Emerging Opportunities & Challenges In Medical & Wellness Tourism In Gujarat

Medical tourism (also called medical travel, health tourism or global health care) is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of traveling across international borders to obtain health care. Medical tourism can be defined as provision of 'cost effective' personal health care/ private medical care in association with the tourism industry for patients needing surgical healthcare and other forms of dedicated & specialized treatment. Medical tourism is an emerging concept. Governments all over the globe are highly concerned about their ability to meet their social obligations in the health sector. They are highlighting it as ‗International standard healthcare services at affordable prices.‘ Medical or Health treatment package tourism is a recurrent form of vacationing, and covers a broad range of medical services. It mingles free time, leisure, fun relaxation, amusement and recreation together with wellness and healthcare packages. At the same time tourists are able to receive an orientation that will help them to improve their life in terms of their health and general well being. It is like rejuvenation and cleans up process on all levels - physical, mental and emotional. Medical or health tourism is among the fastest growing industries in the world. The major forces driving growth of this emerging industry include the rising cost of healthcare and limiting scope of insurance coverage in developed countries, increasing waiting time for treatments, and low cost of treatments elsewhere. India is a destination of all seasons and is home to the Himalayan ranges in the north, a long coastline surrounded by mesmerizing seas in the south. In addition, India boasts of landscapes, historical sites and royal cities, clean beaches, calm mountain retreats, rich cultures and festivities to stimulate. All around the year, India offers distinct range of destinations and experiences. There are lovely retreats amidst the beauty in the Himalayan ranges or the lush-heights of the Western Ghats with cool trekking options, tall peaks, or stretches of white water for the adventure lovers in summer season. Winter season in India comes alive with cultural feasts of music and dance. To refresh in winter season, sun-clad beaches are the best locations. Medical tourism in India is a multi-billion dollar provider industry and attracting millions of foreigners and domestic to visit incredible heritage of country and enjoy the medicinal blessings of traditional Vedas and Upanishads. India is full of well trained, qualified and experienced professionals and doctors. Most of them have earned their professional degrees from abroad and have practices over there, and achieved a confidence of their people. India‗s doctors are most competent and making India a very money-spinning destination for the people who want to undergo treatment for their medical problems and who have frustrated from the long waiting list of medical diagnostic centers of their own country. It is projected that India will capture 2.5% of the total international medical tourism market by the year 2012, with concurrent foreign exchange revenue of $ 2.3 billion. It is also estimated that medical tourism in India will receive around 1.1 million health tourist from all over the world, by the end of 2012. India ranks second for medical tourism in the world. Though it spends less than 1.2% of its GDP on medical services but makes extra efforts to provide extra care and services to the foreign tourist while dealing with them. Medical treatment in India is very cost effective as it charge 20% less than any other foreign country for providing health facilities. It has been seen in the recent past that patient from US, UK, and other foreign countries in a maximum number are coming to India for their treatment. Besides cheaper cost of the treatment other factors are also contributing towards an increase of international health tourist traffic in India. Today Indian clinical and paramedical talent is universally recognised and JCI accreditation to some hospitals of India has proven a boon to Indian medical system which is helping in gaining the faith of foreign patients in India‗s hospitals and professionals. In India they do not have to wait long and to pay extra money for their treatment. The per capita health care cost in Korea is $720, whereas it is $94 in India. Thus India is offering 20% cheaper treatment to them in comparison to US, UK, Singapore and Thailand. Unlike India various Asian countries are coming forward to initiate steps to explore medical tourism potential. Recently Singapore project to develop medical facilities and South Korea is planning to develop medical institutions for foreign patients. From the ancient time India is famous for its traditional treatment therapies and have made a recognized place in the medical literature by providing yunani, aurvedic, allopathic, homeopathy and naturopathy advantage of medicine not only to the Indians but also to the foreigners. History witnessed that millions of people have benefitted with the medicinal wisdom of our skilled medical professionals. Many states of India are now recognized as well known health care centre for providing particular segment of medical treatment like Kerala and Karnataka has emerged as a hub for ayurvedic treatment, and being spacialised in healing the patient with the virtue of natural herbs. Here health tourist not only gain the cure for his disease but also enjoy the benefits of scenic scenes, natural beauty, spas ,and pleasant weather. Further Uttarakhand of India is gaining importance for healing the patient with yoga and meditation and natural medicines. Delhi has emerged as a prime destination for cardiac care , orthopedic care, mental trauma, and other kind of allopathic treatment, and serving millions of domestic and foreign patient at that cost which is comparatively very low than that of their own country. Chennai is known for quality eye care. Medical tourism in India has emerged as the fastest growing segment of tourism industry despite the global economic downturn. High cost of treatments in the developed countries, particularly the USA and UK, has been forcing patients from such regions to look for alternative and cost-effective destinations to get their treatments done. The Indian medical tourism industry is presently at a nascent stage, but has an enormous potential for future growth and development. The main reason for growing importance of medical tourism in India is the cost of medical treatment which is comparatively 40% less, than offered by any other developed countries. Whereas a cardiac patient has to pay US$ 40,000 - 60,000 in the United States, US$ 30,000 in Singapore, US$ 12,000 - 15,000 in Thailand for his treatment, the same treatment can be availed in India in only US$ 3,000 - 6,000 . At London one is charged £350 for some tests which include blood tests, electro-cardiogram tests, chest X-Rays, lung tests and other tests while in India same tests cost only US$ 84.A Magnetic Resonance Imaging (MRI) scan costs US$ 60 at Escorts Hospital in Delhi, compared with roughly US$ 700 in New York. 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. Estimates of the value of medical tourism to India go as high as $2 billion a year by 2012. Patients going to a different country for either urgent or elective medical procedures are fast becoming a worldwide, multibillion-dollar industry. Asia represents

