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Medical Tourism in India: Progress, Opportunities and Challenges

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Medical Tourism in India: Progress,
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Medical Tourism in India: Progress,
Opportunities and Challenges
K.R.Shanmugam
Professor, Madras School of Economics
shanmugam@mse.ac.in
MADRAS SCHOOL OF ECONOMICS
Gandhi Mandapam Road
Chennai 600 025
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March 2013
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iii
Acknowledgements
I am thankful to Korea Development Institute (KDI) for the financial support. The earlier
version of this study was presented at “The International Forum on the Service Sector
Advancement”, orgnaised by the Ministry of Strategy and Finance South Korea and KDI
on September 19, 2011.
K.R. Shanmugam
iv
Abstract
Although the medical tourism is a recent phenomenon, this sector grows exponentially
and emerges as a major force for the growth of services exports worldwide. India is one
of the major players in this industry. Soaring medical costs, high insurance premiums,
increasing number of uninsured and under insured people in developed nations, long
waiting period in the home country, availability of high quality health care services at
affordable rate, and internet/communication channels in developing countries, cheaper
air fares, and tourism aspects are the driving forces of the outbound medical tourism.
Currently India hosts about 1.27 million medical tourists from industrialized countries like
UK and USA and from its neighboring countries such as Bangladesh, Sri Lanka, and
China. Its foreign exchange earning from medical tourism is around US $ 1.8 billion. But
it faces intense regional competitions from Malaysia, Singapore and Thailand.
Against this backdrop, this study attempts to analyze (i) the trends in foreign
tourist arrivals in India and foreign exchange earnings from them, (ii) the factors favoring
the growth of medical tourism in India, including the initiatives of government and
industry (iii) the opportunities available for India to make further progress and (vi) the
challenges facing the industry. Since the data on the exact number of medical tourist
arrivals and revenues are not readily available, this study attempts to estimate the
number of medical tourists and earnings from them till 2015. The projection indicates
that the number of medical tourist in India is likely to reach 2.8 million and the market
will be around US $ 4 billion by 2015. Further, it demonstrates a simple Ricardian model
of trade for healthcare industries in two model countries (India and South Korea) and
shows how they can gain from trade.
Keywords:
medical tourism, healthcare, foreign exchange, comparative advantage,
gains from trade.
JEL Code:
I12, I18, I38
v
CONTENTS
Acknowledgements
iii
Abstract
iv
INTRODUCTION
1
PERFORMANCE OF TOURISM INDUSTRY
5
MEDICAL TOURISM IN INDIA: PROGRESS, OPPORTUNITIES AND
CHALLENGES
11
ECONOMICS OF MEDICAL TOURISM: GAIN FROM TRADE
21
CONCUDING REMARKS
23
References
24
1
Chapter 1
INTRODUCTION
A journey that patients take from one country to another country to get cost effective
and efficient medical treatment, followed by a great vacation at some of the most
beautiful locations is called medical tourism. In simple terms, the medical tourism refers
to “visit by overseas patients for medical treatment and relaxation”.
1
Thus, it is an
amalgamation of two distinct services: healthcare and tourism.
Although the medical tourism is a recent phenomenon, this sector grows
exponentially and emerges as a major force for the growth of services exports worldwide.
Currently, it is a multi billion dollar industry.
2
Countries like Belgium, Costa Rica, Cuba,
Dubai, Hungary, India, Israel, Jordan, Malaysia, Singapore, South Africa, Thailand etc are
actively involved in medical tourism.
Soaring medical costs, high insurance premiums, increasing number of uninsured
and under insured people in developed nations, long waiting period in the home country,
availability of high quality health care services at affordable rate and
internet/communication channels in developing countries, cheaper air fares, and tourism
aspect are the driving forces of the outbound medical tourism. Now more and more
overseas patients travel abroad to get medical treatments, which include electric
procedures as well as complex specialized surgical procedures such as joint replacements
(hip/knee), cardiac surgeries, cosmetic surgery, and dental surgery.
India is one of the major players in this industry. Currently, it hosts about 1.27
million medical tourists from industrialized countries like UK, USA and Canada and from
its neighboring countries such as Bangladesh, Sri Lanka, and China. Its foreign exchange
earning from medical tourism is estimated to be around US $ 1.8 billion. But it faces
intense regional competitions from Malaysia, Singapore and Thailand.
1
It mixes leisure, fun and relaxation together with wellness and healthcare. According to UNESCAP (2007), medical travel
refers to the international phenomenon of individuals traveling, often great distance, to access healthcare services that
are otherwise not available due to high costs, long waiting lists, or limited health care capacity in the country of
origin…….Medical travel is often referred to as medical tourism.
2
The International Trade Commission in Geneva says that medical tourism could grow into a US $ 188 billion global
business by 2013 (Government of India, 2011b).
2
India is one of the major democratic nations of the world. It has achieved
considerable progress after initiation of reforms in 1991. It has emerged as the fourth
largest economy in purchasing power. It is amongst the fastest growing nations in the
world. It has made great advances in many fields particularly Information Technology
(IT). With a large pool of educated English speaking citizens, India has emerged as an
important outsourcing destination for many multi-national companies. It has launched its
own satellites and sent a spacecraft to moon. Thus, India is booming in recent years.
India stands out for the size and dynamism of its services sector (Government of
India, 2012). The share of services in India’s GDP at factor cost is nearly 65 percent.
During 1990-91 to 2011-12, the GDP (factor cost) at 2004-05 prices grew at an average
rate of 6.6 percent while the services GDP grew at 8.04 percent. Except in two years
(1994-95 and 1996-97), services grew faster than GDP (see Chart 1.1). Interestingly for
the last nine years (2003-04 to 2011-12), the GDP at factor cost (real) grew at 8.2
percent per annum while the services GDP grew at 9.6 percent. Thus, one of the striking
aspects of India’s recent growth has been the dynamism of the services, particularly IT
and ITES (IT enabled services). The medical tourism industry is poised to be the next big
success story in India after IT (software).
Chart 1.1: Growth Rates: GDP and Services GDP (%)
0
2
4
6
8
10
12
1990-91
1991-92
1992-93
1993-94
1994-95
1995-96
1996-97
1997-98
1998-99
1999-00
2000-01
2001-02
2002-03
2003-04
2004-05
2005-06
2006-07
2007-08
2008-09
2009-10
2010-11
2011-12
Services GDPfc
3
Against this backdrop, this study attempts to analyze (i) the trends in foreign
tourist arrivals (FTAs) in India and foreign exchange earnings from them, (ii) the factors
favoring the growth of medical tourism in India, including the initiatives of government
and industry (iii) the opportunities available for India to make further progress and (vi)
the challenges facing the industry.
