India continues to make rapid strides in medical tourism. Analysts view medical tourism as a most promising segment, but many areas of concern need to be addressed.
With its low cost advantage and emergence of several private players, it represents the fastest growing market, predicts "Asian Medical Tourism Analysis (2008-2012)," prepared by Research and Markets, an Irish firm.
Actually there is nothing strikingly new about the finding, experts say. India was touted as the global destination for health by the federal government back in 2003 itself.
Since then growing liberalization and entry of more and more private players, has meant that despite setbacks elsewhere in recent years, future seems sound for the health tourism sector.
The West is suffering by its own success. Public health expenditure is going through the roof. As the population ages and demands on healthcare increases, governments find it difficult to sustain the level of healthcare provided to citizens all along.
Besides, most developed countries are plagued by an acute shortage of medical personnel, of every category. To make matters worse, western economies are either turning stagnant or are declining. Consequently long waiting times are becoming an inevitable feature of the health scene, in Europe, particularly.
It is such challenges faced by the West that come as a boon for countries like India. According to the Research and Markets referred to earlier, India, Thailand, Singapore, Malaysia and Philippines could make the most of the difficult health scenario in the developed world.
The medical tourism market in India was estimated at $333 million in 2004. It is projected to reach $2.2 billion by 2012-14.
However, perceptions abroad over hygiene consciousness as also infrastructural constraints could spoil the party, it is feared.
The bulk of patients coming to India are from the SAARC region, from the Middle East, and Africa, though there is potential for exports to the West.
Chennai, capital of the southern Indian state of Tamil Nadu, is certainly in the forefront of health tourism.
Understandably so, for it was the Chennai-based Apollo Group that played a pioneering role in wooing foreign patients on the one hand and upgrading its own facilities on the other.
The time is not far off when we will be the Asian hub says Shamik Banerjee, Head of Corporate Communication, Apollo Group. The bustling metro boasts of a host of multi-specialty hospitals, he points out.
The group itself receives about 25,000 international patients every year, of which more than 3,000 come as medical tourists. Patients come from countries like Bangladesh, Maldives, Sri Lanka, Seychelles, Mauritius and Gulf countries.
The hospital has also tied up with over 10 international insurance companies and has its own health insurance company - Apollo DKV and has third party administrators (TPAs) abroad. In Japan, it has tied up with SOS International and Japan's Emergency Assistance to airlift sick patients and bring them to India for treatment. In Oman and Mauritius, Apollo has tie-ups with the Health Ministries.
Dr S Nirmala, who runs a maternity centre, says, Apollo Hospitals, MIOT Hospitals, Madras Medical Mission, Sankara Nethralaya, Sri Ramachandra University Hospital and Vijaya Hospital were the first to encourage this trend. Soon, other hospitals followed suit by tying up with travel agencies and organizing a network of home-stays.
"Many NRI women, for sentimental and economic reasons, prefer to have their delivery in India. I have had women patients, who have flown down from the US, as late as in their eighth month to have their baby in India. Also, it is almost impossible to get medical attention in the US without insurance, as the costs are highly prohibitive. And for Indian wives, who have gone to the US without a green card, treatment in India is the most cost-effective option," she says.
Good quality health care and the low costs are a major attraction, says Dr Janardhanan, a leading dentist. "As dental work in India is good and economical, dentists receive patronage from people from far-flung areas like the middle-east. An extraction in India would cost around Rs 150, whereas the same procedure in a European country would push the bill upto 100 Euros," he says, adding, "In the field of orthodontistics, the treatment available in India is on par with that offered in developed countries. There is also the added attraction that a rectification surgery in India to improve one's appearance would only cost anywhere between Rs 15,000 and Rs 20,000."
Patients come in for heart problems, renal failure (dialysis), orthopaedic, fertility, pediatric problems, etc. "Also many people combine work with medical treatment. I had come down to India to give a lecture at IIT. I also got my eyes checked here and had new glasses made for me. It's a general trend, many of my Indian friends prefer to have their health check-ups done in India," says Dr David Sundaram of Auckland University, New Zealand.
"My entire family had its dental check-up, tartar cleaning and teeth replacement done in Chennai. In Houston, Texas, where we stay, it is too costly. So, during our annual vacation to India, we try to get our master health check-up done," says Ms Buelah Rao, an accountant in the US and mother of two.
In most city hospitals, it has become common to see patients hailing from African countries, West Asia, the Middle-East and Afghanistan. "Chennai has great potential as a medical tourism hub. When we started our travel agency in 2001, we used to have a few patients signing up from abroad. At that time, I hadn't even heard of the word medical tourism. Now, we have started a separate wing to cater only to foreign clients and another for domestic clients; mostly people from Andhra Pradesh and Karnataka. We have also got our own network and database of home-stays," says Balaji of Prahav Travels.
Tamil Nadu Tourism Development Corporation has also started focusing on this traffic and has identified Meditour India, an NGO, to promote medical tourism in the state. Medical tourist guide Ms Samrita, who also provides accommodation in her 1950s spacious, old-fashioned bungalow, says that her job is a social service. "I have had patients from Bangladesh and Nepal, staying with me. Most of these people are middle-class people like us and are so grateful for every little help extended; of course, we are charging them for it."
Hariharan, closely observing the scene for many years, says, "There are many patients who land up in the city and then scout for the cheapest treatment available. For many illegal immigrants in the UK and US, this is the only option. Since, they risk deportation if they get themselves admitted in the hospitals there, they keep coming to India for medical treatment till they get a work permit or visa."
However, Prof. Rupa Chanda of the Indian Institute of Management, Bangalore, an acknowledged expert on healthcare economics, strikes a note of caution:
"I don't think medical tourism will take off in a very big way in the near future. The reasons are health insurance portability restrictions, and unless that happens, we will get only out-of-pocket paying consumers. That in turn limits our market in the West.
"To tap the European market, we need to have MoUs with public health systems if we are to have a larger market. However, our potential in the region, or with other developing countries say in the Gulf, Africa, is good and we can exploit that further through tie-ups with overseas hospitals and through management of hospitals.
"Also, in terms of segments, for the time being, if we remain limited to the paying base, then areas like cosmetic surgery, alternative medicines are more likely to flourish, compared to more substantive treatments like bypass, surgeries of other kinds, because invasive treatment runs into more perception-related challenges."
But Nithyakalyani, a prominent business journalist based in Chennai and editor of insurance magazine Premium, says despite the current restrictions, sheer cost advantages serving as the pull factor and overburdened hospitals in the West as the push factor, India has a lot to look forward too.
"Indeed these days, it is the insured patients who are more and more likely to opt for treatment in India as insurance providers are allowing it," she says.
At the same time, she also concedes lack of accreditation of Indian hospitals and the lack of recognition of Indian medical qualifications abroad are issues of concern. Some major Indian hospitals have started going in for international accreditation, and that should help.
As for the western perceptions of hygiene standards in India and of the general competence of Indian doctors, many assert that such impressions too are undergoing a sea-change.
Health tourism can go only one way for India, up and up, northwards. No looking back, they are confident.