By G Kamala Vardhana Rao,
Atithi Devo Bhava (अतिथि देवो भव:) is the core ethos of Indian hospitality, the guiding thought for hosts to go out of the way in treating guests with the same reverence as God. This philosophy guides the Indian tourism and hospitality sector to welcome tourists from all over the world and extend them an unforgettable experience. Coupled with the vastness of Indian land and water bodies, the geographic and cultural diversities, and rich historical and natural heritage, India is one of the most remarkable tourist destinations in the world.
India also happens to have an extremely rich history of medicine going back to the Vedic times. Ayurveda, one of the oldest systems of medicine can be traced back to 8000 BCE. The Golden Age of Indian medicine can be traced back to 800 BCE and went on till 1000 CE, which witnessed the writing of Charak Samhita and Sushruta Samhita. Today, many modern methods of treatment and surgeries, such as rhinoplasty, find their roots in these literatures.
Over the years, more streams of medicine like Naturopathy, Unani, Siddha, Sowa-Rigpa and Homoeopathy gained importance, along with Yoga and meditation, which are now acknowledged round the world for their health benefits. Post-independence, as India has progressed exponentially in the field of modern medicine, it has created a unique ecosystem for holistic health which combines the best of modern healthcare, alternative medicine, and wellness. It is the unison of this unique holistic health and wellness ecosystem, with its myriad possibilities that makes India the ultimate destination for Medical Value Tourism (MVT).
Current State of Indian Medical Tourism
A thriving sector globally, medical tourism is estimated to have a market size of USD 44.8 billion in 2019, with some 1.40 crore people traveling to different countries for better medical treatment, essentially forming the medical tourism sector. The sector is expected to grow at a CAGR of 21.1% from 2020 to 2027.
India is ranked 10th out of the top 46 countries in the world in the Medical Tourism Index 2020-21 by Medical Tourism Association. While MVT for India was projected to be USD 9 billion by 2020, despite the debilitating impact of the COVID-19 pandemic on the tourism and hospitality industry, the medical tourism sector is estimated to have been worth USD 5–6 billion. MVT in India is expected to grow to USD 13 billion by 2022.
In 2015, foreign tourist arrivals (FTAs) in India on grounds of medical visa were recorded as 2,33,918, which more than doubled to 2017. Between 2017 and 2019, India experienced over 40% growth in FTAs, with the number of tourists increasing from 495,056 in 2017 to 697,000 in 2019. According to statistics, India receives most of its medical tourists from Afghanistan, Pakistan, Oman, Bangladesh, Maldives, Nigeria, Kenya and Iraq. There is a huge potential for India to realize and aggressively advance towards attracting medical tourists from other parts of the world including Europe and the Americas.
What makes India a leading Medical Tourism Destination
For a country to establish its credibility as a medical tourism destination, it needs a world-class healthcare ecosystem and proven prowess to conduct superlative medical procedures. The following are some of the factors that make Indian healthcare services a medical tourist magnet.
International Level Healthcare Services
India has a strong health infrastructure with many state-of-the-art healthcare facilities offering treatment across specialities. Hospitals are equipped with the latest technologies needed to conduct complex medical procedures, and have exceptional facilities for post-operative care. The facilities are managed by a highly skilled and adept healthcare workforce and administration staff led by reputed and world renowned medical practitioners and surgeons.The facilities ensure quality treatment services for a wide array of ailments, ranging from cosmetic enhancements to complicated cardiac, orthopaedic, and spinal surgeries.
There are around 37 Joint Commission International (JCI) accredited hospitals and 513 National Accreditation Board for Hospitals & Healthcare Providers (NABH) accredited hospitals in India. Clinical outcomes at leading NABH hospitals are comparable to those at internationally recognized facilities. While most of the JCI hospitals are concentrated in a few cities in the country, including Delhi and Mumbai, India is further focusing on increasing the number of JCI-accredited hospitals across other major cities of the country.
Superlative Allied Sectors
To deliver quality treatment, it takes a lot more than just a good hospital. India does not only have international quality healthcare services to its advantage but it also has robust allied sectors which make the healthcare ecosystem complete. These include a strong pharmaceutical and diagnostic sector, rehabilitation services, a thriving quality medical devices industry, and a growing focus on medical R&D.
