Despite the popular myth, Mumbai is not the favoured city for medical tourism, says Dr Akash Rajpal. Data shows Delhi and Gurgaon are much ahead.
It is now a well-received fact that patients come to India from different parts of the world for treatment as it is of expected quality and reasonable price when compared with many other countries. The term used for this growing industry, ‘Medical Tourism’, proved to be an irony. Tourism as a word is analogous to happiness and joy of travelling, but sickness is an undesired experience. After all who wants to get unwell and see a hospital ceiling? It is not a matter of choice but a need, which a patient is forced into when he or she falls sick. Therefore, the term ‘Medical Value Travel’ was rightly coined for patients travelling outside their native city or country seeking good quality care at considerably low cost.
As per data available on government website (pib.nic.in), the number of Foreign Tourist Arrivals (FTAs) in India on Medical Visa were 75, 688 in 2014, 1,34,344 in 2015 and 2,01,333 in 2016, showing a growth of 166%. However, as per 2017 data published by Directorate General of Commercial Intelligence and Statistics, Ministry of Commerce and Industry, the total number of non-residents who availed treatment in India was 4,59,735 for 2015-16 which shows a significant variance against medical visas issued for the same period. This shows that many patients do not avail medical visas for their treatment in India. Many industry sources say that medical visa costs are significantly higher than regular tourist visas and a sense of discomfort or skepticism still exists in terms of disclosure of sickness by the patients to the consulates.
The top five areas of earnings per patient in terms of treatment were Hematology with a revenue of $10315, cardiology ($4159), pediatric surgery ($4040), plastic and reconstructive surgery ($3292) and dentistry with a revenue of $3097. Various leading industry reports indicate that the average market cap of medical value travel in India is $ 3 billion which is poised to grow three- fold in the next three years.
No official data exists for city and state distribution as Clinical Establishment Act requiring all health providers to register their clinical establishments and share patient data is yet to be implemented in all states. However, NABH (National Accreditation Board for Hospitals and Healthcare Providers) accreditation can be a resourceful indication considering patients would be expected to choose a reputed and internationally quality accredited healthcare facility.
As of May 2017, out of the 465 accredited NABH hospitals across the country, the top 10 cities with most NABH hospitals are Delhi + Gurgaon with 60 hospitals, Mumbai + Pune with 37 hospitals, Hyderabad 32, Bangalore 31, Mumbai 22, Noida 16 and Chennai and Pune with 15 hospitals each. This busts the popular myth that Mumbai is potentially the medical value travel hub for India. Delhi and Gurgaon together lead with most number of NABH accredited hospitals followed by Mumbai and Pune combined, and then followed by Hyderabad.
If the states were to be considered for the number of NABH accredited hospitals, then Andhra Pradesh clearly tops the list followed by Delhi and then Maharashtra. The figures show 65 hospitals in Andhra Pradesh are accredited with NABH, 52 in Delhi, 50 in Maharashtra, 41 in Karnataka, 36 each in Gujarat and UP, 33 each in Kerala, Punjab and Tamilnadu and 20 in Haryana. However, industry sources reveal that Chennai, Hyderabad and Delhi NCR lead in terms of absolute volumes of overseas patients.
According to Dr BK Rana, Director, NABH, overseas patients do not prefer Mumbai over other cities due to perception of it being an expensive destination, connectivity issues, expensive hotels for attendants, and even due to perceived higher waiting times because of less number of accredited hospitals. He also sees metros like Delhi NCR more adept at and attuned to promotion of medical value travel activities as many hospitals were created in recent times there with focus on medical value travel, unlike the age-old legacy hospitals in Mumbai that are already filled to capacity with domestic patients, without any need of major marketing activities. As Mumbai is already saturated in bed population ratios, for feasibility purposes, more hospitals are coming up in space-and-connectivity-rich metros like Delhi NCR, which obviously will drive MVT to such areas.
