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Study on Medical Tourism in Three Metropolitan Cities: Hyderabad, Chennai and Mumbai CESS MONOGRAPH 42 Study on Medical Tourism in Three Metropolitan Cities: Hyderabad, Chennai and Mumbai K.S. Babu Ipsita Mohanty P. Usha CENTRE FOR ECONOMIC AND SOCIAL STUDIES Begumpet, Hyderabad-500016 September, 2016 CENTRE FOR ECONOMIC AND SOCIAL STUDIES MONOGRAPH SERIES Number - 42 September, 2016 ISBN 978-81-931589-5-1 Series Editor : M. Gopinath Reddy © 2016, Copyright Reserved Centre for Economic and Social Studies Hyderabad Note: The views expressed in this document are solely those of the individual author(s). Rs. 200/- Published by : Centre for Economic and Social Studies Begumpet, Hyderabad-500 016 Ph : 040-23402789, 23416780, Fax : 040-23406808 Email : [email protected], www.cess.ac.in Printed by : Vidya Graphics 1-8-724/33, Padma Colony, Nallakunta, Hyderabad - 44 Foreword The Centre for Economic and Social Studies (CESS) was established in 1980 to undertake research in the field of economic and social development in India. The Centre recognizes that a comprehensive study of economic and social development issues requires an interdisciplinary approach and tries to involve researchers from various disciplines. The centre's focus has been on policy relevant research through empirical investigation with sound methodology. CESS has made important contributions to social science research in several areas; viz., economic growth and equity, agriculture and livestock development, food security, poverty measurement, evaluation of poverty reduction programmes, environment, natural resource management, district planning, resettlement and rehabilitation, state finances, education, health and demography. It is important to recognize the need to reorient the priorities of research taking into account the contemporary and emerging problems. Social science research needs to respond to the challenges posed by the shifts in the development paradigms like economic reforms and globalization as well as emerging issues such as optimal use of environmental and natural resources, role of new technology and inclusive growth. Dissemination of research findings to fellow researchers and policy thinkers is an important dimension of policy relevant research which directly or indirectly contributes to policy formulation and evaluation. CESS has published several books, journal articles, working papers and monographs over the years. The monographs are basically research studies and project reports done at the centre. They provide an opportunity for CESS faculty, visiting scholars and students to disseminate their research findings in an elaborate form. As part of Research Monograph Series, my colleagues have undertaken a study on Medical Tourism in the three metropolitan cities of India. The present Monograph titled "Medical Tourism in Three Metropolitan Cities: Hyderabad, Chennai and Mumbai" was based on field study in three cities. Medical tourism is an emerging concept to describe the rapidly-growing practice of traveling across international borders to obtain healthcare. India has become a preferred health destination for those who are living abroad as also those foreigners who are looking for a speedy and inexpensive treatment. One of the factors that the patients consider while looking for medical care outside of their country is the accreditation of hospitals. All the hospitals visited for the study were having national accreditation (NABH, NABL) and also few having international accreditation (JCI). The study looked into background characteristics of the foreign tourists seeking medical care, reasons for coming to India for treatment and source of information of foreign tourists to choose India for treatment, details of their medical and travel expenses, their perception about the quality of care, availability of translators, availability of care takers and ethical issues involved in Medical Tourism. The three metropolitan cities were selected because of the large number of foreign patients coming to the cities for treatment. The three cities are well connected to various global destinations. The hospitals here are well equipped with modern amenities and medical professionals CESS Monograph - 42 iv who are highly qualified. The major findings of the study reveal that medical tourism is on the increase in all the three cities. Medical tourists of all age groups and from different countries are coming to the three cities for treatment. Hyderabad had a high percentage of patients coming from Africa followed by Middle East countries while Chennai and Mumbai had patients mostly from Middle East countries. The medical tourists come for various health problems ranging from more serious problems such as cardiac problem and