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Medical Tourism in India

Last updated on January 14, 2023 by ClearIAS Team

Medical tourism is described as any activity that involves a foreign visitor traveling and spending at least one night at the destination to rejuvenate, restore, or maintain health through medical intervention. Since the last decade of the 20th century, India has emerged as a global leader in the medical tourism sector. Read here to learn about the growth of medical tourism in India.

Over the past decade, India has gained a reputation for providing high-quality medical service at low costs to medical tourists traveling from across the globe.

However, with the travel bans during the covid-19 pandemic , the influx of medical tourists had dipped. According to the Tourism Ministry, India registered a negative growth of 79.4% in 2020.

Although, the situation looks positive once more owing to the efforts made to handle the pandemic situation. Market insights suggest the demand forecast to increase at a robust 19 % CAGR in 2022.

Table of Contents

Medical tourism in India

India’s healthcare industry offers a combination of both modern and traditional forms of medicine which sets the country apart from others.

• First, it has a set of world-class doctors and hospitals that provide treatment at fractional rates when compared to other countries.
• Secondly, India’s systems of medicine: AYUSH i.e., Ayurveda, Yoga, Panchakarma, Rejuvenation Therapy, etc, which are the most ancient forms of medicine, are now gaining immense popularity globally.

The government also recently announced plans to launch an AYUSH Mark which is a mark to provide credibility to AYUSH products in India and promote India’s medical tourism sector.

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Additionally, the other medical services and facilities are also backed by the World Health Organisation (WHO) and the US Food and Drug Administration (US FDA).

India’s healthcare industry has advanced significantly over the past 30 years, as seen by the notable accomplishments it has made.

• One of the industries that have contributed the most to revenue and are expanding quickly is healthcare.
• Both public and private providers support the healthcare industry. Over the past few years, national health policies have been crucial in establishing a more inclusive healthcare system to achieve structured Universal Health Coverage (UHC).
• In addition, India provides less expensive treatment alternatives than the US and the UK without sacrificing the standard of healthcare. About one-fourth, less is spent on therapy in India than it is in the United States.

In terms of alternate medical treatment, the Indian medical treatment systems of yoga, ayurveda, rejuvenation therapy, and panchakarma are among the most ancient methods of medical treatment in the world.

The southern state of Kerala has developed medical tourism services as one of its core products for promoting tourism in the region.

Based on the Medical Tourism Index 2020-21, India is ranked 10th out of the top 46 countries, 12th out of the world’s top 20 wellness tourism markets, and 5th out of 10 wellness tourism destinations in Asia-Pacific.

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• India boasts 39 Joint Commission International (JCI) accredited and 657 National Accreditation Board for Hospitals & Healthcare Providers (NABH) accredited hospitals.

India holds an advantage as a medical tourism destination due to the following factors:

• Most of the doctors and surgeons at Indian hospitals are trained or have worked at some of the medical institutions in the US, Europe, or other developed nations.
• Most doctors and nurses are fluent in English.
• Top-of-the-line medical and diagnostic equipment from global international conglomerates is available at many Indian hospitals.
• Indian nurses are among the best in the world. Nearly 1000 recognized nurses-training centers in India, mostly attached to teaching hospitals, graduate nearly 10,000 nurses annually.
• Even the most budget-conscious traveler can afford first-rate service and luxury amenities

Most of the tourists are from Asian or African countries such as Sri Lanka, Bangladesh, Nepal, Maldives, Indonesia, and Kenya, among others.

Chennai, Mumbai, New Delhi, Ahmedabad, and Bengaluru are the top 5 medical tourism destinations in India.

Wellness tourism

Wellness Tourism includes travel for a less stressful lifestyle, promoting a healthier, and finding balance in one’s life.

Ayurveda, Yoga, meditation, Panchakarma, and Rejuvenation Therapy are among the most ancient systems of medical treatment in India and the best way to promote Wellness Tourism.

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The Ministry of Tourism has drafted guidelines for wellness tourism. These guidelines address issues regarding making available quality publicity material, training and capacity building for the service providers, participation in international & domestic Wellness related events, etc.

Mushrooming of wellness centers in the country has given rise to the concern for quality service.

• The Guideline for the Accreditation of wellness centers has been developed by National Board for Accreditation of Hospitals & Healthcare Services (NABH) in consultation with AYUSH and released during the workshop on wellness tourism organized by the Ministry of Tourism in 2011.
• The Ministry of Tourism has also extended its Market Development Assistance (MDA) scheme to wellness tourism service providers including accredited wellness centers.

Impact of Covid-19 on medical tourism

Planned hospital operations decreased by as much as 80% during the state-wide lockdown in India caused by the new coronavirus outbreak, while unplanned systems decreased by 66%.

With the government of India’s assistance, the healthcare sector launched a comprehensive response strategy to combat the epidemic.

• Specialized COVID-19 hospitals and isolation facilities were established, and resource mapping using technology was started.
• The Indian government created several programs and used technology to combat the pandemic.
• The Aarogya Setu app was utilized across the nation to improve contact tracing, syndromic mapping, and infection self-evaluation.
• India not only met its own needs but also stepped up to help other nations during these difficult times.

Despite having several initiatives in place, the Medical Tourism industry of the country still faces some serious challenges.

• One of the major challenges that India is facing is promoting and creating awareness about state-of-the-art facilities in India.
• India is witnessing strong competition from destinations like Thailand, Malaysia, Singapore, Turkey, and South Korea with low-cost options.
• In India, there is a lack of cohesiveness amongst the major players in the industry to come together and represent India on a world platform to acquire newer customers.
• Apart from these, inconsistent fee structure and lack of transparency in billing to foreign patients, and absurdly high margins to trade to refer patients are some of the challenges.
• Most Indian hospitals are also facing a lack of trust from foreign patients. The hospitals have observed poor hygiene awareness in medical attendants, unhygienic food handling, and lack of good hospitality services, heterogeneous pricing of services, and industry standards.

The government can play a vital part to upgrade the medical tourism sector. But the industry is facing the following problems which are caused by the governments. They are:

• no regulations
• taxation anomalies
• bureaucratic roadblocks
• no work on land reforms
• lack of long-term investor-friendly policies
• instability concerning terrorism and communal tensions.

