ROLE OF F ACILIT A TORS IN MEDICAL TOURISM

Abstract:
New technology skills and long waiting list in native land led the evolution of medical tourism. By
growing critical difference prices and readily accessibility of medical services among India and other
countries like Middle East, other developed countries, today there has been rapid rise in foreign
demand for medical treatments and alternative therapies in India. India attracts medical tourists as it
offers high quality and readily acceptable medical services at affordable rates. This paper focuses on
factors influence to seek health care services in India, liaison between medical tourism facilitator and
health care or medical center
Key words: Medical tourism, India, Corporate hospitals, facilitators
l.Introduction:
Origin and Evolution of Medical Tourism
Medical tourism is actually thousands of years old. In ancient Greece, pilgrims, patients came from all
over the Mediterranean to the sanctuary of the healing god, at Epidaurus. Since the early nineteenth
century, when there were no restrictions on travel in Europe, people visited neighboring countries in
order to improve their health. At first, mere traveling was considered to be a good therapy for mental
and physical well being. In the 2 I st century, relatively low-cost jet travel has taken the industry
beyond the wealthy and desperate. Later, mostly wealthy people began traveling to tourist destinations
like the Swiss lakes, the Alps and special tuberculosis sanatoriums, where professional and of tenspecialized medical care was offered I When Buddhism came along roughly 2,500 years later this
only added fuel to the fire and helped India as the epicenter of Eastern cultural, spiritual and medical
progress2. In India, medical tourism includes several health care and various complex surgical
procedures such as cardiac surgery, cosmetic surgery, hip replacement or knee surgery and dental. In
principle, the concept of medical tourism is not something new in India. According to medical tourism
in India, medical tourism is an ancient practice of tourism on the procedure for medical treatment and
medical sites in India3.
Medical tourism has recently become one of the fastest growing fields of the tourism industry.
Medical tourism can be broadly defined as the provision of "cost effective" private medical care in
collaboration with the tourism industry for patients needing surgical and other forms of specialized
treatment4. Because of long waiting list and higher prices and for quality medical care patients going
to a different country for an either urgent or elective medical procedure is fast becoming a worldwide,
multibillion-dollar

industry. Global medical tourism is $20 billion and is expected to double by 20105. In India 'medical
tourism' is growing at the rate of 30% a year and is expected to generate
revenues of Rs.1 00 billion by 2012 as per the study conducted by CII(Confederation of Indian
Industry) and McKinsey6.
Objective of the study is (a) To understand the status of medical tourism in India and factors
influencing the patients to select destination (b) To know the key players of

medical tourism and importance of liaison between the medical tourism facilitator and health or
medical centers .Medical tourism is often seen as adding medical services to the common tourism. But
in many ways, it is more about extending health care services across international borders and
expanding choices for patients on where to access health care. Health services in Medical tourism
packages are often provided through costeffective private medical care for patients needing surgical
and other forms of specialized treatment. This process is being facilitated by the corporate sector
involved in medical care in collaboration with the tourism industry - both private and public7.
Research methodology:
Study area and Data collection:
Sample is limited to Hyderabad hospitals for the primary data and the respondents (patients) were
selected on the basis of their language proficiency. As most of the international patients were from
Middle East, there was a language barrier between the patients and researcher. Collection of data
includes both primary and secondary data. Primary data was collected through observation and
interview method. And secondary data was obtained from both external and internal source. Scope of
the study which includes different areas of Hyderabad major corporate hospitals medical brokerages,
medical tourism facilitators for meeting international patients, pioneers of the industry, and Andhra
Pradesh Tourism Development Corporation.
Limitations of the study:
The result of the study has definite location, time bias and finding will hold good only similar
condition exists i.e., study is limited to major corporate hospitals in Hyderabad for
collection of primary data. There was no questionnaire conducted because of less span of time and
costs were essential consideration. There is a need for further study especially primary data has to
collect from different destinations.
Review of literature:
The critical review of the important studies related to the topic conducted in India and abrod, it helped
in developing frame work for realizing the objectives laid down for the present study Dr.Prem Jagyasi
(MedicaITourismAssociation, sept2009) was stated about role of facilitator pertaining to patient
knowledge and travel activities in a destination.
Panne1.P.Smith and Dana. A.Forgione did research on selecting destination; they have explained and
developed two stages for medical tourism. First stage is about evolution of
foreign country, second is choosing the health care facility. They argued about country specific
characters influence the country of choice including economic condition, political climate and
regulatory policies.Dr.Annamali Murugan spoke about recent changes in health care delivery and
opportunities in Indian medical tourism.
Dr. Christene Lee and Dr. Michael Spisto (2008) explained about Medical tourism, the futer of health
services. John Conell (2006)from university of Sydney did research on medical tourism sea, sun,
surgery with reference to India.Protleger turners discussed on " First world treatment at third world
prices", globalization, bioethics in medical tourism.
Dr. Sam pad kumar swain and A. Suresh babu (2007) mentioned about mile stones of Indian medical
tourism and role of government in promoting medical tourism.JyothLT.(2009) wrote article Kerala as

