Chapter I Introduction to Study

CHAPTER I

INTRODUCTION TO STUDY

CHAPTER I INTRODUCTION TO STUDY 1.1 Introduction 1.2 What is Medical Tourism 1.3 Medical Tourism a Current Global Scenario 1.4 Medical Tourism in India 1.5 Medical Tourism in India 1.5.1 Profile of Maharashtra 1.5.2 Infrastructure of Maharashtra 1.5.3 Maharashtra Tourism Market 1.5.4 Medical Tourism in Maharashtra 1.5.5 Some of the Key Growth Facilitators for Advantage Maharashtra 1.5.6 Cost Comparisons between other Countries, Other States, and Maharashtra 1.6 Statement of the problem 1.7 Relevance of the study 1.8 Significance of the study 1.9 Scope of the study 1.10 Concepts and Definitions of some important terms 1.11 Objectives of the study 1.12 Justification of the objectives 1.13 Hypotheses of the study 1.14 Justification of the hypotheses 1.15 Limitations 1.16 Chapter scheme

1.1 Introduction

Being possesses the right to life and health, and to every human necessities of life including proper medical services. The change is a natural phenomenon; people cannot have a command on the cyclic order of taste, fashion, dislikes, and needs requirements and levels of expectations. This process of change transformation brings change. This change influences our decision making behavior force to welcome a change to place.

For this changing trend, today, the service sector has made significance contribution to the process of economics transformation. Consumption of services such as education, healthcare, transport and communication, civil services, entertainment are considered vital.

The implications of globalization, technological and economic development trends throughout the world. The world is moving very fast on its way to becoming service dominated.

India is one of the major democratic nations of the world. It has achieved considerable progress after initiation of economic reforms in 1991. It has emerged as the fourth largest economy in purchasing power and it is amongst the fastest growing nation in the world. In India, service sector is the fastest growing sector in an economy. The share of services in India’s GDP at factor cost is nearly 65% during 1990-91 to 2011-12 (the GDP factor cost). At 2004-05 services grew faster than GDP for the last nine years (2003-04 to 2011- 12). Tourism is the largest service industry in India with a contribution of 6.23% to the national GDP and 8.78% of the total employment in India.

Tourism is a global phenomenon of the modern society. It is a potential economic activity through worldwide. Tourism Industry is proving new career opportunities in hospitality leisure and health concepts. It is one of the niche industries as an effective instrument for generating employment earning, foreign exchange revenue and for enhancing environment, preservation rejuvenation of the tradition and culture and overall development of economy.

Tourism industry around the world is growing with the developing horizon contributing 9% to the world of GDP. It is the largest and fastest growing industry in the world without exporting health.

It is one of the very crucial sectors for the Indian economy, India’s ranks among the top largest international truism earners and also considering the potentiality and the competitiveness to rank among the top ten global tourist destinations. WTTC predicts that globally tourism sector would contribute 96% of GDP’s and Create 300 million Job by 2020. It has created 23,454,500 jobs that are 5.5. % of total employment. This is expected to rise by 3.2 % in 2016 and in 2026 job will be available 29,629,000.

Tourism in India is expected to make a direct contribution GPP at around 8.6% during 2016-20 (WTTC). The number of Foreign Tourist Arrival (FTAs) in India during 2015 increased to 8.03 million as compared to 7.68 million in 2014. India was better than the growth rate of 4.4 % for the International Tourist arrivals around the world in 2015. Tourism continues to play as imported role as a foreign exchange earner for the country. FEE from tourism industry was US$ 21.07 billion in 2015 as compared to US$ in 20.24 billion in 2014.

Medical Tourism synonymous with the words like health tourism medical travel or global health care and has become a universal concept gaining importance. The word was first used by travel agencies and is today used by media, government, tourism development corporations etc. According to Connell (2006) He describes M.T. as a popular mass culture where people travel to overseas countries to obtain healthcare services facilities such as medical, dental and surgical care whilst having the opportunity to visit the tourist spots of that country.

