Tourism combined with visit for medical treatment is called as medical tourism. Medical tourism is used often synonymously with health tourism, but however health tourism can be differentiated from medical tourism, where health and wellness tourism indicates travel for taking rejuvenation and alternative therapies and spas. Medical tourism encompasses primarily on bio-medical procedures combined with travel and tourism. Health care and tourism industries are among the largest industries in the world. The countries where medical tourism is being actively promoted include Greece, South Africa, Jordan, India, Malaysia, Philippines and Singapore. India was a later entrant into the medical tourism but has catched up well. Medical tourism is becoming popular among world countries mainly for the following reasons: Lack of expertise, Cost effectiveness, availability, long waiting time and care support-family etc. Medical treatment is costly in most developed countries and also they have to wait for long time to get treatment under various schemes. Also patients cannot afford to get various support services during treatment in their home country and hence they look for better options for cost effective treatment in countries like Thailand, India etc. The key selling points of Indian medical tourism industry are the combination of high quality facilities, competent English-speaking medical professionals, cost effectiveness and the attractions of tourism. Dental, eye and cosmetic surgeries cost three to four times more than in India. Medical tourist usually gets a package that includes flights, treatment, hotels and usually post-operative vacation and rejuvenation therapies. India has the best hospitals in the world. Globalisation has boosted the growth of medical tourism further and has lifted nations out of their isolated existence and makes them part of “one-knowledge society”. Medical institutions no more play

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of globalization of markets and easy access to information via the internet has that much more enabled the health traveler to select the destination of his choice. The global medical tourism industry was estimated at USD10.5 billion in 2012. It is expected to grow at a CAGR of 17.9 per cent from 2013-19 to reach USD32.5 billion in 2019. (Business standard 2nd Dec 2013). Medical and health tourism The OECD (Lunt, 2010) differentiates between medical and health tourism. Medical tourism encompasses all those services that consumers use when traveling with the intention of getting some form of treatment. This treatment can contain a full or a partial scope of medical treatments. It is necessary to clearly define the boundary to what health includes, how it is medically treated and what kind of tourist services is included (aesthetic surgery can certainly not be included in the segment of medical tourism). Health tourism is a wider term. It includes organized travel outside of the place of residence for the purpose of improving or restoring an individual‟s health through various forms of medical service.

OBJECTIVE OF STUDY

The main objective of this study is: (i) To analyze the status of medical tourism in India. (ii) To access the potential and growth of medical tourism in India. (iii) To investigate the effects of medical tourism is complementing the growth of hotel and travel Industry business.

LITERATURE REVIEW

Muralidar Trivedi (2013): Since Yoga‟s birth (more than 5,000 years ago), medical travelers and students have trooped to India to learn more about Yoga and other forms of alternative medicine. India gained reputation as the center of Eastern cultural, spiritual, and medicinal progress when Buddhism came along 2,500 years later. And even when Western clinical medicine became more popular and credible, India remained the best destination for alternative medicine practitioners from all over the world. John Connell (2006) says that Medical tourism has grown rapidly during the past decade and several Asian countries have become dominant. Conventional tourism has become a bye-product of this growth, despite its tour packaging and overall benefits to travel industry have been considerable. Rise of medical tourism has emphasized privatization of health care due to accelerated globalization of both health care and tourism. waiting lists and ageing populations in the `rich world countries`, greater affordability of flights and travel and a shift in medical care away from the public sector, such that people are more comfortable with paying for medical services offered by private bodies or companies. Ramirez de Arrelano (2007) Investing in the medical industry is a way of to increase Gross domestic product (GDP), improve services, generate foreign exchange, create a more favorable balance of trade and boost tourism. Hence it is proven that medical tourism helps in boosting tourism. Vincent C.S. Heung (2010) Medical tourism is one of the fastest growing tourism sectors internationally and many countries are planning legally and practically for this market. Developing countries are increasingly offering state-of-the art medical facilities and services to foreign customers. Simon Hudson and Xiang Li (2012) To date, the literature on medical tourism have focused almost exclusively on International medical tourism. However, there a growing number of patients who travel for medical care within their own country. Whittaker (2008) has said that opening up of the health sector trade under the General agreement of Trade in services (GATS) and increased corporatization of medicine with Asian countries are reasons for the growth of medical and health tourism in Asian countries. Mukherjee and Mookerji (2004) mentioned that after Singapore and Thailand, India may be the next multimillion dollar Asian medical industry. Apollo hospitals group, Wockhardt, Escorts, Fortis, Hinduja and Breach Candy are some of the names in healthcare that have come forward to tie up with tourism industry players like Hyatt, Kuoni, Indian Airlines and Bangladeshi carrier GMC offer discount-laced customized packages to international medical tourist to India. Rao (2005) describes that a substantial number of foreigners are coming to India to avail themselves of quality medical treatment at a cost much lower than that of other countries of the world, particularly in the field of cardiology, cardiac surgery, joint replacement, ophthalmology, pathology and Indian systems of medicine etc. Mohanty and Madhav (2006) are of the opinion that the Indian health care industry began to recently emerge as a prime destination for medical tourists by upgrading its technology, gaining greater familiarity with western medical practices and improving its image in terms of quality and cost. Pankaj Mochi (2013) has said The key reason for India‟s emergence as an important destination for

