A GLOBAL/ COUNTRY STUDY AND REPORT ON “MEDICAL TOURISM OF BANGLADESH” Submitted to Gujarat Technological University IN PARTIAL FULFILMENT OF THE REQUIREMENT OF THE AWARD FOR THE DEGREE OF MASTERS OF BUSINESS ADMINISTRATION UNDER THE GUIDANCE OF Prof. (Dr.) Mamta Brahmbhatt SUBMITTED BY Priten Khandavi (11769059209 0) Jay Bhatt (11769059202 1) Mukesh Chaudhary (11769059208 9) Parth Mehta (11769059206 2) Uday Chabhad (11769059208 8) [Batch: 2012-13] MBA Sem III/IV
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A
GLOBAL/ COUNTRY STUDY AND REPORT
ON
“MEDICAL TOURISM OF BANGLADESH”
Submitted to
Gujarat Technological University
IN PARTIAL FULFILMENT OF THE
REQUIREMENT OF THE AWARD FOR THE DEGREE OF
MASTERS OF BUSINESS ADMINISTRATION
UNDER THE GUIDANCE OF
Prof. (Dr.) Mamta Brahmbhatt
SUBMITTED BY
Priten Khandavi (117690592090)
Jay Bhatt (117690592021)
Mukesh Chaudhary (117690592089)
Parth Mehta (117690592062)
Uday Chabhad (117690592088)
[Batch: 2012-13]
MBA Sem III/IV
Shri Jairambhai Patel Institute of Business management and Computer ApplicationMBA PROGRAMME
Affiliated to Gujarat Technological University, Ahmedabad MAY-2013
1
DECLARATION
We, the undersigned students, declare that the conceptual framework of this Global/Country
Study Report entitled “MEDICAL TOURISM OF BANGLADESH’’ has been developed
based on the detailed literature from the websites, books as shown in the bibliographical
reference. We have quoted several statistics, notes, opinions and other information directly
from various government/academic/industry sources with the clear mention of the source of
information. Apart from all this, all other opinions, remarks, inferences and analysis are our
own and original creation.
Moreover, we also declare that for this work, either G.T.U. or any other university has not
conferred any degree or diploma to us before.
Priten Khandavi (117690592090)
Jay Bhatt (117690592021)
Uday Chabhad (117690592088)
Mukesh Chaudhary (117690592089)
Parth Mehta (117690592062)
Place: Gandhinagar
Date:
2
3
ACKNOWLEDGEMENT
We would take the pleasure of thanking all the people, without their support and help, it
would not have been possible to prepare this project.
We take this opportunity to thank Gujarat Technological University by providing an
opportunity to learn and understand a particular industry in a foreign nation.
We would like to express our sincere thanks to the director of our institute Dr. S O Junare
for his constant support and motivation.
Our Hearty thanks go to our project guide Prof. (Dr.) Mamta brahmbhatt, without whose
guidance and encouragement the project study wouldn’t have been possible.
Finally, thanks to our beloved family, whose devotion and candid dedication always inspired
us and encourage us to achieve better off.
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PREFACE
As we are very much interested in business, we chose the course of Business Administration.
M.B.A. Programme is related with administration and management. It is a professional course
rather than vocational and the profession requires the situational how it exists in practical.
The Master of Business Administration Programme is well structured two year post
graduation Programme organized by GTU (Gujarat Technological University) -Ahmadabad.
The Gujarat Technological University prescribes “Global Country Report (GCR)” by
M.B.A. students and then presents a report to them. Global Country Report is an integral part
of M.B.A. and all students have to undergo for GCR around last two semesters (Third &
Fourth Semester) and then prepare a report on the same after studying entire country over
view.
The main objective of GCR at M.B.A. level is to make students aware about Globalization
International business as well as application of management concepts in practical word. And
also to develop skill and knowledge in a student by supplement to the theoretical study of the
business management in general.
Only book knowledge and class-room discussion is not enough for management student.
The M.B.A. Programme provides student with a fundamental functions and actives as well as
an exposure to strategic thinking and management
5
TABLE OF CONTENT
SR PARTICULER PAGENO. NO.
1 Introduction Of Medical Tourism In India1.1 Overview of Medical Tourism in India 11.2 History 31.3 Medical tourism policy 101.4 Various Competitors And Participants In This 11
Market1.5 Medical Tourism Statistics 141.6 Factors affecting Medical Tourism 181.7 Disadvantages and Dangers of Medical Tourism 201.8 Key issues to the medical tourism industry in India 22
2 About Medical Tourism In India2.1 Medical Tourism Great Scope in India 242.2 Importance of Medical Tourism in India 252.3 Other important aspects related to Medical Tourism 30
Policy of Indian Government2.4 International Patient's Guide for Medical Care in India 31
2.5 Facilities/Treatments available in India 382.6 Reason Behind The Growth Of Medical Tourism In
India2.7 SWOT ANALYSIS
3 Medical tourism prospects in Gujarat
3.1 Gujarat Medical tourism 533.2 Policy and Regulation 583.3 Development of Healthcare in Gujarat 593.4 Expanding for better 62
4 Travel destinations countries4.1 Cost Comparison of Medical Treatments: India vs. 63
the World4.2 Destination countries of medical tourism 674.3 Process 684.4 Risk 684.5 Legal Issues 694.6 Ethical issues 704.7 Benefit 71
6
5 Packages and health medical mix
5.1 Health Marketing Mix 755.2 Product 805.3 Price 815.4 Place 855.5 Promotion 85
Image of the country plays an important role in patient‘s decision of choosing a
destination for his treatment. International patients first choose a country depending upon
their budget and more importantly, quality of healthcare infrastructure in the country.
Then they choose a state and then a city where they want to be treated. So, image of a
state as well as a city, local policies and regulations, transport infrastructure in the city –
whether or not the city has any international airport, image of the city – crime rate,
experience of other patients, social milieu are all become deciding factors in patients
choice. Any sort of regulation that directly or indirectly affects travel will affect
international medical travel as well.
