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Medical Tourism: Care Beyond Boundaries Mr. Abhay Soi - Chairman & Managing Director
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Thoughts for discussion
• What is Medical Tourism (‘MT’)
• What drives MT
• Global Trends
• Case Study: Bumrumgrad
• Competitive landscape
• Challenges for MT
• MT India
• Advantage India
• Key Challenges
• Way ahead for MT in India
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What is Medical Tourism:
Medical Tourism refers to
people travelling beyond their boundaries,
to obtain healthcare solutions,
preventive and curative in nature.
Part of our civilization for a long time
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What drives MT: Unavailability of Quality Healthcare driving people to travel
KPMG in India Analysis, 2014
• Most of Africa
• Afghanistan
• Iraq
• CIS countries like Kazakhstan, Uzbekistan, Kyrgyzstan
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What drives MT: Other Features
Unavailability of experts – doctors,
nurses, etc.
Unavailability of Advanced
Technology
Below par Quality of care
Affordability & Cost
Immediate service (vs. long queues)
Privacy / Anonymity
High Cost of service in countries with Govt. funded health programs
developed county problems Developing / third world problems
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Global Trends: Sudden Rise in MT, Globally, with supernormal growth rate
10.5
32.5
0
5
10
15
20
25
30
35
2014 2020
Global MT Value ($ Billion)
Top 5 specialties: • Cardiac Sciences • Orthopedics: Joint replacements & Spine • Neuro Sciences • Oncology • Transplant programs: Liver, Kidney, Bone Marrow
Source: KPMG FICCI Heal 2014
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Global Trends: Sudden Rise in MT, Globally, with supernormal growth rate
• Ageing population
• Increased Awareness
• Improved Physical Connectivity
• Seamless Digital Connectivity Globally
US, EU, Canada, MEA Japan, Korea, Australia, NZ
15% of world
population
Africa South America
SAARC China Russia
85% of world
population
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Global Trends: MT leading to growth in other associated sectors
• Spill-over impact on other sectors…
Medical Tourism Retail
Logistics Travel Forex Earnings
Aviation
Hospitality Tourism
Many countries and private hospitals run focused programs to attract medical tourists from around the world: Turkey, Thailand, Singapore, Malaysia, India
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Global Trends: Choice of Destination determined by …
Systemic Hospital specific
• Availability of relevant expert Doctors
• Credibility of the Hospital
Credibility of the Country: • Overall perception about people • Cultural acceptability
• Proximity to Visitor, physical connectivity
• Facilitation by the Govt / country
Support and facilitation provided by the Hospital
Ease of process to take regulatory approvals
Comfort with the pre-visit services provided by the hospital: Tele-
consults with doctors, diagnosis, counselling, etc
Cost benefit to the MT visitor vis-à-vis other options
Cost of living (travel, acco, food, etc) for family members
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Challenges for MT
Concerted effort by government and private hospitals in developing countries is essential to achieve the purported super-normal growth in MT
First world’s MT Visitors’ challenge
Developing world’s MT Visitors’ challenge
• Affordability
• Language Barriers
• Cultural Differences
• Regulatory process for Med-Visa
• Market infested by unorganized
intermediaries: leading to
increase in cost and
misinformation to patients
• Insurance Portability across
jurisdictions
• Unavailability of outcome data
• Poor perception of Hygiene
• Lack of awareness
• Poor perception and
understanding of quality of care
in evolving MT hubs
• Regulatory process for Med-Visa
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Competitive Landscape: Top 5 countries cater to over 75% of Global MT
DESTINATION NO. OF MVT PATIENTS
THAILAND 2,500,000
MEXICO 1,000,000
USA 800,000
SINGAPORE 500,000
INDIA 200,000
MALAYSIA 200,000
BRAZIL 180,000
TURKEY 110,000
TAIWAN 90,000
COSTA RICA 50,000
• 60% MT driven by lack of relevant expertise and technology in own country
• 15%+ MT driven by cost benefit
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Medical Tourism in India Majority driven by SAARC and Middle East countries
• $ 250 million market in India, set to grow @ 20%+ y-o-y
• Majority from Bangladesh, Maldives, Afghanistan, Iraq, Nigeria
Bangladesh, 22%
Maldives, 17%
Afghanistan, 9%
Iraq, 8% Nigeria, 6%
Russia, 3%
Oman, 3%
Sri Lanka, 3% UAE, 2% USA, 2%
Others, 25%
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Medical Tourism in India Anchored in Metro cities
Spread over 4 to 5 hospitals
Spread over 2 to 3 hospitals
Spread over 3 to 4 hospitals
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Medical Tourism in India Case Mix change over the years
Then Now
2010 till 2016 Early 2000’s
Cardiac Sciences
Specialties
• Primarily CABG, Valve surgeries • Angioplasties
• Min. Invasive Cardiac Surgeries • Ventricular assist devices; • TAVI: Valve replacement without
surgeries
Solid Organ Tx
• Primarily Kidney Transplants • Mainly Liver, Bone Marrow Tx • Kidney Transplants
Ortho. • Spine Surgeries • Joint Replacement
• Minimally invasive spine surgeries • Joint Replacement
Neurology • Brain tumors • Spinal deformities
• Functional neuro-surgeries • Interventional neuro-surgeries
Oncology • Medical, Surgical, Radiation onco • Cyberknife, Robotic surgeries • Targetted chemotherapies • Organi specific onco programs
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Advantage India Strengths / Competitive Advantages
• Medical Talent:
– Doctors: amongst the best globally
– Excellent Nursing care
– Education system provides 30,000 doctors and nurses each year
– India is the largest exporter of medical talent to the world
– Quality of Care: at par with the best
• Culture:
– English speaking population in general
– Acceptance of patients from all races: Absence of racial discrimination
(especially relevant for African travelers)
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Advantage India Strengths / Competitive Advantages
• Technology: Latest Technology, Equipment, Facilities and Infrastructure:
Int’l standards
• Holistic Offer: Options for multiple Alternative Systems of Medicine like
Ayurveda, Yoga, Unani, Siddha, Homeopathy, etc.