Since the data on medical tourist flows and revenues are poor, this study
attempts to project the number of medical tourists and earnings from them till 2015. The
projection indicates that the number of medical tourists in India will likely to reach 2.8
million and the market will be around US $ 3.96 billion by 2015. Further, it demonstrates
a simple Ricardian model of trade for healthcare industries in two model countries-India
and South Korea and shows how they can gain from trade.
5
Chapter 2
PERFORMANCE OF TOURISM INDUSTRY
Tourism is one of the major components of India’s services and engines of growth,
contributing around 6.11 percent of GDP and 10 percent of employment. This sector is
estimated to create 78 jobs per million Indian rupees of investment compared to 45 jobs
per million rupees in the manufacturing sector (Planning Commission, 2011). The annual
growth of this sector is estimated to be 8.1 percent during the last five years.
Performance indicators of this industry that are shown in Table 2.1, Foreign Tourist
Arrivals (FTAs), Foreign Exchange Earnings from Tourism (FEE), Domestic Tourists (DTs)
and Foreign Tourist (FTs) visiting states and union territories of India and Outbound
Tourists (OTs), witnessed significant growth in recent years.
3
3
FTAs refer to the number of arrivals and not the number of persons. The same individual who makes multiple trips to
India is counted each time as a new arrival. A domestic tourist is a person traveling within the country to a place other
than his/her usual place of residence and stays at hotels etc for a duration of not less than 24 hours or one night and not
for more than 12 months at a time for any of the purposes: pleasure, pilgrimage, business or conference meeting, study
and health. A foreign tourist is a person visiting India on a foreign passport staying at least 24 hours in the country.
6
Table 2.1: Indian Tourism Industry: Trends in the Performance Indicators
Year
Foreign
Tourist
Arrivals
(in
Million)
Foreign Exchange Earnings from Tourism
Visits to States and
Union Territories
Out
Bound
Tourism
(Million)
India
(Rs.
crore)
World
(US$
Billion)
India
(US$
Billion)
India's
Share
(%)
India's
Rank
Domestic
(in
Million)
Foreign
(in
Million)
1991
1.68
4318
276.9
1.9
0.67
-
66.67
3.15
1.94
1992
1.87
5951
315.4
2.1
0.67
-
81.46
3.10
2.16
1993
1.76
6611
321.9
2.1
0.66
-
105.81
3.54
2.73
1994
1.89
7129
354.9
2.3
0.64
-
127.12
4.03
2.73
1995
2.12
8430
405.3
2.6
0.64
-
136.64
4.64
3.06
1996
2.29
10046
438.7
2.8
0.65
-
140.12
5.03
3.46
1997
2.37
10511
442.8
2.9
0.65
-
159.88
5.50
3.73
1998
2.36
12150
444.8
2.9
0.66
34th
168.20
5.54
3.81
1999
2.48
12951
458.2
3.0
0.66
35th
190.67
5.83
4.11
2000
2.65
15626
475.3
3.5
0.73
36th
220.11
5.89
4.42
2001
2.54
15083
463.8
3.2
0.69
36th
236.47
5.44
4.56
2002
2.38
15064
481.9
3.1
0.64
37th
269.60
5.16
4.94
2003
2.73
20729
529.3
4.5
0.84
37th
309.04
6.71
5.35
2004
3.46
27944
633.2
6.2
0.97
26th
366.27
8.36
6.21
2005
3.92
33123
679.6
7.5
1.10
22nd
392.01
9.95
7.18
2006
4.45
39025
744.0
8.6
1.16
22nd
462.32
11.74
8.34
2007
5.08
44360
857.0
10.7
1.25
22nd
526.56
13.26
9.78
2008
5.28
51294
939.0
11.8
1.26
22nd
563.03
14.38
10.87
2009
5.17
54960
851.0
11.4
1.34
22nd
668.80
14.37
11.07
2010
5.78
64889
919.0
14.2
1.54
17th
747.70
17.91
12.99
2011
6.29
77591
n.a
16.6
n.a
n.a
850.86
19.95
n.a.
Average Annual Growth Rates (%)
1992-
2002
4.35
14.64
5.68
8.24
-
-
13.87
6.98
8.99
2003-
2011
11.63
20.32
8.71*
21.23
-
-
13.70
16.56
12.97*
Source: Government of India (2011a); * till 2010.
During 2003 to 2011, the FTAs grew at an average rate of 11.6 percent while
FEE (in Indian Rs. crore) grew at 20.3 percent. During 1992 to 2002, they were growing
at 4.4 and 14.6 percent respectively. The FTAs increased continuously from 2.38 million
in 2002 to 6.29 million in 2011. At the same period, FEE increased from Rs. 15064 crore
to Rs. 77591 crore (Chart 2.1).
7
Chart 2.1: Foreign Tourist Arrivals and Foreign Exchange Earnings in India
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
10000
20000
30000
40000
50000
60000
70000
80000
90000
Rs.crore
Foreign Tourist Arrivals (in million) Foreign Exchange Earnigns (in Rs.crore)
Domestic tourism also plays an important role in overall tourism development in
the country. During 2002 to 2011, the number of domestic tourist visits increased from
269.6 million to 850.9 million, witnessing a growth of 13.7 percent in spite of various
adverse factors during this period and the number of foreign tourists visiting Indian
states and union territories increased from 5.16 million to 19.95 million, registering 16.6
percent growth per annum (Table 2.1).
Share of India in world international tourist arrivals increased from 0.39 percent
in 1995 to 0.61 percent in 2010 (not shown). During the same period, the India’s share
in world foreign exchange earnings from tourism increased from 0.64 percent to 1.54
percent.
4
It is noticed from Table 2.1 that during 2002 to 2010 India’s FEE from tourism
grew faster than World FEE from tourism and India’s rank improved from 37 to 17.
Nearly one third of international tourist arrivals (FTAs) in India (29.2 percent) are
catered by USA and UK.
5
Other major source markets for India include Bangladesh (7.5
percent), Sri Lanka (4.6 percent), Canada (4.2 percent), Germany (3.9 percent), France
(3.9 percent), Malaysia (3.1 percent), Australia (2.9 percent) and Japan (2.9 percent).
4
Respective shares of USA, Spain and France in 2010 were 11.26 percent, 5.71 percent and 5.04 percent (not shown).
5
In 2010, nearly 60 percent of FTAs in India were males and rest were female (Government of India, 2011b).
8
These eight countries cumulatively account for nearly 34 percent of FTAs in India (See
Chart 2.2).
Chart 2.2: Foreign Tourist Arrivals in India by Countries (2010)
U.K.
