India has some of the best hospitals and treatment centres in the world with the best facilities. Since it is also one of the most favourable tourist destinations in the world, Medication combines with tourism has come into effect, from which the concept of Medical Tourism is derived. Medical tourism holds immense opportunity for India. This paper examines the various factors that contribute to India’s strength as a preferred destination for medical tourism. It examines the diverse challenges that need to be addressed for the Indian medical tourism industry to realize its potential. It then outlines a range of strategic and tactical initiatives, which would contribute to a faster growth of the industry. Special emphasis is placed on the need for partnership amongst the various stakeholders such as medical and healthcare providers, hospitality and transportation services, tourism departments and the Government.
Medical tourism is the practice of travelling to other countries to receive medical services, which are sometimes packaged with travel and sightseeing excursions. Health tourism or now-a-days it’s called “Business Tourism” refers to tourism that focuses mainly on preventive health programmes.
Medical or health tourism is not a new practice. References may be found of it in historical documents where it is mentioned that people have been travelling for getting medical benefits from natural resources like mineral & hot spring visits, thermal springs, sea & mountain air etc.
Medical tourism in India could account for 3-5% of total healthcare delivery market- an estimate which is based on the cost differential between India and many other countries for health care services ranging from 200% to 800%. Tourists are attracted from different parts of the world including UK, Canada, South Africa and Malaysia. About 1, 00,000 patients come each year. The medical tourism or medical care industry in India is expected to grow into a $1.5 billion industry by 2010. A study conducted by CII- Mckinsey estimates that India could earn US $ 11.3 billion to 22.6 billion by 2012.
According to India's National Health Policy 2002 in order to benefit from the comparative cost advantage enjoyed by domestic health facilities in the secondary and tertiary sector, the policy would support the supply of services to patients of foreign origin on payment. These services which are provided on payment in foreign exchange will be treated as 'deemed exports' and will be entitled to all fiscal incentives extended to export earnings.
In order for the medical tourism industry to grow there are certain requirements that must be met. One of the premier requirements is the need for high quality health institutions.
There is a call for modern infrastructure, world class processes, and contemporary technologies. There is also the requirement for quality manpower with respect to doctors, nurses and technicians. Indian health institutions will have to make focused efforts towards obtaining international accreditation of their hospitals and service delivery practices. Another factor which contributes to the medical tourism industry is the ease of international travel. Many developing, underdeveloped countries do not have facilities for advanced medical care and there is often a dearth of skilled medical professionals for the latest procedures.
There are several factors, which contribute to India’s strength as a destination for medical tourism. Expatriate Indian doctors having excellent reputation and are found in almost every country. Corporate hospitals are coming up in the country with improved facilities, equipment, service standards and better marketing capabilities. India can claim expertise in various medical areas such as cardiac care, joint replacement, dental treatments and cosmetic surgery. The cost of medical services is often as much as ten to fifteen times cheaper than in other countries. For example, phacoemulsification procedure can be performed in India with just Rs. 20,000 as against $ 45,000 in USA refer Table 1).
Challenges to Growth Of Medical Tourism
Several issues pose challenge to the growth of medical tourism and which need to be addressed. Currently India faces strong competition from countries such as Thailand, Singapore and Malaysia.
Cultural and language barriers
Language and cultural barriers can make communication with doctors and other people very frustrating for a person from another country. India has a large number of languages and a high diversity in beliefs, value and culture. The comfort of having a major surgery near home with the family at the bedside is a far cry from the experience in the developing world, where the cultural shock alone can be stressful. Generally there is a fearful state of mind about travelling so far away from home to an unknown place. Communicating with the patients and their families and establishing effective customer relationship is a key challenge.
Issues of International Accreditation
International accreditation would be an important step in making the hospitals eligible for the coverage with foreign insurers. For example, the JCI seal would enable Indian hospitals to be accredited with US insurers. This in turn would attract customers from other parts of the world. JCI is the international arm of the Joint Commission Accreditation for Hospital Organizations. Similarly UK has its own system of accreditation, the Health Quality Service.
Concerns regarding the Quality of Service and Competency of Service Deliverers
Medical tourists are anxious and concerned about the about quality of health care services and the qualification and ability of the health care providers. And even the main problem is the huge scarcity of well-trained professional “Care Providers”. This issue is further aggravated by the fact that most patients and their families are not qualified to judge technical quality and complexity of the variables involved. Hospitals need to focus on indicators to communicate aspects of treatment and care. Negative perceptions related to hygiene/sanitation, pollution and bureaucracy need to be addressed.
Growing Customer Expectations
Patient expectations are growing as he or she has more options for high quality criteria. There is growing pressure for more personalised services. There is a demand for high responsiveness. It is the business of managing the total customer experience- an experience where price is transparent but value is opaque.
Strategies to enhance the Service Experience
The initiatives to build on the quality of service delivery for the customer can be on both a strategic and tactical level. At the very top are issues such as defining the mission and scope of business for the service provider.