Organizations like CII and FICCI organize regular events in these target countries
and encourage delegations from these countries to come and see the facilities that we
have. We ourselves have received several delegations from countries like Kenya and
Tanzania in the past. Government intervention or regulatory intervention is critical for
growth. ―When these patients arrive in the city, we have to notify to the police. Things
like their safety and security, stay and accommodation which may seem very minor for a
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person in India but are very important for a person coming from out of India,‖ Dr Sharma
adds.
Majority of experts agree on the statement that international medical tourism in
India will flourish. Central and state government has realised importance of medical
tourism and he role it can play in the growth of economy. Talking about government
support to promote medical tourism in India in countries abroad, Dr Sharma says,
government is trying well to sell India and medical excellence in India.
3.3 Development of healthcare in Gujarat
Development in medical infrastructure and easily accessible healthcare facilities
has remarkably improved the health index of the population in Gujarat over the last few
years. Well developed ports, roads, airports, rails are also said to be responsible factors.
Today Gujarat has made a rapid progression to the state-of-the-art tertiary care corporate
hospitals getting established in major as well as two and three tier cities. Changing
mindset of the patients who have become quality conscious and more aware of their
healthcare needs can be listed as one he reasons behind this rapid progression. Besides,
growing per capita income and want of specialised and sophisticated healthcare has given
further impetus to this healthcare boom.
Central and state Government has realised importance of medical tourism and the
role it can play in the growth of economy.
Experts agree that healthcare in Gujarat is evolving fast. Earlier most of the
patients from Gujarat used to go to Mumbai and metro cities for treatment. Over the time,
Gujarat has been able to build capabilities within the state reducing number of patients
going outside Gujarat for treatment to negligible. ―Healthcare in Gujarat is becoming
more structured and it will become more so in coming future. I am sure we are looking at
a very bright future as far as healthcare delivery in Gujarat is concerned,‖ says Dr
Sharma.
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For example the prices of some medical treatments packages at Apollo Hospital are given
below:
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Hospitals in India
India offers world-class healthcare that costs substantially less than those in developed
countries, using the same technology delivered by competent Specialists attaining similar
success rates.
Please find below some hospitals that are highly known for their respective specialties :
Apollo Hospital
B.M.Birla Heart Research Centre
Escorts- Heart Surgery and Cardiac Surgery Hospital
Fortis Healthcare
Christian Medical College
Tata Memorial Hospital
Indraprastha Medical Corporation
Institute Cardiovascular Diseases
AIIMS
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Internal medical travel from Gujarat has diminished. Ahmadabad is now recognized as a
city that can provide best-in-class healthcare delivery. That is a reason there are many
patients coming to the city from Rajasthan, which is not as developed as Gujarat in terms
of healthcare and medical infrastructure. ―Gujarat has a good healthcare system.
Government of Gujarat is very supportive; things move fast when it comes to hospitals or
healthcare-related issues,‖ Dr Shah says.
―We take care of our patient-clients just like their relatives would have ‖Devendra
Patel, Director, Medisoft Telemedicine
3.4 Expanding for better
Major corporate hospital groups such as Sterling, Shalby Hospitals, CIMS, Apollo
and Wockhard have made significant investments in setting up state-of-the-art hospitals
in major cities of Gujarat. The other major private players in the state are.
Expansion is happening not only in terms of beds, but also in terms of super specialties.
As Dr Sharma informs, Sterling Hospitals has won the crown of being the only hospital
in Gujarat to have achieved ability to perform functional neurosurgery. The hospital
recently performed a successful surgery for Writer‘s Cramp, achieving the title of being
the first hospital in India and one of the few hospitals across the world to perform this
surgery.
Sterling Hospitals is planning on expanding its facilities to Surat. Shalby
Hospitals is coming up with two new hospitals – one will be in Indore, Madhya Pradesh
and another will be in Naroda, Gujarat. Each will be a 250-bed hospital, together
expanding capacity of Shalby Hospitals by 500 beds.
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CHAPTER:-4 Travel destinations countries
4.1 Cost Comparison of Medical Treatments: India vs. the World
India has no parallels in healthcare when it comes to cost effective treatments in
comparison with other countries. Significant cost differences exist among US, UK and
South Asian countries. Add to it, the waiting time which is almost nil in case of India.
After all, your health cannot be put at stake due to long waiting lists.
The American Medical Association has made a cost comparison study of
healthcare in different countries. According to the statistics released by AMA, a knee
replacement surgery would cost $40,000 in US, $10,000 in Thailand and $13,000 in
Singapore, while the same surgery would cost the person $8500 in India. That gives India
a certain edge when it comes to reasonable medical treatments. In addition, Indian
doctors are renowned all over the world for their prowess and skills.
A heart valve replacement surgery would cost the patients $200,000 in the US and
$90,000 in Britain while it would cost $12,500 in Singapore and $10,000 in Thailand.
The same procedure in India would cost only $8,000. While a bone marrow transplant
would cost $30,000 in India, in US it would cost anywhere between $250,000 - $400,000
while in UK the cost would be of the order of $150,000. Doctors in Thailand would
charge $3,500 for cosmetic surgery while those in US and UK would charge $20,000 and
$10,000, respectively. But in India, it costs only $2000. No matter what procedure you
undergo, you are sure to save 75% to 95% of healthcare costs. Besides, India is a great
place to explore with rich heritage, architecture and culture. So you can always combine
your treatment with a holiday.
Although costs in European countries such as Germany and Belgium may be less
than that in the United States, but Europe is still more expensive than India. In fact, the
data of AMA shows that India is the least expensive when compared to European as well
as other Asian countries. Apart from the cost benefit, you will have the same
sophistication in healthcare in India as available in any western country. Tour operators
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like Indian Holiday provide medical tourism packages at competitive prices and offer you
a hassle free recovery from your ailments and a great holiday too!
So, if you are suffering and medical intervention is inevitable and urgent, and you
are hard pressed to pay from your savings, India is the best option for medical assistance.
Would you not go to a country where top-notch medical professionals provide care for a
fraction of the cost?