market. Transparency Market Research report on Medical Tourism states that the global medical tourism market was valued at US$10.5 billion in 2012, and is expected to reach US$32.5 billion in 2019, growing at a CAGR of 17.9% from 2013 to 2019. A recent study by PHD Chamber of Commerce & Industry (PHDCCI) on Medical and Wellness Tourism opportunities in India (2014) estimates that Indian medical tourism is expected to touch US$ 6 billion (around Rs.36,000 crore) by 2018, with the number of people arriving in the country for medical treatment set to double over the next four years. Currently, the size of the medical tourism industry in India in value terms is estimated at a little over $3 billion, with tourist arrivals estimated at 230,000. Within Asia, India, Thailand and Singapore are the three countries that receive maximum medical tourists owing to low cost of treatment, quality healthcare infrastructure, and availability of highly-skilled doctors. "These three countries together accounted for about 60 per cent of the total Asian revenue in 2012," the report Medical Value Travel in India by KPMG and FICCI said. The fact that the ageing population, particularly in the developed world, is increasing rapidly, putting an extra demand on an already overburdened health infrastructure, thus creating huge opportunities in the Asian medical tourism market. Many people from the developed world come to India for the rejuvenation promised by yoga and ayurvedic massage. There are also more patients coming from poorer countries such as Bangladesh where treatment may not be available. India offers a nice blend of top-class medical expertise at attractive prices thus helping a growing number of Indian corporate hospitals lure foreign patients, including from developed nations such as the UK and the US. Other important parameter why India is seen as a potential destination for Medical tourism is no waiting period as compared to waiting time in countries like Canada, which has set waiting-time benchmarks, e. g. 26 weeks for a hip replacement and 16 weeks for cataract surgery, for non-urgent medical procedures.

India‘s effort to promote medical tourism took off in the late 2002 when McKinsey-CII (2002) study outlined immense potential of this sector. In the same year, the Ministry of Tourism started ―Incredible India‖ - the government‘s big budget market campaign to attract tourists. In the following year, the then Finance Minister Jaswant Singh called for the country to Efforts were made to modernize and expand airports in the country, and to improve road connectivity and other infrastructure facilities. The Government of India promoted 45 private hospitals as Centre of Excellence in its tourism brochure. It introduced a new M or medical visa for medical tourists and their companions too. The Ministry of Health and Family Welfare has set up a National Accreditation Board for hospitals. The government declared medical tourism as services export so that this sector avails tax concessions. At the state level, some state governments participate in healthcare tourism expos abroad. Kerala has made concerted efforts to promote healthcare tourism, leveraging Ayurveda. Karantaka is setting up Bangalore International Health City Corporation. Maharastra has granted the industry status to the tourism activity such that this sector gets all benefits/incentives given to all other industries. Gujarat announced a separate policy for medical tourism. Availability of high quality healthcare professionals and nurses, round the clock services by medical staff, choice of luxury rooms in hospitals, good medical options, high success rates, reputation for treatment in advanced healthcare segment such as cardio vascular surgery, organ transplants, and eye surgery, popularity of Indian traditional wellness systems, diversity of tourist destinations, strength in information technology are the attractive aspects of Indian medical tourism. Today more and more foreigners choose India as their destination for the treatment because of its rich cultural heritage and innumerable tourist attractions. The medical tourism is a growing source of foreign exchange as well as prestige and goodwill outside the country. This sector is an example of how India is profiting from globalization and outsourcing. India has many advantages. The first and the foremost is cost advantage. Then, it has many hospitals equipped with international standards. Most of Indian doctors and other medical staff have world class exposure and are fluent in English which is connecting language globally. India also has a whole lot of natural solutions to health like Ayurveda, and Sidha. It has many exotic tourist spots. Many medical tourists have already chosen India as their destination for treatments. They to some extent help the country to promote itself as a business and tourism destination. India should use these opportunities and make more efforts to advertise these advantages and attract more medical tourists. India is one of the fast growing nations in the world. Perceived as a service hub across the globe, India industry should take this opportunity to attract medical tourists and popularize wellness system in the country such that more and more FTAs could use them. Doctors in western part of the world are increasingly prescribing Indian system of natural healing and medicine to their patients.9 This will make many foreign patients to choose India for treatments. In olden days, people used to travel to USA to get advanced medical treatment. Now the reverse is happening. IT boom and cheaper flights make people to choose alternate health destinations for treatment. The main opportunity presented by medical tourism is its contribution to the growth of health economies. It is a major source for foreign exchange and stimulates economic growth in other sectors including tourism, transport, pharmaceuticals, hotels, food suppliers to hospitals and restaurants. The labor intensive nature of the tourism industry makes it an excellent generator of employment. Medical tourism and the competition on the global health market promote technological advances and improved medical infrastructure.