13.1%
Bangladesh
7.5%
Sri Lanka
4.6%
Canada
4.2%
Germany
3.9%
France
3.9%
Malaysia
3.1%
Oth ers
37.6%
U.S.A
16.1%
Australia
2.9%
Japan
2.9%
Chart 2.3 provides the percentage distribution of FTAs in India by age groups.
Nearly 21 percent of FTAs in India are aged 35-44 years. Around 20 percent of FTAs
aged 45-54 years. 17.4 percent of FTAs belong to 25-34 years category. Thus, nearly 60
percent of FTAs aged between 25 and 54 years.
Chart 2.3: FTAs in India by Age Group in 2010
10
8.3
17.4
21.1
19.9
13.8
9.5
0
5
10
15
20
25
0-14 15-24 25-34 35-44 45-54 55-64 65 &
Above
9
603
724
770
822
850
890
981
996
1082
1144
1253
1290
1721
1734
2448
0
500
1000
1500
2000
2500
3000
France
Malaysia
Turkey
China
Austria
Italy
Canada
Spain
UK
Hong Kong
Thailand
Germany
Switzerland
USA
India
An interesting feature of international tourism in India is that the foreign
exchange earnings (FEE) per international tourist arrived in India is about US $ 2500.
This is relatively high as compared to FEE per tourist in many competitors-China,
Thailand, Malaysia, etc (Chart 2.4). Such a high spent in India may be due to more
number of days spent by foreign tourists in India compared to other countries. The
Survey conducted by the Ministry of Tourism, Government of India indicates that the
foreign tourists to India spend in the range of 7-18 days in India per trip, the overall
average being 16 days (Government of India, 2006).
Chart 2.4: Foreign Exchange Earnings per Tourist (US $) in 2010
Maharastra, Tamil Nadu and Delhi are the major destinations for foreigners
visiting India. They account for nearly 55 percent of foreign visits. Uttar Pradesh (where
Taj Mahal is located) ranks fourth in attracting foreigners and Rajasthan ranks fifth
(Table 2.2).
10
Table 2.2: Top 10 States/UTs in Number of Foreign Tourist Visits in 2010
Top 10 States
Foreign Visits (in lakh)
%
Maharastra
5.1
28.5
Tamil Nadu
2.8
15.7
Delhi
1.9
10.6
Uttar Pradesh
1.7
9.4
Rajasthan
1.3
7.2
West Begal
1.2
6.7
Kerala
0.7
3.7
Bihar
0.6
3.6
Himachal Pradesh
0.5
2.5
Goa
0.4
2.5
Total: Top 10 states
16.1
90.3
Others
1.7
9.7
Total
17.9
100.0
Tourism Promotion in India
The new National Tourism Policy (Government of India, 2002), the Eleventh Five Year
Plan (Planning Commission, 2008) and the Draft Approach to the 12th Fiver Year
(Planning Commission, 2011) reports highlight the importance of tourism sector in terms
of its contribution to GDP and employment generation and proposed to focus on creation
of adequate tourism infrastructure like modernization and expansion of airports, better
hotel accommodation facilities, and improved road connectivity to tourist destinations.
Many action plans and strategies were proposed. Government has also taken various
steps to promote tourism in India.
The major steps are: (i) 23 mega projects were sanctioned to develop quality
tourism infrastructure at tourist destinations in India; (ii) Government has adopted “Code
of Conduct” for “Safe and Honorable Tourism on July 2010; (iii) Along with Incredible
India Campaign, Visa-on Arrival scheme was introduced for tourists from Singapore,
Finland,, New Zealand, Luxembourg, and Japan on a pilot basis from January 2010 and
was extended to many other nations in 2011; and (iv) Government promotes community
tourism, heritage tourism, eco tourism, medical tourism, wellness tourism and the like.
6
Despite all these efforts, the share of India in World tourism receipts is still low at 1.54
percent.
6
The following types of (niche) tourism offered in India: Adventure tourism, sun sand coastal tourism, black water
tourism, eco tourism, architectural treasurers, hill delights, forts and palaces, the deserts, the jungle, island attractions,
pilgrimage, northeastern regions, medical/healthcare tourism and travel tourism.
11
Chapter 3
MEDICAL TOURISM IN INDIA: PROGRESS, OPPORTUNITIES AND
CHALLENGES
Medical Tourism: Progress
India’s effort to promote medical tourism took off in the late 2002 when McKinsey-CII
(2002) study outlined immense potential of this sector. In the same year, the Ministry of
Tourism started “Incredible India - the government’s big budget market campaign to
attract tourists. In the following year, the then Finance Minister Jaswant Singh called for
the country to become a “global health destination” and urged for improving airport
infrastructure to smooth the arrival and the departure of medical tourists.
Efforts were made to modernize and expand airports in the country, and to
improve road connectivity and other infrastructure facilities. The Government of India
promoted 45 private hospitals as Centre of Excellence in its tourism brochure. It
introduced a new M or medical visa for medical tourists and their companions too. The
Ministry of Health and Family Welfare has set up a National Accreditation Board for
hospitals. The government declared medical tourism as services export so that this
sector avails tax concessions.
At the state level, some state governments participate in healthcare tourism
expos abroad. Kerala has made concerted efforts to promote healthcare tourism,
leveraging Ayurveda. Karantaka is setting up Bangalore International Health City
Corporation. Maharastra has granted the industry status to the tourism activity such that
this sector gets all benefits/incentives given to all other industries. Gujarat announced a
separate policy for medical tourism.
The industry has also made various initiatives. Healthcare centers have
established world class infrastructure to attract international patients. They set up
comprehensive diagnostic centres, imaging centres, and world class blood banks.
Hospitals are constantly upgrading technology. Some hospitals have established special
wards for international patients. Some are tying up with travel/tour operators to offer
healthcare tourism as a single service package. Few hospitals are in the process of
continuous innovation of products, services and facilities to give better value to the
customers. While doing so, some hospitals are focusing on cost effective-customer
oriented technology. Many healthcare centers are increasingly participating in
international trade fairs/exhibitions to promote medical tourism. The medical tourism in
12
India has also gained a boost with an increase in investments and FDI from international
players.
Indian healthcare institutions are increasingly going for international accreditation
of hospitals and clinical laboratories. Currently, there are 16 JCI approved hospitals in
India. They are: (1) Ahalia Foundation Eye hospital, Palakkad (Kerala), (2) Apollo
Gleneagle hospitals (Kolkata), (3) Apollo hospitals (Bangalore), (4) Apollo hospitals
(Chennai), (5) Apollo hospitals (Hyderabad), (6) Asian heart Institute (Mumbai), (7)
Fortis Escorts heart hospitals (New Delhi), (8) Fortis Hospitals (Mohali), (9) Fortis
Hospitals (Bangalore), (10) Fortis hospitals (Mumbai), (11) Indraprastha Apollo Hospital
(New Delhi) (12) Moolchand Hospitals, (New Delhi), (13) Narayan Hrudayalaya
(Bangalore), (14) Satguru Partp Singh Apollo Hospitals (Punjab), (15) Shroff Eye hospital
(Mumbai), and (16) Sri Ramachandra Medical Centre (Chennai).