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Following cost comparison tables prove the financial viability of the Indian
healthcare industry:
Cost Comparison of Selected Surgeries:
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Cost comparison between India, Thailand and Singapore:
Procedure India Thailand Singapore
Heart bypass 10,000 11,000 18,500
Heart valve 9,000 10,000 12,500
replacement
Angioplasty 11,000 13,000 13,000
Hip 9,000 12,000 12,000
replacement
Hysterectomy 3,000 4,000 6,000
Knee 8,500 10,000 13,000
replacement
Spinal fusion 5,500 7,000 9,000
Different-different hospitals in India have different medical treatment packages which
includes in medical tourism packages.
Hospitals in India that provide such facility:
- Apollo Hospital
- B.M.Birla Heart Research Centre
- Escorts- Heart Surgery and Cardiac Surgery Hospital
- Fortis Healthcare
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- Christian Medical College
- Tata Memorial Hospital
- Indraprastha Medical Corporation
- Institute Cardiovascular Diseases
- AIIMS
4.2 Destination countries of medical tourism
Include: Argentina, Bolivia, Brazil,
Colombia, Cuba, Turkey, Thailand and Ukraine. In South America, countries such as
Argentina, Bolivia, Brazil and Colombia lead on plastic surgery medical skills relying on
their experienced plastic surgeons. In Bolivia and Colombia, plastic surgery has also
become quite common. According to the "Societal Bolivian de Cirugia Plastica y
Reconstructiva", more than 70% of middle and upper class women in the country have
had some form of plastic surgery. Colombia also provides advanced care in
cardiovascular and transplant surgery.
In Europe Belgium, Poland, Slovakia, and Ukraine are also breaking into the
business. South Africa is taking the term "medical tourism" very literally by promoting
their "medical safaris".
A specialized subset of medical tourism is reproductive tourism and reproductive
outsourcing, which is the practice of traveling abroad to undergo in-vitro fertilization,
surrogate pregnancy and other assisted reproductive technology treatments including
freezing embryos for retro-production.
However, perceptions of medical tourism are not always positive. In places like the US,
which has high standards of quality, medical tourism is viewed as risky. In some parts of
the world, wider political issues can influence where medical tourists will choose to seek
out health care.
Health tourism providers have developed as intermediaries to unite potential
medical tourists with provider hospitals and other organizations. Companies are
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beginning to offer global health care options that will enable North American and
European patients to access world health care at a fraction of the cost of domestic care.
Companies that focus on medical value travel typically provide nurse case managers to
assist patients with pre- and post-travel medical issues. They also help provide resources
for follow-up care upon the patient's return.
4.3 Process
The typical process is as follows: the person seeking medical treatment abroad
contacts a medical tourism provider. The provider usually 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. Certified physicians or
consultants then advise on the medical treatment. 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. The patient travels to the destination
country, where the medical tourism provider assigns a case executive, who takes care of
the patient's accommodation, treatment and any other form of care. Once the treatment is
done, the patient can remain in the tourist destination or return home.
4.4 Risks
Some countries, such as India, Malaysia, or Thailand have very different
infectious disease-related epidemiology to Europe and North America. Exposure to
diseases without having built up natural immunity can be a hazard for weakened
individuals, specifically with respect to gastrointestinal diseases (e.g. Hepatitis A,
amoebic dysentery, paratyphoid) which could weaken progress and expose the patient to
mosquito-transmitted diseases, influenza, and tuberculosis. However, because in poor
tropical nation's diseases run the gamut, doctors seem to be more open to the possibility
of considering any infectious disease, including HIV, TB, and typhoid, while there are
cases in the West where patients were consistently misdiagnosed for years because such
diseases are perceived to be "rare" in the West.
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The quality of post-operative care can also vary dramatically, depending on the
hospital and country, and may be different from US or European standards. Also,
traveling long distances soon after surgery can increase the risk of complications. Long
flights and decreased mobility associated with window seats can predispose one towards
developing deep vein thrombosis and potentially a pulmonary embolism. Other vacation
activities can be problematic as well — for example, scars may become darker and more
noticeable if they sunburn while healing.
Also, health facilities treating medical tourists may lack an adequate complaints
policy to deal appropriately and fairly with complaints made by dissatisfied patients.
Differences in healthcare provider standards around the world have been recognized by
the World Health Organization, and in 2004 it launched the World Alliance for Patient
Safety. This body assists hospitals and government around the world in setting patient
safety policy and practices that can become particularly relevant when providing medical
tourism services.
If there are complications, the patient may need to stay in the foreign country for
longer than planned or if they have returned home, will not have easy access for follow
up care.
4.5 Legal issues
Receiving medical care abroad may subject medical tourists to unfamiliar legal
issues. The limited nature of litigation in various countries is one reason for the lower
cost of care overseas. While some countries currently presenting themselves as attractive
medical tourism destinations provide some form of legal remedies for medical
malpractice, these legal avenues may be unappealing to the medical tourist. Should
problems arise, patients might not be covered by adequate personal insurance or might be
unable to seek compensation via malpractice lawsuits. Hospitals and/or doctors in some
countries may be unable to pay the financial damages awarded by a court to a patient who
has sued them, owing to the hospital and/or the doctor not possessing appropriate
insurance cover and/or medical indemnity.
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4.6 Ethical issue
There can be major ethical issues around medical tourism. For example, the
illegal purchase of organs and tissues for transplantation had been alleged in countries
such as India and China prior to 2007. The declaration distinguishes between ethically
problematic "transplant tourism" and "travel for transplantation". Medical tourism may
raise broader ethical issues for the countries in which it is promoted. For example in
India, some argue that a "policy of 'medical tourism for the classes and health missions
for the masses' will lead to a deepening of the inequities" already embedded in the health
care system. In Thailand, in 2008 it was stated that, "Doctors in Thailand have become so
busy with foreigners that Thai patients are having trouble getting care"..Medical tourism
centered on new technologies, such as stem cell treatments, is often criticized on grounds
of fraud, blatant lack of scientific rationale and patient safety. However, when pioneering
advanced technologies, such as providing 'unproven' therapies to patients outside of
regular clinical trials, it is often challenging to differentiate between acceptable medical
innovation and unacceptable patient exploitation. Some US employers have begun
exploring medical travel programs as a way to cut employee health care costs. Such
proposals have raised stormy debates between employers and trade unions representing
workers, with one union stating that it deplored the "shocking new approach" of offering
employees overseas treatment in return for a share of the company's savings. The unions
also raise the issues of legal liability should something go wrong, and potential job losses
in the US health care industry if treatment is outsourced.