MT is not a new phenomenon but the pace by it is gaining popularity is new. MT in India is considered to be holding immense potential. Travelling of abroad for medical purposes are known as international MT. Travelling for medical purposes within the nation is known as domestic medical tourism. The business of medical travel is promising. More than 135 countries around the world are competing for a share of this global business. The present global tourism market is estimated to be approximately US $

40 billion with an annual growth rate of 20 %. Asia is one of the leading regions in the world for medical tourism. Thailand is the leader among the Asian countries and India is the second largest player. MT Industry in India had earned Rs.5, 000-10,000 Corers in 2012.

Now India is considered as the golden spot for treating patients mostly from the developed countries and for east. Several foreign and domestic tourists prefer Indian states of Maharashtra, Goa, Kerala, Karnataka and Gujarat for see lay medical treatment with tourism. Medical tourism includes outbound, inbound and Intra-bound medical tourism. Outbound Medical Tourism: - Refers to patients travelling out of a country. Inbound Medical Tourism: - Refers patients coming into a country. Intra-bound Medical Tourism: - Refers to patients travelling within a country. It is also called as domestic medical tourism. Now, Maharashtra is also ahead in health care. Maharashtra has the best qualified medical professions in each and every specialized field and this fact has now been realized the world over regarding medical facilities with most competitive charges for treatment of certain medical problems. Maharashtra is now looking for creating a new identity by offering best health services to tourist. Maharashtra offer affordable treatment compared to other part of India and foreign countries. Tourist destinations of Western Maharashtra also have potential for medical tourism. Pune, Kolhapur, Sangli, Solapur are the upcoming Medical Tourism destination in Western Maharashtra. 1.2 What is Medical Tourism? Medical Tourism is also known as Medical Travel, Health tourism, Surgical tourism, Overseas medical and Wellness tourism. In Tourism industry, medical tourism is a promising concept and growing phenomenon. Medical Tourism can be defined as provision of ‘cost effective ‘personal health care or Private medical care in association with the tourism industry for patients needing Surgical heart care and other forms of specialize treatment. Medical tourism includes outbound, inbound and Intra-bound medical tourism.

1.3 Medical Tourism a Current Global Scenario Medical tourism has increased significantly in the last several years with the explosion of complex communication techniques and transportation technologies. Global medical tourism industry faced tremendous competition so; healthcare, hospitality and travel providers are attempting to improve their own services to become more attractive to the customers. The global medical tourism industry was estimated at USD 10.5 billion in 2012. It is expected to grow at a CAGR of 17.9% from 2013-2019 to reach USD 32.5 billion in

2019 (Business standard 2nd Dec. 2013). 1.4 Medical Tourism in India Tourism sector is one of the booming sectors in India and also largest foreign exchange earners. Government of India implemented 'Incredible India Campaign’ in 2002 and 'Athithi Devo Bhava' in the year 2008. The Minister of Finance Government of India took initiatives for develop and promoting medical tourism destinations in 10th 5 year plan. Further 12th 5 year plan (2007-2012) clearly emphasized the importance of sustainable development and growth of medical tourism to India along with promoting India as a world class quality and high-tech healing destination providing low cost medical surgeries and treatment with less waiting time. The 12th plan focuses on providing universal healthcare, strengthens healthcare infrastructure, promoting R and D and enacting strong regulations for the healthcare sector. The NITI Aayog has allocated USD 55 billion under the 12th 5 year plan. Superior quality healthcare, coupled with low treatment costs in comparison to other countries, is benefiting Indian medical tourism which has, in turn, enhanced the prospects of the Indian Healthcare Market. Yoga, Meditation, Ayurveda, Allopathy and other traditional methods of treatment are major service offerings that attract medical tourists from European Nations and the Middle East to India. According in industry estimates, the size of the medical tourism industry stands at Rs.1, 200 - 1,500 crores. Currently Indian Healthcare Market is at Rs.15 billion and growing at over 30% every year.

