Medical Tourism
Preparing for the challenge
Medical tourism offers great potential for Asian hospitals, but they need to be thoroughly prepared in order to make best use of the opportunity.
Bhaskar P Shah
Interventional &
Consultant Cardiologist
and Director
Asian Heart Institute,
India
Medical tourism, where patients travel abroad in search of world-class medical treatment, is growing rapidly and gaining popularity in countries like Thailand, Singapore, Malaysia, India and South Africa. Since time immemorial medical tourism has been prevailing across the world right from the Neolithic and Bronze Age to Jet age (Table 1).
The global medical tourism market was pegged at a little over US$ 40 billion in 2000 and is growing at over 20% p.a. If these figures were to be projected forward it would be a US$ 100 billion opportunity today. Considering such lucrative potential, a former Indian Finance Minister called for India to become a “Global Health Destination”.
Overburdened healthcare infrastructure and high costs in the west are the key drivers for the boom in medical tourism. The healthcare infrastructure in Europe and the United States is under severe pressure. In Britain, the National Health Service (NHS) has a long wait list of patients for surgery. In US the healthcare crisis has different dimensions — it has 50 million uninsured citizens while the insured have to pay dearly for healthcare facilities. To add to this the stringent visa regulations imposed by US and European countries after 9/11 episode has led to a growing number of foreign patients from Middle East to visit Asian countries for treatment. All these factors have opened up avenues for hospitals in various Asian countries to promote medical tourism. So we now need to look into meting the challenges of medical tourism.
A low cost, robust and high value proposition would be to offer highly cost competitive medical treatment with worldclass, cutting edge technology, by worldclass medical specialists in accredited hospitals with world-class infrastructure and facilities.
Cost of comparable treatment in Asia is on an average one-eighth to one-fourth to those in western countries. A cardiac procedure which costs anywhere between US$ 40000 to US$ 60000 in the US, US$ 30000 in Singapore and US$ 12000 to 15000 in Thailand costs only between US$ 3000 to 6000 in India. The associated costs of the surgery are also low. Not only are skilled Indian surgeons available for a lower cost, they are less susceptible to costly litigation. The cost of malpractice insurance in New York is around US$ 100000 while in India it costs only US$ 4000. These factors reduce the overall cost of treatment.
Diagnostic tests in India are also comparatively inexpensive. A Magnetic Resonance Imaging (MRI) scan costs US$ 60 in India compared to US$ 700 in New York. The country also has the potential to emerge as a hub for preventive health screening. At a private clinic in London a routine health check-up (including blood-test, electro- cardiogram test, chest X-rays, lung tests and abdominal ultrasound) costs GBP 350. A comparable check up in India is available for US$ 84 at the Mumbai-based Asian Heart Institute.
The mortality rate of coronary bypass patients at Asian Heart Institute, Mumbai and Escorts, Delhi is 0.8%. According to a 2002 study by the New York State Health Dept., in 1999 the New York-Presbyterian Hospital had a death rate of 2.35% for the same procedure. It is noteworthy that former US President Bill Clinton recently underwent bypass surgery at the same hospital. In India, the overall success rate of cardiac bypasses is 98.7% as opposed to 97.5% in the US.
Hospital accreditations done by JCI, ISO, OSHA etc — the seal of quality, patient safety, quality care, updated technology and organized systems — are a kind of assurance that people look for in any health institution with the two most important parameters being patient care and patient safety.
Hospitals should concentrate on uniform price range for various medical treatments across various hospitals across the country and make it public (to establish transparency) in order to facilitate the entry of foreign patients seeking treatment with us.
Facilities in hospitals seeking foreign patients need to be market driven i.e. attractive to patients, must deliver results and must be competitive. To attract foreign patients the hospital must have willingness and ability to build 5 star facilities, (Table 2), acquire state-of-the-art medical equipment and technology and the ability to attract medical professionals at the top of their respective fields. Full accountability to:
a. Shareholders who are expecting results
b. Patients who have high expectations
c. Top medical professionals who have joined the hospital, ensures delivery of proper results
Competitive imperatives would mean superior and excellent clinical outcomes to gain commanding market share and customer service focus to achieve patient satisfaction and customer delight.