On the part of insurance and allied services, the medical tourism industry in India is also facing some key bottlenecks. They are:

• inadequate insurance cover
• the underdeveloped insurance market in India
• insurance frauds
• overseas companies refusing reimbursement.

The following challenges, due to the infrastructural parts of the medical tourism sector in India, are:

• lack of access
• dearth of capital
• Lack of community participation and awareness
• Non-participation in the rural sector
• lack of concern for sustainability
• complex visa procedures
• lack of good language translators
• airport facilities still being inadequate

Government initiatives for medical tourism

The government has implemented various initiatives to overcome the challenges and push India’s rise as a hub of medical tourism through the promotion of ayurveda, yoga, and other Indian systems of medicine in the international market.

Heal India Initiative:

• Heal in India is a new initiative developed under Ayushman Bharat Digital Mission in which there will be healthcare professionals, and hospital services to help patients seeking medical help in India.
• With this type of initiative, Government aims at promoting Medical Tourism in India via Heal in India Portal.
• It’s another Programme called Heal by India Government that aims to encourage Indian Health care Workers to go abroad and serve patients globally.

Market Development Assistance (MDA) scheme

• MDA scheme offers financial assistance to approved tourism service providers.

Medical Visa provisions

• Special provision has been made for tourists traveling to India for healthcare purposes.
• The Ministry of Home Affairs has introduced a new category of visa, Medical Visa, that can be issued to foreigners traveling to India for healthcare reasons.

Setting up a feedback mechanism to obtain testimonials from tourists traveling to the country for medical purposes.

• This ‘one-step’ portal would add convenience and provide credible information for medical tourists coming to India.

Way forward

To become the top-most medical travel destination, there is a need for significant investments into making the healthcare industry and equipment attractive for international patients.

• Patients spend most of their time in guest houses and are prone to further infections from such places.
• Thus, proper infrastructure and standardization need to be brought into the tourism industry and the nexus of guest house service providers urgently.
• Another aspect that needs to be tapped into is the opportunity for selling Indian health insurance to foreigners. This can generate an additional $9 billion in patient inflow to India.

The government is pulling out all its aces to maximize the industry’s potential. The aim is to make India the No.1 Destination for Medical Tourism in the world, tripling its revenue to $13 billion within 4 years.

The government has also proposed an outlay of US$ 28.7 billion for health and well-being, which is 137% higher than the previous year’s budget outlay.

In the post-Covid world, the demand for the healthcare industry is bound to surge and there is a huge potential for India to realize and aggressively advance towards attracting medical tourists from other parts of the world including Europe and the Americas.

With the government making it their priority to make India the hub of medical tourism, the initiatives combined with the surging demand are sure to make India the center for all medical tourists in the future.

-Article written by Swathi Satish

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Medical tourism in india : next growth driver - current affair for upsc, ias, civil services and state pcs examinations.

Why in News?

According to the market study, titled “Discover Global India Medical Tourism Market Upcoming Trends, Growth Drivers and Challenges”, Indian medical tourism market is expected to more than double by 2022 from its current size in 2016. India has emerged as a preferred healthcare and wellness destination for patients across the globe. As medical treatment costs in the developed countries is ballooning, more and more Western countries are finding the prospect of international travel for medical care increasingly appealing.

Introduction

The modern healthcare and wellness industry revolves around accessibility and affordability. In developed countries like the USA, healthcare services are quite expensive. Besides cost, long waiting lists and limited treatment options are major hindrances in most Western countries. Whereas in developing or least developed countries, factors like domestic policy reform, political instability, travel restrictions, availability of modern healthcare infrastructure and medical personnel all contribute to the demand for affordable healthcare. This is where medical tourism as a niche has emerged.

India has always been known for its rich heritage of ‘wellness’ traditions and has enormous possibilities to offer to ‘wellness’ seekers. The Indian wellness industry is one of the fastest growing segments of the travel and leisure industry. India has the potential to become a leading ‘wellness’ destination for the global travellers. The Indian healthcare sector, particularly the private entities, boast state-of-the-art infrastructure along with well-qualified practitioners.

This has led to foreign tourists coming in for affordable treatment, while eventually allowing for tourism at other sites of the country. Indian healthcare industry also competes with the best in the world in terms of, infrastructure, technology, specialist doctors and nurses. The country has the finest and one of the largest pools of doctors and paramedics in South Asia, with many of them being of global repute. India’s expertise in highly specialized areas of organ transplants, cardiology, oncology, etc. has made India an emerging hotspot for medical value travel.

India has an unmatched heritage represented by its ancient and ageold traditional treatment methods, such as Ayurveda, Yoga, Unani, Siddha and Homoeopathy (AYUSH), which have time and again proved its efficacy for the patients and are now widely accepted as alternative treatment procedures in many geographies. In recent times, more and more patients are coming to India to benefit from the time tested and health-restorative AYUSH treatments in combination.

What is Medical Tourism?

Medical tourism (also called 'Medical Travel', 'Health Tourism' or 'Global Health Care') is a term used to describe the rapidly growing practice of travelling across international borders to seek medical services. Services typically sought by travellers include elective and essential procedures as well as complex surgeries etc. In other words, it may be defined as ‘activities related to travel and hosting a foreign tourist who stays at least one night at the destination region for the purpose of maintaining, improving or restoring health through medical intervention'.

Such medical intervention may be broadly classified into following three categories:

• Medical Treatment: Treatment for curative purpose that may include cardiac surgery, organ transplant, hip and knee replacement etc.
• Wellness & Rejuvenation: Offerings focused on rejuvenation or for aesthetic reasons such as cosmetic surgery, stress relief, spas etc.
• Alternative Medicine: AYUSH would be the major category under it.

Of late, medical tourism is transitioning towards 'Medical Value Travel' (MVT). MVT, as a term, has started to gain currency in order to define visits by overseas patients for availing medical treatment. The reason behind MVT’s popularity may be attributed to the fact that it captures patient’s healthcare seeking behavior as well as the wider economic impact of such travel on nations hosting them.