1.5 Medical Tourism in Maharashtra 1.5.1 PROFILE OF MAHARASHTRA Maharashtra is the third largest state in the country and populous state with a population of 96.75 million. It is also economically developed state. Maharashtra has the highest level of urbanization among major states in India 43% of the population residing in urban areas. The density of population is 314 persons per square kilometer. It has largest industrial economies in the country. Maharashtra is abounds in numerous tourist attractions like ancient cave temples, forests and wildlife, unique hill stations, beaches, ancient forts and monuments, pilgrimage centers, tradition of festivals. Maharashtra is the commercial and financial state of India is now coming up as the most suitable destination for medical truism within the country. 1.5.2 Maharashtra Infrastructure Maharashtra state has a well developed infrastructure. It has good road, rail and port and air connectivity. There are 3 international and five domestic airports. Maharashtra ranks first amongst all the Indian states in terms of GSDP. The rail transport system of Maharashtra is well developed. Indian Railways headquarters in Mumbai. The state is well connected to its six neighboring states and other parts of India through 18 National Highways. 1.5.3 Maharashtra Tourism Market Maharashtra state ranked 1st in foreign tourists arrivals. It received nearly 4.8 million tourists, Tamil Nadu 3.4 million welcomed people and New Delhi welcomed 2.2 million foreigners, 5th ranked in domestic tourist arrivals. Maharashtra received 66.3 million domestic tourists. (India Tourism Statistics 2013) Top 10 destinations in Maharashtra Domestic Destinations Foreign Destinations 1. Shirdi 1. Gate way of India 2. Ellora 2. Juhu Chowpathi 3. Gateway of India 3. Tadoba Tiger Project 4. Juhu Chowpathi 4. Elephanta Caves 5. Tadoba Tiger Project 5. Marine Drive 6. Elephanta Caves 6. Ellora

7. Mahalakshmi Temple, Mumbai 7. Lonavala 8. Mahalakshmi Temple, Kholapur 8. Khandala 9. Lonavala 9. Haji Ali 10. Khandala 10. Aghakhan Palace 1.5.4 Medical Tourism in Maharashtra Maharashtra has been in the forefront of healthcare development in the country. The Indian healthcare delivery system is categorized into two major components public and private. In recent years Maharashtra is top most health care destination. Medical facilities in Maharashtra is well advanced with world class health facilities zero waiting time and most importantly one tenth of medical costs spent in the US or UK. One of the main reasons, Maharashtra geographic location which is easily accessible and well connected with all the parts of not only India but with rest of the world also. Majority of foreigner’s come for cardiac surgery, joint replacement, plastic surgery, in- vitro fertilization, knee surgery. Maharashtra has the best qualified professionals in each and every field is one of the strength of increasing share of medical tourism. Now, Maharashtra is creating a new identity by offering best health services to tourist. The specialized Allopathy and Ayurvedic clinics and hospitals gaining popularity through word of mouth and this are contributing to the inflow of medical tourists. The facilities and equipment available at the hospitals are comparable with the best hospitals in the country seven in the world. Recently with an objective of 'To deliver ‘value for money' healthcare with a "Human Touch" FICCI and the Govt. of Maharashtra have joined hands to provide best available services to the patients coming from other parts of the country and world at the reasonable price with qualitative services. Mumbai is the most preferred medical tourist distinction. Medical cancer and Research institute receive lot of inquiries from foreign countries especially from NRI's. The major hospital of Mumbai are mainly Bombay Hospital and Medical Research center, Asian Heart Institute, Wockhardt Hospital, P.D. Hinduja Hospital and Medical Research

Center, Breach Candy Hospital, Tata Memorial Centre, Apollo Hospital and Leelavati Hospital. Pune is second preferred medical tourist destination. The major hospitals are Ruby Hall Clinic, Sancheti Institute for Orthopedics and Rehabilitation, Aditya Birla Memorial Hospital and Jeghanir Hospital. Around Pune many wellness centers like Kaivalyadham, International yoga centre. Apart from metro cities, small cities have potential to attract people from across the world. These are the sunshine cities Maharashtra that is Nashik, Kolhapur, Aurangabad, Nagpur, Solapur and Sangli. Maharashtra is one of the best emerging medical tourism destination and also better scope in medical tourism in the coming years in yoga, Ayurveda, Homeopathy, Unani and Allopathic medicines. 1.5.5 Some of the Key Growth Facilitators for Advantage Maharashtra 1. Specialized hospitals and clinics. 2. Well qualified suspended and experienced professional doctors, surgeons with respective fields. 3. Hospitals as highly equipped with latest life saving technological equipments. 4. Doctors are serving in various international projects and making valuable and important contribution in international assignments. 5. Low cost delivery. 6. Knowledge of English Language 7. Well connected with base metros like Delhi and other parts. 8. Most attractive state for medical foreign tourist. 9. Zero waiting periods for all patients. 10. One tenth to one twentieth of the costs involved for medical treatment in USA or UK. 11. Good roads and infrastructure compared to other states of India.

