4447
MEDICAL TOURISM: TREATMENT, THERAPY &
TOURISM
Dr. Teena Bagga, Sushant Kumar Vishnoi, Surbhi Jain, Rakhi Sharma
Abstract: Globalization not only leads the trade and businesses across borders, countries and continents, but also bring along the emergence and development of the concept of tourism. Medical tourism enables the patients to choose medically superior countries for treatment. Being well informed and updated about the country specific developments, technological and medicinal inventions & innovations, security and privacy provisions are some of the critical success factors duly acknowledged by visitors before choosing a medical tourism destination. This research study reveals the various factors like low cost of medical expenditures, state-of-the-art medical equipment’s, dual service of medical treatment plus tourism (vacation) and medical ecosystem of the host country, acknowledged by medical travelers while selecting their preferred medical tourism destination.
Keywords: Medical Treatment, Medical Tourism, Medical Tourism Destination
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1 INTRODUCTION
Since time immemorial human races travel through time, to places of significance leading to the accomplishment of required task or work. Travelling journeys of humans started with physical needs of search of food and fulfilling habitats then it moved on to psychological needs satisfaction through social relations and communications. Contemporary travelling habits of people range from leisure and fun [1] to solution of medical complications. India as a country is very rich in medical history be it the origination of Ayurveda: healing through herbs.The same legacy of Ayurvedic supremacy is being bought forward to contemporary medical practices by syncing medical ecosystem i.e., state-of-the-art medical equipment’s, high tech medical institutions and artificial enables processes and systems for disease recognition and cure [2]. Medical tourism is a practice of travelling to countries offering competitive advantage of world class treatment at low cost regarding wellness and health related treatment [3]. The objective of medical travel is getting long-term healthcare treatment or elective surgery and can be broken down into diagnostic, clinical, invasive or life-style related medical orientations [4]. The most popular treatments for medical tourists include cosmetic surgery, dentistry, cardiovascular, orthopedics, cancer treatments, weight loss treatments, and general tests and health checkups [5]. Some of the most popular and fastest growing medical tourist destinations worldwide are Thailand, Hungary, Singapore, Malaysia, India [6]. India over the years standing on the reforms of Indian govt. and backed by innovation of the medical stakeholders is rapidly developing into the hot medical destination.
Dr. Teena Bagga is currently working as Professor, Amity University Uttar Pradesh, India, MB-9899808189.E- mail: teena.bagga@gmail.com.
Sushant Kumar Vishnoi is currently pursuing Ph.D. from Amity University Uttar Pradesh, India, MB-9999663163. E-mail: sushantsinghvishnoi@gmail.com
Surbhi Jain is currently pursuing Ph.D. from Amity University Uttar Pradesh, India, MB-9999219738. E-mail: surbhijain.991@gmail.com.
Rakhi Sharma is currently pursuing Ph.D. from Amity University Uttar
Pradesh,India, MB-9718857325. E- mail:
rakhi09sharma@gmail.com.
The number of people visiting India on medical visa stands at 4.27 lakh in year 2017, bringing in 3 billion dollars of foreign exchange. With an accelerated growth rate of 20% over the next year, India medical tourism industry is expected to move to a whopping $ 9 Billion by 2020. The maximum number of medical tourist’s visiting India are from Bangladesh and stands at 2.2 lakh in year 2017 [7]. Major medical service providers such as the Tata, Wockhardt, Max, Apollo invested heavily in setting state-of-the-art infrastructure facilities attracting and servicing foreign medical visitors [8]. Besides monetary benefits the reputation and recognition of Indian medical supremacy is talked about around the world building a positive image and improving Indian standing among the world map of medically leading countries. Based on the expertise possessed by the Indian medical practitioner, growing infrastructure of world class hospitals and pharma companies, structural reforms support of government machinery, strict adherence to accreditations or standards of care and innovation centric culture of medical, India is developing into a super bowl of medical tourism destination. The actual motivations of patients-customers of medical tourism and their perception of post travel satisfaction are the two basic ingredients that can bolster the medical scenario of any medical destination. The motivation of cost-effective treatment of highest order, distance of medical destination, medical visa rules and timing of issue, medical expertise and specialization possessed by the doctors, availability of state-of-the-art machinery, packages and offering provided by the medical institution and percentage record of successful clinical operations. The post-travel experience or satisfaction can be measured by clinical-operation recovery and medical complications, institution communication, cost considerations.