health tourism destination: SWOT analysis.P .J.Shyju(2007) did research on prospects of medical
tourism in India
Growth of Medical Tourism
A combination of multiple factors has contributed to the recent increase in popularity of medical
tourism. High cost of healthcare in the industrialized nations and the dramatic reduction in cost of
international travel together has created a market for medical tourism. At the same time a destination
is needed for these medical tourists. In the recent years, the medical technology and standards of
healthcare in many developing countries has seen a revolution. Today, countries like India, the East
Indies, South America and South East Asia offer treatment facilities at par with international standards
at just a fraction of cost. Also, the~e countries offer numerous options for touring, sightseeing,
shopping, and exploring. With the current growth rate of medical tourism it is expected that
destinations for medical tourists will also increase rapidly as health care facilities improve around the
world Although, India is a recent entrant into the medical tourism arena, it is poised to emerge as a
major global player. As per research reports, approx. 150,000 medical tourists came to India in 2005
and the numbers are expected to increase at the rate of28%
in the coming years. In fact a study estimates that India has the potential to attract 1
billion medical tourists a year.(Indi Quest Research Report, 2007). Further, as per the study by
McKinsey and the Confederation of Indian Industry, medical tourism in India is expected to become a
Rs.lOO billion ($2.2b) business by 20128. The Indian government predicts that India's $17-billion-ayear health-care industry could grow 13 per cent in each of the next six years, boosted by medical
tourism, which industry watchers say is growing at 30 per cent annually9.
India as a medical tourism destination
"Health is Wealth." Today, everyone around the world knows and accepts the importance of Health.
This changing attitude and way of living of people are the primary reasons why the healthcare
industry across the globe has caught up in the limelight and gaining it's momentum as days pass by.
Unlike in'other Industries, in the health care industry, it's not merely machines or technology that
matters. A lot depends on the skill and clinical
judgments of the doctors. India, as we all know, is already very well known for its high

Panne1.P.Smith and Dana. A.Forgione did research on selecting destination; they have explained and
developed two stages for medical tourism. First stage is about evolution of
foreign country, second is choosing the health care facility. They argued about country specific
characters influence the country of choice including economic condition, political climate and
regulatory policies.Dr.Annamali Murugan spoke about recent changes in health care delivery and
opportunities in Indian medical tourism.
Dr. Christene Lee and Dr. Michael Spisto (2008) explained about Medical tourism, the futer of health
services. John Conell (2006)from university of Sydney did research on medical tourism sea, sun,
surgery with reference to India.Protleger turners discussed on " First world treatment at third world
prices", globalization, bioethics in medical tourism.
Dr. Sam pad kumar swain and A. Suresh babu (2007) mentioned about mile stones of Indian medical
tourism and role of government in promoting medical tourism.JyothLT.(2009) wrote article Kerala as
health tourism destination: SWOT analysis.P .J.Shyju(2007) did research on prospects of medical
tourism in India

