0 PREFACE “Good Health is a chariot of mental and physical peace which takes you towards the path of success, happiness and prosperity” Tourism Industry around the world is growing with the developing horizon contributing 9% to the world GDP and facilitating 1,035 tourist globally. Among the several branches of this flourishing tree –Medical Tourism is the one that is emerging as a strongest bud of prosperity and wellbeing for the entire ecosystem of Tourism Industry. The term medical tourism is often used in the context of patients traveling abroad for medical care to countries such as Mexico, Costa Rica, India, Thailand and Singapore - and this is certainly true. However, there is also a growing trend towards “domestic” medical tourism, in which patients travel from one area of the country to another for medical care. Regardless of the reason, the common denominator in all medical tourism related activities is that patients are traveling away from their home region to access these services. "Whether it is affordability, accessibility, availability or better quality, in the final analysis, patients are searching for better perceived value." Medical tourism is not a new phenomenon. In fact, archaeological evidence from the third millennium B.C. suggests that ancient Mesopotamians traveled to the temple of a healing god or goddess at Tell Brak, Syria, in search of a cure for eye disorders. A few thousand years later the Greeks and Romans would travel by foot or ship to spas and cult centers all around the Mediterranean. The Asclepia Temples, dedicated in honor of the Greek god of medicine, were some of the world’s first health centers. Pilgrims would sometimes spend several nights in the temple, hoping Asclepios would appear in a dream and suggest a diagnosis or treatment. Later in the 16th and 17th centuries, spa towns such as St. Moritz and Bath became prime destinations for the European upper classes looking to soothe their ills. More recently, the wealthier citizens of underdeveloped nations have begun traveling to renowned medical institutions in the United States or Europe, usually for invasive medical procedures such as open heart surgery or cancer treatments that require a high degree of specialization and experience. Over the last fifteen years, however, the trend has reversed itself as increasing numbers of patients have begun traveling from developed nations such as the United States and Canada to so called “underdeveloped” nations in search of affordable medical care or treatment options not available at home. Most media attention has focused – often in a negative light - on patients traveling for what are referred to as “elective” procedures such as plastic surgery or dental. However, a growing number of patients are traveling for more acute care procedures such as open heart surgery, spinal procedures or hip and knee replacements. A rapidly aging U.S. population coupled with escalating healthcare costs and the uncertainty of healthcare reform are expected to increase medical tourism’s appeal even further. Patients from all walks of life and from many regions in the U.S. and abroad are currently traveling for medical care. The global medical tourism industry is growing by 20 - 30% annually. Every year, about 7 million people grab their passports and fly abroad looking for quality, affordable medical care — everything from dental work to weight-loss surgery to cancer treatment. That's fuelling an industry worth as much as $40 billion According to the World Travel & Tourism Council (WTTC), medical tourism contributed 9 percent of global GDP (more than US$6 trillion) and accounted for 255 million jobs in 2011. 1 Source: http://www.kpmg.de/ 60% of clinics, hospitals and medical tourism reported growth in international patient numbers over the last 12 months. 23% saw no increase and 17% experienced a decline. 80% expect their international patient numbers to grow over the next 12 months. 49% expect annual growth of more than 10% pa in the medical tourism market over the next five years. Over the next five years, cosmetic surgery is seen as the biggest growth area for medical travel (cited by 56% of respondents), with dental treatment (43%), cancer treatment (43%) and infertility treatment (40%) also expected to experience significant growth. Leading destinations in terms of quality and range of services provided to international patients- USA, Thailand and Singapore at the top Nearly 80% of demand for medical travel is driven by cost savings. Cosmetic surgery leads all other treatments, representing 38% of demand. About 92% of total spending on medical travel per patient is less than $30,000. Medical tourists spend between $7,475 and $15,833 per medical travel trip. For 6 million patients, medical