2 LITERATURE REVIEW
Medical Tourism is the rising alternative for medical patients measured by the parameters of availability, accessibility, affordability and ethical comparisons of medical procedures in home and host country [9]. Health and Medical tourism can be branched to a host of interrelationships between dental tourism, stem cell tourism, abortion tourism, well-ness and well-being tourism, stem-cell and transplant tourism and onto these are clinched the associated risks and ethical principles [10]. Evolution and development of medical tourism can be enthused to six themes namely ethical implications, service quality, sensitive practices in medical tourism, health specific medical tourism, marketing of medical tourism destinations, globalization policies impacting international patients [11],[12]. Dissentingly the other path of medical tourism issues is related to organ transplantation and aiding beautification [13]. With the conceptualization and application of policy reforms of Globalization, the Medical Tourism sectors takes a strong move forward encompassing global boundaries for state-of-the-art healthcare and wellness treatment. The exponential growth of medical tourism across the world can be attributed to availability of reliable and valid information about the competitive medical infrastructures of respective countries and choosing the best fit. The problem of multiple medical destinations to choose from can be overcome by taking into consideration the diversified services of ―Medical Tourism Facilitators‖ which expertise in trip coordination responsibilities and specializes in the selection of the most appropriate medical hub [14]. Moreover, medical tourism facilitators and medical doctors as key supply chain members of transnational healthcare must encourage tourism practitioner to consider attitude, expectations and self-understanding [15]. The affective component i.e. emotional, somatic financial and political state once considered ancillary by medical tourists now a days is more fundamentally in tuned into traveler’s perception of health care, cultural difference and expression of risk [16]. The diagnosis and synthesis of patient’s agenda of duality i.e. central premise of pleasure seeking from the biodiversity and eco-environment of the destination alongside the treatment of medical condition. The satisfaction derived by the patient travelers can be measured from their medical experience of facilities and services provided. Additional dimensions about medical tourists needs to be researched on numerous parameters of evaluating traveler’s information sources, information reliability and information privacy [17] and associated risk of medical care abroad, gathering traveler’s prospective and retrospective synergies and finally the patient motivations of medical tourism centric treatment [18]. Inequitable delivery of medical or healthcare facilities globally is the prime reason of the emergence of medical tourism inflated by empirical evidence of successful medical transformations and surgical success rates developing synergies between the destination and departure countries [19]. Factor considerations for choosing international medical destination is the amalgamation of economic conditions, regulatory policies, political climate whereas the choice of international medical facility gives centerstage to accreditation standards, quality of care practices, associated cost and the medical associates/physician training [20],[21]. Moreover, supply and demand characteristics in the home country can also
be a significant contributing factor to the emergence of medical tourism [22]. Furthermore, the concept of travel medicine i.e. patient’s health and safety concerns while travelling; is heating researching community around giving prime importance to travelling intricacies/nitty-gritty of tourist mortality (kidnapping, murder), spread of fatal diseases, road traffic accidents, minor hospitalization [23]. Chief factors acting as barriers of developing medical tourism can be attributed to medical bills costs, government reforms, infrastructure or superstructure, policies or regulations, promotion or advertisement of the medical destination competencies, skilled manpower, availability of information and communication [24].
2.1 OBJECTIVES:
To identify the key factors considered by medical tourists for selecting their medical tourism destinations and to examine how treatment can be aligned with post treatment therapy and tourism.
3 RESEARCH METHODOLOGY:
Primary data is collected from 200 medical tourists based on age, gender and country of origin (tourists home country) by self-administered questionnaire in offline mode to examine the factors considered by them while finalizing their medical tourism destinations. Secondary research is also utilized for aggregating information on the study by reviewing associated literature to ease the buildup of fundamental structure of research study. Exploratory & descriptive research is used to explore and describe the factors considered by the tourists to choose their preferred medical tourism destination. Convenience sampling is used for collecting data from medical visitors at Focus Imaging & Research Centre, Hauz Khas (Delhi) and excel and SPSS tools are used for data analysis.