the most sought after and their caring approach towards treatment is well recognized. Pachanee, C. (2009) found that Mode 2 trade in health services in Thailand has occurred and was initiated by the private sector itself. It has occurred outside the multilateral and regional trade agreements. Thailand is recognized as a leading exporter of medical services to foreign patients due to its high capacity and good marketing strategies. Thailand could learn from experience of other countries that promote Mode 2 (medical tourism) trade in health services on how impacts on the health systems are prevented, measured and addressed. Mishra. R and K. Shailesh (2012) found that there are different opinions as to whether medical tourism is still a promising industry or had been considered firmly established. The industry is being followed and promoted by several trustworthy organizations, including the Medical Tourism Association (MTA), the Deloitte Center for Health Solutions, and the Joint Commission International. India‟s medical tourism is dominated by the private sector from the corporate houses. Carrera and Bridges (2006) for example, define health tourism as ―the organized travel outside one„s local environment for the maintenance, enhancement or restoration of an individual„s well-being in mind and body. This definition encompasses medical tourism, which is delimited to organize travel outside one„s natural health care jurisdiction for the enhancement or restoration of the individual„s health through medical intervention. Jain (2006) states that most patients from countries like the USA and UK travel to developing countries such as India for treatment because India offers some of the cheapest pricing options of treatment, offers a good holiday, and there are no waiting lists or queues to stand in. Expert Hospital Staff: India has a number of hospitals, large pool of doctors (approx 7, 00,000), nurses & supporting staff with required specialization and expertise and the language advantage (English speaking skills) servicing patients. Many of these doctors after having specialized and practiced in the Western countries have returned home to set up impressive state of the art facilities with the latest in equipment, technology and service levels in all major metros In India.

The most popular treatments sought in India by medical tourists are alternative medicine, bone-marrow transplant, cardiac bypass surgery, eye and treatment are conducted using the latest technologically advanced and cutting edge diagnostic equipment. Stringent quality assurance exercises consistently ensure reliable and high quality test results in a timely manner. Quality Already 21 Indian hospitals have been accredited by the Joint Commission International (JCI) which is the International arm of the Joint Commission Accreditation for Hospital Organisations (JCAHO). Accreditation and compliance with quality expectations are important since they provide tourists with confidence that the services are meeting international standards. Almost all Indian Hospitals servicing Medical Tourists are accredited either by Joint Commission International (JCI) which is the world central body for accreditation for hospitals headquartered in USA and its accreditation is considered a gold standard for health care. National Board for Accreditation of Hospitals and Health Care is governing body for JCI and follow International safety standards. India remains a safe and preferred medical tourism destination. Personalized Services In India, according to the famous words “Atithi Devo Bhava” refers tourists are treated as God. Foreign patients are understood as guest for the country and they are given a place equal to that of god in Indian culture. FTA‟s for Medical Tourism In 2012 USA and UK account for the highest number of FTA‟s for India, however the number for medical tourism to India was significantly less. Bangladesh tourists account for the highest number of medical tourists to India in 2012 followed by Srilankans and then Germany and Malaysia. Medical Packages (Treatments) Provided The following are the broad category of medical packages provided by Indian hospitals, Dental Care, Eye Care Heart Surgery, Cosmetic Surgery, Orthopedic Surgery, Health Checkup, Pediatrics, ENT Care, Gastroenteroloy, Nephrology, Neuro Surgery, Oncology Ophthalmology, Psychiatry and Genitourinary Care.

Internet has made available all information related to hospitals available and treatment offered all over the world and people can select their destination based on the information and facilities offered. Chennai has been called India‟s health capital because of its best quality hospitals and doctors and Chennai gets about 45 % of the total foreign medical tourists coming to India for treatment. This has benefitted the hotels and resorts in Chennai.

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Industry and now the FICCI and the Medical tourism council of Maharashtra has taken a joint initiative to promote medical tourism. It is an initiative by the Government of Maharashtra and many actions have been taken to provide the best medical facilities.

Government of India, the Ministry of Health and Family Welfare and the Ministry of Tourism have jointly formed a Task Force with a view to promoting India as a Health Destination for persons across the globe so as to enable them to gainfully utilize the health care expertise and infrastructure available in the country. The aim is to expand the range of the tourism products in India, both for domestic and international market. For this, streamlining of immigration process for medical visitors is necessary. In this connection, the Government of India has introduced a new category of Medical Visa (M-Visa) which can be given for specific period to foreign tourists coming to India for medical treatment. The Ministry of Tourism India (MoT) is planning to extend its Market Development Assistance (MDA) scheme to cover Joint Commission International (JCI) and the National Accreditation Board of Hospitals (NABH) certified hospitals.