7
Among the selective
countries shown in Chart 3.1, India ranks second in number of JCI hospitals, next only to
Thailand.
Chart 3.1: JCI Accredited Hospitals in Selective Countries
18
16
15
14
12
7
7
5
4
4
3
2
1
1
1
0
2
4
6
8
10
12
14
16
18
20
Thailand
India
China
Singapore
South Korea
Malaysia
Spain
Indonesia
Germany
Philippines
Costa Rica
Japan
Bangaladesh
Pakistan
Belgium
There are 63 NABH (National Accreditation Board for Hospitals) approved
hospitals in India and 395 hospitals have also applied for NABA accreditation. Majority of
population speak English. Most of doctors and medical staff have world class exposure
and fluency in English.
8
While India has some of the best (world class) medical
procedures, it offers a whole lot of natural solutions to health-Ayurveda, Sidha, Unani,
7
Source: India http://www.jointcommissioninternational.org/JCI-Accredited-Organizations/
8
Language being one of the major barriers in other countries gives India a competitive edge over those nations.
13
Yoga, Acupuncture, Homeopathy, Naturopathy, Aroma therapy, Herbal Oil massage, etc.
India offers significant savings to the foreign patients. For almost all treatments, India
has cost advantages. Its price is the lowest among any nation in the world (see Table
3.1).
Table 3.1: Cost Competitiveness (US$)
Procedures
USA
India
Thai-
land
Singa-
pore
Mala-
ysia
South
Korea
Mexico
Costa
Rica
UAE
Heart Bypass
133000
7000
22000
16300
12000
31700
27000
24100
40900
Heart valve
replacement
140000
9500
25000
22000
13400
42000
30000
30000
50600
Hip
Replacement
57000
7020
12700
1200
7500
10600
13900
11400
46000
Knee
Replacement
53000
9200
11500
9600
12000
11800
14900
10700
40200
Face Lift
16000
4800
5000
7500
6400
6600
11300
4900
n/a
Lap. Gastric
Bypass
52000
9300
13000
16500
12700
9300
11000
n/a
n/a
Hotels are the most visible and important parts of a country’s infrastructure. This
industry is closely linked with (medical) tourism industry. Hotel industry is growing rapidly
in India in recent years. In 2003, there were 1722 hotels in India. They increased to 2483
in 2010 (Table 3.2). During this period, while number of rooms in one-star hotels
declined by about 62 percent, number of rooms in 5-star hotels increased by about 103
percent.
14
Table 3.2: Approved Hotels and Rooms: 2003 and 2010
Category of Hotels
No. of Hotels
No. of Rooms
2003
2010
% Change
2003
2010
% change
One Star
201
67
-66.7
6606
2537
-61.6
Two Star
533
307
-42.4
17629
8446
-52.1
Three star
551
869
57.7
26071
36585
40.3
Four Star
122
157
28.7
8655
12059
39.3
Five Star
85
149
75.3
10416
17144
64.6
Five Star Deluxe
74
153
106.8
16885
34187
102.5
Apartment
-
8
756
Time Share Resorts
-
1
62
Heritage Hotels
77
146
89.6
2124
3879
82.6
Silver Bed & Breakfast
Establishments
469
1540
Guest House
1
40
Unclassified
79
156
97.5
3334
580
-82.6
Total
1722
2483
44.2
91720
117815
28.5
Further the number of recognized tour operators increased in many states in
India over the years. Chart 3.2 shows the number of recognized tour operators in major
Indian states and union territories (UTs) in India as on December 2010. Delhi,
Maharastra and Tamil Nadu are the top three states and union territories in number of
recognized tour operators.
Availability of high quality healthcare professionals and nurses, round the clock
services by medical staff, choice of luxury rooms in hospitals, good medical options, high
success rates, reputation for treatment in advanced healthcare segment such as cardio
vascular surgery, organ transplants, and eye surgery, popularity of Indian traditional
wellness systems, diversity of tourist destinations, strength in information technology are
the attractive aspects of Indian medical tourism. Today more and more foreigners choose
India as their destination for the treatment because of its rich cultural heritage and
innumerable tourist attractions. The medical tourism is a growing source of foreign
exchange as well as prestige and goodwill outside the country. This sector is an example
of how India is profiting from globalization and outsourcing.
15
Busines s and
Profess ional,
18.6
Visiting
Relatives and
Friends, 27.5
Others, 27.2
Medical
Treatment, 2.7
Leisure and
Recreation, 24
Chart 3.2: Recognized Tour Operators in Major States and UTs as on 31 Dec 2010
641
184
126
70
62
35
35
33
29
28
21
19
18
79
0
100
200
300
400
500
600
700
Delhi
Maharashtra
Tamil Nadu
Kerala
Karnataka
Uttar Pradesh
West Bengal
Haryana
Andhra Prdesh
Rajasthan
Gujarat
Goa
Punjab
Others
FTAs For Medical Treatment
Chart 3.3 depicts the proportion of FTAs by the purpose of visit. Nearly 28 percent of
FTAs in India visited friends and relatives; 24 percent visited for recreation and leisure;
and 18.6 percent came for business and professional activity. Only 2.7 percent of FTAs in
2010 were medical tourists. That is, of the total FTAs in India of 5.78 million, only 1.56
lakh visited for medical treatments in India in 2010.
Chart 3.3: Proportion of FTAs in India by Purpose of Visit (2010)
Source: Government of India (2011b).
16
Of the 1.56 lakh FTAs who visited India for medical treatments in 2010, 36694
FTAs were from Maldives (i.e., 23.5 percent) and 35853 were from Bangladesh (23
percent). Thus, nearly 50 percent of FTAs in India who visited for medical treatment
purpose were from these two countries. India also hosts medical tourists from USA, UK,
Canada and Germany (Chart 3.4).
Chart 3.4: FTAs in India for Medical Treatment (2010)
36694
35853
6773
6021
5820
5211
5064
3184
1870
1863
1721
1612
1519
1357
1257
1139
969
38019
0
5000
10000
15000
20000
25000
30000
35000
40000
Maldives
Bangladesh
Iraq
Nigeria
Oman
Afghanistan
Sri Lanka
UAE
Tanzania
USA
Others
Malaysia
UK
Nepal
Kenya
Germany
Canada
Others
According a research project commissioned by the Government of India to Indian
Institute of Tourism and Travel Management, cardiac treatment (30 percent) is the most
popular procedure in Indian medical tourism, followed by orthopedic including joint
replacement (15 percent), nephrology (12 percent), Nero-surgery (11 percent), cancer
(11 percent) and all others including cosmetic surgery (22 percent).
