It is not difficult to visualise Pradeep Uniyal and Dr Ajay Thakker perched on two ends of a see-saw representing the two sides of medical tourism – hospitality and treatment. Dr Thakker is the Chairman and CEO of Jupiter LifeLine Hospitals, which owns Fortune Park LakeCity in Thane, India’s first hotel located within a hospital, launched in March this year. Uniyal is India’s first hotel general manager entrusted with a job of juggling profitability with ambience, sensitivity and special food – suitable for some of his patient-guests yet pleasing to the corporate traveller or caregiver who inhabits the business hotel as well.
“Incidentally, my next door neighbour is a hospital,” says Uniyal, who displays on his desk bottles of healthy honey to be served with breakfast, instead of standard jam and marmalade costing less than half the amount. Positioned as a business hotel by ITC, Fortune Park LakeCity, which has drawn 8% room occupancy and 35% of food & beverage revenue from the hospital since its opening, is consciously careful of its neighbour. The hotel does not plan to play host to loud parties or serve alcohol even when spirits are good for business.
A restricted-access door connects the hospital to the hotel. “We had decided right at the design stage that we are going to have two separate entrances – one to the hotel and one to the hospital. Only health supermarket and the wellness restaurant are connected and open-access,” says Dr Thakker sampling fat-free club sandwiches, served with soy ‘vegetarian sausages’.
Strict as he is, three months into inception the good doctor has acquiesced to serving non-vegetarian food to guests – by popular demand. Dr Thakker and Uniyal are both determined to have the best hospital and hotel they can, respectively, creating a model medical destination. Uniyal, who personally supervises the hotel chef’s experiments with food that meet both health and taste requirements, says, “Our guests feel confident that ours is a health-conscious hotel.”
Some of the guests include rich businessmen from Saudi Arabia, NRIs from Africa and domestic business travellers – a representative sample of medical tourists in India. Dr Thakker gives an example of how it works: “One of our corporate guests checked into the hotel in the evening and had scheduled his first meeting only at 1pm. Since he had no time at home so he opted to get a health checkup before going for a meeting. He was diagnosed with coronary artery disease and found that he needed angiography.”
Now, marketing plans on the drawing board include combining the room rent with a health check up, reserving the first two hours of the day in the outpatient department for hotel guests, with the reports waiting at the reception in the evening. “We are in touch with a couple of airlines to club their tickets with a medical package. We can club together a hotel room with heart surgery or knee replacement,” says Dr Thakker.
The business of medical hospitality is about detail, says senior executive vice president Pawan Verma of ITC’s hotels division: “They [guests] participate, or “co-create” the necessary service. The most common emerging model is that of a hotel as a facility serving the medical tourist briefly before medical treatment, and longer during the convalescence process.”
Given that the average medical tourist in India spends more than $7,000 per visit, compared to an ordinary vacationer’s per-capita spend of $3,000 per visitor (according to statistics by the Ministry of Tourism), this attention to detail is more likely to pay off than any investments this year.
Potential
“As far as medical travel is concerned recession never hit India. The market is huge, but only 8 to 10 hospitals are reaching the bulk. There is potential for growth in the top 100 hospitals in the 10-12 cities that have international air connectivity,” says executive director Pradeep Thukral of Indian Medical Travel Association (IMTA) one of the organisations working with Indian hospitals and tourism bodies to promote health travel.
India aims to increase its portion of the US$60-billion global medical tourism market. Consultancy firm Deloitte estimates that the country’s business will grow at 27% each year. Like Chennai, Mumbai, Delhi and Ahmedabad are seeing medical infrastructure come up with Medanta Medicity, Max Healthcare, Apollo Hospitals, Fortis Healthcare, Sir Ganga Ram Hospital, etc. Many hospitals are accredited by the Joint Commission International (JCI), an international body. Not only the metros, but cities such as Hyderabad, Nagpur and Pune are popular destinations for health travel, depending on their connectedness. “Nagpur has Air Arabia connectivity so there are a lot of UAE patients coming into the city,” says Thukral.
