Healthcare Telemedicine and Medical Tourism in India

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A brief report on Healthcare, Telemedicine & Medical Tourism in India

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A brief report on Healthcare, Telemedicine & Medical Tourism in India

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1.1 Introduction
The Healthcare sector, in India, is at an inflection point and is poised for rapid growth in the
medium term. However, Indian healthcare expenditure is still amongst the lowest globally and there
are significant challenges to be addressed both in terms of accessibility of healthcare service and
quality of patient care. While this represents significant opportunity for the private sector, the
Government can alsoplay an important role in facilitating this evolution.
The healthcare industry includes medical care providers, physicians, specialist clinics, nursing homes,
hospitals, medical diagnostic centers, and pathology laboratories. In terms of revenue and
employment, healthcare is one of India’s largest service-sector industries. During the 1990s, Indian
healthcare grew at a compound annual rate of 16%. The total value of the sector is more than$34
billion. This translates to $34 per capita, or roughly 6% of GDP. The Indian health care industry was
valued at US$ 79 billion in 2012, and is expected to reach US $160 billion by 2017. The Indian
healthcare sector is expected to grow at about 15 percent year-on-year (y-o-y), on account of factors
such as rapid growth in infrastructure development, creation of demand for higher levels of
healthcare, rising awareness of end users, and launch of innovative insurance, reimbursement, and
financing policies.
Healthcare spending in India accounts for over 5 per cent of the country's GDP. Out of this, the
public spending in percentage is around 1 per cent of GDP. The presence of public health care is
not only weak but also under-utilized and inefficient. Meanwhile, private sector is quite dominant in
the healthcare sector. Around 80 percent of total spending on healthcare in India comes from the
private sector. Inadequate public investment in health infrastructure has given an opportunity to
private hospitals to capture a larger share of the market. In addition the demand for hospital services
has been increasing due to the rise in lifestyle related diseases.
1.2 Indian Healthcare Industry Trends
 Healthcare sector has witnessed positive upward trend even during recession
 Reports suggest that healthcare is going to be one of the major sector that would fuel the
economic growth and will contribute to the increased revenues, along with IT Services and
Education sectors,
 According to the All India Management Association in collaboration with Boston
Consulting Group and the Confederation of Indian Industries (CII) together in their “India’s
New Opportunities- 2020”, they have also forecasted 40 millions new jobs and around 200
billion increased revenues by 2020.

The Indian healthcare industry has witnessed a massive spurt in healthcare spend and is expected to
reach US$100billion by 2015 from the current ~US$65 billion, growing at a CAGR of 20% a year
Revenues from the healthcare sector account for 5.2 percent of the GDP, making it the third largest
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growth segment in India. The Indian healthcare market is currently estimated at US$ 34.2 billion.
Healthcare revenue in India is set to reach US$ 280 billion by 2020; expenditure is likely to grow at a
compound annual growth rate (CAGR) of 12 per cent over 2012-15. Rising incomes, greater health
awareness, lifestyle diseases, and increasing insurance penetration will contribute to growth.
Healthcare delivery and pharmaceuticals account for nearly 75% of the total healthcare market. India
has only 0.7 beds per 1,000 people, far below the global average of 2.6.India needs to add 2 million
beds to the existing 1.1 million by 2027, and requires immediate investments of $82 billion to make
up for its infrastructure deficit.
The Indian healthcare industry is poised to grow at a compounded annual growth rate of 15 per
cent. Nearly 90 per cent of this growth will come from the private sector. In India, private
healthcare accounts for almost 68 percent of the country’s total healthcare expenditure. Funds in the
Indian healthcare sector have been largely private. The private sector provides 60 per cent of all
outpatient care in India and as much as 40 percent of all in-patient care. It is estimated that nearly 70
per cent of all hospitals and 40 per cent of hospital beds in the country are in the private sector. The
health insurance is growing steadily but profitability is a challenge because of the high claims and
other commission and management expenses. It expects 20 per cent growth in business to Rs 150
billion in 2013-14.
The investments in medical and surgical instruments segment is amount to US$115.29 million over
the period August 1991 to April 2007. The healthcare equipment sector attracted 8.8 per cent of the
total investments in terms of deal value with an aggregate of US$ 249.01 million (20 deals). The
hospital and diagnostics centres in India received foreign direct investment (FDI) worth US$
1,597.33 million, while drugs & pharmaceutical and medical & surgical appliances industry registered
FDI worth US$ 10,318.17 million and US$ 622.99 million, respectively during April 2000 to March
In 2006, imports of medical equipment and supplies were valued at US$1,125.8million, an increase
of 21.7% over 2005.The healthcare sector attracted US$ 379 million in 2007 which is 6.8 percent of
the total private equity (PE) investment of US$ 5.93 billion.