Medical Tourists and Revenues
Since the data on the exact number of medical tourist arrivals and revenues are not
readily available, we project/estimate the number of medical tourists and earnings from
them till 2015. According to the data compiled by the Ministry of tourism from major
airports, 0.16 million are medical tourists in India (in 2010). The International Passenger
Survey (2003) conducted by the Ministry of tourism estimated that 10 percent of about 2
million non resident Indians (NRIs) who visited India got medical treatments in India
(Goutam, 2008). The same share if extrapolated for the year 2010 would give an
17
estimated number of 0.3 million NRIs visiting India to undergo various medical
treatments (Table 3.3).
Table 3.3: Number of Medical Tourists in India and Revenues in 2010
Details
Persons
(million)
Avg.
Expenditure
(US$)
Foreign
Exchange
Earnings (US
$ million)
I. Foreign Tourist Arrivals (FTAs)
5.78
II. Medical Toursits (2.7% of FTAs)
0.16
2500
400
III. Number of NRI Visitors
3
IV. 10% of NRIs with HC objectives
0.3
1500
450
V. 5% of FTAs using wellness system
0.29
750
217.5
Total Number of Medical Tourists (II+IV+V)
0.75
1067.5
Further, there are a large number of international visitors including NRIs who
come for other purposes, but use wellness systems such as Yoga, Ayurveda and Sidha. If
we assume that 5 percent of FTAs use such wellness systems in India, the estimated
number of medical tourists under this category would be 0.29 million. These three
categories of tourists add up to 0.75 million (in 2010).
Using the average spending by FTAs in India of US $ 2500 per person, the
estimated total spending incurred by FTAs visiting for medical purpose works out to be
US $ 400 million. Assuming that NRIs spend US $ 1500 per person for medical treatment
in India (60 percent of what FTAs spent) and FTAs using wellness system in India on an
average spend US $ 750, the estimated total spending by these categories of medical
tourists work out to be US $ 450 million and US $ 217.5 million respectively. Putting
together, the medical tourism industry in India generated a revenue of US $ 1067.5
million (approximately Rs. 6000 crore) in 2010 (Table 3.3).
In Table 3.4, we have given the projected number of medical tourists in India
and revenues from them up to 2015. Scenario (pessimistic) 1 assumes 10 percent growth
due to global slow down in recent years, while Scenario 2 assumes 20 percent growth
(consistent with past 9 years growth) and Scenario 3 (optimistic) assumes 30 percent
growth. The estimated number of medial tourists in India in 2015 would be between
1.21 million and 2.78 million. The estimated revenue would lie between US $ 1719 million
to US $ 3964 million in 2015.
18
Table 3.4: Medical Tourists and Revenues up to 2015 in India: Projected
Details
2010
2011
2012
2013
2014
2015
Scenario 1 (10 Percent Growth)
Medical Tourists (million)
0.75
0.83
0.91
1.00
1.10
1.21
Revenues (US $ million)
1067.5
1174.3
1291.7
1420.8
1562.9
1719.2
Scenario 2 (20 Percent Growth)
Medical Tourists (million)
0.75
0.90
1.08
1.30
1.56
1.87
Revenues (US $ million)
1067.5
1281.0
1537.2
1844.6
2213.6
2656.3
Scenario 3 (30 Percent Growth)
Medical Tourists (million)
0.75
0.98
1.27
1.65
2.14
2.78
Revenues (US $ million)
1067.5
1387.8
1804.1
2345.3
3048.9
3963.6
Medical Tourism: Opportunities
India has many advantages. The first and the foremost is cost advantage. Then, it has
many hospitals equipped with international standards. Most of Indian doctors and other
medical staff have world class exposure and are fluent in English which is connecting
language globally. India also has a whole lot of natural solutions to health like Ayurveda,
and Sidha. It has many exotic tourist spots. Many medical tourists have already chosen
India as their destination for treatments. They to some extent help the country to
promote itself as a business and tourism destination. India should use these opportunities
and make more efforts to advertise these advantages and attract more medical tourists.
India is one of the fast growing nations in the world. Perceived as a service hub
across the globe, India has attracted a large number of global companies to set up their
base in India. This has already resulted in increased flow of business travel. The medical
tourism industry should take this opportunity to attract medical tourists and popularize
wellness system in the country such that more and more FTAs could use them.
Doctors in western part of the world are increasingly prescribing Indian system of
natural healing and medicine to their patients.
9
This will make many foreign patients to
choose India for treatments. In olden days, people used to travel to USA to get advanced
medical treatment. Now the reverse is happening. IT boom and cheaper flights make
people to choose alternate health destinations for treatment.
9
For instance, Ayurveda is now an official healthcare treatment in Hungary.
19
Fast paced life style increases demand for wellness tourism and alternative
cures.
10
Health insurance in country like USA covers only critical care and not cosmetic
care and beauty treatments. For those who seek cosmetic/beauty treatments choose low
cost destinations like India.
Soaring medical costs, high insurance premiums, long waiting lists, large number
of uninsured/under insured and insured in many advance nations force people in those
nations to be medical tourists. Insurance companies and employers also prefer to send
patients to India in order to reduce health care expenses. Large Indian community living
abroad also makes use of significant part of medical tourism in India.
In Japan, USA, UK and many other European nations, the proportion of elder
people has increased rapidly. At the same time, life expectancy has also increased
steadily. The combined result is: significant demand for natural healthcare system.
Inability of many healthcare systems drives many individuals to seek alternative to
domestic healthcare. Demand from countries with underdeveloped healthcare capacities
also increases.
The main opportunity presented by medical tourism is its contribution to the
growth of health economies. It is a major source for foreign exchange and stimulates
economic growth in other sectors including tourism, transport, pharmaceuticals, hotels,
food suppliers to hospitals and restaurants. The labor intensive nature of the tourism
industry makes it an excellent generator of employment. Medical tourism and the
competition on the global health market promote technological advances and improved
medical infrastructure.
It may stem brain drain. NRIs may return as they find medical sector in India
more lucrative than before. Modern hospitals that make significant investment in facilities
and staff, in part to compete for international patients, now also provide the benefits and
working conditions to satisfy the aspirations of medical professionals who would
otherwise move outside the country (UNESCAP, 2007). Greater competition from private
sector may force changes in public sector health systems in the country.
10
Now people like to get away from the daily hustle of life and get a quick treatment at an affordable price followed by a
great vacation at some of the most beautiful location.