Medical Tourism and Healthcare Tourism are interchangeably, however According to World Tourism Organization (WTO), ―Tourism associated with travel to health spas or resort destinations where the primary purpose is to improve the traveler‟s physical well-being through a process comprising physical exercises and therapy, dietary control, and medical services relevant to health maintenance‖ is defined as Medical Tourism. Health Tourism has three branches of different tourism

• Medical Tourism

• Wellness Tourism

• Curative Tourism

Health tourism structure is shown in Figure 1 and 2 Medical Tourism - Figures 1 explain that Medical Tourism is the major branch of health tourism. In this tourism surgical and non-surgical are consider major activities. The focus of present study is on medical tourism.

Wellness Tourism -Wellness tourism in many ways, this is one of the most ancient forms of tourism, if one considers the scrupulous attention paid to well-being by Romans and Greeks, the quests for spiritual enlightenment of Mediaeval pilgrims, or the medical seaside and spa tourism of the 18th and 19th century European élite. Arguably, however, there has been an unprecedented intensification in the pursuit of wellness in the history of tourism in recent years. The proliferation of wellness centres, holistic retreats, spas, spiritual pilgrimages, complementary and alternative therapies is unprecedented (House of Lords Report 2000). Myers, Sweeney and Witmer (2005) define wellness as being „a way of life oriented toward optimal health and well-being in which the body, mind, and spirit are integrated by the individual to live more fully within the human and natural community‟.

a) Wellness is multi-dimensional; b) Wellness research and practice should be oriented towards identifying causes of wellness rather than causes of illness; c) Wellness is about balance; and d) Wellness is relative, subjective or perceptual. The destination in wellness tourism is often an alternative space in which one can engage in self-analysis without the stresses and distractions of home. The addition of a supportive, like-minded „community‟ can sometimes help to further encourage the individual on a journey of self-discovery. However, for other wellness tourists, the age old preoccupation with rest, relaxation and escapism reigns supreme. But arguably all wellness tourists are self-aware, active seekers of enhanced well-being, health and happiness. Curative Tourism - Travel for treatment and recreation became one of the major purposes of tourism. Curative tourism is not exclusive to those who have body disorders, but also include others who want to relax, retrieve vitality and for mental, physical and spiritual fitness. The term curative tourism has not exactly been raised as an independent concept; instead most of the research was mainly about health tourism. As a result, many scholars have defined health tourism, which implies curative and/or medical tourism in different ways.