Growth of Medical Tourism

A combination of multiple factors has contributed to the recent increase in popularity of medical
tourism. High cost of healthcare in the industrialized nations and the dramatic reduction in cost of
international travel together has created a market for medical tourism. At the same time a destination
is needed for these medical tourists. In the recent years, the medical technology and standards of
healthcare in many developing countries has seen a revolution. Today, countries like India, the East
Indies, South America and South East Asia offer treatment facilities at par with international standards
at just a fraction of cost. Also, the~e countries offer numerous options for touring, sightseeing,
shopping, and exploring. With the current growth rate of medical tourism it is expected that
destinations for medical tourists will also increase rapidly as health care facilities improve around the
world Although, India is a recent entrant into the medical tourism arena, it is poised to emerge as a
major global player. As per research reports, approx. 150,000 medical tourists came to India in 2005
and the numbers are expected to increase at the rate of28%
in the coming years. In fact a study estimates that India has the potential to attract 1 billion medical
tourists a year.(Indi Quest Research Report, 2007). Further, as per the study by McKinsey and the
Confederation of Indian Industry, medical tourism in India is expected to become a Rs.lOO billion
($2.2b) business by 20128. The Indian government predicts that India's $17-billion-a-year health-care
industry could grow 13 per cent in each of the next six years, boosted by medical tourism, which
industry watchers say is growing at 30 per cent annually9.
India as a medical tourism destination
"Health is Wealth." Today, everyone around the world knows and accepts the importance of Health.
This changing attitude and way of living of people are the primary reasons why the healthcare
industry across the globe has caught up in the limelight and gaining it's momentum as days pass by.
Unlike in'other Industries, in the health care industry, it's not merely machines or technology that
matters. A lot depends on the skill and clinical
judgments of the doctors. India, as we all know, is already very well known for its high
level of professionalism and knowledge in the health care and medical Industry. Though there are
other countries where medical tourism is already being actively promoted such as Greece, South
Africa, Jordan, Malaysia, Philippines and Singapore, India is fast emerging as the most preferred,
competent and cost effective contender in the world with respect to medical tourism. Long recognized
for its cultural and scenic beauty, India is now being put up on international map as a haven for those
seeking quality and
affordable healthcarelO, India has more than a 100 health-care institutions, which are of
world standard. The major Indian health destinations include Delhi, Mumbai, Bangalore, Chennai and
Thiruvantapuram. The south Indian city of Chennai has been declared India's Health Capital, and is
estimated to receive 45 per cent of health tourists from abroad and 30-40 per cent of domestic health
touristsl', India is particularly well known for its low-cost advanced medical procedures, ranging from
heart surgery, joint
replacements and hir resurfacing to cataract operations, cosmetic surgery, dentistry and
gallstone removal 12, 3.
Outstanding Service