Employers may offer incentives such as paying for air travel and waiving out-of-pocket
expenses for care outside of the US. For example, in January 2008, Hannaford Bros., a
supermarket chain based in Maine, began paying the entire medical bill for employees to
travel to Singapore for hip and knee replacements, including travel for the patient and
companion. Medical travel packages can integrate with all types of health insurance,
including limited benefit plans, preferred provider organizations and high deductible
health plans.
In 2000 Blue Shield of California began the United States' first cross border
health plan. Patients in California could travel to one of the three certified hospitals in
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Mexico for treatment under California Blue Shield. In 2007, a subsidiary of BlueCross
BlueShield of South Carolina, Companion Global Healthcare, teamed up with hospitals in
Thailand, Singapore, Turkey, Ireland, Costa Rica and India. A 2008 article in Fast
Company discusses the globalization of healthcare and describes how various players in
the US healthcare market have begun to explore it.
Traveling for medical management in another country for better technology,
services and standard, saving cost, availability and other reasons is medical tourism.
Millions of patients worldwide visit hospitals and clinics each year in countries other than
their own. India alone received 4, 50,000 patients in 2007 and they paid just 20% of what
hey would have paid in USA. Destination countries can be any one but India, Thailand,
Singapore, Malaysia, Philippines, Turkey Belgium, Hungary, South Korea Brazil, Costa
Rica, Panama, Mexico, USA are leading one.
You might go for medical tourism if -
1. You want to save up to 90% on world class medical treatment.
2. Insurance cover for you does not exist or is unknot sufficient.
3. Procedure advised to you is not offered in your country.
4. Insurance company does no cover procedure you plan to undergo.
4.7 Benefits
4.7.1 Cost savings.
The single biggest reason people travel to other countries for medical treatment is
the opportunity to save money. Depending upon the country and type of treatment,
uninsured and underinsured patients, as well as those seeking elective care, can realize 15
to 85 percent savings over the cost of treatment in the United States. Or, as one successful
health traveler put it, "I took out my credit card instead of a second mortgage on my
home." As baby boomers become senior boomers, costs of healthcare and prescriptions
are devouring nearly 30 percent of retirement and pre-retirement incomes. With the word
getting out about top-quality treatments at deep discounts overseas, informed patients are
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finding creative alternatives abroad. Airfare and lodging costs are governed by individual
preferences. To compute a ballpark estimate of total costs, add $5,000 to the amounts
shown in the table for you and a companion, figuring coach airfare and hotel rooms
averaging $150 per night. For example, a hip replacement in Delhi, India, would cost
about $10,000, for an estimated savings of at least $20,000 compared with the U.S. price.
The estimates above are for treatments alone. Airfare, hospital stay (if any), and lodging
vary considerably. Savings on dentistry become more dramatic when "big mouth-work"
is required, involving several teeth or full restorations. Savings of $15,000 or more are
common.
4.7.2 Better-quality care.
Governments of countries such as India and Thailand have poured billions of
dollars into improving their healthcare systems, which are now aggressively catering to
the international health traveler. VIP waiting lounges, deluxe hospital suites, and staffed
recuperation resorts are common amenities, along with free transportation to and from
airports, low-cost meal plans for companions, and discounted hotels affiliated with the
hospital. Moreover, physicians and staff in treatment centers abroad are often far more
accessible than their U.S. counterparts
4.7.3 Excluded treatments
Although health insurance policies vary according to the underwriter and
individual, your plan probably excludes a variety of treatments, such as cosmetic
surgeries, dental care, vision treatments, reproductive/infertility procedures, certain no
emergency cardiovascular and orthopedic surgeries, weight loss programs, substance
abuse rehabilitation, and prosthetics—to name only a few. Even the most robust health
insurance plans exclude a variety of conditions and treatments. You, the policyholder,
must pay these expenses out of pocket. In addition, many policies place restrictions on
prescriptions (some quite expensive), postoperative care, congenital disorders, and pre-
existing conditions. Rich or cash-challenged, young or not-so-young, heavily or only
lightly insured, folks who get sick or desire a treatment (even one recommended by their
physician) often find their insurance won't cover it. Confronting increasingly expensive
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choices at home, nearly 40 percent of American health travelers hit the road for elective
treatments. In countries such as India, Singapore, Dubai, and Thailand, this trend has
spawned entire industries, offering excellent treatment and ancillary facilities at costs far
lower than U.S. prices.
4.7.4 Unique Procedures.
Some procedures like orthopedic procedure known as hip resurfacing, a less
expensive alternative to the traditional hip replacement still no practiced in the United
States. While this procedure has been performed for more than a decade throughout
Europe and Asia, it was only recently approved in the United States, and its availability
here remains spotty. Some procedures and prescriptions are simply not allowed in your
country. Either Government or the Food and Drug Administration has specifically
disallowed a certain treatment, or perhaps it's still in the testing and clinical trials stage or
was only recently approved. Such treatments are often offered abroad. Hundreds of
forward-thinking Americans, many having suffered years of chronic pain, have found
relief in India, where hip resurfacing techniques, materials, and instrumentation have
been perfected, and the procedure is routine.
4.7.5 No waiting.
For decades, thousands of Canadian and British subscribers to universal, "free"
healthcare plans have endured waits as long as two years for established procedures.
"Some of us die before we get to the operating table," commented one exasperated
patient, who journeyed to India for an open-heart procedure. In the United States, long
waits are a growing problem, particularly among war veterans covered under the
Veterans Administration Act, for whom long queues are becoming far too common.
Some patients figure it's better to pay out of pocket to get out of pain or to halt a
deteriorating condition than to suffer the anxiety and frustration of waiting for a far-future
appointment and other medical uncertainties.
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4.7.6 Sufficient stay:
Medical travelers will welcome the flexibility at the best hospitals abroad, where
they are often aggressively encouraged to spend extra time in the hospital post-procedure.
Patient-to-staff ratios are usually lower abroad, as are hospital-borne infection rates.
There is no push out policy in overseas hospital, patient remains in hospital as longs as
necessary and for doctors and hospital.