Medical Tourism Industry in India

According to the Ministry of Tourism, the provisional estimates of total Foreign Exchange Earnings (FEE) through medical tourism during 2015, 2016 and 2017 were INR 1,35,193 crore, INR 1,54,146 crore and INR 1,77,874 crore, respectively. Furthermore, NITI Aayog in its report has identified MVT as a major source of FEE. India currently has around 18 per cent of the global medical tourism market. According to a report by FICCI and IMS Health. India's MVT was pegged at $3 billion in 2015 and is estimated to grow at a CAGR of 15%. It has been estimated that by 2020, India’s medical tourism industry could be worth $9 billion and account for 20% of the global market share.

A rare combination of advanced facilities, skilled doctors and low cost of treatment has made India a popular hub of medical tourism, attracting a large number of foreign patients every year. The total number of such visitors in 2017 was 4.95 lakh. This number had stood at around 2.34 lakh in 2015 and 4.27 lakh in 2016.

Bangladesh and Afghanistan continued to be the top countries from where the maximum number foreign tourist arrivals (for medical purpose) were seen. In 2017, about 2.21 lakh tourists from Bangladesh are estimated to have come to India for medical reasons, compared to 1.20 lakh in 2015 and 2.10 lakh in 2016. Likewise, the number of medical tourists from Afghanistan stood at 27,505 in 2015 and 61,231 in 2016. The number declined to 55,681 in 2017.

Other countries from where large numbers of medical tourists came to India include Iraq, Oman, Maldives, Yemen, Uzbekistan and Sudan. The report pointed out that in curative care, India was the preferred destination for cardiology, orthopaedics, transplants, and ophthalmology. India also enjoyed high credibility in wellness, preventive, and alternative medicine (AYUSH).

Dental tourism is another area under medical tourism and accounts for 10% of the medical tourism. The government is keen to promote it.

Factors Driving Health Tourism in India

India holds an advantage as a medical tourism destination due to the following factors:

• India has over 500+ Accredited Healthcare providers (JCI & NABH) and uses world-class technologies at par with the western world. Indian Doctors are known for their excellence across the globe, one of the studies reveals that over 10 per cent of the doctors practising in the UK and US are Indian.
• High quality nursing capability providing high or equivalent standards of medical care as in patients home country.
• The cost of quality of medical procedures and services are low in India when compared to other competitors in the field.
• Use of modern medical technology, high-quality implants and internationally accepted medical supplies.
• Diverse geography with numerous tourism destinations to suit the patients schedule.
• Modern hospital and hotel facilities, good air and surface transport, developed tele-communications network and improving tourism infrastructure.
• Medical wisa norms have been simplified to ensure hassle-free visa for medical patient and attendant.
• India is known for offering alternative medicines and has certified and accredited wellness and ayurveda centres.

Other Side of the Coin

Approximately 22% of the Indian population lives below the poverty line and many do not have access to healthcare services. Despite being a fundamental right under Article 21, primary healthcare remains in shambles. The under-investment in the primary healthcare sector is evident from the fact that public health expenditure constitute 1.16 % of GDP whereas, in 2016-17, it was approximately 1.4 %. This is way below the world average of 6%.

Furthermore, healthcare in India is considered the most affordable across the globe, yet for most Indians it is expensive. Additionally, the rate of Indian’s out-of-pocket spending on healthcare is one the world’s highest since the health insurance penetration rate in India is approximately only 20%. World Banks’s 2017 report on ‘Tracking Universal Health Coverage’ also points out the “catastrophic spending on health” by Indians, illustrating that outof- pocket medical expenditure exceeds 10 and 25% of household total income or consumption.

While the government has taken several progressive steps concerning medical visas, more can be done to ease the travel of medical tourists to India. Additionally, the market continues to be largely unregulated, with several informal agents and intermediaries connecting prospective patients to health facilities. Domestic or international accreditation has been acquired by a relatively small number of health facilities, primarily hospitals.

Most importantly perhaps, there is considerable lack of awareness in target markets about India’s capabilities, infrastructure and cost advantage in the health and wellness space. In many countries, there are misconceptions about India’s traditional systems of medicine such as Yoga and Ayurveda which are often perceived to be exclusive to Indian culture or even related to religion, instead of means for promoting healthy living.

Government Initiatives

Government is promoting the emergence of India as a medical destination to the world.

The Ministry of Home Affairs (MHA) has taken several steps towards boosting medical tourism such as extending e-Visa to 161 countries. Besides, the MHA has extended the duration of stay on e-Visa from 30 to 60 days and also allowed triple entry in e-Medical Visa cases.

The Ministry of Tourism has recently released revised guidelines for the promotion of wellness and medical as niche tourism product. As per the guidelines, the ministry offers financial support to accredited medical and wellness tourism service providers, Chambers of Commerce and other organisations as marketing development assistance, for publicity, organising workshops/events/seminars and for organising wellness and medical tourism promotion shows.

Way Forward

India has already emerged as one of the major hubs for provision of care to MVT patients. With the given scale of healthcare infrastructure and the projected growth, India can further strengthen its standing among the current popular MVT destinations like Thailand, Singapore, Malaysia, Mexico etc.

In order to strengthen its position on medical tourism, India would need to focus on dual objectives of ‘tourism friendliness’ and ‘patient centricity’. However, achieving the stated vision of being ‘The Provider to the World’ would necessitate coordinated efforts by all key stakeholders be it government, providers, facilitators, regulators, insurers and soon.

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• Topic: Indian Economy and issues relating to planning, mobilization of resources, growth, development and employment.

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MEDICAL VALUE TRAVEL IN INDIA

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• India hosted the ‘One Earth One Health – Advantage Healthcare India – 2023’ programme in New Delhi , in a bid to promote India as a hub for medical tourism.