• Unmatched Cost Advantge: @ 10% cost of developed world
– Cheap cost of living for long stay visitors, attendants, family members
• Access: Within 7 hours flying time from 70% of world’s population
• Tourism: Exotic tourism circuit around all metro cities
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Advantage India Government Support
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Advantage India: Price Advantage:
30%
65%
90%
45%
80%
65%
40% 45%
55%
75%
65%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
India: Amongst the cheapest and the best provider of ‘quality healthcare’
Cost of healthcare delivery: % discount to cost of service in USA
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Key Challenges India still lags behind Competition!!!
• Regulatory process flow for issuing M-visas: ‐ No separate fast track process for M visas; common queues for
Med & other Visitors @ airports;
Regulatory support
• Public / Civil infra. lags even some developing countries
• Limited number of quality tertiary / quaternary care facilities
• Majority of MVT flow is from non-English speaking countries:
‐ Need trained linguists to assist Arabic, African, CIS visitors
• While cost of treatment is less in India, ancillary costs may be high,
especially for visitors from low income economies
Public and Private
Infrastructure
Market Structure
• Patient flow driven by unorganized middle-men
• Few players have formal, transparent protocols for patient
counselling and communication for MT visitors
• Competition from other Asian countries
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Way forward for MT in India
Aspect Issues Plan
Regulatory framework
• Complicated visa regulations
• Stringent laws for surrogacy, organ donation
• Ease the medical visa policy • Streamline norms around organ
transplant, surrogacy, etc.
PR & Marketing • Inadequate PR backed by government
• Adequately promote India’s competitive advantages: Price, Talent, Quality of Care
• Structured promotion program with marketing by govt. forum
Quality of healthcare
• Limited number of high-end facilities
• Government support to facilitate greenfield facilities dedicated for MT
Hospitality • Lack of quality affordable accommodation in MT hubs like Mumbai, Delhi
• Dedicate health cities for MT visitors providing space for developing all ancillary services like accommodation for long stay patients & family members
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Way forward for MT in India
Aspect Issues Plan
Public Infrastructure
• Poor quality public infrastructure hampering overall service quality and perception
• Develop and connect micro-markets in each healthcare hub with key public utilities like airport, train, BRTS, etc.
Beyond Allopathy • Inadequate promotion of alternative treatments
• Canvas all alternative treatment systems under one roof and take them to international markets: Unani, Naturopathy, Siddha, Yoga, Homeopathy, Ayurveda,
Government Initiatives
• Below-par use of digital campaigning, promotion
• Absence of single nodal agency for promoting healthcare to MT visitors
• Budget level allocation to establish India as MT hub with global footprint.
• Engage experts to take India to the world via multiple marketing platforms
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Our Experience BLK Super Specialty Hospital, Delhi
• Dedicated End-to-End Eco-system:
– Annual traffic: 40,000+ OPD & 3,000+ IPD MT visitors
– Tie-ups: 15+ Health Ministries, 3 Universities, 15
embassies, Int’l TPAs
– Website: Multi-lingual website for target nations 0
10000
20000
30000
40000
50000
FY '12 FY '13 FY '14 FY '15 FY '16
Annual MT patients at BLK
– International OPDs: Teams of 2-5 doctors travel every week: From ‘Fiji to Finland’
– Pre-Travel support: Tele-consults, Skype calls, diagnostic support
– Translators: Pool of translators supporting 18 different languages
– Logistics: Direct pick-up from the Tarmac for Int’l patients
– Visa & currency: End-to-end handholding for entire travel schedule
– Food: Dedicated Chefs for 12 different cuisines, prepared every day
– Quality of care: International patients lounge, in-room admission & discharge
– Accommodation: Tied-up hotels at affordable rates for attendants
– Tourism: Packages via hospital vendor network
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Thank You!!!
BLK Super Specialty Hospital, Delhi Nanavati Super Specialty Hospital, Mumbai
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Global Trends: Case Study of MT oriented business: Bumrungrad, Bangkok
• One of the largest private hospitals in Southeast Asia
• Most popular MT destination
• Of the 1 million patients/ yr, 50% are foreign nationals
• Marketing offices in 16 countries (Australia, Bangladesh, UAE, China)
• Multi-lingual website
– End-to-end online assistance to patients
– Pre & post consults, Appointment, travel, stay, etc.
• Medical coordination office, dedicated team of 30+:
– Collaborates with patient’s primary doctor, even after the patient is discharged
• Wide range of accommodations from low-priced four-bed rooms to suites
• 51 room serviced apartment complex, for inbound long stay patients
– Patients can rent this accommodation for a day, a week, or a month.