India’s reputation as a producer of quality vaccines and pharma products got a boost during the Covid-19 pandemic.
India should thus look to increase its share in the world wellness tourism market. Medical Value Travel (MVT) in India is expected to grow to $13 billion by 2026.
The word medical tourism is often used in this context, but what is it really?
It means people from abroad coming to India for treatment of the body and the mind.
It includes allopathy, nature cure like involving Ayurveda/Yoga and spiritual Indic philosophy with the last three being an integral part of India for centuries. India offers excellent options for rejuvenation and alternate therapies.
What is India’s advantage? Quality medical care, lower cost, doctors/nurses fluent in English and a rich tradition of wellness.
In 2019, foreign tourist arrivals (FTAs) in India based on medical visa was 697,000 (2017: 495,056). India receives most of its medical tourists from Afghanistan, Oman, Bangladesh, Maldives, Nigeria, Kenya and Iraq.
Let us look at country-wise foreign tourist arrivals in 2020 based on medical purposes (186,644). Due to the pandemic this might not be representative but gives us an idea of the likely minimum we can expect.
The 2020 table shows India’s neighbourhood, West Asia and Africa are significant contributors to medical visa travel (MVT). To the countries above add Sudan, Tanzania and Yemen.
The above numbers indicate there is scope for substantial improvement.
We cannot take solace in the fact that the number of such visas issued by the Dubai Consulate increased from 523 in 2016 to 545 in 2017.
India needs to increase the absolute numbers with more patients from Europe, Africa and Central Asia. After all, just look at the cost differential.
A former diplomat who worked in the Netherlands in the early 2000s told this author that getting appointments for non-life-threatening diseases took months, whereas in India there is virtually zero waiting time for any procedure.
Also, the situation was compounded because there were no private medical practitioners in the Netherlands.
According to a former diplomat who worked in Africa, India must look to help those at the bottom of the pyramid.
An Indian origin doctor who works in Nairobi (note: Kenya is amongst the more prosperous countries in Africa) was good to share insights of Kenya’s healthcare sector with the author.
He said that every Kenyan has to contribute to the NHIF (National Health Insurance Fund). To encourage use of local facilities, the government of Kenya has put restrictions on Kenyans who wish to travel overseas for treatment.
To travel they have to produce a certificate from a local doctor that Kenya does not have facilities to treat that illness. The rich, however, prefer to travel overseas for treatment.
The cost of treatment in Kenya is 4-5 times that of India. Trust in Indian doctors is high. Service levels in Kenya are lower than in India.
Aga Khan and Nairobi Hospital (British era) are amongst the best private hospitals there.
Other private hospitals are those set by a community of Indian doctors, who have worked there for, say, 25 plus years, and local businessmen. Kenya attracts patients from Rwanda, Ethiopia, Uganda and Tanzania.
Kenya has just four or five medical colleges between the private and public sectors. Main sicknesses are HIV, tuberculosis, malaria, and heart/kidney transplant.
MVT must also be looked at through the prism of foreign policy and benefits like earning forex, creating jobs and earning tax revenues.
Simultaneously, state governments will be supportive if they are convinced about the benefits and multiplier effect of MVT.
Here are some ideas on what India can do to promote MVT.
Medical tourism requires a cross-ministry and public-private partnership effort.
The ministry of health, external affairs, Ayush, tourism and civil aviation need to work together with private hospitals and state governments.
Tourism should be understood to include medical, and not just be restricted to heritage and sight-seeing.
A collaborative effort and regular interaction between ministries and hospitals would build an element of trust essential if the potential has to be realised. Read on.
1. Patients should be given visas only when treated at National Accreditation Board-recognised hospitals and healthcare providers (NABH). This will ensure better treatment and patients will not be swayed by agents of unaccredited hospitals.
MVT should include Indian forms of wellness like Ayurveda, Yoga, Siddha, Spiritual Philosophy, etc.
2. Visas take time, sometimes over three months. Can a visa system be designed such that it is given in a maximum of seven working days?
For eg, all documents (including Indian hospital invite letter, local police report) should be uploadable on a visa portal which is scrutinised and followed by a personal interview on day 8. To speed up the process, visas can be city-specific.
3. Hospitals in designated cities like Mumbai, NCR, Kolkata, Bengaluru and Chennai that have international connectivity can cater to medical tourists. It may make sense to focus on a few cities and provide internationally comparable services.
This will enable building and sharing of standardised infrastructure like hotels and guesthouses besides making management easier.
Wellness hubs though, could be outside of the metros.
4. Help-desks at airports must cater to all customer needs, be it medical, transport, sightseeing, visa, ambulance, emergencies, baggage loss and handling of cash.
5. A common problem is when patients bring huge amounts of foreign currency which gets lost or is stolen. Imagine being stranded in an alien country without money.
The help-desk should accept foreign currency, open a bank account there and then credit the rupee equivalent and give the patient a rupee cheque-book. If a documents check-list is given to the patient before leaving for India, opening accounts would be easier.
When the patient is leaving the country, the unspent rupees can be converted into dollars (or his local currency) and given to the patient.
Banks at airport would need to give a certificate to the patient and hospital for the dollars and rupee equivalent spent in India. The hospital would need the certificate to claim appropriate tax-breaks.
If required, the law/rules need to be amended to enable hospitals to get tax breaks in such cases.
For this system to work, the designated bank must have a person at the help-desk.
If the entry of patients is (at least initially) limited to a few cities this is very doable.
6. Since every patient has to visit the FRRO (Foreign Regional Registration Office) once, it would help if an MVT person is attached to the office concerned.
7. There could be a Central Grievance Committee, under the Ministry of Health, where all patients can make complaints. The committee could have government and hospital representatives.