MEDICAL AND WELLNESS TOURISM: https://www.iasgyan.in/daily-current-affairs/national-strategy-and-roadmap-for-medical-and-wellness-tourism

Highlights of the Summit

• With 500 foreign participants from over 70 countries, the two-day summit aimed to promote the export of medical services from India.
• Another aim is to provide networking opportunities for Medical Value Travel (MVT) experts, industry stakeholders and professionals.
• Highlighting the Indian philosophy of ‘Vasudhaiva Kutumbakam’ (the world is one family), PM Modi said India sees medical value travel and health workforce mobility as important for a healthy planet.
• Urging countries to invest in India’s medicine industry, he pointed out that India ranked tenth globally for medical tourism, as per the Medical Tourism Index 2020-2021 (MTI).

Medical Tourism: An Introduction

• Atithi Devo Bhava ( अतिथि देवो भव :) is the core ethos of Indian hospitality, the guiding thought for hosts to go out of the way in treating guests with the same reverence as God. This philosophy guides the Indian tourism and hospitality sector to welcome tourists from all over the world and extend them an unforgettable experience.
• Coupled with the vastness of Indian land and water bodies, the geographic and cultural diversities, and rich historical and natural heritage, India is one of the most remarkable tourist destinations in the world.
• India also happens to have an extremely rich history of medicine going back to the Vedic times. Ayurveda, one of the oldest systems of medicine can be traced back to 8000 BCE. The Golden Age of Indian medicine can be traced back to 800 BCE and went on till 1000 CE, which witnessed the writing of Charak Samhita and Sushruta Samhita . Today, many modern methods of treatment and surgeries, such as rhinoplasty, find their roots in these literatures.
• Over the years, more streams of medicine like Naturopathy, Unani, Siddha, Sowa-Rigpa and Homoeopathy gained importance , along with Yoga and meditation, which are now acknowledged round the world for their health benefits.
• Post-independence, as India has progressed exponentially in the field of modern medicine, it has created a unique ecosystem for holistic health that combines the best of modern healthcare, alternative medicine, and wellness.
• It is the unison of this unique holistic health and wellness ecosystem, with its myriad possibilities that makes India the ultimate destination for Medical Value Tourism (MVT).

Defining Medical Tourism

• Medical tourism — also known as medical value travel, health tourism or global healthcare — is the practice of travelling across international borders seeking medical services, mainly elective or complex surgeries .
• Stakeholders in medical tourism include airlines, hospitals, wellness centres, and hotels, among others .
• Currently, the most sought-after destination for such procedures is Canada with its favorable environment, its robust medical tourism industry, and its top-quality facilities and services.
• While universal healthcare is available to its citizens, most government hospitals in Canada also cater to foreign patients.

Current State of Indian Medical Tourism

• India is ranked 10th out of the top 46 countries in the world in the Medical Tourism Index 2020-21 by Medical Tourism Association.
• Medical tourism in India has been on the rise in the past decade – with most patients hailing from Bangladesh and Afghanistan.
• From 2015-2018, the number of foreign medical tourists steadily increased from 2.34 lakhs to 4.95 lakhs .
• Apart from India’s neighbours, tourists from Iraq, Oman, Maldives, Yemen, Uzbekistan and Sudan chose India for medical services due to advanced facilities, skilled doctors and low cost of treatment.
• NITI AAYOG pegged India’s MVT at $3 billion in 2015 and estimated it to grow at 15%. Moreover, it was estimated to rise to $9 billion by 2020, accounting for 20% of the global market share.
• However, as the world shut down in the wake of the COVID-19 pandemic in 2020, MVT dropped as well, with the number of foreign arrivals in India dropping to 1.83 lakhs.
• As India imposed a strict lockdown to arrest the spread of the virus, MVT earnings dropped, failing to breach the predicted $9 billion mark.
• The industry rebounded in 2021 as restrictions eased and war broke out between Russia and Ukraine , leading to a rise in the cost of treatment in the West. This pushed medical tourists to Asia and India in particular.
• The Centre rolled out the ‘National Strategy and Roadmap for Medical and Wellness Tourism’ in January 2022 to provide health services to the world at large.
• Currently, India, ranked tenth with a score of 69.80 on the Medical Tourism Index, offers over 200 types of medical services ranging from fertility treatments to skincare.
• The most sought-after treatments are cancer treatment and organ transplant surgeries, as these are 65-90% cheaper rates when compared to US, Europe, Australia or even Singapore .
• India has 40 healthcare facilities accredited to the Joint Commission International (JCI) and 1400 National Accreditation Board for Hospitals and Healthcare Providers (NABH)-accredited hospitals. It also accounts for 6% of the global MVT market.
• NITI Aayog estimates that the Indian economy could earn an additional $9 billion by 2026 from MVT and wellness tourism . Globally, the MVT market is projected to grow from $13.98 billion in 2021 to $53.51 billion in 2028 at a CAGR of 21.1%.

Why is India a preferred MVT destination?

• India is a preferred location for medical tourists due to its cost-effective healthcare services, quality diagnostic equipment and trained doctors, with many of them fluent in English .
• As per the Ministry of Tourism, India has 1000 recognized nurses-training centres with 10,000 nurses graduating annually.
• India also has ayurveda, yoga & naturopathy and other traditional systems of medicine for the treatment of various ailments, promoting wellness tourism.

In a nutshell,

The following are some of the factors that make Indian healthcare services a medical tourist magnet.

International Level Healthcare Services

• India has a strong health infrastructure with many state-of-the-art healthcare facilities offering treatment across specialities. Hospitals are equipped with the latest technologies needed to conduct complex medical procedures, and have exceptional facilities for post-operative care.
• The facilities are managed by a highly skilled and adept healthcare workforce and administration staff led by reputed and world renowned medical practitioners and surgeons.The facilities ensure quality treatment services for a wide array of ailments, ranging from cosmetic enhancements to complicated cardiac, orthopaedic, and spinal surgeries.
• There are around 37 Joint Commission International (JCI) accredited hospitals and 513 National Accreditation Board for Hospitals & Healthcare Providers (NABH) accredited hospitals in India. Clinical outcomes at leading NABH hospitals are comparable to those at internationally recognized facilities. While most of the JCI hospitals are concentrated in a few cities in the country, including Delhi and Mumbai, India is further focusing on increasing the number of JCI-accredited hospitals across other major cities of the country.