1.5.6 Cost Comparison of Charges: TABLE 1.1: Cost Comparison of Charges Procedure Abroad India Maharashtra (Other states) Total Hip Replacement 6.50 Lakh 2.60 Lakh 1.30 Lakh Total knee Replacement 7.50 Lakh 3.50 Lakh 2.30 Lakh Simple Spine Surgery 3.20 Lakh 210 Lakh 1.00 Lakh Spine Surgery with Implant 9.60 Lakh 2.40 Lakh 1.30 Lakh Simple Brain Tumor 1.92 Lakh 50,000 30,000 Open Heart Surgery 8.40 Lakh 2.50 Lakh 1.50 Lakh Deformity Correction 1.50 Lakh 60,000 30,000 Source: (Webmed Central > Research article) Cost effectiveness is one of the most important factors for Medical tourist to attract people from across the world. From the above Table, In the state of Maharashtra cities like Mumbai, Pune, Nashik, Aurangabad, Nagpur, Kolhapur, Sangli, Solapur the cost of treatment is very low compare to abroad and other states in India. India is a huge magnet for attracting foreign patients for medical treatments. The Maharashtra State Govt. has announced a medical tourism policy 2016, which will be helpful for providing better health care facilities and give exposure to the medical fraternity. The policy is also expected to give a lot of revenue to the government. Apart from the medical tourism council, the IMC chamber of commerce and industry is also looking into creating a task force which will put together its suggestions for drafting the necessary and appropriate policies for the promotion of medical tourism in the state (speech : IMC President Deepak Premnarayen). 1.6 Statement of Problem: Globalization process has been started step by step after economic reforms of 19991 and this process creating the opportunity and also will be create faster growth and indication for future trend in medical tourism. Medical tourism may continue to build bridges of communication, understanding and medical co-operation throughout the world. And also changing population structure, improvement in living standard, more disposable income, fewer working hours and long leisure time, better educated people, more advanced

10 technology, quick access, higher quality care, ageing population factors contribute to the growth of medical tourism industry and continuing trend towards growth in the future. Preliminary literature review shows that the medical tourism is not a new concept but the business of medical travel is promising. Now many countries starting to promote medical tourism as an option to boost tourism derived income. Last several years Information Technology has significantly growing because of use of new innovative communication techniques and advance developed transportation technologies so, global medical tourism industry faced tremendous competition for attracting prospective patients (medical tourist) and in addition hospitals, hospitality and travel providers are offer best and improved services to attracting medical tourist.

Medical Tourism market is estimated around USD 3 billion in 2015 and is expected to reach USD 8 billion in 2020. Indian medical tourism is growing at a CAGR of 20 percent. Inflow of medical tourists is to cross 3.2 million by 2016 compared to 0.85 million in 2012. The Indian government is taking initiative and NITl , Aayog has allocated USD55 billion under the 12th five year plan to the ministry of Health and family welfare Govt. also encouraging the private sector and Investments in infrastructure.

Domestic Medical tourism is travelling from an individual’s usual place of residence to another within the country for getting better medical treatment or for want of less expensive treatment available in his/her usual place of residence. Now in India, Intra- bound Medical tourism is gaining not only in metro cities but also number of small cities is also to take positive advantage. State hospitals were giving best treatment with low cost and quality services to medical tourists. They also tie up with foreign hospitals as well as providing services (outsourcing) to foreign hospitals.

This study will explore the current global trend affecting the medical tourism industry in western Maharashtra and to find out the scope of medical tourism within the states (Intra- bound Medical Tourism) and outside boundaries (Inbound Medical Tourism) by referencing cases and examples (destinations). To study the doctor, patients (tourist) and common people level of awareness and attitude towards concept of Medical Tourism in western Maharashtra.

The study entitled “A study of trends and opportunities of medical tourism in Western Maharashtra” is undertaken. The study is covered period of 5 years and special area of specialty, multi-specialist hospitals and super specialty hospitals.