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Market break‐up by revenues (2012E)
Medical Equipment & 
Medical Insurance
2.1 The Indian healthcare Industry
 The Indian healthcare industry is seen to be growing at a much rapid pace than it was
anticipated before and is expected to become a USD 250 billion by 2020.
 According to the Investment Commission of India the healthcare sector has experienced
phenomenal growth of more than 12 percent per annum in the last four years
 This growth is expected to be driven by a number of factors: rising life expectancy, rising
income levels of Indian households, increasing penetration of health insurance and rising
incidence of lifestyle-related diseases in the country has led to increased spending on
healthcare delivery.

2.2 Current Size of the Healthcare Industry
 The Indian Healthcare sector currently represents a USD 40 Billion industry. A break-up of
the sector of 2012 is provided:

 India’s healthcare spend is significantly low when compared to the global, developed and
other similar emerging economies.

 The Indian healthcare spend is less than half the global average in percentage terms when
compared on a “percent of GDP” basis.

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As is noted from the comparison below, Private Sector contribution to the healthcare sector at 75 %
is amongst the highest in the world in percentage terms. Public spending, on the other hand,
isamongst the lowest in the world and is 23% points lower than the global average.


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2.6 Healthcare infrastructure deficiencies
The penetration of healthcare infrastructure in India is much lower than that of developed countries
and even lower than the global average.
2.7 Current Infrastructure
The healthcare infrastructure in India is inadequate compared with the global standards. It lags
behind the global average in terms of healthcare infrastructure and manpower. India has an average
0.6 doctors per 1000 population against the global average of 1.23 17 which suggests an evident
manpower gap.
Hospital Bed
(per 10000
2000-2010 12 31 39 24 30
Doctor Density
2000-2010 6 27 21 17 14
Births attended
skilled health
2000-2010 47 99 NA 97 98
No of doctors 2010 6,43,520 7,93,648 1,26,126 3,20,013 18,62,630
No. of Nurses 2010 13,72,059 29,27,000 37,200 5,49,423 122,59,240
No. of Dentists 2010 55,344 4,63,663 25,914 2,17,217 1,36,520
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1000 population
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* latest year available data