3.1 Data Analysis:
Table 1: Respondents Profile:
Profile Frequency Percentage Cumulative % Gender
Male 140 70 70
Female 60 30 100
Age
Below 18 50 25 25
Between 19 to 30 70 35 60 Between 30 to 40 41 20.5 80.5 Between 40 to 50 19 9.5 90.5
50 and above 20 10 100
Country
Iraq 20 10 10
Afghanistan 40 20 30
Bangladesh 80 40 70
Iran 40 20 90
Other 20 10 100
TOTAL 200 100 100
4449 visiting India for medical treatment belongs to Bangladesh
followed by Afghanistan, Iran, Iraq & others. The countries which comes under the other countries’ category are South Africa, Canada, Singapore, Pakistan, Srilanka, Nepal etc.
Table 2: Medical Service Required
MEDICAL SERVICE Percentage
Dental surgery/treatment/restorative 12
Weight loss/LAP-BAND/gastric bypass 3
Cosmetic/plastic/reconstructive surgery 30
Sexual reassignment surgery 5
Sight treatment/Lasik 5
Alternative care (acupuncture, chiropractic,
etc.) 2
Reproductive care. 1
Comprehensive medical checkup 2 Orthopedics (joint, spine, sports medicine,
etc.) 5
Cardiovascular/heart surgery (angioplasty,
CABG, transplant), etc. 25
Cancer 5
Organ Transplant 5
Figure: Medical Treatment Required
Figure 1 presents a clearer picture of the medical reasons/complications foreign medical tourist visiting India being cosmetic and plastic surgery (30%), followed by cardiovascular surgery and dental surgery. The reasons for the same can be attributed to the efficiency and competency of the medical practitioner and low cost of the surgical operation.
Table 3: Medical Insurance Coverage
Medical Insurance Coverage Percentage
Home country 35
Destination country 25
No medical insurance coverage 40
Figure: 3 Insurance Coverage
Figure 3 brings forth the important dimension of insurance services visitors are covered by before visiting the medical destinations. Majority of visitors doesn’t hold any insurance while travelling to medical tourism destination with only 25% are covered in destination country and 35% are covered on home country.
Table: 4 Source of Information
Source of Information Percentage
Advice of domestic doctor 8
Word of mouth from friend or family 5
Medical tourism intermediary website 35
Online medical communities 5
Website of the hospital 7
Medical tourism blog 14 Reading the testimonies of other
patients 7
News source (television, magazine) 7
Social media 12
Figure: 4 Information Sources
Figure 4 opens us about the traveler’s source of Information which is topped by medical tourism intermediary websites (35%) well followed by medical tourism blogs (14%) and marginally equaled by social media websites (12%). Advice of domestic doctors is also been positively considered by 8% respondents whereas the least of them only 5% takes reference from online medical communities before visiting medical tourism destinations.
12
3
30
5 5
2 1 2 5
25
5 5
MEDICAL SERVICE
REQUIRED
35
25
40
Yes in home country Yes in destination country
No medical insurance coverage
MEDICAL INSURANCE
COVERAGE
8 5
35
5 7 14 7 7 12
Table 5: Alternative Countries Considered for Treatment Countries considered for
medical treatment except India Percentage
Brazil 10
Malaysia 20
Thailand 40
Turkey 20
Canada 10
Figure: 5 Country Consideration
Figure 5 represents the alternative medical destinations considered by visitors and the chart is topped by Thailand (40%) as the most looked alternative medical tourism with added advantage of plentiful rejuvenating centers and vacation spots and is well followed by Malaysia, equaled by Turkey and preceded by Brazil and Canada.
Table 6: Time Horizon of Medical Treatment
Days spent on medical treatment Percentage
1-3 days 8
3-5 days 12
5-15 days 25
15-30 days 45
More than a month 10
Figure: 6 Time spent on medical treatment
Figure 6 represents 45% of respondents choosing to spend 15-30 days on medical treatment procedures for actual recovery signifying the critical aspect of medical conditions they choose to get operated for. Next in the list is 25% respondents choosing the time duration of 5-15 days, well followed by 3-5 days tenure and least dictated by 8% respondents coming to India for minor treatments and choosing to stay for a brief duration of only 1-3 days.