Many cities are seeing the mushrooming of Health Care Facilitators (HCFs) or specialist travel agents such as Medico Global, AADI MediTour, Indo Medical Tourism, Mediescapes India, etc. One of the oldest of these agencies is Forerunners Healthcare, based out of Nasik, claiming to be India’s first medical travel company. The company is running an aggressive online PR campaign positioning India as a destination for affordable, specific healthcare. “We have been in the field for the past seven years. On an average, we successfully coordinate about 300 cases a year, facilitating treatment in various places including Mumbai, Delhi, Chennai, Goa, Kerala, Bengaluru, Hyderabad and Nagpur,” says founder Dr Dheeraj Bhojwani.
The patient world traveller
If one looked at the WHO definition of health pegged to wellness, it would seem that every tourist in India is a medical tourist – from the ones lying on their back on beach destinations in Kerala getting a Shirodhara oil treatment, to the UK regulars at Goa’s resorts who time their root-canal treatment to coincide with their vacation, to cancer patients from Tanzania who look for the best possible cancer treatment or knee replacement in India.
“There are three kinds of medical tourism,” says Dr Thakker, differentiating between wellness and spa-related travel, cosmetic treatments and need-based medical travel, positioning his property firmly as a serious medical destination aimed at 1.1million health tourists that are predicted to enter India in a 2009 report by the Confederation of Industries (CII)-McKinsey.
Hotels all over India have been adapting to the need of the medical traveller for a while. The Taj at Fisherman’s Cove in Chennai, for instance, draws many of its guests from nearby Apollo Hospital, which has long been a destination for medical tourists. Chennai sees 45% of inbound health tourists and 30% to 40% of domestic health tourists – a number only set to increase. According to the CII-McKinsey report, medical tourism will generate US$2.4 billion during 2009–2012 for India by attracting 1.1million health tourists, up from 150,000 in 2002 and 450,000 in 2007.
Dr Bhojwani says that the profile of the medical traveller has been changing over the years. “Initially, we used to get many patients from countries such as the US, Canada, UK. In the past five years, the numbers have significantly dropped due to competition from Mexico, Argentina and Thailand. East European countries such as Hungary and Poland have got into the field for the last two to three years, and they are more accessible for patients in Europe and the US.”
According to Dr Bhojwani, about 50% of medical tourists are budget patients, and East Africa is becoming so significant that Forerunners is planning to open centres there. “By the first week of August we’ll open support centres in Africa, manned by our staff, who’ll immediately connect patients to doctors in India,” he says. Afro-Asians spend up to an estimated $20 billion per year on healthcare outside their countries.
A 2007 study by Venkata Krishna Prasad classifies medical tourists into three groups. The first group, he says, is made up of the Americans and Europeans travelling for facelifts, dental treatment, botox treatments, tummy tucks et al – surgery not covered by medical insurance.
The second large group is of travellers from the Middle East. An agency in Saudi Arabia estimated that each year more than 5,00,000 people from the Middle East travel seeking medical treatment, and India attracted 70,000-plus medical travellers from the region in 2006. Thukral says, “Iraq’s local health care system is not in place. Even if they have the money, it is difficult for them to go to hospitals in the UK or the US. India always welcomes them. Oman, Yemen, East Africa, Tanzania, Ethiopia, Ghana are the most promising countries with the same paying capacity as patients from the US and the UK .”
The third group is from countries with generally poor infrastructure, who seek treatment at a neighbouring country. Countries such as Bangladesh, Pakistan and Nepal come under this category.
Service providers encourage this group because there is instant familiarity with Indian food and lifestyle. The Americans and the Europeans, on the other hand, are classified as “headache clients”. According to IMTA, “people coming from the Indian subcontinent – Bangaldeshi patients, people from Nepal, Bhutan, Sri Lanka and other SAARC countries make up about 35% to 40% of all medical travellers.”
A world of difference
Healthcare policies, wars, strained political relationships, accessibility all affect the medical tourist. “Patients from UK and the US make up less than 7% to 8% of the total. The new healthcare policy in the US will have a bearing on our industry,” says Thukral.
Many Indian hospitals such as Fortis and Apollo have already tied up with US corporate clients to treat their employees.
India’s many USPs
“Medical tourism in India is not a cost arbitration story. You can’t quick-fix a heart. Medical treatment in India is better than what is available in the developed world,” says Thukral, listing India’s benefits, including the fact that an Indian surgeon would hone his skills on four to five surgeries a day compared to the same number handled by a doctor in the US in a month. “Patients are paying less money for superior service. Consumers move where they have the best value for money,” he says.