Superlative Allied Sectors

• To deliver quality treatment, it takes a lot more than just a good hospital. India does not only have international quality healthcare services to its advantage but it also has robust allied sectors which make the healthcare ecosystem complete.
• These include a strong pharmaceutical and diagnostic sector, rehabilitation services, a thriving quality medical devices industry, and a growing focus on medical R&D.

Diagnostics and medical devices sectors

• India has cumulatively attracted over USD 25,300 million in its three key healthcare pillars, that of Drugs and Pharmaceuticals, Hospitals and Diagnostics Centres, and Medical and Surgical Appliances in the last decade. Estimated at USD 11 billion, India happens to be the 4th largest medical device market in Asia, and is projected to reach USD 50 billion by 2025.
• The diagnostics segment in the country is valued at USD 4 billion, with 25% of the market being capitalised by leading organised players.

Pharmaceutical industry

• Exporting medicines to over 200 countries, India is known as the pharmacy of the world. With a market size of USD 41 billion, the sector is third largest globally by volume, with a 33% lower cost of production than the United States.
• The quality compliance rate of Indian Pharmaceutical industry is extremely high. India has 664 US FDA approved facilities, over 2,050 World Health Organisation-Good Manufacturing Practices (WHO-GMP) approved plants and over 697 European GMP compliant plants.
• Consequently, India is the world capital of producing affordable, but high quality medicines. With 20% of global generic drugs exports by volume, the industry is world’s largest provider of generic medicines, producing 60,000 generic brands across 60 therapeutic categories.
• Out of the top 20 global generic companies, 8 are Indian. Furthermore, around 62% of the global demand for vaccines is met by India.
• All these factors make Indian healthcare service delivery add the essential reliability factor to high-end medical treatment, a decisive factor for medical tourism

Low Cost of Treatment

• Affordability of high quality treatment is clearly the differentiator in the domain of medical tourism.
• There is a stark difference in the cost of common medical procedures offered in India in comparison with close competitors in the segment. Of 19 medical procedures, ranging from heart bypass and spinal fusion to liposuction and IVF treatment, India records the lowest price in 13 of them and moderate price in the remaining 6.
• For instance, on comparing the cost of treatment in India with that in Thailand, Malaysia, Singapore, Turkey, and South Korea, heart bypass would cost USD 7900 against USD 15000, USD 12100, USD 17200, USD 13900, and USD 26,000, respectively. Similarly, hip resurfacing would cost approximately USD 9,700 in India compared to USD 16,350 in Singapore and USD 19,500 in South Korea. This is the major factor which makes it possible for International tourists to opt for elective treatment in India.

The “Value” Add in Medical Tourism

• Medical tourism has evolved far and beyond just visiting a country for an important surgery. Yes, excellence in healthcare is central to the value proposition.
• However, for a nation like India which has so much to offer to global citizens, medical tourism has emerged to be that much more. The wellness quotient has rapidly become crucial and increasingly gaining global traction.
• Global Wellness Institute states that the world wellness tourism market was estimated to be USD 639 billion in 2017 with secondary wellness International travellers accounting for 89% of the trips and 86% of the expenditure and domestic wellness travel contributing 82% of total trips and 65% of expenditure. In the same year, as per the estimates by Global Wellness Tourism, India ranked 7th amongst the leading 20 wellness tourism markets, with 560 lakh trips in wellness tourism generating a total revenue of USD 16.3 billion.
• India also happens to be the 3rd amongst the top 10 wellness countries in Asia Pacific. Consequently, it has taken a leap ahead from medical tourism to medical value tourism (MVT).
• In addition to extending the richness of Indian hospitality, with the blending essence of its food, nature, and culture, medical value tourism from an Indian standpoint is offering holistic health and wellbeing.
• It is noteworthy that India is perhaps the only country with an entire ministry dedicated to alternative medicine, rejuvenation therapies and yoga. There is a conscious focus towards steering the global population away from disease and treatment cycle to a lifestyle of preventive and holistic health, one which entails mental, physical and spiritual wellbeing.
• MVT is based on the understanding of the health, and not healthcare, seeking behaviour of the 21st century citizen. Today, Indian wellness tourism stands strong on the timeless foundations of Ayurveda, Yoga, and meditation, while concerted efforts are being made to revive and promote alternative medicines, along with stress relieving and rejuvenation therapies.

What are the government’s efforts towards Strengthening MVT

• The Centre has launched a ‘Heal in India’ campaign to market the nation as a wellness and medical tourism destination.
• Targetting the global demand for holistic healing for lifestyle diseases such as diabetes, the government is pitching Ayurveda, yoga and naturopathy — falling under the ambit of the Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy (AYUSH) ministry — as an alternative to modern medicine.
• India has launched e-visas for MVT travelers from 156 nations and has also accredited AYUSH centres, formalising their status in the Indian medical industry.
• Under ‘Heal in India’, thirty-seven hospitals including thirty private hospitals across 17 cities have been identified to cater to MVT. Moreover, Centre has widened its health assurance scheme ‘PM Jan Aarogya Yojana’, covering approximately 500 million people and established 150,000 health & wellness centres .
• The Centre also plans to launch a one-stop online MVT portal, which will include mapping of all medical facilitators including government and private hospitals, booking of services, payments and post-operative services.
• For better visibility, the MVT portal will be integrated with India’s tourism website— Incredible India.
• In 2015, the National Medical & Wellness Tourism Board (NMWTB) was constituted to function as the overarching organisation to provide institutional framework and further the promotion of medical and wellness tourism.
• Going forward in 2018, MVT was identified as one of the 12 “Champion Services Sectors” to be receiving a part of the 5,000 crore dedicated fund created by the Central Government to strengthen these sectors.
• Distinct roles defined for five ministries and NABH.
• State Governments to enhance the ground infrastructure and promote MVT proactively.
• Transparency in transactions by hospitals and healthcare facilities.
• Industry associations to create market outreach and promote Brand India.
• Allied sectors to boost accessibility by way of flights, accommodation.

What are the hurdles for the MVT sector?