Table: 7 Time Spent on Activities Besides Medical Treatment
Days spent on activities besides
medical treatment Percentage
1-3 days 9
3-5 days 12
5-15 days 45
15-30 days 25
More than a month 9
Figure: 7 Time Invested on Associated Activities
Figure 7 summarizes the importance assigned by medical tourists to post surgery vacationing, recovery and therapeutic wellness with 45% staying in India for a duration of 5-15 days post clinical surgery with only 9% desiring to stay for more than a month signifying the eagerness of visitors to return to their respective families.
10
20
40
20
10
B R A Z I L M A L A Y S I A T H A I L A N D T U R K E Y C A N A D A
MEDICAL TREATMENT
COUNTRY
CONSIDERATION
EXCEPT INDIA
8 12
25
45
10
1 - 3 D A Y S
3 - 5 D A Y S
5 - 1 5 D A Y S
1 5 - 3 0 D A Y S
M O R E T H A N A M O N T H
DAYS SPENT ON
MEDICAL
TREATMENT
9 12
45
25
9
4451 Table: 8 Factors Considered by Medical Tourists While
Choosing Medical Destination Factors considered by medical tourist’s while choosing medical destination
Mean Standard Deviation
Shorter waiting times than the home country 4.1 .728
Less expensive medical treatment 4.2 .732
Preference of privacy and confidentiality. 3.5 .623
Various types and availability of medical services.
4.0 .713
Ease of visa procedures 4.0 .713
Recognized hospital/medical facility reputation.
4.5 .756
Ease of medical treatment arrangements. 4.3 .732
Table 8 presents the weightages respondents assign to the factors before choosing medical destinations. The reputation of the medical facility/hospital with a mean value of 4.5 is the prime factor considered by medical visitor’s before choosing a medical tourism destination followed by ease in arrangements of medical treatments having mean score of 4.3. Skillsets and medical experience possessed by the destination country medical practitioners are a major factor of consideration by medical traveler’s before finalizing a medical destination. Travelers also assign due weightage to the cost of medical treatment with a mean score of 4.2 in destination country and the duration of waiting times in home country. The least preference respondents assign to is preference of privacy and confidentiality of medical treatment with a mean value of 3.5.
Table: 9 Overall Rating of Travelling and Tourism Experience
When it comes to rating traveling and tourism experience, the destination offered:
Mean Standard Deviation
A great place for relaxation after medical treatment.
3.7 .654
Positive reputation as a tourist destination.
3.8 .660
Political stability. 4.0 .713
Variety of existing tourist attractions for recuperating patients.
4.0 .713
Opportunity to combine medical service with a vacation.
4.5 .623
Tourism safety from crime and/or terrorist attack.
4.0 .713
Ease of travel arrangements. 4.2 .732
Ease of lodging arrangements. 4.0 .713
Ease of transportation. 3.8 .660
Friendliness and helpfulness of the local people.
4.0 .713
No language barriers while traveling to your destination.
3.8 .660
Ease of accessibility when traveling from the home country
4.3 .732
Table 9 showcases the importance attributed by visitors to travelling and tourism experience both during and post-surgical and clinical medical treatment. Topping the charts is opportunity to combine medical service with a vacation with a mean score of 4.5 indicating the dualist benefits medical tourists seek before choosing a medical destination. They eye top class medical treatment and equally best spaced tourism spots for leisure and vacationing. Second in the chart is ease of accessibility of medical tourism destination from home country well followed by ease of travel arrangements. Closely following are factors such as destination country political environment stability, Safety of travelers from crimes and terrorist attacks, ease of lodging arrangements each with a mean score of 4.0 indicating the importance visitors assign to their safety and security before travelling.
Table: 10 Overall Rating of The Quality of Tourists Medical Tourism Experience
Regarding the quality of medical tourist’s overall medical tourism experience:
Mean Standard Deviation
Airport clearance was hassle-free 4.0 .713
Accommodation was easily available 4.1 .724
Taxi Apps services were efficient 3.8 .697
Getting SIM in India on my valid passport is easy
4.3 .721
Food of my preference can be easily delivered at my doorstep
4.1 .724
The process for setting up the medical procedure appointment was simple and easy.
