health care and also for tourists, who need health care
during their stay in India.
Indian hospitals getting recognition from international insurance companies
will bring in more patients from abroad, says Anil K Maini, head, marketing,
Health care buisness, Escorts Heart Institute and Research Centre, "The
centre is fast emerging as a favourite destination for patients from neighbouring
countries, Africa and CIS. About 1,000 patients from abroad are treated in Escorts
on an annual basis."
Last Leaf
Only a few hospitals are making conscious efforts to increase the existing inflow
of health tourists. But it has to be a concerted effort of various agencies
besides the healthcare and tourism industry, who have to work in unison to reap
the harvest. Further, there are hardly any packages for medical tourists. Travel
agents and tour operators are yet to seriously consider this niche segment.
They can tie up with hospitals to offer complete healthcare packages that would
include recuperating in a resort in some scenic area. For instance, Great India
Tours has come up with a complete package that includes consultations with doctors,
hospital admission, accommodation for escorts and visit to some resort post-treatment.
It is time others take the opportunity as well and make hay while the sun shines.