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3.1 Key Players in the Healthcare Segment:
The government's share in the healthcare delivery market is 20% while 80% is with the private
sector. Private players have made significant investments in setting up state-of-the-art private
hospitals in cities like Mumbai, New Delhi, Chennai, and Hyderabad. The following are the major
domestic private healthcare providers in India
3.1.1 Apollo Hospitals: Apollo Hospitals has emerged as the single largest private hospital group in
South Asia. It operates hospitals, dispensaries, clinics, and laboratories. It manages a network of
approximately 41 specialty hospitals and clinics with a bed capacity of over 9,000 across the country
and abroad. It has tied up with insurers like BUPA (UK),Vanbreda (Belgium) and Mondial (France)
It has a joint venture with Singapore based Parkway Group Healthcare PTE Ltd.
3.1.2 The Escorts Group: This has a presence in specialized cardiac treatment and multi-specialty care
hospitals providing a whole gamut of specialized medical services. Escorts operate ten hospitals
across India. The group is also reputed for tertiary care services such as neurology, neurosurgery,
plastic surgery, and urology. Escorts Heart Institute and Research Centre (EHIRC) has a 325 bed
tertiary care institute, with 9 operation theatres, 5 cath labs, 2 heart command centers and world
class facilities. It has carried out over 80,000 angiographies and 43,000 cardiac surgeries over the past
fifteen years – which is a world record
3.1.3 Fortis Healthcare: This is a company founded by the promoters of the Indian pharmaceutical
major, Ranbaxy Laboratories, started operations in 2001. It has approximately 12 hospitals with
1,900 beds. It has operations across North India in the cities of Delhi, Noida, Mohali, Amritsar,
Faridabad, Raipur, and Srinagar. Ithas a joint venture with Real Estate player DLF to set up
hospitals across the country with an investment of about US$ 1.5 billion
3.1.4 Max Healthcare: This is a fully owned subsidiary of the highly diversified Max Group, with a chain
of clinics and hospitals with a bed capacity of 1200. On an average, Max Healthcare treats 30,000
patients every month, with 200 new patients visiting the facilities every day. It has collaborated with
Singapore General Hospital in the areas of medical practices, nursing, paramedical research and
3.1.5 Wockhardt: This is among India’s leading pharmaceutical and healthcare companies. Since
inception in 1989, the Wockhardt Hospital & Heart Institute has become a renowned tertiary level
heart centre providing cardiac care to patients of all age groups. It is the first recognized hospital in
South Asia on the worldwide panel of Blue Cross blue Shield, the largest provider of health
insurance in USA. It has approximately 10 hospitals with 1,500 beds. It has entered into Public-
Private Partnership with the Government of Gujarat to manage the 275-bed Palanpur Civil General
Hospital in Gujarat.
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3.1.6 Manipal Health Systems: Its chain consists of approximately 9 primary centres at7 rural locations,
8 secondary hospitals at urban and semi-urban locations and 3tertiary hospitals at urban and
semi-urban locations. It has a joint venture with Pantaloon Retail for comprehensive retail
healthcare foray.
3.1.7 Aravind Eye Hospital: This hospital in South India is the single largest provider of eye surgery in
the world. In 1998, its hospitals saw 1.2 million outpatients’ and performed 183,000 cataract
surgeries. It costs Aravind about US$ 10 to conduct a cataract operation. It costs hospitals in the
United States about US$ 1,650 to perform the same operation.
3.2 Foreign collaboration in the Indian Healthcare sector:
Since liberalization in 1991, a growing number of Indian companies have formed alliances with
foreign firms. The following are some of such alliances:
 Wockhardt collaborated with Harvard Medical International Inc. USA
 Fortis Healthcare collaborated with Partners Healthcare System, USA
 Birla Heart & Research Centre collaborated with Cleveland Clinic Foundation, USA
 Max Healthcare and Singapore General Hospital (SGH) have entered into collaboration for
medical practice, research, training, and education in healthcare services.
 Apollo-Gleneagles Hospitals Ltd. It’s a 50:50 joint ventures between Apollo Hospitals Ltd
and Parkway Group of Singapore. The joint venture is also looking at business opportunities
overseas in West Asia and North Africa.
 Apollo Hospitals has also entered into a partnership with Yemen’s Hayel Saeed Anam
Group to provide advisory services to the latter’s hospital project.

3.3 Foreign players in India:
 The US-based Atlas Medical Software, which specializes in developing software solutions for
the healthcare industry, has set up its operations in India.
 Bayer Diagnostics, one of the largest diagnostic businesses in the world.
 GE-BEL, a joint venture between General Electricals and Bharat Electronics Limited is the
only manufacturer of X-ray and CT tubes in South Asia.
 UK-based Isoft Group plc (iSOFT), one of the world’s leading suppliers of application
systems for hospitals and healthcare organizations.
 Phillip sells about US$ 43-49 million worth of medical systems in India.
 The US-based healthcare products major, Proton Health Care is making an entry into India
with its range of digital health monitoring devices.
 Siemens is a leading manufacturer of medical equipment with a market share of more than
30 per cent in India.
 Wipro GE Medical Systems, a joint venture between GE Medical Systems and Wipro
Corporation, is India’s largest medical systems sales and service provider