4.7.7 Attraction of the new and different.
Although traveling abroad for medical care can be challenging, many patients
welcome the chance to blaze a trail, and they find the creature comforts often offered
abroad a welcome relief from the sterile, impersonal hospital environments so often
encountered in U.S. treatment centers. For others, simply being in a new and interesting
culture lends distraction to an otherwise worrisome, tedious process. And getting away
from the myriad obligations of home and professional life can yield healthful effects at a
stressful time. What's more, travel—and particularly international travel—can be a life-
changing experience. You might be humbled by the limousine ride from Indira Gandhi
International Airport to a hotel in central New Delhi or struck by the simple, elegant
graciousness of professionals and ordinary people in Thailand, or wowed by the sheer
beauty of the mountain range outside a dental office window in Mexico. As one veteran
medical traveler put it, "I brought back far more from this trip than a new set of teeth."
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CHAPTER:-5 Packages and health medical mix
5.1 Health Marketing Mix
Marketing mix is the set of controllable variables that an organization uses to influence
the target market. The four Ps have long been the basis for marketing strategy in most
industries and are increasingly being considered by healthcare organizations. Below
follows the implementation of 4 Ps to health services.
Product: the product decision involves deciding what goods or services should be offered
to a group of customers. ―An important element is new product development. As
technology and tastes change, products become out-of-date and inferior to competition so
companies must replace them with features that customers
Value: Product decisions also involve choices r regarding brand names, warranties,
packaging and the services which should accompany the product offering‖. The decision
of designing the product or service is crucial due to the fact that it gives the opportunity
to the company to keep a step ahead of its competitors. It is worth mentioning that before
designing the product, the company should take into consideration the future needs of
customers by formulating the market and being pioneer. In the health industry, the
product represents goods, services, or ideas offered by a healthcare organization. The
product is difficult to precisely be defined in healthcare, creating a challenge for
healthcare marketers. While, on the other hand, it is more difficult to quantify services
and consumers evaluate them differently from more tangible products. Health services
have changed and nowadays it is not necessarily the client himself who seeks medical
treatment but it can be the other way round. However it is the specific nature of the
―product‖ of healthcare that needs to be further explained and looked into.
Price: ―price in general is a key element of the marketing mix because it represents
a basis what the company receives for the product or service which is being marketed. All
the other elements represent costs, for example, expenditure on product design (product),
advertising and salespeople (promotion), transportation and distribution (place).
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Marketers, therefore, need to be very clear about pricing objectives, methods and the
factors which influence price setting. They also must take into account the necessity to
discount and give allowances in some transactions. These requirements can
influence the level of list price chosen, perhaps with an element of negotiation
margin built in (Jobber D., 1998:14). Price in the health services sector means that
a healthcare provider offers a service in exchange for its customers money. For
example, an employee paying an annual premium to a health plan, an insurance company
reimbursing a physician s fee and a consumer purchasing over-the-counter drugs are all
exchanges involving a specified price. In past pricing wasn't essential in the choosing of
medical tourism service segment. Cost effectiveness was negligible compared to the
desired result. Nowadays this has slightly changed but the introduction of private
insurance companies and the larger market share of private hospitals and clinics
has created a more competitive environment. Besides public hospitals are unable to
cope with the larger number of medical cases and needs, while furthermore private
hospitals offer diversified health packages depending on the patient financial
background. Due to the fact that the healthcare environment changes, the pricing for
health services is becoming a growing concern for marketers whose challenge is in
developing an understanding of what a customer is willing to exchange for some
satisfying good or service and a pricing approach compatible with the goals of the
organization and its cost constraints.
Promotion:―decisions have to be made with respect to the promotional mix: advertising,
personal selling, sales promotions and public relations. By these means the target
audience is made aware of the existence of a product or service and the benefits (both
economical and psychological) that it confers on customers (Jobber D., 1998:14)‖.
Regarding to health services, promotion represents any way of informing the market that
the organization has developed a response to meet its needs and includes the mechanisms
available for facilitating the hoped-for exchange. The promotional mix refers to the
various communication techniques such as advertising, personal selling, sales promotion,
and public relations or product publicity available to the marketer to achieve specific
goals. Nowadays marketing has moved from ―mouth to mouth‖ advertisement to more
sophisticated methods. It is not so strange anymore that health
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services should promoted and there is a rising interest in health related awareness and a
need to learn more in an accessible way. Also medical related world days have been
established to further promote public awareness. Finally the organizations through
their donations or sponsorship in charity or scientific research as an indirect
advertisement become popular.
Place:―place involves decisions concerning the distribution channels to be used and
their management, the locations of outlets, methods of transportation and inventory
levels to be held. The objective is to ensure that products and services are available in the
proper qualities, at the right time and place. Distribution channels consist of
organizations such as retailers or wholesalers through which goods pass on their way to
customers. Producers need to manage their relationships with these organizations
well because they may provide the only cost-effective access to the marketplace
(Jobber D., 1998:14)‖. Place in the health industry may refer to the location or the
hours a health service can be accessed. While in past years a physician could establish
an office in a location convenient for him, today the consumer increasingly
dictates the role of place in the marketing mix. In this, have also contribute the
economies of scale which have made modern and high tech equipment affordable to a
greater number of (even small) private hospitals and clinics in almost every city helping
prevent movement of clients to larger cities for specialized and complex medical
checkups. In some cases place factors may enhance perceptions of the quality of the
product, as when the physician s office or hospital is in a trendy location or on a
campus that facilitates efficiency of care. Also all major cities even the most remote are
able to ensure quality medical treatment for their citizens. Unfortunately
mountainous areas, small towns and little islands still lack complicated medical
equipment and have to move in many cases. Doctors who make house calls may be the
only way that home bound patients can get routine care. Systems or health plans
may speed up or hinder the setting of appointments by making them available
through online communications, for example. Finally, the ability to have one s
medical record available online has added a different dimension to the concept of place.