Cost is a factor. The cost of medical services in India is almost 30% lower than Western countries and the cheapest in South-East Asia. A report by the Planning Commission says that while a heart bypass surgery may cost a patient $6,000 in India, the same surgery will set him back $7,894 in Thailand, $10,417 in Singapore and almost quadruple or $23,938 in the US.
According to the American Medical Association data, as against a charge of $5,000 for a spinal fusion in India, a patient will pay $62,000 in the US, $9,000 in Singapore and $7,000 in Thailand.
India is noted for an average of 99.5% success rate of physiotherapists helping patients regain their physical fitness after surgery. In addition, tele-consultancy is a rapidly growing service available for expert opinion and information transmission.
Language is another factor. In the medical field, India enjoys the same advantage as it does in outsourcing.
The government as stakeholder
Today, medical tourism gets instant recognition with many state tourism boards. Tourism minister Jay Narayan Vyas of Gujarat told TGI in an earlier interview: “We have already undertaken a Rs100 crore project for the construction of an Ayurved College and a 300-bed Ayurved hospital. ”
Karnataka is taking aggressive steps in this direction. Director, tourism K Viswanatha Reddy of Karnataka Tourism says, “We are projecting Bengaluru as the best place to get the most sophisticated, yet cheap medical help.”
The Ministry of Tourism’s Market Development Assistance (MDA) scheme offsets overseas marketing costs for travel companies earning foreign exchange. By opening up the MDA, hospital groups will be made eligible for financial assistance, including publicity through printed material, travel and stay expenses for sales-cum-study tours and participation fees for trade fairs and exhibitions.
The Government has also been working towards providing priority medical visas. However, much needs to be done in this regard. Patients often have to personally visit their local Indian embassy more than once before being granted a visa. Embassies are not very sympathetic to patient needs or urgency. The longest wait time is about two to three weeks. “We are urging the government to introduce a visa-on-arrival scheme for many countries and modify the medical visa scheme,” says Thukral.
The National Health Policy declares that treatment of foreign patients is legally an “export” and deemed “eligible for all fiscal incentives extended to export earnings.”
The caregiver as a tourist
One of the most important persons for a medical travel agency is the caregiver. While the person has no medical needs, he often doubles as counsellor, says Dr Thakker.
Patients tend to stay longer because long flights and decreased mobility in a cramped airline cabin are a known risk factor for pulmonary embolus economy class syndrome. Medical tourism patients often combine their medical trips with vacation time.
“Many people come in looking for a holiday, as well as for medical reasons. In places like Goa, Delhi and Agra, large hospital chains have come up because 10% of people are medical tourists, while the rest are medical travellers,” says Thukral.
Process
Typically, the person seeking medical treatment abroad contacts a medical tourism facilitator. During the course of the first conversation, the facilitator requires the patient to provide a medical report, including the nature of ailment, local doctor’s opinion, medical history and diagnosis, and may request additional information.
“We immediately put him in touch with three different experts. The opinion is free of cost. After that, we arrange a teleconferencing call,” says Dr Bhojwani. The approximate expenditure, choice of hospitals and tourist destinations, and duration of stay, etc, is discussed. After signing consent bonds and agreements, the patient is given recommendation letters for a medical visa, to be procured from the concerned embassy. “Sometimes the embassy requires the patient to be checked by their doctor,” says Thukral.
“An average patient takes about four to six weeks to come to India once he has initiated contact. Some patients are short-term conversion. The shortest time period they stay in India is five days, the average is nine days, and the longest can be many months. Cancer patients need to be updated for at least a year,” says Dr Bhojwani.
The category of patients that can’t be overlooked is that of the domestic health traveller. “In some ways, the foreign health tourist is incidental to our needs. I believe there is a lot of potential in domestic health tourism, which has not been addressed at all. Places in North Maharashtra and MP borders are deficient in health infrastructure, and they all travel for treatment,” says Dr Thakker.
heal the world
(NULL)
It is not difficult to visualise Pradeep Uniyal and Dr Ajay Thakker perched on two ends of a see-saw representing the two sides of medical tourism – hospitality and treatment. Dr Thakker is the Chairman and CEO of Jupiter LifeLine Hospitals, which owns Fortune Park LakeCity in Thane, India’s first hotel located within a hospital, launched in March this year. Uniyal is India’s first hotel general manager entrusted with a job of juggling profitability with ambience, sensitivity and special food – suitable for some of his patient-guests yet pleasing to the corporate traveller or caregiver who inhabits the business hotel as well.