20
Medical Tourism in India: Challenges and Issues
The challenges facing Indian medical tourism industry are as follows:
i. No strong Government support/initiative to promote medical tourism.
ii. Lack of coordination among various players in the industry-airline operators,
hotels and hospitals.
iii. The negative perceptions about India with regard to public sanitation/ hygiene
standards or prevalence of contagious diseases.
iv. No proper accreditation and regulation system for hospitals.
v. Lack of uniform pricing policy across hospitals.
vi. Strong competitions from many other players.
vii. Lack of insurance policies for this sector.
viii. Low investments in health infrastructure.
ix. Growth generates healthcare challenges in booming India. The country
graduates 27,000 doctors each year but most want to work in cities. But millions
must walk miles to see a physician.
x. Inequalities in healthcare access between private and public systems may
increase
xi. This may induce domestic brain drain from public to private sector.
xii. Indian Government’s campaign to make India a primary medical tourism
destination may divert attention from primary healthcare and other sectors.
xiii. Availability of hotel rooms in India is considered to be more difficult as compared
to other countries. In addition, the cost of accommodation is another hindrance
to middle-level international travelers visiting India.
xiv. Public-Private Partnership is required to provide quality services to attract
potential healthcare seekers from various countries.
21
Chapter 4
ECONOMICS OF MEDICAL TOURISM: GAIN FROM TRADE
In this chapter, we adopt Ricardo’s (1817) model of comparative advantage to the cost of
medical surgeries to demonstrate how specialization and free trade between two nations-
India and South Korea result in gains from medical tourism trade.
11
This model is based
on the following assumptions:
(i) There are only two countries;
(ii) There are only two kinds of medical services - bypass surgery and hip
replacement. These services are homogenous in quality;
(iii) No economies of scale and no transportation cost;
(iv) No barriers to trade; and
(v) Perfect knowledge exists.
Table 4.1 shows the cost of production for bypass surgery and hip replacement
in India and South Korea. India has absolute advantage in both services, in terms of low
cost of production. Based on (approximate) number of hospitals or capacity in each
country, Table 4.1 also shows the maximum production capacities in medical treatments
per hospital per day for sample nations. India can perform a maximum of 10 bypass
surgeries or zero hip replacement surgery or 10 hip replacement surgeries and zero
bypass surgery. South Korea, given its capacity can produce either 2 bypass surgery or 6
hip replacement surgery.
Table 4.1: Unit Costs of Bypass and Hip Replacement, and Outputs in Autarky
in India and South Korea
Procedure
Unit Cost (US $)
Maximum Output
Autarky
India
South
Korea
India
South
Korea
India
South
Korea
Total
Capacity
70000
66000
By pass
7000
30000
10
2
5
1
6
Hip
Replacement
7020
10500
10
6
5
3
8
Total
20
8
10
4
14
We assume that production possibility frontiers are constant (i.e., opportunity
costs are constant). In the case of Autarky (i.e., absence of trade situation), India gives
11
This section is primarily based on Piazolo and Zanca (2011).
22
up -1 unit of hip replacement for an additional unit of bypass surgery. This trade-off is
opportunity cost of bypass surgery in India. The opportunity cost of bypass surgery in
South Korea is -0.35. The opportunity costs of hip replacement in respective countries
are 1 and 3. In autarky, if we assume that each country divides its production capacity
equally between bypass and hip replacement, India can perform 5 bypass surgeries and
5 hip replacement surgeries and South Korea can perform 1 bypass and 3 hip
replacement services.
Table 4.2 demonstrates how both countries gain from free trade and
specialization. If we allow for medical tourism flow between India and South Korea, the
point of production moves towards the level of services at which each country has a
comparative advantage. India has absolute advantage in both services. But South Korea
has a comparative advantage in hip replacement (its opportunity cost is 3). Therefore,
under free trade, South Korea can fully specialized in production of hip replacement,
while India can shift it production slightly towards bypass surgery. Due to vast
differences in opportunity costs, the full specialization is not feasible for India.
Table 4.2: Economics of Medical Tourism: Gains From Trade and Specialization
Details
India
South Korea
Total
Bypass
Hip
Replacement
Bypass
Hip
Replacement
Production
7
3
0
6
16
Trade
Give 2
Get 3
Get 2
Give 3
Consumption
5
6
2
3
Total Gain =
2
As a result of comparative advantage and international trade, the aggregate
production increases from 14 to 16. Indian hospitals can perform 7 bypass surgeries and
3 hip replacement surgeries while hospitals in South Korea can perform only 6 hip
replacements. Two South Korean medical tourists can go to India for bypass surgery
while three Indian medical tourists can fly to South Korea for hip replacement.
Consumers in both countries are strictly better off under free trade than under autarky.
Under the autarky and given resources, 10 Indian patients and 4 South Korean patients
are treated. But under free trade arrangement, 11 India patents and 5 South Korean
patients are treated. The total gain from trade and specialization in this case is 2.
23
Chapter 5
CONCUDING REMARKS
The medical tourism is an outsourcing medical services primarily expensive surgery to
low cost countries. It offers financial value for growing burden of the costs in matured
markets like USA. It also provides an alternative for millions of uninsured people to
receive affordable and accessible medical services from developing countries.
India is an important player in this industry as it has many advantages. Its cost is
the lowest in the world. It has many internationally accredited hospitals. Most of its
doctors and medical staff have world class exposure and fluency in English. In addition, it
is rich in cultural heritage and has innumerable tourist attractions. It also offers a wide
variety of alternative medicines. In 2010, there were 7,50,000 medical tourists in India.
The foreign exchange earning from this sector was around US $ 1068 million.
This sector is expected to grow exponentially due to external as well as internal
factors. The external forces are: soaring medical costs, high insurance premiums, long
waiting lists, large number of uninsured/under insured and insured in many advance
nations. The internal factors are: availability of high quality medical professionals and
medical staff, large number of world class hospitals and infrastructure, government
promotion, tax concession etc. Estimates indicate that the number of medical tourists in
India will increase to 2.8 million and the exchange earnings will rise to US $ 3964 million
in 2015.
Lack of regulation in the healthcare system, lack of coordination among various
players in the industry (airline operators, hotels and hospitals), unethical profession
behavior, competitions from many other players, low investments in health infrastructure,
increasing inequalities in healthcare access between private and public systems, and
domestic brain drain from public to private sector are the major challenges facing this
sector.
24
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Gandhi Mandapam Road
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March 2013
MONOGRAPH 26/2013
K.R.Shanmugam
Medical Tourism in India: Progress,
Opportunities and Challenges
... At the same time, life expectancy has also increased progressively, which has resulted in increased demand for natural health care strategies. 90,91 India has the ability to deliver such strategies. It was estimated that about 1.27 million medical tourists from several countries around the globe, such as the UK, the USA, Canada, China, Bangladesh, and Sri Lanka, visit India with the hope of better, safer traditional herbal medicinal treatment. ...