1.7 Relevance of the Study:

Selection of the topic is most important work before one can carry out a research work in a particular filed. The selection of research topic entitled “A Study of Trends and Opportunities of Medical Tourism in Western Maharashtra” is not very arbitrary. Since no study on Medical Tourism in Western Maharashtra has been carried out so far from the point of view of its trends and opportunities in Western Maharashtra .The proposed research is primarily aimed in assessing the trends and opportunities of medical tourism in western Maharashtra The proposed study is going to find out scope and favorable destination in western Maharashtra and suggests action plans, which will helps the hospitals in promoting medical tourism in western Maharashtra.

1.8 Significance of the Study:

Each and every study has its own importance. In this present research work an attempt has been made to search the co-relations between the regional society and hospital and destinations and other related organizations in the Western Maharashtra. Medical tourism is emerging as an important activity in India. MT has a vast scope. It can contribute directly and indirectly to the national and regional economy. It benefits gaining from the hospital infrastructural facilities and services and employment generation on the national and global scale. Hence, it was important to carry out systematic study to understand the present in the medical tourism industry.

Maharashtra is one of the top states in India for medical tourism. This research work is related to the W.M. The research provides information about Indian medical tourism market and evaluates the medical tourism market size, tourist arrivals, accreditations, human resources in India and Maharashtra and studied the awareness of medical tourism among doctors, patients and non medical people. This study was also analyzed the strengths, weakness, opportunities and bottlenecks in W.M. and make recommendations

12 thereof. Various trends can be utilized to develop the medical facilities in small potential cities also. All these can help in growth of medical tourism in W.M.

1.9 Scope of the Study:

The Scope of study is very vital. The present study has geographical and conceptual scope. 1.9.1 Geographical Scope:

For the purpose of the study western Maharashtra State has been selected because Maharashtra has contributed much to the field of medicine. Medical Tourism has gained momentum in India and significantly in Maharashtra. By considering all these aspects researcher has selected the geographical area of Western Maharashtra for the purpose of research. The total number of district in Maharashtra is 36. These districts are grouped into six administrative divisions. From out of those six divisions the researcher has selected only one division i.e. Pune division. Pune division includes Pune (Pune-Head Quarter), Sangli, Satara, Kolhapur and Solapur. The scope of present study is limited towards the trends and opportunities of MT in western Maharashtra. This study has covered only specialty, multi specialty and super- specialty Allopathic hospitals. Intra-bound and Inbound medical tourists at Pune, Solapur, Sangli, Miraj, Kholapur Satara are considered by the researcher.

1.9.2 Conceptual Scope:

MT has emerged as the fastest segment of tourism industry. Indian MT sector is expected to experience CAGR of 17 % during the period 2015-20. Indian has become the best destination for MT for high-end surgeries at in expensive costs. India offers varied basket of medical services and rejuvenations facilities to patients at reasonable prices. Under this study the following points were studied. i) The current Scenario of medical tourism in India and Maharashtra. ii) Potential and growth of medical tourism in western Maharashtra. iii) Basic reasons and factors which are in western Maharashtra.

13 iv) The level of awareness, attitude and behavior of doctors and patients towards medical tourism. v) The current trends and opportunities in medical tourism in western Maharashtra and there favorable palaces. vi) The performance of medical tourism in Western Maharashtra. vii) Government policy and role of Govt. towards promoting medical tourism in western Maharashtra. 1.10 Working Definitions of Terms Used:

Following are some of the working definitions of the terms used in the study. i) Tourism: - Tourism is temporary and short term movement of people from one place to another place. ii) Medical Tourism: - Medical Tourism refers to travel undergone for the purpose of medical treatment and rejuvenation. iii) Medical Tourist: - Tourist is one those who avail healthcare services from hospitals. They are the ultimate users of hospitals services. iv) Allopathy (Greek) :- allos- othrpathos- suffering, a terms invented by Hahnemann, the promulgator of homeopathy, to describe that method of treatment of disease that consists of using medicines whose action upon the body in health produces morbid phenomena different from those of the disease treated. v) Ayurveda: - Ayurvedic medicine is an ancient system of health care that is native to the India subcontinent Ayurveda is also one among the few traditional system of medicine to contain a sophisticated system of surgery. vi) Homeopathy: - It is a treatment that seeks to stimulate the body’s defense mechanisms and processes so as to prevent or treat illness. vii) Hospital: - An institution for the temporary reception of the sick. An organization where patients get medical advice treatment for curing their illness or aliments. viii) Hospitality: - It is the art of making people / patients feel good at home. ix) Product: - A product is anything that can be offered to a market to satisfy a need. It includes physical objects, services, persons, places, organizations and ideas.