A medical tourism refers to an increasing tendency among people from England, the U.S.and many third world countries where medical services are either very expensive or not available, to leave their countries in search of more affordable health options, often packaged with tourist attractions. Medical tourism is a new concept where two important service industries are dovetailing to attract people who seek healthcare services located beyond the geographical territory of their country. It provides state of the art private medical care in collaboration with the tourism industry to get patients from other countries at highly competitive price when compared to those prevalent in the western countries. A new growth sector is medical tourism. Medical tourism in India is a developing concept whereby people from world over visit India for their medical and relaxation needs. Most common treatments are heart technology in which it is at par with those in USA, UK and Europe. India has some of the best hospital and treatment centers in the world with the best facilities. Since it is also one of the most favourable tourist destination in the world, Medication combines with tourism has come into effect, from which the concept of Medical tourism is derived. It is currently growing at around 30% per annum. Medical tourist arrivals are expected to reach one million soon. If a liver transplant costs in the range of 137,867 USD- 160,845 USD in Europe and double that in the US , a few Indian hospitals have the wherewithal to o it around 34,466 USD- 45,955 USD . Similarly, if a heart surgery in the US costs about Rs 45,955 USD. Medical tourism in India has evolved at a great place and the Indian Sub –continent attracts patients from Southeast Asia, Africa and the Middle East. India‘s emergence as the preferred Global Healthcare destination has attracted patients from the globe to come to India particularly Gujarat for treatment which is estimated to contribute 25-31% of the industry earnings of one hundred thousand crores. Medical tourism is focused as potential growth sector in Gujarat. Gujarat‘s leading city, Ahmedabad is a fabulous place for medical tour or medical treatments venue for India‘s leading exhibition for the travel and tourism industry. Ahmedabad is a preferred medical tourism destination all over the world. With world class health facilities, zero waiting time and affordable cost, Ahmedabad is becoming one of the most sought after medical tourism destination in India. Apart from the world class amenities, Hospitals offer pick up and drop service and ambulance services also. The 108 Service is the highly appreciated ‗Medical at doorstep‘ Service. Patients who required dedicated treatment and Surgery can avail the ‗cost effective‘ facility with medical camps, travel trips and entertainment. As part of its Navratri Celebration 2004, the Government of Gujarat took the opportunity to promote its World –class medical facilities and medical expertise making Gujarat as a destination for medical tourism for Non Resident Indians. There were two major events organized during the nine days of Navratri; an exhibition on medical tourism where leading hospital of the state had an opportunity to show their facilities and service packages, and a seminar for discussing issues and concerns related to medical tourism in India and Gujarat. With over five million tourists visiting Gujarat in the last two years, Gujarat tourism has planned a number of initiatives to develop its tourism infrastructure across the state. Of these, one of the main focuses this year will be the development Government are keen on focusing on Medical Tourism as a major sector. ―Gujarat has got some of the best medical facilities and we have already started work on improving the medical infrastructure,‖ he revealed. The Government of Gujarat sees this occasion as a beginning for making Gujarat a Global Health Destination. The longterm plans include • Establishing a Medical tourism council • Developing a Medical tourism policy • MOUS with private hospital for provision of high quality health care • Introduction of Nursing Home act • Accreditation of service providers so that quality services are assured. In the long run the Government can think of promoting Medical University, Public health Act and Emergency services act. Gujarat has an edge over other player in terms of medical tourism for the following reasons: • Gujarat is able to provide top quality health care facilities at much cheaper rate. • Long waiting lists and consequent delays is getting requisite medical treatment from the public healthcare system in the UK, and unaffordable insurance and expensive private hospitals in the US also contribute to the inflow of medical tourists to India. • The private sector which was earlier playing a modest role in the healthcare sector in Gujarat has now become a booming industry equipped with the most up-to-date technology. • Gujarat doctors and surgeons are known throughout the world for their talent, dedication and experience. • The growth of communication has enhanced the visibility of leading hospitals, doctors and surgeons. Hospitals and medical professional are now showcasing their skills and specialties, pricing, etc., on websites, and such information is now readily available to prospective patients across the world. • The prices of medicines too are relatively low in Gujarat, as the pharmaceutical industry is able to produce and market drugs at a low cost. • Non-conventional therapies such as Ayurveda, Unnani and Homeopathy are also attracting • Traditional systems of Naturopathy and Yoga also attract a lot of foreign patients to India. • The Indian education system is churning out an estimated 20,000 to 30,000 doctors and nurses each year. • Most of the good hospitals in Gujarat are also going in for ISI and JCI certification. • To maintain its position in the medical tourism industry and withstand growing competition in this field, Gujarat should have a proper short-term and long- term strategy.

TOURISM

Wellness evolved about 4200 BC when the Sumerians recuperated their health by bathing in thermal springs and fountains located in temples. Medical care can be dated back to 1500 BC with the Greeks laying a foundation stone in a temple in honor of their God of Medicine. Ever since, history has evidence of man travelling out of his country to avail himself of suitable medical treatment. Currently more than 50 countries are engaged in medical tourism with various developing nations. The reasons for growth in medical and wellness tourism evolve from the following: One, high levels of uninsured population (as in the case of USA); two, lack of private participation and high waiting times (as in UK); three, pressures of aging population and over- hospital stay (as in Japan); four, dearth of sufficient and cost-effective healthcare facilities across various parts of the world; five, elective surgery with privacy (such as Botox treatment, rhino plastic, liposuction, etc); and six, inefficient healthcare systems in developing and underdeveloped world.