Health services
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According to the World Health Organization, health is a state of complete
physical, mental and social well-being and not merely the absence of disease or
infirmity. ―Essentially, health does not only mean diseases of body and soul but
also concerns a more general sense which has to do with an equilibrium state
between humans and the physical, biologic and social environment compatible with
full functional activity‖ ( Last JM., 1997:56). It can be seen that, health services are
organized so as to mediate in an effective way between health providers and people
who need medical care. Health care can be delivered by healthcare professionals,
dentists, nurses, pharmacies and other healthcare providers.
Figure 2.4: Production of health in society (Liaropoulos L., 20 07:66) Depending on the
nature of the health services they are classified as follows:
A. Primary Health Care
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―It is essential care made universally accessible to individuals and families in the
community by means acceptable to them, through their full participation and at cost
the community and country can afford. It forms an integral part both of the
country s health systems of which it is the nucleus and the overall social and
economic development of the country (World Health Organization 1978:12). ―The
purpose of existence primary care is something more than providing health care to
patients when it is needed. Health providers have to care for people throughout the course
of their lives. They should treat people as members of a community whose
health must be protected and enhanced and not as body parts with disorders that require
treating‖ (The World Health Report 2008: 11) This primary care requires among other
matters, accessibility to all patients and the existence of necessary therapeutic and
diagnostic centers which will be available to public 24 hours a day. This means
that a well-organized, political and financial supported system is required which
seems to be unaffordable to both developed and developing countries.
B. Secondary Health Care
The secondary health care is provided primarily by hospitals, by specific health
providers and health professionals who do not have the first contact with the patients.
However, the providers of health care may not necessarily work in hospitals as well as
hospitals can provide primary care services only in certain cases such as through the
outpatient clinic or laboratories. Institutional care is distinguished from non-hospital care
due to the fact that their main purpose is to provide collective services on an individual
basis. The various institutions, the main of which is the hospital, constitute the main
providers which gather medical knowledge of various sciences and expertise with
the purpose of investigation and treatment illness usually in its acute phase. The main
characteristic of institutional care is the reliance on the industrial or animation of
production where the division of labor enables many patients to benefit from
advances in scientific knowledge to the extent and in ways which are not possible on an
individual basis. ―The hospital or institution included in the general hospital sector
is a factor y of specialized services through a highly complex of production
process. Depending on the characteristics, hospitals can be distinguished according to:
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Their purpose or function
The type of cases that are hospitalized
Their legal form
Their geographic scope and the population with access to them
Their educational role (Liaropoulos L., 2007:74)
―Especially in Greece the secondary health services are provided by three
structures: a) the public hospitals which function is under the national health system and
responsible for their administration, organization, operation and financing is the state, b)
the public hospitals outside the national health system in which included the military
hospitals, the hospitals of some insurance agents such as the Social Insurance Institution
and the hospitals of Ministry of Justice and c) private hospitals and clinics that operate as
profit units‖ (Economou C., 2004:26)
C. Tertiary Health Care
―Tertiary y health care requires specialized knowledge and advanced equipment. It is
provided by university clinics which have the necessary technological infrastructure and
qualified staff in order to provide high expertise of health services. Depending on the
range of services provided, hospitals are divided into general hospitals which possess at
least surgical and pathological sector in specific parts and specific hospitals which have
hospitalization departments in one specialty. Finally, depending on the duration of
hospitalization divided into acute hospitalization and chronic disease situations‖
(Economic C., 2004:27).
5.2 Product: - Healthcare overseas Pvt. Ltd.
As of medical tourism provider offering various medical packages for our clients. The
basic motto of our company is to cater services to upper middle class family Bangladesh.
The basic advantage for them is cheapest treatment as compared to other countries like
U.S. and with the help of experienced doctor.
The services or the packages we offer are:-
1) Quit drugs habit treatment
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2)
3)
4) Heart surgery packages like Cardiac Surgery And Cardiology, Open Heart Surgery, Angiographies and Angioplasties.
5) Treatments of different skin problems including skin grafting
5.3 Price
Procedure Charges in India & USA
Procedure United States (USD) Approx India (USD) Approx
Bone Marrow transplant USD 2,50,000 USD 69,200
Liver Transplant USD 3,00,000 USD 69,350
Heart Surgery USD 30,000 USD 8,700
Orthopedic Surgery USD 20,000 USD 6,300
Cataract Surgery USD 2,000 USD 1,350
Smile Designing USD 8,000 USD 1,100
Metal Free Bridge USD 5,500 USD 600
Dental Implants USD 3,500 USD 900
Porcelain Metal Bridge USD 3,000 USD 600
Porcelain Metal Crown USD 1,000 USD 100
Tooth Impactions USD 2,000 USD 125
Root Canal Treatment USD 1,000 USD 110
Tooth Whitening USD 800 USD 125
Tooth Colored Composite USD 500 USD 30
Fillings / Tooth Cleaning USD 300 USD 90
COST COMPARISON – INDIA VS UNITED KINGDOM (UK)
Bone marrow transplantation surgery.
Knee replacement
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Significant cost differences exist between U.K. and India when it comes to medical
treatment. Accompanied with the cost are waiting times which exist in U.K. for patients
which range from 3 months to over months.
India is not only cheaper but the waiting time is almost nil. This is due to the outburst of
the private sector which comprises of hospitals and clinics with the latest technology and
best practitioners.