“Incidentally, my next door neighbour is a hospital,” says Uniyal, who displays on his desk bottles of healthy honey to be served with breakfast, instead of standard jam and marmalade costing less than half the amount. Positioned as a business hotel by ITC, Fortune Park LakeCity, which has drawn 8% room occupancy and 35% of food & beverage revenue from the hospital since its opening, is consciously careful of its neighbour. The hotel does not plan to play host to loud parties or serve alcohol even when spirits are good for business.
A restricted-access door connects the hospital to the hotel. “We had decided right at the design stage that we are going to have two separate entrances – one to the hotel and one to the hospital. Only health supermarket and the wellness restaurant are connected and open-access,” says Dr Thakker sampling fat-free club sandwiches, served with soy ‘vegetarian sausages’.
Strict as he is, three months into inception the good doctor has acquiesced to serving non-vegetarian food to guests – by popular demand. Dr Thakker and Uniyal are both determined to have the best hospital and hotel they can, respectively, creating a model medical destination. Uniyal, who personally supervises the hotel chef’s experiments with food that meet both health and taste requirements, says, “Our guests feel confident that ours is a health-conscious hotel.”
Some of the guests include rich businessmen from Saudi Arabia, NRIs from Africa and domestic business travellers – a representative sample of medical tourists in India. Dr Thakker gives an example of how it works: “One of our corporate guests checked into the hotel in the evening and had scheduled his first meeting only at 1pm. Since he had no time at home so he opted to get a health checkup before going for a meeting. He was diagnosed with coronary artery disease and found that he needed angiography.”
Now, marketing plans on the drawing board include combining the room rent with a health check up, reserving the first two hours of the day in the outpatient department for hotel guests, with the reports waiting at the reception in the evening. “We are in touch with a couple of airlines to club their tickets with a medical package. We can club together a hotel room with heart surgery or knee replacement,” says Dr Thakker.
The business of medical hospitality is about detail, says senior executive vice president Pawan Verma of ITC’s hotels division: “They [guests] participate, or “co-create” the necessary service. The most common emerging model is that of a hotel as a facility serving the medical tourist briefly before medical treatment, and longer during the convalescence process.”
Given that the average medical tourist in India spends more than $7,000 per visit, compared to an ordinary vacationer’s per-capita spend of $3,000 per visitor (according to statistics by the Ministry of Tourism), this attention to detail is more likely to pay off than any investments this year.
Potential
“As far as medical travel is concerned recession never hit India. The market is huge, but only 8 to 10 hospitals are reaching the bulk. There is potential for growth in the top 100 hospitals in the 10-12 cities that have international air connectivity,” says executive director Pradeep Thukral of Indian Medical Travel Association (IMTA) one of the organisations working with Indian hospitals and tourism bodies to promote health travel.
India aims to increase its portion of the US$60-billion global medical tourism market. Consultancy firm Deloitte estimates that the country’s business will grow at 27% each year. Like Chennai, Mumbai, Delhi and Ahmedabad are seeing medical infrastructure come up with Medanta Medicity, Max Healthcare, Apollo Hospitals, Fortis Healthcare, Sir Ganga Ram Hospital, etc. Many hospitals are accredited by the Joint Commission International (JCI), an international body. Not only the metros, but cities such as Hyderabad, Nagpur and Pune are popular destinations for health travel, depending on their connectedness. “Nagpur has Air Arabia connectivity so there are a lot of UAE patients coming into the city,” says Thukral.
Many cities are seeing the mushrooming of Health Care Facilitators (HCFs) or specialist travel agents such as Medico Global, AADI MediTour, Indo Medical Tourism, Mediescapes India, etc. One of the oldest of these agencies is Forerunners Healthcare, based out of Nasik, claiming to be India’s first medical travel company. The company is running an aggressive online PR campaign positioning India as a destination for affordable, specific healthcare. “We have been in the field for the past seven years. On an average, we successfully coordinate about 300 cases a year, facilitating treatment in various places including Mumbai, Delhi, Chennai, Goa, Kerala, Bengaluru, Hyderabad and Nagpur,” says founder Dr Dheeraj Bhojwani.