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1.1 Introduction
Telemedicine is the use of telecommunication and information technologies in order to provide
clinical health care at a distance. It helps eliminate distance barriers and can improve access to
medical services that would often not be consistently available in distant rural communities. It is also
used to save lives in critical care and emergency situations.
Although there were distant precursors to telemedicine, it is essentially a product of 20th century
telecommunication and information technologies. These technologies permit communications
between patient and medical staff with both convenience and fidelity, as well as the transmission of
medical, imaging and health informatics data from one site to another. Early forms of telemedicine
achieved with telephone and radio have been supplemented with video telephony, advanced
diagnostic methods supported by distributed client/server applications, and additionally with
telemedical devices to support in-home care.
1.2 Disambiguation
Other expressions similar to telemedicine are the terms "telehealth" and "eHealth", which are
frequently used to denote broader definitions of remote healthcare not always involving active
clinical treatments. Telehealth and eHealth are at times incorrectly interchanged with telemedicine.
Like the terms "medicine" and "health care", telemedicine often refers only to the provision of
clinical services while the term telehealth can refer to clinical and non-clinical services involving
medical education, administration, and research.

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Telemedicine can be broken into three main categories: store-and-forward, remote monitoring and
(real-time) interactive services.
2.1.1 Store-and-forward telemedicine
It involves acquiring medical data (like medical images, biosignals etc.) and then transmitting this
data to a doctor or medical specialist at a convenient time for assessment offline. It does not require
the presence of both parties at the same time. Dermatology (cf: teledermatology), radiology, and
pathology are common specialties that are conducive to asynchronous telemedicine. A properly
structured medical record preferably in electronic form should be a component of this transfer. A
key difference between traditional in-person patient meetings and telemedicine encounters is the
omission of an actual physical examination and history. The 'store-and-forward' process requires the
clinician to rely on history report and audio/video information in lieu of a physical examination.
2.1.2 Remote monitoring
It is also known as self-monitoring or testing, enables medical professionals to monitor a patient
remotely using various technological devices. This method is primarily used for managing chronic
diseases or specific conditions, such as heart disease, diabetes mellitus, or asthma. These services can
provide comparable health outcomes to traditional in-person patient encounters, supply greater
satisfaction to patients, and may be cost-effective.
2.1.3 Interactive telemedicine services provide real-time interactions between patient and provider, to
include phone conversations, online communication, and home visits. Many activities such as history
review, physical examination, psychiatric evaluations and ophthalmology assessments can be
conducted comparably to those done in traditional face-to-face visits. In addition, “clinician-
interactive” telemedicine services may be less costly than in-person clinical visit.