3.8 .695
Medical records and information were easily assembled and transmitted.
3.4 .616
Short waiting time for the medical examination from the physician.
3.8 .695
Doctors adequately explained my condition, results, and medical process.
4.3 .721
Doctors allowed me to ask many questions, enough to clarify everything.
3.4 .616
The medical staff was polite possessing good communication skills.
3.4 .616
The hospital had state-of-the-art facilities and equip.
4.4 .737
The medical facility valued and respected patients’ privacy, confidentiality, and disclosure.
3.7 .686
The payment procedure was quick and simple.
Effective coordination of arrangements between the patient, hospital, third-party insurance companies, and/or other involved businesses.
3.3 .610
Table 10 encompass medical tourist’s allocating prime mean score of 4.4 to state-of-the-art equipment’s and facilities to rate the quality of overall medical experience of tourism destination which is closely followed by doctor skills in adequately explaining medical condition, process and test results and ease of getting a SIM card on providing valid documents i.e. passport copies for communicating with the associated stakeholders and family member’s. Associated factor of prevalent accommodation facilities of the destination country and food preferences of the visitors with respective mean scores of 4.1 also influence their selection of the medical destination and enhances the quality of their overall experience. Equally important and well considered is the hassle-free clearance from destination country airports which in turn is followed by efficiency of taxi app services, ease and suppleness of process of setting a medical appointment, shortest possible waiting time duration for medical examination by the physician all with a mean value of 3.8. Factors to the likes of ease of payment procedures and effective coordination of arrangements between the patient, hospital, third-party insurance companies, and/or other involved businesses which the medical tourists consider least important and provides them a mean weightage of 3.3.
4 FINDINGS:
The study reveals that majority of medical tourists coming to Indian for treatment and tourism belong to the age bracket of 19-30 years and are coming from Bangladesh with 30% of them seeking treatment for cosmetic & plastic surgery. For 35% of travellers, prime source of required information are intermediary websites followed by blogs (14%) & social media (12%). At least, 45% of visitors coming for treatment are staying for a brief period of 15 to 30 days for seeking post treatment recovery and vacationing. Thailand (40% alternative tourism destination preference) tops the chart as alternative medical tourism destination for obvious reasons of plentiful rejuvenating centres and vacationing spots. Medical tourism destinations were chosen on the simple reasons of reputation of medical facility (mean score 4.5), state-of-the-art equipment’s and facilities (mean score 4.4). Succeeding the list is opportunity to combine medical service with a vacation with a mean score of 4.5 indicating the medical tourists seek dual benefits before choosing a medical tourism destination.
5 CONCLUSIONS:
The process of touring medical destination for getting state-of-the-art medical treatments at lowest possible costs requires researching and head hunting (for the simple reason of getting a know-how of host country unique selling prepositions and core competency as a medical destination). The amount of foreign exchange reserves medical tourists bring to the destination countries is well noticed and dwelled into the policy initiatives by the respective governments and reform machinery of the
countries. Prevailing competition among low cost medically superior countries making the game altogether more pruned to designing and promoting medical tourism through websites, devising medical complications specific clinical packages, customizing web pages with respect to language and currency considerations and incorporating all trending and competent virtues of staying ahead in the highly competitive market segment of medical tourism.
6 LIMITATIONS:
One major limitation of the study was the size of the survey i.e., 200 responses are not enough to predict the real picture of medical tourism scenario of any country. The reasons of emergence and preference of India as the rising medical tourism destination are therefore cannot be generalized. Secondly, area of survey is only limited to single hospital i.e., Focus Imaging & Research Centre, Hauz Khas (Delhi) which offers limited insight in recommending the action plan for the Indian medical tourism landscape. Thirdly, as the visiting foreign patients belong to different countries and cultures; language barrier while interacting with some of the respondents proved difficult and time consuming, than anticipated, in data collection phase.
ACKNOWLEDGEMENT:
Authors are thankful to Dr. Teena Bagga for her mentoring and guidance towards the conceptualization of the research study. Authors also express their deep gratitude towards esteemed reviewers, editors for their valuable suggestion and comments.REFERENCES
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