The patient world traveller
If one looked at the WHO definition of health pegged to wellness, it would seem that every tourist in India is a medical tourist – from the ones lying on their back on beach destinations in Kerala getting a Shirodhara oil treatment, to the UK regulars at Goa’s resorts who time their root-canal treatment to coincide with their vacation, to cancer patients from Tanzania who look for the best possible cancer treatment or knee replacement in India.
“There are three kinds of medical tourism,” says Dr Thakker, differentiating between wellness and spa-related travel, cosmetic treatments and need-based medical travel, positioning his property firmly as a serious medical destination aimed at 1.1million health tourists that are predicted to enter India in a 2009 report by the Confederation of Industries (CII)-McKinsey.
Hotels all over India have been adapting to the need of the medical traveller for a while. The Taj at Fisherman’s Cove in Chennai, for instance, draws many of its guests from nearby Apollo Hospital, which has long been a destination for medical tourists. Chennai sees 45% of inbound health tourists and 30% to 40% of domestic health tourists – a number only set to increase. According to the CII-McKinsey report, medical tourism will generate US$2.4 billion during 2009–2012 for India by attracting 1.1million health tourists, up from 150,000 in 2002 and 450,000 in 2007.
Dr Bhojwani says that the profile of the medical traveller has been changing over the years. “Initially, we used to get many patients from countries such as the US, Canada, UK. In the past five years, the numbers have significantly dropped due to competition from Mexico, Argentina and Thailand. East European countries such as Hungary and Poland have got into the field for the last two to three years, and they are more accessible for patients in Europe and the US.”
According to Dr Bhojwani, about 50% of medical tourists are budget patients, and East Africa is becoming so significant that Forerunners is planning to open centres there. “By the first week of August we’ll open support centres in Africa, manned by our staff, who’ll immediately connect patients to doctors in India,” he says. Afro-Asians spend up to an estimated $20 billion per year on healthcare outside their countries.
A 2007 study by Venkata Krishna Prasad classifies medical tourists into three groups. The first group, he says, is made up of the Americans and Europeans travelling for facelifts, dental treatment, botox treatments, tummy tucks et al – surgery not covered by medical insurance.
The second large group is of travellers from the Middle East. An agency in Saudi Arabia estimated that each year more than 5,00,000 people from the Middle East travel seeking medical treatment, and India attracted 70,000-plus medical travellers from the region in 2006. Thukral says, “Iraq’s local health care system is not in place. Even if they have the money, it is difficult for them to go to hospitals in the UK or the US. India always welcomes them. Oman, Yemen, East Africa, Tanzania, Ethiopia, Ghana are the most promising countries with the same paying capacity as patients from the US and the UK .”
The third group is from countries with generally poor infrastructure, who seek treatment at a neighbouring country. Countries such as Bangladesh, Pakistan and Nepal come under this category.
Service providers encourage this group because there is instant familiarity with Indian food and lifestyle. The Americans and the Europeans, on the other hand, are classified as “headache clients”. According to IMTA, “people coming from the Indian subcontinent – Bangaldeshi patients, people from Nepal, Bhutan, Sri Lanka and other SAARC countries make up about 35% to 40% of all medical travellers.”
A world of difference
Healthcare policies, wars, strained political relationships, accessibility all affect the medical tourist. “Patients from UK and the US make up less than 7% to 8% of the total. The new healthcare policy in the US will have a bearing on our industry,” says Thukral.
Many Indian hospitals such as Fortis and Apollo have already tied up with US corporate clients to treat their employees.
India’s many USPs
“Medical tourism in India is not a cost arbitration story. You can’t quick-fix a heart. Medical treatment in India is better than what is available in the developed world,” says Thukral, listing India’s benefits, including the fact that an Indian surgeon would hone his skills on four to five surgeries a day compared to the same number handled by a doctor in the US in a month. “Patients are paying less money for superior service. Consumers move where they have the best value for money,” he says.
