C M Y K
1
1.1 OBJECTIVES
Introduction
The wealth of a country is judged among other things by the health of its citizens. Worldwide, countries are seeking to provide viable healthcare solutions to its population. Improvement in healthcare in a society means more than the availability of doctors or hospitals or medicines. Improvement in healthcare occurs through promotion of health consciousness through a range of activities that would suit to various sections of the society – children, youth and elders. In this perspective, Indian traditional healthcare systems such as Ayurveda and Yoga, as also the concept of spiritual healings are popular amongst both domestic and international tourists. It is generally considered that a person who travels from one region (or a country) to another for the purpose of undertaking treatment is a healthcare tourist. However, this definition excludes people who travel to another region (or a country) to explore, enjoy and rejuvenate, either the body or the mind or both without undergoing medical treatment. Flow of tourism is far higher in absolute number as well as volume of business generated if the latter aspect is taken into account. Tourism to, and associated activities to places like sea-side, mountains, river-beds, forests, plains, valleys, temples or historic monuments provide rejuvenation to the body and mind and thereby bestow the overall well-being upon the person involved with such activities. India has many tourist attractions that have healing abilities and are capable of providing rewarding experiences of life. India
24
C M Y K
C M Y K
Introduction
has the Himalayan ranges in the north, and a long coastline surrounded by three seas in the south. In addition, India is rich varied different landscapes, enchanting historical sites and royal cities, clean beaches, serene mountain retreats, cultures and festivities to enjoy and rejuvenate. In any part of the year, India can offer a wide selection of destinations and experiences. In summer, there are lonely retreats in the Himalayas or the lush-heights of the western Ghats with cool trekking trails, tall peaks, or stretches of white water for the adventure seekers. In the cool Indian winter, cities come alive with cultural feasts of music and dance. The sun-claud beaches are ideal locations for rejuvenation in the winter. The wild-life sanctuaries with their abundance of flora and fauna provide delights to the mind and rejuvenation to the body. The objective of this study is to review the tourism scenario in the world market and India, analyse the healthcare demand in the world, identify the healthcare and tourism solutions available in India to cater to the demand and to benchmark India with other countries, considering exclusiveness of India in various segments of tourism and healthcare solutions.
1.2 CONCEPT
Though the concept of healthcare tourism is thousands of years old, it has got its prominence rather recently. In ancient Greece, pilgrims and patients came from all over the Mediterranean to the sanctuary of the healing god, Asklepios, at Epidaurus. In Roman Britain, patients took the waters at a shrine at Bath, a practice that continued for 2,000 years. Since 18th century, wealthy Europeans travelled to Spas in the Nile. In the 21st century, relatively low-cost air travel has facilitated the growth of the industry, as travelling across continents has become affordable to even middle class population. Currently, healthcare tourists are travelling in large numbers to countries / regions, where the quality of healthcare is at comparable standards and yet the cost is significantly lower. Such healthcare destinations also offer numerous options for touring, sight-seeing, shopping, exploring and even lounging of healthy diets. The evolution of healthcare tourism in the world is depicted in Exhibit – 1.
25
C M Y K
C M Y K
Healthcare Tourism: Opportunities for India
Exhibit 1: Evolution of Healthcare Tourism
Source: Adapted from Issue – 11, 2006, Asian Hospital and Healthcare Management, SPG Media (P) Ltd, Hyderabad.
1.3 DEFINITION
According to World Tourism Organisation (WTO), “Tourism associated with travel to health spas or resort destinations where the primary purpose is to improve the traveller’s physical well being through a process comprising physical exercises and therapy, dietary control, and medical services relevant to health maintenance” is defined as Medical Tourism. However, “Medical Tourism” and “Healthcare Tourism” are interchangeably used. The term medical tourism has emerged from the practice of citizens of developed countries travelling to developing countries around the world, to receive a variety of medical services, mainly due to continually rising costs of the same services and complicated procedures to avail such medical services in their home countries. Thus, medical tourism can be defined as provision
26
C M Y K
C M Y K
Introduction
of ‘cost effective’ private medical care in collaboration with the tourism industry for patients needing surgical and other forms of specialized treatment. Thus, patients going to another country for either urgent or elective medical procedures could be defined as medical tourists. This process is being facilitated by the corporate sector involved in medical care as well as the tourism industry both private and public. Healthcare tourism, however, could be defined in a broader perspective. Patients travelling abroad with the objective of overall wellness, without any urgent or elective medical procedures, may also be covered under the healthcare tourism. Healthcare tourism thus could become a common form of vacationing, and covers a broad spectrum of healthcare services, mixing with leisure / relaxation, with the overall objective of wellness and healthcare. The objective of the healthcare tourism is to offer an opportunity to be away from the daily routine and come into a different surrounding for relaxation. During the stay, the tourist receives an orientation that will help improve life in terms of health and general well being. It is like rejuvenation and cleansing process at all levels - physical, mental and emotional.