Hospitality is about serving the guests to provide them with "feel-good effect".
"Athithi devo bhavha" (Guest is God) has been one .of central tenets of Indian culture since times
immemorial. In India, the guest is treated with utmost warmth and respect, and is provided the best
services. India has a large number of service personnel trained in the hospitality industry that ensures
a high level of service qualityl4.
Factors that influencing the patients elect India for Health care
The availability of numerous Hospitals and Clinics in each and every part of India, whether urban,
semi-urban, or rural, with 24 Hours medical facilities and well qualified staff prevents the problems of
waiting lists as seen in American, Canadian or European hospitals. In addition, the one on one
attention as seen in most Indian Hospitals and the availability of professionally trained personal
nurses and 24 hour servants are the
Unimaginable luxuries for people coming from most developed countries. The treatment in India is
cost effective and very efficient. This is a major factor that attracts medical tourists from all around
the globe particularly in the field of dentistry. But on a personal level, Indian doctors and hospitals are
globally known for their kindness and personal
care towards their patients. The language barrier creates only a small hurdle as most of
the doctors and hospitals speak and understand English and the Prescriptions are written in English. It
is said, "Faith is the best healer." The strong confidence people have in Indian medical systems and
practices attract them to India. Its reputation precedes it. Finally, leisure tourism is already very much
in demand in India as the country offers diverse cultural and scenic beauty. India has almost all sorts
of destinations like high mountains, vast deserts, scenic beaches, historical monuments, religious
temples etc. Known for its hospitality for tourists, the country has opened doors to welcome the
medical patients with the same hospitality. So, if you require medical treatments of any kind consider
becoming a medical tourist. and get a free vacation with the savings your treatment bills without
compromising on quality.
Safety and Quality Standards Driving Patient Expectations
Cost and quality don't always mesh, but these two factors are the most common reasons that people
travel abroad for health care. Americans, for example, travel to India, Thailand, Singapore, Costa
Rica, and other countries for joint replacement, cosmetic surgery, dental treatments, or heart surgery
to take advantage of costs that can be drastically lower than in the United States. Some Americans
also seek care outside their home country in order to access what are considered alternative treatments
that are not yet approved in the United Statesl5.
One 2008 report found that more than 750,000 Americans sought treatment outside the United States
in 2007 and projected that number to grow to 6 million by 20 I O. People in other parts of the world
are also leaving their countries for medical care, sometimes coming to the United States. The same
report estimated that more than 400,000 non-U.S. residents will seek care in the United States 16.
Medical tourism facilitator as a key player
A medical tourism support system goes far beyond the obvious arrangements like travel,
accommodation, medical services, and pre & post-operative care and tourism activities. It needs to
meticulously deliver impeccable services
The Concept and role

The process of deciding on medical tourism is no doubt a challenging task for a medical traveler. It
requires critical preparations such as identification of reliable providers, flawless travel arrangements,
and a understanding of preoperative and postoperative arrangements, amongst many other steps
involved in the planning. Because of the complexity of this decision-making process, some medical
travelers seek help from travel agents or international patient departments of the hospitals or
concierge service providers. All these agencies could act as intermediaries, but none of them could
offer flawless comprehensive medical tourism support services as a one-stop facilitator. This lacuna at
one level or the other, coupled with complex decision making giving birth to the concept of the
Medical Tourism Facilitator, which is an agency with the team of
Professionals equipped to offer a seamless combination of complicated arrangements within medical
tourism.
Before I enunciate the role expected to be essayed by a Medical Tourism Facilitator, I would like to
touch upon the concern shrouding the medical tourism industry. Lack of
government emanated legal issues has ensured that the sector has become an easy "Quick Start". As a
result, robust tribes of new facilitators are cropping up on the eighth continent - The Internet - and are
raising major concerns for the growth of the medical tourism industry The role of Medical Tou~ism
Facilitators becomes extremely significant for the growth of medical tourism in wake of this growing
criticism; after all, they represent patients' first face-to face contact with the entire concept of medical
tourism.
Thus, it becomes vital that the facilitators put fourth authorized and authentic meaning of

