Cover Story

The new prescription

India has already become a preferred medical tourism destination; the challenge is to keep it that way - through forming synergies with related verticals, accreditation and developing supporting infrastructure. By Gayatri Vijaykumar

According to an ASSOCHAM report, states that offer ayurvedic and medical tourism are likely to be the largest beneficiary of the 2010 Commonwealth Games and may garner around Rs 800 crore. Undergoing even a minor treatment in the West is expensive compared to costs here, which is why about 25 to 30 per cent of the inbound tourists can be tapped for medical tourism. An increasing number of hospitals are equipped with world-class facilities and it is a known fact that surgeries in India are almost half as expensive as its western counterpart because of next-to-nothing import duties on the equipment.

Synergy is needed

But medical tourism is an area that requires the involvement of many players from across industries - from the tour operator that takes care of all the travel arrangements, to the insurance company that covers the patient during the treatment, the hospital where the patient undergoes treatment to the hotel where the patient stays either while undergoing treatment or post recuperating.

Explaining how the hotel and the hospital can work in conjunction, P K Mohankumar, area director for Bangalore and general manager of The Taj West End, says, "The front-end activities from marketing to travel reservations, managing the patient's arrival and departure is the hospital's responsibility. Once that is taken care of, through the same front-end system, the patient can be put through to the doctor. This would lead to a seamless flow." According to him, the hotel reservation network can also engage reservation staff to sell a medical package.

There is an emerging trend of companies having a mixed portfolio of hotels, hospitals, ayurvedic resorts and travel agencies under one umbrella. The Alcon Victor Group which is into construction, real estate and hospitality has also entered into the medical tourism arena with Apollo Victor Hospital, a 150-bed super speciality hospitality in Goa, where it owns properties including Devaaya - an ayurvedic resort. Victor M Albuquerque, the group's CMD, reveals, "We have now started promoting medical tourism and are targeting the European market to Goa for treatments ranging from cosmetic and plastic surgery, dentistry and orthopaedics. We are promoting Goa as an alternate destination to Kerala. That was the idea behind Devaaya."

In Mumbai a travel firm, requesting anoymity, is also working closely with international insurance companies and social security authorities to facilitate smooth transit of patients.

The players

Many players have entered this segment today. Better infrastructure and a higher number of inbound tourists have made Cougar Resorts & Travels for instance look at cosmetic treatments. Arun Raghavan, its director, says, "We take care of the patient's entire journey. Hospitals too play an integral part in this process. Some even facilitate pick-ups and stay for relatives within the hospital premises. We even incorporate leisure activities in the itinerary if advised by doctors."

He is now looking at developing contacts worldwide so as to blend the aspects of 'medical' and 'tourism'. Through this, the partner having prospective clients will send the patients' medical papers to the tour operator and co-ordinate with the doctors/hospitals. The treatment, number of days required and the overall cost will be determined accordingly. "If the patient wants to add more days to their itinerary, we work around the package and provide them with options. For us, the area of beauty treatments and cosmetic surgery is an interesting segment as India is a cheaper alternative vis-a-vis other countries with state-of-the-art equipment," says Raghavan.

The availability of qualified doctors in the state coupled with the brand name Kerala has created as a top tourism destination makes it the top choice for promoting medical tourism. The Kerala Institute of Medical Sciences (KIMS) was awarded the 2004-05 'Health Tourism Award' for introducing the most innovative project in the field of tourism. The tertiary care multi-specialty institution attracts a large number of foreign patients. E M Najeeb, executive director of KIMS, says, "Last year we witnessed 25,000 foreign arrivals - 4,000 more than the previous year. We have an international patient relations department, which takes care of their every requirement right from the hospital arrangements to logistics."

Bengaluru is also making its mark in the medical tourism scene. Says Mohankumar, "It can be termed as a medical tourism city. The existence of a number of hospitals of international standards attracts a lot of patients from abroad." In a bid to tap the potential of the city, Albuqurque plans to set up a health mall in the heart of Bangalore. "We will be setting up infrastructure with medical operation facilities, ICUs, nursing, where each department will be handled by physicians/surgeons who will bring their own equipment. I want to do this not only to promote medical tourism in the international market but also within India."