• India’s MVT sector lacks government regulations and monitoring .
• While both the Ministry of Health and Tourism are involved in the promotion of MVT, a separate body is needed to head MVT and coordinate between various stakeholders.
• The prices for medical treatments differ as per the healthcare facility, leading to confusion as to the actual price for a particular procedure. The lack of a price range also leaves tourists susceptible to cheating .
• India also does not provide medical insurance portability, that is, allowing coverage of medical treatments under the tourists’ existing insurance plans.
• India’s national medical accreditation — (National Accreditation Board for Hospitals & Healthcare Providers) NABH— is not known globally . Most foreign countries prefer the US-based JCI accreditation to the NABH, limiting options for MVT facilitators in India.
• Health insurance portability by way of extended insurance cover. It would be relevant to work towards inclusion of Indian Health Insurance companies in the global market. Alternatively, hospitals may be empanelled directly by international TPAs.
• Developing Medical Enclaves for Foreign Patients. A medical complex with customised features, amenities and medical facilities may be created, with hospitals or healthcare companies gaining by way of concessional rates, duties, etc on infrastructure creation as well as consumables. The development of such hospi-towns may be explored on PPP mode.
• Development of SWTX. Special Wellness Tourism Zones may be encouraged at state level offering comprehensive end-to-end services for health, medical and wellness interventions, again developed on PPP model or with FDI.
• Capacity Building. With the anticipated increase in inflow, groundwork for policy alignment, infrastructure development as well as skilling needs to be expedited in order to be future-ready.
• Online MVT Portal. The existing portal needs a makeover with integration of all services a medical traveller would need, while also carrying advisories, regulations and information for transparency and ease.

Closing Remarks

• There is already a major demand for wellness and alternate cures from the global population pursuing a fast-paced modern lifestyle.
• The high cost of services and long waiting periods have made people look eastwards.
• The countries lacking in adequate medical facilities are also looking upto India for cost-effective medical care and wellness services.
• The large Indian diaspora spread across the world are not only the most precious tourist segments but also the largest messengers of Indian hospitality to the world.
• Amidst such escalating popularity and growing demand for MVT, the COVID-19 pandemic has put the spotlight back on healthy living, preventive medicines, nutrition, and immunity building. Knowing that the infection shows wide ranging symptoms and impacts various organ systems, its actual impact on the global population is yet to be assessed, with public health experts believing that it may have a significant effect on the long-term health of the affected population.
• Therefore, the demand for healthcare and wellness services is bound to surge in post-COVID world, with more and more people looking out for avenues of quality medical care and holistic wellness . For this global population, which is in real need for potent health and wellness solutions, medical value tourism could well be India’s thrust sector with sizable revenue prospects.

https://www.thehindu.com/news/national/explained-why-is-centre-promoting-medical-value-travel-a-look-at-the-billions-worthy-industry-indias-growth/article66789848.ece

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Charting The Future: India's Medical Tourism Sector Set For Explosive Growth

Arya Rakshita

• 08 Dec 2023 04:42 PM

In an era defined by globalisation, India has emerged as a frontrunner in the booming medical tourism industry. The Medical Tourism Index 2023-24 highlights India's prominent position, projecting a remarkable revenue surge in the healthcare sector, expected to reach Rs 2,670.37 Bn by 2027, with an impressive compound annual growth rate (CAGR) of approximately 34.92 per cent from 2023 to 2027. Indian medical tourism accounts for about 6.5 per cent of the global tourism market. According to Global Data, the current market size of the Medical Tourism Industry is around USD 31.91 Billion.

NITI Ayog estimates Indian Economy could earn an additional USD 9 Billion by 2026 from Medical Value Travel (MVT) and Wellness tourism.

India's Unique Healthcare Landscape:

According to FICCI, the MVT Industry in 2021 was estimated to have a market size of Rs.3.9L crores of around USD 49.6 billion and is expected to grow at a CAGR of 29.3 per cent to reach a market size of 15L crores of around  USD 192.9 billion by 2026.

India offers over 200 types of medical services and has over 40 Healthcare facilities accredited by Joint Commission International(JCI) and 1400 National Accreditation Board For Hospitals and Healthcare Providers(NABH) accredited Hospitals.

Ranked 10th globally, 12th in wellness tourism markets, and 5th in Asia-Pacific, India's healthcare industry seamlessly integrates modern medical practices with traditional systems such as Ayurveda and Yoga. The availability of top-notch healthcare infrastructure, a pool of well-trained medical experts, and cost-effective treatment alternatives make India an appealing destination for those seeking high-quality healthcare services, say industry experts.

Anas Abdul Wajid, Senior Director and Chief Sales and Marketing Officer at Max Healthcare, emphasises, "India has become a popular choice for medical value travel in recent times, In the first year after Covid the business recovered completely and grew by 10 per cent compared to the pre-Covid levels " 

Medical Treatments That Garner Maximum Footfall

Medical procedures like heart surgery, knee transplant, cosmetic surgery and dental care attract maximum footfall in the case of medical tourism as the cost of treatment in India is considered to be the lowest in Asia, much lower than Thailand, Indonesia, Singapore and Hong Kong, FICCI’s official data claims. 

As per the 2023 findings from HFS Research and MediConnect India, the cost of dental implants in India stands at USD 1000, a notable contrast to the United States where it is USD 2800 and Thailand where it is USD 3636. Additionally, the expense for knee transplants in India is USD 6200, significantly lower than the US at USD 50000 and Thailand at USD 12297. Similarly, for angioplasty, the cost in India is USD 3300, substantially less than the US (USD 57000) and Thailand (USD 3788).

Leading Players and Specialised Services:

Catering to diverse medical needs major players in the Indian healthcare landscape, including Max Healthcare, Apollo Hospitals, Fortis Healthcare and Manipal, attract medical tourists for specialised treatments like transplants, cardiac surgeries, oncology, orthopaedics, and neurosciences. 

Dr Harinder Singh Sidhu, Senior Vice President of Corporate Development, Head of international Business at Apollo Hospitals, emphasises the cornerstone of their services, stating, "Orthopaedic procedures are another cornerstone of our services, drawing medical tourists with the promise of top-tier care and cost-effectiveness." Apollo Hospitals alone conducts around 30 per cent of its 23,000 transplants for international patients from over 50 countries, he added.