Diagnostics and medical devices sectors
India has cumulatively attracted over USD 25,300 million in its three key healthcare pillars, that of Drugs and Pharmaceuticals, Hospitals and Diagnostics Centres, and Medical and Surgical Appliances in the last decade. Estimated at USD 11 billion, India happens to be the 4th largest medical device market in Asia, and is projected to reach USD 50 billion by 2025. The diagnostics segment in the country is valued at USD 4 billion, with 25% of the market being capitalised by leading organised players.
Exporting medicines to over 200 countries, India is known as the pharmacy of the world. With a market size of USD 41 billion, the sector is third largest globally by volume, with a 33% lower cost of production than the United States. The quality compliance rate of Indian Pharmaceutical industry is extremely high. India has 664 US FDA approved facilities, over 2,050 World Health Organisation-Good Manufacturing Practices (WHO-GMP) approved plants and over 697 European GMP compliant plants. Consequently, India is the world capital of producing affordable, but high quality medicines. With 20% of global generic drugs exports by volume, the industry is world’s largest provider of generic medicines, producing 60,000 generic brands across 60 therapeutic categories. Out of the top 20 global generic companies, 8 are Indian. Furthermore, around 62% of the global demand for vaccines is met by India. All these factors make Indian healthcare service delivery add the essential reliability factor to high-end medical treatment, a decisive factor for medical tourism
Low Cost of Treatment
Affordability of high quality treatment is clearly the differentiator in the domain of medical tourism. There is a stark difference in the cost of common medical procedures offered in India in comparison with close competitors in the segment. Of 19 medical procedures, ranging from heart bypass and spinal fusion to liposuction and IVF treatment, India records the lowest price in 13 of them and moderate price in the remaining 6.
For instance, on comparing the cost of treatment in India with that in Thailand, Malaysia, Singapore, Turkey, and South Korea, heart bypass would cost USD 7900 against USD 15000, USD 12100, USD 17200, USD 13900, and USD 26,000, respectively. Similarly, hip resurfacing would cost approximately USD 9,700 in India compared to USD 16,350 in Singapore and USD 19,500 in South Korea. This is the major factor which makes it possible for International tourists to opt for elective treatment in India.
The “Value” Add in Medical Tourism
Medical tourism has evolved far and beyond just visiting a country for an important surgery. Yes, excellence in healthcare is central to the value proposition. However, for a nation like India which has so much to offer to global citizens, medical tourism has emerged to be that much more. The wellness quotient has rapidly become crucial and increasingly gaining global traction.
Global Wellness Institute states that the world wellness tourism market was estimated to be USD 639 billion in 2017 with secondary wellness International travellers accounting for 89% of the trips and 86% of the expenditure and domestic wellness travel contributing 82% of total trips and 65% of expenditure. In the same year, as per the estimates by Global Wellness Tourism, India ranked 7th amongst the leading 20 wellness tourism markets, with 560 lakh trips in wellness tourism generating a total revenue of USD 16.3 billion.
India also happens to be the 3rd amongst the top 10 wellness countries in Asia Pacific. Consequently, it has taken a leap ahead from medical tourism to medical value tourism (MVT). In addition to extending the richness of Indian hospitality, with the blending essence of its food, nature, and culture, medical value tourism from an Indian standpoint is offering holistic health and wellbeing.
It is noteworthy that India is perhaps the only country with an entire ministry dedicated to alternative medicine, rejuvenation therapies and yoga. There is a conscious focus towards steering the global population away from disease and treatment cycle to a lifestyle of preventive and holistic health, one which entails mental, physical and spiritual wellbeing. MVT is based on the understanding of the health, and not healthcare, seeking behaviour of the 21st century citizen. Today, Indian wellness tourism stands strong on the timeless foundations of Ayurveda, Yoga, and meditation, while concerted efforts are being made to revive and promote alternative medicines, along with stress relieving and rejuvenation therapies.