Dr Jyoti Singh, Director, EMSOS PVT LTD, which runs an International Air Ambulance service, reveals that they get 35 patients a year with a 30% YOY growth, of which 55% of patients prefer Delhi NCR to any other Indian city, followed by 30% opting for Mumbai, and the rest going to Bangalore and Chennai for Liver Transplant, Oncology, Kidney Transplant and Heart Surgery, in that order. “Patients prefer Delhi NCR due to better overseas branding of doctors and availability of more number of specialists supported by larger number of accredited centers in comparison to Mumbai”, says Dr Singh.
Many industry sources say that Mumbai charges multiple times of Chennai or Delhi rates, which also contributes to its reduced medical value travel stats. For example, if a top Chennai hospital charges Rs 1000 for an IPD visit or OPD consult, many branded hospitals with few exceptions charge up to Rs 10000 or more for the same in certain bed categories. Amends are already in place though as according to maharashtratourism.gov.in the state has launched Maharashtra Tourism Policy 2016 with a focus on Medical Value Travel. Even Indian Merchants Chamber has set up a Medical Value Travel Taskforce as per Dr Ahmed Mecklai, a member of this task force.
When it comes to government support, the Ministry Of Tourism (Niche Tourism Division) has been proactively promoting Medical Value Tourism in appropriate countries. It offers monetary incentive of Rs 10 Lakhs to NABH accredited hospitals, and medical value travel facilitators as an assistance to their overseas medical tourism related marketing activities.
Dr Rana informs that Government Of India (GOI) promotes Medical Value Travel (MVT) in a combined effort through Ministry Of Tourism, Department Of Commerce and Services, and Service Export Promotion Council (SEPC). “As MVT patients have many times complained that their expectations were not met, GOI has brought on board NABH to lay down accreditation standards in medical value travel facilitation to enable trust and accountability. Accreditation’s objective is to assure overseas patients that they will receive the service and value additions as promised. Therefore, NABH has started accrediting MVT facilitators and already two facilitators have been accredited with many more in the pipeline”. SEPC’s official MVT portal indiahealthcaretourism.com, launched by Prime Minister Narendra Modi, enlists all NABH accredited hospitals and facilitators with their scope of services, connectivity and other FAQs, and is aggressively promoted overseas as a trusted first level of contact to prevent fraud and address grievances.
All oversees patients come with certain expectations and it is not necessary those are met once the patient lands on a foreign land. Surveys indicate that the concerns that affect medical value travelers are: quality of treatment, ease of physical movement between home and destination country, cost of treatment including Non-treatment expenses and hidden charges, language and translation services, concierge services including care for passports, tickets and foreign currency, facilities for attendants like hotel and sightseeing, food, cultural requirements and prayer facility, competence and professionalism of doctors and staff, hassle free disengagement from hospital after the care is over, clear follow-up instructions and settlement of bills, post procedure monitoring and availability of medicines in home country, untoward incident like death, funeral services/ transport of deceased to home country, litigation issues, and touts and frauds.
According to a study published on tourism.gov.in, by and large the expectations of medical value travelers were met barring the core expectation on overall costs. There is still a lack of clarity on actual vs incurred costs by patients and that gap is as high as 26 percent in experience vs expectation. Expectations on wait time, quality and competence were all met with a higher than expected rating for doctors and nursing competence.
Many hospitals now offer a professional support service to overseas patients, which takes care of language barriers, food and cultural preferences. Mumbai hospitals like Jaslok Hospital and Dr LH Hiranandani Hospital have special facilities and value additions for overseas patients which include concierge and airport pickup facilities, locker facilities, translator services, custom cuisines, hotel accommodation and prayer needs. Many hospitals even bootstrap with existing nursing and paramedic staff that speak required languages to interact with foreign patients.
Dr. Ahmad Mecklai, CEO of AAA Healthcare consultancy (FIRST NABH Certified Medical Value Travel Facilitator) says, “There is a scope for better transparency in terms of costs and value added services offered by hospitals. AAA is working on providing value additions like second opinions and decision support services.”
There is no doubt that India is a hot medical value destination and every state and city is competitively eying for that pie. Recent NABH accreditation numbers indicate competitive spirit among hospitals and its shift towards a quality mindset across the country providing first world treatment at third world prices. However, all stakeholders including government have to push the image of transparency and trust, and facilitate skill development in required areas to efficiently and professionally deal with overseas patients. Mumbai, are you listening?