" Global patients choose Manipal Hospitals for cutting-edge medical procedures, including oncology services such as bone marrow transplants, advanced radiation therapy, chemotherapy, and state-of-the-art robotic surgery. Additionally, the hospital is renowned for its expertise in cardiology and spine surgery.,” remarked Vikas Tayer, Head, of International Healthcare Services at Manipal Health Enterprises.

Another industry expert Wajid opines,”The top specialities at our hospital that attract the most medical tourists are Transplants (Liver, Bone Marrow, and Kidney), Cardiac Surgeries (including Paediatric Cardiac Surgeries), Oncology and Orthopaedics and Neuro-Sciences.”

Challenges and Opportunities on the Horizon: 

While navigating the future of medical tourism challenges such as visa issues persist, India anticipates tremendous opportunities in the medical tourism industry. The nation's reputation as the "Hospital capital of the world" is growing due to cost-effective healthcare and minimal waiting times for treatment. The government’s forthcoming initiatives, including Heal in India,  will further propel the growth of medical tourism, industry elites say.

Anil Vinayak, GCOO at Fortis Healthcare, highlights the challenges, stating, "Visas from countries such as Afghanistan, Pakistan, etc., are not issued. Political unrest in many countries (Sudan, Ethiopia, Afghanistan, Yemen, etc.) is a major concern and impacts Medical Value Travel (MVT) adversely." However, amidst challenges, there are significant growth opportunities as well, Vinayak added.

Projections and Revenue Growth:

A lucrative future awaits the medical tourism industry. The revenue from medical tourism in India has steadily increased, reaching USD 7.4 billion in 2022, with projections indicating a staggering USD 43.5 billion by 2032, industry experts claim.

Industry experts, including Tayer, highlight robust growth in international business, reflecting a demand for high-quality medical services in India. Another Industry expert Wajid, opines, "In the first year after Covid, the business recovered completely and grew by 10 per cent compared to the pre-Covid levels. This year, International business is growing more than 27 per cent over last year." 

“As per Apollo Group, international medical travel revenue has increased by 18 per cent in FY FY23-24 compared to last financial year,” says Sidhu.

While Vinayak said,” Fortis has a consistent increase in revenues from medical travel. International patient revenues stood at INR 126.7 Crores, a growth of 15.6 per cent over Q2FY23 and 10.6 per cent over Q1FY24. International patient revenue contribution increased to 8.3 per cent of hospital revenues versus 8.0 in Q2FY23 and Q1FY24. Post-covid revenues have witnessed an average increase of 15 per cent from pre-covid days.”

Industry experts highlight that The Indian government has prioritised three key areas to boost medical tourism, targeting a threefold increase in revenue to USD13 billion within four years. These priorities involve creating a distinctive brand for India as a wellness destination, enhancing medical and wellness tourism infrastructure, and establishing an Online Medical Tourism Portal. 

To overcome challenges like awareness and infrastructure, the government collaborates with ministries, private sectors, and healthcare stakeholders. Initiatives such as the Heal in India campaign and Marketing Development Assistance Scheme contribute to this. By easing medical visa norms and investing in infrastructure in key cities, the government fosters collaboration with the private sector. 

Rajeev Taneja, Founder and CEO of Global Care remarked, “The One Earth - One Health initiative and the 6th International Summit on Medical Value Travel underscored the commitment to sustainable medical tourism. The goal is to position India globally, with the government aiming for USD 53.51 billion in the sector by 2028.” This growth is fostered through collaborations between the public and private sectors, allowing for 100 per cent foreign direct investment in medical infrastructure and offering fiscal incentives, he added.

Efforts include creating a comprehensive digital portal for streamlined patient journeys and promoting India as a destination for medical value travel and wellness tourism. The government envisions India as a sustainable and responsible medical and wellness tourism destination and aims to create a robust framework through dedicated agencies, governance structures, and institutional frameworks. Partnerships with source markets are also considered for effective medical care arrangements, suggests experts.

Looking Ahead, navigating challenges and embracing opportunities as India's medical tourism industry charts its course for the next five years, challenges like visa issues, global competition, and geopolitical disturbances loom. However, opportunities abound, and India can leverage its dynamic market by identifying emerging regions with healthcare needs, embracing cutting-edge healthcare solutions, and enhancing accessibility through improved connectivity. 

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Ministry of Tourism has formulated a National Strategy and Roadmap for Medical and Wellness Tourism in order to boost Medical Tourism in the country

Ministry of Tourism has formulated a National Strategy and Roadmap for Medical and Wellness Tourism in order to boost Medical Tourism in the country . The Strategy has identified the following key pillars:

i.          Develop a brand for India as a wellness destination

ii.         Strengthen the ecosystem for medical and wellness tourism

iii.        Enable digitalization by setting up Online Medical Value Travel (MVT) Portal

iv.        Enhancement of accessibility for Medical Value Travel

v.         Promoting Wellness Tourism

vi.        Governance and Institutional Framework

The Government of India liberalized the e-Tourist Visa Scheme pursuant to the Cabinet approval on 30.11.2016 and the e-Tourist Visa (eTV) scheme was renamed to e-Visa scheme and at present it has e-Medical Visa and e-Medical Attendant Visa as sub-categories of e-visa.

In the case of e-Medical Visa and for e-Medical Attendant Visa, triple entry is permitted and extension may be granted up to 6 months on case to case basis on merits of each case by the Foreigners Regional Registration Officer (FRRO)/Foreigners Registration Officer (FRO) concerned. Medical Attendant Visa was co-terminus with the validity of the principal e-Visa holder.

Further, as conveyed by Ministry of Health & Family Welfare, it is coordinating with other Ministries and stakeholders to promote medical value travel in the country. Several rounds of stakeholder consultations have been conducted with line Ministries, Hospitals, MVT facilitators, Insurance Companies and NABH etc. to identify the challenges and opportunities in the sector.

This reply was given by Minister of Tourism Shri G Kishan Reddy in Lok Sabha today.