... It has been estimated that foreign-exchange earnings for this are nearly US$1.8 billion and the market will grow to around US$3.96 billion by 2015 due to the visits of 2.8 million medical tourists. 91 This situation clearly indicates the benefit and acceptance of Ayurveda and other Indian medical systems around the world. The potentialities of India are acknowledged by such conditions, which also indicate that there is the opportunity to integrate herbal medicinal systems/formulations into the modern health care system. ...
... Medical tourism also presents the opportunity to boost the country's economic conditions and will encourage people toward Indian traditional herbal medicinal systems. 91 The Materia Medica of India contains 2,000 drugs of natural origin along with their therapeutic utilities, which are derived from traditional systems of medicine. Among these, 400 are from mineral and animal sources, and the rest are from vegetable sources. ...
Article
Full-text available
Saikat Sen, Raja Chakraborty Institute of Pharmacy, Assam Down Town University, Guwahati, Assam, IndiaAbstract: Indian traditional codified medicinal systems and folk medicine are a vast lexicon of herbal formulations and medicinal plants. In last few decades, the popularity of herbal medicine/products has increased worldwide, not only as part of conventional treatment strategies but also for health care management, and thus the opportunity to promote Indian traditional medicine is increasing globally. Recently people from several developed and developing countries have been attracted toward traditional Indian herbal medicines. A large number of modern medicines are derived from the plants used in Ayurveda and other traditional medicinal systems. Ayurveda and other traditional herbal medicines are capable of addressing some modern unmet medical needs, and can provide the basis for developing potential medicines. Lack of drug standardization, information, quality control, and strict monitoring are the primary lacunae in the promotion of traditional Indian herbal products. In recent years several regulatory and promotional approaches have been undertaken to overcome such problems. Quality control, rigorous research to establish the effectiveness and safety, and credible clinical trials of the herbal products are required. Thus the careful and scientific integration of Indian traditional herbal medicine into evidence-based clinical management of diseases is essential to provide better health care facilities to people.Keywords: traditional medicine, herbal drug, India, Ayurveda
...  to modernize and expand airports in the country and to improve road connectivity and other infrastructural facilities,  to promote many hospitals as centre of excellence in its tourism brochure,  to ease the medical tourist arrivals 'M' and 'MX' visa is introduced,  to avail tax concessions, medical tourism is declared as service sector,  National Accreditation Board for Hospitals established to promote quality care of healthcare institutions,  at the state level Kerala, Karnataka, Maharashtra and Gujarat have made many concerned efforts to promote healthcare tourism As a result of such measures, the total FTAs in India of 6.57 million, 2.6 % were for medical treatments in 2012. Its foreign exchange earnings from medical tourism are estimated to be around US $ 1.8 billion in 2010 (Shanmugam, 2013) [1] . In fact Medical Tourism Climate Survey Report 2014 conducted by IMTEC states that India is second largest country after Thailand in accommodating foreign patients (IMTJ, 2014) [2] . ...
...  to modernize and expand airports in the country and to improve road connectivity and other infrastructural facilities,  to promote many hospitals as centre of excellence in its tourism brochure,  to ease the medical tourist arrivals 'M' and 'MX' visa is introduced,  to avail tax concessions, medical tourism is declared as service sector,  National Accreditation Board for Hospitals established to promote quality care of healthcare institutions,  at the state level Kerala, Karnataka, Maharashtra and Gujarat have made many concerned efforts to promote healthcare tourism As a result of such measures, the total FTAs in India of 6.57 million, 2.6 % were for medical treatments in 2012. Its foreign exchange earnings from medical tourism are estimated to be around US $ 1.8 billion in 2010 (Shanmugam, 2013) [1] . In fact Medical Tourism Climate Survey Report 2014 conducted by IMTEC states that India is second largest country after Thailand in accommodating foreign patients (IMTJ, 2014) [2] . ...
... The factors that contribute to medical tourism are such as costly medical care, higher insurance costs, out of pocket and underinsured people in developing nations, the availability of quality medical facilities in the world, a marginal waiting time and cheaper airfares (Shanmugam, 2013). Nowadays more and more overseas patients travel abroad to get medical treatment including complex specialized surgical procedures such as cardiac surgeries, joint replacement, cosmetic surgery, and dental surgery. ...
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Today, medical tourism is an industry that offers tremendous potential because of its low-cost medical treatment as well as a strong hospitality advantage for developing country like India. The medical tourism industry could have impressive growth shown by the software and pharmaceutical industry in India in the last decade. Medical tourism offers a significant opportunity to contribute to the growth of healthcare economies' of the country. The number of patients arriving in India to seek medical treatment is rising because the provision of high-quality health facilities at an affordable rate is projected to make medical tourism the next major foreign exchange earner. Medical Tourism is the key foreign exchange earner and promotes economic growth in other fields, such as tourism, transportation, pharmaceutical goods, hotels, and restaurant. In this study, the researcher has tried to assess the impact of the Indian Medical Tourism sector on the Economy.
... According to the Nigeria Medical Association (NMA), while Nigeria loses over US$500 million annually, India gains about US$260 million of the resultant cash flight. Buoyed by the boom of its medical tourism due ostensibly to Nigerians' patronage, India's projection for the year 2014 was to realize a huge sum of between US$1bn and US$2bn from a medical tourism market worth over US$20bn (Shanmugam, 2013). ...
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The paper examines the growing phenomenon of medical tourism in Nigeria‐India relations. It discusses the evolving relationship between Nigeria and India and the growing presence of Indian investments in the Nigerian medical sector. The attraction of Nigerians to Indian hospitals is to seek quality and cost effective healthcare services. This has been necessitated by mismanagement resulting in the under‐development of the health sector in Nigeria. India on the other hand has emerged as a major health provider because of its ability to offer ‘first‐class treatment at Third World prices’. While India gains from inflow of a large number of Nigerian medical tourists, Nigeria loses from the outflow medical tourists due to the resultant cash flight. The paper also discussed the challenges of medical tourism sector in India. These include complex visa procedures, lack of insurance covers, poor airport facilities to carter for patients who arrive with critical conditions and accommodation challenges. Nigeria and India relations can be further strengthened for mutual benefits by expanding the partnership in the medical sector. The recent inflow of Indian medical centres into Nigeria, such as the Apollo Clinics, Primus hospital, Vedic Lifecare Clinic, Mecure Healthcare Services Ltd, amongst others, provides the foundation for expanding partnership in this sector. That notwithstanding the number of Nigerians visiting Indian for medical tourism remains huge. Accordingly, the paper concludes by recommending an increased role on the part of the Nigerian government in improving healthcare service delivery in the country. Considering the huge prospects in the health sector, the paper also recommends that Nigerian and Indian entrepreneurs should partner and invest massively in the provision of quality, affordable and accessible healthcare services in Nigeria.