1.4 HEALTHCARE IN A BROADER PERSPECTIVE
There are two major types of healthcare solutions in the world – a) traditional or indigenous system, and b) allopathic or modern healthcare system. While the latter can be defined as ‘cosmopolitan’, as they are not limited to a region or territory, acceptance of the former as a valuable healthcare solution is increasing all over the world. The renewed interest in using traditional healthcare solutions is mainly due to the advantages of minimal side effects and recognition of time-tested health solutions.
1.4.1 Traditional Therapies In many countries, the citizens have varied health seeking behaviours with the prevalence of multiplicity of medical or healing systems. Many of these systems have evolved over a period of time, due to competitive environment and have gone through changes in healing solutions. In a competitive environment, some of these healing systems either may get absorbed by a dominant healing system or probably die out. A healthcare system may thus
27
C M Y K
C M Y K
Healthcare Tourism: Opportunities for India
be defined as ‘a pattern of social institutions and cultural traditions that evolves from deliberate behaviour to enhance health’. It should be, against this background, noted that every healing system is a service that is being availed by a particular group of people. With the globalisation, the spread of such systems is also faster with more number of people going for diverse therapies that are originally unique to a country. When the end users move to another region or territory, they may be called healthcare tourists. In the context of India, notable traditional healthcare systems that are attracting international travellers include Ayurveda and Yoga. In addition to indigenous therapies / healthcare systems, there are also healing solutions that are prevalent in different societies. One such healing solution popular across the world is faith healing or spiritual healing.
1.4.2 Faith / Spiritual Healing Faith healing refers to healing that is believed to have occurred supernaturally, as a result of prayers or other forms, rather than through the use of medicines or the involvement of physicians. Such healing services are often referred to as miracles. Since such healing solutions are available only in some parts of the world, it is important for people from other regions to travel for availing such healing services.
The concept of spiritual tourism is not well defined. In a general context, spiritual tourism can be interchanged with religious tourism. However, religious tourism (pilgrimage) is one of the various forms spiritual tourism. It may be mentioned that pilgrimage used to be one of the oldest forms of tourism flows all over the world. Pilgrim centers such as Mecca, Jerusalem, temples in India are attracting large flow of tourists since many years. Religious events such as Kumbha Mela have also been traditionally attracting large number of tourists. Spiritual tourism adds to this form of tourism by travelers who are looking for a meaning while on vacation. Thus, spiritual tourism, in a broader context, also includes availing of healthcare systems that are providing psychological peace, mental strength, and inner-purity. Many concepts and solutions could be brought under this umbrella, such as journeys to sacred places, Yoga / meditation camps, or even trips focusing on astrology and
28
C M Y K
C M Y K
Introduction
mythology. However, in the context of popularity and origin of India, we may mainly highlight Yoga as one such solution. At present, spiritual tourism is one of the fastest growing segments in the travel industry worldwide. The growing individualism in our society has led to the growth of spiritual tourism. Exhibit – 2 explains the commonly used methods of spiritual healing. There are mainly non-economic dimensions in spiritual tourism. In general, the faith healers do a free service with the objective of providing health for all; however, a nominal fee is charged for undergoing a structured healing course. In many cases, the healers keep a box to receive offerings, which shows that the fees collected are not under compulsion. Large number of tourists are travelling to destinations that offer spiritual healthcare / faith healing. National governments are also promoting spiritual tourism considering its potential. Government of Malaysia, through the Tourism Malaysia promotes spiritual tourism with the existing tourism circuits of Hindu temples, Chinese
Exhibit 2: One or More Methods of Spiritual Healing
Source: Exim Research
29
C M Y K
C M Y K
Healthcare Tourism: Opportunities for India
shrines, mosques, churches and gurdwaras. Malaysia Tourism promotes religious festivals, such as Lantern festival of Chinese, St. Anne’s Feast celebrated by Christians and ‘Thaipusam’ festival celebrated by Hindus to attract large number of tourists from all over the world. Faith healing in Nepal, a neighbouring country to India, dates back to the pre-historic times with the Shamans using tantric spirits to heal the people. Philippines promotes spiritual tourism and projects the country as ‘international Mecca of spiritual tourism’.