cancer and also more simple problems as master health check up. Medical Tourism combines medical treatment with tourism. However, for many of the patients in the study, travelling was not an important aspect during their stay in India. Though many of the international patients did not face any problems in getting visa, almost all the patients were of the opinion that getting visa to India was a lengthy process and could be frustrating for patients, particularly those with serious health problems. It is necessary for the government to look into this matter and ensure speedy visa clearance and immigration by developing simplified systems of issuing medical visas. Visa can also be extended depending on the condition of the patients. The study shows that English speaking capabilities of nurses and paramedical staff in the hospitals is poor. Interpreters are required who assist foreign patients in their communication with doctors and healthcare attendants. Though almost all the hospitals visited had interpreters for the patients but there were only few interpreters in each hospital, sometimes only one, who were not always available. The satisfaction level of international patients with the quality of care and relationship with doctors and staff of the hospital is an important parameter that influences the success of Medical Tourism. Almost all the international patients coming to the three cities for treatment were satisfied by their overall experience in the hospitals. The future of medical Tourism in the three cities seems promising. With the availability of world class facilities in private hospitals that are continuously upgraded and internationally recognized and highly qualified medical professionals and skilled health staff, India has great potential to attract more and more international patients for medical treatment. However, if India has to become a world player in medical tourism industry, public and private health sectors and voluntary organizations should create a congenial atmosphere for the growth of medical tourism. I hope the recommendations from the study will be useful to the policy makers, health professionals and academicians. S. Galab Director, CESS Study on Medical Tourism in Three Metropolitan Cities: Hyderabad, Chennai and Mumbai v CONTENTS Page No. Foreword iii List of Maps and Figures ix List of Tables xi Acknowlegments xvii Executive summary xix 1: Introduction 1 1.1 Tourism 1 1.2 Medical Tourism 4 1.2.1 History of Medical Tourism 5 1.2.2 Contemporary Medical Tourism 5 1.2.3 Countries Promoting Medical Tourism 6 1.2.3a Source Countries of Medical Tourists 7 1.2.3b Medical procedures 7 1.2.4 Medical Travel Companies 9 1.2.5 Medical Tourism in Asia 9 1.3 Medical Tourism in India 10 1.3.1 The Role of Private Sector in Promoting Medical Tourism in India 12 1.3.2 Government Initiatives to promote Medical Tourism in India 13 1.3.3a Contribution of Medical Tourism to Indian Economy 15 1.3.4 Constraints of Medical Tourism 15 1.4 Reasons for Medical Tourism 16 1.5 Medical and Travel Expenses of Tourists 17 1.5.1 Cost Comparison 17 1.5.2 Medical Tourism Insurance 18 1.6 Quality of Health Care 19 1.6.1 Quality and Safety Concern 19 1.6.2 Qualification of Medical Staff 20 1.6.3 Accreditation of Hospitals 20 1.7 Ethical Issues 21 1.8 Need of the Study 24 1.9 Objectives of the Study 24 2: Methodology 25 2.1 Location of Study Area 25 a) Hyderabad 27 b) Chennai 28 c) Mumbai 29 2.2 Data Collection 30 CESS Monograph - 42 vi 2.3 Questionnaires for Primary Data Collection 31 2.3.1 Foreign Patient Questionnaire 32 2.3.2 Hospital Questionnaire 33 2.3.3 Observation Tool 33 2.4 Pilot Study 34 2.5 Limitations 34 3: Medical Tourism in Hyderabad 37 3.1 Introduction 37 3.1.1 A Demographic Profile of Andhra Pradesh 38 3.1.2 Tourism in Andhra Pradesh 38 3.1.3 Health Care in Andhra Pradesh 38 3.2 Hyderabad 40 3.2.1 Demographic Profile of Hyderabad 40 3.2.2 Tourism in Hyderabad 41 3.2.3 Health Care in Hyderabad 43 3.2.4 Medical Tourism in Hyderabad 44 3.2.5 Accreditation of Hospitals 44 3.3 Hospitals Visited for the Study 46 3.4 Study of International Patients 54 3.4.1 Background Characteristics of International Patients 54 3.4.2 Background Characteristics of Family Members of International Patients 60 3.4.3 Reasons for Coming to India 68 3.4.4 Visa 73 3.4.5 Medical and Travel Expenses 76 3.4.5a Insurance 77 3.4.5b Expenditure 78 3.4.5c Tourism 80 3.4.6 Availability of Translators/Interpreters 81 3.4.7 Quality of Care 83 3.5 Ethical Issues 95 3.6 Summary 96 4: Medical Tourism in Chennai 99 4.1 Introduction 99 4.1.1 A Demographic Profile of Tamil Nadu 100 4.1.2 Tourism in Tamil Nadu 100 4.1.3 Health Care in Tamil Nadu 101 4.2 Chennai 102 4.2.1 A Demographic Profile of Chennai 102 4.2.2 Tourism in Chennai 103 Study on Medical Tourism in Three Metropolitan