Kolkata as a medical hub

Lured by a growing market that today includes Bangladesh, Bhutan, Nepal and Myanmar, healthcare institutions are making a beeline for Kolkata with a combined budget of Rs 3,000 crore. The city can already expect investments to the tune of Rs 4,500 crore over the next 10 years should all plans on the drawing board mature.

The size of the market estimated at present is 500 million patients. Five to seven mega hospitals are already on the anvil and will come up in the next five years. In the process, Kolkata will not only see its existing players expand operations but also the entry of new entrants in healthcare business. The Eastern Metropolitan Bypass is fast emerging as the strong health-line of the city with most of the developments happening around it. In addition to the major groups, the Neotia-Elbit Healthciti, a 1,000-bed, multi-speciality project with a stem cell research centre, is also coming up in the vicinity. Apollo Gleneagles Hospitals, the 325-bed multi-speciality hospital of the Apollo Group provides specialised services in emergency care, cardiology, neurology, dermatology, gynaecology and obstetrics, gastroenterology, hepatology, orthopaedics and a host of other specialties.

Peerless Hospital & BK Roy Research Centre, the 300-bed multi-speciality tertiary hospital of the Peerless Group too offers services in six 'super' speciality areas - cardiology, cardio-thoracic surgery, neurosciences, orthopaedics, paediatrics, neonatology and gastroenterology. Nearly 25,000 foreign patients a year, mainly from Bangladesh, are treated at the hospital.

The state government has been inviting private participation in a big way and has framed new public-private participation policy guidelines. It currently provides land to private promoters who in turn will set up medical facilities.

Case Study: Dr Rajkrishnan's dental clinic

When Dr Rajkrishnan set up Dr Rajkrishnan's Dental Clinic in 1995, little did he know that it would attract so many foreign patients. "My first international patient came from Florida in 1997. He was on a trip to Kerala when he started experiencing dental pain. Despite his inhibitions on the capability of an Indian dentist, he visited the clinic. He brought back two more patients with him the same year."

Then in 2000, he saw a shift from a predominantly US clientele to a European one. This was the time when Kerala saw a number of people from countries like Germany, Switzerland and Austria settling down in the state. "Most of the promotion till then was word of mouth. However, in 2005, we started attending various travel expos and marts abroad." Dr Rajkrishnan's team attended WTM London, ITB Berlin, ATM Dubai and the Kerala Travel Mart and started interacting with the travel trade to explore ways of working together. "There are 3,000 practicing dentists in the state, 1,200 dental offices and 23 dental schools. We have immense potential and can promote the state as a dental tourism destination."

Dr Rajkrishnan calls his package a "dental vacation". Explaining the process by which this package is enabled, he says, "We get mails from patients abroad with reference from their regular dentists. We ask for their dental records and inform the patients about the duration of their treatment. We also recommend hotels where they can stay. The tour operators on our panel co-ordinate with these patients for their schedule."

According to Dr Rajkrishnan, foreign patients spend five to ten times less than what they would spend in their own countries. This, coupled with the availability of qualified doctors and echnology, makes the treatment a valuable proposition.

Promoting ayurveda

According to ASSOCHAM, the domestic ayurvedic market is currently estimated at Rs 3,000 crore and this is expected to go up to around Rs 5,000 crore in the next two years. Speaking about the role of ayurveda in promoting medical tourism, P R Krishnakumar, managing director of The Arya Vaidya Pharmacy (Coimbatore), says, "There are a number of ailments that allopathy fails to cure. There was a time when ayurveda was not popular even within the country. But there is a lot more awareness about ayurveda today."

Located in Coimbatore, Tamil Nadu, the 120-bed hospital is a clinical wing of the Arya Vaidya Pharmacy. According to Krishnakumar, a substantial number of patients from Kenya, parts of Africa, Australia and Europe visit the hospital for rejuvenation. "We also work with Taj Kumarakom and Taj Calicut and have posted two representative doctors in each property," he explains.

Kairali Ayurvedic Health Resort, Palakkad, the flagship property of the Kairali Group is another important player on the scene. The property was recently selected to be one of the top 50 wellness destinations in the world by National Geographic. The group has 100 acres of land in Palakkad of which 50 acres have been used up for the resort. According to Ram Mohan, its VP (Marketing & PR), almost 70 per cent of its guests are from Europe.

The Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha & Homeopathy (AYUSH), established by the Ministry of Health & Family Welfare in 1995, has taken steps to spread more awareness about this form of therapy. According to Krishnakumar, AYUSH will be opening ayurvedic desks in Indian embassies abroad and also plans to conduct road shows with an overall budget of Rs 500 crore.

Accreditation a must

Obviously, safety is a big concern and it is necessary for the government to impose stringent regulations to ensure that only serious players are involved. Hospital accreditation plays an important role in this regard. Healthcare in the West is insurance-driven and most insurance companies only cover patients who get treated from accredited hospitals.

A few major hospitals have accredited themselves with Indian and international accreditation agencies. Stresses Sivaram Rajagopalan, principal consultant with Shiva Consultants, "There needs to be standardised treatment across the board for both the local and foreign patients. Hospitals should take up the required accreditation." Speaking about the importance of accreditation, Najeeb says, "The government should create awareness among medical institutions that have sufficient infrastructure to go for quality accreditation and promote their hospital in the international medical tourism arena."

In 2006, India launched an accreditation programme for secondary and tertiary hospitals by the National Board for Hospitals & Healthcare Providers (NABH), which has so far given accreditation to 11 hospitals throughout India with 58 applications pending. In the international arena, the Joint Commission International (JCI) is an important accreditation agency. Launched in 1999, JCI is a division of Joint Commission Resources (JCR), the subsidiary of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The commission accredits hospitals based on core areas such as adherence to international standards of clinical care, safe environment, safe medication, quality of staff training, respect for rights and privacy and international infection control standards. The Wockhardt Hospital in Mumbai is the first super specialty hospital in South Asia to get the JCI accreditation.

No accreditation agencies or guidelines have been formulated for ayurveda. However, those in the field are trying to push the government to formulate guidelines in order to regulate the sector. "We realise the need for strict regulations governing ayurveda and those who practice it. We are requesting the government to bring in accreditation procedures to ensure quality of treatment," explains Krishnakumar.

The challenges

Even though India attracts a large number of patients from South East Asia, South Asia and the Middle East, it has not been able to penetrate the European and American markets. So what is preventing India from tapping these high potential markets in the West? Mohankumar feels that India lags behind competitors like Thailand, Singapore and Malaysia in terms of the kind of promotion it does. "The Singapore model is worth replicating as it is primarily driven by the government. It is being promoted as a high-end medical tourism destination. In a democratic set up, all promotion has to be undertaken by the state," he explains.

According to him, it is necessary to get all stakeholders on a single platform and conduct road shows in the US, UK and other European countries in order to promote India as a medical tourism destination abroad. Dr R B Smarta, managing director of Interlink, a pharmaceutical and healthcare consultancy company, adds, "Several factors can promote medical tourism, such as institutions like day-care centres, support service such as nursing associations, linkages with infrastructure facilities for transporting patients from airports and railway stations and liaison with organisations such as NGOs for acquiring knowledge and leveraging opportunities."

According to Dr Rajkrishnan, a public-private partnership model can be explored by the government. "The government should work as a facilitator and create a platform in the form of travel marts to promote medical tourism." In addition, he feels that with an increase in the demand for quality healthcare, the supply side has to be strengthened. "Training is an area we have to focus on. It is necessary to work with the basic staff to improve their communication skills," he adds.

The Government of India is also issuing medical visas, which enable foreign nationals to enter India up to three times a year and is valid for a year. It can be extended by a year and state governments and Foreigners Regional Registration Officers have the right to extend it. Under the visa plan, the patient can be accompanied by two family members or attendants.

It is also important to have infrastructure like hotels and service apartments in place. Today India is desperate for more hotel rooms and across categories, which is the pressing need of the hour. It is vital for the government to draft and implement policies that can attract investors towards building infrastructure in the hospitality industry.

However, the future for medical tourism is brighter than ever. A booming economy and the availability of the latest technologies give India a competitive edge over many other nations in the region. As Mohankumar puts it, spearheading the medical tourism movement will be cities like Bengaluru, Chennai and Chandigarh.

With inputs from Anupama Sushil (New Delhi), Chetan Kapoor, Arshiya Khan, Andrea Lopez (Mumbai) and Joy Roy Choudhary (Kolkata)