1.5 FEATURES
There are some distinguishing features of healthcare tourism which are outlined below: One of the important features of healthcare tourism is that it is not an impulsive activity. However, packages are woven with attractive features to draw the tourists. Another important feature of healthcare tourism is the willingness to spend. While, the cost of packages are attractive to wealthier segments, this may not be working in favour to attract patients from poorer countries. In such a scenario, the non-availability of such facilities in the home country and the quality of services provided in the host country play an important role. Healthcare tourism is also non-seasonal. This attribute can either be used to buffer seasonal business for resorts and locationspecific properties, or as the main business itself. Some countries such as Thailand are promoting healthcare tourism as main business for the properties developed for this purpose. In India, some of the hospitals / healthcare centres in Kerala that provide Ayurvedic treatment adopt this model of business. The nonrequirement for custom-builds is a strong characteristic in favour of the hotels. The patient and the family in this model stay in hotels during pre-operative and to some extent during the post-operative periods. Another important feature of healthcare tourism is that the average duration of stay is longer as compared to the conventional corporate / holiday travel. Depending upon the procedures and nature of treatment, the average stay of a healthcare tourist ranges between two weeks to two months. For example, procedures as
30
C M Y K
C M Y K
Introduction
complex as open-heart surgery, including post-operative care, involve a stay for at least two weeks. It has been reported that the persons who travel outside the country seeking low cost healthcare are predominantly uninsured or underinsured population in developed countries. In addition, the new trend is that the corporates in developed countries are increasingly sending their employees to low cost healthcare destinations to reduce the expenditure on healthcare for their employees. Successful treatment associated with satisfactory services are considered as important factors for getting repeat business, as healthcare tourism is not a one time business. In conventional tourism, the satisfactory services alone are enough to get repeat business.
1.6 GROWING DEMAND
People travel for availing healthcare services in another country for various reasons. Tourists from the United States are primarily travelling to other destinations as the cost of getting treatment in home country is costlier by four to ten times depending on the treatment procedures. Many tourists from European countries primarily travel to other destinations due to the complexity of availing the healthcare services in their home country. Some of the tourists from Middle East and Africa region, travel due to affordability of treatment and quality of services rendered. A section of people travel to India purely on the basis of the availability of specialty healthcare services, such as Ayurveda, Yoga. Healthcare centres set up for this purpose attracts tourists with specialty healthcare services that are not associated with any emergency medical services. In developed countries, there are increasing trends towards acceptance of Indian healthcare systems such as Ayurvedic therapies and Yoga. Growth of middleclass population in developing world and increasing interest in the industrialised countries has greatly increased the demand for Indian healthcare systems. With the growth in low-cost airline traffic, the feature of affordability works in multiple ways and brings in more population as healthcare tourists.
31
C M Y K
C M Y K
Healthcare Tourism: Opportunities for India
Many people from the developed world are coming to India not only for the rejuvenation, promised by yoga and Ayurvedic therapies, but also for urgent medical treatment such as hip replacement, heart or brain surgery. The combination of high quality and low cost services is also attracting repeated stream of international patients.
1.7 HEALTHCARE TOURISM : ONE FORM OF TRADE IN HEALTHCARE SERVICES
Many countries probably did not think of health care as something that is traded internationally. However, it is being increasingly offered cross-border in two ways (Exhibit – 3). Vast majority of cross border health care services are availed by the patients from developed countries, by undertaking travel to the host countries, which are increasingly developing countries. In such cases, the services are very specialized and are either available at low cost or a decision to purchase the service was taken after waiting for long period in home countries. This category of trade in healthcare services also includes unplanned emergencies that may occur when a foreigner falls sick or injured while traveling to other countries. In such cases, neither the service nor the service provider crosses a border; instead, the patient goes to where the service is available. Consequently, this is not typically considered as trade in the way it is generally understood, although
Exhibit 3: Two Forms of Trade in Healthcare
Source: Exim Research
32
C M Y K
C M Y K
Introduction
some suggest that it should still be considered as trade in health care services. Another form of trade in healthcare services would be when the healthcare services cross the border, the service provider as well as the patient stay wherever they are. This type of cross border trade in healthcare services happens with the advancement in communication technologies. The use of advanced diagnostic testing technologies, satellite communication, tele-health consultation, and the Internet may make it possible, and perhaps even desirable, for a patient from one country to get the advice and expertise of highly regarded specialists in other countries. In fact, there are examples of physicians being able to assist in surgeries through satellite transmissions linking a doctor in one country with a surgery being performed in another country. Such form of trade in healthcare services are minuscule at present; however, with the advent of technology, trade in health care services under this mode is likely to become increasingly common.
1.8 IN SUM
The demand for healthcare services is growing and many countries are competing with each other for a share in the global healthcare tourism demand. Developing countries are in an advantageous position, as the cost and complexity of providing the services are relatively low. India stands to gain with the increasing demand from abroad for availing of healthcare services from abroad. However, the competition will be tough as other countries are finding innovative ways to attract the tourists. It is, in this context, appropriate to analyse the growing demand for healthcare services, as also the models of other countries that are projecting themselves as healthcare destinations.
33
C M Y K