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 Telemedicine can be extremely beneficial for people living in isolated communities and
remote regions and is currently being applied in virtually all medical domains. Patients who
live in such areas can be seen by a doctor or specialist, who can provide an accurate and
complete examination, while the patient may not have to travel or wait the normal distances
or times like those from conventional hospital or GP visits. Recent developments in mobile
collaboration technology with the use of hand-held mobile devices allow healthcare
professionals in multiple locations the ability to view, discuss, and assess patient issues as if
they were in the same room.
 Telemedicine can be used as a teaching tool, by which experienced medical staff can observe,
show, and instruct medical staff in another location, more effective or faster examination
techniques. It improved access to healthcare for patients in remote locations.
 Telemedicine has been shown to reduce the cost of healthcare and increase efficiency
through better management of chronic diseases, shared health professional staffing, reduced
travel times, and fewer or shorter hospital stays. Several studies have documented increased
patient satisfaction of telemedicine over the past fifteen years.
 Tele-monitoring is a medical practice that involves remotely monitoring patients who are not
at the same location as the health care provider. In general, a patient will have a number of
monitoring devices at home, and the results of these devices will be transmitted via
telephone to the health care provider. Telemonitoring is a convenient way for patients to
avoid travel and to perform some of the more basic work of healthcare for themselves.
 In addition to objective technological monitoring, most telemonitoring programs include
subjective questioning regarding the patient's health and comfort. This questioning can take
place automatically over the phone, or telemonitoring software can help keep the patient in
touch with the health care provider. The provider can then make decisions about the
patient's treatment based on a combination of subjective and objective information similar
to what would be revealed during an on-site appointment.
 Some of the more common things that telemonitoring devices keep track of include blood
pressure, heart rate, weight, blood glucose, and hemoglobin. Telemonitoring is capable of
providing information about any vital signs, as long as the patient has the necessary
monitoring equipment at his or her location. Depending on the severity of the patient's
condition, the provider may check these statistics on a daily or weekly basis to determine the
best course of treatment. The first Ayurvedic telemedicine center was established in India in
2007 by Partap Chauhan, an Indian Ayurvedic doctor and the Director of Jiva Ayurveda.
Teledoc used Nokia phones running Javascript to link mobile ayurvedic field techs with
doctors in the Jiva Institute clinic; at its peak, Teledoc reached about 1,000 villagers per
month in Haryana province, primarily treating chronic diseases such as diabetes.
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1.1 Introduction
Medical tourism (also called medical travel, health tourism, or global healthcare) is a term initially
coined by travel agencies and the mass media to describe the rapidly-growing practice of travelling
across international borders to obtain health care. It also refers pejoratively to the practice of
healthcare providers travelling internationally to deliver healthcare.
India receives hundreds of thousands of tourists that come in to the country to undergo medical
treatments, then leaving the country and going back home. It is called Medical Tourism and it is a
blooming global industry as India has become a main medical tourism hub.This phenomenon of
people traveling across national borders for medical care has existed for centuries. However, only in
the recent decades has it really taken off and fully blossomed, as patients have realized that they have
options other than receiving local medical treatment and it is their right to check elsewhere and take
advantage of the fact that the improvement of the means of transportation along with the internet is
turning our world into a global village.
The major reason people are traveling abroad for treatments are the high medical costs as many
patients do not have proper medical insurance (or any at all) and when in need of surgery, they
cannot afford to pay for it. Surgery abroad can lower the cost to 33%-50% of the price in the USA
for example.
Long waiting lists is another cause people will travel abroad for medical care as they prefer to have
surgery on their own terms, earlier than later. Patients will rather not live in discomfort for extensive
periods of time and rather have the same surgery abroad much faster. A final reason can be that
another country has a better or more advanced medical technology and research in the specific field
of surgery and the patient will prefer to travel to that destination.
1.2 Medical Tourism in India
India was one of the first countries to recognize the potential of medical tourism and currently it is
the leading destination for global medical tourists. Already in 2004, India has received 150,000
medical tourists and this number has grown by a whopping 33% by 2008 to 200,000 inbound
medical tourists. It is estimated that by the year 2015, India will receive over half a million annual
medical tourists annually.
This is no coincidence, India’s private medical sector offers the most advance medical treatments
and technology available in the world today. Patients can come in and enjoy deluxe accommodations
and be treated by the finest doctors that have western medical training, all for the lowest prices. In
addition to this, patients are not expected to face any language barriers as a most of the population
in India speaks English.
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The government in the country is supporting this industry as well, assisting hospitals in acquiring the
JCI accreditations and awarding funds for renovations and add-ons, everything they can do to
improve both the private and public medical sectors in the country. And if all this isn’t enough, after
receiving medical treatment and recovering, patients are free to keep traveling and enjoy a vacation
in India and the countries surrounding it as India is located in the heart of East Asia.