These steps would make India a patient-friendly destination and enhance overall customer satisfaction.
8. MVT needs a one-stop portal that provides all information on available hospitals, treatment offered with indicative prices, testimonials, Ayurveda and Yoga rejuvenation and learning centres and colleges to learn Indic philosophy. Each centre of learning should be mapped on site to an international airport.
All this would make things easy and increase transparency. The Services Export Promotion Council, set up by the Ministry of Commerce and Industry, is a useful website that can be improved.
Patients should be encouraged to give feedback on the portal and rate their hospital experience. A dedicated multi-lingual helpline would help.
Standardisation of rates and treatments across hospitals is a good concept but actual cost will vary depending on the condition of the patient and what happens on the operation table. Instead, strengthen the feedback and complaint mechanism as a remedy for erring hospitals.
9. Ambassadors of each country must ascertain the medical treatment system in their host country and identify gaps just like the former diplomat, based on experience, did so above.
The Ministry of External Affairs (MEA) could share this information with the ministries of health and tourism who should work with partners to tap that market.
10. The Ministry of Health must, on receipt of inputs from NABH, prepare a paper on the services India offers and its competitiveness. This paper must be shared with the Ministry of External Affairs and in turn with the consulates of countries who send patients.
11. The MEA must have an annual budget for subsidising the cost of medical treatment for residents from relatively poorer countries, for example, countries in Africa or Central Asia. (Dynamic list)
The subsidy could take two forms for poor patients, those who come to India and those who get treated in Indian hospitals in those countries. Option one would be easier to administer.
This move shall increase the number of medical tourists and generate goodwill for India. The concept is similar to the PLI (Production-Linked Incentive) scheme that seeks to enhance investment and employment in the manufacturing sector.
The subsidy idea is endorsed by the former diplomat and Kenya-based Indian doctor quoted above. The exact framework can be worked out.
Thus, MVT becomes an integral part of India’s foreign policy.
12. According to a former diplomat who worked in Africa, the subsidy might help the more well-to-do people and not those at the bottom of the pyramid.
So to help the poor he suggested that Indian hospital chains could, one, enhance local skills through training and, two, set up hospitals in African countries (Apollo Hospitals partners with Balmers Healthcare to set up a tertiary hospital in Kenya) Apollo has hospitals in Bahrain, Nigeria, Bangladesh and Dubai.
Narayana Health has a hospital in Caymans Islands and supports a project in St Lucia. Once Indian hospitals build infrastructure in these countries, only the more complicated cases could be sent to India.
Some Indian doctors in Kenya who have been there for 25-plus years and set up hospitals would welcome move to upgrade skills.
13. If India wishes to make these countries Atmanirbhar, it could allow Indian medical colleges to open branches in select countries, thereby increasing the number of doctors.
So it is not only about MVT but contributing to global well-being. (Also read Africans seeking healthcare in India, draw hospitals to Africa).
14. The key is to reach out to poorer African countries and the poor across nations.
It is not possible for Indian hospital chains to set up hospitals in every African country. They could follow a hub-and-spoke model. For example, Nairobi could be a hub for countries in East Africa and so on.
So also local hospitals set up by Indian hospital chains should be authorised to undertake post-operative care and prescribe medicine to patients who were treated at the chain’s Indian hospital.
15. Indian hospital chains who set up hospitals in, say, Africa and Central Asia must be provided lines of credit by Exim Bank, ie, loans at a concessional rate of interest.
16. Insurance companies, especially those which are joint-ventures with foreign companies like Bajaj-Allianz, could try selling Indian health insurance to foreigners who wish to be treated in India.
This would enhance the revenues of both partners and ensure prompt payment by insurance companies in India for treatment at domestic hospitals.
17. Indian MNCs like Tatas could, for their employees in companies like Jaguar and Tata Steel Europe, provide for medical insurance in India. A tie-up with group company Air India or Vistara could provide discounted air-fares.
18. India could help the United Kingdom (UK) by offering medical services for its citizens in India. Since the National Health Service is funded by the UK government, a reduction in cost impacts its fiscal deficit.
Whilst the exact nature of the service can be decided, logistics would not be easy. A technology-based platform that is integrated with airlines and service providers might make this idea fly. Perhaps, the matter can be included in the FTA (free trade agreement) discussions underway with UK.
19. Patients come from African and West Asian countries and India’s neighbourhood. They are invariably accompanied by a caretaker who doubles up as an interpreter and, in return, expects a commission from the hospital.
Whilst payment of commission is a reality, every effort must be made for direct contact between consulate, patient and hospital.
For every patient referred by the Embassy the hospital must pay a management fee, at a pre-determined percentage, to the government of India for services rendered.
20. Patients who need follow up care mostly return to the hospital and buy medicines locally since Indian hospital prescriptions are not accepted in the host country.
The MEA must, based on inputs from the Ministry of Health, speak to their counterparts whereby prescriptions given by NABH hospitals are accepted in the host country. This preludes the need for the patient to visit India only to buy medicines.
21. Hospitals must hire local interpreters who know the language of patient’s country and give an option of hiring a caretaker.
22. The Home Ministry should be involved to the extent that MVT does not become a tool for illegal immigration.
The 'Heal in India' initiative aims to position the country as a global hub for medical and wellness tourism. We need to think big and in an integrated cross-functional innovative way.
Medical tourists should be treated as guests with India’s approach of Atithi Devo Bhava.
Quality medical care at an affordable price could be India’s tagline for medical tourism.
The writer is an independent columnist, travel photojournalist and chartered accountant, and founder of eSamskriti. He tweets at @sanjeev1927.
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