Each hospital should have a dedicated international patient centre which could match up to a 5 star hotel lounge. This centre provides foreign language services, transportation co-ordination including airport pick-up ground and air ambulance services, internet, fax and modem lines in patients rooms, long term lodging arrangements for patients families, VIP concierge services for shopping, dining, sight-seeing, visa assistance and special events.
Service With Style
Some added amenities that are being offered as a part of the bouquet of healthcare services in large hospitals include:
• 24 hour pharmacy that serves both patients and others
• Spacious waiting areas
• In-house cafeteria, sometimes outsourced to reputed restaurant chains
• Coffee vending machines
• Internet access
• Prayer room
• Florist, gift and book shops
• Valet parking with ample car park space
• ATM machines and banking counters
• Travel desk and translators
• In-hospital accommodation
Strict medical staff governance is the hallmark of a good medical institute. This governance needs to include proper credentialing of medical faculty, professional ethics, regular mortality and morbidity review, regular internal and external medical audits, continuing medical education programmes, professional training and clinical research.
A well-developed marketing department in the hospital is a necessity for intense marketing and publicity of medical facilities. The west is more likely than not largely ignorant about hospitals in Asia and there is therefore a huge psychological hurdle. The promotional effort can be accomplished with a focus on specific countries through a well-organized word-of-mouth and media campaign (print or electronic) or referral network involving tie-ups with foreign governments, insurance companies and overseas doctors. However tie-ups with travel agents based abroad helps in better exposure and marketing. Road shows and exhibitions in targeted countries are good means for marketing.
Strategic tie-ups and alliances in the industry are now assuming greater importance. For instance Manipal Hospital has a tie-up with the governments of Tanzania and Mauritius. Further, agreements with foreign travel insurance providers give the hospitals a significant international exposure. Tie-ups with foreign insurance companies assures hassle-free cash-less benefits. As hospitals upgrade their services to global benchmarks, the country’s medical care is increasingly gaining acceptance among international insurers, for instance, USbased private healthcare insurers Blue cross and Blue Shield and British health insurer BUPA now insure clients being treated at a number of private hospitals in India.
Bringing healthcare providers/hospitals with facilitator-tour operator together will help to develop suitable healthcare cum travel packages. Tour operators are playing a role greater than just arranging a patient’s tour itinerary, with their services covering everything from pre-treatment counselling to post-treatment care. The healthcare tourism packages typically include identifying the appropriate hospital for required treatment, appointment with doctors, travel arrangements, accommodation, logistics and facilities for those accompanying the patients and maintaining post-treatment assistance via e-mail.
There is a greater need for public-private partnerships as this will enable developing health infrastructure and policy, through sharing of technology, physical and human resources, and information. Part of the revenue generated through globalisation of this sector can be channelled towards the overall development of the healthcare system.
There is also a need for taking a holistic approach towards healthcare and delivery. For example, wellness tourism which is meant for rejuvenation of the body and mind involving services such as Herbal therapy, Naturopathy, Yoga, Aroma therapy, Reiki and Music therapy require no advanced medical expertise, and are highly sought after by many tourists coming in for treatment.
Setting up of an International Assistance Centre in a foreign country with the following goals is also necessary: The centre must be able to create awareness about medical tourism facilities among local populace. It must provide detailed information about facilities, procedures, and competencies and costs. It should have facilities for preliminary diagnostics and expert opinion through tele-medicine technologies. It should be able to manage complete travel & stay plan and co-ordinate appointments. It should give posttreatment patient management. Above all, it should build trust and confidence in the clientele.
And last, but not the least, understanding of the different cultural backgrounds of medical tourists is of paramount importance because the topic of healthcare is very personal and means different things to different cultures. Non-verbal communication, which is influenced by culture, is also an important part of diagnosis. Further, a good cultural understanding can help in speedy patient recovery.