... [16][17][18][19] Apart from this, several researchers have focused on medical service providers or suppliers' point of few and performed SOWT analysis by identifying the strengths, weaknesses, opportunities, and threats for particular locations of medical tourism destinations. 11,[20][21][22][23][24] However, latest studies performed by researchers 25 explored new areas in medical tourism and explained the role of service quality, patient satisfaction, trust, and price reasonableness on re-visit intentions. ...
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Perceived risks, travel motivations, and destination cognitive and affective image have been extensively studied in tourism literature, yet literature related to these variables in medical tourism literature is sparse. The concept argued in this article is founded on the decision-making models used in tourism literature and drawing on work of prominent scholars in tourism. Findings of the literature review suggest that Medical Tourists’ perceived risks about destination and travel motivations will have impact on the image of medical tourism destinations.
... Thailand for example attracts more patients from developed countries because of already es- tablished quality tourism infrastructure offer ex- cellent accommodation and hospitality services to international patients (81). Despite offering excel- lent medical care to international patients by hos- pitals in India most of the international patients visit India worry about accommodation quality, food hygiene, and personal safety (82,83). Tourism and vacation aspect is also a pull factors for international patients. ...
Conference Paper
Perceived risks, travel motivations and destination cognitive and affective image has been extensively studied in tourism literature, yet literature related to these variables in medical tourism literature is sparse. The concept argued in this article is founded on the decision making models used in tourism literature and drawing on work of prominent scholars in tourism. Findings of the literature review suggest that international patients’ perceived risks about destination and travel motivations will have impact on the image of medical tourism destinations.
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: In the recent era medical tourism has certain significance place in the tourism industry, In India now famous for low cost medical service with high quality medical treatment. The countries where medical tourism is being actively promoted include Greece, South Africa, Jordan, India, Malaysia, Philippines and Singapore. Recently, Indian healthcare sector shows huge advancements in fields such as technology, infrastructure, and manpower, catapulting India as one of the preferred medical destinations in the world and invariably paving path to an entirely new sector, the medical tourism industry. The medical tourism in India will touch the $8 billion mark by the end of 2020, the influx of the population that experiences a saving of close to 50 to 70 percent on medical tourism industry. Cost effectiveness is a major factor in India, because a patient can undergo any type of treatment at an extremely affordable cost without compromising the quality and other reason is of course the availability of medical visa without any hassle. The Indian government predicts that, India $17-billion-a-year healthcare 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 annually. This study has been focused by the fully by secondary data, which are collected from the Indian tourism department, and also it analyze the growth percentage in Past years, it will be more helpful to medical service providers. Mainly this study's objective was examining the foreign exchange earning option through medical tourism and analysis of annual growth of foreign tourist in India. It proves that the annual growth an efficiency of handling capacity of Indian medical the medical industry.
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The objective of this paper is to demonstrate a simple Ricardian model of international trade for health care industries of different countries. Our motivation is to illustrate that specialization and free trade result in gains from international trade. We will shed some light on the economics of outbound as well as inbound medical tourism. By adopting the model of comparative advantage to the costs of medical surgeries, we will show that trade between our two model countries - India and the USA - is beneficial to both of them. We focused on these two countries due to their prominence in worldwide medical tourism flows, as well as due to their significant difference in per capita income. By specializing on the type of surgery they are most efficient in producing, it will enhance the well being of both nations. Numerical examples and graphical presentations help to support our arguments. Beside the global aspect of medical tourism, we also want to shed some light into regional patient flows with a focus on Germany and Hungary. In addition, we will lift some of the more restrictive assumptions. By including transportation costs as well as a larger variety of surgical services, the central message of the beneficial effect of specialization still remains, even though the general picture becomes slightly blurred. There is evidence for support of a more multi-polar international system of trade in medical services the moment one extends the economic analysis with additional countries.
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The same rule which regulates the relative value of commodities in one country does not regulate the relative value of the commodities exchanged between two or more countries. Under a system of perfectly free commerce, each country naturally devotes its capital and labor to such employments as are most beneficial to each. This pursuit of individual advantage is admirably connected with the universal good of the whole. By stimulating industry, by rewarding ingenuity, and by using most efficaciously the peculiar powers bestowed by nature, it distributes labor most effectively and most economically: while, by increasing the general mass of productions, it diffuses general benefit, and binds together, by one common tie of interest and intercourse, the universal society of nations throughout the civilised world. It is this principle which determines that wine shall be made in France and Portugal, that corn sell be grown in America and Poland, and that hardware and other goods shall be manufactured in England…
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A flagship annual document of the Ministry of Finance, Government of India, Economic Survey 2009-10 reviews the developments in the Indian economy over the past 12 months, summarizes the performance on major development programmes, and highlights the policy initiatives of the government and the prospects of the economy in the short to medium term. With detailed statistical data covering all aspects of the economy-macro as well as sectoral-the report provides an overview of the following issues: state of the Indian economy; challenges, policy responses, and medium-term prospects; fiscal policy and monetary management; financial intermediation and the role of markets; external sector, balance of payments, and trade; agriculture and industrial development; energy, infrastructure, and communications; and human development and public programmes. Highlighting a growth rate of 9.7 per cent in 2010-11, the Economic Survey presents India as one of the fastest growing economies in the world. While there has been a remarkable rise in savings, investment, and private consumption and a strong recovery in agriculture, short-run deceleration in industry and manufacturing remains a matter of concern. The Survey also identifies wide-ranging challenges faced by India and suggests inclusive development in key sectors with the right strategies, policies, and interventions.
International Passenger Survey-2003: Incredible India, Ministry of Tourism
  • India Government
Government of India (2006), International Passenger Survey-2003: Incredible India, Ministry of Tourism, February 2006.
India Tourism Statistics 2010 at a Glance: Incredible India, Ministry of Tourism
  • India Government
Government of India (2011a), India Tourism Statistics 2010 at a Glance: Incredible India, Ministry of Tourism, July 2011.
Medical Travel in Asia and the Pacific: Challenges and Opportunities, Economic and Social Commission for Asia and Pacific
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UN ESCAP (2007), Medical Travel in Asia and the Pacific: Challenges and Opportunities, Economic and Social Commission for Asia and Pacific.
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Healthcare Tourism: Opportunities for India, Exim bank
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Goutam, Vinayshil (2008), Healthcare Tourism: Opportunities for India, Exim bank. Government of India (2002), National Tourism Policy 2002, Ministry of Tourism, New Delhi.