Medical Tourism as not a mere tourism sojourn or medical trip, but a high quality medical treatment
with a "Touch of Tourism". Integrated knowledge of medical services, tourism & travel facilitation
and concierge services which form a three-dimensional support to the traveler is central to the
business and a must have for any Medical Tourism Facilitator. So with such responsibilities resting on
them, they play an important
function of bridging the gap between industry players and the consumer.
Understanding of Medical Services
Like any other industry, Consumer is King and it is of utmost importance that the facilitator
understands what travelers want and accordingly, what pitches to make to genuine providers. It is
crucial to develop a sound patient-provider matrix. Since one can't rely only on online information,
which tends to often mislead; facilitators therefore should act as reliable and sensitive consultants.
Awareness of ethical medical procedures, medico-legal law and accreditation systems of the provider
play an important role. Again, pre-and postoperative arrangements are of utmost importance. This
requires that the Medical Tourism Facilitators have a basic understanding of the medical subject so
that they can confidently explain their offered services with all the technical details, thereby providing
better medical! healthcare experience. Such comprehension should not be limited only to obvious
activities such as travel booking, accommodation arrangements, tourism exposure guidance, but
should include understanding of environmental, cultural, political, security, and community factors of
the destination. Development of customized
benefits with special need arrangements, interpreter provision and preparation of
unexpected services in case of unsuccessful medical treatment are some of the critical points. A key
component of wholesome experience for travelers deals with destination management by third party

providers. These specialized professionals take care of a medical tourist's entire trip right from pick up
from airport to booking hotel accommodation; from a hospital consultation visit and surgery to
assistance in the post-op check up; and finally delivering the patient back to the airport. Additionally a
facilitator should be available for the traveler in case of any unexpected incident. Concierge Services
must be well understood by the facilitator to provide that "door step" service experience to the
medical tourist so that they do not face any trouble either in finding accommodation or the hospital or
in reaching back to their countries.
Optional Components
If the medical traveler is traveling with an international insurance policy or through an employer,
he/she may not be aware of any formalities required by providers and insurance companies. In such
case, a facilitator should pre-arrange all m necessary
documentation to avoid any unnecessary delay in the treatment. .
Medical services are not without complication; even after complete preparation, things might go
wrong, as in some cases they will. In such cases a facilitators should have arrangements for unexpected events that may include amongst others- long stay treatment, additional expenses, death
related arrangements, etc. A medical tourism insurance policy could be helpful for traveler.
The presence of International Certification for a medical facilitator helps them to be better prepared in
the field of healthcare protocols - patient protocols, pre-operative and post-operative protocols,
communication protocols and legal liabilities to protect

organizations; in addition to receiving continuous education on latest trends in quality management

practices. Accreditation, not only helps to improve the quality of service, it also creates confidence,
trust and creates credibility for facilitator in the eyes of patients. Placing the right processes and
procedures in position can reduce the likelihood of errors
and troubles happening with foreign patients, and it certainly increases the chances of positive
outcomes. Every accredited facilitator is a gain for Medical Tourism. Apollo hospital's Suneeta Reddy
said the incidence of problems is not even 0.01% so far, because the success rates are very good and
clinical outcomes are so good -- we are lCI (Joint Commission International) accredited -- and
patients have the same rights in India as they would in the U.S., so they are protected. But I think that
it's just a hurdle that we need to overcome. Once we have done this, we will be tying up with
insurance companies and benefits companies to see how we can assist people who need that type of
health care.( 1 5) 18 Industry, and should be truly recognized as intrinsic to its growth. There are 13
lCI accredited hospitals in India.
The international Society for Quality in healthcare Inc (ISQua) is a WHO recognized body, which
aims at a global platform for assessing and recognizing national Accreditations. have already been
successfully accredited by ISQua. Indian National standards National Accreditation Board for
Hospitals and Healthcare Providers (NAB H) have been bench marked with other accreditation
standards as well such as that of UK,
Australia etc. NABH is a member of ISQua Accreditation Council and participates in ISQua Annual
Conference. They are under stage of review by ISQua for accreditation. Membership with ISQua has
already been accepted and Accreditation is expected soon. Also, NABH collaboration with ACHS
shows the evidence for Global Acceptance of the Indian Standards 17 .
Conclusion