Tourism industry is growing day by day in the world and India is sharing a major part of world tourism receipts and world tourism traffic and has proved successful in maintaining its place on world tourism map. According to the World Travel and Tourism Council (WTTC), tourism industry will create about 40 million jobs for the people by 2019. Though India shares only 1.24 % of international tourist receipts and 0.59% of international tourist traffic but this contribution cannot be neglected. The major constraint in the expansion of Medical Tourism in India is non-availability of adequate infrastructure including adequate air seat capacity, accessibility to tourist destinations, accommodation and trained manpower in sufficient number. Poor

places are factors that contribute to poor visitor experience. Lack of capital, Lack of Community participation and awareness, Lack of involvement from rural sector, Lack of concern for sustainability, Complex visa procedures, and Lack of good language translators are the other reasons which are serving as the constraints in the way of medical tourism. Hospitals of India are lacking behind in providing the hygienic medical facilities and room services including hygienic food to the patient, as a result Indian hospitals are losing trust of foreign patients. The government of India can play a significant role in improving the status of medical tourism by removing political instability, terrorism Bureaucratic roadblocks, and Taxation anomalies. Indian Government should launch long term revenue generating projects and investor friendly policies to get benefitted from medical tourism. Government should make provisions to provide Quality accreditations to the Indian health centers, training and development to the Doctors, Nurses and Para medical staffs, and should apply the customer oriented approach to improve the image of Indian hospitals. Other major constraints in the development of medical tourism in India is the partial attitude of the government towards corporate and public hospitals. Government cannot neglect the role of corporate hospitals as a source of foreign exchange earner, a provider of high class medical facilities and technology, a medium of fulfilling the demands of foreign patients. In future government may be compelled to grant them greater subsidies and exemptions for their development . This would create a pressure on public funds and subsides. This diversion of funds from public-sector to corporate-sector will create a line/difference between aristocrats and budgetary class. Indian Government has already given them the advantage of subsidies in the field of land, import of health equipment, and other machineries. Development of medical tourism can put an extra pressure on government to subsidize them even more which will lead to the wastage of scarce resources available for health . The challenges facing Indian medical tourism industry are as follows: i. No strong Government support/initiative to promote medical tourism. ii. Lack of coordination among various players in the industry-airline operators, hotels and hospitals. iv. No proper accreditation and regulation system for hospitals. v. Lack of uniform pricing policy across hospitals. vi. Strong competitions from many other players. vii. Lack of insurance policies for this sector. viii. Low investments in health infrastructure. ix. Growth generates healthcare challenges in booming India. The country graduates 27,000 doctors each year but most want to work in cities. But millions must walk miles to see a physician. x. Inequalities in healthcare access between private and public systems may increase xi. This may induce domestic brain drain from public to private sector. xii. Indian Government‘s campaign to make India a primary medical tourism destination may divert attention from primary healthcare and other sectors. xiii. Availability of hotel rooms in India is considered to be more difficult as compared to other countries. In addition, the cost of accommodation is another hindrance to middle-level international travelers visiting India. xiv. Public-Private Partnership is required to provide quality services to attract potential healthcare seekers from various countries.

Medical tourism in India has emerged as the fastest growing segment of tourism industry despite the global economic downturn. India is offering very low cost treatments not only to Indians but also to the foreigners. Patient from USA and UK, are coming to India to look for alternative and cost-effective destinations to get their treatments done. The Indian medical tourism industry is presently at a blossoming stage, but has an enormous potential for future growth and development. 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. Estimates of the value of medical tourism to India go as high as $2 billion a year by 2012. tourism. Tourist should be granted quicker visa or visa on arrival so that they can make hassle free travel and can contact the Immigration Department at any point of entry for quick clearance. Acknowledging the importance of medical tourism, Government has granted several reductions, exemptions and tax incentives to the service providers. Medical tourism in Gujarat is at infant stage, as more people from different countries are choosing Gujarat as the destination for health treatment. Gujarat is estimated to contribute 25-31% of the industry earnings of one hundred thousand crores. According to CII report, the cost of medical treatment in India is less than 1/3rd of that in many European and US hospitals. If handled skillfully, this sector has the potential for generating a lot of employment as well as foreign exchange revenue, which will help in the overall development of Gujarat state as well as country.

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