Touring for Health - The Checkup

Imagine walking in a park, supported by crutches and pain encroaching you each time you take a step forward. Every passing day the suffering increases and the medications prescribed to relieve pain are taking a toll on your body. All these is just because your hip replacement surgery has been scheduled two years from the day you were diagnosed.

Now visualize another set up wherein your surgery has been done within few days of radiological examinations and diagnosis. You feel perfectly alright and ready to explore the country you flew to, to get this premiere treatment. The cost of everything including the flight tickets, recreation and visa sums up to be a fraction of what you would have paid in your home country despite of long waiting period, making your experience furthermore satisfactory. The scenario described here provides an impression of medical tourism.

So what is Medical Tourism?

Medical Tourism refers to practice of individuals traveling to another country to seek medical treatment or healthcare services. This can include a wide range of medical procedures, from elective surgeries to specialized procedures, often motivated by factors such as lower costs, shorter waiting periods or access to specific medical expertise.

Brief history of Medical Tourism :-

The Greeks established an early medical tourism system by creating Asclepia Temples dedicated to their god of medicine, Asclepius. These temples were among the earliest health centers globally.

Constructed in 1248 AD, Mansuri Hospital in Cairo stood as the world’s largest and most sophisticated medical facility of its era. With the capability to house 8,000 individuals, it became a sought-after healthcare destination for people from diverse backgrounds.

During the 16th century, the rich and the elite of Europe rediscovered Roman baths and flocked to tourist towns with spas like St. Mortiz, Ville d’Eaux, Baden Baden, Aachen and Bath in England.

But in contrast to historical trends, there has been a shift in recent years where medical tourism is predominantly from developed nations to developing ones or to be more precise, people flying overseas in search of affordable medical services.

Why do people cross borders for healthcare services?

Affordability : In developed countries like America, Australia, UK etc. healthcare services provided by private sectors are exorbitantly priced and often undercovered in medical insurances. A research states that health care and prescription costs in the US eat into nearly 30% of retirement and pre-retirement incomes. Hence, people prefer to travel to countries that perform medical procedures at a fraction of the cost charged in their home countries without sacrificing quality. A surge in medical tourism was noticed when numerous Americans lost their health insurance amid the coronavirus pandemic.
Accessibility : In few countries like UK and Canada, citizens are unable to avail the high quality medical care provided by national health services due to long waiting periods. For instance, In July 2023, more than 7 million patients were waiting for treatments, with more than 350,000 left waiting longer than 52 weeks in UK. People in need of prompt solution to their suffering look for treatment options in foreign countries, thus contributing to the growth of medical tourism.
Availability : People travel from underdeveloped/ developing countries to developing/ developed countries offering quality assured healthcare facilities unavailable in their home countries. A significant number comes from the Middle East, commonly seeking better treatment options in their neighboring countries. These patients are often willing to swap burdens such as costs, distance and unfamiliar culture with top-notch healthcare facilities.
Acceptability : Medical services, which might be affordable, available or accessible, but are not acceptable in the patient’s own country due to religious, political or other social reasons often compels citizens to cross borders. For example, many transgenders born in countries where gender affirming surgery is considered illegal travel to LGBTQ+ friendly nations like Canada. Another example is of stem cell therapy.
For Discretionary procedures such as breast augmentation and reduction, liposuction etc. This section of medical tourists aims to find smaller, specialised service providers instead of larger, multi-speciality hospitals.

Disadvantages of Medical Tourism :-

On numerous occasions, medical tourists experience dissatisfaction with the service due to social and cultural factors such as language barrier, food , discrimination on basis of race etc. Language barrier being the main concern as it can lead to wrong interpretations of symptoms hence the wrong diagnosis and treatment.
Post treatment, patients usually travel back to their home countries to save on accommodations or due to termination of their medical visa, posing challenges for healthcare providers in the destination country to monitor and strategize for long term outcomes. Telemedicine has addressed the issues of consultations, treatment planning and post treatment follow-ups at some levels but management of treatment/ drugs/surgery related complications still offers a challenge to medical tourism industry. Tackling complications in home countries can be expensive as they might not be covered under health insurance.
Air travel possess the risk of clot formation, including deep vein thrombosis after surgery. Also, probability of contracting infections which are prevalent in the host country is high as patients are often immunocompromised or lack immunization against those specific pathogens.
The residents of the host country are facing negative consequences due to medical tourism. Mainly because the private healthcare sector entices esteemed healthcare professionals away from public sectors and rural areas. Additionally, resources are redirected from primary healthcare services to prioritize technology-intensive tertiary services, thereby stressing on treatment more than prevention with limited benefits for the local population. All these worsening the pre-existing disparities in the worldwide distribution of health and wealth.
In countries where medical tourism is still emerging, visitors are often not backed up by legal provisions. In such a scenario if anything goes haywire, medical tourists often find themselves stranded since they cannot seek assistance from their home country either.
Contentment from medical support provided by other countries can hamper the growth healthcare industry in source country. Example, Oman has long been delaying the advancement of PET technology as patients are casually sent abroad for its access, imposing a financial burden on the government.