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A patient can travel to India for just about any medical procedure he or she needs to have done. The
most common major surgeries patients fly in for is open heart surgery and orthopedic joint
replacement surgery as these are very expensive types of necessary surgery if you do not have proper
medical insurance. Indian hospitals today excel in these kinds of treatments and there are many
hospitals specialize in both medicine fields.
Cosmetic procedures are also a very popular type of procedure to have done in India since medical
insurance does not usually cover this kind of operation and the costs can be fairly high. Patients will
travel for any plastic surgery, starting from breast augmentation and enlargements to complete
facelifts and tummy tucks. There are many private hospitals in India as some stand out with world
renowned names. Apollo Hospitals is a main Indian chain that runs 53 different hospitals with over
8,500 beds. Max Healthcare is another known private hospital chain that runs eight medical centers
in the national capital region in India.
2.1 Medical tourism is a growing sector in India. India’s medical tourism sector is expected to
experience an annual growth rate of 30%, making it a $200 billion industry by 2015. As medical
treatment costs in the developed world balloon - with the United States leading the way - more and
more Westerners are finding the prospect of international travel for medical care increasingly
appealing. An estimated 150,000 of these travel to India for low-priced healthcare procedures every
Advantages for medical tourists include reduced costs, the availability of latest medical technologies
and a growing compliance on international quality standards, as well as the fact that foreigners are
less likely to face a language barrier in India. The Indian government is taking steps to address
infrastructure issues that hinder the country's growth in medical tourism.
Most estimates claim treatment costs in India start at around a tenth of the price of comparable
treatment in America or Britain. The most popular treatments sought in India by medical tourists are
alternative medicine, bone-marrow transplant, cardiac bypass, eye surgery, and hip replacement.
India is known in particular for heart surgery, hip resurfacing, and other areas of advanced medicine.
2.2 Growing Prospects: India could be hosting 2.4 million medical tourists by 2020, almost four times
the number it catered to in 2010. And that’s not all. The figure is projected to rise to 4.9 million
tourists by 2025, Of the over 600,000-odd medical tourists that visit India today, over half or 55%
hail from two regions Africa and West Asia. The market size of medical value travel would cross Rs.
620 billion by 2020 and Rs. 2,000 billion by 2025 from Rs. 45 billion in 2010, which forecasts a 30%
annual growth for the industry for the next 15 years.
In the National Capital Region (NCR) alone, the three largest hospital chains, Apollo Hospitals,
Fortis Healthcare, and Max Healthcare attended to 15,500 foreign patients in 2010. Of this, a quarter
or more of the tourists who visited fortis and Max came from West Asia while Apollo derived one-
fifth of the traffic from this region. Africa accounts for 32% of Max’s medical tourists, 15% of
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Fortis’ and a fifth of Apollo’s share of medical tourists. Neighboring Saarc countries account for
40% of Fortis’, 25% of Apollo’s and 18% of Max’s traffic of medical tourists. The United States,
Europe and other countries accounts for only one fifth of the total patient pool for all the three
hospital groups.
Acknowledging Asia as the biggest gainer of global medical value travel, Analysts identify two large
drivers that could spur the projected growth. The presence and expansion of multiple well-
established corporate organizations (hospital groups), and India's unique position to embrace
Ayurveda and alternative medicine as it adopts a more holistic approach towards healthcare delivery
could attract more wellness tourists, different from those who come here for core surgeries mainly
in the areas of cardiac or other general procedures.
A rate chart comparing costs of different procedures could make it clear as to why India could utilise
its edge in weaning away a large share of tourists from other destinations. A coronary artery bypass
graft that could cost $70,000-133,000 in the US and between $16,000 -22,000 in other medical
tourism hotspots like Thailand and Singapore, costs about $7,000 in India, according to Indian
Medical Value Travel Association.
A bypass surgery with heart valve replacement that costs $75,000-140,000 in the US and between
$22000-25000 in Thailand and Singapore is done in India at $9,500. Similarly, a hip or knee
replacement that can set you back in the US by $30,000 to $55,000 and can cost between $9000 to
$12,700 in Thailand and Singapore would only cost $7200 in India. Even cosmetic surgeries, such as
a facelift, for which customers have to shell out anywhere between $10,000 to $16,000 in the US,
$7500 in Singapore and $5000 in Thailand, costs just $4800 in India.
Even then compared to the Southeast Asian countries, India has not been a runaway success in
medical tourism yet. Head of a corporate hospital explains that value is just one variable a medical
tourist considers while firming up a decision. The entire infrastructure in these (Southeast Asian)
economies is customised to give a pleasant experience to the medical tourist, from the point he lands
till he leaves. They have also been marketed for very long as medical and wellness tourism
destinations. That is not the case in India, where hospitals are operating as 'islands of excellence' and
the supporting infrastructure around it is often poor, Also India hopped into the race to lure in
medical tourists very late and the segment is still picking up.

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