1. Is medical tourism a small initiative on the part of the institution or is it an area of major focus?
2. What type of segmentation and target market selection has the management undertaken?
3. Who would form the biggest, most profitable, most attractive customers?
4. Do they fall under a logical group?
5. Which segmentation criteria or combination of criteria would be the most appropriate?
Table 2 provides some examples of various segmentation bases as applied to medical and health tourism.
Bases of Segmenting the Health and Tourism Market
Segmentation base |
Examples |
Geographic |
USA, UK, Nepal, Arab world, Africa. |
Demographic |
Age, sex, income, education, NRIs. |
Psycho graphic/Lifestyle |
Spending patterns, risk averse, attitude toward health and fitness. |
Benefits sought |
People wanting to mix fun with treatment, People seeking less expensive treatment. People seeking faster treatment without waiting time, better quality of treatment; issues of confidentiality. |
Behavioural |
First time consumers, frequent purchasers of service; membership status |
Ensuring High Quality Treatment
It must be ensured that the basic product that is the quality of treatment of an ailment or injury is of high quality. The technical outcome of the service should be excellent. For this it is necessary to have the facilities, equipment and trained and competent staff. Similarly in the case of preventive healthcare, suitable programmes should be developed which are based on the study of physiological condition, lifestyle, work pressures and related environment.
Focusing on the Functional Outcome;-
The functional outcome of the service experience needs to be given equal attention. This may begin with something like “door-to-door travel” and “stay arrangement” so that patients can arrange travel documents. Putting the patient in touch with doctor before travelling would also help to alleviate some of the anxiety related to medical treatment. A clean and pleasant servicescape, minimum waiting time or delays for tests and treatment, appropriate food and other services would all contribute to the service experience for the patient and his/her attendants.
Genuine Patient Centric Approach
It is necessary to develop a service-oriented team. Personal caring and warmth is an important factor in enhancing the service experience. Going to the extent of caring for attendant is a must for reassurance. This would require a careful selection procedure- one which ensures hiring people not only with the right skills and qualifications but also with the right service attitude and then training them suitably. Doctors and the patients should not be viewed in superior-subordinate roles. There needs to be positive, customer –focused attitude in the hospitals as this is what is going to help to deliver service quality.
Focus on Two-Way Communication
At the very least, it is necessary to have interpreters and some multi-lingual staff. The service employees must be sensitized to the culture and practices of the patients- at least to some extent. Doctor should explain the treatment protocols to patients and relatives. Comprehensive patient feedback system to guide patients for after care & solve problems, if any, should be set up. A dedicated international patients’ service desk would also help. A comprehensive patient feedback system to guide patients for after care & solve problems, if any, should be instituted.
Transparency can be built by direct contact between hospital/doctors and patients. Eliminating middlemen/travel agents can be an effective strategy for reducing miscommunication. Proactive follow up after discharge even when the patient forgets must be implemented. It is also necessary to have effective complaint or grievance handling system so that negative feedback can be used to improve the service and thereby convert a weakness in to strength.
Promoting the Service
The customer needs to be educated about the value of the offerings in a credible manner.
Reference of service experience from previous patients is a major factor in building trust. It is the satisfied customer who will spread a positive message about India healthcare. Conducting workshops in target countries, tie-ups with health services in other countries, having a presence on the web could all be used to promote awareness about India’s strength in medical treatment and preventive healthcare.
Information could be made available at Indian Embassies abroad. Locating early adopters, opinion leaders and promoting the services with them would help to achieve faster growth. The industry body Confederation of Indian Industries is already working in partnership with 29 Hospitals with national accreditation across 16 states to work out price band for speciality services.
Also, various sectors of the health care industry are working closely the with tourism ministry to incorporate health care packages under the ‘Incredible India’ campaign. Tie up of with hotels, travel agencies, and other related institutions would lead to a better integration of services. The international conferences-business channel route can also be used to promote health care services. Employer-sponsored programmes for medical care with organizations abroad can be implemented to promote the services.
Development of Alternative Therapies
The Indian medical tourism and healthcare industry can develop a significant competitive advantage through promotion and packaging alternate therapies such as ayurveda, naturopathy, homeopathy and yoga. For example Kerala has actively implemented initiatives which promote its ancient indigenous therapies on Ayurveda.
Need for a Collaborative Approach
It is necessary for the various stake holders involved in promoting medical tourism in the country to work together. A panel of efficient doctors and hospitals to provide the core services along with infrastructure and marketing support provided by the hospitality industry, transportation services tourism boards and government. For example, recently the Ministry of External Affairs informed the embassies of 18 countries, the procedure for medical visa procedures would henceforth be completed within 48 hours. Also, permission would be given to outsource the visa procedures to a third party during peak season.
Conclusion
India has several advantages in the field of medical tourism. However, this is still an evolving concept and several challenges need to be addressed. Focused efforts on several fronts would be required for the medical tourism industry in India to realize its promise. The medical and healthcare institutions, the hospitality industry, transportation providers, and the government need to work in concert to promote medical tourism in India.
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