Procedure
Cost comparison between India, USA, Thailand, Singapore:
Procedure United Kingdom (USD) Approx India (USD) Approx
Open Heart Surgery USD 18,000 USD 4,800
Cranio-Facial surgery and skull base USD 13,000 USD 4,500
Neuro- surgery with Hypothermia USD 21,000 USD 6,800
Complex spine surgery with implants USD 13,000 USD 4,600
Simple Spine Surgery USD 6,500 USD 2,300
Simple Brain Tumor -Biopsy - USD 4,300 USD1,200
SurgeryUSD 10,000 USD 4,600
Parkinsons
- LesionUSD 6,500 USD 2,300
- DBS
USD 26,000 USD 17,800
Hip Replacement USD 13,000 USD 4,500
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Procedure US Cost India Thailand Singapore
Heart Bypass $130,000 $10,000 $11,000 $18,500
Heart Valve
Replacement $160,000 $9,000 $10,000 $12,500
Angioplasty $57,000 $11,000 $13,000 $13,000
Hip $43,000 $9,000 $12,000 $12,000
Replacement
Hysterectomy $20,000 $3,000 $4,500 $6,000
Knee $40,000 $8,500 $10,000 $13,000
Replacement
Spinal Fusion $62,000 $5,500 $7,000 $9,000
*approximate retail costs, US figures based on HCUP data, intl. figures based on hospital
quotes in named countries
Here's a brief comparison of the cost of few of the Dental treatment procedures between
USA and India
Dental Procedure Cost in USA ($) Cost in India ($)
General Dentist Top End Dentist Top End Dentist
Smile designing - 8,000 1,000
Metal Free Bridge - 5,500 500
Dental Implants - 3,500 800
Porcelain Metal Bridge 1,800 3,000 300
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Porcelain Metal Crown 600 1,000 80
Tooth impactions 500 2,000 100
Root canal Treatment 600 1,000 100
Tooth whitening 350 800 110
Tooth colored composite 200 500 25
fillings
Tooth cleaning 100 300 75
5.4 Package for course of quit drugs, drinking habit and smoking
habit. Name: Quit drugs habit organization.
Location: Nal sarovar
This course is available for Indian or non-Indian citizen.
Younger can also join this course without any hesitation.
Person who wants to join this course must follow the registration process.
No one can allow to using drugs during course.
Family residency is available with A/C rooms, food, and other supporting tools.
Only ayurvedic and homeopathic treatments are available.
Course handle by good skilled and experienced doctors.
For 1 person Rs 1, 00,000/- Indian rupees. Including with accommodation, food, total course of 30 days, medicines, and one day small picnic in a week.
For 1 person Rs 60,000/- Indian rupees. Including with accommodation, food, total course of 15 days, medicines, and one day small picnic in a week.
For 1 person Rs 1, 50,000/- Indian rupees. Including with accommodation, food, total course of 45 days, medicines, and one day small picnic in a week.
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Travelling charges from Mumbai to Ahmadabad by air and Ahmadabad to Nalsarovar by road are included.
Scheduled for course (MON TO SAT)
TIME PARTICULER5:00 AM TO 6:30 AM YOGA, EXERCISE, SPORTS ACTIVITY7:30 AM TO 7:45 AM BREAK FAST7:50 AM TO 11:50 AM MEDICAL TREATMENT12:00 PM TO 1:00 PM LUNCH BREAK1:00PM TO 3:30 PM PHYSICAL TREATMENT3:30 PM TO 4:00 BREAKFAST4:00 PM T0 7:00 PM PSYCHOLOGICAL TREATMENT7:00 PM TO 8:00 PM DINNER8:00 PM TO 10:00 PM OTHER ACTIVITY
Organization provide A/C car for traveling at cost of Rs. 13/- kmpl.
5.4 Place
Nalsorver
Knee replacement center.
5.5 Promotion
The key "selling points" of the medical tourism industry are its "cost effectiveness" and
its combination with the attractions of tourism. The latter also uses the ploy of selling the
"exotica" of the countries involved as well as the packaging of health care with traditional
therapies and treatment methods.
Price advantage is, of course, a major selling point. The slogan, thus is, "First World
treatment' at Third World prices". The cost differential across the board is huge: only a
tenth and sometimes even a sixteenth of the cost in the West. Open-heart surgery could
cost up to $70,000 in Britain and up to $150,000 in the US; in India's best hospitals it
could cost between $3,000 and $10,000. Knee surgery (on both knees) costs 350,000
rupees ($7,700) in India; in Britain this costs £10,000 ($16,950), more than twice as
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much. Dental, eye and cosmetic surgeries in Western countries cost three to four times as
much as in India.
The price advantage is however offset today for patients from the developed countries by
concerns regarding standards, insurance coverage and other infrastructure. This is where
the tourism and medical industries are trying to pool resources, and also putting pressure
on the government. We shall turn to their implications later.
The entire concept of medical tourism hangs on the efficiency, skill and competency level
of the doctors, specialists and consultants etc. World over patients and hospitals trust
Indian doctors without doubt. This is therefore an advantage for India. Patients from
around the globe expect the best of services solely based on the reputation of doctors of
Indian origin. But so far the government has failed to realize the advantage of this
important factor. This reputation and goodwill that Indian doctors enjoy could be
leveraged to attract and promote Indian medical tourism.
The other most important reason why India has not been able to attract more customers is
that there is no specific campaign which only promotes medical promotes medical
tourism. The incredible India campaign has catapulted India in the top 5 must visit unique
destination for lonely planet but so far as it goes Thailand, Bangkok and other east Asian
countries are still market leaders. Therefore there is still scope that with specific
marketing, advertising and promotion campaigns considerable number of tourists can be
attracted.
In India the strong tradition of traditional systems of health care such as in Kerala, for
example, is utilized. Kerala Ayurveda centres have been established at multiple locations
in various metro cities, thus highlighting the advantages of Ayurveda in health
management. The health tourism focus has seen Kerala participate in various trade shows
and expos wherein the advantages of this traditional form of medicine are showcased.
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A generic problem with medical tourism is that it reinforces the medicalised view of
health care. By promoting the notion that medical services can be bought off the shelf
from the lowest priced provider anywhere in the globe, it also takes away the pressure
from the government to provide comprehensive health care to all its citizens. It is a
deepening of the whole notion of health care that is being pushed today which
emphasizes on technology and private enterprise.
The important question here is for whom the 'cost effective' services is to be provided.
Clearly the services are "cost effective" for those who can pay and in addition come from
countries where medical care costs are exorbitant - because of the failure of the
government to provide affordable medical care. It thus attracts only a small fraction that
can pay for medical care and leaves out large sections that are denied medical care but
cannot afford to pay. The demand for cost effective specialized care is coming from the
developed countries where there has been a decline in public spending and rise in life
expectancy and non-communicable diseases that requires specialist services.
Urban concentration of health care providers is a well-known fact - 59 per cent of India's
practitioners (73 per cent allopathic) are located in cities, and especially metropolitan
ones. Medical tourism promotes an "internal brain drain" with more health professionals
being drawn to large urban centers, and within them, to large corporate run specialty
institutions.