Cost is a factor. The cost of medical services in India is almost 30% lower than Western countries and the cheapest in South-East Asia. A report by the Planning Commission says that while a heart bypass surgery may cost a patient $6,000 in India, the same surgery will set him back $7,894 in Thailand, $10,417 in Singapore and almost quadruple or $23,938 in the US.
According to the American Medical Association data, as against a charge of $5,000 for a spinal fusion in India, a patient will pay $62,000 in the US, $9,000 in Singapore and $7,000 in Thailand.
India is noted for an average of 99.5% success rate of physiotherapists helping patients regain their physical fitness after surgery. In addition, tele-consultancy is a rapidly growing service available for expert opinion and information transmission.
Language is another factor. In the medical field, India enjoys the same advantage as it does in outsourcing.
The government as stakeholder
Today, medical tourism gets instant recognition with many state tourism boards. Tourism minister Jay Narayan Vyas of Gujarat told TGI in an earlier interview: “We have already undertaken a Rs100 crore project for the construction of an Ayurved College and a 300-bed Ayurved hospital. ”
Karnataka is taking aggressive steps in this direction. Director, tourism K Viswanatha Reddy of Karnataka Tourism says, “We are projecting Bengaluru as the best place to get the most sophisticated, yet cheap medical help.”
The Ministry of Tourism’s Market Development Assistance (MDA) scheme offsets overseas marketing costs for travel companies earning foreign exchange. By opening up the MDA, hospital groups will be made eligible for financial assistance, including publicity through printed material, travel and stay expenses for sales-cum-study tours and participation fees for trade fairs and exhibitions.
The Government has also been working towards providing priority medical visas. However, much needs to be done in this regard. Patients often have to personally visit their local Indian embassy more than once before being granted a visa. Embassies are not very sympathetic to patient needs or urgency. The longest wait time is about two to three weeks. “We are urging the government to introduce a visa-on-arrival scheme for many countries and modify the medical visa scheme,” says Thukral.
The National Health Policy declares that treatment of foreign patients is legally an “export” and deemed “eligible for all fiscal incentives extended to export earnings.”
The caregiver as a tourist
One of the most important persons for a medical travel agency is the caregiver. While the person has no medical needs, he often doubles as counsellor, says Dr Thakker.
Patients tend to stay longer because long flights and decreased mobility in a cramped airline cabin are a known risk factor for pulmonary embolus economy class syndrome. Medical tourism patients often combine their medical trips with vacation time.
“Many people come in looking for a holiday, as well as for medical reasons. In places like Goa, Delhi and Agra, large hospital chains have come up because 10% of people are medical tourists, while the rest are medical travellers,” says Thukral.
Process
Typically, the person seeking medical treatment abroad contacts a medical tourism facilitator. During the course of the first conversation, the facilitator requires the patient to provide a medical report, including the nature of ailment, local doctor’s opinion, medical history and diagnosis, and may request additional information.
“We immediately put him in touch with three different experts. The opinion is free of cost. After that, we arrange a teleconferencing call,” says Dr Bhojwani. The approximate expenditure, choice of hospitals and tourist destinations, and duration of stay, etc, is discussed. After signing consent bonds and agreements, the patient is given recommendation letters for a medical visa, to be procured from the concerned embassy. “Sometimes the embassy requires the patient to be checked by their doctor,” says Thukral.
“An average patient takes about four to six weeks to come to India once he has initiated contact. Some patients are short-term conversion. The shortest time period they stay in India is five days, the average is nine days, and the longest can be many months. Cancer patients need to be updated for at least a year,” says Dr Bhojwani.
The category of patients that can’t be overlooked is that of the domestic health traveller. “In some ways, the foreign health tourist is incidental to our needs. I believe there is a lot of potential in domestic health tourism, which has not been addressed at all. Places in North Maharashtra and MP borders are deficient in health infrastructure, and they all travel for treatment,” says Dr Thakker.
Zee Zest Unlimit Awards 2024: A spectacular evening of excellence and glamour
Leisure Hotels Group introduces new ‘Sociotel’ concept
JM Financial Private Equity invests Rs 45 Crore in Energy Beverages Pvt Ltd
Fortune Hotels inks a new alliance in Palampur
Pride Hotels debuts in Punjab
One Rep Global inaugurates luxury roadshow, ‘One Edge’