travel may contribute $45 – $95 billion to global GDP. Latin America and Asia are the two leading regions for medical travel. Mexico and India respectively have the highest demand for medical tourism. Almost 76% of patients with a future interest in medical travel are American. Medical Travelers by Source and Destination To Asia Europe Latin America Middle North America From East Africa 95% 4% 1% Asia 93% 1% 6% Europe 39% 10% 5% 13% 33% Latin America 1% 12% 87% Middle 32% 8% 2% 58% East North America 45% 26% 2% 27% Oceania 99% 1% McKinsey Report Asia is one of the leading regions in the world for medical tourism with following facts: Asia medical tourism industry has been growing at the rate of 20% per annually and expected to reach US$ 8.5Billion by 2015. Asia in itself generates revenues in billions and consists of 12.7% of the global market. A growth rate of 17.6% and 23% of revenue growth is expected by 2013. The coalescing of quality healthcare 2 at affordable costs and leisure tourism makes Asia one of the top choice destinations for medical tourists. Asia medical tourist number of arrivals is expected to cross the figure of 10 Million numbers by 2015. Thailand is the leader among the Asian countries, which received maximum number of foreign patients in 2012. India is the second largest player, closely followed by Singapore, Philippines and Malaysia Thailand holding more than 40% share in Asia medical tourist arrivals in 2011. Its medical tourism market is also expected to be more than double by 2015 from its current market in 2011. India was one of the first countries to recognize the potential of medical tourism. From the year 2009 to 2011 the number of medical tourists in India has grown by 30%. It is estimated that by the year 2015, India will receive nearly half a Million medical tourists annually making it a 9,500-crore industry by 2015. Malaysia has seen an impressive growth in medical tourism industry. Malaysia medical tourism market has grown more than 8 times in 2011 compared to its market in 2003.The international patient arrivals to Malaysia are expected to grow with a CAGR of 29.27 percent for the period of 2009 to 2013. Singapore medical facilities are considered to be the best in Asia but its treatment cost are bit costlier compared to its competitors. Singapore medical tourist arrivals are expected to be more than 1 Million by 2015. Philippines started off bit late for the medical tourism but are catching up quickly. Its medical tourism market is expected to grow with a CAGR of 9% for the period of 2012 – 2015. South Korea is a fast-growing medical tourism destination. It is forecasted that by 2015, South Korea will attract more than 300 Thousand medical tourists. Taiwan medical tourism has become one of the biggest attractions for mid to high income Chinese tourists. The country's medical tourism market is expected to increase at 7% CAGR from 2012 to 2015. Present scenario of Indian medical Tourism Industry Statistics suggest that the medical tourism industry in India is worth $333 million (Rs 1,450 Crore) while according to the study by CII-McKinsey, country had earned Rs 5,000-10,000 crore in 2012. Medical Tourist in India Number of Medical Tourist 3500000 3000000 2500000 2000000 1500000 1000000 Numberof Medical Tourist 500000 0 2005 2008 2011 2015 Years 3 Revenue Earned 14000 12000 12000 10000 8000 7500 Crores 6000 4000 2000 0 2013 2015 Employment Scenario: Presently, in India, the healthcare sector has an estimated revenue of around $30 billion constituting 5% of GDP and offering employment to around 4 million people [Source: Confederation of Indian Industry (CII)]. All the above finding makes it clear that there is a tremendous scope of medical tourism industry to grow beyond its peripheries, what require is to explore it properly and to make aware all the directly and indirectly associated communities with the changing trends of this booming industry. NIMA takes the opportunity to present this compilation after gathering all the information related to Medical Tourism (secondary research) including basic concepts of health wellbeing and medical tourism, Global, Asian and Indian Scenario, SWOT analysis of India as a medical tourism destination, understanding the medical tourism system and developing business in India ,best super specialty hospitals in India, prospects and challenges for tourist visiting India for medical tourism, skills required for medical tourist facilitators and future trend in medical tourism industry compiled in nine chapters for the reader. Every Chapter takes the reader towards the basic understanding of the current and emerging trends of medical tourism Industry with major emphasis on Indian perspective. Dr. Gulshan Sharma Ph.D (Tourism- Service