Medical tourism is going to result in a number of demands and changes in the
areas of financing and regulations. There will be a greater push for encouraging private
insurance tied to systems of accreditation of private hospitals. There is a huge concern in
the developed countries about the quality of care and clinical expertise in developing
countries and this will push for both insurance and regulatory regimes. The potential for
earning revenues through medical tourism will become an important argument for private
hospitals demanding more subsidies from the government in the long run. In countries
like India, the corporate private sector has already received considerable subsidies in the
form of land, reduced import duties for medical equipment etc. Medical tourism will only
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further legitimize their demands and put pressure on the government to subsidies them
even more. This is worrying because the scarce resources available for health will go into
subsidizing the corporate sector. It thus has serious consequences for equity and cost of
services and raises a very fundamental question: why should developing countries be
subsidizing the health care of developed countries?.
Mediums of Promotions:-
Television
Radio
News Paper
Hoardings
Brochures
Internet websites
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Chapter 6 :-Recommendation
1. Here majority of the patients are from US, UK and Australia. So hospital should try to
capture the number of patients from other than these country.
2. The majority of the patients are coming for the Cardiac, Orthopaedic, Dental & Cosmetic
treatment, so our hospitals should develop super specialty ward and department to capture
more number of patients.
3. Our hospitals should develop alternative therapy ward or department like Ayurveda,
Yunani, Spa and Yoga along with the rehabilitation centres.
4. To increase the Advertisement of the Hospitals by using different media.
5. As most of the patients are satisfied with the Treatment and Facilities provided by the
hospitals, so hospitals should maintain them.
6. For patients who are dissatisfied with the treatment and facilities, hospitals should try to
know the reasons behind the dissatisfaction.
7. Hospital should reduced the Professional Attitude towards the NRIs patients.
8. Increase travel facility for the overseas tourists
9. Improve and modernize airport infrastructure and services.
10. Make more and more advertisement by using different medias to capture more market
shares.
11. Create public awareness about economic and social benefits of tourism.
12. The heath care centres can also dispatch membership card to their customers, this will result
in retaining of the customers for a longer period of time
13. The promoters should hold various campaigns in different nations and continents and offer
better discount packages.
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Chapter 7 :-Conclusion
India is a developing country and a lot needs to be done before we can call ourselves as a
developed country, all we can claim is to be a progressive one. After the dotcom boom in the
nineties we have gone through a lean patch as such. India as an emerging nation needs to grow
both from with in and outside; in the sense development needs to done both for the Indian
Diaspora and at the same time opportunities need to be grasped and developed so that overseas
investment pours in.
After the dotcom rush India has again got the opportunity to earn billions of dollars with medical
tourism . We have all the bases coved in the sense we have the qualified doctors and consultants,
we have already developed the trust of people the world over in the past decades and we also
have the exotic environment meant for tourism. All that we do need is to make the transition
from being a potential destination to a fully rewarding and sound medical tourism destination
which is equivalent to or better than any service offered world over.
The question that India will have to handle in the coming years is how to justify giving world
class medical care to visitors where as it spends just 1.4 % of its GDP on medical care of its own
people. Health of its own people will reflect on the robustness of the general state of the country.
So unless this is balanced off the issue of biasness will keep on cropping up.
Time and again we see that the root of all our national issues and problems arise from having an
inherently weak infrastructure with poorly executed law and order and political red tape.
Compounded with the problem of over population, dwindling natural resources and reckless
disregard for the environment we stand at a junction where things can go haywire or they might
become extremely successful if we only start resolving them. Currently it is like moving 1 step
ahead and then going 3 steps backwards. Medical tourism is based on having a well oiled
network of tour operators, medical facilities, hotels, conventional tour packages and
infrastructure tools such as electronic connectivity, air network and good sanitation. Only then
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we can compete with already established markets such as in Thailand , south American states
such as Mexico and Costa Rica etc.
Although the situation appears to be grim there is still hope. One step at a time is all that is
needed. First and foremost is to have the basic infrastructure in place such as having proper road
and rail connectivity, having a good network of airports to all the major states and cities and with
the countries from where the potential tourists will arrive such as the US the middle east and
western Europe and also the major African and Islamic countries in Asia. Secondly but more
importantly there is a need to put forward the information required by the tourists. Aggressive
marketing is the only way to go as seen in the case of Thailand, Singapore , malyasia etc. Not
only that there should be government authorized websites where people can get all the
information regarding surgeries, hotels, cost comparison etc . They have to be developed
exclusively for the medical tourism purpose. Twenty four hours helpline, television
advertisements, getting information and advertisements published in medical journals and
popular magazines etc is a worthwhile investment. We have already seen how successful the
Incredible India campaign is. Based on similar line but exclusively for medical tourism other
such campaigns must be developed.
Since India already has the advantage of having highly qualified, English speaking doctors and
medical staff it seems just a matter of time when medical tourism will take off in a big way. We
have the cost advantage, we have the skills advantage we even have world class facilities and so
all we need is a better image, a functional infrastructure and some clever promotional campaign.
This is a golden opportunity which we cannot pass up. Not only that the overseas currency that
we earn is going to give our own people various benefits. It just seems like a circle in which all
the bodies who participate have a win win situation on hand.
The idea of doing this project was to bring to light how medical tourism is the 21 st century‘s
golden goose for India. Bringing out all the true facts, the weak points and in general trying to
understand the phenomenon itself of medical tourism has been insightful. This project has been
laborious since finding out relevant information is difficult and there are very few sources to find
it out from. It has been worthwhile doing this project on medical tourism since it is an upcoming
industry with lots of potential and also facing various difficulties. The main idea
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behind doing this project was to highlight all the important features and data and give atleast a
birds eye view over the concept of tourism for medical purpose.
In conclusion We can easily say that medical tourism for India is a once in a life time
opportunity and we certainly need to take up on our strong points in order to become the leading
nation in this area. We hope we have done justice to my project and based on the data collected
we might easily say that India is the place where people come to heal themselves since god‘s
grace seeps and flows through all the pores of India.
We are a nation of people who feel honor in helping out and healing the mind and the spirit. I
therefore dedicate this project to all the worthy doctors and medical professionals and to India
my mother and may gods will guide us to to a better and prosperous era.