14 x) Satisfaction: - Satisfaction is a state of mind felt by a tourist / patient who has experienced a medical performance (or outcome) that has fulfilled his or her expectations. xi) Technology: - Mechanical devices, pharmaceuticals and techniques used in medical, surgical, diagnostic and therapeutic procedures. These devises and techniques are often related to innovations in treatment methods and advances in patient care.

1.11 Objectives of the Study: The present study has following objectives. 1. To review the current scenario of medical tourism in India and Maharashtra. 2. To study the product profiles of medical tourism provided in Western Maharashtra. 3. To access the potential and growth of medical tourism in Western Maharashtra. 4. To find and analyze the basic reasons and factors which influence the people to take treatment in western Maharashtra. (In-bound , Intra-bound) 5. To access the level of awareness, attitude and behavior of doctors, patients towards (the concepts of) medical tourism. 6. To identify favorable places and current trends and opportunities in the medical tourism industry in Maharashtra. 7. To find out the performance of various hospitals in the region of Western Maharashtra based on certain parameters and criteria’s to Judge the market viability of medical tourism. 8. To review the Govt. policy and know the role of govt. in promoting Maharashtra medical tourism in western Maharashtra.

1.12 Justification of the objectives:

The above stated objectives are justified on the ground that today India is considered the leading country promoting medical tourism. Medical tourism will expand greatly in future mainly due to the revolution that is taking place on both the demand and supply side. Medical tourism is influenced by geographical, technological, demographical,

15 globalization ,economic, political environments and also consumer demand, cost factor, local and regional factors, infrastructure and capital investment factors. The study has focus on intra-bound and inbound medical tourism in Western Maharashtra. Understanding the nature and anticipate future trends is very important for study. So realize the true potential of Medical Tourism encourages selecting the topic of medical tourism for research. By knowing the potential of Medical Tourism in India, the ministry of tourism has adopted the sustainable tourism route and incorporated it into the innovative rural tourism project.

1.13 Statement of Hypotheses:

Based on the objectives of the study, following hypotheses were framed:

1. H0- There exists less awareness level (20 % - 35 %) among doctors, patients towards the concept of medical tourism in western Maharashtra.

H1- There exists high awareness level (70 % to 85 %) among doctors, patients towards the concept of Medical Tourism in Western Maharashtra.

2. H0- In Western Maharashtra, medical tourist has mostly preferred allopathic treatments as compared to Ayurvedic treatments.

H1- In Western Maharashtra, medical tourist preferred both allopathic treatments and Ayurvedic treatments.

3. H0- The state of Western Maharashtra has tremendous potential for promoting medical tourism.

H1-The state of Western Maharashtra has moderate potential for promoting medical tourism.

4. H0- There exist no significant relationship between the previous treatments; travel experience, trust and distrust are more likely to decide on having a medical treatment.

H1-There exist significant relationship between the previous treatments; travel experience, trust and distrust are more likely to decide on having a medical treatment.

1.14 Limitation: 1) The concept of medical tourism is new one to Western Maharashtra hospitals and accordingly the literature available in this area is limited. 2) This study is considered only allopathic specialty, multi-specialty and super Specialty hospitals. 3) This study is considered only surgical, pediatric, neurologist, orthopedic, cancer dental, eye-care, cardiologists and gynecologist hospitals. 4) This study is considered a period from 2009 to 2014. 5) The majority of domestic medical tourist didn’t know the meaning of medical tourism so we had to explain to them about it and number of patient was confused the concept of MT. So proportion of respondents would show reluctance to answer or complete a questionnaire. 6) In case of doctors, they couldn’t answer due to high workload/busy schedule or absence of someone with authority to answer.

7) In case of hospitals, doctors do not have knowledge about medical tourism but they do not want to participate. Finally many questions concerning like financial data, patient numbers or other relevant sensitive data of the hospitals answers were left blank.