Country specific characters influencing the country choice including cost, hospital accreditation,
quality of care, physician training, regulatory policies, economic conditions impact the choice of
health care facility.
The biggest challenge that the Indian hospitals face is assuring the foreign patients that they will
receive quality care with no hidden costs. The industry experts need to develop the decision making
models through a thorough study on the factors that motivate the patients to choose India as a health
care solution spot. The basic expectations that the industry feels are important to be concerned about
are, Hygiene, Staff ( trained technically as well as in soft skills), Customization, Insurance Cover,
Stability, Connectivity, International standard certification, Para - Medical Ambulance facilities
Dental Tourism (or Dental Treatment Outsourcing) is now an acknowledged field in itself. Owing to
the huge difference in dental treatment costs between developed and developing nations, it is not
surprising to find that dental patients in greater numbers from developed nations are now seeking
standardized dental treatments from highly qualified
dentists in developing nations, which was otherwise unaffordable. The presence of
International Certification for a medical ~acilitator in India and rest of the world helps them to be
better prepared in the field of healthcare protocols - patient protocols, preoperative and postoperative protocols, communication protocols and legal liabilities to protect organizations lCI
accredited and patients have the same rights in India as they
would in the U.S.so they are protected. There are 13 JCI accredited hospitals in India and some
hospitals are waiting for JCI accreditation.
Medical Tourism Facilitator plays a vital dual role first, in attracting medical tourists and second, in
providing quality experience through medical, travel, concierge, and insurance-facilitation services.
Hence, this key player largely influences the medical tourism industry's growth.

Acknowledgements:
The author would be grateful toDr. AKVS Reddy DG NITHM, Ms.Jaishree Anand Dean (hospitality)
Dr.E.Shivanagi Reddy department of Archeology, AndhraPradesh Mr.A.Raghu faculty and faculty
NITHM, Dr.Pothukuchi Thrayambakam and for their help and encouragement for writing the paper.
And I would like to thank Mr.Anand Banda, Ms.Vijayalaxmi, Mr. Neeraj Goyel, Mr.Ramesh, Dr.
Nivedita Rao, Mr.Giri and my friends for their help in providing necessary information

References

(1) International Marketing Conference on Marketing & Society, 8- I 0 April, 2007, IIMK)

(2) Dr.Zuber Mujeeb Shaikh and Dr. Gazala Khan-a case study on medical torism

(3) http://india-medical-tourism.net/history-of-medical-tourism. html

(4) www.recoverdiscover.com

(5) Woodman, J.;(2007) Patients Beyond Borders-Evelybody's Guide to Affordable World Class
Medical Tourism; Catanoba Publishing, USA.

(6) McIntosh, C. Medical tourism: Need surgery, will travel, CBC News Online, June 18, 2004

(7) Gupta Sen Amit, "Medical Tourism and Public Health ", People's Democracy, Vol. 28, No. 19, 9
May, 2004

(8) The Hindu, 17.4.2005; "are we ready for medical tourism?" http://www.thehindu.com/t
hehindulmag

(9) Suneeta Reddy Apollo Hospitals': 'Medical Tourism Is a Huge Market': India Knowledge Wharton
(http://knowledge. wharton. upenn. edulindia/article. cfm)

(10) Dr. Nimit Garg MDS (Periodontics) is a Consultant for Max Healthcare inNew Delhi, India

(II) Macguire, Suzanne (2007). India - The Emerging Global Health Destination. EzineArticles,
http://ezineartic1es.com

(12) DR. Arati verma and DR. Shalini Shalla 08, MEDICAL TOURISMN issue-2 February 20

(13) Health care:IBEF:India brand equity foundation.www.ibef.com

(14) Grant R Muddle 'your guide to international medicine', MEDICAL TOURISMN issue-2,
February 2008
(15) Karen H. Timmons published online: Aug 4,2009 MTA...

(16) Deloitte Center for Health Solutions: Medical Tourism: Consumers in Search of Valw!: 2008
Survey of Health Care Consumers.

(17) Worldmedassist.com, Medical tourism magazine, February 2008,your guide to international

medicine