Efforts towards Strengthening MVT
Through progressive policy interventions, the Indian Government in the past 7 years has taken numerous measures to strengthen MVT. To begin with, the Government added medical visits to the e-tourist visa regime which was launched in 2014 to make the visa process seamless. Under the provision, e-tourist visas included medical attendants as well, while the medical visa process has been eased to accommodate multiple entries and long-term stay. In the following year, the National Medical & Wellness Tourism Board (NMWTB) was constituted to function as the overarching organisation to provide institutional framework and further the promotion of medical and wellness tourism. The campaign ‘Heal in India’ was subsequently conceptualised to take the India’s value proposition of holistic health to the world.
Going forward in 2018, MVT was identified as one of the 12 “Champion Services Sectors” to be receiving a part of the 5,000 crore dedicated fund created by the Central Government to strengthen these sectors. In addition to numerous other measures to promote health and wellness tourism in the International arena, the Government made an additional allocation of INR 2,970 Crore for Ministry of AYUSH in the Union Budget 2021-22. Furthermore, well-stated guidelines have been released for accreditation of Ayurveda and Panchakarma Centres for implementation.
The latest initiative of the Ministry of Tourism in this sector is to formulate the Draft National Strategy and Roadmap for Medical and Wellness Tourism, recognising the tremendous potential of medical and wellness tourism sectors towards attaining the objective of Atmanirbhar Bharat. The sector will undoubtedly gain momentum and impetus with a formalised, strategic approach implemented at the Centre. The National Strategy aims at formulating an institutional framework, developing a brand, and strengthening the ecosystem towards both, availability and quality assurance, centred around the following salient features:
- Distinct roles defined for five ministries and NABH
- State Governments to enhance the ground infrastructure and promote MVT proactively
- Transparency in transactions by hospitals and healthcare facilities
- Industry associations to create market outreach and promote Brand India
- Allied sectors to boost accessibility by way of flights, accommodation
On an urgent basis, there is need for organising the sector by way of registration, accreditation and categorisation of MVT facilitators as well as Medical Service Providers. This would provide a mechanism for mutual coordination between only registered and accredited bodies to create a trustworthy ecosystem, eliminating undesirable elements. The following steps are envisaged to achieve the required outcome:
- Health insurance portability by way of extended insurance cover. It would be relevant to work towards inclusion of Indian Health Insurance companies in the global market. Alternatively, hospitals may be empanelled directly by international TPAs.
- Developing Medical Enclaves for Foreign Patients. A medical complex with customised features, amenities and medical facilities may be created, with hospitals or healthcare companies gaining by way of concessional rates, duties, etc on infrastructure creation as well as consumables. The development of such hospi-towns may be explored on PPP mode.
- Development of SWTX. Special Wellness Tourism Zones may be encouraged at state level offering comprehensive end-t-oend services for health, medical and wellness interventions, again developed on PPP model or with FDI.
- Capacity Building. With the anticipated increase in inflow, groundwork for policy alignment, infrastructure development as well as skilling needs to be expedited in order to be future-ready.
- Online MVT Portal. The existing portal needs a makeover with integration of all services a medical traveller would need, while also carrying advisories, regulations and information for transparency and ease.
MVT in the post-COVID World
There is already a major demand for wellness and alternate cures from the global population pursuing a fast-paced modern lifestyle. The high cost of services and long waiting periods have made people look eastwards. The countries lacking in adequate medical facilities are also looking upto India for cost-effective medical care and wellness services. The large Indian diaspora spread across the world are not only the most precious tourist segments but also the largest messengers of Indian hospitality to the world.
Amidst such escalating popularity and growing demand for MVT, the COVID-19 pandemic has put the spotlight back on healthy living, preventive medicines, nutrition, and immunity building. Knowing that the infection shows wide ranging symptoms and impacts various organ systems, its actual impact on the global population is yet to be assessed, with public health experts believing that it may have a significant effect on the long-term health of the affected population. Therefore, the demand for healthcare and wellness services is bound to surge in post-COVID world, with more and more people looking out for avenues of quality medical care and holistic wellness. For this global population, which is in real need for potent health and wellness solutions, medical value tourism could well be India’s thrust sector with sizable revenue prospects.