Medical Tourism in India :-

While medical tourism is a contemporary aspect contributing to globalization, India has welcomed foreigners ever since the inception of Yoga and Buddhism earning a reputation as a healing hub. Alternative medicines i.e Ayurveda and Homeopathy also adds to India’s immense strength in medical field.

An article from Hindustan Times suggests that, medical tourism in India, in mid-2020, was estimated to be worth around USD 9 billion which makes India stand at Number 10 in the Global Medical Tourism Index among 46 countries.

According to a report by the Ministry of Tourism, India received over 500,000 medical tourists in 2019, generating a revenue of over $3 billion. After experiencing a decline in 2020 and 2021 due to the pandemic, the figures have rebounded in 2022 and surpassed the peak of 2019. Around 6,50,000 medical tourists visited India in 2022.

As of now, India has total 52 JCI-accredited hospitals all over the country keeping itself at par with world health standards. Among the top ones are Fortis in Delhi, Aster medcity in Kochi, Apollo in Kolkata, chennai and Hyderabad, Artemis in Gurugram, CIMS hospital in Ahmedabad, Kokilaben Dhirubhai Ambani hospital in Mumbai and so on. Foreign patients opting for medical treatment in India gain increased confidence from hospitals accredited by JCI. Hence more number of JCI accredited hospitals aids in propelling the growth of medical tourism in India.

Source countries seeking medical services in India are Africa, Middle East countries, neighboring countries like Bangladesh, Pakistan, Nepal, Sri-lanka etc. and small portion of western world.

– Image taken from study conducted by Indian Institute of Tourism and Travel Management.

India’s extensive prowess in the medical tourism is attributed to its unparalleled knowledge, highly skilled physicians trained at prestigious foreign as well as Indian institutions, cooperative and empathetic medical staff, little communication gap as doctors and nurses speak English, minimal or no waiting time, top-tier medical technology and care at a fraction of the expense compared to Western countries and most importantly, the acknowledgement of potential for growth by the government. Also, approximately 90,000 doctors are graduating annually, of which large portion contributes to the India’s growing pool of healthcare workforce. Hence providing medical tourists with whole package of best possible services. The ministry’s report states that the number of medical tourists visiting India has been increasing at a rate of 22-25% per year because of all these reasons.

Chennai being the health capital of India embraces the major population of international patients.

Study conducted by Indian Institute of Tourism and Travel Management suggests that cardiac treatment (30%) is the most popular product of Indian medical tourism. This is followed by Orthopaedics (including joint replacement) (15%), Nephrology (12%), Neuro surgery (11%) and Cancer (11%). All others account for balance (22% of product demanded).

Measures taken by India to flourish Medical Tourism :-

India has implemented Medical Visa and Medical Attendant Visa to enhance convenience for patients and their companions. Presently, India provides e-medical visas to over 150 countries, typically processing them within 24-48 hours. Visa-on-arrival is also offered to medical tourists from certain countries. All the procedures are conducted with keeping principles of digital India in mind.
” Heal in India” initiative has created an online portal (called Medical Value Travel) for easier excess to information regarding availability of treatment and its cost, competent doctors and medical staff, accredited hospitals, accommodation, waiting period, recreational activities and much more to international patients so that they can effectively plan an end to end journey. Hospitals attracting medical tourists have their own online portal as well. This has proved to be a strong and cost-effective marketing approach.
Investment in high quality infrastructure, provision of land and subsidies, concession on imports.

Improvements required to boost medical tourism :-

Establish additional multi-specialty hospitals throughout India with accreditation from JCI or NABH by focusing more on achieving international quality and infrastructure standards.
International patients service centers can be set up to bridge the gap between medical tourists and health service providers. Also, to guide patients to select the right course of action thereby increasing credibility of medical tourism in India. Telemedicine can facilitate the process. This measure has been brought into practice in Singapore. Also, facilitation counters can be set up at major airports.
Government can use India’s USP of short waiting periods to lure patients from countries like UK, Canada and Australia where patients usually face the complications of long waiting period. More patients from these countries means increased revenue.
Stringent rules need to be formulated to protect the rights of medical tourists as well as the health care providers. Additionally, clear rules and regulations should be in place to guarantee that the earnings generated from health tourism benefit the public sector thereby shielding the local population from its ill effects.
Tie-up with insurance companies in western world.