Based on the facts and figures collected, we can definitely say that India has become a favorite destination for medical tourists from other countries. Medical tourism is a growing sector in India. India‟s medical tourism sector is expected to experience an annual growth rate of 30%, making it a Rs. 9,500-crore industry by 2015. An estimated 150,000 of these travel to India for low-priced healthcare procedures every year. Foreign Tourist Arrivals (FTAs) in India during 2013 were 6.97 million with a growth of 5.9% as compared to the FTAs of 6.58 million during 2012 registering a growth of 4.3% over 2011. (MoT Annual report 2013-14) Indian healthcare institutions are increasingly going for international accreditation of hospitals and clinical laboratories. Currently, There are 21 JCI accredited hospitals in India and growing. They are: (1) Artemis health Institute (Gurgaon) (2) Asian heart institute & research centre (Mumbai) (3) Ahalia Foundation Eye hospital, Palakkad (Kerala), (4) Aster Medicity (Kochi) (5) Apollo Gleneagle hospitals (Kolkata), (6) Apollo hospitals (Bangalore), (7) Apollo hospitals (Chennai), (8) Apollo hospitals (Hyderabad), (9) Asian heart Institute (Mumbai), continental hospitals limited (Hyderabad) (10) Fortis Escorts heart hospitals (New Delhi), (11) Fortis Hospitals (Mohali), (12) Fortis Hospitals (Bangalore), (13) Fortis hospitals (Mumbai), (Bangalore), (18) Narayana Multi-speciality hospital (Jaipur) (19) Satguru Partp Singh Apollo Hospitals (Punjab), (20) Shroff Eye hospital (Mumbai), and (21) Sri Ramachandra Medical Centre (Chennai). There are 63 NABH (National Accreditation Board for Hospitals) approved hospitals in India and 395 hospitals have also applied for NABA accreditation. Medical Tourism Complementing Hotel & Travel Business The flow of medical tourists to India has benefitted the hotel Industry very much. Many hotels and resorts have tied-up with leading hospitals for providing accommodation for post treatment and also they provide rejuvenation therapies also. Some surgeries require check-up after one week and hence the patient is required to stay and the patients prefer to use this time to stay in resorts and also visit some tourist places leisurely at comfort. The hotels and resorts have taken up with the situation and pulled the business. Some rooms are reserved for particular hospitals who have tied-up with them which assure them confirmed rooms for their patients. Also the visitors and relations who accompany the patients require accommodation and need to stay in hotels nearby. Star Hotels have reported increased room bookings from medical tourists, especially in New Delhi, Bangalore, Hyderabad and Chennai cities. The three star and four star segments are more benefits from the medical tourism sector. There are also resorts which have reported regular business from medical tourists through tie-up with hospitals. Travel industry is also much benefitted by the medical tourists inflow. The cascading effect of tourist‟s money being spent throughout the host economy begins at frontline tourist establishments, eg hotels, restaurants and taxis. The effect of this spending then permeates throughout the economy creating impacts at three different levels: i.e. at the direct, indirect, and induced levels. This is the multiplier effect. In case of medical tourists, it begins from hospitals and moves to hotels. Travel companies offer packages which include return Air tickets, hotel accommodation post treatment and sight-seeing packages. There are web portal companies like www.healthtourism.com offering all sight-seeing and hotel stay packages with varied options to the patients. Medical tourists coming from other countries have access to all information from different websites which provide specialized services to them which include taxi pick-up from airport and also daily car service and also nursing services etc. Needless to say that the growth of medical tourism In India has created many job opportunities in the hospital, hotel and travel sectors in order to provide professional service for the foreign tourist who are in

Their travel, accommodation, food and sightseeing needs have created new jobs in the fields. The tourists feel easy when all their requirements are taken care of at a reasonable cost compared to their country. There is a tremendous potential for the hotel industry also to tap the growing flow of medical tourists by offering more specialized services to the guests and patients staying in the hotel. Challenges Faced by Medical Tourism in India (i) Commercialization of the profession is one point which some doctors are not comfortable since the personal doctor-patient relationship will be missing.

(vii) Brain drain from government sector to private sector. (viii) Increase in medical costs for local people.

CONCLUSION

Based on this research, we conclude the following: Medical tourism in India has shown tremendous growth and achieved excellence in providing quality service and performance to the patients. Globalization has boosted the flow of many foreign tourists from other countries due to the excellent standards of hospitals and services provided by Indian hospitals and its growing at 30 % in 2015 and in the current year 2015 foreign medical tourists expected at 2.8 ranks 2nd among world countries next to Thailand in Foreign medical tourist arrivals, this is mainly due to the best doctors available and English speaking and quality facilities available in hospitals and no waiting time. The hotel and tour packages offered by the hospitals is an added advantage. It was found that Tamilnadu gets the highest number of medical tourists in India due to best hospitals available. Medical tourism has also complimented the hotel and travel industry by providing continual business to this sector and also generated new job opportunities. Many hotels and resorts have already tied-up with some hospitals understanding the potential of business. There are some challenges also faced by Indian medical industry like no post treatment care possible when required, inequalities in government and private hospitals, lack of industry standards, brain drain and increased costs for local people. Indian medical tourism has got the potential to reach the number one position by numbers of foreign medical tourists arrival and foreign exchange earnings by 2018 if the good standards of service are maintained. Medical tourism can certainly contribute to the country‟s economic growth as well.

REFERENCES

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