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The Flipside of Medical Tourism: Organ Transplant Rackets

Why in News?

• Newspapers carry frequent stories of acts of spontaneous solidarity by ordinary Indians donating organs.
• Simultaneously, there is news of scandals, often involving the buying of organs from the vulnerable. 
• Every news on organ transplantation poses difficult questions and tests us collectively and therefore it becomes imperative to understand the flipside of medical tourism and challenges in tackling organ transplant rackets.

The Paradox of Organ Transplant System in India

• Newspapers frequently share heartwarming accounts of ordinary Indians selflessly donating organs from deceased family members, reflecting acts of spontaneous solidarity.
• Instances of parents donating their brain-dead babies' organs amid unimaginable grief showcase the altruistic nature of organ donation.
• Scientific breakthroughs in transplantation highlight the positive impact of collaboration, teamwork, and advancements in healthcare.
• Amidst the uplifting stories, there are disheartening instances of organ trafficking scandals, often involving the vulnerable.
• Recently, a Kolkata hospital was investigated for luring Nepalese street children as kidney donors.
• A recent Myanmar-based ring was exposed for arranging paid kidney donors, leading to transplants in a prominent Delhi hospital through forged documents.
• Despite being illegal globally, the buying and selling of human organs persist due to high demand and normalisation of body commodification.
• Also, unethical transplantation requires the collusion of expert doctors whose professional oaths condemn organ trading.

Strange Dichotomy of Medical Tourism in India in the Context of Organ Transplant

• The growth of transplantation in India, largely in the private sector, has been exponential, focusing on tertiary care.
• Transplants need well-trained personnel, technology, advanced intensive care and an institutional drive for good outcomes.
• These conditions were met in an expanding private sector, especially corporate hospitals.
• Corporate hospitals, driven by an institutional push for positive outcomes, have facilitated access to transplants beyond kidneys for a section of Indians who previously lacked such accessibility.
• Medical tourism, leveraging India's healthcare expertise, seems beneficial in a globalised world, with patients from other countries seeking treatment and India earning revenue.
• The assumption is that profits from the private sector are reinvested, contributing to the country's economic growth.
• Recognising the revenue potential in medical tourism, the corporate health sector in India has actively engaged in transplantation.
• They attract patients from South Asia, Central Asia, and Africa.
• Transplantation is relatively inexpensive for foreigners in India compared to the global average.
• The whole scenario of medical tourism and revenue generation creates a peculiar dichotomy where it remains costly for ordinary Indians.

Challenges/Complexities in Transplantation Medical Tourism

• Transplantation medical tourism involves very sick patients navigating a foreign country with a different language and culture.
• Post-operative care for both donors and recipients extends beyond the operation, raising questions about the effectiveness of follow-up care upon their return.
• The challenge lies in establishing a relationship between donor and recipient when they travel across borders.
• Differentiating between paid and voluntary donations becomes crucial, requiring a robust system to prevent exploitation and coercion.
• Embassies are tasked with issuing certificates ruling out coercion or payment, but due diligence in this regard appears lacking.
• Experience suggests that there may be gaps in the verification process, compromising the authenticity of these certificates.
• Authorisation Committees in India are entrusted with ruling out organ trade, but conflicts of interest may compromise their impartiality.
• Hospitals, driven by the pursuit of numbers and revenue, may inadvertently contribute to ethical lapses.
• In the absence of a well-organised mechanism, informal referrals based on monetary commissions are prevalent.
• Most foreign patients are recruited through agents who handle travel logistics and paperwork, potentially introducing vulnerabilities.
• Questions arise about whether transplant doctors are aware of or misled by forged paperwork, raising concerns about their role in detecting subterfuge.
• While doctors claim it is not their responsibility to detect deceit, professional oaths place an ethical obligation on them to uphold the integrity of the medical profession.
• In a country where trust in healthcare is already under threat, news of a substantial number of foreigners receiving transplants poses a double-edged challenge
• Trust is crucial for the success of the deceased donation after death project, and previous incidents of foreigners receiving heart transplants resulted in a significant drop in donations.
• Private hospitals, equipped with the capacity to perform transplants, are positioned to meet the demand swiftly, contributing to revenue generation.
• The monetised health system is prone to seizing opportunities, whether legitimate or, if necessary, through illegitimate means to meet the demands of patients seeking transplants.
• Global disparities in the availability of organ transplants lead patients to seek solutions abroad, often in countries like India where medical tourism is thriving.
• The ability to pay for transplantation services becomes a crucial factor, further highlighting the economic dimensions of healthcare access.

Actions to Be Taken to Make Organ Transplantation Transparent in India

• The world has demonstrated that the future of organ transplantation lies in donation after death, emphasising the importance of deceased organ donation.
• In India, continuous appeals are made to ordinary citizens to donate organs after death, with support from the government, including the Prime Minister's involvement.
• The effectiveness of organ donation campaigns is contingent on the selflessness of citizens, but scandals in the transplantation system may erode trust.
• Citizens may be hesitant to participate in donation efforts if they perceive a scandalous environment or if they question the fairness of the system.
• A pressing ethical concern arises from the disparity between encouraging citizens to donate organs and the inability of many to afford transplants when needed.
• The fairness of urging altruism while failing to address the financial barriers to transplantation raises difficult questions about the equity of the healthcare system.
• The dilemmas associated with organ transplantation highlight the complex interplay of scientific progress, economic interests, etc., to address challenges in healthcare access and organ donation.
• Balancing these challenges and concerns of healthcare requires a careful and collaborative approach.

Q1) What is the meaning of medical tourism?

Medical tourism (also called medical travel, health tourism or global healthcare) is a term used to describe the rapidly-growing practice of travelling across international borders to seek healthcare services. Services typically sought by travellers include elective procedures as well as complex surgeries, etc.

Q2) What is the contribution of medical tourism in India?

This has the capability to generate an additional $9 billion in patient inflow to India. To maximise the industry's potential, the government is pulling out all its aces. The aim is to make India the number one Destination for Medical Tourism in the world, tripling its revenue to $13 billion within 4 years.

Source: The Indian Express

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