1.15 Chapter Scheme:

The present study entitled “A Study of trends and opportunities of Medical Tourism in Western Maharashtra” has been organized in nine Chapters.

Chapter I: Introduction and design of the study

It covers introduction, statement of the problem, scope, objectives of the study, hypothesis, operational definitions of the concepts, methodology, sampling design, geographical area, period of the study, tools of analysis, limitation of the study and chapter scheme.

Chapter II: Review of the Literature The second topic is related with review of past studies on books, journals, papers, unpublished thesis, news papers, websites etc.

Chapter III: Research Methodology: It is associated with research methodology, scope and limitations of the study, the objectives and hypotheses of the study. In order to fulfill the objectives sources of data collected and sampling size of the study, questionnaire used for data collection and data processing and statistical techniques used for the data processing etc is explained in this chapter.

Chapter IV: Theoretical Background of Medical Tourism It is related with introduction to medical tourism, overall view of the Medical Tourism industry at the international, national, state and district levels.

Chapter V: Profile of Study Areas

It is related to profile of study areas. It covered the information about the destinations and the hospitals in Western Maharashtra.

Chapter VI: Data Analysis and Interpretation

This topic deals with Data Analysis and Interpretation, identified the various level of attitude, awareness of doctors, tourists, and non-medical peoples toward the concept of medical tourism. It also analyzed trends and opportunities of Medical Tourism in Western Maharashtra.

Chapter VII: Findings, Suggestions and Conclusion

This topic deals with summary of findings, suggestions and conclusion. The last section of the study gives the generalization of the previous topics. At the same time findings and results along with suggestions to understand the existing trends and opportunities of medical tourism in Western Maharashtra and also mentioned the scope for further research.

REFERENCES

1. C. Eugine Franco, X. Antony Thanaraj (2011) Marketing of Hospital services, discovery publishing house PVT. LTD. New Delhi, PP- 1-5. 2. S.M. Jha (2011) Services Marketing , Himalaya Publishing house, Mumbai, PP.1- 10 3. D.S. Bhardwaj Krishank Kamra, Manjula Chaudhary, (2006) International Tourism- Issues and challenges, Kanishka Publishers, Distributors, New Delhi , PP-3- 4. Mr. Mukund Gupta (2017),Research scholar in smart city Development-Skill Development -Essential to a Successful and Robust Tourism Sector growth through secured Governance,PP-4-8 5. Indian Tourism Statistics 2015 Government of India, Ministry of Tourism Market Research Division. 6. Ketan Vira, Dr. R.K. Singh - Analytical study as role of MT Council of Maharashtra in promoting MT in Maharashtra. 7. NIMA (2013)- The changing world of MT Skilling India – for Health Wellness Medical Tourism industry- International Conference. 8. M.S. Nanita Tyagi, Dr. Rinzing Lama (2016), A study of perspective of challenges for medical Tourism in India, ICRTESM-16, PP-1170-1178. 9. Anil P Bankar, Potential for promoting Medical Tourism in Maharashtra, Webmedcentral.com 10. Dr. R. Kumar, Dr. Raj Bahadur,(2008),Medical Tourism in India management and promotion, Deep and Deep Publication Pvt. Ltd., New Delhi. 11. Niramal Dubey, (2001) ,Hospitality, Tourism and Hotel Management, Sonali publications- New Delhi-12. 12. K. sing, (2008) Medical Tourism - global outlook and Indian Scenario, Kanishka Publishers and distributors, New Delhi 13. Rajpal K. Tayade, Dr. Varsha S. Sukhadev,(2017), The growth impact of M.T. in India, I JARTIE Vol-2 Issue - 3 Page No. 2009-2013

14. Sabyasachi Bose, "A study on problems and prospects of Medical Tourism in India with strategic implications." A PJMNR, Vol. 3 (11), Nov (2014) PP-1-13. 15. India Brand Equity Foundation Healthcare report Jan - 2016 16. Medical Tourism Magazine (2016) Page 73 Global NTT 17. ITTTM, (2011) A Study of problems and challenges faced by medical tourists visiting India. 18. Global MTI (2016): MT Index The leading industrial Tool. 19. IBEF www.ibet.org (2016). 20. Ajay Baksi, A K Verma (2013) Domestic medical tourism in India: Some facets, Journal of Hospitality and Management Tourism.